Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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There is considerable debate regarding whether anemia qualifies as a prognostic factor for stroke. The purpose of this study was twofold: first, to assess the influence of anemia on vascular risk factors and clinical presentations in patients with first-ever atherosclerosis-related ischemic stroke and, second, to evaluate whether anemia may be of prognostic importance. A total of 774 consecutive patients with first-ever atherosclerosis-related ischemic stroke were prospectively investigated. ⋯ The Kaplan-Meier analysis for patients with and without anemia showed different survival curves (Log-rank test p<0.001). Within 3 years of the onset of first-ever atherosclerosis-related ischemic stroke, patients who had anemia at the time of the initial admission had an associated higher mortality rate. The stroke risk factors of being older than 70 years and having chronic renal insufficiency were more frequently observed in those patients with anemia.
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There is an increasing amount of published literature supporting the use of decompressive craniectomy in the management of raised intracranial pressure and it appears that this procedure will become established as a method by which intracranial hypertension can be treated. While technically fairly straightforward, a decompressive craniectomy is not without complications. A further complication is presented here, which has not been previously reported. ⋯ He suffered further cerebral injury and subsequently died. Following a detailed review of the case a number of recommendations were made and a specific post-decompressive craniectomy operational policy for the assessment and management of these patients was implemented. While we accept that these particular guidelines are specific to a particular institution, this case highlights the need to view these patients as a particularly high risk and recommend that institutions review or establish a specific policy regarding their management.
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We investigated the neuroprotective effects of pre- and postconditioning on infarct volume in the transient middle cerebral artery occlusion (MCAo) model in rats. Thirty-two male rats were divided into occlusion, preconditioning, postconditioning and both pre- and postconditioning groups. MCAo (120 minutes) was monitored with continuous cerebral tissue oxygen (O2) pressure (PtiO2). ⋯ Comparison of infarct volumes showed a significant difference between the conditioned groups and occlusion group. Although there was better protection in the preconditioning group compared with the other two conditioned groups, the results did not reach statistically significant levels. The results suggest that preconditioning, postconditioning and pre/post conditioning have protective effects on cerebral ischemia.