Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2014
Functional status three months after the first ischemic stroke is associated with long-term outcome: data from a community-based cohort.
The impact of public health interventions to reduce disability after stroke may be underestimated if only the modest effects on short-term disability are measured. We estimated the impact of differences in short-term functional outcome on long-term functional outcome. ⋯ In patients with ischemic stroke who survive to 3 months, a three grade simplified mRS summarizes the patient risk profile and stroke characteristics. These data confirm that modest differences in the functional status at 3 months are associated with significant differences in survival and functional status over 7 years follow-up and have implications for health care planning and the health economic assessment of treatments for acute stroke.
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Cerebrovascular diseases · Jan 2014
Observational StudyThrombelastography maximal clot strength could predict one-year functional outcome in patients with ischemic stroke.
Elevated maximal clot strength, measured by thrombelastography (TEG) maximum amplitude (MA) has been associated with a higher risk for ischemic events in patients with coronary artery diseases. However, it has not been investigated in patients with cerebrovascular diseases. In the current study, we aimed to evaluate the predictive ability of TEG-MA in assessing the risk for ischemic event recurrence and the functional outcome after index ischemic stroke. ⋯ We found that higher TEG-MA levels could predict an unfavorable functional outcome after index ischemic stroke. Further, large-scale studies are required to investigate the relationship between MA levels and risk of recurrent ischemic events in ischemic stroke patients.
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Cerebrovascular diseases · Jan 2014
Cerebral microbleeds are not associated with long-term cognitive outcome in patients with transient ischemic attack or minor stroke.
Cerebral microbleeds have been related to cerebrovascular disease and dementia. They occur more frequently in patients with ischemic stroke than in the general population, but their relation to cognition in these patients is uncertain, particularly in the long run. We examined the relationship between microbleeds in patients with a transient ischemic attack (TIA) or minor ischemic stroke, and cognitive performance 4 years later. ⋯ In this sample of patients with a recent TIA or minor ischemic stroke, microbleeds were not associated with cognitive performance 4 years later. Apparently, this association is different from other markers of small vessel disease.
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Cerebrovascular diseases · Jan 2014
Posttreatment variables improve outcome prediction after intra-arterial therapy for acute ischemic stroke.
There are multiple clinical and radiographic factors that influence outcomes after endovascular reperfusion therapy (ERT) in acute ischemic stroke (AIS). We sought to derive and validate an outcome prediction score for AIS patients undergoing ERT based on readily available pretreatment and posttreatment factors. ⋯ Among AIS patients treated with ERT, pretreatment scores such as the THRIVE score provide only fair prognostic information. Inclusion of posttreatment variables such as reperfusion and symptomatic hemorrhage greatly influences outcome and results in improved outcome prediction.
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Cerebrovascular diseases · Jan 2014
Arterial spin labeling perfusion MRI in children and young adults with previous ischemic stroke and unilateral intracranial arteriopathy.
Little is known about cerebral blood flow (CBF) in young patients with ischemic stroke caused by an intracranial arteriopathy. Arterial spin labeling (ASL) perfusion is a noninvasive technique for measuring CBF. We aimed to investigate whether, in young patients with unilateral intracranial arteriopathy and previous ischemic stroke, CBF is compromised in noninfarcted brain areas of the symptomatic hemisphere and whether this is related to the severity of the arteriopathy. ⋯ This study shows that more than half of young patients with previous ischemic stroke in the MCA territory and a unilateral intracranial arteriopathy have hypoperfusion in the noninfarcted cortex of the symptomatic hemisphere when CBF is visually assessed using a CBF map, in particular in patients with a severe arteriopathy. In the same patients, quantification of CBF shows hypoperfusion in the symptomatic hemisphere in only 18%. This discrepancy is caused by labeled blood within the arteries that has not yet reached the tissue at the time of imaging. Visual assessment can show hypoperfusion, while the quantified CBF in a similar region appears higher when the intravascular labeled blood is included in the region of interest. Further research should focus on elucidating whether cerebral perfusion deficits in young stroke patients with intracranial arteriopathy might help to identify patients who are at risk of poor outcome or stroke recurrence.