Neurologic clinics
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The endovascular treatment of cerebral aneurysms has been shown to be a safe and effective treatment alternative to surgical management. Technologic advances in coil design, stents, and liquid embolic agents may revolutionize such treatment. ⋯ Therefore, a multidisciplinary approach with combination therapy should be used. As for understanding the natural history of intracranial atherosclerosis disease, it is to be hoped that the results of recently launched and future randomized clinical trials will clarify the role of intracranial percutaneous transluminal angioplasty and stenting.
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The emergency department (ED) is the entry point into the health care system for many stroke victims. Rapid evaluation, diagnosis and treatment of stroke in the prehospital setting as well as the ED are integral to preventing morbidity and mortality. ⋯ An organized ED approach including implementing stroke care pathways and collaborating with specialized stroke teams in the ED enhance the ability to identify and manage stroke patients effectively. This approach has the potential to improve outcomes on a large scale.
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The pathophysiology of acute ischemic stroke involves occlusion of a cerebral artery; therefore, cerebral reperfusion is the primary goal of acute treatment. This article discusses established and emerging therapies for acute ischemic stroke. In addition to thrombolysis, acute treatment with antiplatelet agents and other medications and neuroprotection are reviewed. The general medical management of acute ischemic stroke patients is also reviewed.