Neurology
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In our metropolitan area, the Stroke Code (SC) system allows immediate transfer of patients with acute stroke to a stroke center. It may be activated by community hospitals (A), emergency medical services (EMS, B), or the emergency department of the stroke center (C). Our aim was to analyze whether the SC activation source influences the access to thrombolytic therapy and outcome of patients with ischemic stroke. ⋯ Patients arriving directly to the stroke center via emergency medical services or on their own receive neurologic attention sooner, are more frequently treated with tPA, and have better clinical outcome than those patients who are first taken to a community hospital.
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Autopsy studies in patients who have been declared brain dead are rare. Total brain necrosis ("respirator brain") has been a common finding in the distant past. The time to brain fixation has been shortened as a result of timely organ transplant protocols, therefore the neuropathologic findings may be different than previously described. ⋯ No distinctive neuropathologic features were apparent in our series of patients with brain death. Neuronal ischemic changes were frequently profound, but mild changes were present in a third of the examined hemispheres and in half of the brainstems. Respirator brain with extensive ischemic neuronal loss and tissue fragmentation was not observed. Neuropathologic examination is therefore not diagnostic of brain death.
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Cerebral microbleeds are focal deposits of hemosiderin that can be visualized with MRI. Little is known on their prevalence in the general population and on their etiology. It has been suggested that, in analogy to spontaneous intracranial hemorrhage, the etiology of microbleeds differs according to their location in the brain, with lobar microbleeds being caused by cerebral amyloid angiopathy and deep or infratentorial microbleeds resulting from hypertension and atherosclerosis. We investigated the prevalence of and risk factors for microbleeds in the general population aged 60 years and older. ⋯ The prevalence of cerebral microbleeds is high. Our data support the hypothesis that strictly lobar microbleeds are related to cerebral amyloid angiopathy, whereas microbleeds in a deep or infratentorial location result from hypertensive or atherosclerotic microangiopathy.