Neurological research
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Cerebral perfusion pressure (CPP)-oriented therapy and the Lund concept lie on opposite ends of the CPP scale, in the management of head injury. Optimization of CPP by monitoring cerebral vascular pressure reactivity is an alternative approach that may reconcile these two divergent approaches, preventing both injurious hypotension and hypertension with an individualized CPP target. ⋯ Pilot studies indicating feasibility of autoregulation-oriented CPP optimization have been performed in adult and paediatric traumatic brain injury, aneurysmal subarachnoid haemorrhage, and in patients undergoing cardiothoracic surgery. It remains to be prospectively demonstrated whether optimal CPP management is able to improve outcome.
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Neurological research · Mar 2013
ReviewClinical course and treatment of vertebrobasilar dolichoectasia: a systematic review of the literature.
Vertebrobasilar dolichoectasia is a rare condition with unsettled clinical course and treatment. We performed a systematic review of the literature on clinical course and treatment of vertebrobasilar dolichoectasia. ⋯ Patients with vertebrobasilar dolichoectasia are at high risk of ischemic stroke, brainstem compression, and death. Hemorrhagic complications are less common. Risk of bias in the included studies was too high to make any recommendation regarding treatment.
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Neurological research · Mar 2013
ReviewRefractory status epilepticus: new insights in presentation, treatment, and outcome.
Refractory status epilepticus (RSE), defined as status epilepticus that fails to respond to the acute administration of two antiepileptic medications, occurs in approximately a third of patients with status epilepticus, and is associated with increased hospital length of stay, mortality, and functional disability. Common presentations include: (1) generalized convulsive status epilepticus or complex partial status epilepticus that continue despite initial therapies; (2) stupor or coma following a generalized convulsive or complex partial seizure; or (3) stupor or coma following brain surgery or acute brain injury. When status epilepticus continues or recurs 24 hours or more after the initiation of anesthetic therapy, or recurs on the reduction or withdrawal of anesthesia, it is termed super RSE. ⋯ Patients with cardiopulmonary complications and prolonged duration of drug-induced coma tend to have worse post-treatment functional outcomes. However, significant improvement over time can occur in survivors, and thus treatment is justified even in patients who require prolonged anesthetic coma. The strongest predictors of outcome are duration of anesthetic coma, etiology, and development of cardiopulmonary complications.
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Neurological research · Mar 2013
Clinical relevance of negative initial angiogram in spontaneous subarachnoid hemorrhage.
We aimed to compare the presentation, management, and clinical course in patients with perimesencephalic and nonperimesencephalic (aneurysmal) bleeding patterns on noncontrast CT, but negative initial 4-vessel digital subtraction angiography (DSA). ⋯ In this series, perimesencephalic SAH was associated with good clinical grades, consistently negative initial and follow-up angiograms, and an excellent prognosis. In contrast, non-perimesencephalic SAH was associated with a worse clinical presentation, higher complication rates, higher rates of true aneurysm detection on follow-up angiogram, and a poorer outcome.
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Neurological research · Jan 2013
Persistence of secondary prevention medications after acute ischemic stroke or transient ischemic attack in Chinese population: data from China National Stroke Registry.
Although proven stroke secondary prevention medications are available, persistent use is required to be effective. The present study aimed to investigate the degree of secondary prevention medications persistence after acute ischemic stroke (AIS) or transient ischemic attack (TIA), factors influencing persistence and its association with stroke outcomes. ⋯ Almost one-third of patients of AIS/TIA had stopped one or more secondary prevention medications by 3-month postdischarge. Further studies on identifying potential barriers and means to improve persistent use of secondary prevention interventions are needed.