Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2013
Antihypertensives are administered selectively in emergency department patients with subarachnoid hemorrhage.
Elevated blood pressure is common in patients with acute subarachnoid hemorrhage (SAH). American Heart Association guidelines do not specify a blood pressure target, but limited data suggest that systolic blood pressure (SBP)≥160 mmHg is associated with increased risk of rebleeding and neurologic decline. In a population-based study, we determined the frequency of antihypertensive therapy in emergency department (ED) patients with SAH and the proportion of those patients with SBP≥160 mmHg who received this therapy. ⋯ Age, sex, Glascow Coma Scale score, and National Institutes of Health Stroke Scale score were similar between treated and untreated patients. In the absence of definitive evidence, current blood pressure management in local EDs appears reasonable. Further studies of blood pressure management in acute SAH are warranted.
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J Stroke Cerebrovasc Dis · Nov 2013
Case ReportsUnexpected arterial recanalization after decompressive hemicraniectomy.
We report a 43-year-old patient with malignant embolic ischemic stroke in the right middle cerebral artery (MCA), treated by decompressive hemicraniectomy. Cerebrovascular ultrasound detected a subtotally occluding thrombus in the right internal carotid artery and a partial occlusion of the ipsilateral MCA. After the surgery, complete recanalization of the affected vessels was observed.
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J Stroke Cerebrovasc Dis · Nov 2013
123I-IMP-SPECT in a patient with cerebral proliferative angiopathy: a case report.
Cerebral proliferative angiopathy (CPA) is a new clinical entity demonstrating a diffuse network of densely enhanced vascular abnormalities with intermingled normal brain parenchyma and is distinguishable from classical arteriovenous malformations by specific clinical and imaging markers. However, the pathophysiological nature of this disease is unclear, and there is no consensus on the treatment. We describe cerebral perfusion abnormalities in a patient with CPA by using N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography (123I-IMP-SPECT) and perfusion-weighted magnetic resonance imaging. ⋯ In addition, acetazolamide-stressed 123I-IMP-SPECT exhibited severely impaired cerebrovascular reactivity over the affected hemisphere, suggesting that his focal neurological deficits were related to the cerebral ischemia. The perfusion abnormalities on 123I-IMP-SPECT in a CPA patient have never been previously reported. The concept of vascular malformation-related hypoperfusion is discussed.
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J Stroke Cerebrovasc Dis · Nov 2013
Does small aneurysm size predict intraoperative rupture during coiling in ruptured and unruptured aneurysms?
Aneurysm size is a possible risk factor for intraoperative rupture (IOR) during coiling procedures. We aim to determine if aneurysm size 4 mm or smaller predicts IOR. ⋯ Aneurysm size 4 mm or smaller is a risk factor for IOR in ruptured but not unruptured aneurysms. This additional risk factor should be considered when planning the management of small, ruptured aneurysms.