1,721,335 research outputs found
Neurovascular emergencies
No full textWorldwide, a stroke occurs every second out of two, with an incidence of about 260 per 100,000 persons per year. Annually, there are about 6 million stroke-related deaths and about 100 million patients who remain disabled. At present, it is necessary to consider that, even though the overall number of strokes is increasing, due to the global population growth, increasing life expectancy and ageing populations, stroke incidence and disability are in decline, reflecting the improvement of prevention and treatment strategies. The aim of this book is to update stroke clinicians, emergency clinicians and practitioners, relying upon current optimal strategies of intervention to treat stroke patients, from diagnosis up until available acute therapies. This will be done using practical and easy to read flow-charts, mirroring the most common clinical settings. Also, a focus will be placed upon the early phase of stroke when intervention is recommended, in order to obtain an optimal response to therapy. In fact, since stroke is a time-dependent disease, the sooner we intervene, the better the prognosis. If we consider that -on average - 1.9 million neurons die, 14 billion of synapses melt and 12 km of neural fibers are lost every minute from stroke onset, it can definitely be said that time is brain
Secondary prevention of atherothrombotic cerebrovascular events
No full textSecondary prevention of atherosclerotic stroke and transient ischemic attack includes both conventional approaches to vascular risk factor management (blood pressure lowering, cholesterol reduction with statins and smoking cessation), antiplatelet therapy and more specific interventions, such as carotid revascularization. The objective of this review is to discuss effective interventions for optimal secondary prevention of atherosclerotic strokeSecondary prevention of atherosclerotic stroke and transient ischemic attack includes both conventional approaches to vascular risk factor management (blood pressure lowering, cholesterol reduction with statins and smoking cessation), antiplatelet therapy and more specific interventions, such as carotid revascularization. The objective of this review is to discuss effective interventions for optimal secondary prevention of atherosclerotic stroke
Blaise Pascal and his visual experiences
No full textBlaise Pascal (1623-1662) the mathematician, physicist, and theologian, is often considered as an example of classical French prose. Pascal's primary scientific contribution was the principle of hydrostatics, known as Pascal's Law. Furthermore, he is also regarded as one of the most important French philosophers, principally due to his publication: "Pensées". There is documentation affirming that Pascal suffered from visual migraines with recurring headaches, episodes of blindness in half of his visual field, zigzag, fortification spectra, and other visual hallucinations. It has been hypothesised that these migraine aura experiences acted as a source of inspiration for Pascal's philosophical reflections. Pascal's sudden religious conversion, probably the most decisive moment in Pascal's personal life, during the night of the 23rd to 24th of November 1654, was accompanied by a lighted vision which he interpreted as fire convincing him of God's "reality and presence". This experience may have been triggered by the effects of a migraine aura attack. This spiritual epiphany led him to dedicate the rest of his life to religious and philosophical interests
Cerebrovascular complications of neck manipulation
No full textThe safety of spinal manipulation is an issue that demands regular and rigorous assessment, as manipulation of the upper spine has been associated with serious adverse events such as cerebrovascular accidents due to cervical artery dissection. A correlation between stroke and cervical manipulation has been reported with increasing frequency, and each new report seems to reignite debate between neurologists and manual therapists. Specific risk factors for cerebrovascular complications related to spinal manipulation have not been identified yet; for this reason, any patient may be at risk, particularly those below 45 years of age. Patients undergoing spinal manipulative therapy need to consent to the possible risk of stroke or vascular injury from the procedure.The safety of spinal manipulation is an issue that demands regular and rigorous assessment, as manipulation of the upper spine has been associated with serious adverse events such as cerebrovascular accidents due to cervical artery dissection. A correlation between stroke and cervical manipulation has been reported with increasing frequency, and each new report seems to reignite debate between neurologists and manual therapists. Specific risk factors for cerebrovascular complications related to spinal manipulation have not been identified yet; for this reason, any patient may be at risk, particularly those below 45 years of age. Patients undergoing spinal manipulative therapy need to consent to the possible risk of stroke or vascular injury from the procedure. Copyright © 2008 S. Karger AG
Sex Is Not a Risk Factor in Outcome When a Stroke Unit Treats the Patient
No full textSex Is Not a Risk Factor in Outcome When a Stroke Unit
Treats the Patien
Thrombolysis in dementia patients with acute stroke: is it justified?
No full textThe administration of thrombolytic therapy in
elderly patients with dementia and acute ischemic stroke
may be controversial, because the reported risk of rt-PA
associated intracerebral hemorrhage in these patients is
higher compared with that of patients without dementia
and because these patients are already disabled. Moreover,
there are known risk factors for hemorrhagic
transformation in patients with dementia: amyloid
angiopathy, leukoaraiosis and the presence of microbleeds.
In this review, we describe the impact of dementia
on functional outcome following thrombolytic therapy for
acute ischemic stroke and discuss some of the issues
related to the use of this therapy in this specific patient’s
population.The administration of thrombolytic therapy in elderly patients with dementia and acute ischemic stroke may be controversial, because the reported risk of rt-PA associated intracerebral hemorrhage in these patients is higher compared with that of patients without dementia and because these patients are already disabled. Moreover, there are known risk factors for hemorrhagic transformation in patients with dementia: amyloid angiopathy, leukoaraiosis and the presence of microbleeds. In this review, we describe the impact of dementia on functional outcome following thrombolytic therapy for acute ischemic stroke and discuss some of the issues related to the use of this therapy in this specific patient’s population
Antithrombotic therapy in carotid artery stenosis: an update
No full textCarotid stenosis is generally associated with high risks of stroke and vascular events. In asymptomatic and symptomatic patients, with or without revascularization, optimal managements of carotid artery stenosis require the use of medications or lifestyle modifications (stopping smoking and monitoring hypertension, hyperlipidemia, and diabetes) to control the processes associated with atheroma to reduce the risk of embolic events. Moreover, antiplatelet therapy should be considered. There is little evidence that antiplatelet therapy is beneficial in preventing stroke or the progression of stenosis in asymptomatic patients, whereas, evidence of a benefit from antiplatelet therapy for secondary prevention of recurrent stroke in symptomatic patients with carotid atherosclerosis is more robust. Also, in patients undergoing carotid endarterectomy, perioperative antithrombotic therapy should include aspirin, while the addition of clopidogrel should be decided case-by-case. Furthermore, perioperative antithrombotic therapy in patients undergoing carotid stenting should consist a combination of aspirin plus clopidogrel.Carotid stenosis is generally associated with high risks of stroke and vascular events. In asymptomatic and symptomatic patients, with or without revascularization, optimal managements of carotid artery stenosis require the use of medications or lifestyle modifications (stopping smoking and monitoring hypertension, hyperlipidemia, and diabetes) to control the processes associated with atheroma to reduce the risk of embolic events. Moreover, antiplatelet therapy should be considered. There is little evidence that antiplatelet therapy is beneficial in preventing stroke or the progression of stenosis in asymptomatic patients, whereas, evidence of a benefit from antiplatelet therapy for secondary prevention of recurrent stroke in symptomatic patients with carotid atherosclerosis is more robust. Also, in patients undergoing carotid endarterectomy, perioperative antithrombotic therapy should include aspirin, while the addition of clopidogrel should be decided case-by-case. Furthermore, perio..
Pure sensory syndromes in thalamic stroke
No full textWe studied 25 patients with an acute thalamic stroke (infarct or hemorrhage) on CT or MRI scan and sensory dysfunction, among the 3,628 patients with first-time stroke included in the Lausanne Stroke Registry. Twelve patients had a right-sided infarct, 11 a left-sided infarct, and 2 a left-sided thalamic hemorrhage. Sensory symptoms or signs were the only clinical abnormality. The presumed causes of stroke were small artery disease in 21 patients including both cases of hemorrhage, emboligenic heart disease in 2, while the etiology of ischemic stroke was undetermined in 2 patients. Nine patients had a loss of all modalities of sensation with faciobrachiocrural distribution, 5 patients suffered dissociated sensory loss with faciobrachiocrural distribution and 11 patients showed a dissociated involvement of sensation with a partial distribution pattern. The inferolateral region (thalamogeniculate arteries) was involved in all patients. Six patients complained of pain and/or dysesthesias during the stroke; 5 of them had involvement of the nucleus ventrocaudalis (in 3 with damage to the nucleus ventro-oralis intermedius, and in one to the pulvinar) and 1 patient had involvement of the nucleus ventro-oralis intermedius. Eighteen patients complained of paresthesias in the contralateral part of the body; 16 of them had involvement of the nucleus ventrocaudalis (in 4 with damage to the nucleus ventro-oralis intermedius, in 1 with damage to the nucleus ventro-oralis intermedius, and nucleus ventro-oralis externus, and in one with damage to the nucleus parvocellularis and pulvinar). Four patients developed delayed pain and/or dysesthesias; all of them had involvement of the nucleus ventrocaudalis (in 1 with damage to the nucleus parvocellularis and pulvinar). Time lag from stroke onset to developing pain ranged from 2 to 15 days (mean 10.5 days). One patient with dissociated involvement of sensation with a partial distribution pattern had paresthesias and dissociated hemisensory loss involving position sense without pain and temperature sensations. This patient had involvement of the posterolateral part of the nucleus ventrocaudalis. In conclusion, sensory dysfunction and delayed pain are more often found in thalamic lesions that involve the nucleus ventrocaudalis, and nucleus ventro-oralis intermedius. Restricted sensory abnormalities correlate with very small lesions located in critical areas within these nuclei.We studied 25 patients with an acute thalamic stroke (infarct or hemorrhage) on CT or MRI scan and sensory dysfunction, among the 3628 patients with first-time stroke included in the Lausanne Stroke Registry. Twelve patients had a right-sided infarct, 11 a left-sided infarct, and 2 a left-sided thalamic hemorrhage. Sensory symptoms or signs were the only clinical abnormality. The presumed causes of stroke were small artery disease in 21 patients including both cases of hemorrhage, emboligenic heart disease in 2, while the etiology of ischemic stroke was undetermined in 2 patients. Nine patients had a loss of all modalities of sensation with faciobrachiocrural distribution, 5 patients suffered dissociated sensory loss with faciobrachiocrural distribution and 11 patients showed a dissociated involvement of sensation with a partial distribution pattern. The inferolateral region (thalamogeniculate arteries) was involved in all patients. Six patients complained of pain and/or dysesthesias d..
Solutions to reduce cardiovascular events in patients with atrial fibrillation
No full textAF is the most common sustained cardiac rhythm disorder and an established risk factor for ischemic stroke. Ischemic strokes which occur in patients with AF are particularly severe and disabling. In addition, stroke recurrence is more common in patients with AF compared with those without it. Previous cerebrovascular events, age, hypertension, diabetes, and heart failure are risk factors for stroke in patients with AF.
Various risk stratification schemes have been developed to quantify the risk for stroke in patients with AF. Currently, the most frequently used schemes to assess stroke risk in patients with AF are CHADS2, the ACC/AHA/ESC and American College of Chest Physicians (ACCP) schemes.
Current risk scores are largely derived from risk factors identified from clinical trials and many potential risk factors have not been properly considered. Consequently, the stroke risk in many patients could be underestimated, and these patients could receive a suboptimal antithrombotic prophylaxis.
There is substantial evidence for the benefit of vitamin K antagonists (VKA) in preventing stroke and reducing mortality. Novel oral anticoagulants are available for stroke prevention in patients with AF which overcome some of the difficulties associated with VKA. The introduction of novel oral anticoagulants in clinical practice and the advances in identifying patients at risk of stroke together may overcome many of the difficulties in providing effective stroke prevention for patients with AF.AF is the most common sustained cardiac rhythm disorder and an established risk factor for ischemic stroke. Ischemic strokes which occur in patients with AF are particularly severe and disabling. In addition, stroke recurrence is more common in patients with AF compared with those without it. Previous cerebrovascular events, age, hypertension, diabetes, and heart failure are risk factors for stroke in patients with AF. Various risk stratification schemes have been developed to quantify the risk for stroke in patients with AF. Currently, the most frequently used schemes to assess stroke risk in patients with AF are CHADS2, the ACC/AHA/ESC and American College of Chest Physicians (ACCP) schemes. Current risk scores are largely derived from risk factors identified from clinical trials and many potential risk factors have not been properly considered. Consequently, the stroke risk in many patients could be underestimated, and these patients could receive a suboptimal antithrombotic prophyl..
Prevenzione e terapia dell'ictus ischemico
No full textLe malattie vascolari sono in italia la prima causa di morte e fra esse l' ictus è in prima posizione, seguito dall' infarto del miocardio. Diversi studi hanno recentemente dimostrato che l' intervento precoce è l' unica possibilità che permette di migliorare la prognosi del paziente. In questo volume vengono descritte, sviluppate e discusse le conoscenze acquisite dai più recenti trial clinici che hanno ottenuto risultati importanti applicabili alla buona pratica clinica
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