RESUMO
In this paper, the authors' aim is to provide an evidence-based review of primary and secondary ischemic stroke prevention guidelines covering most of the common risk factors and stroke etiologies for the practicing neurosurgeon. The key to stroke prevention is in the identification and treatment of the major risk factors for stroke. These include hypertension, heart disease, diabetes mellitus, dyslipidemia, and tobacco smoking. An updated approach to secondary prevention of stroke in the setting of intracranial and extracranial large vessel atherosclerosis and cardioembolism is provided along with a brief overview of pertinent clinical trials. Novel pharmacological options for prevention of cardioembolic strokes, such as new alternatives to warfarin, are addressed with recommendations for interruption of therapy for elective surgical procedures. In addition, the authors have reviewed the anticoagulation guidelines and the risk of thromboembolic complications of such therapies in the perioperative period, which is an invaluable piece of information for neurosurgeons. Less common etiologies such as arterial dissections and patent foramen ovale are also briefly discussed. Finally, the authors have outlined the quality measures in the Medicare Physician Quality Reporting System and essential guidelines for Primary Stroke Center certification, which have implications for day-to-day neurosurgical practice.
Assuntos
Isquemia Encefálica/epidemiologia , Isquemia Encefálica/prevenção & controle , Medicina Baseada em Evidências/normas , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Adulto , Isquemia Encefálica/cirurgia , Humanos , Arteriosclerose Intracraniana/prevenção & controle , Arteriosclerose Intracraniana/cirurgia , Arteriosclerose Intracraniana/terapia , Embolia Intracraniana/prevenção & controle , Embolia Intracraniana/cirurgia , Embolia Intracraniana/terapia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Procedimentos Neurocirúrgicos/tendências , Medição de Risco/normas , Acidente Vascular Cerebral/cirurgiaRESUMO
After the discovery and characterization of the H(3)R and H(4)R receptors, they have become widely anticipated as potential therapeutic agents in the treatment of sleep disorders. In preliminary studies, histamine H(3) receptor (H(3)R) antagonists and inverse agonists have demonstrated promise in the treatment of sleep disorders associated with excessive daytime sleepiness. This review article summarizes the current research in this area and characteristics of H(3)R and H(3)R antagonists and inverse agonists in development.