Stroke; a journal of cerebral circulation
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Transcranial Doppler ultrasonography (TCD) provides useful information on cerebral circulation even under raised intracranial pressure. This study was designed to evaluate the correlation between cerebral blood flow (CBF) and TCD parameters under conditions of boundary intracranial hypertension that can cause brain death. ⋯ The critical level of brain circulation can be detected by Doppler sonography, indicating that TCD is available as a tool for the assessment of cerebral circulatory arrest in brain death.
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Near-infrared spectroscopy (NIRS) derives information about the concentrations of oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb) from measurements of light attenuation caused by these chromosphores. The aim of this study was to assess NIRS as a tool for testing CO2 reactivity in patients with carotid artery disease. ⋯ NIRS shows potential as an alternative technique for testing CO2 reactivity in patients with carotid disease provided that conditions are carefully controlled. Marked changes in arterial blood pressure may render the NIRS reactivity indices unreliable, and the contribution from extracranial tissue must be taken into account when significant.
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Multicenter Study Comparative Study
Ambulatory blood pressure monitoring in acute stroke. The West Birmingham Stroke Project.
Ambulatory blood pressure monitoring (ABPM) devices are increasingly used in the assessment of hypertension, but their value in patients after a stroke is unknown, despite the fact that hypertension is an important cause of stroke and many patients have relatively high blood pressure (BP) levels at presentation. We therefore investigated the clinical use of a 24-hour oscillometric ABPM device in patients after acute stroke. We also investigated ABPM in different types of stroke (thrombosis, hemorrhage, and transient ischemic attack) and ethnic and sex differences. ⋯ This study demonstrates higher systolic BPs as recorded by ABPM (but not manually) in patients with intracerebral hemorrhage than in those with cerebral infarcts; higher levels were also found in blacks. ABPM recordings are useful in the assessment of BP in patients with stroke, who may be considered nondippers.
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Comparative Study
Outcome of aneurysmal subarachnoid hemorrhage in patients on anticoagulant treatment.
Intracranial hemorrhage is an important complication of treatment with anticoagulants. We studied outcome of aneurysmal subarachnoid hemorrhage (SAH) occurring in patients on anticoagulant drugs because this may influence management of patients needing anticoagulant treatment but with increased risk of aneurysmal hemorrhage. ⋯ The outcome of aneurysmal SAH in patients or anticoagulant drugs is extremely poor. The explanation for the worse prognosis in patients on anticoagulants lies in a worse clinical condition from the outset. The poor outcome urges a reconsideration of the balance of risks for anticoagulant treatment in patients with an unoperated intracranial aneurysm or with a family history of SAH and may lead to withholding treatment with anticoagulant drugs or to a preventive operation.
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Hemorrhagic ventricular dilatation (HVD) is a prominent feature of human intraventricular hemorrhage (IVH) and a strong indicator for poor outcome. We developed an IVH model to define the mechanisms responsible for HVD and to test the efficacy of intraventricular administration of tissue plasminogen activator (TPA) in the treatment of HVD. ⋯ These results suggest that intraventricular bleeding may cause impairment of cerebrospinal fluid circulation but that the mass effect of clots distending the ventricle walls is the most important mechanism responsible for HVD. This model closely imitates several prominent features of human IVH and may therefore be a useful tool for preclinical assessment of the efficacy and safety of treatment with TPA.