Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2009
Multicenter StudyStroke in the very elderly: hospital care, case fatality and disposition.
The worldwide growing number of older people represents a new phenomenon. Considering that the prevalence of stroke increases with age and higher life expectancy, the prevalence of stroke will likely rise in the next decade. However, limited information is available about the burden of stroke in individuals over 90. ⋯ In our study, stroke patients over 90 had higher risk-adjusted mortality, longer hospitalization, and were less likely to be discharged to their original place of residence. In view of these findings, strategies need to be implemented to facilitate equal access to specialized stroke care for the elderly.
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Telestroke is the application of telemedicine in stroke care. Hence, teleconsultation means the performance of consultation by a remotely located expert through the use of high-quality videoconferencing. Remote evaluation of stroke patients via telemedicine is increasingly utilized, particularly in neurologically underserved areas. ⋯ However, improved clinical outcomes of stroke patients have only been investigated and shown when telemedicine was combined with the Stroke Unit concept based on specialized stroke wards and organized stroke care. More scientific evaluation is needed in the fields of cost effectiveness, quality management and implementation of further technological innovations. There are still insufficient data about the use of telemedicine in stroke prevention, rehabilitation and post-stroke care.
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Cerebrovascular diseases · Jan 2009
ReviewRelevance of neuroimaging in the evaluation of cerebral ischemia.
The rapid development of neuroimaging techniques has provided us with a wide range of tools for the assessment of patients who may have experienced cerebrovascular events. Each of these technologies provides specific and potentially informative insights. For clinical practice, however, we always have to tailor our diagnostic approach according to a maximum benefit/minimal burden and cost ratio. ⋯ For patients in the postacute phase of acute ischemic stroke, neuroimaging should contribute a maximum of information to the clarification of stroke etiology to allow for specific secondary prevention. Patients with transient ischemic attacks appear to represent yet another distinct group of patients who can benefit greatly from a rapid and comprehensive neuroimaging evaluation, as this allows identification of individuals at a specifically high risk for a subsequent stroke. Using these categories, the relevance of respective neuroimaging tools can be substantiated by a large body of evidence.
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Cerebrovascular diseases · Jan 2009
ReviewGenetic association studies in ischaemic stroke: replication failure and prospects.
Although hundreds of genetic association studies of ischaemic stroke have been published, the failure to replicate associations has led to scepticism about their findings. Possible explanations for this failure are: (1) a false-positive association in the initial study; (2) a false-negative association in a replication study; (3) methodological differences (e.g. study populations or study designs). We review underlying causes for replication failure, such as small sample size, multiple testing and publication bias, and methods to deal with these problems. We also make suggestions about the design of genetic association studies in ischaemic stroke with regard to stroke subtype classification, candidate pathways, subgroups, intermediate phenotypes and potential clinical impact.
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Cerebrovascular diseases · Jan 2009
ReviewHigh blood pressure in acute ischaemic stroke--broadening therapeutic horizons.
High blood pressure (BP) is present in 80% of patients with acute ischaemic stroke and is independently associated with poor outcome. Although this epidemiology suggests that BP should be lowered acutely, concerns about dysfunctional cerebral autoregulation suggest otherwise. Several small randomised trials have assessed cerebral blood flow with various antihypertensive classes and agents in acute ischaemic stroke. ⋯ Two larger trials reported that glucose-potassium-insulin therapy (GIST) or magnesium (IMAGES) lowered BP but had no effect on functional outcome. The INTERACT pilot trial studied patients with intracerebral haemorrhage and found that an intensive BP-lowering regime non-significantly reduced haematoma expansion. There are four large ongoing trials examining whether to continue or stop pre-stroke antihypertensive therapy (COSSACS, ENOS) or lower BP in acute stroke (ENOS, SCAST) or haemorrhage (INTERACT 2).