Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2009
ReviewOld and new anticoagulant agents for the prevention and treatment of patients with ischemic stroke.
Vitamin K antagonists are the only oral anticoagulants available and are considered as well-established treatment to prevent a first stroke or a recurrent stroke in patients with atrial fibrillation. The difficulties in the routine management of these patients cause an underuse of vitamin K antagonists. For long-term use, there is a need for safer and more effective oral anticoagulants that do not require routine monitoring of coagulation. ⋯ Direct thrombin inhibitors include ximelagatran and dabigatran etexilate. Although ximelagatran was withdrawn early because of liver toxicity, it provided convincing evidence that new oral anticoagulants have the potential to replace warfarin. However, even if these new drugs prove superior to dose-adjusted warfarin, their benefits must be substantial (retaining high efficacy with added safety and convenience) to offset their increased cost.
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Cerebrovascular diseases · Jan 2009
ReviewTelestroke networking offers multiple benefits beyond thrombolysis.
Patients with acute ischemic stroke (AIS) require immediate attention and stroke expertise, which is rarely offered by community hospitals. Telestroke networks were originally established for delivering thrombolysis to inhabitants of underserved regions where stroke expertise was not available 24/7. Rapidly expanding experience addresses the fact that thrombolysis, when given using telestroke consultation, is as safe and effective as when it is given in a stroke center. ⋯ Further benefits may be: to facilitate staff recruitment to spoke hospitals, to deliver expertise to developing countries, participation of spoke hospitals to acute stroke treatment trials and stroke prevention trials, and environmental effects. The magnitude of these benefits will become more obvious in the near future because this exciting field is progressing fast. The Finnish experience suggests that telestroke is a versatile tool for improving acute stroke care of inhabitants in underserved regions and it should be made more widely available.
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Cerebrovascular diseases · Jan 2009
ReviewDiagnosis of intracerebral hemorrhage with transcranial ultrasound.
In acute stroke, different sonographic methods can be used to assess structural and hemodynamic compromise. Structural abnormalities of brain parenchyma such as primary intracerebral hemorrhage (ICH) and epiphenomena such as midline shift can be detected by native transcranial B-mode ultrasound. ⋯ According to recent data, ultrasound perfusion imaging provides additional information for the diagnosis of ICH and may differentiate ischemic from hemorrhagic stroke. This review summarizes the impact of these different transcranial ultrasound methods on diagnosis and monitoring of ICH.
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Cerebrovascular diseases · Jan 2009
ReviewPoststroke emotional and behavior impairment: a narrative review.
Emotional and behavioral disturbances are a frequent complication in stroke survivors. They are underdiagnosed, have a high impact on quality of life and are often a precipitant of institutionalization. ⋯ In this article, we update some of the most common or relevant poststroke emotional and behavioral disturbances, including poststroke mania and poststroke depression, poststroke anxiety disorders, posttraumatic stress disorder, personality changes with focus on apathy and disturbances of emotional expression control. Significant advances in the management of poststroke emotional and behavioral disturbances will need the use of comparable instruments and methods and multicenter collaboration.
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Cerebrovascular diseases · Jan 2009
ReviewQuality of life after stroke: the importance of a good recovery.
Health-related quality of life (HRQoL) is a recognized and important outcome after stroke. An increased survival and the presence of moderate impairment in long-term stroke survivors impact their HRQoL. ⋯ Physical and psychosocial well-being is greatly affected in stroke survivors and their caregivers.