Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · May 2011
Case Reports Comparative StudyEarly recovery and better evacuation rate in neuroendoscopic surgery for spontaneous intracerebral hemorrhage using a multifunctional cannula: preliminary study in comparison with craniotomy.
Neuroendoscopy is a promising therapeutic option for spontaneous intracerebral hemorrhage (ICH). We sought to compare the clinical outcomes between neuroendoscopic surgery and craniotomy for spontaneous ICH. We retrospectively analyzed the clinical and radiographic data of 43 patients treated with 23 neuroendoscopic procedures (endoscopy group) and 20 microsurgical procedures (craniotomy group). ⋯ The mean change in GCS score was +4.8 for the endoscopy group and -0.1 for the craniotomy group (P < .001). Our data indicate that in patients with ICH, endoscopic surgery is safe and feasible, and may promote earlier recovery. Our results warrant a future prospective, randomized, controlled efficacy trial.
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J Stroke Cerebrovasc Dis · May 2011
Poststroke discharge destination: functional independence and sociodemographic factors in urban Japan.
To assess how functional independence and sociodemographic factors influence discharge destination of patients recovering from stroke in urban Japan. Patients recovering from first-ever stroke (supratentorial lesions) discharged from a long-term rehabilitation hospital. Scores for individual patients were collected at both admission and discharge for the motor components of the Functional Independence Measure (FIM-m), and FIM-m increase was ascertained; patients were also surveyed to gather data for explanatory variables: age, sex, type of stroke, length of hospital stay, number of people in the household, co-residence with a spouse, and number of sons/daughters. ⋯ Meanwhile, improvement in FIM-m score was not statistically significantly related to discharge destination. Our findings indicate that level of functional independence and number of co-resident household members are powerful predictors of discharge destination. For patients with a lower level of functional independence, the presence of a social network to provide support and care is a decisive factor in discharge to home.
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J Stroke Cerebrovasc Dis · May 2011
In-hospital mortality in acute ischemic stroke treated with hemicraniectomy in US hospitals.
Hemicraniectomy is a surgical procedure performed to prevent cerebral herniation and death in patients who have sustained a massive ischemic stroke in the anterior circulation territory. Information on in-hospital mortality in patients with large ischemic stroke treated with hemicraniectomy outside randomized trials is lacking. We sought to identify in-hospital mortality associated with hemicraniectomy in a large US sample. ⋯ The rate of hospital utilization of hemicraniectomy varied between 0.04% and 0.06% among all stroke admissions; the trend did not change significantly over the 7-year study period (P = .06). The mortality rate in hemicraniectomy-treated patients was significantly lower than in historical cohorts however, hemicraniectomy remains associated with high in-hospital mortality. The rate of utilization of hemicraniectomy for AIS in US hospitals has remained essentially unchanged.
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J Stroke Cerebrovasc Dis · May 2011
Case ReportsHyperperfusion syndrome after neck clipping of a ruptured aneurysm on a dolichoectatic middle cerebral artery.
A 40-year-old female presented with sudden onset of severe headache and vomiting due to subarachnoid hemorrhage. Angiography demonstrated a saccular aneurysm on a dolichoectatic left middle cerebral artery (MCA) and delayed filling of the MCA. Magnetic resonance imaging showed a partially thrombosed giant aneurysm on the dolichoectatic MCA. ⋯ The saccular aneurysm was formed on the dolichoectatic MCA, presumably due to an abnormal arterial wall and hemodynamic stress. The preoperative hypoperfusion might have been caused not only by the giant aneurysm, but also to some degree by the dolichoectatic MCA. After neck clipping, the increase in blood flow might have caused hyperperfusion.
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J Stroke Cerebrovasc Dis · May 2011
Case ReportsRecanalization of middle cerebral artery and intracranial aneurysm in the same ischemic territory with intravenous administration of recombinant tissue plasminogen activator: case report.
We report a case of middle cerebral artery (MCA) embolism accompanied by unruptured intracranial aneurysm in the same ischemic MCA territory, successfully treated with intravenous administration of recombinant tissue plasminogen activator (rt-PA). A 66-year-old right-handed man presented with abruptly decreased consciousness and right motor paralysis. He had a National Institute of Health Stroke Scale (NIHSS) score of 26 points on admission. ⋯ The patient's NIHSS and modified Rankin Scale scores were each 1 at 3 months after onset. Recanalization of both the occluded MCA and the occluded intracranial aneurysm in the same ischemic territory was neuroradiologically confirmed. This case illustrates that the efficacy, safety, and risk of hemorrhage during intravenous thrombolysis for acute ischemic stroke patients with unruptured intracranial aneurysm merit further examination.