International journal of stroke : official journal of the International Stroke Society
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Intracranial pressure elevation, peaking three to seven post-stroke is well recognized following large strokes. Data following small-moderate stroke are limited. Therapeutic hypothermia improves outcome after cardiac arrest, is strongly neuroprotective in experimental stroke, and is under clinical trial in stroke. Hypothermia lowers elevated intracranial pressure; however, rebound intracranial pressure elevation and neurological deterioration may occur during rewarming. ⋯ We saw major intracranial pressure elevation 24 h after stroke in two rat strains, even after small strokes. Short-duration hypothermia prevented the intracranial pressure rise, an effect sustained for at least 18 h after rewarming. The findings have potentially important implications for design of future clinical trials.
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Existing methods of primary stroke prevention are not sufficiently effective. Based on the recently developed Stroke Riskometer app, a new 'mass-elevated risk stroke/cardiovascular disease prevention' approach as an addition to the currently adopted absolute risk stroke/cardiovascular disease prevention approach is being advocated. We believe this approach is far more appealing to the individuals concerned and could be as efficient as the conventional population-based approach because it allows identification and engagement in prevention of all individuals who are at an increased (even slightly increased) risk of stroke and cardiovascular disease. ⋯ Second, it employs self-management strategies to engage the person concerned in stroke/cardiovascular disease prevention, which is tailored to the person's individual risk profile. Preventative strategies similar to the Stroke Riskometer could be developed for other non-communicable disorders for which reliable predictive models and preventative recommendations exist. This would help reduce the burden of non-communicable disorders worldwide.
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Randomized Controlled Trial Multicenter Study
A multicenter, randomized, double-blinded, placebo-controlled phase III study of Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III).
In adults, intraventricular thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) facilitates resolution of intraventricular haemorrhage (IVH), reduces intracranial pressure, decreases duration of cerebrospinal fluid diversion, and may ameliorate direct neural injury. We hypothesize that patients with small parenchymal haematoma volumes (<30 cc) and relatively large IVH causing acute obstructive hydrocephalus would have improved clinical outcomes when given injections of low-dose rtPA to accelerate lysis and evacuation of IVH compared with placebo. ⋯ The primary outcome measure is dichotomized modified Rankin Scale 0-3 vs. 4-6 at 180 days. Clinical secondary outcomes include additional modified Rankin Scale dichotomizations at 180 days (0-4 vs. 5-6), ordinal modified Rankin Scale (0-6), mortality and safety events at 30 days, mortality at 180 days, functional status measures, type and intensity of intensive care unit management, rate and extent of ventricular blood clot removal, and quality of life measures.
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Intravenous thrombolysis for acute ischemic stroke with recombinant tissue plasminogen activator has been shown to be beneficial up to 4.5-hours of symptom onset. ⋯ Our initial experience confirms that thrombolysis for ischemic stroke in the extended window is safe and beneficial.
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Review Meta Analysis
Intravenous insulin treatment in acute stroke: a systematic review and meta-analysis of randomized controlled trials.
Poststroke hyperglycemia has been associated with unfavorable outcome. Several trials investigated the use of intravenous insulin to control hyperglycemia in acute stroke. This meta-analysis summarizes all available evidence from randomized controlled trials in order to assess its efficacy and safety. ⋯ This meta-analysis of randomized controlled trials does not support the use of intravenous insulin in hyperglycemic stroke patients to improve mortality or functional outcome. The risk of hypoglycemia is increased, however.