Stroke; a journal of cerebral circulation
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The aim of this retrospective multicenter study was to evaluate the outcome of distal anterior cerebral artery (DACA) aneurysms and to determine the incidence, causes, and consequences of unfavorable outcomes. ⋯ The authors suggest that the proportion of ruptured DACA aneurysms evolving to a GOS 1 or 2 was similar to that of aneurysms found in other locations, after early surgery. Endovascular treatment should be considered in the management of uncommon ruptured fusiform DACA aneurysms.
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Randomized Controlled Trial Clinical Trial
Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group.
We sought to identify variables associated with intracerebral hemorrhage in patients with acute ischemic stroke who receive tissue plasminogen activator (t-PA). ⋯ Despite a higher rate of intracerebral hemorrhage, patients with severe strokes or edema or mass effect on the baseline-CT are reasonable candidates for t-PA, if it is administered within 3 hours of onset.
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Previous studies from this laboratory have shown that mild intraischemic or prolonged (i.e., 12 to 24 hours) postischemic hypothermia conveys long-lasting (1 to 6 months) protection against CA1 injury. However, these studies have used young animals (aged approximately 3 to 5 months). Stroke incidence rises sharply in late middle age at a time when changes in brain chemistry could alter the response to neuroprotective treatments. Therefore, we evaluated the efficacy of hypothermia in an older population (aged 18 to 20 months) of gerbils. ⋯ This study demonstrates that both intraischemic and prolonged postischemic hypothermia provide robust and lasting (30-day survival) histological protection against a severe ischemic insult. The extent of behavioral protection with postischemic hypothermia was less than that previously observed in younger animals. This suggests that neuroprotective treatments in young animals may lose efficacy as a result of aging.
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Four rire prodromique, described as pathological laughter preceding the onset of an apoplectic attack, is a rare phenomenon. ⋯ The clinicoanatomic correlates of this phenomenon are discussed.
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Although recent studies suggest a high prevalence of obstructive sleep apnea (OSA) in patients with acute stroke, a systematic characterization of sleep-disordered breathing based on the severity and topography of stroke has not been performed. ⋯ Sleep-disordered breathing is frequent in patients with acute stroke, rarely has localizing value, and can also be found in patients with mild neurological deficits. Respiratory disturbances in stroke victims can be explained only in part by topography and extension of acute brain damage.