Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2006
Review Case ReportsThe fetal variant of the circle of Willis and its influence on the cerebral collateral circulation.
In a fetal-type posterior circle of Willis (FTP) there is an embryonic derivation of the posterior cerebral artery (PCA) from the internal carotid artery (ICA). Besides the fact that a larger area is thus dependent on the ICA, leptomeningeal vessels cannot develop between the anterior and posterior circulation. The tentorium namely prevents cerebellar vessels from connecting to the PCA territory. ⋯ An overview of the literature is given. We propose to define a partial FTP, in which a small P1 segment between the basilar artery and the postcommunicating part of the PCA is present, and a full FTP, in which the P1 segment is absent. Whether a full FTP is a risk factor for stroke should be subject of further investigation.
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Cerebrovascular diseases · Jan 2006
Case Reports Randomized Controlled Trial Comparative StudySafety and therapeutical benefit of hemicraniectomy combined with mild hypothermia in comparison with hemicraniectomy alone in patients with malignant ischemic stroke.
Both for hemicraniectomy and for hypothermia, several reports describe a beneficial effect in patients with malignant supratentorial cerebral ischemia. We compared the safety and the clinical outcome in patients with a malignant supratentorial infarction who were treated with hemicraniectomy alone (HA) or received a combination therapy with hemicraniectomy and hypothermia of 35 degrees C (HH), respectively. ⋯ The present study suggests that a combined therapy of mild hypothermia and hemicraniectomy in malignant brain infarction does not imply additional risks by side effects and improves functional outcome as compared with hemicraniectomy alone.
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Cerebrovascular diseases · Jan 2006
Comparative StudyModified Rankin scale with expanded guidance scheme and interview questionnaire: interrater agreement and reproducibility of assessment.
The modified Rankin scale (mRS) is commonly employed as a measure of functional outcome after stroke. The purpose of this study was to investigate the reliability of the mRS using an expanded guidance scheme and a corresponding questionnaire on an unprecedentedly large scale. ⋯ The data obtained suggest that our guidance scheme and questionnaire are useful for ensuring the quality of assessments made with the mRS.
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Cerebrovascular diseases · Jan 2006
Comparative StudyCombined carotid and transcranial ultrasound findings compared with clinical classification and stroke severity in acute ischemic stroke.
The aim of this study was to assess the association between cerebral hemodynamics and the clinical picture as defined by the Oxfordshire Community Stroke Project (OCSP) classification, as well as the clinical severity as defined by the National Institute of Health Stroke Scale (NIHSS) within the first 6 h of an acute middle cerebral artery (MCA) stroke onset. ⋯ Neither the OCSP classification nor the NIHSS grading provided reliable information about the site or presence of intracranial arterial occlusion in acute stroke within the first 6 h after stroke onset in the individual patient. The results of this study strongly suggest that selection of acute ischemic stroke patients for thrombolysis should also include an assessment of cerebral hemodynamics.
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Cerebrovascular diseases · Jan 2006
New modalities and aspects of antiplatelet therapy for stroke prevention.
Antiplatelet therapy is indicated for secondary prevention of ischaemic stroke. The first-line antiplatelet agent is aspirin. ⋯ Strategies against aspirin resistance may include alternative use of other antiplatelet agents, combination of aspirin with other antiplatelet agents and investigation into molecular targets to develop novel antiplatelet agents. Progress in antiplatelet therapy should be directed at further reducing the risk of ischaemic events including ischaemic stroke without increasing the risk of haemorrhagic events including haemorrhagic stroke.