Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · May 2014
ReviewSearching for salvageable brain: the detection of ischemic penumbra using various imaging modalities?
Various imaging modalities are used to identify the ischemic penumbra in patients with acute ischemic stroke. Although single-photon emission computed tomography (CT), perfusion-weighted magnetic resonance imaging (MRI), and perfusion CT are used to evaluate residual cerebral blood flow in the ischemic area, validation of the perfusion threshold for the penumbra has not been established. ⋯ A mismatch of these abnormalities is thought to correspond to the ischemic penumbra and has been used in clinical trials. Although new ligands, such as (18)F-fluoromisonidazole, that bind to hypoxic but viable ischemic tissue are currently available, positron emission tomography has yet to be developed as a clinical tool.
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J Stroke Cerebrovasc Dis · May 2014
Does symptom onset to primary stroke center time goals affect stroke outcome?
Treating acute ischemic stroke (AIS) within 4.5 hours and door-to-needle time of less than 60 minutes may optimize recovery. It is unknown if onset to Primary Stroke Center (PSC) time goals affect outcome. The purpose of this study was to examine effects of symptom onset to PSC time goals on outcome. ⋯ In our Comprehensive Stroke Center (CSC), onset to PSC time goals were not significant predictors of the 90-day outcome. Expedited care processes in CSC may compensate for differences in outcome. These results should be validated in a larger cohort and in PSCs versus CSCs.
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J Stroke Cerebrovasc Dis · May 2014
Case ReportsLateral medullary stroke in patient with granulomatous polyangiitis.
Granulomatous polyangiitis (GPA), also known as Wegener granulomatosis, is a systemic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis that infrequently affects the central nervous system. We report a 41-year-old man with lateral medullary infarction who developed rapidly progressive renal failure. ⋯ He had resolution of his neurologic deficits and improvement in renal function. This case report highlights the importance to consider GPA vasculitis in the differential diagnosis of stroke in patients with development of acute kidney injury.
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J Stroke Cerebrovasc Dis · May 2014
Case ReportsAcute foot drop syndrome mimicking peroneal nerve injury: an atypical presentation of ischemic stroke.
Foot drop syndrome is a frequent neurologic condition usually caused by peroneal nerve damage. On rare occasions, foot drop may present as the single neurologic manifestation of intracranial lesions. ⋯ Three months later, his motor deficit had completely improved (modified Rankin scale score = 0). To our knowledge, this is the second report of sudden isolated foot drop caused by a cortical infarction.
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J Stroke Cerebrovasc Dis · May 2014
Tracheostomy after severe ischemic stroke: a population-based study.
Stroke can result in varying degrees of respiratory failure. Some patients require tracheostomy in order to facilitate weaning from mechanical ventilation, long-term airway protection, or a combination of the two. Little is known about the rate and predictors of this outcome in patients with severe stroke. We aim to determine the rate of tracheostomy after severe ischemic stroke. ⋯ Tracheostomy is common after decompressive craniectomy and is strongly associated with the development of pneumonia. Given its impact on patient function and potentially modifiable associated factors, tracheostomy may warrant further study as an important patient-centered outcome among patients with stroke.