Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewHealth Care Organization for the Management of Stroke: The French Perspective.
Stroke, a major burden to society, can now be treated in increasingly larger numbers of patients. Intravenous thrombolysis and mechanical thrombectomy are both now standard of care with class I, level of evidence A. ⋯ France is a developed country with a centralized national health care system accessible for all citizens. This article discusses current challenges in the implementation of the delivery of stroke care and some solutions that are being evaluated by the medical community.
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The most feared complication after acute ischemic stroke is symptomatic or asymptomatic hemorrhagic conversion. Neuroimaging and clinical criteria are used to predict development of hemorrhage. ⋯ Malignant infarction develops when cytotoxic edema is large enough to lead to herniation and death. Post-stroke neuroimaging prognosticators have been described and should be assessed early so that appropriate treatment is offered before herniation leads to additional tissue injury.
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewMR Imaging Selection of Acute Stroke Patients with Emergent Large Vessel Occlusions for Thrombectomy.
Acute stroke caused by large vessel occlusions (LVOs) are common. The time window to treat is up to 24 hours, and the most important factor is the size of the ischemic core. ⋯ The necessary sequences are obtainable rapidly, comparable to computed tomography scans. Available evidence suggests that most patients with LVOs are slow progressors defined as having a small core 6 hours or more after ictus onset.
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Neuroimaging Clin. N. Am. · Nov 2018
Review Case ReportsClot Pathophysiology: Why Is It Clinically Important?
Cerebral ischemic stroke treatment may change significantly now that clots are actually physically removed from the patient using thrombectomy. This allows for an analysis of the content of the clots as well as the correlation of the imaging findings and the clot behavior and morphology. This article illustrates how the interaction of different clots varies in the clinical setting and how analysis of clot composition, as well as the search for new pharmacologic targets, can lead to a better understanding of the pathophysiology and therapy resistance, in turn providing possibilities for a better approach in the treatment.
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Teleradiology, transfer of radiology images to a distant diagnostician, has existed for more than 50 years and is a fundamental element in telestroke programs. Teleradiology allows access to expertise for accurate and rapid interpretation of noncontrast CT (NCCT) scans to distinguish ischemic stroke from hemorrhagic stroke. ⋯ Innovations in CT software and ambulance-based CT scans are significantly improving outcomes by matching patients to effective treatment paradigms. This article reviews telestroke models, NCCT interpretation pearls, and access challenges to the latest neuroradiology technology within rural and underserved regions.