Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · May 2008
Comparative StudyComparison of combined venous and arterial thrombolysis with primary arterial therapy using recombinant tissue plasminogen activator in acute ischemic stroke.
We sought to compare the safety and efficacy of combined intravenous (IV) and intra-arterial (IA) thrombolysis with primary IA therapy using tissue plasminogen activator for acute ischemic stroke presenting within 6 hours of symptom onset. ⋯ This study demonstrates that both combined IV/IA and primary IA recombinant tissue plasminogen activator therapy is feasible and safe in the treatment of acute ischemic stroke. Combined IV/IA therapy may be associated with an improvement in clinical outcome without a significant increase in the risk of symptomatic intracerebral hemorrhage and mortality compared with IA therapy.
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J Stroke Cerebrovasc Dis · May 2008
The effect of physiologic derangement in patients with stroke treated with thrombolysis.
Body temperature, blood glucose, and blood pressure (BP) may interfere with outcome in patients with acute ischemic stroke treated with thrombolysis. ⋯ The current study indicates that in patients with ischemic stroke, high body temperature and high blood glucose after thrombolysis are associated with poor prognosis. Frequent monitoring of these parameters and the appropriate treatment of it, if elevated, are important during the first few days after thrombolysis. High systolic BP both before and after thrombolysis was associated with poor outcome. This finding may support the practice of reducing systolic BP below 185 mm Hg both before and after thrombolysis.
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J Stroke Cerebrovasc Dis · May 2008
Randomized Controlled Trial Multicenter StudyLiving well with stroke: design and methods for a randomized controlled trial of a psychosocial behavioral intervention for poststroke depression.
Depression is a sufficiently common sequela of a completed stroke to warrant intervention to improve mood, social, and functional outcome. Pharmacologic trials suggest short-term mood improvement from antidepressant treatment but no studies to date have determined whether these short-term gains can be enhanced and extended by a brief psychosocial/behavioral intervention delivered by advanced practice nurses. In addition, drug trials have not reported on functional outcomes such as limitations in ability, limitations in participation, and overall quality of survival. This randomized controlled trial was designed to evaluate the short- and long-term efficacy of a new brief psychosocial/behavioral intervention adjunctive to antidepressant treatment in reducing poststroke depression and improving functional outcomes. ⋯ This article provides detail on the design and treatment methods of this randomized trial in progress. Findings from this study provide important information regarding the long-term efficacy of such a behavioral intervention in reducing poststroke depression and subsequent impaired aspects of psychosocial and physical recovery.
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J Stroke Cerebrovasc Dis · May 2008
Case ReportsThrombosis, growth, recanalization, and rupture of a saccular, non-giant cerebral aneurysm.
A partly thrombosed, saccular, non-giant left internal carotid artery aneurysm was discovered during an evaluation for headaches in a 75-year-old woman. A mirror-image aneurysm of the right internal carotid artery was also found. During the course of about a year, the left-sided aneurysm thrombosed, grew to giant proportions, recanalized, and ruptured. ⋯ Even a saccular, non-giant, thrombosed aneurysm can be potentially dangerous. Such an aneurysm requires careful monitoring. If clinically appropriate, aneurysm treatment is indicated.