Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2008
Multicenter Study Comparative StudyGeographic differences in acute stroke care in Catalunya: impact of a regional interhospital network.
Limited resources prevent specialized care in community hospitals (CH) challenging geographical equity. We studied the impact of a regional interhospital network based on urgent transfer from 4 CH to a referral stroke center (RSC). ⋯ An interhospital network based on transfers to an RSC does not warrant geographical equity: equal access to best therapeutic interventions is only partially achieved at the expense of a high proportion of unnecessary transfers.
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Cerebrovascular diseases · Jan 2008
Review Case ReportsCerebral vasculitis and stroke in Lyme neuroborreliosis. Two case reports and review of current knowledge.
We report on 2 patients with cerebral vasculitis and stroke due to Lyme neuroborreliosis (LNB). Both patients had a prodromal stage involving headaches, and showed meningeal enhancement in addition to ischemic infarctions on brain magnetic resonance imaging and diffuse vasculitis on vascular imaging. ⋯ Stroke physicians should be aware of this rare presentation of LNB. A review of the current knowledge on cerebral vasculitis due to LNB is provided.
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Cerebrovascular diseases · Jan 2008
Multicenter Study Clinical TrialIntravenous thrombolysis with rt-PA in acute ischemic stroke patients aged older than 80 years in Italy.
Intravenous (i.v.) thrombolysis with rt-PA within 3 h from symptom onset is the only approved treatment of pharmacological revascularization in acute ischemic stroke. However, little information exists on its use in elderly patients, in particular those aged >80 years, who at present are excluded from treatment. ⋯ Acute ischemic stroke patients aged >80 years treated with i.v. rt-PA have a higher mortality than younger patients, but there are no differences for SICH nor for favorable outcome. Our data suggest that thrombolytic therapy should not be a priori denied for appropriately selected >80-year-old patients but randomized controlled clinical trials are necessary before definite recommendations can be given.
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Cerebrovascular diseases · Jan 2008
Review Historical ArticleIs counterpulsation a potential therapy for ischemic stroke?
Despite the rapid progress in stroke prevention, effective acute stroke treatment except for thrombolysis is still lacking. Hypoperfusion is related to unfavorable functional outcome, further strokes and long-term mortality. Therefore, the need for a safe and effective way of increasing the cerebral blood flow seems obvious. Currently, there is a growing body of evidence to suggest that external counterpulsation (ECP) may enhance the blood supply to the brain and thus may be beneficial to patients with ischemic stroke. ⋯ Randomized-controlled trials with a large sample size are needed to further define the efficacy and safety of ECP in acute stroke management. Future studies should provide insight into the value of ECP in ischemic stroke as well as its possible mechanisms.
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Cerebrovascular diseases · Jan 2008
Comparative StudyMajor vascular events after transient ischaemic attack and minor ischaemic stroke: post hoc modelling of incidence dynamics.
Only few follow-up studies have compared the long-term risk of such major vascular events (MVE) as myocardial infarction (MI) and/or stroke following transient ischaemic attack (TIA) or minor ischaemic stroke (MIS). Estimates of relative risk and cumulative long-term occurrence of MVE may provide better information and contribute to the optimization of treatment decisions. ⋯ The age- and sex-adjusted cumulative 36-month hazard of MVE is higher after MIS than after TIA, but MVE fatality was higher after TIA than after MIS. Although stroke incidence was higher (up to 3 times that of MI), with the highest difference between months 8 and 18, MI fatality was always higher in absolute, relative or adjusted terms. The above alarming patterns and increasing, diverging tendencies for MVE indicate a higher long-term cumulative risk after MIS compared with TIA. These results confirm our hypothesis of a differential risk of TIA versus MIS and, at least, point toward equal importance of therapies aimed at preventing MVE in both types of preceding conditions (TIA or MIS) and the increased fatality after MI, in particular in patients with TIA.