Stroke; a journal of cerebral circulation
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To demonstrate that paramedic initiation of intravenous magnesium sulfate (Mg) in the field in focal stroke patients is feasible, safe, and yields significant time-savings compared with in-hospital initiation of neuroprotective therapy. ⋯ Field initiation of Mg sulfate in acute stroke patients is feasible and safe. Prehospital trial conduct substantially reduces on-scene to needle time and permits hyperacute delivery of neuroprotective therapy.
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Comparative Study
Ultrasound perfusion imaging in acute middle cerebral artery infarction predicts outcome.
Initial reports indicate that transcranial harmonic imaging after ultrasound contrast agent bolus injection (BHI) can detect cerebral perfusion deficits in acute ischemic stroke. We evaluated parametric images of the bolus washout kinetics. ⋯ In the early phase of acute ischemic stroke, BHI after SonoVue bolus injection is a useful ultrasound tool for analyzing cerebral perfusion deficits at the patient's bedside. BHI data correlate with the definite area of infarction and outcome after 4 months.
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Do-not-resuscitate (DNR) orders are commonly used after severe stroke. We hypothesized that there is significant variability in how these orders are applied after intracerebral hemorrhage and that this influences outcome. ⋯ In-hospital mortality after intracerebral hemorrhage is significantly influenced by the rate at which treating hospitals use DNR orders, even after adjusting for case mix. This is not due solely to individual patient DNR status, but rather some other aspect of overall care.
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Comparative Study
Outcome of acute stroke patients without visible occlusion on early arteriography.
The aim of this study was to determine the clinical and radiological outcome of acute stroke patients who had no vessel occlusion on arteriography and to define predictors of clinical outcome. ⋯ Most acute stroke patients with normal early arteriography show infarcts on brain imaging; however, clinical outcome is usually favorable.
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Comparative Study
Neuroprotection by hyperbaric oxygenation after experimental focal cerebral ischemia monitored by MRI.
Hyperbaric oxygenation (HBO) after focal cerebral ischemia reduces infarct size and improves outcome when applied early after stroke. Here, we evaluated effects of HBO on permanent focal cerebral ischemia and applied magnetic resonance imaging (MRI) monitoring to study lesion evolution. ⋯ As monitored by MRI HBO treatment reversed ischemic lesion size between 3 and 5 hours after ischemia and achieved a long-lasting neuroprotective effect without significant oxidative damage.