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https://www.readbyqxmd.com/read/29664455/physician-awareness-of-decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction-in-saudi-arabia-and-the-gulf-countries
#1
Hosam M Al-Jehani, Abdulaziz Alsharydah, Seba A Rammal, Saleh S Baeesa, Mohammad Mekhlafi
OBJECTIVE: To explore the perspective on Decompressive craniectomy (DH) of each of these specialties to establish common grounds for improved clinical practice. METHODS: An electronic survey was distributed via email and social media groups to members of these specialties in Kingdom of Saudi Arabia and the Gulf countries. Local practices, common triggers for referral for DH, perceived outcomes of these procedures, individual impression of what constitutes good clinical outcomes were explored...
April 2018: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
https://www.readbyqxmd.com/read/29663853/collateral-pial-circulation-relates-to-the-degree-of-brain-edema-on-ct-24-hours-after-ischemic-stroke
#2
Orlando Galego, Joana Jesus-Ribeiro, Mariana Baptista, João Sargento-Freitas, Ana Inês Martins, Fernando Silva, Gustavo Cordeiro Santos, Luís Cunha, César Nunes, Egídio Machado
Background Cerebral edema is frequent in patients with acute ischemic stroke (AIS) who undergo reperfusion therapy and is associated with high mortality. The impact of collateral pial circulation (CPC) status on the development of edema has not yet been determined. Methods We studied consecutive patients with AIS and documented M1-middle cerebral artery (MCA) and/or distal internal carotid artery (ICA) occlusion who underwent reperfusion treatment. Edema was graded on the 24-hour non-contrast computed tomography (NCCT) scan...
January 1, 2018: Neuroradiology Journal
https://www.readbyqxmd.com/read/29653270/decompressive-craniotomy-for-malignant-middle-cerebral-artery-infarction-optimal-timing-and-literature-review
#3
Ahmed Elsawaf, Ayman Galhom
OBJECT: To compare the results of early or delayed decompressive craniotomy (DC) for cases of malignant middle cerebral artery (MCA) infarction. STUDY DESIGN: Prospective comparative study METHODS: Prospective randomized study on consecutive series of a 46 patients with malignant MCA territory infarction. Patients were divided randomly into two groups: Group I; 27 patients who were followed till obvious deterioration of conscious level happened, Group II; 19 patients who were operated prophylactically in 6 hours of presentation even with no clear deterioration of conscious level or radiology's findings...
April 10, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29651748/improved-reperfusion-and-vasculoprotection-by-the-poly-adp-ribose-polymerase-inhibitor-pj34-after-stroke-and-thrombolysis-in-mice
#4
Mohamad El Amki, Dominique Lerouet, Marie Garraud, Fei Teng, Virginie Beray-Berthat, Bérard Coqueran, Benoît Barsacq, Charlotte Abbou, Bruno Palmier, Catherine Marchand-Leroux, Isabelle Margaill
Benefits from thrombolysis with recombinant tissue plasminogen activator (rt-PA) after ischemic stroke remain limited due to a narrow therapeutic window, low reperfusion rates, and increased risk of hemorrhagic transformations (HT). Experimental data showed that rt-PA enhances the post-ischemic activation of poly(ADP-ribose)polymerase (PARP) which in turn contributes to blood-brain barrier injury. The aim of the present study was to evaluate whether PJ34, a potent PARP inhibitor, improves poor reperfusion induced by delayed rt-PA administration, exerts vasculoprotective effects, and finally increases the therapeutic window of rt-PA...
April 12, 2018: Molecular Neurobiology
https://www.readbyqxmd.com/read/29651563/predictors-of-decompressive-hemicraniectomy-in-malignant-middle-cerebral-artery-stroke
#5
Saadat Kamran, Abdul Salam, Naveed Akhtar, Atlantic D'soza, Ashfaq Shuaib
Identification of factors in malignant middle cerebral artery (MMCA) stroke patients that may be useful in selecting patients for DHC. This study was a retrospective multicenter study of patients referred for DHC based on the criteria of the randomized control trials of DHC in MMCA stroke. Demographic, clinical, and radiology data were analyzed. Patients who underwent DHC were compared to those who survived without surgery. Two hundred three patients with MMCA strokes were identified: 137 underwent DHC, 47 survived without DHC, and 19 refused surgery and died...
April 12, 2018: Neurosurgical Review
https://www.readbyqxmd.com/read/29644406/the-wessex-modified-richmond-sedation-scale-as-a-novel-tool-for-monitoring-patients-at-risk-of-malignant-mca-syndrome
#6
Tayyib T A Hayat, Matthew A Myers, John Hell, Matthew Cordingly, Diederik O Bulters, Nicolas Weir, George Pengas
BACKGROUND: The Wessex Modified Richmond Sedation Scale (WMRSS) has been developed with the aim of improving the early identification of patients requiring decompressive hemicraniectomy for malignant middle cerebral artery syndrome (MMS). The objective of this study was to evaluate the WMRSS against the Glasgow Coma Scale (GCS). METHODS: A retrospective study was conducted of patients admitted to our unit for observation of MMS. Data were obtained on WMRSS and GCS recordings from admission up to 120-h post-ictus...
April 11, 2018: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29628948/clinical-and-imaging-outcomes-of-endovascular-therapy-in-patients-with-acute-large-vessel-occlusion-stroke-and-mild-clinical-symptoms
#7
Meredith T Bowen, Leticia C Rebello, Mehdi Bouslama, Diogo C Haussen, Jonathan A Grossberg, Nicolas A Bianchi, Samir Belagaje, Aaron Anderson, Michael R Frankel, Raul G Nogueira
Background: The minimal stroke severity justifying endovascular intervention remains elusive. However, a significant proportion of patients presenting with large vessel occlusion stroke (LVOS) and mild symptoms go untreated and face poor outcomes. We aimed to evaluate the clinical outcomes of patients presenting with LVOS and low symptom scores (National Institutes of Health Stroke Scale [NIHSS] score ≤8) undergoing endovascular therapy (ET). Methods: We performed a retrospective analysis of a prospectively collected ET database between September 2010 and March 2016...
February 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29628942/clinical-and-angiographic-outcomes-with-the-combined-local-aspiration-and-retriever-in-the-north-american-solitaire-stent-retriever-acute-stroke-nasa-registry
#8
Tim W Malisch, Osama O Zaidat, Alicia C Castonguay, Franklin A Marden, Rishi Gupta, Chung-Huan J Sun, Coleman O Martin, William E Holloway, Nils Mueller-Kronast, Joey English, Italo Linfante, Guilherme Dabus, Hormozd Bozorgchami, Andrew Xavier, Ansaar T Rai, Michael Froehler, Aamir Badruddin, Thanh N Nguyen, M Asif Taqi, Michael G Abraham, Vallabh Janardhan, Hashem Shaltoni, Robin Novakovic, Albert J Yoo, Alex Abou-Chebl, Peng Roc Chen, Gavin W Britz, Ritesh Kaushal, Ashish Nanda, Raul G Nogueira
Background: Various techniques are used to enhance the results of mechanical thrombectomy with stent-retrievers, including proximal arrest with balloon guide catheter (BGC), conventional large bore proximal catheter (CGC), or in combination with local aspiration through a large-bore catheter positioned at the clot interface (Aspiration-Retriever Technique for Stroke [ARTS]). We evaluated the impact of ARTS in the North American Solitaire Acute Stroke (NASA) registry. Summary: Data on the use of the aspiration technique were available for 285 anterior circulation patients, of which 29 underwent ARTS technique, 131 CGC, and 125 BGC...
February 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29627025/cerebrovascular-imaging-of-cerebral-ischemia-in-acute-type-a-aortic-dissection
#9
Soichiro Matsubara, Masatoshi Koga, Tomoyuki Ohara, Yasuyuki Iguchi, Kenji Minatoya, Yoshio Tahara, Tetsuya Fukuda, Yuichi Miyazaki, Katsufumi Kajimoto, Yuki Sakamoto, Naoki Makita, Naoki Tokuda, Kazuyuki Nagatsuka, Yukio Ando, Kazunori Toyoda
BACKGROUND AND PURPOSE: Stanford type A aortic dissection (AAD) sometimes causes acute ischemic stroke (AIS) or transient ischemic attack (TIA). There is little understanding of cerebrovascular imaging of AIS or TIA in patients with AAD. METHODS: Consecutive AIS/TIA patients with AAD who were admitted within 4.5 h of onset were reviewed. We compared findings of MRI/MRA between these and consecutive AIS/TIA patients without AAD within 4.5 h of onset. RESULTS: Seventeen AAD and 249 non-AAD patients were identified...
May 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29622432/sirtuin-5-as-a-novel-target-to-blunt-blood-brain-barrier-damage-induced-by-cerebral-ischemia-reperfusion-injury
#10
Candela Diaz-Cañestro, Mario Merlini, Nicole R Bonetti, Luca Liberale, Patricia Wüst, Sylvie Briand-Schumacher, Jan Klohs, Sara Costantino, Melroy Miranda, Gabriele Schoedon-Geiser, Gerd A Kullak-Ublick, Alexander Akhmedov, Francesco Paneni, Jürg H Beer, Thomas F Lüscher, Giovanni G Camici
BACKGROUND: In acute ischemic stroke (AIS) patients, impaired blood-brain barrier (BBB) integrity is associated with hemorrhagic transformation and worsened outcome. Yet, the mechanisms underlying these relationships are poorly understood and consequently therapeutic strategies are lacking. This study sought to determine whether SIRT5 contributes to BBB damage following I/R brain injury. METHODS AND RESULTS: SIRT5 knockout (SIRT5-/- ) and wild type (WT) mice underwent transient middle cerebral artery (MCA) occlusion (tMCAO) followed by 48h of reperfusion...
June 1, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29620280/melatonin-protects-brain-against-ischemia-reperfusion-injury-by-attenuating-endoplasmic-reticulum-stress
#11
Yu Wen Lin, Tsung Ying Chen, Chia Yang Hung, Shih Huang Tai, Sheng Yang Huang, Che Chao Chang, Hsin Yi Hung, E Jian Lee
Endoplasmic reticulum (ER) stress plays a vital role in mediating ischemic reperfusion damage in brain. In this study, we evaluated whether melatonin inhibits ER stress in cultured neurons exposed to oxygen and glucose deprivation (OGD) and in rats subjected to transient focal cerebral ischemia. Sprague-Dawley rats were treated with melatonin (5 mg/kg) or control at reperfusion onset after transient occlusion of the right middle cerebral artery (MCA) for 90 min. Brain infarction and hemorrhage within infarcts were measured...
March 30, 2018: International Journal of Molecular Medicine
https://www.readbyqxmd.com/read/29614647/reduced-cerebrovascular-reserve-capacity-as-a-biomarker-of-microangiopathy-in-alzheimer-s-disease-and-mild-cognitive-impairment
#12
Barbora Soukupova Urbanova, Jaroslava Paulasova Schwabova, Hana Magerova, Petr Jansky, Hana Markova, Martin Vyhnalek, Jan Laczo, Jakub Hort, Ales Tomek
BACKGROUND: Cerebral microangiopathy in Alzheimer's disease (AD) causes chronic hypoperfusion and probably accelerates neurodegenerative changes. OBJECTIVE: We hypothesize microvascular impairment could be present already in mild cognitive impairment (MCI) and can be revealed using transcranial color-coded sonography (TCCS) and the breath-holding maneuver. METHODS: Three groups of subjects (AD in the stage of dementia, MCI, and cognitively normal controls) with detailed neuropsychological testing and low cerebrovascular burden (no history of stroke, no intra- or extracranial artery stenoses, and no severe vascular lesions on brain MRI), underwent a TCCS assessment of peak systolic (PSV), mean flow (MFV), and end diastolic velocities (EDV) and resistance and pulsatility indices (RI, PI) in large intracranial vessels bilaterally...
March 24, 2018: Journal of Alzheimer's Disease: JAD
https://www.readbyqxmd.com/read/29610036/paradoxical-association-of-symptomatic-local-vasogenic-edema-with-global-cerebral-hypoperfusion-after-direct-revascularization-surgery-for-adult-moyamoya-disease
#13
Ryosuke Tashiro, Miki Fujimura, Shunji Mugikura, Kuniyasu Niizuma, Hidenori Endo, Toshiki Endo, Teiji Tominaga
BACKGROUND: Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis is the standard treatment for Moyamoya disease (MMD). Cerebral hyperperfusion syndrome is a potential complication of this procedure and can cause local vasogenic edema and/or delayed intracerebral hemorrhage. Cerebral hypoperfusion is a contradictory postoperative pathophysiological condition implicated in MMD, but its association with symptomatic local vasogenic edema has not been reported. CASE REPORT: A 31-year-old woman with MMD underwent left STA-MCA anastomosis 3 months after a minor completed stroke in bilateral hemispheres...
March 30, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29607557/maternal-hemodynamics-fetal-biometry-and-dopplers-in-pregnancies-followed-up-for-suspected-fetal-growth-restriction
#14
Llinos A Roberts, Hua Zen Ling, Liona Poon, Kypros H Nicolaides, Nikos A Kametas
OBJECTIVES: To assess whether in a cohort of patients with small for gestational age (SGA) foetuses with estimated fetal weight ≤10th percentile, maternal hemodynamics, fetal biometry and Dopplers at presentation, can predict the subsequent development of abnormal fetal Dopplers or delivery with birthweight <3rd percentile. METHODS: The study population comprised of 86 singleton pregnancies with SGA fetuses presenting at a median gestational age of 32 (range 26-35) weeks...
April 1, 2018: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29576013/omega-3-fatty-acid-supplement-reduces-activation-of-nadph-oxidase-in-intracranial-atherosclerosis-stenosis
#15
Jiamei Shen, Radhika Rastogi, Longfei Guan, Fengwu Li, Huishan Du, Xiaokun Geng, Yuchuan Ding
Objectives Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide. We adapted a rat model of atherosclerosis to study brain intracranial atherosclerosis, and further investigated how omega-3 fatty acids (O3FA) attenuated the development of ICAS by reducing the generation of reactive oxygen species (ROS) and the activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) activity. Methods Adult male Sprague-Dawley rats were divided into control normal-cholesterol or high-cholesterol diet groups with or without O3FA for up to 6 weeks...
March 24, 2018: Neurological Research
https://www.readbyqxmd.com/read/29571928/hemodynamic-changes-during-rewarming-phase-of-whole-body-hypothermia-therapy-in-neonates-with-hypoxic-ischemic-encephalopathy
#16
Tai-Wei Wu, Benita Tamrazi, Sadaf Soleymani, Istvan Seri, Shahab Noori
OBJECTIVE: To delineate the systemic and cerebral hemodynamic response to incremental increases in core temperature during the rewarming phase of therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: Continuous hemodynamic data, including heart rate (HR), mean arterial blood pressure (MBP), cardiac output by electrical velocimetry (COEV ), arterial oxygen saturation, and renal (RrSO2 ) and cerebral (CrSO2 ) regional tissue oxygen saturation, were collected from 4 hours before the start of rewarming to 1 hour after the completion of rewarming...
March 20, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29564192/herpes-simplex-virus-encephalitis-atypical-presentation-as-a-right-middle-cerebral-artery-stroke
#17
Maria Shoaib, Jacqueline J Kraus, Muhammad T Khan
Herpes simplex virus encephalitis (HSVE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis. We report a case of HSVE presenting as a stroke mimic in a 76-year-old female with a history of atrial fibrillation on warfarin. She was admitted to our medical intensive care unit with intermittent fever, lethargy, and new onset left-sided hemiparesis...
January 15, 2018: Curēus
https://www.readbyqxmd.com/read/29560003/a-rare-case-of-carotid-web-presenting-with-ischemic-stroke-in-a-young-woman-and-a-brief-review-of-the-literature
#18
Kyaw Kyaw, Htun Latt, Sammy San Myint Aung, Jay Babu, Rajesh Rangaswamy
Carotid web is a radiological description of a shelf-like intraluminal filling defect in the carotid bulb. It is histologically defined as atypical fibromuscular dysplasia (FMD), with abnormal fibrosis and smooth muscle cell hyperplasia in the tunica intima . The spur-like intraluminal protrusion can serve as a nidus for thrombus formation, which could cause systemic embolism and ischemic strokes. We report a case of a 20-year-old female patient presenting with acute ischemic stroke in the ipsilateral middle cerebral artery (MCA) territory...
2018: Case Reports in Medicine
https://www.readbyqxmd.com/read/29545253/randomized-assessment-of-the-safety-and-efficacy-of-intra-arterial-infusion-of-autologous-stem-cells-in-subacute-ischemic-stroke
#19
V Bhatia, V Gupta, D Khurana, R R Sharma, N Khandelwal
BACKGROUND AND PURPOSE: Stroke is a debilitating illness for which treatment window is limited. Most patients present to the healthcare facility beyond that window. Autologous stem cells have shown some promise for this group of patients. This study was performed to evaluate the safety and the efficacy of intra-arterial infusion of bone marrow-derived mononuclear cells in patients with middle cerebral artery ischemic stroke. MATERIALS AND METHODS: A prospective, randomized, open-label, blinded-end point study was performed from July 2015 to June 2016...
March 15, 2018: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29544461/clinical-and-radiological-factors-associated-with-unfavorable-outcome-after-intravenous-thrombolysis-in-patients-with-mild-ischemic-stroke
#20
Dae-Hyun Kim, Deok-Soo Lee, Hyun-Wook Nah, Jae-Kwan Cha
BACKGROUND: A significant proportion of patients with mild ischemic stroke become disabled despite receiving intravenous thrombolytic therapy. The purpose of this study was to assess the clinical and radiological factors associated with unfavorable outcomes in patients with minor ischemic stroke that received intravenous recombinant tissue plasminogen activator (rt-PA) therapy. METHODS: We identified anterior circulation stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 who received intravenous thrombolysis within 4...
March 15, 2018: BMC Neurology
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