Seminars in neurology
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Seminars in neurology · Nov 2010
ReviewTelestrokologists: treating stroke patients here, there, and everywhere with telemedicine.
Telemedicine is the use of electronic communication methods, such as the telephone, the Internet, and videoconferencing, to exchange medical information from one geographic site to another. Telestroke is the use of telemedicine specifically for stroke care. ⋯ A telestrokologist is a strokologist who is proficient with telemedicine tools and techniques necessary for remote stroke practice. In this article, the author discusses how enabling telemedicine technologies facilitate novel healthcare delivery modes for telestrokologists and the stroke patients they treat, here, there, and everywhere.
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Intracranial aneurysms (IAs) are acquired lesions, with a genetic predisposition in selected patients. They are very common in the population, occurring in ~2% of people in the United States. Intracranial aneurysms may present with subarachnoid hemorrhage, the most feared complication of IA, but most commonly they are detected on brain imaging performed for reasons unrelated to the IA. ⋯ This decision is complex and is dependent on numerous factors, including the natural history of the unruptured intracranial aneurysm, in comparison to the risk of unruptured intracranial aneurysm treatment. For those not treated with interventional treatment, repeat imaging at some intermittency may be recommended. In this article, the data regarding the natural history of unruptured intracranial aneurysm and the procedure-associated morbidity and mortality are reviewed, as well as the predictors of hemorrhage, and the likelihood of unruptured intracranial aneurysm growth should conservative management with intermittent repeat imaging be recommended.
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Seminars in neurology · Nov 2010
ReviewAcute stroke management: endovascular options for treatment.
The management of acute ischemic stroke has advanced greatly over the past 2 decades. New interventions, including intravenous and endovascular treatment strategies, have evolved to recanalize arteries and salvage the ischemic brain. ⋯ The major techniques that have defined the current field of interventional acute stroke management and the relevant past and current data, and ongoing clinical trials on interventional stroke therapy will be reviewed. New issues, such as futile recanalization, and time to microcatheter, will also be discussed.
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Seminars in neurology · Nov 2010
ReviewAneurysmal subarachnoid hemorrhage: an overview for the practicing neurologist.
Subarachnoid hemorrhage (SAH) accounts for ~5% of strokes, but causes high rates of morbidity and mortality and occurs at a relatively young age. The rupture of an intracranial aneurysm is the leading cause of nontraumatic SAH and will be the subject of this review. Rebleeding remains the most imminent danger until the aneurysm is secured (i.e., excluded from the cerebral circulation). ⋯ Hemodynamic augmentation therapy remains the mainstay of medical treatment, but various agents are being tested as means to prevent or ameliorate vasospasm, including magnesium sulfate, statins, and an endothelin antagonist. Medically refractory vasospasm demands angioplasty of the affected vessel or intraarterial infusion of vasodilators. In this review, the authors provide an overview of the diagnosis and management of aneurysmal SAH with an emphasis on these main topics.
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The initial management of a patient with suspected stroke necessitates a rapid and focused evaluation. Establishing the time of symptom onset, performing a focused neurologic examination, and interpreting ancillary tests facilitates delivery of acute stroke therapies to eligible patients. ⋯ Results from randomized clinical trials of intravenous thrombolysis, glucose management, and blood pressure management in acute ischemic stroke patients will be highlighted. External ultrasound as an adjunct to intravenous thrombolysis and treatment of those patients that wake up with stroke symptoms will also be discussed.