Magnetic Resonance Imaging in Stroke Study
Yanlin Wang-Fischer in Manual of Stroke Models in Rats, 2008
The T2-relaxation time imaging (T2) in which CSF has high signal intensity in relation to brain tissue has been a popular tool for rat stroke study.1,17 T2-relaxation time imaging is uniquely suited to the assessment of the development, progression, and regression of brain edema and intracerebral hemorrhage in vivo. It can define the number spatial distribution and quantitate the size of brain lesions better than any other imaging modality in rodents.1–3,5 This technique offers a novel possibility to do repeated measurements and thus monitor the development of cerebral lesions as well as the effect of therapeutic measures at different stages of developing cerebral injury. In the animal study,1 repeated cerebral MRI measurements revealed two important points. First, approximately 70% of rats developed changes in T2 MRI before they showed neurological symptoms. Either the affected brain areas were not involved in motor function or they were not large enough to cause disorders in behavior. Thus, T2 MRI is a powerful tool in the temporal definition of the onset of cerebral lesions.
Blood Pressure Control in Acute Stroke
Stephen M. Cohn, Alan Lisbon, Stephen Heard in 50 Landmark Papers, 2021
Whether or not hypertension should be treated in acute stroke and how low the pressure should be decreased, if at all, are controversial. Data from randomized controlled trials do not provide much guidance. The MAPAS trial randomized patients to one of three groups based on targeted blood pressure control within 12 hours of stroke onset [2]. There was no difference among the groups in the percentage of good clinical outcome measured at 90 days, although patients in the higher systolic blood pressure range had an increased rate of symptomatic intracranial hemorrhage. However, a logistic regression analysis adjusted for confounders found that the maintenance of systolic blood pressure in the range of 161–180 mm Hg was associated with improved outcomes compared to the other two groups. A randomized controlled prehospital trial comparing transdermal nitroglycerin (NTG) to placebo administered within 4 hours of stroke onset found that NTG had statistically significant but clinically modest effects on lowering blood pressure. Ninety-day functional outcome was not different between groups. The trial included patients with ischemic stroke, transient ischemic attack, and intracerebral hemorrhage [3]. Data from other large trials do not provide much guidance as enrollment of patients was allowed up to 30–48 hours following stroke onset and some also enrolled patients with intracerebral hemorrhage. Finally, a number of meta-analyses have failed to demonstrate convincingly a beneficial effect on outcome.
Stroke
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
The diagnosis of an intracerebral hemorrhage is based on sudden headache, focal neurologic deficits, and especially in high-risk patients, reduced consciousness. An intracerebral hemorrhage must be distinguished from hypoglycemia, ischemic stroke, subarachnoid hemorrhage, and seizures. Immediate blood glucose level measurement is required, as is immediate CT or MRI. Diagnosis is usually via neuroimaging. If no hemorrhage is seen but a subarachnoid hemorrhage is clinically suspected, a lumbar puncture is required. Within hours of the start of hemorrhage, CT angiography can reveal areas where the contrast agent extravasates into the clot – known as a spot sign. This indicates continuing bleeding. The hematoma is likely to expand, worsening the outcome.
Real-world effectiveness and safety of rivaroxaban versus warfarin among non-valvular atrial fibrillation patients with obesity in a US population
Published in Current Medical Research and Opinion, 2021
Jeffrey S. Berger, François Laliberté, Akshay Kharat, Dominique Lejeune, Kenneth Todd Moore, Young Jung, Patrick Lefebvre, Veronica Ashton
The effectiveness outcome was the composite of stroke (ischemic or hemorrhagic) or SE (stroke/SE), which was defined as a primary diagnosis of stroke or SE documented in a hospitalization or emergency room visit (see Table S2 for the list of diagnosis codes used to identify stroke/SE). The effectiveness outcomes were also assessed separately (i.e. stroke, ischemic stroke, hemorrhagic stroke, and SE). The safety outcome was the occurrence of a major bleeding event, which was identified using hospitalizations with diagnoses and procedures indicating an episode of bleeding (i.e. Cunningham algorithm)34. Of note, hemorrhagic stroke was also included in the definition of a major bleeding event and included intracranial hemorrhage (ICD-9-CM: 432.x; ICD-10-CM: I62.xx), intracerebral hemorrhage (ICD-9-CM: 431.x; ICD-10-CM: I61.x), and subarachnoid hemorrhage (ICD-9-CM: 430.x; ICD-10-CM: I60.xx).
Pediatric ventricular assist devices: what are the key considerations and requirements?
Published in Expert Review of Medical Devices, 2020
Roland Hetzer, Mariano Francisco del Maria Javier, Eva Maria Javier Delmo
The increased incidence of both thromboembolic and hemorrhagic neurologic events in smaller patients illustrates that anticoagulation is a particular challenge in children. Lower blood flow in a relatively oversize device can lead to areas of stasis and thrombus formation. However, an unphysiologically large stroke volume may lead to systolic hypertension, which might increase the risk of brain hemorrhage. The solution to this problem should therefore not simply be more aggressive, but smarter, better controlled anticoagulation. The effects of Coumadin are harder to control in children, and delayed management with heparin may be a better option to avoid transient over-anticoagulation. Further, the effects of inhibitors of platelet aggregation in children may be different from those in adults. These drugs have to be studied more extensively in children, so we can better define their role in management. Presently, there is an increased enthusiasm about Bivalirudin since studies have provided no evidence of clot/fibrin or thrombus formation; hence, it should be considered as a mainstay anticoagulant.
Successful treatment of multidrug-resistant Acinetobacter baumannii meningitis with ampicillin sulbactam in primary hospital
Published in British Journal of Neurosurgery, 2018
Leitao Sun, Xiaohong Wang, Zefu Li
Twelve patients (eight men and four women) between 29 and 72 years of age were included. The most common underlying condition was intracerebral hemorrhage and severe traumatic brain injury (9 cases) (Table 1). All patients underwent surgical procedures, involving 10 craniotomies, 2 burr hole drillings, and 5 placements of external CSF shunts, which were in place for 3-15 days (9.6 ± 4.6 days) before onset of meningitis. Six patients applicated ICP monitoring. Two patients had CSF fistulae at the craniotomy and/or burr hole sites. One case had A. baumannii surgical wound infection prior to meningitis. Ten patients had been in the intensive care unit and eleven had received antimicrobial treatment prior to onset of meningitis. All the patients had fever (39.06 ± 0.69 °C), neck stiffness or meningeal signs, and a low consciousness level (coma in nine cases and stupor and somnolence in three cases). Leukocytosis (185,427 ± 5,894/µl) with a polymorphonuclear predominance was noted in ten patients. In all CSF specimens, pleocytosis (3,983 ± 3,327 cells/µl.) with a polymorphonuclear predominance, an elevated protein level (453 ± 309 mg/dl.), and a low glucose level (15 ± 12 mg/dL) were noted.
Related Knowledge Centers
- Dizziness
- Intraparenchymal Hemorrhage
- Lightheadedness
- Skull
- Hemiparesis
- Stroke
- Headache
- Vertigo
- Intraventricular Hemorrhage
- Altered Level of Consciousness