Stroke; a journal of cerebral circulation
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Randomized Controlled Trial
Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery.
Cognitive decline after cardiac surgery remains common and diminishes patients' quality of life. Based on experimental and clinical evidence, this study assessed the potential of intravenously administered lidocaine to reduce postoperative cognitive dysfunction after cardiac surgery using cardiopulmonary bypass. ⋯ Lidocaine administered during and after cardiac surgery does not reduce the high rate of postoperative cognitive dysfunction. Higher doses of lidocaine and diabetic status were independent predictors of cognitive decline. Protective effects of lower dose lidocaine in nondiabetic subjects need to be further evaluated.
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Review
Deferoxamine mesylate: a new hope for intracerebral hemorrhage: from bench to clinical trials.
Iron resulting from hemoglobin degradation is linked to delayed neuronal injury after intracerebral hemorrhage. Extensive preclinical investigations indicate that the iron chelator, deferoxamine mesylate, is effective in limiting hemoglobin- and iron-mediated neurotoxicity. However, clinical studies evaluating the use of deferoxamine in intracerebral hemorrhage are shortcoming. This article reviews the potential role of deferoxamine as a promising neuroprotective agent to target the secondary effects of intracerebral hemorrhage to limit brain injury and improve outcome, and ongoing efforts to translate the preclinical findings into clinical investigations.
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Early hematoma growth is one of the main determinants of mortality in patients with intracranial hemorrhage (ICH). Transcranial duplex sonography (TDS) might represent a useful tool for the bedside monitoring of early ICH enlargement. We aimed to correlate ICH volumes measured by TDS and CT scan in patients with ICH evaluated <3 hours of symptom onset. ⋯ TDS showed an excellent correlation with CT in measuring the extent of bleeding in patients with hyperacute ICH. TDS may represent a reliable useful tool for monitoring ICH noninvasively at the patient's bedside.
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Randomized Controlled Trial Multicenter Study
Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial.
Electrocardiographic abnormalities are common after subarachnoid hemorrhage, but their significance remains uncertain. The aim of this study was to determine whether any specific electrocardiographic abnormalities are independently associated with adverse neurological outcomes. ⋯ Bradycardia, relative tachycardia, and nonspecific ST- and T-wave abnormalities are strongly and independently associated with 3-month mortality after subarachnoid hemorrhage. Further research should be performed to determine whether there is a causal relationship between cardiac dysfunction and neurological outcome after subarachnoid hemorrhage.
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Multicenter Study
Optimal Tmax threshold for predicting penumbral tissue in acute stroke.
We sought to assess whether the volume of the ischemic penumbra can be estimated more accurately by altering the threshold selected for defining perfusion-weighting imaging (PWI) lesions. ⋯ Defining PWI lesions based on a stricter Tmax threshold than the standard >2 seconds delay appears to provide more a reliable estimate of the volume of the ischemic penumbra in stroke patients imaged between 3 and 6 hours after symptom onset. A threshold between 4 and 6 seconds appears optimal for early identification of critically hypoperfused tissue.