Current neurology and neuroscience reports
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Curr Neurol Neurosci Rep · Jan 2008
ReviewDevelopment of regional programs to speed treatment of stroke.
The pathophysiology of ischemic stroke dictates that treatments be administered shortly after symptom onset to be beneficial. Intravenous tissue plasminogen activator is the only drug proven to be effective in stroke; it is approved for administration within a 3-hour window. ⋯ Due to a lack of stroke specialists in many communities, some hospitals may not be prepared to provide intravenous thrombolytic therapy around the clock, and time lost transporting patients to tertiary centers may mitigate the benefits of thrombolysis. Telestroke may be the best alternative in this scenario, extending acute stroke therapies to patients who would otherwise not receive treatment.
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Recent advances in the development and administration of chemotherapy for malignant diseases have led to prolonged survival of patients and the promise of a return to normal lives. The cost of progress comes with a price, however, and the nervous system is frequently the target of therapy-induced toxicity. Unlike more immediate toxicities that affect the gastrointestinal tract and bone marrow, chemotherapy-induced neurotoxicity is frequently delayed in onset and may progress over time. In the peripheral nervous system, the major brunt of the toxic attack is directed against the peripheral nerve, targeting the neuronal cell body, the axonal transport system, the myelin sheath, and glial support structures, resulting in chemotherapy-induced peripheral neuropathy.