Stroke; a journal of cerebral circulation
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Predictors of clinical outcome in aneurysmal subarachnoid hemorrhage (SAH) vary in reliability. Measurement of cerebral venous hemodynamics by transcranial color-coded duplexsonography (TCCS) has become of increasing interest lately, and correlation with intracranial pressure (ICP) seems to be high. The aim of the presented study was to assess changes of cerebral venous hemodynamics in SAH and evaluate its relationship with clinical outcome. ⋯ Increased ICP values correlate with increased venous flow velocities. In SAH, increased ICP and increased venous flow velocities are associated with poor outcome. Flow velocity of the transversal sinus is a highly sensitive, reliable, and early predictor of outcome in SAH.
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Development of a method to continuously assess cerebrovascular autoregulation of patients with traumatic brain injury would facilitate therapeutic intervention and thus reduce secondary complications. ⋯ Evaluation of changes of the HMF of cerebrovascular pressure transmission with respect to CPP changes permits continuous monitoring of cerebral autoregulation.
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The clinical and hemodynamic impacts of basilar artery (BA) vasospasm (VS) after aneurysmal subarachnoid hemorrhage (SAH) are ill-defined. The purpose of the present study was to evaluate the relationship between BA-VS and regional cerebral blood flow (rCBF) with posterior circulation after aneurysmal SAH. ⋯ These findings suggest for the first time that BA-VS after aneurysmal SAH is associated with hypoperfusion to BS and other posterior circulation territories. The risk for delayed BS ischemia increased significantly when TCD BA-FVs were >115 cm/s.
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We aimed to determine the diagnostic value of perfusion computed tomography (PCT) and CT angiography (CTA) including CTA source images (CTA-SI) in comparison with perfusion-weighted magnetic resonance imaging (MRI) (PWI) and diffusion-weighted MRI (DWI) in acute stroke <6 hours. ⋯ In hyperacute stroke, the combination of PCT and CTA can render important diagnostic information regarding the infarct extent and the perfusion deficit. Lesions on PCT-TTP and PCT-CBV do not differ from lesions on PWI-TTP and PWI-CBV; lesions on CTA source images do not differ from lesions on DWI. The combination of noncontrast-enhanced CT (NECT), perfusion CT (PCT), and CT angiography (CTA) can render additional information within <15 minutes and may help in therapeutic decision-making if PWI and DWI are not available or cannot be performed on specific patients.
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Although atrial fibrillation is the most frequent cause of cardioembolic stroke, this arrhythmia remains underdiagnosed, as it is often asymptomatic or intermittent and, thus, may not be detected on standard 12-lead ECG or even 24-hour ECG recording (Holter). In this study, we hypothesized that 7-day ambulatory ECG monitoring using an event-loop recording (ELR) device would detect otherwise occult episodes atrial fibrillation and flutter (AF) after acute stroke or transient ischemic attack (TIA). ⋯ Following acute stroke or TIA, ELR identified patients with AF, which remained undetected with standard ECG and with Holter. ELR should, therefore, be considered in every patient in whom a cardioembolic mechanism is suspected.