Stroke; a journal of cerebral circulation
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Clinical Trial
Effects of hypothermia on excitatory amino acids and metabolism in stroke patients: a microdialysis study.
The objective of this study was to assess the effect of therapeutic moderate hypothermia on excitatory amino acids and metabolism by applying cerebral microdialysis in patients suffering from space-occupying middle cerebral artery infarction. ⋯ Cerebral microdialysis is a safe and feasible bedside method for neurochemical monitoring indicating normal brain tissue, potentially salvageable brain tissue, and irreversibly damaged areas in stroke. We could demonstrate that hypothermia decreases glutamate, glycerol, lactate, and pyruvate in the "tissue at risk" area of the infarct but not within the infarct core. Thus, future treatment strategies for life-threatening stroke should be guided by close neurochemical monitoring.
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Active management of ruptured intracranial aneurysm in subarachnoid hemorrhage is indicated in patients with favorable prognosis. Outcome prediction is based on patient characteristics and clinical and radiological factors. Current clinical grading scales are imprecise, with low interobserver reproducibility. Therefore, outcome prediction remains inconsistent and decision making becomes difficult, especially for patients with poor clinical grade. ⋯ Apolipoprotein E epsilon4 genotype is related to poor outcome in patients with subarachnoid hemorrhage.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized controlled study of stroke unit care versus stroke team care in different stroke subtypes.
The benefits of stroke unit management may vary according to stroke subtype. A post hoc analysis of the influence of stroke subtype on stroke unit effectiveness was undertaken by using prospective data collected in a randomized controlled trial. ⋯ Stroke units improve the outcome in patients with large-vessel infarcts but not in those with lacunar syndromes. For lacunar strokes, stroke unit management may be associated with higher initial health costs for equivalent benefit.
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Clinical Trial
Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke.
The purpose of this study was to prospectively evaluate the effects of body position in patients with large supratentorial stroke. ⋯ In patients with large hemispheric stroke without an acute ICP crisis, cerebral perfusion pressure was maximal in the horizontal position although ICP was usually at its highest point. If adequate cerebral perfusion pressure is considered more desirable than the absolute level of ICP, the horizontal position is optimal for these patients.
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We have recently reported the safety of intraventricular sodium nitroprusside for the treatment of cerebral ischemia from vasospasm. Treatments have been accompanied previously by cerebral angiography to gauge treatment effect on established vasospasm. We presently report the safe coadministration of intraventricular sodium nitroprusside and thiosulfate in 10 patients with secured ruptured cerebral aneurysms in the intensive care unit, without the use of cerebral angiography for vasospasm treatment. ⋯ Intraventricular sodium nitroprusside with thiosulfate may be safely administered in the intensive care unit setting without the requirement of cerebral angiography to guide the effects of therapy.