Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewReperfusion Changes After Stroke and Practical Approaches for Neuroprotection.
Reperfusion is the first line of care in a growing number of eligible acute ischemic stroke patients. Early reperfusion with thrombolytic drugs and endovascular mechanical devices is associated with improved outcome and lower mortality rates compared with natural history. ⋯ In this article, the functional and structural changes and underlying molecular mechanisms of ischemia and reperfusion are reviewed. The pathways that lead to reperfusion injury and novel neuroprotective strategies with endogenous properties are discussed.
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewOligemia, Penumbra, Infarction: Understanding Hypoperfusion with Neuroimaging.
Despite recent progress in the treatment of acute ischemic stroke with multiple trials demonstrating improved clinical outcome associated with endovascular thrombectomy up to 24 hours after onset, there is potential opportunity for optimal patient selection and treatment algorithm to further improve treatment outcome. Current limitation is in part caused by inconsistency of imaging protocols and imaging-based definitions of oligemia, penumbra, and infarction core within the various hypoperfusion states. To truly maximize the impact of imaging in acute ischemic stroke, imaging definitions of hypoperfusion states need to be more consistent and validated to correctly reflect different severities of ischemic injury.
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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.