Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jan 2014
Decompressive surgery for malignant cerebral venous sinus thrombosis: a retrospective case series from Pakistan and comparative literature review.
Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke in the West; however, it is prevalent in Asia and the Middle East. CVST is treated with dose-adjusted heparin or heparinoid followed by warfarin to facilitate recanalization of venous sinuses. For those with progressive malignant cerebral edema, the role of decompressive surgery has been reported from developed countries. We present data on decompressive craniectomy from a tertiary care stroke center in a developing country and compare our results and population with that described in the international literature. ⋯ Patients who received decompressive hemicraniectomy in Pakistan for CVST had excellent outcomes in all cases when intervention was performed with intact preoperative pupillary reflexes. Of the data reviewed, most reported (two-third) patients show the same prognosticators; however, one third show that even with nonreactive pupils complete recovery is possible.
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J Stroke Cerebrovasc Dis · Jan 2014
Comparative StudyRelative changes in transcranial Doppler velocities are inferior to absolute thresholds in prediction of symptomatic vasospasm after subarachnoid hemorrhage.
The absolute transcranial Doppler (TCD) velocity threshold has been validated as a screening tool for vasospasm after subarchnoid hemorrhage (SAH). We assessed whether relative changes in velocity were superior to absolute TCD thresholds in the detection of symptomatic vasospasm. We reviewed consecutive patients with aneurysmal SAH who underwent serial TCD monitoring and survived at least 7 days. ⋯ The best characteristics were observed for the combination of MFV >175 cm/s and/or maximal LR >6 (AUC 0.81). Our data suggest that absolute thresholds of TCD FVmean provide the most accurate prediction of symptomatic MCA vasospasm after SAH. Other thresholds, including relative change from baseline and day-to-day changes, are inferior to established absolute thresholds.
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J Stroke Cerebrovasc Dis · Jan 2014
Observational StudyTissue plasminogen activator overdose in acute ischemic stroke patients linked to poorer functional outcomes.
The dose of intravenous tissue plasminogen activator (tPA) administered in acute ischemic stroke patients is calculated using the patient's weight (0.9 mg/kg). Patients are rarely weighed before treatment in actual practice, although overestimating patient weights leads to higher doses of tPA, which may adversely influence outcome. ⋯ Our findings provide support for the practice of accurately weighing all acute ischemic stroke patients before thrombolysis.
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J Stroke Cerebrovasc Dis · Jan 2014
Clinical use of computed tomographic perfusion for the diagnosis and prediction of lesion growth in acute ischemic stroke.
Computed tomography perfusion (CTP) mapping in research centers correlates well with diffusion-weighted imaging (DWI) lesions and may accurately differentiate the infarct core from ischemic penumbra. The value of CTP in real-world clinical practice has not been fully established. We investigated the yield of CTP-derived cerebral blood volume (CBV) and mean transient time (MTT) for the detection of cerebral ischemia and ischemic penumbra in a sample of acute ischemic stroke (AIS) patients. ⋯ In real-world use, acute imaging with CTP did not predict stroke or DWI lesions with sufficient accuracy. Our findings argue against the use of CTP for screening AIS patients until real-world implementations match the accuracy reported from specialized research centers.
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J Stroke Cerebrovasc Dis · Jan 2014
Internal cerebral vein asymmetry on follow-up brain computed tomography after intravenous thrombolysis in acute anterior circulation ischemic stroke is associated with poor outcome.
Identifying early predictors of functional outcome after acute ischemic stroke (AIS) is important for planning rehabilitation strategies. Internal cerebral veins (ICV) drain deep parts of brain, run parallel to each other, and consistently seen on computed tomography angiography (CTA). Even minor asymmetry in their filling can be identified. We hypothesized that venous drainage would be impaired in patients with acute occlusion of internal carotid artery or middle cerebral artery. Because systemic thrombolysis can alter the vascular findings, we evaluated the relationship between ICV asymmetry on follow-up CTA and functional outcome. ⋯ ICV asymmetry on follow-up CTA after intravenous thrombolysis is an early predictor of poor functional outcome.