Stroke; a journal of cerebral circulation
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Comparative Study
Therapeutic milestone: stroke declines from the second to the third leading organ- and disease-specific cause of death in the United States.
Stroke mortality rates declined for much of the second half of the 20th century, but recent trends and their relation to other organ- and disease-specific causes of death have not been characterized. ⋯ With stroke death rates decreasing substantially in the United States from 1996 to 2005, stroke moved from the second to the third leading organ- and disease-specific cause of death. Women and blacks may warrant attention for targeted stroke prevention and treatment because they continue to have disproportionately high stroke death rates.
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Letter Randomized Controlled Trial Comparative Study
Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction.
"Sinking skin flap" (SSF) syndrome is a rare complication after large craniectomy that may progress to "paradoxical" herniation as a consequence of atmospheric pressure exceeding intracranial pressure. The prevalence and characteristics of SSF syndrome after hemicraniectomy for malignant infarction of the middle cerebral artery are not well known. ⋯ SSF syndrome either clinically symptomatic or asymptomatic affects one fourth of patients 3 to 5 months after hemicraniectomy for malignant middle cerebral artery infarction. It should be diagnosed as early as possible to avoid progression to a paradoxical herniation.
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Multicenter Study Comparative Study
Impact of baseline tissue status (diffusion-weighted imaging lesion) versus perfusion status (severity of hypoperfusion) on hemorrhagic transformation.
The frequency of hemorrhagic transformation (HT) on gradient echo imaging and its impact on stroke outcomes continues to be debated. We investigated the factors associated with HTs and the influence of the HTs observed on gradient echo imaging on the early course after a stroke. ⋯ The results of this study indicate that the perfusion status (severe perfusion delay) rather than the tissue status (diffusion-weighted imaging lesions) and aggressive treatment were independently associated with HTs. HT on gradient echo imaging was common but usually associated with severe hypoperfusion and not always associated with clinical deterioration.
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Comparative Study
Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease.
Enlarged perivascular spaces in the brain are common but generally overlooked and of uncertain pathophysiology. They may reflect underlying cerebral small vessel disease. We determined whether enlarged perivascular spaces were associated with lacunar stroke subtype and white matter hyperintensities, markers of established small vessel disease. ⋯ Although prevalent in patients with vascular risk factors and stroke, enlarged perivascular spaces are specifically associated with lacunar ischemic stroke and white matter hyperintensities. Further studies should determine the mechanism of this association while including adequate controls to account for stroke and vascular risk factors. Enlarged perivascular spaces should not be overlooked in studies of small vessel disease.