1,721,052 research outputs found
Teaching NeuroImages: A Disintegrating Rock
No full textResumen no disponibleFil: Hawkes, Maximiliano Alberto. Fleni. Departamento de Medicina Interna; Argentina. Fleni. Departamento de Neurología; Argentina.Fil: Rabinstein, Alejandro A. Mayo Clinic. Department of Neurology. Division of Critical Care Neurology; Estados Unidos
Acute Ischemic Stroke
No full textIschemic stroke is a medical emergency associated with significant morbidity and mortality. Over the past 25 years, the treatment of acute ischemic stroke has dramatically evolved. Currently, ischemic brain reperfusion is possible with pharmacologic, endovascular, and combined treatments. More recently, the use of advanced imaging allows identifying patients with salvageable ischemic brain tissue beyond the classic time-based window (tissue-based window) who benefit from reperfusion treatments. Stroke patients also benefit from monitoring in dedicated stroke units. This specialized environment is ideal for the detection and treatment of neurological deterioration and potential complications, and the timely institution of secondary prevention treatments and rehabilitation. This chapter aims to provide an updated and practical evidence-based guidance to the initial evaluation and treatment of acute stroke patients.Fil: Hawkes, Maximiliano Alberto. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.Fil: Rabinstein, Alejandro A. Mayo Clinic. Department of Neurology. Division of Critical Care Neurology; Estados Unidos
Neurological Prognostication After Cardiac Arrest in the Era of Target Temperature Management
No full textPurpose of Review
The purpose of this study is to provide an updated review on neurological prognostication in comatose patients after cardiac arrest in light of current targeted temperature management (TTM) strategies.
Recent Findings
With improved pre-hospital and hospital care, death due to cardiac arrest is decreasing. Yet, most survivors have poor neurological outcomes. While TTM has demonstrated to improve neurological outcomes, it may cloud our prognostic accuracy. A multimodal approach is currently used to diminish prognostic uncertainty.
Summary
The neurological examination remains the mainstay for prognosis after cardiac arrest. The combination electroencephalogram, somatosensory evoked potentials, and neuron-specific enolase improve prognostic accuracy, mostly in patients who underwent TTM. Quantitative analysis of pupillary reaction and EEG background variability, neuroimaging (CT perfusion and DWI-MRI), and middle/long-latency evoked potentials are promising methods that may further improve the precision of outcome prognostication.Fil: Hawkes, Maximiliano Alberto. Fleni. Departamento de Medicina Interna; Argentina. Fleni. Departamento de Neurología; Argentina.Fil: Rabinstein, Alejandro A. Mayo Clinic. Department of Neurology. Division of Critical Care Neurology; Estados Unidos
Diabetes and Stroke: What Are the Connections?
Get PDFStroke is a major cause of death and long-term disability worldwide. Diabetes is associated with an increased risk of cardiovascular complications, including stroke. People with diabetes have a 1.5–2 times higher risk of stroke compared with people without diabetes, with risk increasing with diabetes duration. These risks may also differ according to sex, with a greater risk observed among women versus men. Several mechanisms associated with diabetes lead to stroke, including large artery atherosclerosis, cerebral small vessel disease, and cardiac embolism. Hyperglycemia confers increased risk for worse outcomes in people presenting with acute ischemic stroke, compared with people with normal glycemia. Moreover, people with diabetes may have poorer post-stroke outcomes and higher risk of stroke recurrence than those without diabetes. Appropriate management of diabetes and other vascular risk factors may improve stroke outcomes and reduce the risk for recurrent stroke. Secondary stroke prevention guidelines recommend screening for diabetes following a stroke. The diabetes medications pioglitazone and glucagon-like peptide-1 receptor agonists have demonstrated protection against stroke in randomized controlled trials; this protective effect is believed to be independent of glycemic control. Neurologists are often involved in the management of modifiable risk factors for stroke (including hypertension, hyperlipidemia, and atrial fibrillation), but less often in the direct management of diabetes. This review provides an overview of the relationships between diabetes and stroke, including epidemiology, pathophysiology, post-stroke outcomes, and treatments for people with stroke and diabetes. This should aid neurologists in diabetes-related decision-making when treating people with acute or recurrent stroke
Acute Intracranial Hypertension During Pregnancy: Special Considerations and Management Adjustments
No full textPregnancy is associated with a number of pathophysiological changes (including modification of vascular resistance, increased vascular permeability, and coagulative disorders) that can lead to specific (eclampsia, preeclampsia) or not specific (intracranial hemorrhage) neurological complications. In addition to these disorders, pregnancy can affect numerous preexisting neurologic conditions, including epilepsy, brain tumors, and intracerebral bleeding from cerebral aneurysm or arteriovenous malformations. Intracranial complications related to pregnancy can expose patients to a high risk of intracranial hypertension (IHT). Unfortunately, at present, the therapeutic measures that are generally adopted for the control of elevated intracranial pressure (ICP) in the general population have not been examined in pregnant patients, and their efficacy and safety for the mother and the fetus is still unknown. In addition, no specific guidelines for the application of the staircase approach, including escalating treatments with increasing intensity of level, for the management of IHT exist for this population. Although some of basic measures can be considered safe even in pregnant patients (management of stable hemodynamic and respiratory function, optimization of systemic physiology), some other interventions, such as hyperventilation, osmotic therapy, hypothermia, barbiturates, and decompressive craniectomy, can lead to specific concerns for the safety of both mother and fetus. The aim of this review is to summarize the neurological pathophysiological changes occurring during pregnancy and explore the effects of the possible therapeutic interventions applied to the general population for the management of IHT during pregnancy, taking into consideration ethical and clinical concerns as well as the decision for the timing of treatment and delivery
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Can we stop the stuttering in stroke? Interventions in 40 patients with acute lacunes
No full textBackground
Whether any treatment can stop fluctuations of stuttering lacunar syndromes (SLS) is unclear. Case reports have variably suggested effectiveness of intravenous thrombolysis, dual antiplatelet treatment, blood pressure augmentation and anticoagulation. We aim to describe our experience with different treatments used in in patients presenting with SLS and their effect on clinical fluctuations and functional outcome.
Methods
We collected demographic and clinical data of consecutive adult patients with SLS. Descriptive summaries were reported as median and inter-quartile range (IQR) for continuous variables and as frequencies and percentages for categorical variables.
Results
Forty patients (72 ± 10 years, 36% female) were included. Pure motor syndrome (57%) was the most frequent clinical presentation. Clinical fluctuations stopped and the improvement was temporally related to aspirin-clopidogrel in 11/17 cases, intravenous thrombolysis in 4/6 cases, blood pressure augmentation in 1/3 cases and aspirin in 1/7 cases. Two patients continued fluctuating after IVT and later responded to blood pressure augmentation (n = 1) or aspirin-clopidogrel (n = 1).
Conclusions
Aspirin plus clopidogrel may be followed by clinical improvement when intravenous thrombolysis is not an option. Blood pressure augmentation may beneficial as ad-on treatment in patients with labile blood pressure.Fil: Hawkes, Maximiliano Alberto. Fleni. Departamento de Medicina Interna; Argentina. Fleni. Departamento de Neurología; Argentina.Fil: Braksick, Sherri A. University of Kansas Medical Center. Department of Neurology; Estados Unidos.Fil: Zhang, Wei. Mayo Clinic. Department of Neurology. Division of Critical Care Neurology; Estados Unidos.Fil: Wijdicks, Eelco F.M. Mayo Clinic. Department of Neurology. Division of Critical Care Neurology; Estados Unidos.Fil: Rabinstein, Alejandro A. Mayo Clinic. Department of Neurology. Division of Critical Care Neurology; Estados Unidos
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