Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Jul 2008
Effect of delayed mild brain hypothermia on edema formation after intracerebral hemorrhage in rats.
Secondary consequences of intracerebral hemorrhage (ICH) including inflammation, edema, and oxidative damage all contribute to cell death after ICH. Brain hypothermia (BH) has been used as an effective neuroprotective treatment in experimental brain ischemia and traumatic brain injury. In this study, we first attempted to evaluate the effect of delayed mild BH (35 degrees C) on brain edema formation 48 hours after ICH. ⋯ Furthermore, HT6 treatment (n = 5) significantly improved neurologic recovery assessed with forelimb placing score compared with NT treatment (42.0 +/- 5.8 v 12.0 +/- 3.7, P < .05). In conclusion, mild BH significantly reduces the brain edema formation after ICH, even when the BH is applied 24 hours after hematoma induction in rats. Several neuroprotective mechanisms, including reduced BBB disruption, inflammation and oxidative damage, are suggested in this study.
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J Stroke Cerebrovasc Dis · Jul 2008
Case ReportsConcurrent presentation of perimesencephalic subarachnoid hemorrhage and ischemic stroke.
Perimesencephalic subarachnoid hemorrhage (SAH) is a relatively benign form of SAH. The etiology of this condition is unknown but venous leakage has been believed to be the most likely cause. This report describes a patient with perimesencephalic SAH who presented with a concurrent acute pontine infarct demonstrated on diffusion-weighted magnetic resonance imaging. These findings suggest that in some instances perimesencephalic SAH is caused by rupture of a perforating artery.
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J Stroke Cerebrovasc Dis · May 2008
Comparative StudyComparison of combined venous and arterial thrombolysis with primary arterial therapy using recombinant tissue plasminogen activator in acute ischemic stroke.
We sought to compare the safety and efficacy of combined intravenous (IV) and intra-arterial (IA) thrombolysis with primary IA therapy using tissue plasminogen activator for acute ischemic stroke presenting within 6 hours of symptom onset. ⋯ This study demonstrates that both combined IV/IA and primary IA recombinant tissue plasminogen activator therapy is feasible and safe in the treatment of acute ischemic stroke. Combined IV/IA therapy may be associated with an improvement in clinical outcome without a significant increase in the risk of symptomatic intracerebral hemorrhage and mortality compared with IA therapy.
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J Stroke Cerebrovasc Dis · May 2008
The effect of physiologic derangement in patients with stroke treated with thrombolysis.
Body temperature, blood glucose, and blood pressure (BP) may interfere with outcome in patients with acute ischemic stroke treated with thrombolysis. ⋯ The current study indicates that in patients with ischemic stroke, high body temperature and high blood glucose after thrombolysis are associated with poor prognosis. Frequent monitoring of these parameters and the appropriate treatment of it, if elevated, are important during the first few days after thrombolysis. High systolic BP both before and after thrombolysis was associated with poor outcome. This finding may support the practice of reducing systolic BP below 185 mm Hg both before and after thrombolysis.
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J Stroke Cerebrovasc Dis · May 2008
Randomized Controlled Trial Multicenter StudyLiving well with stroke: design and methods for a randomized controlled trial of a psychosocial behavioral intervention for poststroke depression.
Depression is a sufficiently common sequela of a completed stroke to warrant intervention to improve mood, social, and functional outcome. Pharmacologic trials suggest short-term mood improvement from antidepressant treatment but no studies to date have determined whether these short-term gains can be enhanced and extended by a brief psychosocial/behavioral intervention delivered by advanced practice nurses. In addition, drug trials have not reported on functional outcomes such as limitations in ability, limitations in participation, and overall quality of survival. This randomized controlled trial was designed to evaluate the short- and long-term efficacy of a new brief psychosocial/behavioral intervention adjunctive to antidepressant treatment in reducing poststroke depression and improving functional outcomes. ⋯ This article provides detail on the design and treatment methods of this randomized trial in progress. Findings from this study provide important information regarding the long-term efficacy of such a behavioral intervention in reducing poststroke depression and subsequent impaired aspects of psychosocial and physical recovery.