Cerebrovascular diseases
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Cerebrovascular diseases · Aug 2010
Presence of deep white matter lesions on diffusion-weighted imaging is a negative predictor of early dramatic improvement after intravenous tissue plasminogen activator thrombolysis.
The impact of deep white matter lesions observed at the corona radiata on diffusion-weighted MRI (DWI-W lesions) on the clinical recovery of patients after tissue plasminogen activator (tPA) therapy is unclear. Our goal was to elucidate whether DWI findings before tPA could predict clinical recovery. ⋯ DWI-ASPECTS and DWI-W lesions appear to be useful tools for predicting early dramatic improvement.
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Cerebrovascular diseases · Feb 2010
Symptom progression or fluctuation in transient ischemic attack patients predicts subsequent stroke.
The aim of this study was to investigate whether progression or fluctuation of transient ischemic attack (TIA) symptoms is a predictor of subsequent stroke. ⋯ Progression or fluctuation of TIA symptoms may be an important predictor of subsequent stroke. A detailed interview about the characteristics of each attack is also indispensable for the provision of appropriate care to TIA patients.
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Cerebrovascular diseases · Feb 2010
Randomized Controlled Trial Multicenter Study Comparative StudyEffect of intravenous tirofiban and aspirin in reducing short-term and long-term neurologic deficit in patients with ischemic stroke: a double-blind randomized trial.
Thrombolysis with rt-PA is the only approved pharmacological therapy for acute ischemic stroke presently administrable in a 3-hour window (very recently extended to 4.5 h). After this time, the choice is limited to endovascular treatment and antiplatelet drugs, mainly aspirin (ASA), the efficacy of which in the acute phase of stroke has poorly been evaluated. We compared the efficacy of tirofiban, a GP-IIb/IIIa inhibitor, and ASA, with both drugs being administered within 6 h. ⋯ In spite of the fact that the null hypothesis was not supported by our data, we found results supporting the safety (and potential efficacy) of ASA and tirofiban when used in the first hours of acute ischemic stroke. However, this needs to be confirmed by further studies.
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Cerebrovascular diseases · Feb 2010
Comparative StudyAngiographic pattern of symptomatic severe M1 stenosis: comparison with presenting symptoms, infarct patterns, perfusion status, and outcome after recanalization.
Several angiographic patterns distal to severe M1 stenosis have been identified. We have assessed the relationship between these angiographic patterns and patient presenting symptoms, infarct patterns, perfusion status and outcome after recanalization. ⋯ Patients with severe M1 stenosis had 3 different angiographic patterns, which correlated with presenting symptoms, infarct patterns and perfusion status. Differences in patterns may be related to variation in collateral circulation at the ACA-MCA borderzone and hypoperfusion status.
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Cerebrovascular diseases · Feb 2010
The spot sign in intracerebral hemorrhage: the importance of looking for contrast extravasation.
The 'spot sign' is a bright spot on computerized tomography angiography (CTA) source images predictive of hematoma growth. Contrast extravasation (CE) is seen on routine head CT following CTA as pooling of contrast within the hematoma. Our aim was to re-evaluate the predictive value of both the spot sign and CE and measure the reliability of scoring them. ⋯ In ICH patients, the presence of the spot sign or CE is highly correlated with early ICH growth. In our experience, CE is a more sensitive predictor of ICH growth with a better negative predictive value than the spot sign; CE is more consistently identified even by experienced clinicians. Postcontrast CT should be done routinely after CTA in patients presenting with ICH within 4 h. Patients who are CE-positive may be candidates for hemostatic therapies or early surgical intervention.