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haemorrhagic stroke

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https://www.readbyqxmd.com/read/27906117/carotid-artery-stenting-versus-no-stenting-assisting-thrombectomy-for-acute-ischaemic-stroke-protocol-for-a-systematic-review-of-randomised-clinical-trials-with-meta-analyses-and-trial-sequential-analyses
#1
Henrik Steglich-Arnholm, Markus Holtmannspötter, Christian Gluud, Derk Wolfgang Krieger
BACKGROUND: In patients with intracranial large vessel arterial occlusion, ipsilateral extracranial carotid artery occlusions or near-occlusions pose a significant hurdle in endovascular management of acute ischaemic stroke. Stenting of the carotid lesion may be beneficial in this situation to provide a stable access for introducing catheters through the carotid lesion into the intracranial vasculature and the target occlusion. Furthermore, carotid stenting may ensure ample blood flow for wash-out of clot material and reperfusion of the ischaemic penumbral tissue...
December 1, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27900893/prompt-treatment-with-alteplase-is-essential-for-patients-with-severe-ischaemic-stroke
#2
(no author information available yet)
Thrombolysis with alteplase delivered within 4.5 hours of the onset of ischaemic stroke significantly improves the chances of good outcomes, but it also increases the risk of intracerebral haemorrhage, which can cause death or functional impairment.
November 30, 2016: Nursing Older People
https://www.readbyqxmd.com/read/27898582/antithrombotic-therapy-in-patients-with-cerebral-microbleeds
#3
Duncan Wilson, David J Werring
PURPOSE OF REVIEW: Cerebral microbleeds (CMBs) are a radiological marker of cerebral small vessel disease corresponding to small haemosiderin foci identified by blood-sensitive MRI. CMBs are common in older community populations, and in individuals with ischaemic stroke or transient ischaemic attack (TIA), and intracerebral haemorrhage (ICH). We summarize how CMBs might contribute to assessing the future risk of ischaemic stroke and ICH to inform antithrombotic (antiplatelet or anticoagulant) decisions...
November 24, 2016: Current Opinion in Neurology
https://www.readbyqxmd.com/read/27894313/identifying-the-barriers-and-enablers-for-a-triage-treatment-and-transfer-clinical-intervention-to-manage-acute-stroke-patients-in-the-emergency-department-a-systematic-review-using-the-theoretical-domains-framework-tdf
#4
REVIEW
Louise E Craig, Elizabeth McInnes, Natalie Taylor, Rohan Grimley, Dominique A Cadilhac, Julie Considine, Sandy Middleton
BACKGROUND: Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED...
November 28, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27887976/the-establishment-of-a-telestroke-service-using-multimodal-ct-imaging-decision-assistance-turning-on-the-fog-lights
#5
REVIEW
Jelle Demeestere, Claire Sewell, Jennifer Rudd, Timothy Ang, Louise Jordan, James Wills, Carlos Garcia-Esperon, Ferdinand Miteff, Venkatesh Krishnamurthy, Neil Spratt, Longting Lin, Andrew Bivard, Mark Parsons, Christopher Levi
Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke. We implemented a telestroke service supported by multimodal CT imaging in a rural hospital in Australia. Over 21months we conducted an evaluation of service activation, thrombolysis rates and use of multimodal imaging to assess the feasibility of the service. Rates of symptomatic intracranial haemorrhage and 90-day modified Rankin Score were used as safety outcomes...
November 22, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27873213/is-management-of-hyperglycaemia-in-acute-phase-stroke-still-a-dilemma
#6
REVIEW
C Savopoulos, G Kaiafa, I Kanellos, A Fountouki, D Theofanidis, A I Hatzitolios
INTRODUCTION: Close monitoring of blood glucose levels during the immediate post-acute stroke phase is of great clinical value, as there is evidence that the risk of neurological deterioration is associated with both hyper- and hypoglycaemia. The aim of this review paper is to summarise the evidence on post-stroke blood glucose management and its impact on clinical outcomes, during the early post-acute stage. FINDINGS: Post-stroke hyperglycaemia has been associated with increased cerebral oedema, haemorrhagic transformation, lower likelihood of recanalisation and deteriorating neurological state...
November 21, 2016: Journal of Endocrinological Investigation
https://www.readbyqxmd.com/read/27869561/successful-drug-coated-balloon-angioplasty-and-single-anti-platelet-therapy-to-treat-an-ischaemic-stroke-patient-with-haemorrhage-and-acute-coronary-syndrome
#7
Hee Hwa Ho, Kwang How Mok
A 55-year-old male presented with two challenging problems, i.e. acute coronary syndrome (ACS) and a major bleeding episode. He first presented with ischaemic stroke and was treated with thrombolysis. However this was complicated by haemorrhagic transformation. He subsequently developed ACS with urgent coronary angiography demonstrating a critical stenosis in the proximal left anterior descending artery. Percutaneous coronary intervention (PCI) was deemed necessary but we were mindful of causing bleeding complications from the use of anti-thrombotic therapy...
November 21, 2016: Acute Cardiac Care
https://www.readbyqxmd.com/read/27868275/effectiveness-and-safety-of-drugs-used-for-stroke-prevention-in-a-cohort-of-non-valvular-atrial-fibrillation-patients-from-a-primary-care-electronic-database
#8
Maria Giner-Soriano, Albert Roso-Llorach, Cristina Vedia Urgell, Xavier Castells, Dolors Capellà, Ignacio Ferreira-González, Josep Maria Elorza-Ricart, Marc Casajuana, Amelia Troncoso Mariño, Eduard Diògene, Bonaventura Bolíbar, Concepció Violan, Rosa Morros
PURPOSE: The aim of this study was to assess effectiveness and safety of antithrombotics for stroke prevention in non-valvular atrial fibrillation in real-use conditions. METHODS: We used a population-based retrospective cohort study. Information emerges from SIDIAP, a database containing anonymized information from electronic health records from 274 primary healthcare centres of the Catalan Health Institute, Catalonia (Spain), with a reference population of 5 835 000 people...
November 20, 2016: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/27864774/comparison-of-an-automatic-analysis-and-a-manual-analysis-of-conjunctival-microcirculation-in-a-sheep-model-of-haemorrhagic-shock
#9
Philip-Helge Arnemann, Michael Hessler, Tim Kampmeier, Andrea Morelli, Hugo Karel Van Aken, Martin Westphal, Sebastian Rehberg, Christian Ertmer
BACKGROUND: Life-threatening diseases of critically ill patients are known to derange microcirculation. Automatic analysis of microcirculation would provide a bedside diagnostic tool for microcirculatory disorders and allow immediate therapeutic decisions based upon microcirculation analysis. METHODS: After induction of general anaesthesia and instrumentation for haemodynamic monitoring, haemorrhagic shock was induced in ten female sheep by stepwise blood withdrawal of 3 × 10 mL per kilogram body weight...
December 2016: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/27862464/randomized-assessment-of-imatinib-in-patients-with-acute-ischaemic-stroke-treated-with-intravenous-thrombolysis
#10
N Wahlgren, M Thorén, B Höjeberg, T-B Käll, A-C Laska, C Sjöstrand, J Höijer, H Almqvist, S Holmin, A Lilja, L Fredriksson, D Lawrence, U Eriksson, N Ahmed
BACKGROUND: Imatinib, a tyrosine kinase inhibitor, has been shown to restore blood-brain barrier integrity and reduce infarct size, haemorrhagic transformation and cerebral oedema in stroke models treated with tissue plasminogen activator. We evaluated the safety of imatinib, based on clinical and neuroradiological data, and its potential influence on neurological and functional outcomes. METHODS: A phase II randomized trial was performed in patients with acute ischaemic stroke treated with intravenous thrombolysis...
November 14, 2016: Journal of Internal Medicine
https://www.readbyqxmd.com/read/27854159/sheehan-s-syndrome-and-sickle-cell-disease-the-story-of-natasha
#11
Barbara A Wilson, Anita Rose, Gerhard Florschutz
Sheehan's syndrome (SS) is one of the pituitary disorders caused by severe blood loss during childbirth leading to necrosis of the pituitary gland. Diagnosis is made following severe haemorrhage, failure to produce milk and failure to menstruate. Rare in countries with good obstetric care, SS is still frequent in those countries with poor healthcare services. The majority of papers published on SS do not mention psychological or neuropsychological sequelae. Of those that do, mood disorders are sometimes reported and occasionally cognitive problems are noted, typically attention, memory or executive deficits...
November 17, 2016: Neuropsychological Rehabilitation
https://www.readbyqxmd.com/read/27846246/systematic-review-and-meta-analysis-of-randomised-trials-to-ascertain-fatal-gastrointestinal-bleeding-events-attributable-to-preventive-low-dose-aspirin-no-evidence-of-increased-risk
#12
Peter C Elwood, Gareth Morgan, Julieta Galante, John W K Chia, Sunil Dolwani, J Michael Graziano, Mark Kelson, Angel Lanas, Marcus Longley, Ceri J Phillips, Janet Pickering, Stephen E Roberts, Swee S Soon, Will Steward, Delyth Morris, Alison L Weightman
BACKGROUND: Aspirin has been shown to lower the incidence and the mortality of vascular disease and cancer but its wider adoption appears to be seriously impeded by concerns about gastrointestinal (GI) bleeding. Unlike heart attacks, stroke and cancer, GI bleeding is an acute event, usually followed by complete recovery. We propose therefore that a more appropriate evaluation of the risk-benefit balance would be based on fatal adverse events, rather than on the incidence of bleeding. We therefore present a literature search and meta-analysis to ascertain fatal events attributable to low-dose aspirin...
2016: PloS One
https://www.readbyqxmd.com/read/27827286/-hypertension-due-to-fibromuscular-dysplasia-look-for-additional-disease-sites
#13
M L Maas, J M Kroese, S J H Bredie, C T Postma, F E de Leeuw, L J Schultze Kool, N P Riksen
Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vasculopathy that can lead to arterial stenosis, occlusion, aneurysms, and dissection. FMD of the renal arteries can lead to renovascular hypertension. Percutaneous angioplasty of the renal arteries (PTRA) can lead to normalization of blood pressure in 45% of patients with renal artery stenosis caused by FMD, particularly in younger patients and patients with a short history of hypertension. A considerable number of the patients with renovascular FMD also have cervical FMD, which can lead to ischaemic or haemorrhagic stroke...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27821152/a-20-year-multicentre-outcome-analysis-of-salvage-mechanical-circulatory-support-for-refractory-cardiogenic-shock-after-cardiac-surgery
#14
Maziar Khorsandi, Scott Dougherty, Andrew Sinclair, Keith Buchan, Fiona MacLennan, Omar Bouamra, Philip Curry, Vipin Zamvar, Geoffrey Berg, Nawwar Al-Attar
BACKGROUND: Refractory post-cardiotomy cardiogenic shock (PCCS) is a relatively rare phenomenon that can lead to rapid multi-organ dysfunction syndrome and is almost invariably fatal without advanced mechanical circulatory support (AMCS), namely extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). In this multicentre observational study we retrospectively analyzed the outcomes of salvage venoarterial ECMO (VA ECMO) and VAD for refractory PCCS in the 3 adult cardiothoracic surgery centres in Scotland over a 20-year period...
November 8, 2016: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/27819760/reversible-cerebral-vasoconstriction-syndrome-in-association-with-fingolimod-use
#15
Scott Belliston, Jayshree Sundararajan, Kathy Newell, Sharon Lynch
BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS), also known as Call-Fleming syndrome, is characterized by thunderclap headaches, non-aneurysmal segmental cerebral vasoconstriction seen on arteriogram, and spontaneously resolves within twelve weeks. Fingolimod has been reported to cause posterior reversible encephalopathy syndrome (PRES) and one case of RCVS. OBJECTIVE: We report a case of RCVS possibly related to fingolimod use, and compare to cases of adverse outcomes in fingolimod use...
November 7, 2016: International Journal of Neuroscience
https://www.readbyqxmd.com/read/27816340/management-of-spontaneous-intracerebral-haemorrhages
#16
Barbara Casolla, Romain Tortuyaux, Charlotte Cordonnier
Spontaneous intracerebral haemorrhage is defined as a collection of blood in the cerebral parenchyma that is not caused by trauma. It represents roughly 10-20% of all strokes. The clinical presentation is unspecific and the diagnosis requires brain imaging. ICH is a medical emergency and ICH patients have to be admitted in an acute stroke unit. The priority is to fight against ICH expansion. The first step consists in the administration of a specific antagonist of the antithrombotic treatment when available, and in the strict control of blood pressure...
November 2, 2016: La Presse Médicale
https://www.readbyqxmd.com/read/27810853/simple-prediction-scores-predict-good-and-devastating-outcomes-after-stroke-more-accurately-than-physicians
#17
John Michael Reid, Dingwei Dai, Susanna Delmonte, Carl Counsell, Stephen J Phillips, Mary Joan MacLeod
INTRODUCTION: physicians are often asked to prognosticate soon after a patient presents with stroke. This study aimed to compare two outcome prediction scores (Five Simple Variables [FSV] score and the PLAN [Preadmission comorbidities, Level of consciousness, Age, and focal Neurologic deficit]) with informal prediction by physicians. METHODS: demographic and clinical variables were prospectively collected from consecutive patients hospitalised with acute ischaemic or haemorrhagic stroke (2012-13)...
November 3, 2016: Age and Ageing
https://www.readbyqxmd.com/read/27798199/predictors-of-atherosclerotic-events-in-patients-on-haemodialysis-post-hoc-analyses-from-the-aurora-study
#18
Marit D Solbu, Geir Mjøen, Patrick B Mark, Hallvard Holdaas, Bengt Fellström, Roland E Schmieder, Faiez Zannad, William G Herrington, Alan G Jardine
BACKGROUND: Patients on haemodialysis (HD) are at high risk for cardiovascular events, but heart failure and sudden death are more common than atherosclerotic events. The A Study to Evaluate the Use of Rosuvastatinin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA) trial was designed to assess the effect of rosuvastatin on myocardial infarction and death from any cardiac cause in 2773 HD patients. We studied predictors of the atherosclerotic cardiovascular events in AURORA...
October 17, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27797878/intravenous-thrombolysis-in-a-patient-taking-warfarin-with-an-international-normalised-ratio-of-1-9
#19
Joanna Kefas, Mohit Bhandari, Naman Bhatt
Intravenous thrombolysis is the mainstay medical treatment for acute ischaemic strokes, but has strict eligibility criteria. Symptomatic intracranial haemorrhage (sICH) is the most adverse complication. A woman aged 76 years presented with signs of an acute stroke and despite not meeting the eligibility criteria, given her background use of warfarin, she received intravenous thrombolysis with an excellent outcome. This is the first fully documented case report of the contraindicated use of intravenous thrombolysis in a patient presenting with an acute ischaemic stroke on a background of concurrent use of warfarin with an international normalised ratio (INR) as high as 1...
October 25, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27793806/important-factors-in-predicting-mortality-outcome-from-stroke-findings-from-the-anglia-stroke-clinical-network-evaluation-study
#20
Phyo Kyaw Myint, Max O Bachmann, Yoon Kong Loke, Stanley D Musgrave, Gill M Price, Rachel Hale, Anthony Kneale Metcalf, David A Turner, Diana J Day, Elizabeth A Warburton, John F Potter
BACKGROUND: although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short- and medium-term mortality. METHODS: data from a prospective multicentre study (2009-12) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient-related factors and service characteristics on stroke mortality outcome at 7, 30 and 365 days post stroke, and time to death within 1 year...
October 28, 2016: Age and Ageing
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