Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2009
Normal magnetic resonance perfusion-weighted imaging in lacunar infarcts predicts a low risk of early deterioration.
Current clinical tools to identify lacunar infarct patients at risk of deterioration are inadequate, and imaging techniques to predict fluctuation and deterioration would be of value. We sought to determine the occurrence of MRI perfusion-weighted imaging (PWI) abnormalities in lacunes, and whether they help predict clinical and radiological outcome. ⋯ MR-PWI abnormalities are seen in two thirds of lacunar infarcts, and are associated with stroke rather than TIA. Normal PWI identifies patients at low risk of early clinical deterioration.
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Cerebrovascular diseases · Jan 2009
Comparative StudyContrast transcranial Doppler can diagnose large patent foramen ovale.
Contrast transesophageal echocardiography (c-TEE) and contrast transcranial Doppler (c-TCD) are useful diagnostic tools for detecting right-to-left shunts (RLS). However, the diagnostic accuracy of c-TCD for patent foramen ovale (PFO) remains uncertain. We investigated the relationship between the size of PFO determined by c-TEE and c-TCD findings and assessed the detectable rate of RLS by c-TCD. ⋯ When two or more MES were determined by c-TCD, large PFO could be accurately diagnosed.
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Cerebrovascular diseases · Jan 2009
Characterisation of the diagnostic window of serum glial fibrillary acidic protein for the differentiation of intracerebral haemorrhage and ischaemic stroke.
The rapid differentiation between intracerebral haemorrhage (ICH) and ischaemic stroke (IS) using biomarker testing would allow the prehospital, cause-specific management of stroke patients. Based on single measurements made during the acute phase of stroke, the value of serum glial fibrillary acidic protein (GFAP) was reported to be higher in ICH patients than in IS patients. The aim of the present study was to characterise the diagnostic window of serum GFAP for differentiating between ICH and IS. ⋯ The time window between 2 and 6 h after stroke onset is best for using GFAP to differentiate between ICH and IS. In the very early phase (i.e. <2 h), sensitivity for detecting ICH is low, thus hampering the application of GFAP as a near-patient test in the prehospital phase.
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Cerebrovascular diseases · Jan 2009
Five-year survival after first-ever ischaemic stroke is worse in total anterior circulation infarcts: the SINPAC cohort.
Few studies have addressed predictors of long-term mortality after first-ever ischaemic stroke. ⋯ Our study extends the prognostic value of the OCSP classification to 5-year survival.
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Cerebrovascular diseases · Jan 2009
Randomized Controlled Trial Multicenter StudyFrequency of sustained intracranial pressure elevation during treatment of severe intraventricular hemorrhage.
Elevated intracranial pressure (ICP) is an important marker of neurological deterioration. The occurrence and significance of elevated ICP and low cerebral perfusion pressure (CPP) in aggressively treated spontaneous intraventricular hemorrhage (IVH) are not defined. ⋯ In the intensive care unit, initial ICP measured with an EVD was uncommonly elevated (1/11 patients) in this group of severe IVH patients despite acute obstructive hydrocephalus. Frequent monitoring reveals ICP elevation >20 mm Hg in 14% of observations during use of EVD. ICP elevation, though it can occur, is not routinely associated with EVD closure for thrombolytic treatment with UK.