Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
-
J Stroke Cerebrovasc Dis · Nov 2013
Multicenter StudyThe impact of intracranial carotid artery calcification on the development of thrombolysis-induced intracerebral hemorrhage.
We aimed to assess whether intracranial carotid artery calcification (ICAC) evident on head computed tomography is a risk factor for symptomatic intracerebral hemorrhage (sICH) following tissue plasminogen activator (tPA) treatment for acute stroke. ⋯ A significantly higher percentage of patients with moderate to severe ICAC developed ICH following tPA administration for stroke. ICAC severity is an independent risk factor for ICH events. ICAC severity can help predict short-term and long-term functional dependency in tPA-treated patients, although this can be confounded by other cardiovascular risk factors and stroke severity.
-
J Stroke Cerebrovasc Dis · Nov 2013
A proposal for the classification of etiologies of neurologic deterioration after acute ischemic stroke.
Neurologic deterioration (ND) occurs in one third of patients with ischemic stroke and contributes to morbidity and mortality in these patients. Etiologies of ND and clinical outcome according to ND etiology are incompletely understood. ⋯ In the present study, the authors identified probable etiologies of ND after ischemic stroke. Delineating the cause of ND could play an important role in the management of the patient and help set expectations for prognosis after ND has occurred. Prospective studies are needed to validate these proposed definitions of ND.
-
J Stroke Cerebrovasc Dis · Nov 2013
Comparative StudyDecompressive hemicraniectomy for malignant hemispheric stroke in the elderly: comparison of outcomes between individuals 61-70 and >70 years of age.
Malignant hemispheric infarction is a life-threatening condition with a high mortality rate. Decompressive hemicraniectomy (DHC) is frequently a life-saving procedure that has shown the highest grade of evidence for patients 18 to 60 years of age. However, the efficacy of DHC in patients>60 years of age has rarely been investigated. ⋯ We suggest that the efficacy of DHC in malignant hemispheric stroke patients between 61 and 70 years of age be further investigated in future randomized trials. By contrast, it appears unlikely that patients>70 years of age would benefit from DHC.
-
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.
-
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.