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https://www.readbyqxmd.com/read/28228574/delays-in-door-to-needle-times-and-their-impact-on-treatment-time-and-outcomes-in-get-with-the-guidelines-stroke
#1
Noreen Kamal, Shubin Sheng, Ying Xian, Roland Matsouaka, Michael D Hill, Deepak L Bhatt, Jeffrey L Saver, Mathew J Reeves, Gregg C Fonarow, Lee H Schwamm, Eric E Smith
BACKGROUND AND PURPOSE: Despite quality improvement programs such as the American Heart Association/American Stroke Association Target Stroke initiative, a substantial portion of acute ischemic stroke patients are still treated with tissue-type plasminogen activator (alteplase) later than 60 minutes from arrival. This study aims to describe the documented reasons for delays and the associations between reasons for delays and patient outcomes. METHODS: We analyzed the characteristics of 55 296 patients who received intravenous alteplase in 1422 hospitals participating in Get With The Guidelines-Stroke from October 2012 to April 2015, excluding transferred patients and inpatient strokes...
February 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28226329/transfrontal-and-transsphenoidal-approaches-to-pediatric-craniopharyngioma-a-national-perspective
#2
Yimo Lin, Daniel Hansen, Christina M Sayama, I-Wen Pan, Sandi Lam
INTRODUCTION: This study compared transsphenoidal (TS) and transfrontal (TF) approaches to craniopharyngioma utilizing a national database. METHODS: The Kids' Inpatient Database (2003, 2006, and 2009) was surveyed for patients with a diagnosis of craniopharyngioma who underwent a subset of surgical interventions to compare TS and TF surgery. Demographics, hospital variables, and complications/comorbidities were analyzed with multivariate regression. RESULTS: 314 admissions (TS = 104, TF = 210) were identified...
February 23, 2017: Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28226082/stroke-occurring-in-patients-with-cognitive-impairment-or-dementia
#3
Solène Moulin, Didier Leys
Objective: To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods: Literature search. Results: (i) A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii) Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii) Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv) Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others...
February 2017: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/28217513/clinical-and-epidemiological-study-of-stress-hyperglycemia-among-medical-intensive-care-unit-patients-in-central-india
#4
Jitendra Sharma, Sachin Chittawar, Ram Singh Maniram, T N Dubey, Ambrish Singh
BACKGROUND: Stress hyperglycemia is common in patients presenting at the emergency medical ward and is associated with poor prognosis and increased risk of mortality. AIMS AND OBJECTIVE: To study and determine the prevalence and factors associated with stress hyperglycemia. MATERIALS AND METHODS: A cross-sectional observational study was performed on 536 nondiabetic patients presented to the Intensive Care Unit (ICU) at Gandhi Medical College and allied Hamidia Hospital, Bhopal, between March 31, 2015, and May 28, 2015...
January 2017: Indian Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28208901/a-comparative-study-of-neurological-complications-in-chronic-kidney-disease-with-special-reference-to-its-stages-and-haemodialysis-status
#5
S G Shyam Lakshman, P Ravikumar, Giridhari Kar, Dwijen Das, Kallol Bhattacharjee, Prithwiraj Bhattacharjee
INTRODUCTION: Globally, Chronic Kidney Disease (CKD) is a critical and rapidly growing health problem and also a major cause of mortality and morbidity. Neurological complications occur in all levels of the nervous system. Central nervous system complications include cerebrovascular accidents, posterior reversible encephalopathy syndrome, osmotic demyelization syndrome, cerebral infection and sinus vein thrombosis. Peripheral nervous system complications include polyneuropathy, mononeuropathy and carpal tunnel syndrome...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28203183/cerebral-venous-thrombosis-in-the-superior-sagittal-sinus-as-a-rare-cause-of-a-paroxysmal-kinetic-tremor
#6
Kei Murao, Shuji Arakawa, Yoshihiko Furuta, Masahiro Shijo, Tetsuro Ago, Takanari Kitazono
Cerebral venous thrombosis (CVT) has a broad spectrum of clinical presentation compared to arterial etiology. Seizure is one of the common symptoms and is more frequent than in other stroke types. Hence, transient neurological symptoms in CVT patients are usually due to epileptic seizures, while transient repetitive movement disorder is extremely rare except as a complication of epilepsy. We report a case of CVT in the superior sagittal sinus with a 1-year history of paroxysmal kinetic tremor without evident epilepsy...
September 2016: Case Reports in Neurology
https://www.readbyqxmd.com/read/28201864/recurrent-contrast-induced-encephalopathy-following-coronary-angiography
#7
Roberto Spina, Neil Simon, Romesh Markus, David W M Muller, Krishna Kathir
Contrast-induced encephalopathy (CIE) is an acute and reversible neurological disturbance associated with the intra-arterial administration of iodinated contrast medium during cardiac catheterisation. It may manifest with encephalopathy, motor and sensory disturbances; vision disturbances, including cortical blindness, ophthalmoplegia, aphasia; and seizures. Disruption of the blood-brain barrier and direct neuronal toxicity are believed to be implicated in the pathophysiology of the syndrome. Symptoms appear soon after contrast administration and resolve completely within 24-48 h...
February 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28194288/variability-in-clinical-presentation-of-neonatal-stroke-report-of-four-cases
#8
Sonia Joseph, Dimitrios Angelis, Robert Bennett, Bhargavi Kola, Amanda Hughes
Neonatal stroke can be a cause of long term neurodevelopmental disability, seizures, and impaired cognitive function. We present four cases of neonatal stroke, associated with different risk factors and clinical presentations. Two of these newborns were born to mothers with no prenatal care.
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/28190440/neurologic-complications-in-critically-ill-pregnant-patients
#9
W L Wright
Neurologic complications in a critically ill pregnant woman are uncommon but some of the complications (such as eclampsia) are unique to pregnancy and the puerperal period. Other neurologic complications (such as seizures in the setting of epilepsy) may worsen during pregnancy. Clinical signs and symptoms such as seizure, headache, weakness, focal neurologic deficits, and decreased level of consciousness require careful consideration of potential causes to ensure prompt treatment measures are instituted to prevent ongoing neurologic injury...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#10
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28190436/neurologic-complications-of-cardiac-and-vascular-surgery
#11
K N Sheth, E Nourollahzadeh
This chapter will provide an overview of the major neurologic complications of common cardiac and vascular surgeries, such as coronary artery bypass grafting and carotid endarterectomy. Neurologic complications after cardiac and vascular surgeries can cause significant morbidity and mortality, which can negate the beneficial effects of the intervention. Some of the complications to be discussed include ischemic and hemorrhagic stroke, seizures, delirium, cognitive dysfunction, cerebral hyperperfusion syndrome, cranial nerve injuries, and peripheral neuropathies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187816/multimodal-neurologic-monitoring
#12
G Korbakis, P M Vespa
Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. Multimodal monitoring is the concept of using various tools and data integration to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187798/critical-care-in-acute-ischemic-stroke
#13
M McDermott, T Jacobs, L Morgenstern
Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28185658/long-term-outcome-in-patients-with-transient-global-amnesia-a-population-based-study
#14
Julieta E Arena, Robert D Brown, Jay Mandrekar, Alejandro A Rabinstein
OBJECTIVE: To study the long-term risk of cerebrovascular events, seizures, and cognitive impairment in patients with transient global amnesia (TGA). PATIENTS AND METHODS: Data for all patients diagnosed with possible TGA in Olmsted County, Minnesota, between January 1, 1985, through December 31, 2010, were retrieved from the Rochester Epidemiology Project database. Transient global amnesia was defined clinically. End points were cerebrovascular event (stroke or transient ischemic attack), seizure, or cognitive impairment (mild cognitive impairment or dementia) during follow-up...
February 6, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28169020/description-of-stroke-mimics-after-complete-neurovascular-assessment
#15
C Avellaneda-Gómez, A Rodríguez Campello, E Giralt Steinhauer, A Gómez González, M Serra Martínez, P de Ceballos Cerrajería, A Zabalza de Torres, E Cuadrado-Godia, A Ois Santiago, J Jiménez-Conde, J Roquer
INTRODUCTION: A considerable percentage of events initially diagnosed as ischaemic stroke have non-cerebrovascular causes; these are called stroke mimics (SM). Currently available evidence about these events is heterogeneous and comes from studies with small samples. OBJECTIVE: The purpose of our study is to identify conditions that may present as SM, define their epidemiological and clinical characteristics, and determine the percentage of cases of SM treated with intravenous fibrinolysis...
February 4, 2017: Neurología: Publicación Oficial de la Sociedad Española de Neurología
https://www.readbyqxmd.com/read/28167446/various-modifications-of-the-intrahippocampal-kainate-model-of-mesial-temporal-lobe-epilepsy-in-rats-fail-to-resolve-the-marked-rat-to-mouse-differences-in-type-and-frequency-of-spontaneous-seizures-in-this-model
#16
Rebecca Klee, Claudia Brandt, Kathrin Töllner, Wolfgang Löscher
Temporal lobe epilepsy (TLE) is the most common type of acquired epilepsy in adults. TLE can develop after diverse brain insults, including traumatic brain injury, infections, stroke, or prolonged status epilepticus (SE). Post-SE rodent models of TLE are widely used to understand mechanisms of epileptogenesis and develop treatments for epilepsy prevention. In this respect, the intrahippocampal kainate model of TLE in mice is of interest, because highly frequent spontaneous electrographic seizures develop in the kainate focus, allowing evaluation of both anti-seizure and anti-epileptogenic effects of novel drugs with only short EEG recording periods, which is not possible in any other model of TLE, including the intrahippocampal kainate model in rats...
February 3, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28162872/simple-and-effective-method-to-lower-body-core-temperatures-of-hyperthermic-patients
#17
John P O'Connor
Hyperthermia is a potentially life threatening scenario that may occur in patients due to accompanying morbidities, exertion, or exposure to dry and arid environmental conditions. In particular, heat stroke may result from environmental exposure combined with a lack of thermoregulation. Key clinical findings in the diagnosis of heatstroke are (1) a history of heat stress or exposure, (2) a rectal temperature greater than 40 °C, and (3) central nervous system dysfunction (altered mental state, disorientation, stupor, seizures, or coma) (Prendergast and Erickson, 2014 [1])...
January 30, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28123618/comparison-of-neurological-clinical-manifestation-in-patients-with-hemorrhagic-and-ischemic-stroke
#18
Seyedhossein Ojaghihaghighi, Samad Shams Vahdati, Akram Mikaeilpour, Ali Ramouz
BACKGROUND: Cerebrovascular accident (CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't significant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients...
2017: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28121745/neurotoxicity-associated-with-dimethyl-sulfoxide-used-in-allogeneic-stem-cell-transplantation
#19
Eda Ataseven, Özlem Tüfekçi, Şebnem Yilmaz, Handan Güleryüz, Hale Ören
Dimethyl sulfoxide (DMSO) is a cryoprotective agent used in storage of frozen stem cells in stem cell transplantation. Central nervous system side effects of DMSO such as epileptic seizures, stroke, transient global amnesia, and temporary leucoencephalopathy are rarely seen. Here, we report a pediatric patient who developed seizures after DMSO-cryopreserved stem cell infusion and whose magnetic resonance imaging of the brain demonstrated parietal and occipital focal cortical T2-signal intensity increase. DMSO toxicity should be kept in mind in patients who received cryopreserved stem cell infusion and magnetic resonance imaging may be helpful in differential diagnosis of central nervous system involvement...
January 24, 2017: Journal of Pediatric Hematology/oncology
https://www.readbyqxmd.com/read/28120069/middle-temporal-gyrus-versus-inferior-temporal-gyrus-transcortical-approaches-to-high-grade-astrocytomas-in-the-mediobasal-temporal-lobe-a-comparison-of-outcomes-functional-restoration-and-surgical-considerations
#20
Alfredo Quinones-Hinojosa, Shaan M Raza, Ishrat Ahmed, Jordina Rincon-Torroella, Kaisorn Chaichana, Alessandro Olivi
INTRODUCTION: High-grade astrocytomas of the mesial temporal lobe may pose surgical challenges. Several approaches (trans-sylvian, subtemporal, and transcortical) have been designed to circumnavigate the critical neurovascular structures and white fiber tracts that surround this area. Considering the paucity of literature on the transcortical approach for these lesions, we describe our institutional experience with transcortical approaches to Grade III/IV astrocytomas in the mesial temporal lobe...
2017: Acta Neurochirurgica. Supplement
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