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management of stroke

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https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#1
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28806148/atrial-fibrillation-ablation
#2
Rakesh Latchamsetty, Fred Morady
The prevalence of atrial fibrillation (AF) has risen significantly over the past two decades. Catheter ablation is an increasingly utilized treatment strategy and has evolved significantly over the same time period. Successful ablation improves patient symptoms, reduces stroke risk, and can preserve or improve cardiac function. Recurrences following ablation can occur, particularly in patients with persistent AF. Procedural efficacy can best be improved through continued advancements in ablation technology and strategy, better understanding of the mechanisms of AF initiation and perpetuation, and rigorous integration of ablation into a multidisciplinary AF management approach...
August 14, 2017: Annual Review of Medicine
https://www.readbyqxmd.com/read/28805237/adult-spasticity-international-registry-study-methodology-and-baseline-patient-health-care-provider-and-caregiver-characteristics
#3
Gerard E Francisco, Daniel S Bandari, Ganesh Bavikatte, Wolfgang H Jost, Aubrey Manack Adams, Joan Largent, Alberto Esquenazi
OBJECTIVE: The main aim of this study was to determine the utilization patterns and effectiveness of onabotulinumtoxinA (Botox®) for treatment of spasticity in clinical practice. DESIGN: An international, multicentre, prospective, observational study at selected sites in North America, Europe, and Asia. PATIENTS: Adult patients with newly diagnosed or established focal spasticity, including those who had previously received treatment with onabotulinum-toxin A...
August 14, 2017: Journal of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28805107/effects-of-high-frequency-repetitive-transcranial-magnetic-stimulation-on-reducing-hemiplegic-shoulder-pain-in-patients-with-chronic-stoke-a-randomized-controlled-trial
#4
Gyu-Sik Choi, Min Cheol Chang
OBJECTIVE: To examine whether high-frequency (10 Hz) repetitive transcranial magnetic stimulation (rTMS), applied over the primary motor cortex of the affected hemisphere, could be used to manage hemiplegic shoulder pain (HSP). METHODS: Twenty-four chronic stroke patients with chronic HSP, randomly assigned into the rTMS group (10 sessions of high-frequency stimulation) or the sham group (sham stimulation), was performed. The Numeric Rating Scale (NRS) was used to evaluate the intensity of pain at pre-treatment, and at one day, and one, two, and four weeks after treatment...
August 12, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28803441/thermoregulation-disorders-of-central-origin-how-to-diagnose-and-treat
#5
Marta Zawadzka, Marta Szmuda, Maria Mazurkiewicz-Bełdzińska
Fever is a common symptom in the Intensive Care Unit. At least half of febrile episodes are caused by infection. Excluding infectious etiology and other non-infectious causes of fever, especially in patients with central nervous system (CNS) disorders, attention should be paid to disturbances of thermoregulatory centre. In particular, subarachnoid haemorrhage, cerebral trauma, along with ischaemic or haemorrhagic stroke are strongly associated with the development of central fever. Proper, speedy diagnosis of the cause of fever makes it possible to implement preventive measures against the harmful effects of hyperthermia on the CNS and to avoid the consequences of inappropriate treatment...
2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28803173/ruptured-vertebral-artery-dissecting-aneurysm-concurrent-with-spontaneous-cervical-internal-carotid-artery-dissection-a-report-of-three-cases-and-literature-review
#6
Yosuke Akamatsu, Kenichi Sato, Hidenori Endo, Yasushi Matsumoto, Teiji Tominaga
BACKGROUND: Multiple dissections rarely occur with ruptured vertebral artery dissecting aneurysms (VADAs). Here, we report three cases of ruptured VADA concurrent with spontaneous cervical internal carotid artery (ICA) dissection. CASE DESCRIPTION: None of the three patients had a history of vasculopathy or trauma. All ruptured VADAs were treated with internal coil trapping in the acute stage of subarachnoid hemorrhage (SAH). Rebleeding was not observed in any patients after the treatment...
August 9, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28802751/acute-management-of-hemostasis-in-patients-with-neurological-injury
#7
REVIEW
M Irem Baharoglu, Anneke Brand, Maria M Koopman, Marinus Vermeulen, Yvo B W E M Roos
Neurological injuries can be divided into those with traumatic and nontraumatic causes. The largest groups are traumatic brain injury (TBI) and nontraumatic stroke. TBI patients may present with intracranial hemorrhages (contusions, or subdural or epidural hematomas). Strokes are ischemic or hemorrhagic. In all these disorders, thrombosis and hemostasis play a major role. Treatment aims to either cease bleeding and/or restore perfusion. We reviewed hemostatic and thrombolytic therapies in patients with neurological injuries by MEDLINE and EMBASE search using various key words for neurological disorders and hemostatic therapies restricted to English language and human adults...
July 13, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28801210/the-longitudinal-relationship-between-hand-hip-and-knee-osteoarthritis-and-cardiovascular-events-a-population-based-cohort-study
#8
Tetyana Kendzerska, Peter Jüni, Lauren K King, Ruth Croxford, Ian Stanaitis, Gillian A Hawker
OBJECTIVE: In this population-based cohort study, we examined the association between the presence of symptomatic osteoarthritis (OA) and risk for cardiovascular (CV) events. METHOD: A cohort aged ≥55 years recruited from 1996-98 was followed through provincial health administrative data to 2014. Demographics, joint complaints and functional limitations were collected. Hip, knee and hand OA were defined using a validated definition. Using Cox-regressions, the relationship between OA and a composite CV outcome (myocardial infarction, stroke, angina, heart failure, revascularization) was assessed controlling for age, BMI, sex, pre-existing metabolic factors, comorbidities, income status, primary care exposure and functional limitations...
August 8, 2017: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/28800833/bleeding-risk-scores-in-atrial-fibrillation-and-venous-thromboembolism
#9
REVIEW
Hanis Zulkifly, Gregory Y H Lip, Deirdre A Lane
Patients receiving oral anticoagulant (OAC) therapy for stroke prevention in atrial fibrillation (AF) and prevention of venous thromboembolism (VTE) face an increased risk of bleeding with OAC treatment. Clinicians need to weigh the benefits of OAC treatment against the risk of bleeding. To help formalize bleeding risk assessment, various bleeding risk scores have been developed to help predict the risk of bleeding in AF and VTE patients receiving OAC therapy. This review summarizes the literature involving original studies deriving bleeding risk scores and validation studies of these scores for stroke prevention in AF and treatment/prevention of VTE...
July 14, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28800605/stroke-survivors-with-severe-mental-illness-are-they-at-risk-for-increased-non-psychiatric-hospitalizations
#10
Flavius Robert Lilly, Joel Culpepper, Mary Stuart, Donald Steinwachs
BACKGROUND: This study examined outcomes for two groups of stroke survivors treated in Veteran Health Administration (VHA) hospitals, those with a severe mental illness (SMI) and those without prior psychiatric diagnoses, to examine risk of non-psychiatric medical hospitalizations over five years after initial stroke. METHODS: This retrospective cohort study included 523 veterans who survived an initial stroke hospitalization in a VHA medical center during fiscal year 2003...
2017: PloS One
https://www.readbyqxmd.com/read/28800149/atrial-fibrillation-variability-on-long-term-monitoring-of-implantable-cardiac-rhythm-management-devices
#11
Rachel M Kaplan, Paul D Ziegler, Jodi Koehler, Taya V Glotzer, Rod S Passman
BACKGROUND: Atrial fibrillation (AF) burden and duration are predictors of thromboembolic events. The random nature of these measures may affect clinical decision making. The objective of this study was to determine temporal changes in AF burden as detected by continuous monitoring. HYPOTHESIS: AF burden changes over time when detected by continuous monitoring. METHODS: A post hoc analysis of patients enrolled in the TRENDS (A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics) study with ≥1 stroke risk factor(s) who were implanted with a dual-chamber cardiac rhythm management device (CRMD) and had AF burden data available for ≥2 years was performed...
August 11, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28798906/cerebral-sinovenous-thrombosis
#12
REVIEW
Rebecca Ichord
Cerebral sinovenous thrombosis (CSVT) is a rare but serious cerebrovascular disorder affecting children from the newborn period through childhood and adolescence. The incidence is estimated at 0.6/100,000/year, with 30-50% occurring in newborns. Causes are diverse and are highly age dependent. Acute systemic illness is the dominant risk factor among newborns. In childhood CSVT, acute infections of the head and neck such as mastoiditis are most common, followed by chronic underlying diseases such as nephrotic syndrome, cancer, and inflammatory bowel disease...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28797584/long-term-outcomes-of-frozen-elephant-trunk-for-type-a-aortic-dissection-in-patients-with-marfan-syndrome
#13
Wei-Guo Ma, Wei Zhang, Jun-Ming Zhu, Bulat A Ziganshin, Ai-Hua Zhi, Jun Zheng, Yong-Min Liu, John A Elefteriades, Li-Zhong Sun
OBJECTIVE: The use of the frozen elephant trunk (FET) technique for repair of type A aortic dissection (TAAD) in Marfan syndrome (MFS) is controversial. We seek to evaluate the efficacy of FET and total arch replacement (TAR) for TAAD in patients with MFS. METHODS: The early and long-term outcomes were analyzed for 106 patients with MFS (mean age, 34.5 ± 9.7 years) undergoing FET + TAR for TAAD. RESULTS: Operative mortality was 6.6% (7 of 106)...
June 16, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28797259/gender-differences-in-hospital-admissions-for-major-cardiovascular-events-and-procedures-in-people-with-and-without-diabetes-in-england-a-nationwide-study-2004-2014
#14
Anthony A Laverty, Alex Bottle, Sung-Hee Kim, Bhakti Visani, Azeem Majeed, Christopher Millett, Eszter P Vamos
BACKGROUND: Secondary prevention of cardiovascular disease (CVD) has improved immensely during the past decade but controversies persist on cardiovascular benefits among women with diabetes. We investigated 11-year trends in hospital admission rates for acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) in people with and without diabetes by gender in England. METHODS: We identified all hospital admissions for cardiovascular disease causes among people aged 17 years and above between 2004 and 2014 in England...
August 10, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/28796425/comparison-of-stroke-volume-measurements-during-hemodialysis-using-bioimpedance-cardiography-and-echocardiography
#15
Michael J Germain, Jyovani Joubert, Daniel O'Grady, Brian H Nathanson, Yossi Chait, Nathan W Levin
BACKGROUND: Fluid management remains a major challenge of hemodialysis (HD) care, with serious implications for morbidity and mortality. Intradialytic fluid management is typically guided by blood pressure, an indirect resultant of hemodynamics status. Direct measurements of hemodynamic parameters may improve cardiovascular outcomes by providing rational bases for intervention. We compare stroke volume (SV) measurements using a noninvasive, regional biompedance cardiography device (NiCaS) with Doppler echocardiography (Echo) in HD setting...
August 10, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28795688/interventional-and-surgical-occlusion-of-the-left-atrial-appendage
#16
REVIEW
Etem Caliskan, James L Cox, David R Holmes, Bernhard Meier, Dhanunjaya R Lakkireddy, Volkmar Falk, Sacha P Salzberg, Maximilian Y Emmert
With a steadily increasing prevalence, atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide and an independent risk factor for stroke caused by thromboembolic events. The left atrial appendage (LAA) is the primary source of thromboemboli in patients with nonvalvular AF who have a stroke. Novel strategies (such as mechanical and nonpharmacological intervention) targeting the LAA in patients with AF for stroke prevention have become a major focus during the past decade. Some devices for percutaneous LAA occlusion are supported by robust clinical data obtained from randomized trials or large registries, and are a valid alternative to pharmacological stroke prevention...
August 10, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28795332/the-patterns-of-non-vitamin-k-antagonist-oral-anticoagulants-noacs-use-in-patients-with-atrial-fibrillation-in-seven-balkan-countries-a-report-from-the-balkan-af-survey
#17
Tatjana S Potpara, Elina Trendafilova, Gheorghe-Andrei Dan, Artan Goda, Zumreta Kusljugic, Sime Manola, Ljilja Music, Viktor Gjini, Belma Pojskic, Mircea Ioakim Popescu, Catalina Arsenescu Georgescu, Elena S Dimitrova, Delyana Kamenova, Uliks Ekmeciu, Denis Mrsic, Ana Nenezic, Sandro Brusich, Srdjan Milanov, Ivan Zeljkovic, Gregory Y H Lip
INTRODUCTION: Data on management of atrial fibrillation (AF) in the Balkan Region are scarce. To capture the patterns in AF management in contemporary clinical practice in the Balkan countries a prospective survey was conducted between December 2014 and February 2015, and we report results pertinent to the use of non-vitamin K antagonist oral anticoagulants (NOACs). METHODS: A 14-week prospective, multicenter survey of consecutive AF patients seen by cardiologists or internal medicine specialists was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania, and Serbia (a total of about 50 million inhabitants)...
August 9, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28794053/low-flow-severe-aortic-stenosis-evolving-role-of-transcatheter-aortic-valve-replacement
#18
REVIEW
Matthew D Saybolt, Paul N Fiorilli, Zachary M Gertz, Howard C Herrmann
The definition of severe aortic stenosis has classically and retrospectively been based on the natural history of patients with medically managed aortic stenosis and preserved left ventricular function in an era where surgical aortic valve replacement was the sole therapy. We now recognize that this disease is more heterogeneous and includes important subsets of patients with low stroke volume index (low flow) and low-gradient with reduced (classical) or preserved (paradoxical) ejection fraction. These patients pose diagnostic and treatment dilemmas, requiring a comprehensive assessment with integration of multimodality imaging, testing, and clinical assessment...
August 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28793822/dose-response-head-to-head-comparison-of-inodilators-dobutamine-milrinone-and-levosimendan-in-chronic-experimental-pulmonary-hypertension
#19
Marta Tavares-Silva, Mohamed Alaa, Sara Leite, José Oliveira-Pinto, Lucas Lopes, Adelino F Leite-Moreira, André P Lourenço
The choice of inodilator drug in the acute management of patients with pulmonary hypertension (PH) having right ventricular (RV) failure remains unsettled and challenging. Comprehensive experimental evaluations may provide further insight and fundamental translational research clues to support inodilator selection and clinical trial design. Our aim was to compare acute dose-response hemodynamic effects of inodilators dobutamine (DOB), milrinone (MIL), and levosimendan (LEV) in chronic experimental PH. Seven-week-old male Wistar rats were randomly injected with 60 mg·kg(-1) monocrotaline (MCT) or vehicle (Ctrl, n = 7) and underwent systemic and pulmonary artery (PA) pressure and RV pressure-volume (PV) hemodynamic evaluation under halogenate anesthesia 24 to 30 days after injection...
September 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28792285/awareness-and-management-of-elevated-blood-pressure-among-human-immunodeficiency-virus-infected-adults-receiving-antiretroviral-therapy-in-urban-zambia-a-call-to-action
#20
Sophie Bauer, Mwanza Wa Mwanza, Roma Chilengi, Charles B Holmes, Zude Zyambo, Hansjakob Furrer, Matthias Egger, Gilles Wandeler, Michael J Vinikoor
The prevalence of high blood pressure (HBP) and hypertension (HTN), awareness of the diagnoses, and use of anti-hypertensive drugs were examined among human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy (ART) in Zambia's capital Lusaka. Within a prospective cohort based at two public sector ART clinics, BP was measured at ART initiation and every 6 months thereafter as a routine clinic procedure. Predictors of HBP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) during one year on ART were analyzed using logistic regression, and the proportion with HTN (2+ episodes of HBP >3 months apart) described...
2017: Global Health Action
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