Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Sep 2016
Case ReportsSuperselective Provocative Test with Propofol Using Motor-Evoked Potential Monitoring for Managing Cerebral Arteriovenous Malformations Fed by the Anterior Choroidal Artery.
When feeder artery obliteration is performed via an endovascular procedure to treat cerebral arteriovenous malformation (AVM), it is important to prevent the ischemic complications that are associated with feeder occlusion. A provocative test may be beneficial in some cases to protect against ischemic complications. ⋯ The patient underwent a superselective provocative test with a 3 mg of propofol under general anesthesia using motor-evoked potential monitoring. The feeder embolization was performed as planned after the provocative test, and the patient exhibited no neurological deficits, such as hemiparesis, during the procedure.
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J Stroke Cerebrovasc Dis · Sep 2016
Prophylactic Use of Antiepileptic Drugs in Patients with Spontaneous Intracerebral Hemorrhage.
The effect of prophylactic antiepileptic drugs (AEDs) on mortality and functional outcome in patients with intracerebral hemorrhage (ICH) is uncertain. ⋯ Patients with higher ICH scores and larger hemorrhages are more likely to receive prophylactic AEDs. We found no independent effect of prophylactic AED treatment on outcome after ICH.
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J Stroke Cerebrovasc Dis · Sep 2016
Case ReportsCerebral Venous Thrombosis Associated with Intracranial Hemorrhage and Timing of Anticoagulation after Hemicraniectomy.
Cerebral venous thrombosis (CVT) is a rare cerebrovascular event that can present with headache, seizure, and focal neurological deficits. Approximately 30%-40% of patients with CVT also present with intracranial hemorrhage. Current guidelines recommend anticoagulation after CVT even in the setting of intracranial hemorrhage, but the timing of initiation is unclear. We present a case of CVT where timing of anticoagulation was unclear by current guidelines. ⋯ This case illustrates the challenge of determining when to resume anticoagulation for CVT.
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J Stroke Cerebrovasc Dis · Sep 2016
Early Initiation of Anticoagulation with Direct Oral Anticoagulants in Patients after Transient Ischemic Attack or Ischemic Stroke.
Direct oral anticoagulants (DOACs) are increasingly used for secondary prevention of cardioembolic stroke. While DOACs are associated with a long-term reduced risk of intracranial hemorrhage compared to vitamin K antagonists, pivotal trials avoided the very early period after stroke and few data exist on early initiation of DOAC therapy post stroke. ⋯ No severe safety issues were observed in early initiation of DOACs for secondary prevention after acute stroke in our in-patient cohort.
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J Stroke Cerebrovasc Dis · Sep 2016
Prescribing Aerobic Exercise Intensity without a Cardiopulmonary Exercise Test Post Stroke: Utility of the Six-Minute Walk Test.
The cardiopulmonary exercise test (CPET) is an established method for determining target exercise training intensity (ventilatory threshold [VAT]) and cardiovascular risk; unfortunately, CPET is not readily accessible to people post stroke. The objective of this study was to determine the utility of the 6-minute walk test (6MWT) as a less resource-intensive alternative to CPET for prescribing exercise intensity to people post stroke with motor impairments. ⋯ The 6MWT-hr was not interchangeable with the target training VAT-hr determined by CPET. However, in combination with CPET, the 6MWT will indicate when deficits preclude walking alone as the primary exercise modality for optimizing cardiovascular fitness. Future studies to develop a less resource-intensive, multimodal alternative to the CPET for prescribing exercise are needed. A modality that minimizes the effect of stroke deficits, specifically poor balance, should be included.