Current neurology and neuroscience reports
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Curr Neurol Neurosci Rep · Jan 2009
ReviewTreatment of intracerebral hemorrhage: what should we do now?
Intracerebral hemorrhage (ICH) is the most lethal type of stroke. Level I, class A evidence of effective treatment is lacking. ⋯ In addition, patients with ICHs may have better outcome when medical care is optimized according to the published ICH treatment guidelines. Stem cell therapy has shown promise for better functional recovery.
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Transcranial Doppler ultrasonography (TCD) is the only noninvasive real-time neuroimaging modality for the evaluation of characteristics of blood flow in basal intracerebral vessels that adds physiologic information to structural imaging. TCD has been rapidly evolving from a simple noninvasive diagnostic tool to an imaging modality with a broad spectrum of clinical applications. ⋯ In the neurointensive care unit, TCD is useful for detecting increased intracranial pressure and confirming cerebral circulatory arrest. TCD is of established value for screening children with sickle cell disease and detecting and monitoring vasospasm after spontaneous subarachnoid hemorrhage.
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Curr Neurol Neurosci Rep · Jan 2009
Amyotrophic lateral sclerosis: clinical management and research update.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that selectively affects the motor neurons of the brain and spinal cord. ALS occurs in about 1 in 100,000 individuals. ⋯ The mainstay of clinical management includes pharmacologic management of symptoms, management of dysphagia and respiratory symptoms, palliative care, and multidisciplinary care clinics. In this review, we discuss the clinical management of ALS, recent modifications to the diagnostic criteria, and current clinical trials.
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Curr Neurol Neurosci Rep · Jan 2009
Development of an emergency department response to acute stroke ("Code Stroke").
Minimizing delays is a crucial step in improving outcomes with acute stroke therapies whose efficacy is clearly time dependent. Logistic and human barriers to rapid stroke care can be overcome with a systematic "Code Stroke" approach provided by a structured multidisciplinary acute stroke response team. ⋯ On the other hand, maintaining proficiency of the team's operation is time consuming and personally onerous for team responders. Successful maintenance requires strong departmental and institutional commitment.