Stroke; a journal of cerebral circulation
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Seizures within the first 48 hours of a first stroke or transient ischemic attack (TIA) are an independent prognostic factor for in-hospital mortality. The aim of this study was to determine predictive factors of early seizures in first-ever stroke patients. ⋯ Cortical involvement in the neuroimaging studies and agitated acute confusional state at the onset of stroke were independent predictive factors of early seizures in first-ever stroke patients. The efficacy of anticonvulsant drugs in the prophylactic control of seizures should be assessed in prospective, randomized, double-blind clinical trials conducted in the subgroup of patients with the highest risk of developing epileptic seizures.
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Cerebral blood flow after cardiac arrest is reduced during the delayed hypoperfusion phase, while cerebral metabolic rate of oxygen returns to baseline values. Hypocapnia can induce cerebral ischemia in neurosurgical patients who already have reduced cerebral blood flow. The purpose of the present study was to determine whether comatose patients resuscitated from a cardiac arrest have a normal cerebrovascular reactivity to changes in PaCO2 and whether hypocapnia causes cerebral ischemia. ⋯ The cerebrovascular reactivity to changes in arterial carbon dioxide tension is preserved in comatose patients resuscitated from a cardiac arrest. Hyperventilation may induce cerebral ischemia in the postresuscitation period.
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Multicenter Study Clinical Trial
A systems approach to immediate evaluation and management of hyperacute stroke. Experience at eight centers and implications for community practice and patient care. The National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study Group.
With the approval by the Food and Drug Administration of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke within 180 minutes of symptom onset, patients and prehospital and hospital systems will now have to treat stroke as a medical emergency. It is thus critical to develop efficient hospital-based methods for hyperacute stroke patient evaluation and intervention at both community-based and tertiary care academic centers. ⋯ Hyperacute stroke treatment can be initiated, often within 55 minutes of patient arrival at the hospital, in both community and academic settings when all aspects of stroke care processes are identified, streamlined, and built into the day-to-day operations of the prehospital and hospital healthcare delivery system.