Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsMultistage indocyanine green videoangiography for the convexity dural arteriovenous fistula with angiographically occult pial fistula.
Recently, intraoperative indocyanine green (ICG) videoangiography has become a common technique for treating cerebrovascular diseases. We report a case of dural arteriovenous fistula (AVF) treated with direct surgery using intraoperative ICG videoangiography. A 41-year-old man with right hemiplegia caused by a left subcortical hemorrhage was transferred to our hospital. ⋯ Accurate detection of all fistular points and complete resection, including the dura mater and pial vessels, are necessary to avoid rebleeding caused by the residual dural AVF due to incomplete obliteration of the fistular points. Intraoperative ICG videoangiography could provide information on angiographically occult vascular malformation, such as pial fistulas, that cannot be detected by preoperative DSA. Our findings suggest that multistage intraoperative ICG videoangiography can be quite useful for complete resection of a dural AVF with angiographically occult pial fistula.
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J Stroke Cerebrovasc Dis · Nov 2012
Case ReportsRotational vertigo associated with putaminal infarction.
A 57-year-old man was admitted because of left hemiparesis. A magnetic resonance imaging scan of the brain revealed a recent infarct from the dorsal side of the right putamen to the corona radiata. ⋯ Repeat magnetic resonance imaging scans on days 2 and 11 revealed no additional lesions. The present case indicates that rotational vertigo might result from a small, supratentorial, subcortical lesion.
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Our objective is to summarize the evidence that supports the reliability of telemedicine for diagnosis and efficacy in acute stroke treatment, identify strategies for funding the development of a telestroke network, and to present issues with respect to economic sustainability, cost effectiveness, and the status of reimbursement for telestroke.
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Our objectives are to identify and help overcome obstacles to telestroke practice, to present tips for sustaining a telestroke network, to suggest strategies for obtaining buy-in from clinicians and administrative leadership and providers, and to identify and engage champions and stakeholders of telestroke.
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The objectives of this manuscript are to identify key components to maintaining the logistic and/or operational sustainability of a telestroke network, to identify best practices to be considered for assessment and management of acute stroke when planning for and developing a telestroke network, to show practical steps to enable progress toward implementing a telestroke solution for optimizing acute stroke care, to incorporate evidence-based practice guidelines and care pathways into a telestroke network, to emphasize technology variables and options, and to propose metrics to use when determining the performance, outcomes, and quality of a telestroke network.