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Wen Yea Hwong, Michiel L Bots, Sharmini Selvarajah, L Jaap Kappelle, Zariah Abdul Aziz, Norsima Nazifah Sidek, Ilonca Vaartjes
BACKGROUND: A shortage of computed tomographic (CT) machines in low and middle income countries often results in delayed CT imaging for patients suspected of a stroke. Yet, time constraint is one of the most important aspects for patients with an ischemic stroke to benefit from thrombolytic therapy. We set out to assess whether application of the Siriraj Stroke Score is able to assist physicians in prioritizing patients with a high probability of having an ischemic stroke for urgent CT imaging...
2016: PloS One
Sergio Amaro, Carlos Laredo, Arturo Renú, Laura Llull, Salvatore Rudilosso, Víctor Obach, Xabier Urra, Anna M Planas, Ángel Chamorro
BACKGROUND AND PURPOSE: Identification of neuroprotective therapies in acute ischemic stroke is imperative. We report a predefined analysis of the URICO-ICTUS trial (Efficacy Study of Combined Treatment With Uric Acid and r-tPA in Acute Ischemic Stroke) assessing the efficacy of uric acid (UA) compared with placebo to prevent early ischemic worsening (EIW) and the relevance of collateral circulation. METHODS: URICO-ICTUS was a double-blind, placebo-controlled, phase 2b trial where a total of 411 patients treated with alteplase within 4...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Christoph Scherfler, Alois Josef Schiefecker, Margarete Delazer, Ronny Beer, Thomas Bodner, Georg Spinka, Mario Kofler, Bettina Pfausler, Christian Kremser, Michael Schocke, Thomas Benke, Elke R Gizewski, Erich Schmutzhard, Raimund Helbok
OBJECTIVE: MRI parameters of iron concentration (R2*, transverse relaxation rate), microstructural integrity (mean diffusivity and fractional anisotropy), as well as gray and white matter volumes were analyzed in patients with subarachnoid hemorrhage (SAH) and uncomplicated clinical course to detect the evolution of brain tissue changes 3 weeks and 12 months after ictus. METHODS: MRI scans of 14 SAH patients (aneurysm of the anterior communicating artery, n = 5; no aneurysm n = 9) were compared with 14 age-matched healthy control subjects...
October 2016: Annals of Clinical and Translational Neurology
Junya Hatakeyama, Toshiharu Yanagisawa, Erina Kudo, Shuntaro Togashi, Hiroaki Shimizu
Progressive cerebral infarction in patients with hemorrhagic onset of moyamoya disease is rare, and a treatment strategy is not well established. Here, we report a case that was successfully treated with emergency bypass surgery. A 58-year-old woman presented with a sudden disturbance of consciousness and right-sided hemiparesis. Computed tomography(CT)showed intraventricular hemorrhage involving the head of the left caudate nucleus. Ventricular drainage was immediately performed, and the patient was treated conservatively...
October 2016: No Shinkei Geka. Neurological Surgery
Natalia Del Campo, Matteo Cesari, Marco Canevelli, Emiel O Hoogendijk, Matthieu Lilamand, Eirini Kelaiditi, Maria E Soto, Pierre-Jean Ousset, Michael W Weiner, Sandrine Andrieu, Bruno Vellas
OBJECTIVES: Recent evidence suggests that a substantial minority of people clinically diagnosed with probable Alzheimer disease (AD) in fact do not fulfill the neuropathological criteria for the disease. A clinical hallmark of these phenocopies of AD is that these individuals tend to remain cognitively stable for extended periods of time, in contrast to their peers with confirmed AD who show a progressive decline. We aimed to examine the prevalence of patients clinically diagnosed with mild-to-moderate AD who do not experience the expected clinically significant cognitive decline and identify markers easily available in routine medical practice predictive of a stable cognitive prognosis in this population...
October 1, 2016: Journal of the American Medical Directors Association
Liling Zeng, Jianwen Guo, Jing Wang, Qixin Zhang, Haijun Li, Rongming Lin
BACKGROUND: Hypertensive intracerebral hemorrhage (HICH) is one of the most devastating forms of stroke. Currently, no specific therapies for HICH except general medical care. However, in China, medicine of promoting blood circulation (PBC) and removing blood stasis (RBS) are widely and efficiently used to treat HICH and become a potentially effective treatment for the secondary effects of HICH to alleviate brain injury, accelerate neuronal recovery, and improve the prognosis. In order to evaluate the safety and effect of PBC and RBS herbal drugs, we design a prospective, randomized, open, double-blind controlled clinical trial on the hematoma enlargement in HICH patients treating with PBC and RBS herbal medicine within 6 h time window from the symptom onset...
2016: SpringerPlus
Simon Lammy, Basel Al-Romhain, Laura Osborne, Edward J St George
A 10-year retrospective case series of patients undergoing decompressive craniectomy for malignant middle cerebral artery infarction (mMCAI) was undertaken (2005-2015). Patient demographics, co-morbidities, pre- and post-operative neurological state, operative timescales, craniectomy dimensions and Glasgow Outcome Scale (GOS) scores were analysed. Overall 40 patients underwent a decompressive craniectomy for mMCAI with a 30-day mortality of 17.5% (n=7). 17 patients (42.5%) were male with a mean age of 43yrs (range: 16-64yrs)...
September 14, 2016: World Neurosurgery
Yuhai Zhang, Rami Al-Aref, Haixia Fu, Yunxue Yang, Yugong Feng, Chao Zhao, Jun Dong, Guoqing Sun
AIM: To identify whether neuronavigation-assisted aspiration (NA) combined with electro-acupuncture (EA) provides better motor recovery in events of Hypertensive Putaminal Hematoma (HPH) sized 30 to 50 ml. This study aims to examine whether NA and EA have additional value to cerebral hemorrhage motor rehabilitation. MATERIAL AND METHODS: 240 patients with HPH sized 30 to 50 ml were admitted within 6 to 10 hours after stroke ictus were included in this study. All the cases were divided into 4 groups and each group contains 60 cases equally...
January 25, 2016: Turkish Neurosurgery
Marco Canevelli, Eirini Kelaiditi, Natalia Del Campo, Giuseppe Bruno, Bruno Vellas, Matteo Cesari
BACKGROUND: Different rates of cognitive progression have been observed among Alzheimer disease (AD) patients. The present study aimed at evaluating whether the rate of cognitive worsening in AD may be predicted by widely available and easy-to-assess factors. METHODS: Mild to moderate AD patients were recruited in the ICTUS study. Multinomial logistic regression analysis was performed to measure the association between several sociodemographic and clinical variables and 3 different rates of cognitive decline defined by modifications (after 1 year of follow-up) of the Mini Mental State Examination (MMSE) score: (1) "slow" progression, as indicated by a decrease in the MMSE score ≤1 point; (2) "intermediate" progression, decrease in the MMSE score between 2 and 5 points; and (3) "rapid" progression, decrease in the MMSE score ≥6 points...
July 2016: Alzheimer Disease and Associated Disorders
X Leng, L Lan, L Liu, T W Leung, K S Wong
BACKGROUND AND PURPOSE: Baseline collateral status has been correlated with outcomes of acute ischaemic stroke patients receiving intravenous thrombolysis (IVT) in previous studies. We carried out the current systematic review and meta-analysis to synthesize currently available evidence regarding such correlations. METHODS: Full-text articles published since 2000 were retrieved and screened. The overall effect sizes of good versus poor collateral status over a series of outcomes and certain baseline features were estimated by random-effects models and presented in risk ratios (RRs) or mean differences...
August 1, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Jennifer A Frontera, J Javier Provencio, Fatima A Sehba, Thomas M McIntyre, Amy S Nowacki, Errol Gordon, Jonathan M Weimer, Louis Aledort
BACKGROUND: Early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (SAH) is an important predictor of poor functional outcome, yet the underlying mechanism is not well understood. Animal studies suggest that platelet activation and inflammation with subsequent microthrombosis and ischemia may be a mechanism of EBI. METHODS: A prospective, hypothesis-driven study of spontaneous, SAH patients and controls was conducted. Platelet activation [thromboelastography maximum amplitude (MA)] and inflammation [C-reactive protein (CRP)] were measured serially over time during the first 72 h following SAH onset...
July 18, 2016: Neurocritical Care
K Tangen, N S Narasimhan, K Sierzega, T Preden, A Alaraj, A A Linninger
Subarachnoid hemorrhage (SAH) mostly occurs following the rupture of cerebral aneurysm causing blood to leak into the cranial subarachnoid space (SAS). Hemorrhage volume has been linked to the development of secondary vasospasm. Therefore, eliminating blood contaminants from the cerebrospinal fluid (CSF) space after the initial hemorrhage could improve patient outcomes and prevent the development of vasospasm. A number of clinical trials demonstrate that lumbar drainage effectively clears hemorrhagic debris from the cranial compartment...
July 6, 2016: Annals of Biomedical Engineering
K M Sand, H Naess, R M Nilsen, L Thomassen, J M Hoff
OBJECTIVES: Patients with posterior circulation infarction (PCI) have more subtle symptoms than anterior circulation infarction (ACI) and could come too late for acute intervention. This study aimed to describe the clinical presentation, management, and outcome of PCI in the NORSTROKE registry. METHODS: All patients with PCI admitted to the Department of Neurology at Haukeland University Hospital and registered in the NORSTROKE database 2006-2013 were included (n=686)...
July 6, 2016: Acta Neurologica Scandinavica
Mohamed A Labib, Mitesh Shah, Amin B Kassam, Ronald Young, Lloyd Zucker, Anthony Maioriello, Gavin Britz, Charles Agbi, J D Day, Gary Gallia, Robert Kerr, Gustavo Pradilla, Richard Rovin, Charles Kulwin, Julian Bailes
BACKGROUND: Subcortical injury resulting from conventional surgical management of intracranial hemorrhage may counteract the potential benefits of hematoma evacuation. OBJECTIVE: To evaluate the safety and potential benefits of a novel, minimally invasive approach for clot evacuation in a multicenter study. METHODS: The integrated approach incorporates 5 competencies: (1) image interpretation and trajectory planning, (2) dynamic navigation, (3) atraumatic access system (BrainPath, NICO Corp, Indianapolis, Indiana), (4) extracorporeal optics, and (5) automated atraumatic resection...
June 17, 2016: Neurosurgery
J Marta Moreno, M Bestué Cardiel, A Giménez Muñoz, M Palacín Larroy
INTRODUCTION: In 2008, stroke mortality, morbidity, and disability rates in Aragon were higher than the average in Spain. These data underscored the need to develop a stroke care programme (PAIA). MATERIAL AND METHODS: We present the dynamics of planning, implementation, evaluation, and improvement developed between 2009 and 2014 as well as the results of the PAIA after that 5-year period. RESULTS: Structure, processes, and outcomes have improved with reference to the key indicators of healthcare (audit: 2008, 2010, 2012) among others: stroke rate in 2013 was 2...
June 14, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
David Panczykowski, Matthew Pease, Yin Zhao, Gregory Weiner, William Ares, Elizabeth Crago, Brian Jankowitz, Andrew F Ducruet
BACKGROUND AND PURPOSE: The utility of prophylactic antiepileptic drug (AED) administration after spontaneous subarachnoid hemorrhage remains controversial. AEDs have not clearly been associated with a reduction in seizure incidence and have been associated with both neurological worsening and delayed functional recovery in this setting. METHODS: We retrospectively analyzed a prospectively collected database of subarachnoid hemorrhage patients admitted to our institution between 2005 and 2010...
July 2016: Stroke; a Journal of Cerebral Circulation
R Jaychandran, G Chaitanya, P Satishchandra, R D Bharath, K Thennarasu, S Sinha
PURPOSE: The peri-ictal autonomic disturbances have been studied as predictors of seizure outcome and as markers of seizure onset. We studied the changes in heart rate (HR), HRV, oxygen saturation and blood pressure (BP) in the peri-ictal period in patients with drug-resistant localization-related epilepsy. METHODOLOGY: Ninety one subjects undergoing video-EEG monitoring, underwent continuous HR, SpO2, BP and Lead II ECG monitoring. The changes during the preictal, ictal and postictal periods were analyzed for 57 seizures in 42 patients with artifact-free recordings and correlated with VEEG ictal onset and MRI characteristics...
September 2016: Epilepsy Research
William O Tatum, Emily K Acton, Michael E Langston, Kirsten Yelvington, Cammi Bowman, Jerry J Shih, William P Cheshire
PURPOSE: To assess and compare peak, multimodal ictal vital signs (iVS) during epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES). METHODS: Between 4/1/2010 and 4/1/2011, 183 adults had video-EEG monitoring, with 96 consecutive patients meeting inclusion criteria. Heart rate (HR), oxygen saturation (SaO2), and blood pressure (BP) were obtained at baseline and during an ictus. The motor semiology of each ES and PNES was also assessed. Student t-test, Fischer's Test, Wilcoxon Test (p=<0...
August 2016: Seizure: the Journal of the British Epilepsy Association
Takeshi Satow, Tomotaka Kawase, Atsushi Kitamura, Yuki Kajitani, Takuya Yamaguchi, Nobuhiko Tanabe, Reiko Otoi, Taro Komuro, Akira Kobayashi, Hirokazu Nagata, Tatsuya Mima
BACKGROUND: Walking ability is important in stroke patients to maintain daily life. Nevertheless, its improvement is limited with conventional physical therapy in chronic stage. We report the case of a chronic stroke patient showing a remarkable improvement in gait function after a new neurorehabilitation protocol using transcranial direct current stimulation (tDCS) and neuromuscular electrical stimulation (NMES). CASE PRESENTATION: A 62-year-old male with left putaminal hemorrhage suffered from severe right hemiparesis...
January 2016: Case Reports in Neurology
Wi-Sun Ryu, Dawid Schellingerhout, Sang-Wook Jeong, Matthias Nahrendorf, Dong-Eog Kim
BACKGROUND: Dyslipidemia is associated with chronic cardiovascular disease. However, the effect of dyslipidemia on acute ischemic stroke is unclear. We hypothesized that dyslipidemia could contribute to early neurological deterioration (END) after ischemic stroke. METHODS: A total of 410 acute ischemic stroke patients who were admitted to our stroke center within 24 hours after ictus were consecutively included in this study. END was defined as any new neurological symptoms/signs or any neurological worsening occurring during the admission and/or within 3 weeks after the index stroke...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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