Management of acute stroke. Specific nursing care and treatments in the stroke unit.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

Management of acute stroke. Specific nursing care and treatments in the stroke unit. / Manejo del ictus agudo. Tratamientos y cuidados específicos de enfermería en la Unidad de Ictus.

OBJECTIVE: This study provides a series of updated, evidence-based recommendations for the management of acute stroke. We aim to lay a foundation for the development of individual centres' internal protocols, serving as a reference for nursing care. METHODS: We review the available evidence on acute stroke care. The most recent national and international guidelines were consulted. Levels of evidence and degrees of recommendation are based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: The study describes prehospital acute stroke care, the operation of the code stroke protocol, care provided by the stroke team upon the patient's arrival at hospital, reperfusion treatments and their limitations, admission to the stroke unit, nursing care in the stroke unit, and discharge from hospital. CONCLUSIONS: These guidelines provide general, evidence-based recommendations to guide professionals who care for patients with acute stroke. However, limited data are available on some aspects, showing the need for continued research on acute stroke management.

[Cavernous sinus syndrome secondary to thrombophlebitis due to Streptococcus intermedius complicated with vasculitis of the internal carotid artery and brain abscesses]. / Síndrome de seno cavernoso secundario a una tromboflebitis por Streptococcus intermedius complicada con vasculitis de la arteria carótida interna y abscesos cerebrales.

INTRODUCTION: Thrombophlebitis of the cavernous sinus is a severe infectious disease with high mortality and morbidity. It is usually diagnosed at a late stage and requires a number of visits to the emergency department in most cases, and the prognosis is highly dependent on prompt treatment. Despite its severity, evidence regarding treatment with corticosteroids and anticoagulation therapy is scarce and controversial. One of its complications is arteritis, which can be mistaken for medium to large vessel vasculitis, as in this case. CASE REPORT: A 26-year-old female, who visited due to headache and left palpebral oedema. Imaging tests revealed thrombosis in the left cavernous sinus and significant narrowing of the internal carotid artery. The clinical picture was interpreted as secondary to an inflammatory vascular process and treatment with corticosteroids was initiated, with a good response. However, soon afterwards, fever and contralateral palpebral oedema developed. In the blood cultures a growth of Streptococcus intermedius was obtained and thrombophlebitis of the cavernous sinus was diagnosed. Despite initiating antibiotic and anticoagulation therapy, the patient suffered a right hemiplegia secondary to the formation of frontotemporal abscesses. Surgical drainage was performed and the patient progressed well. In the absence of other infectious foci, and due to the oral origin of the germ, a prophylactic multiple exodontia was performed. CONCLUSION: Thrombophlebitis should be considered as a diagnostic option both in headaches with ocular symptoms and in medium to large vessel arteritis so that they can be treated in a timely manner.

TITLE: Síndrome de seno cavernoso secundario a una tromboflebitis por Streptococcus intermedius complicada con vasculitis de la arteria carótida interna y abscesos cerebrales.Introducción. La tromboflebitis del seno cavernoso es una enfermedad infecciosa grave con alta mortalidad y morbilidad. Su diagnóstico suele ser tardío y requiere múltiples visitas a urgencias en la mayoría de casos, y el pronóstico es altamente dependiente de su rápido tratamiento. A pesar de su gravedad, la evidencia con respecto al tratamiento con corticoides y anticoagulación es escasa y controvertida. Entre sus complicaciones se encuentra la arteritis, la cual puede confundirse con una vasculitis de mediano-gran vaso, como en este caso. Caso clínico. Mujer de 26 años, que acude por una cefalea y un edema palpebral izquierdo. En las pruebas de imagen se evidencia trombosis del seno cavernoso izquierdo y una estrechez importante de la arteria carótida interna. Se interpreta el cuadro como secundario a un proceso vascular inflamatorio y se inician corticoides, con buena respuesta. Sin embargo, al poco tiempo se presenta fiebre y edema palpebral contralateral. En los hemocultivos se obtiene un crecimiento de Streptococcus intermedius y se diagnostica una tromboflebitis del seno cavernoso. A pesar del inicio de antibióticos y anticoagulación, sufre una hemiplejía derecha secundaria a la formación de abscesos frontotemporales. Se procede al drenaje quirúrgico y la paciente cursa con buena evolución. Ante la ausencia de otros focos infecciosos, y debido a la procedencia oral del germen, se realiza una exodoncia múltiple profiláctica. Conclusión. Se recomienda considerar la tromboflebitis como una opción diagnóstica tanto en las cefaleas con síntomas oculares como en la arteritis de mediano-gran vaso para su tratamiento oportuno.

Deamidation of asparagine in a major histocompatibility complex-bound peptide affects T cell recognition but does not explain type B reactivity.

We have analyzed a panel of T cell hybridomas specific for the chemically dominant epitope of hen egg-white lysozyme 48-61 which has asparagine 59 as an important T cell receptor contact residue. A number of T cells recognize 48-61 with asparagine at position 59, but not the aspartic acid or isoaspartic acid derivatives. Conversely, we find T cells that specifically recognize 48-61 bearing an isoaspartic acid at residue 59, but not asparagine. For other T cells, asparagine, aspartic acid, or isoaspartic acid at residue 59 is irrelevant. We present evidence that our previous distinction between type A and type B T cells is not explained by asparagine deamidation at residue 59.

Unusual appearance of an en plaque meningioma of the cervical spinal canal. A case report and literature review.

STUDY DESIGN: A case report of a patient with cervical spinal cord and nerve root compression caused by a meningioma en plaque together with calcification of the posterior longitudinal ligament is presented,with a review of the literature. OBJECTIVE: To present the diagnosis of a calcified dural meningioma en plaque, with extradural extension into the ligamentum flavum, in a woman with cervical myelopathy and neuropathy. SUMMARY OF BACKGROUND DATA: This case demonstrates that the cervical spine can be involved in dural meningioma en plaque with calcifications, in a manner mimicking ossification of the ligamentum flavum, which has never been previously reported. METHODS: A patient presenting with cervical cord and nerve root compression caused by ossification of the posterior longitudinal ligament and a concurrent calcified dural meningioma en plaque was treated surgically and has made a gradual recovery. Imaging studies,surgical findings, and histopathologic evaluation were analyzed to support the diagnosis. RESULTS: At surgery, ossification of the posterior longitudinal ligament was noted, along with a calcified lesion involving the posterior cervical dura and the adjacent ligamentum flavum. A calcified meningioma was diagnosed by histopathologic examination of the dural-based lesion. CONCLUSION: Although previously not described, the diagnosis of calcified dural meningioma en plaque should be considered in all patients presenting with spinal cord and/or nerve root compression,even at cervical levels. Although ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum are more common etiologies of partially circumferential spinal calcification, dural-based meningiomas with extension into the surrounding ligaments demand early recognition because they can be associated with a poorer prognosis.

Dealing with resistant learners. Educator strategies.

Resistant learners are one of the many challenges critical care educators face. The educator must be aware of the elements that contribute to learner resistance and work effectively to eliminate them. Efforts should be made to design programs that are outcome focused and provide direct benefit to each learner. When resistance presents, the educator must search for ways to secure the resisters' buy-in or minimize their impact. Managing resistant learners is never easy, but when the educator is armed with the right tools, their negative impact can be reduced or eliminated.