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1.
N Z Med J ; 133(1512): 88-92, 2020 04 03.
Artículo en Inglés | MEDLINE | ID: mdl-32242183

RESUMEN

Dissection of a cervical artery is a well-known cause of stroke, especially in younger patients. We describe the case of a 39-year-old male, who presented to our emergency department after a one-day history of headache and vomiting, with associated sudden onset posterior neck pain and cerebellar signs following a massage. Computed tomography angiogram and brain demonstrated bilateral vertebral artery dissection and cerebellar stroke. He was admitted to hospital for monitoring and conservative management with antiplatelet therapy, resulting in a good outcome. This is the first reported case of bilateral vertebral artery dissection and stroke to be associated with massage. This case also suggests, unlike many reports in the literature, that significant vascular pathology can result from massage even without cervical spine manipulation.


Asunto(s)
Masaje/efectos adversos , Accidente Cerebrovascular/etiología , Disección de la Arteria Vertebral/etiología , Adulto , Cerebelo/irrigación sanguínea , Tratamiento Conservador , Humanos , Imagen por Resonancia Magnética , Masculino , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Disección de la Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/terapia
2.
Medicine (Baltimore) ; 99(16): e19803, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32311996

RESUMEN

BACKGROUND: Available evidence shows conflicting results with regard to a potential detrimental effect of hypertension on clinical outcomes in patients who undergo mechanical thrombectomy (MT). We performed a meta-analysis to evaluate the impact of hypertension on the prognosis of patients with acute ischaemic stroke (AIS) treated by MT. METHODS: We systematically reviewed previous studies in the PubMed, EMBASE, and Cochrane library databases that reported MT outcomes in AIS patients and their relationships with hypertension or blood pressure. We used a poor outcome (modified Rankin score >2 at 3 months) as the primary end point. Mortality and symptomatic intracranial hemorrhage were the secondary end points. We incorporated a random effect for trials in all models. RESULTS: Data from 6650 patients in 31 articles that evaluated the effect of hypertension or blood pressure on outcomes after MT were included. Compared with patients without hypertension, patients with hypertension had significantly higher odds of a poor outcome (odds ratio 0.70; 95% confidence interval 0.57-0.85; I = 43%) and higher mortality (odds ratio 1.70; 95% confidence interval 1.26-2.29; I = 33%). Symptomatic intracranial hemorrhage did not differ by patient hypertension status. CONCLUSIONS: The present study confirms that hypertension and high blood pressure are associated with a poor outcome at 3 months after MT in AIS patients. However, the causal relationship between hypertension and a poor outcome remains undetermined, and further investigations are required to ascertain whether AIS patients receiving MT could benefit from intensive blood pressure control.


Asunto(s)
Isquemia Encefálica/terapia , Hipertensión/complicaciones , Trombolisis Mecánica , Accidente Cerebrovascular/terapia , Humanos , Resultado del Tratamiento
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(3. Vyp. 2): 23-28, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32307426

RESUMEN

Over the past decade, non-invasive brain stimulation, in particular transcranial stimulation by direct electric current (TES), has been increasingly included in the array of methods used for rehabilitation of patients with post-stroke impairments (motor, speech, cognitive). Development of stimulation protocols with determination of the zones of exposure, as well as better understanding of the patterns of restoration of functional systems, became possible due to basic research using functional MRI paradigm. However, the complexity of the organization of the speech system, the variety of forms of aphasia that occur when it is damaged, the individual variability of neuroplastic processes, motivated a search for optimal stimulation protocols that contribute to the personification of the rehabilitation process. Portability, low cost of equipment, a good safety and tolerance profile, as well as a proven effect on neuroplasticity processes, are the undoubted advantages of TES-therapy. There is reason to believe that further study and clinical testing of this technique will turn it into the promising tool for enhancing the effectiveness of classical speech therapy approaches in patients with post-stroke aphasia.


Asunto(s)
Afasia/complicaciones , Afasia/terapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Estimulación Transcraneal de Corriente Directa , Estimulación Magnética Transcraneal , Encéfalo/fisiología , Encéfalo/fisiopatología , Humanos , Accidente Cerebrovascular/terapia
4.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(3. Vyp. 2): 33-41, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32307428

RESUMEN

INTRODUCTION: This paper is an adapted translation of recommendations on telestroke provided by the European Stroke Organization. Lack of stroke specialists determines that many European rural areas remain underserved. Use of telemedicine in stroke care has shown to be safe, increase use of evidence-based therapy and enable coverage of large areas of low population density. An aim of the study is to summarise the following recommendations of the Telestroke Committee of the European Stroke Organization on the setup of telestroke networks in Europe: Hospitals participating in telestroke networks should be chosen according to criteria that include population density, transportation distance, geographic specifics and in-hospital infrastructure and professional resources. Three hospital categories are identified to be part of a hub-and-spoke network: (1) the Telemedicine Stroke Centre (an European Stroke Organization stroke centre or equivalent with specific infrastructure and setup for network and telemedicine support), (2) the telemedicine-assisted stroke Unit (equivalent to an European Stroke Organization stroke unit but without 24 h onsite stroke expertise) and (3) the telemedicine-assisted stroke ready hospital (only covering hyperacute treatment in the emergency department and transferring all patients for further treatment).


Asunto(s)
Accidente Cerebrovascular/terapia , Telemedicina/organización & administración , Europa (Continente) , Humanos , Guías de Práctica Clínica como Asunto , Telemedicina/normas , Traducciones
5.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(3. Vyp. 2): 49-53, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32307430

RESUMEN

AIM: To evaluate the efficacy of including cytoflavin in rehabilitation measures in the early recovery period of patients with ischemic stroke. MATERIAL AND METHODS: Results of rehabilitation measures of 100 patients (50 women and 50 men, aged 18 to 85 years) in the early recovery period of ischemic stroke were analyzed. Psychological testing included NIHSS, MMSE, Rankin scale, Rivermead mobility index, exercise tolerance test. Depending on the rehabilitation scheme, patients were divided into the main group (n=50), who received a verticalization course and cytoflavin (intravenously, drip 20.0 ml in 250.0 ml 5% glucose for 14 days). The control group (n=50) included patients who received standard treatment. RESULTS AND CONCLUSION: Inclusion of cytoflavin in the rehabilitation scheme for patients with ischemic stroke increased the effectiveness of treatment, which was manifested by a decrease in the severity of neurological disorders assessed with NIHSS by 17.6% in the main group versus 10.8% in the control group (p<0.05) and recovery of cognitive functions assessed with MMSE by 5.8% versus 1.6%, respectively (p<0.05). In addition, there was a positive dynamics in the restoration of blood pressure (by 37.1% in the main group versus 30.6% in the control group (p<0.05)).


Asunto(s)
Isquemia Encefálica/terapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea/efectos de los fármacos , Isquemia Encefálica/metabolismo , Cognición/efectos de los fármacos , Combinación de Medicamentos , Femenino , Mononucleótido de Flavina/administración & dosificación , Mononucleótido de Flavina/farmacología , Mononucleótido de Flavina/uso terapéutico , Humanos , Inosina Difosfato/administración & dosificación , Inosina Difosfato/farmacología , Inosina Difosfato/uso terapéutico , Masculino , Persona de Mediana Edad , Niacinamida/administración & dosificación , Niacinamida/farmacología , Niacinamida/uso terapéutico , Accidente Cerebrovascular/metabolismo , Succinatos/administración & dosificación , Succinatos/farmacología , Succinatos/uso terapéutico , Resultado del Tratamiento , Adulto Joven
6.
Neurol Sci ; 41(5): 1003-1005, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32270359

RESUMEN

Since the outbreak of the COVID-19 epidemic which in our region, Veneto (Italy), dates back to February, we were confronted with several challenges, but with a constant aim of keeping our Stroke Unit COVID-free. For this reason, in addition to creating a dedicated hot-spot as a pre-triage just outside the Emergency Department, together with the Neuroradiology Unit we obtained a mobile CT unit that could be used by COVID-positive or COVID-suspected patients. Furthermore, thanks to the collaboration with colleagues from different specialties (Infectious Disease, Internal Medicine, Intensive Care, Emergency Medicine), dedicated areas for COVID patients were activated. This led to a substantial change of our acute stoke management pathway. As the number of COVID patients increased, and the WHO declared a state of pandemic, this new stroke pathway has been fully tested. We would like to share our experience and send a clear message to keep a high attention on stroke as an emergency condition, because we have observed a decreased number of patients with minor strokes and TIAs, longer onset-to-door and door-to-treatment times for major strokes, and a reduced number of transfers from spokes. We strongly believe that the general population and family doctors are rightly focused on COVID. However, to remain at home with stroke symptoms does not mean to "stay safe at home".


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Accidente Cerebrovascular/terapia , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Manejo de la Enfermedad , Brotes de Enfermedades , Servicio de Urgencia en Hospital , Italia/epidemiología , Pandemias , Neumonía Viral/complicaciones , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/virología
7.
Medicine (Baltimore) ; 99(16): e19671, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32311940

RESUMEN

BACKGROUND: The treatment of post-stroke depression (PSD) with anti-depressant drugs is partly practical. Transcranial alternating current stimulation (tACS) offers the potential for a novel treatment modality for adult patients with PSD. In this study, we will assess the efficacy and safety of tACS for treating PSD and explore its effect on gamma and beta-oscillations involving in emotional regulation. METHODS: The prospective study is an 8-week, double-blind, randomized, placebo-controlled trial. Seventy eligible participants with mild to moderate PSD aged between 18 years and 70 years will be recruited and randomly assigned to either active tACS intervention group or sham group. Daily 40-minute, 77.5-Hz, 15-mA sessions of active or sham tACS targeting the forehead and both mastoid areas on weekdays for 4 consecutive weeks (week 4), and an additional 4-week observational period (week 8) will be followed up. The primary outcome is the proportion of participants having an improvement at week 8 according to the Hamilton Depression Rating Scale 17-Item (HAMD-17) score, including the proportion of participants having a decrease of ≥ 50% in HAMD-17 score or clinical recovery (HAMD-17 score ≤ 7). Secondary outcomes include neurological function, independence level, activities of daily living, disease severity, anxiety, and cognitive function. The exploratory outcomes are gamma and beta-oscillations assessed at baseline, week 4, and week 8. Data will be analyzed by logistical regression analyses and mixed-effects models. DISCUSSION: The study will be the first randomized controlled trial to evaluate the efficacy and safety of tACS at a 77.5-Hz frequency and 15-mA current in reducing depressive severity in patients with PSD. The results of the study will present a base for future studies on the tACS in PSD and its possible mechanism. TRIAL REGISTRATION NUMBER: NCT03903068, pre-results.


Asunto(s)
Depresión/etiología , Depresión/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular/complicaciones , Estimulación Transcraneal de Corriente Directa , Adolescente , Adulto , Anciano , Ondas Encefálicas , Depresión/fisiopatología , Método Doble Ciego , Humanos , Persona de Mediana Edad , Seguridad del Paciente , Selección de Paciente , Escalas de Valoración Psiquiátrica , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/terapia , Estimulación Transcraneal de Corriente Directa/métodos , Adulto Joven
9.
J Cardiovasc Surg (Torino) ; 61(2): 149-158, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32225134

RESUMEN

INTRODUCTION: Acute ischemic stroke is a leading cause of morbidity and mortality worldwide, and the incidence of ischemic stroke is predicted to increase in coming years. Carotid atherosclerotic occlusive disease accounts for up to 20% of all ischemic strokes, and mounting evidence suggests that, in the setting of an acute ischemic stroke due to carotid disease, earlier treatment with carotid intervention results in better outcomes. In patients with acute ischemic stroke, systemic or intravenous thrombolysis (IVT) has revolutionized ischemic stroke therapy, and intravenous tissue plasminogen activator (tPA) has become the principal treatment for acute ischemic stroke when administered within 3 to 4.5 hours of neurologic symptom onset. Given these trends in acute ischemic stroke therapy, vascular specialists are increasingly asked to perform carotid intervention following IVT, but reports in the literature examining outcomes in this circumstance are scarce, and the data regarding the appropriate interval from IVT to carotid endarterectomy (CEA) remains controversial. EVIDENCE ACQUISITION: Literature searches were performed in PubMed (MEDLINE) and Ovid examining journal articles published between January 1st, 1998 and September 30th, 2019. The search terms used were: "urgent carotid endarterectomy," "carotid endarterectomy" AND "thrombolysis," "acute stroke and thrombolysis," "timing of carotid endarterectomy," and various combinations of these terms. EVIDENCE SYTNHESIS: A total of 21 published reports detailing outcomes in 1165 patients have been published to date, with an average interval from IVT to CEA of 7.1 days, a cumulative 30-day stroke and death rate of 4.1% (0-18%) and a mean frequency of intracranial hemorrhage of 2.6% (0-18%). The aggregate data from the 21 reported series suggest that CEA can be performed safely within the first 14 days after the onset of neurologic symptoms in patients receiving antecedent IVT, however, data regarding the safety of urgent CEA within 48 to 72 hours of thrombolysis is conflicting, with some series reporting excellent results and others showing an increased risk of ICH, stroke, and/or death in these select patients. CONCLUSIONS: Given the trend toward expedited treatment of acute ischemic stroke with subsequent transfer to regional referral centers, vascular specialists will be confronted with an increasing number of patients who may require urgent CEA after antecedent IVT. Further study is warranted to clearly delineate the appropriate interval from IVT to CEA and, specifically, to establish the safety of CEA with 72 hours of tPA administration.


Asunto(s)
Endarterectomía Carotidea/métodos , Mortalidad Hospitalaria , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/uso terapéutico , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/mortalidad , Isquemia Encefálica/terapia , Causas de Muerte , Terapia Combinada , Urgencias Médicas , Endarterectomía Carotidea/mortalidad , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Medición de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Análisis de Supervivencia , Factores de Tiempo
10.
Medicine (Baltimore) ; 99(9): e19386, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118788

RESUMEN

Case-control studies have shown that noxious thermal stimulation (TS) can improve arm function in patients with stroke. However, the neural mechanisms underlying this improvement are largely unknown. We explored functional neural activation due to noxious and innocuous TS intervention applied to the paretic arm of patients with stroke. Sixteen participants with unilateral cortical infarctions were allocated to one of two groups: noxious TS (8 patients; temperature combination: hot pain 46°C to 47°C, cold pain 7°C-8°C) or innocuous TS (n = 8; temperature combination: hot 40°C-41°C, cold 20°C-21°C). All subjects underwent fMRI scanning before and after 30 min TS intervention and performed a finger tapping task with the affected hand. Immediate brain activation effects were assessed according to thermal type (noxious vs. innocuous TS) and time (pre-TS vs post-TS). Regions activated by noxious TS relative to innocuous TS (P < .05, adjusted for multiple comparisons) were related to motor performance and sensory function in the bilateral primary somatosensory cortices, anterior cingulate cortex, insula, thalamus, hippocampus and unilateral primary motor cortex, secondary somatosensory cortex at the contralateral side of lesion, and unilateral supplementary motor area at the ipsilateral side of lesion. Greater activation responses were observed in the side contralateral to the lesion, suggesting a significant intervention effect. Our preliminary findings suggest that noxious TS may induce neuroplastic changes unconstrained to the local area.Trial registration: NCT01418404.


Asunto(s)
Calor/uso terapéutico , Estimulación Física/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Adulto , Anciano , Análisis de Varianza , Estudios de Casos y Controles , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Estimulación Física/instrumentación , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular/instrumentación
11.
Medicine (Baltimore) ; 99(10): e19447, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150098

RESUMEN

Antiplatelet agents have been administered to patients with acute ischemic stroke after endovascular therapy. This study was designed to provide initial data to compare thromboelastography (TEG) with the conventional coagulation test (CCT) to analyze the coagulation function of antiplatelet drugs in such patients.The present retrospective cohort study included 240 patients who received endovascular therapy from September 2012 to December 2017. The baseline and clinical characteristics of these patients were collected with respect to TEG (parameters: R, K, maximal amplitude (MA), and α angle) and CCT (parameters: PT, activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR), and platelet count (PLT)) on day 5 after aspirin and clopidogrel post-endovascular interventions. The correlation and agreement of these 2 detecting methods were analyzed. Additionally, the area under the receiver operating characteristic curve (AUROC) was used to analyze the effectiveness of these 2 methods in detecting unfavorable clinical outcomes, including symptomatic intracranial hemorrhage and early neurological deterioration.The 3 pairs of parameters (R and APTT, K and APTT, and α angle and FIB) were in agreement for identifying hypercoagulability, while R and APTT, K and APTT, K and PLT, and α angle and PLT were in agreement for identifying hypocoagulability. The AUROC of parameter R for detecting symptomatic intracranial hemorrhage was 0.817, while that of parameter FIB for predicting early neurological deterioration was 0.887.Parameter FIB derived from CCT might be advantageous for evaluating early neurological deterioration, while parameter R detected by TEG might be superior for evaluating symptomatic intracranial hemorrhage.


Asunto(s)
Pruebas de Coagulación Sanguínea , Isquemia Encefálica/terapia , Hemorragias Intracraneales/diagnóstico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular/terapia , Tromboelastografía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Estudios de Cohortes , Procedimientos Endovasculares , Femenino , Humanos , Relación Normalizada Internacional , Hemorragias Intracraneales/sangre , Hemorragias Intracraneales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tiempo de Tromboplastina Parcial , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven
12.
Medicine (Baltimore) ; 99(10): e19337, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150072

RESUMEN

OBJECTIVE: To examine the efficacy of combined inspiratory and expiratory respiratory muscle training (RMT) with respect to the swallowing function, pulmonary function, functional performance, and dysarthria in patients with stroke. DESIGN: Prospective, randomized controlled trial. SETTING: Tertiary hospital. PARTICIPANTS: The trial included 21 subjects (12 men, 9 women) aged 35 to 80 years presenting with 6 months history of unilateral stroke, respiratory muscle weakness (≥70% predicted maximal inspiratory pressure (MIP) and/or ≤70% maximal expiratory pressure (MEP)), dysphagia, or dysarthria. These subjects were randomly assigned to the control (n = 10, rehabilitation) and experimental (n = 11, rehabilitation with RMT) groups. INTERVENTION: Inspiratory RMT starting from 30% to 60% of MIP and expiratory RMT starting from 15% to 75% of MEP for 5 days/week for 6 weeks. MAIN OUTCOME MEASURES: MIP, MEP, pulmonary function, peak cough flow, perception of dyspnea, Fatigue Assessment Scale, Modified Rankin Scale, Brunnstrom stage, Barthel index, Functional Oral Intake Scale (FOIS), and parameters of voice analysis. RESULTS: Significant differences were observed between both groups in terms of MIP, forced vital capacity (FVC), and forced expiratory volume per second (FEV1) of the percentage predicted. Significant difference was found with respect to the change in fatigue, shimmer percent, amplitude perturbation quotient, and voice turbulence index (VTI) according to the acoustic analysis in the RMT group. The FEV1/FVC ratio was negatively correlated with jitter percent, relative average perturbation, pitch perturbation quotient, and VTI; the maximum mid-expiratory flow (MMEF) and MMEF% were also negatively correlated with VTI. Significant differences among participants of the same group were observed while comparing the Brunnstrom stage before and after training of the affected limbs and the Barthel scale and FOIS scores in both the groups. CONCLUSIONS: Altogether, 6-week combined inspiratory and expiratory RMT is feasible as adjuvant therapy for stroke patients to improve fatigue level, respiratory muscle strength, lung volume, respiratory flow, and dysarthria.Clinical trial registration number (Clinical Trial Identifier): NCT03491111.


Asunto(s)
Ejercicios Respiratorios/métodos , Trastornos de Deglución/terapia , Disartria/terapia , Debilidad Muscular/terapia , Accidente Cerebrovascular/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Ejercicios Respiratorios/normas , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Disartria/etiología , Disartria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Debilidad Muscular/etiología , Debilidad Muscular/fisiopatología , Estudios Prospectivos , Músculos Respiratorios/fisiopatología , Estadísticas no Paramétricas , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia
13.
Zhonghua Nei Ke Za Zhi ; 59(4): 277-285, 2020 Apr 01.
Artículo en Chino | MEDLINE | ID: mdl-32209193

RESUMEN

Endovascular intervention is an important therapy of cerebrovascular diseases. Standard and comprehensive assessment before interventional therapy improves safety of procedure and reduces complications. There is a lack of consistent understanding on preoperative evaluation of interventional therapy for non-acute ischemic cerebrovascular diseases in China. Neurovascular Intervention Group of Chinese Society of Neurology organized some cerebrovascular disease experts in China to discuss that and formed this expert consensus.


Asunto(s)
Trastornos Cerebrovasculares , Procedimientos Endovasculares/métodos , Accidente Cerebrovascular , Trastornos Cerebrovasculares/diagnóstico , Trastornos Cerebrovasculares/terapia , China , Consenso , Humanos , Neurología , Sociedades Médicas , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/terapia
15.
BMJ ; 368: l6983, 2020 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-32054610

RESUMEN

Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.


Asunto(s)
Anticoagulantes/uso terapéutico , Isquemia Encefálica/terapia , Servicios Médicos de Urgencia , Prevención Secundaria/métodos , Accidente Cerebrovascular/terapia , Isquemia Encefálica/diagnóstico , Protocolos Clínicos , Guías como Asunto , Humanos , Accidente Cerebrovascular/diagnóstico , Terapia Trombolítica
16.
Khirurgiia (Mosk) ; (2): 74-78, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32105259

RESUMEN

A review is devoted to carotid endarterectomy for symptomatic carotid stenosis in acute period of ischemic stroke. Patient selection criteria, dates of surgical intervention and perioperative risk were analyzed.


Asunto(s)
Isquemia Encefálica , Estenosis Carotídea , Endarterectomía Carotidea , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Estenosis Carotídea/terapia , Humanos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/terapia
17.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 37(1): 169-173, 2020 Feb 25.
Artículo en Chino | MEDLINE | ID: mdl-32096391

RESUMEN

Neurological damage caused by stroke is one of the main causes of motor dysfunction in patients, which brings great spiritual and economic burdens for society and families. Motor imagery is an important assisting method for the rehabilitation of patients after stroke, which is easy to learn with low cost and has great significance in improving the motor function and the quality of patient's life. This paper mainly summarizes the positive effects of motor imagery on post-stroke rehabilitation, outlines the physiological performance and theoretical model of motor imagery, the influencing factors of motor imagery, the scoring criteria of motor imagery and analyzes the shortcomings such as the few kinds of experimental subject, the subjective evaluation method and the low resolution of the experimental equipment in the process of rehabilitation of motor function in post-stroke patients. It is hopeful that patients with stroke will be more scientifically and effectively using motor imagery therapy.


Asunto(s)
Imágenes en Psicoterapia , Rehabilitación de Accidente Cerebrovascular/psicología , Accidente Cerebrovascular/terapia , Humanos , Recuperación de la Función
18.
Am Heart J ; 222: 105-111, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32028136

RESUMEN

The AHA Guidelines recommend developing multi-tiered systems for the care of patients with acute stroke.1 An ideal stroke system of care should ensure that all patients receive the most efficient and timely care, regardless of how they first enter or access the medical care system. Coordination among the components of a stroke system is the most challenging but most essential aspect of any system of care. The Implementation of Best Practices For Acute Stroke Care-Developing and Optimizing Regional Systems of Stroke Care (IMPROVE Stroke Care) project, is designed to implement existing guidelines and systematically improve the acute stroke system of care in the Southeastern United States. Project participation includes 9 hub hospitals, approximately 80 spoke hospitals, numerous pre-hospital agencies (911, fire, and emergency medical services) and communities within the region. The goal of the IMPROVE Stroke program is to develop a regional integrated stroke care system that identifies, classifies, and treats acute ischemic stroke patients more rapidly and effectively with reperfusion therapy. The project will identify gaps and barriers to implementation of stroke systems of care, leverage existing resources within the regions, aid in designing strategies to improve care processes, bring regional representatives together to agree on and implement best practices, protocols, and plans based on guidelines, and establish methods to monitor quality of care. The impact of implementation of stroke systems of care on mortality and long-term functional outcomes will be measured.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Servicios Médicos de Urgencia/normas , Accidente Cerebrovascular/terapia , Humanos
19.
Arq Neuropsiquiatr ; 78(1): 39-43, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-32074189

RESUMEN

OBJECTIVE: Stroke is an important cause of morbidity and mortality worldwide. Reperfusion therapy with intravenous tissue plasminogen activator (IV-tPA) was first implemented in 1996. More recently, endovascular reperfusion with mechanical thrombectomy (MT) demonstrated a robust beneficial effect, extending the 4.5 h time window. In our country, there are difficulties to achieve the implementation of both procedures. Our purpose is to report the early experience of a Comprehensive Stroke Center in the use of MT for acute stroke. METHODS: Analysis of consecutive patients from January 2015 to September 2018, who received reperfusion treatment with MT. Demographic data, treatment times, previous use of IV-tPA, site of obstruction, recanalization, outcomes and disability after stroke were assessed. RESULTS: We admitted 891 patients with acute ischemic stroke during this period. Ninety-seven received IV-tPA (11%) and 27 were treated with MT (3%). In the MT group, mean age was 66.0±14.5 years. Median NIHSS before MT was 20 (range:14‒24). The most prevalent etiology was cardioembolic stroke (52%). Prior to MT, 16 of 27 patients (59%) received IV-tPA. Previous tPA treatment did not affect onset to recanalization time or door-to-puncture time. For MT, door-to-puncture time was 104±50 minutes and onset to recanalization was 289±153 minutes. Successful recanalization (mTICI grade 2b/3) was achieved in 21 patients (78%). At three-month follow-up, the median NIHSS was 5 (range:4‒15) and mRS was 0‒2 in 37%, and ≥3 in 63%. CONCLUSIONS: With adequate logistics and strict selection criteria, MT can be implemented in our population with results like those reported in large clinical trials.


Asunto(s)
Isquemia Encefálica/terapia , Trombolisis Mecánica/métodos , Reperfusión/métodos , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Argentina , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento
20.
BMC Health Serv Res ; 20(1): 75, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007089

RESUMEN

Value-Based Medicine (VBM) is imposing itself as 'a new paradigm in healthcare management and medical practice.In this perspective paper, we discuss the role of VBM in dealing with the large productivity issue of the healthcare industry and examine some of the worldwide industrial and technological trends linked with VBM introduction. To clarify the points, we discuss examples of VBM management of stroke patients.In our conclusions, we support the idea of VBM as a strategic aid to manage rising costs in healthcare, and we explore the idea that VBM, by establishing value-generating networks among different healthcare stakeholders, can serve as the long sought-after redistributive mechanism that compensate patients for the industrial exploitation of their personal medical records.


Asunto(s)
Prestación de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Accidente Cerebrovascular/terapia , Control de Costos/métodos , Humanos , Accidente Cerebrovascular/economía
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