Journal articles on the topic 'Brain Stroke Monitoring'
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Rehman, Fazal ur, Sikander Idrees, Muhammad Hashim, and Syed Maroof Hashmi. "HYPERTENSIVE HEMORRHAGIC STROKE;." Professional Medical Journal 24, no. 08 (August 8, 2017): 1195–99. http://dx.doi.org/10.29309/tpmj/2017.24.08.958.
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Objectives: The aim of our study is to evaluate the use of intracranial pressuremonitoring as a predictor of neurological deterioration in patients with hemorrhagic stroke andevaluate the relationship of continuous intracranial pressure monitoring with warning signsof brain herniation and hematoma enlargement in our setup. Study Design: Randomizedcontrolled trial. Period: 02 years duration from June 2014 to June 2016. Setting: Tertiary CareHospital in Karachi Pakistan. Method: Patients in group A had continuous monitoring of theintracranial pressures by having an implant device placed under general anesthesia. Bothgroups were given the required treatment as per guideline, including blood pressure reduction,diuretic and mannitol as per requirement. Both the groups were assessed clinically after every8 hours in the initial three days and then every day till no deterioration were observed for 5 days(pupils, reflexes, extremity test etc) and a repeat CT scan was performed at 24 hours after theonset of initial stroke. While in the control group pressures were monitored using neurologicalsigns and clinical measurements, and the dose of mannitol was adjusted accordingly. Theoutcome was assessed within 1 month duration from the onset of hemorrhagic stroke, and theparameters used were hematoma progression and herniation of the brain. Results: The patientpopulation consisted of n= 100 patients, who presented to our hospital with a primary diagnosisof hemorrhagic stroke, as confirmed by CT scan. The patient population was divided into twogroups using a random number generator, group A consisted of the patients who underwentintracranial pressure monitoring and had n= 52 patients, while group B consisted of the controlgroup (no objective ICP measurement) and had n= 48 patients in the group. The incidence ofenlargement of the hematoma in group A was n= 16 (30.76%) and in the control group was n=18 (37.5%). And when it comes to brain herniation n= 6 (11.53%) patients developed it in theICP monitoring group and n= 10 (20.833%) developed it in the control group respectively. Wefound that the mortality rate in our study population was n= 4 (7.69%) in ICP monitoring groupand n= 5 (10.41%) in the control group having a p value of 0.04, the neurological outcome in thetwo groups also had statistically significant differences, having a p value of 0.03. Conclusion: Inour study we found a lower incidence of secondary brain herniation in patients who underwentcontinuous intracranial pressure monitoring as compared to control group, furthermore thesepatients had better neurological outcomes.
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Bhatt, Mohammed Wasim, and Sparsh Sharma. "An IoMT-Based Approach for Real-Time Monitoring Using Wearable Neuro-Sensors." Journal of Healthcare Engineering 2023 (February 13, 2023): 1–10. http://dx.doi.org/10.1155/2023/1066547.
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The Internet of Things (IoT) has demonstrated over the past few decades to be a powerful tool for connecting various medical equipment with in-built sensors and healthcare professionals to deliver superior health services that also reach remote areas. In addition to reducing healthcare costs, increasing access to clinical services, and enhancing operational effectiveness in the healthcare industry, it has also enhanced patient health safety. Recent research has focused on using EEG to assist and comprehend brain changes in rehabilitation facilities. These technologies can spot fluctuations in EEG constraints during treatment, which could result in more effective therapy and better functional outcomes. As a result, we have tried to use an IoT-based system for real-time monitoring of the constraints. Another unknown patient who is suffering from acute ischemic stroke may experience stroke-in-evolution or an early worsening of neurological symptoms, which is frequently associated with poor clinical outcomes. Because of this, managing an acute stroke requires early detection of these indications. The present investigation work will act as a standard reference for academic researchers, medical professionals, and everyone else involved in the use of IoMT. This study aims to anticipate strokes sooner and prevent their consequences by early intervention using an Internet of Things (IoT)-based system. Also, this study proposes usage of wearable equipment that can monitor and analyze brain signals for improved treatment and the prevention of stroke-related complications.
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Scapaticci, Rosa, Loreto Di Donato, Ilaria Catapano, and Lorenzo Crocco. "A FEASIBILITY STUDY ON MICROWAVE IMAGING FOR BRAIN STROKE MONITORING." Progress In Electromagnetics Research B 40 (2012): 305–24. http://dx.doi.org/10.2528/pierb12022006.
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Sztriha, Laszlo K., Ruth L. O’Gorman, Michel Modo, Gareth J. Barker, Steven C. R. Williams, and Lalit Kalra. "Monitoring Brain Repair in Stroke Using Advanced Magnetic Resonance Imaging." Stroke 43, no. 11 (November 2012): 3124–31. http://dx.doi.org/10.1161/strokeaha.111.649244.
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Walsh, Kyle B. "Non-invasive sensor technology for prehospital stroke diagnosis: Current status and future directions." International Journal of Stroke 14, no. 6 (July 26, 2019): 592–602. http://dx.doi.org/10.1177/1747493019866621.
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Background The diagnosis of stroke in the prehospital environment is the subject of intense interest and research. There are a number of non-invasive external brain monitoring devices in development that utilize various technologies to function as sensors for stroke and other neurological conditions. Future increased use of one or more of these devices could result in substantial changes in the current processes for stroke diagnosis and treatment, including transportation of stroke patients by emergency medical services. Aims The present review will summarize information about 10 stroke sensor devices currently in development, utilizing various forms of technology, and all of which are external, non-invasive brain monitoring devices. Summary of review Ten devices are discussed including the technology utilized, the indications for use (stroke and, when relevant, other neurological conditions), the environment(s) indicated for use (with a focus on the prehospital setting), a description of the physical structure of each instrument, and, when available, findings that have been published in peer-reviewed journals or otherwise reported. The review is organized based on the technology utilized by each device, and seven distinct forms were identified: accelerometers, electroencephalography (EEG), microwaves, near-infrared, radiofrequency, transcranial doppler ultrasound, and volumetric impedance phase shift spectroscopy. Conclusions Non-invasive external brain monitoring devices are in various stages of development and have promise as stroke sensors in the prehospital setting. Some of the potential applications include to differentiate stroke from non-stroke, ischemic from hemorrhage stroke, and large vessel occlusion (LVO) from non-LVO ischemic stroke. Successful stroke diagnosis prior to hospital arrival could transform the current diagnostic and treatment paradigm for this disease.
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Liu, Shuang, Jie Guo, Jiayuan Meng, Zhijun Wang, Yang Yao, Jiajia Yang, Hongzhi Qi, and Dong Ming. "Abnormal EEG Complexity and Functional Connectivity of Brain in Patients with Acute Thalamic Ischemic Stroke." Computational and Mathematical Methods in Medicine 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/2582478.
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Ischemic thalamus stroke has become a serious cardiovascular and cerebral disease in recent years. To date the existing researches mostly concentrated on the power spectral density (PSD) in several frequency bands. In this paper, we investigated the nonlinear features of EEG and brain functional connectivity in patients with acute thalamic ischemic stroke and healthy subjects. Electroencephalography (EEG) in resting condition with eyes closed was recorded for 12 stroke patients and 11 healthy subjects as control group. Lempel-Ziv complexity (LZC), Sample Entropy (SampEn), and brain network using partial directed coherence (PDC) were calculated for feature extraction. Results showed that patients had increased mean LZC and SampEn than the controls, which implied the stroke group has higher EEG complexity. For the brain network, the stroke group displayed a trend of weaker cortical connectivity, which suggests a functional impairment of information transmission in cortical connections in stroke patients. These findings suggest that nonlinear analysis and brain network could provide essential information for better understanding the brain dysfunction in the stroke and assisting monitoring or prognostication of stroke evolution.
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Et. al., Ganesh Birajadar,. "Epilepsy Identification using EEG signal monitoring." Turkish Journal of Computer and Mathematics Education (TURCOMAT) 12, no. 2 (April 10, 2021): 2366–71. http://dx.doi.org/10.17762/turcomat.v12i2.2022.
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Electroencephalogram (EEG) is nothing but measuring electric activity of brain. EEG is non-stationary signal. EEG characterizes human behavior. There are many brain abnormalities that can be identified and treated using EEG behavior analysis. As per researchers study Epilepsy is commonly happening disorder that is getting spread over the time. It is nothing but sudden stroke in brain where patient suffers from unusual activities seizures. Sometimes symptoms are such severe that ignorance leads to death. So it is important to identify its earlier symptoms and treat it in time so as to avoid risk. EEG signals are used for getting features in time as well as frequency domain. These features are further analyzed and classified to identify EEG abnormality.
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Ramsay, S. C., C. Weiller, R. Myers, J. E. Cremer, S. K. Luthra, A. A. Lammertsma, and R. S. J. Frackowiak. "Monitoring by PET of macrophage accumulation in brain after ischaemic stroke." Lancet 339, no. 8800 (April 1992): 1054–55. http://dx.doi.org/10.1016/0140-6736(92)90576-o.
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Allen, Baxter B., Caitlin E. Hoffman, Chani S. Traube, Steven L. Weinstein, and Jeffrey P. Greenfield. "Continuous Brain Tissue Oxygenation Monitoring in the Management of Pediatric Stroke." Neurocritical Care 15, no. 3 (March 17, 2011): 529–36. http://dx.doi.org/10.1007/s12028-011-9531-x.
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Allen. "Terapi Tissue Plasminogen Activator untuk Stroke Iskemik Akut." Cermin Dunia Kedokteran 50, no. 3 (March 1, 2023): 167–70. http://dx.doi.org/10.55175/cdk.v50i3.661.
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Prevalensi stroke terus meningkat setiap tahun. Penanganan kasus stroke harus dilakukan sesegera mungkin untuk memaksimalkan pemulihan serta mencegah berulang. Pada kasus stroke iskemik akut, pengobatan fibrinolitik tPA terbukti efektif. Beberapa kriteria pemberian harus dipenuhi. Pasien yang mendapat tPA harus mendapat observasi tekanan darah ketat dan memastikan tidak terjadi efek samping perdarahan. Hingga saat ini, hanya alteplase yang disetujui untuk pengobatan fibrinolitik pada pasien stroke iskemik akut. Telaah ilmiah berbasis bukti menunjukkan manfaat tPA lain. yaitu tenecteplase.
The prevalence of stroke continues to increase. To minimize brain injury, prompt management is necessary to maximize patient recovery and prevent recurrent strokes. Fibrinolytic tPA has been proven to be effective for acute ischemic stroke. Several criteria must be met before tPA administration. Patients should receive close monitoring of blood pressure and for bleeding risk. Until recently, only tPA alteplase has been approved for fibrinolytic treatment in acute ischemic stroke. Several evidence-based studies have shown the benefits of tenecteplase - another tPA - in acute ischemic stroke management.
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ALI, ASAD, AHMAD DANYAL, and AFTAB TURABI. "STROKE." Professional Medical Journal 12, no. 02 (June 25, 2006): 114–17. http://dx.doi.org/10.29309/tpmj/2005.12.02.5137.
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Stroke was defined according to WHO criteria as rapidly developingsymptoms and / or signs of focal and at times global loss of cerebral function with no apparent cause other than thatof vascular disease1. Stroke is grossly divided into either2 1). Thrombotic. 2). Embolic. 3).Hemorrhagic type (Whichmay be either intra cerebral bleed or subarachnoid hemorrhage). The brain, like other organs of the body, requires anadequate vascular system in order to supply it with nutrients and oxygen and to remove metabolic wastes and carbondioxide. Stabilization of medical problem with careful monitoring, and active prevention and timely management ofsecondary complications are of the utmost important for reducing stroke morality rates and avoiding further ischemicbrain injury. For the ischemic cerebral lesion itself, as yet no treatment or combination of treatment has beenestablished to be universally effective3. However, current studies allow for the following 5 potential therapeutic areasto be identified.
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Tobon Vasquez, Jorge A., Rosa Scapaticci, Giovanna Turvani, Gennaro Bellizzi, David O. Rodriguez-Duarte, Nadine Joachimowicz, Bernard Duchêne, et al. "A Prototype Microwave System for 3D Brain Stroke Imaging." Sensors 20, no. 9 (May 3, 2020): 2607. http://dx.doi.org/10.3390/s20092607.
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This work focuses on brain stroke imaging via microwave technology. In particular, the open issue of monitoring patients after stroke onset is addressed here in order to provide clinicians with a tool to control the effectiveness of administered therapies during the follow-up period. In this paper, a novel prototype is presented and characterized. The device is based on a low-complexity architecture which makes use of a minimum number of properly positioned and designed antennas placed on a helmet. It exploits a differential imaging approach and provides 3D images of the stroke. Preliminary experiments involving a 3D phantom filled with brain tissue-mimicking liquid confirm the potential of the technology in imaging a spherical target mimicking a stroke of a radius equal to 1.25 cm.
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Bodó, Mihály. "A noninvasive, continuous brain monitoring method: rheoencephalography (REG)." DRC Sustainable Future: Journal of Environment, Agriculture, and Energy 1, no. 2 (October 2, 2020): 103–19. http://dx.doi.org/10.37281/1.2.3.
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This paper deals with the sustainability under anoxic conditions of human beings, both when healthy, and diseased. As our attention is focused these days on the environment, sustainability, and green energy, a similar effort is being made in neuromonitoring to switch from invasive to noninvasive monitoring methods. Keys to these changes are computerization and shrinking size of electronic hardware. Computerization is going on in all areas of biomedical engineering, both in research and in clinical fields of medicine. In neurology, brain imaging is the most characteristic change in recent decades. These modalities of imaging (MRI, CT, PET scan, etc.) are predominantly utilized for localizing brain pathology. Brain imaging offers great spatial resolution, but poor time resolution. Therefore, for continuous monitoring, neurocritical care departments require an additional tool with good time resolution. There are invasive and noninvasive neuromonitoring methods. The standard method to monitor intracranial pressure (ICP) is an invasive method. Computerization allows for calculating the cerebral blood flow autoregulation (CBF AR) index (pressure reactivity index - PRx) from ICP and systemic arterial pressure (SAP) in real time, continuously, but invasively. The new development, discussed in this paper, is to calculate this index noninvasively by using rheoencephalography (REG), called REGx. We present the road to this invention and summarize multifold REG related results, such as using REG for primary stroke prevention screening, comparison incidence of arteriosclerotic risk factors, various studies by using CBF manipulations, and correlations with other neuromonitoring methods, and validation with in vitro and in vivo methods. REG by using different algorithms allow for real time calculation of autoregulated blood flow. This paper presents results of validation of CBF algorithms as an effective, noninvasive method. The author’s intent is to supply sufficient physiological background information. This review covers the author’s research efforts over several decades; it pertains multiple studies and has an updated addition to human sustainability by considering that Covid-19 is increasing stroke and cardiovascular disease (CVD) morbidity and mortality.
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Sycheva, M. A., S. V. Astrakov, Yu T. Кuryachenko, N. A. Porotnikova, and N. V. Oleksyuk. "Effect of the neurovegetative blockade on haemodinamic parameters and the course of acute period of stroke." Bulletin of Siberian Medicine 8, no. 3(2) (June 28, 2009): 39–42. http://dx.doi.org/10.20538/1682-0363-2009-3(2)-39-42.
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For the study of effect neurovegetative blockade of the brain on the course of an stroke in the acute period was carried out noninvasion monitoring of the basic parameters systems haemodinamic and a vegetative homeostasis with use of Kerdo Index at 110 patients with different types of stroke. The neurovegetative blockade having been started in the first day of the brain damage promotes the decrease of damaging reactions manifestations, normalization of vegetative homeostasis and promonting more favourable course of acute period stroke and its prognosis.
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Fagan, Susan C., Barbara J. Zarowitz, and Sylvie Robert. "“Brain Attack”: An Indication for Thrombolysis?" Annals of Pharmacotherapy 26, no. 1 (January 1992): 73–80. http://dx.doi.org/10.1177/106002809202600114.
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OBJECTIVE: The primary objective of this article is to introduce the reader to the use of thrombolytics in the acute treatment of ischemic stroke. Theory and experimental evidence to support this approach are emphasized in addition to potential adverse effects of thrombolysis. DATA SOURCES: A MEDLINE search was used to identify pertinent literature, including reviews. STUDY SELECTION: Studies were selected for detailed review if they involved stroke patients and addressed possible toxicities of therapy. Any abstracts concerning ongoing clinical trials also were reviewed. DATA EXTRACTION: Data from animal investigations using tissue plasminogen activator for the acute treatment of several models of cerebral ischemia were used to support the importance of early treatment (within six hours of symptom onset). Also, studies performed in animal models of stroke revealed that thrombolysis could be accomplished safely in acute ischemic stroke. All human studies published to date are anecdotal case reports, but point to the safety of thrombolysis if administered early. Reviews of ongoing multicenter trials are taken from published abstracts and proceedings. DATA SYNTHESIS: Thrombolysis holds promise as a hyperacute therapy for acute stroke; however, the risk of intracerebral hemorrhage remains. Crucial to the success of this and any other therapy for acute stroke is the ability to treat patients within hours of symptom onset. Also, the importance of concomitant medications such as heparin and aspirin has not yet been addressed. CONCLUSIONS: Pharmacists need to be knowledgeable of new treatments of stroke and the risks associated with them. As patient educators, pharmacists can contribute to public awareness by promoting the early recognition of stroke symptoms. As pharmacotherapists, pharmacists need to understand the risks and the important monitoring parameters related to thrombolysis. The results of ongoing multicenter clinical trials are awaited before making a final judgment on the usefulness of thrombolysis in acute ischemic stroke.
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Xu, Chengyang, Ang Zheng, Tianyi He, and Zhipeng Cao. "Brain–Heart Axis and Biomarkers of Cardiac Damage and Dysfunction after Stroke: A Systematic Review and Meta-Analysis." International Journal of Molecular Sciences 21, no. 7 (March 28, 2020): 2347. http://dx.doi.org/10.3390/ijms21072347.
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Background: Cardiac complications after a stroke are the second leading cause of death worldwide, affecting the treatment and outcomes of stroke patients. Cardiac biomarkers such as cardiac troponin (cTn), brain natriuretic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) have been frequently reported in patients undergoing a stroke. The aim of the present study is to meta-analyze the relationship between changes in such cardiac biomarkers and stroke and to present a systematic review of the previous literature, so as to explore the brain–heart axis. Methods: We searched four online databases pertinent to the literature, including PubMed, Embase, the Cochrane Library, and the Web of Science. Then, we performed a meta-analysis to investigate changes in cTn, BNP, and NT-proBNP associated with different types of stroke. Results and Conclusions: A significant increase in cTnI concentration was found in patients exhibiting a brain hemorrhage. BNP increased in cases of brain infarction, while the NT-proBNP concentration was significantly elevated in patients suffering an acute ischemic stroke and brain hemorrhage, indicating cardiac damage and dysfunction after a stroke. Our analysis suggests that several potential mechanisms may be involved in the brain–heart axis. Finally, clinicians should pay careful attention to monitoring cardiac function in the treatment of cerebrovascular diseases in order to provide a timely and more accurate treatment.
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Sillerud, Laurel O., Yirong Yang, Lisa Y. Yang, Kelsey B. Duval, Jeffrey Thompson, and Yi Yang. "Longitudinal monitoring of microglial/macrophage activation in ischemic rat brain using Iba-1-specific nanoparticle-enhanced magnetic resonance imaging." Journal of Cerebral Blood Flow & Metabolism 40, no. 1_suppl (September 22, 2020): S117—S133. http://dx.doi.org/10.1177/0271678x20953913.
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Microglial/macrophage activation plays a dual role in response to brain injury after a stroke, promoting early neuroinflammation and benefit for neurovascular recovery. Therefore, the dynamics of stroke-induced cerebral microglial/macrophage activation are of substantial interest. This study used novel anti-Iba-1-targeted superparamagnetic iron–platinum (FePt) nanoparticles in conjunction with magnetic resonance imaging (MRI) to measure the spatiotemporal changes of the microglial/macrophage activation in living rat brain for four weeks post-stroke. Ischemic lesion areas were identified and measured using T2-weighted MR images. After injection of the FePt-nanoparticles, T2*-weighted MR images showed that the nanoparticles were seen solely in brain regions that coincided with areas of active microglia/macrophages detected by post-mortem immunohistochemistry. Good agreement in morphological and distributive dynamic changes was also observed between the Fe+-cells and the Iba-1+-microglia/macrophages. The spatiotemporal changes of nanoparticle detected by T2*-weighted images paralleled the changes of microglial/macrophage activation and phenotypes measured by post-mortem immunohistochemistry over the four weeks post-stroke. Maximum microglial/macrophage activation occurred seven days post-stroke for both measures, and the diminished activation found after two weeks continued to four weeks. Our results suggest that nanoparticle-enhanced MRI may constitute a novel approach for monitoring the dynamic development of neuroinflammation in living animals during the progression and treatment of stroke.
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Febryanto, Dwi, Retnaningsih, and Fitria Handayani. "Assessment Of Afasia in Stroke Patients: Case Study." Journal Of Nursing Practice 3, no. 2 (April 29, 2020): 210–19. http://dx.doi.org/10.30994/jnp.v3i2.88.
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Introduction: Aphasia is understood as difficulty in understanding or producing language caused by disorders involving the brain hemispheres. Early assessment of aphasia is very important to prevent the emergence of telegraphic speech styles, improve welfare, independence, social participation, quality of life, reduce length of stay and care costs, but there is little literature on this subject, especially in stroke patients. Purpose: This study is to provide an overview of the assessment of aphasia in stroke patients. Methods: The design of a case study involving 6 participants and data collection was carried out by conducting an assessment using the Language Aphasia Screening Test (LAST) instrument which was monitored for 3 days, including monitoring errors for naming images, monitoring mismatches repeating words and sentences, monitoring spontaneous pronunciation, monitoring image comprehension, monitoring comprehension of verbal instructions.Results: A total of 6 ischemic stroke patients were found wrong in repeating words and sentences. Conclusion: In aphasic stroke patients all language modalities are impaired, ranging from spontaneous speech, repetition, naming, language comprehension, reading and writing
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Doehner, Wolfram, David Manuel Leistner, Heinrich J. Audebert, and Jan F. Scheitz. "The role of cardiologists on the stroke unit." European Heart Journal Supplements 22, Supplement_M (November 2020): M3—M12. http://dx.doi.org/10.1093/eurheartj/suaa160.
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Abstract Cardiologists need a better understanding of stroke and of cardiac implications in modern stroke management. Stroke is a leading disease in terms of mortality and disability in our society. Up to half of ischaemic strokes are directly related to cardiac and large artery diseases and cardiovascular risk factors are involved in most other strokes. Moreover, in an acute stroke direct central brain signals and a consecutive autonomic/vegetative imbalance may account for severe and life-threatening cardiovascular complications. The strong cerebro-cardiac link in acute stroke has recently been addressed as the stroke-heart syndrome that requires careful cardiovascular monitoring and immediate therapeutic measures. The regular involvement of cardiologic expertise in daily work on a stroke unit is therefore of high importance and a cornerstone of up-to-date comprehensive stroke care concepts. The main targets of the cardiologists’ contribution to acute stroke care can be categorized in three main areas (i) diagnostics workup of stroke aetiology, (ii) treatment and prevention of complications, and (iii) secondary prevention and sub-acute workup of cardiovascular comorbidity. All three aspects are by themselves highly relevant to support optimal acute management and to improve the short-term and long-term outcomes of patients. In this article, an overview is provided on these main targets of cardiologists’ contribution to acute stroke management.
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Zhang, Ding, Gang Liu, Liemi Huang, Lun Zhang, Xinghua Gui, Jiping Tao, Pengli Zeng, and Min Ding. "Monitoring of Motor Nerve Function Rehabilitation in Patients with Upper Extremity Hemiplegia Based on Functional Magnetic Resonance Imaging." Journal of Medical Imaging and Health Informatics 11, no. 6 (June 1, 2021): 1761–70. http://dx.doi.org/10.1166/jmihi.2021.3699.
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Through functional magnetic resonance imaging (fMRI) technology, it is planned to use complex brain network technology to track brain functional imaging tracking treatment of stroke hemiplegia with scalp acupuncture. Functional magnetic resonance imaging (fMRI) can continuously monitor the rehabilitation process of motor nerve function in patients with stroke and upper limb hemiplegia, and explore the mechanism of brain plasticity changes at different levels of neural function cortex, motor function neural circuit, and behavior level. First, the fMRI test uses a block design, and the subjects complete the movement of the thumb and index finger. After completing the dysfunction assessment, fMRI data collection was performed on the patient before the CIMT treatment using a magnetic resonance apparatus, and a second fMRI data collection was performed 2 weeks after the CIMT treatment; only one fMRI data collection was performed on the volunteers. The functional magnetic resonance data was processed using the AFNI software package, and the functional scores of subjects were calculated using SPSS software. Second, studying the remodeling of residual brain tissue and functional compensation pathways can help to further clarify the recovery mechanism of motor function after stroke hemiplegia. Finally, compulsory exercise therapy can effectively improve upper limb motor dysfunction in stroke patients. The forced use of upper extremities during treatment induces the reorganization and compensation of cerebral cortical functional areas. This change in brain functional areas is consistent with the increase of upper extremity movement and improvement of motor function, fMRI can provide neuronal reorganization after exercise therapy evidence with compensation.
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Amouzegar Zavareh, Seyed Mohammadreza, Hasan Araghizade, Nahid Eskandari, and Marzieh Lak. "Brain oximetry is not a good monitor on reducing neurological complications after cardiac surgery." Universa Medicina 38, no. 2 (June 17, 2019): 81. http://dx.doi.org/10.18051/univmed.2019.v38.81-89.
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Background<br />Cerebral deoxygenation is related to several adverse systemic consequences. We aimed to assess the effect of noninvasive monitoring of cerebral oxygenation on reducing neurological complications after cardiac surgery.<br /><br />Methods <br />In this randomized clinical trial, subjects were randomized into two groups: intervention group (111 subjects with monitoring of cerebral oximetry) and control group (112 subjects without any monitoring of cerebral oximetry). Monitoring of regional cerebral oxygen saturation (rScO2) was performed in the intervention group without any monitoring of cerebral oxygenation. The rScO2 was not recorded in the control group and no specific treatments were employed. Any neurological complications such as hallucinations, delirium, stroke, and length of stay in ICU after surgery were recorded. A p-value less than 0.05 was used as a cut-off for statistical significance.<br /><br />Results<br />After surgery, in the intervention group one (1/111=0.09%) patient suffered from stroke and one patient had delirium, while in the control group three patients had stroke and three (3/112=2.6%) had delirium. There was no significant difference between the two groups regarding complications (p=0.527). The length of stay in ICU was 3.49 ± 0.96 days in the case group and 3.40 ± 0.80 days in the control group and there was no significant difference in the two groups (p=0.477).<br /><br />Conclusion<br />Monitoring of rScO2 does not seem to be a good monitor for brain oxygenation. Further studies are needed to judge the usefulness of rScO2 for monitoring brain oxygenation.
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Freedman, Ben, Hooman Kamel, Isabelle C. Van Gelder, and Renate B. Schnabel. "Atrial fibrillation: villain or bystander in vascular brain injury." European Heart Journal Supplements 22, Supplement_M (November 2020): M51—M59. http://dx.doi.org/10.1093/eurheartj/suaa166.
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Abstract Atrial fibrillation (AF) and stroke are inextricably connected, with classical Virchow pathophysiology explaining thromboembolism through blood stasis in the fibrillating left atrium. This conceptualization has been reinforced by the remarkable efficacy of oral anticoagulant (OAC) for stroke prevention in AF. A number of observations showing that the presence of AF is neither necessary nor sufficient for stroke, cast doubt on the causal role of AF as a villain in vascular brain injury (VBI). The requirement for additional risk factors before AF increases stroke risk; temporal disconnect of AF from a stroke in patients with no AF for months before stroke during continuous ECG monitoring but manifesting AF only after stroke; and increasing recognition of the role of atrial cardiomyopathy and atrial substrate in AF-related stroke, and also stroke without AF, have led to rethinking the pathogenetic model of cardioembolic stroke. This is quite separate from recognition that in AF, shared cardiovascular risk factors can lead both to non-embolic stroke, or emboli from the aorta and carotid arteries. Meanwhile, VBI is now expanded to include dementia and cognitive decline: research is required to see if reduced by OAC. A changed conceptual model with less focus on the arrhythmia, and more on atrial substrate/cardiomyopathy causing VBI both in the presence or absence of AF, is required to allow us to better prevent AF-related VBI. It could direct focus towards prevention of the atrial cardiomyopathy though much work is required to better define this entity before the balance between AF as villain or bystander can be determined.
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Funchal, Bruno Ferreira, Maramélia Miranda Alves, Ítalo C. Suriano, Feres Eduardo Chaddad-Neto, Maria E. M. R. Ferraz, and Gisele Sampaio Silva. "Intracranial pressure following decompressive hemicraniectomy for malignant cerebral infarction: clinical and treatment correlations." Arquivos de Neuro-Psiquiatria 76, no. 12 (December 2018): 812–15. http://dx.doi.org/10.1590/0004-282x20180132.
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ABSTRACT Decompressive craniectomy (DC) reduces mortality and improves outcome in patients with massive brain infarctions. The role of intracranial pressure (ICP) monitoring following DC for stroke has not been well established. Methods: We evaluated 14 patients admitted to a tertiary hospital with malignant middle cerebral artery infarctions, from October 2010 to February 2015, who underwent DC and had ICP monitoring. Patients with and without episodes of ICP elevation were compared. Results: Fourteen patients were submitted to DC and had ICP monitoring following the procedure during the period. Ten patients (71.4%) had at least one episode of sustained elevated ICP in the first seven days after surgery. Maximal ICP levels had no correlation with age, time to hemicraniectomy or Glasgow Coma Scores at admission, but had a trend toward correlation with the National Institutes of Health Stroke Scale score at admission (p = 0.1). Ventriculitis occurred in 21.4% of the patients. Conclusions: High ICP episodes and ventriculitis were common in patients following hemicraniectomy for malignant middle cerebral artery strokes. Therefore, the implications of ICP and benefits of the procedure should be firmly established.
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Sarwar, Imran, Giovanna Turvani, Mario Casu, Jorge Tobon, Francesca Vipiana, Rosa Scapaticci, and Lorenzo Crocco. "Low-Cost Low-Power Acceleration of a Microwave Imaging Algorithm for Brain Stroke Monitoring." Journal of Low Power Electronics and Applications 8, no. 4 (November 1, 2018): 43. http://dx.doi.org/10.3390/jlpea8040043.
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Microwave imaging can effectively image the evolution of a hemorrhagic stroke thanks to the dielectric contrast between the blood and the surrounding brain tissues. To keep low both the form factor and the power consumption in a bedside device, we propose implementing a microwave imaging algorithm for stroke monitoring in a programmable system-on-chip, in which a simple ARM-based CPU offloads to an FPGA the heavy part of the computation. Compared to a full-software implementation in the ARM CPU, we obtain a 5× speed increase with hardware acceleration without loss in accuracy and precision.
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Seoane, Fernando, Seyed Reza Atefi, Jens Tomner, Konstantinos Kostulas, and Kaj Lindecrantz. "Electrical Bioimpedance Spectroscopy on Acute Unilateral Stroke Patients: Initial Observations regarding Differences between Sides." BioMed Research International 2015 (2015): 1–12. http://dx.doi.org/10.1155/2015/613247.
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Purpose. Electrical Bioimpedance Cerebral Monitoring is assessment in real time of health of brain tissue through study of passive dielectric properties of brain. During the last two decades theory and technology have been developed in parallel with animal experiments aiming to confirm feasibility of using bioimpedance-based technology for prompt detection of brain damage. Here, for the first time, we show that electrical bioimpedance measurements for left and right hemispheres are significantly different in acute cases of unilateral stroke within 24 hours from onset.Methods. Electrical BIS measurements have been taken in healthy volunteers and patients suffering from acute stroke within 24 hours of onset. BIS measurements have been obtained using SFB7 bioimpedance spectrometer manufactured by Impedimed ltd. and 4-electrode method. Measurement electrodes, current, and voltage have been placed according to 10–20 EEG system obtaining mutual BIS measurements from 4 different channels situated in pairs symmetrically from the midsagittal line. Obtained BIS data has been analyzed, assessing for symmetries and differences regarding healthy control data.Results. 7 out of 10 patients for Side-2-Side comparisons and 8 out 10 for central/lateral comparison presented values outside the range defined by healthy control group. When combined only 1 of 10 patients exhibited values within the healthy range.Conclusions. If these initial observations are confirmed with more patients, we can foresee emerging of noninvasive monitoring technology for brain damage with the potential to lead to paradigm shift in treatment of brain stroke and traumatic brain damage.
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Mustafa, Lis Diana, Azam Muzakhim Imamuddin, and Yoyok Heru Prasetio. "Rancang bangun alat monitoring fisioterapi pasien pasca stroke menggunakan sensor MPU6050 melalui media transmisi bluetooth." JURNAL ELTEK 19, no. 2 (October 29, 2021): 39. http://dx.doi.org/10.33795/eltek.v19i2.281.
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Stroke Transient Ischemic Attack (TIA ) adalah kondisi stroke ringan. Stroke ringan diakibatkan oleh berkurangnya suplai darah menuju otak. Kelumpuhan disebabkan oleh kurangnya aliran darah ke otak, sehingga sisi tubuh akan mengalami kelumpuhan terutama pada siku dan lutut. Fisioterapi pada pasien pasca stroke ringan dilakukan dengan metode terapi gerakan antara lain seperti penggunaan alat bantu fisioterapi pasien pasca stroke menggunakan sensor MPU6050 melalui media transmisi Bluetooth. Sistem rancangan ini membantu latihan pada pasien berbentuk sensor MPU6050 yang digunakan untuk mendeteksi sudut serta banyaknya gerakan rehabilitasi pasien pasca stroke. Sensor gyroscope menghasilkan deteksi sudut pada siku sebesar 150 dan sudut pada lutut sebesar 135 . Data yang didapatkan diproses oleh arduino nano menggunakan metode I2C. Penelitian ini bertujuan untuk merancang alat bantu fisioterapi pasien pasca stroke berbasis mikrokontroler guna memperoleh hasil yang maksimal karena bentuk alat ini yang portable.
Stroke Transient Ischemic Attack (TIA) is a mild stroke condition that can be caused by reduced blood supply to the brain due to blocked blood vessels. Lack of blood flow to the brain can cause paralysis, usually only on one side of the body such as the elbows and knees. Physiotherapy in post-stroke patients is carried out using movement therapy methods, including elbow and knee flexion. Currently, patients come to the therapist or vice versa to perform therapeutic movements, so a telemonitoring system for post-stroke patient physiotherapy tools is made using the MPU6050 sensor which is connected to ESP 232 and the internet network and can be monitored by therapists and clinic admins where the therapy is done. This system helps monitor elbow and knew flexion exercises using the MPU6050 sensor which is used to detect the angle and number of rehabilitation movements of post-stroke patients. . From the results of testing the accuracy of this sensor is able to detect the angle of elbow movement from 00-1500 and knee flexion angle of 00-1350 by 99%.The telemonitoring application for physiotherapy tools for post-stroke patients based on Android is equipped with a therapist menu so that the number of movements and the average angle of movement of the knees and elbows can be monitored by the therapist, this tool can also be used anywhere and anytime due to the portable form of this tool.
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Harpaz, Dorin, Raymond C. S. Seet, Robert S. Marks, and Alfred I. Y. Tok. "B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor." Biosensors 10, no. 9 (August 26, 2020): 107. http://dx.doi.org/10.3390/bios10090107.
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Stroke is a widespread condition that causes 7 million deaths globally. Survivors suffer from a range of disabilities that affect their everyday life. It is a complex condition and there is a need to monitor the different signals that are associated with it. Stroke patients need to be rapidly diagnosed in the emergency department in order to allow the admission of the time-limited treatment of tissue plasminogen activator (tPA). Stroke diagnostics show the use of sophisticated technologies; however, they still contain limitations. The hidden information and technological advancements behind the utilization of biomarkers for stroke triaging are significant. Stroke biomarkers can revolutionize the way stroke patients are diagnosed, monitored, and how they recover. Different biomarkers indicate different cascades and exhibit unique expression patterns which are connected to certain pathologies in the human body. Over the past decades, B-type natriuretic peptide (BNP) and its derivative N-terminal fragment (NT-proBNP) have been increasingly investigated and highlighted as significant cardiovascular biomarkers. This work reviews the recent studies that have reported on the usefulness of BNP and NT-proBNP for stroke triaging. Their classification association is also presented, with increased mortality in stroke, correlation with cardioembolic stroke, and an indication of a second stroke recurrence. Moreover, recent scientific efforts conducted for the technological advancement of a bedside point-of-care (POC) device for BNP and NT-proBNP measurements are discussed. The conclusions presented in this review may hopefully assist in the major efforts that are currently being conducted in order to improve the care of stroke patients.
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Khaliq, Adnan, Mumtaz Ali, Farooq Azam, Akram Ullah, Hamayun Tahir, and Nayab Gul. "Hemorrhagic Stroke May Be the Sequelae of Brain Tumors." Pakistan Journal Of Neurological Surgery 24, no. 4 (January 1, 2021): 328–36. http://dx.doi.org/10.36552/pjns.v24i4.494.
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Objective: Hemorrhagic stroke is a common neurosurgical emergency caused by multiple pathological conditions. Brain tumors can also present with acute neurodeficits secondary to hemorrhagic stroke. This study as case series was conducted to report the clinical presentation, radiological findings, causes and management of brain tumors presenting as hemorrhagic stroke.
Materials and Methods: Clinical assessment and radiological investigations were done, including CT brain and MRI brain with contrast. Surgery was done with evacuation of the hematoma and excision of tumor, and the tissue was sent for histopathology. Post operatively patients were shifted to the intensive care unit for monitoring and ventilator support if needed. Adjuvant treatment was guided according to histopathology report.
Results: Total number of patients who were diagnosed to have a bleed in brain tumor were thirteen (n = 13). There were 6 (46%) males and 7 (54%) females. Mean age was 55 years. Among 13 patients, 4 (31%) patients had metastatic brain tumors and 9 (69%) patients had primary brain tumors. Diagnosis was done on CT brain, MRI brain and confirmed on histopathology of tissue obtained during surgery. Out of 13 patients, 5 (38%) patients were asymptomatic prior to hemorrhage and 8 (62%) patients had neurodeficits before and recent episodes of bleeding, which caused deterioration of neurological state.
Conclusion: Malignant primary and metastatic brain tumors can present as acute focal deficits due to brain hemorrhage. Diagnosis is based on clinical presentation, radiological features and histopathology.
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Munawar, Awais, Zartasha Mustansar, Ahmed E. Nadeem, and Mahmood Akhtar. "AN INVESTIGATION INTO ELECTROMAGNETIC BASED IMPEDANCE TOMOGRAPHY USING REALISTIC HUMAN HEAD MODEL." International Journal of Pharmacy and Pharmaceutical Sciences 8, no. 2 (September 17, 2016): 35. http://dx.doi.org/10.22159/ijpps.2016v8s2.15217.
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<p class="lead">The objective of this research is to investigate the feasibility of Electromagnetic based Impedance Tomography (EMIT) for brain stroke detection, localization and classification. Electromagnetic based Impedance Tomography employing microwave imaging technique is an emerging brain stroke diagnostic modality. It relies on the significant contrast between dielectric properties of the normal and abnormal brain tissues. To study the interaction between micro-wave signals and head tissues, the simulations are performed using a geometrically simple 3-D ellipsoid head model with emulated stroke. Finite Element numerical technique is adopted to find the solution of Maxwell’s equations to measure the transmitted and backscattered signals in forward problem. Contrast Source Inversion technique is proposed to solve the inverse scattering problem and reconstruct brain images based on calculated dielectric profiles. Detailed analysis is performed to determine the safety limits of transmitted signals to minimize ionizing effects while ensuring maximum penetration. The simulations verify the inhomogeneous and frequency-dispersive behavior of brain tissue’s dielectric properties. The solution of the forward problem demonstrates the microwave signals scattering by the multilayer structure of the head model, duly validated by analytical results. The scattering phenomena can be fully capitalized by image reconstruction algorithm to obtain brain images and detect stroke presence. The initial results obtained in this research and prior work indicates that EMIT-based head imaging system has a potential for rapid stroke detection, classification, and continuous brain monitoring and offers a comparatively cost-effective solution.</p>
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van Putten, Michel J. A. M., and Dénes L. J. Tavy. "Continuous Quantitative EEG Monitoring in Hemispheric Stroke Patients Using the Brain Symmetry Index." Stroke 35, no. 11 (November 2004): 2489–92. http://dx.doi.org/10.1161/01.str.0000144649.49861.1d.
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Tobon Vasquez, Jorge A., Rosa Scapaticci, Giovanna Turvani, Gennaro Bellizzi, Nadine Joachimowicz, Bernard Duchêne, Enrico Tedeschi, Mario R. Casu, Lorenzo Crocco, and Francesca Vipiana. "Design and Experimental Assessment of a 2D Microwave Imaging System for Brain Stroke Monitoring." International Journal of Antennas and Propagation 2019 (May 5, 2019): 1–12. http://dx.doi.org/10.1155/2019/8065036.
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The aim of this paper is to present and experimentally verify the first prototype of a microwave imaging system specifically designed and realized for the continuous monitoring of patients affected by brain stroke, immediately after its onset and diagnosis. The device is a 2D version of the 3D system, currently under construction, and consists of an array of 12 printed monopole antennas connected to a two-port vector network analyzer through a switching matrix so that each antenna can act as a transmitter or receiver, thereby allowing the acquisition of the entire multistatic multiview scattering matrix required for the imaging. The system has been experimentally tested on 2D phantoms with electric properties mimicking the brain. The presence and the evolution of the stroke have been reproduced by filling a proper cavity in the phantom with a liquid having the electric properties of blood. A differential approach has been adopted by acquiring the scattering matrix before and after the filling of the blood cavity. The so achieved differential dataset has been processed by means of a linear imaging algorithm in order to reconstruct the stroke location and dimension. Moreover, the effect of pre- and postprocessing operations on the measured data is investigated. A good agreement has been obtained between the reconstructions and the actual scenario. As a final remark, it is worth noting that the entire data acquisition and processing are sufficiently fast to allow a real-time monitoring.
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Rodrigues, Rita, Renata Silva, Luís Fontão, Luís Ruano, and José Mário Roriz. "Acute Ischemic Stroke in Pregnancy." Case Reports in Neurology 11, no. 1 (February 8, 2019): 37–40. http://dx.doi.org/10.1159/000496386.
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Stroke is an uncommon but serious potential complication of pregnancy. The management of acute ischemic stroke in pregnant women remains a complex challenge that extends beyond the limits of clinical trial evidence. Patient 1 was a 29-year-old woman 27 weeks into her first pregnancy, without remarkable past medical history or vascular risk factors. She was admitted 1 h after sudden onset of a left total anterior circulation syndrome (National Institute of Health Stroke Scale [NIHSS] score of 23). CT and angio-CT scans were normal. Thrombolysis was performed, with mild clinical improvement. Brain MRI showed multi-territorial embolic events. Extended blood panel, cervical-transcranial ultrasound, 48-h ECG monitoring, and transthoracic echocardiogram were unremarkable. She was started on aspirin and low-molecular-weight heparin (LMWH), giving birth to a healthy child 10 weeks later. Patient 2 was a 45-year-old woman 34 weeks into her pregnancy, without remarkable past medical history or vascular risk factors. She was admitted 30 min after sudden onset of a left partial anterior circulation syndrome, already partially recovered (NIHSS score of 4). The CT scan showed only a subacute right incidental middle cerebral artery infarct, while the angio-CT confirmed a left M3 branch occlusion. Thrombolysis and thrombectomy were contraindicated by the recent contralateral infarct, mild deficits, and distal occlusion site. Brain MRI also suggested an embolic etiology and LMWH was started. Extended blood panel, 48-h ECG monitoring, and transthoracic echocardiogram were normal. She gave birth to a healthy baby 4 weeks later. These cases emphasize the growing real-world evidence of the emergent use of CT, IV contrast, and recombinant tissue plasminogen activator in pregnant women with acute stroke, while also illustrating the importance of an individualized management, accounting for the safety of both mother and child.
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Hanna, Lydia, and Richard Gibbs. "Brain Protection in the Endo-Management of Proximal Aortic Aneurysms." Hearts 1, no. 2 (July 1, 2020): 25–37. http://dx.doi.org/10.3390/hearts1020005.
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Neurological brain injury (NBI) remains the most feared complication following thoracic endovascular aortic repair (TEVAR), and can manifest as clinically overt stroke and/or more covert injury, detected only on explicit neuropsychological testing. Microembolic signals (MES) detected on transcranial Doppler (TCD) monitoring of the cerebral arteries during TEVAR and the high prevalence and incidence of new ischaemic infarcts on diffusion-weighted magnetic resonance imaging (DW-MRI) suggests procedure-related solid and gaseous cerebral microembolisation to be an important cause of NBI. Any intervention that can reduce the embolic burden during TEVAR may, therefore, help mitigate the risk of stroke and the covert impact of ischaemic infarcts to the function of the brain. This perspective article provides an understanding of the mechanism of stroke and reviews the available evidence regarding potential neuroprotective strategies that target high-risk procedural steps of TEVAR to reduce periprocedural cerebral embolisation.
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Schneweis, Susanne, Frank Staub, Christian Dohmen, Gerit Brinker, Michael Neveling, Rudolf Graf, Wolf-Dieter Heiss, and Martin Grond. "Extracellular markers of impending malignant brain edema in large hemispheric stroke." Stroke 32, suppl_1 (January 2001): 337. http://dx.doi.org/10.1161/str.32.suppl_1.337-a.
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117 Background: The development of malignant brain edema is a life-threatening complication of large hemispheric stroke. Hemicraniectomy and hypothermia are two invasive therapeutic options aiming to reduce mortality and to improve outcome in space-occupying MCA-infarction. The earlier such interventions are initiated the better is the chance of favourable outcome. However, therapeutic decision making is quite arbitrary as clinical observation, imaging or ICP measurement do not yield reliable prognostic criteria. Objective: To assess potential predictors of evolution of malignant brain edema in large MCA-infarction by microdialysis. Subjects and Methods: Following an ongoing prospective clinical trial invasive monitoring was performed in eight patients with large MCA-infarction. 18–36 hours after stroke onset a microdialysis probe was inserted in the parenchyma of the ipsilateral frontal lobe together with an ICP measuring device. Extracellular concentrations of glutamate, lactate, pyruvate, glycerol and various aminoacids were measured continuously for five days. CCT scans were performed on admission, after 6–12 h and at day 5. Scans were scrutinized for presence of mass-effect and size of infarction. Neurological deficit was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: Median NIHSS at baseline was 18 pts. (range 15–29 pts.). All patients suffered from a large stroke covering more than two thirds of the MCA-territory. In 4/8 patients an infarction of the entire territory of the MCA developed, in 3 of them with fatal space-occupying brain edema. The dynamics of the different substances varied in accordance with the clinical course, size of infarction and local brain edema: in patients with a massive edema in CCT an increase in glutamate concentrations and lactate/pyruvate-ratio was found, whereas patients without mass-effect demonstrated generally low and stable concentrations of these substances. Conclusion: In patients with large hemispheric infarction, bedside monitoring with microdialysis is feasible and may be valuable to predict impending malignant brain edema.
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Alsubaie, RS, M. Paquet, J. Paturel, S. Fridman, K. Kimpinski, and LA Sposato. "P.094 Characterizing post-stroke autonomic functioning. sub-study protocol of the clinical arm of PARADISE study." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 45, s2 (June 2018): S41. http://dx.doi.org/10.1017/cjn.2018.196.
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Background: Strokes can cause a variety of cardiovascular complications. The underlying mechanisms are largely unknown but there is evidence that dysautonomia plays a role in stroke induced-heart injury (SIHI) and arrhythmias triggered by damage of specific brain regions involved in the autonomic regulation of cardiac functions. Understanding these mechanisms could aid in preventing these cardiovascular consequences. We hypothesize that compared to -patients with sinus rhythm (SR) or with cardiogenic atrial fibrillation known before the stroke (cKAF) or diagnosed after the stroke (cAFDAS), those with neurogenic AFDAS (nAFDAS) will show a specific pattern of autonomic functioning. Methods: We will prospectively evaluate 200 ischemic stroke patients at the London Health Sciences Center University Hospital. Participants will undergo continuous electrocardiographic monitoring during 14 days. Based on pre-specified criteria, patients with AFDAS will be classified into presumably neurogenic vs cardiogenic. We will assess autonomic function within 14 days after stroke onset by using the Autonomic Reflex Screening. We will compare markers of cardiac dysfunction with autonomic changes, as well as specific stroke topographies for SR, cKAF, cAFDAS, and nAFDAS. Results: We are currently performing an interim analysis. Conclusions: Characterizing the autonomic changes that occur after ischemic stroke and their relationship with heart injury will help to advance knowledge on the pathophysiology of SIHI.
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Mrozek, Ségolène, Fanny Vardon, and Thomas Geeraerts. "Brain Temperature: Physiology and Pathophysiology after Brain Injury." Anesthesiology Research and Practice 2012 (2012): 1–13. http://dx.doi.org/10.1155/2012/989487.
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The regulation of brain temperature is largely dependent on the metabolic activity of brain tissue and remains complex. In intensive care clinical practice, the continuous monitoring of core temperature in patients with brain injury is currently highly recommended. After major brain injury, brain temperature is often higher than and can vary independently of systemic temperature. It has been shown that in cases of brain injury, the brain is extremely sensitive and vulnerable to small variations in temperature. The prevention of fever has been proposed as a therapeutic tool to limit neuronal injury. However, temperature control after traumatic brain injury, subarachnoid hemorrhage, or stroke can be challenging. Furthermore, fever may also have beneficial effects, especially in cases involving infections. While therapeutic hypothermia has shown beneficial effects in animal models, its use is still debated in clinical practice. This paper aims to describe the physiology and pathophysiology of changes in brain temperature after brain injury and to study the effects of controlling brain temperature after such injury.
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Tiwari, Yash V., Jianfei Lu, Qiang Shen, Bianca Cerqueira, and Timothy Q. Duong. "Magnetic resonance imaging of blood–brain barrier permeability in ischemic stroke using diffusion-weighted arterial spin labeling in rats." Journal of Cerebral Blood Flow & Metabolism 37, no. 8 (January 1, 2016): 2706–15. http://dx.doi.org/10.1177/0271678x16673385.
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Diffusion-weighted arterial spin labeling magnetic resonance imaging has recently been proposed to quantify the rate of water exchange (Kw) across the blood–brain barrier in humans. This study aimed to evaluate the blood–brain barrier disruption in transient (60 min) ischemic stroke using Kw magnetic resonance imaging with cross-validation by dynamic contrast-enhanced magnetic resonance imaging and Evans blue histology in the same rats. The major findings were: (i) at 90 min after stroke (30 min after reperfusion), group Kw magnetic resonance imaging data showed no significant blood–brain barrier permeability changes, although a few animals showed slightly abnormal Kw. Dynamic contrast-enhanced magnetic resonance imaging confirmed this finding in the same animals. (ii) At two days after stroke, Kw magnetic resonance imaging revealed significant blood–brain barrier disruption. Regions with abnormal Kw showed substantial overlap with regions of hyperintense T2 (vasogenic edema) and hyperperfusion. Dynamic contrast-enhanced magnetic resonance imaging and Evans blue histology confirmed these findings in the same animals. The Kw values in the normal contralesional hemisphere and the ipsilesional ischemic core two days after stroke were: 363 ± 17 and 261 ± 18 min−1, respectively (P < 0.05, n = 9). Kw magnetic resonance imaging is sensitive to blood–brain barrier permeability changes in stroke, consistent with dynamic contrast-enhanced magnetic resonance imaging and Evans blue extravasation. Kw magnetic resonance imaging offers advantages over existing techniques because contrast agent is not needed and repeated measurements can be made for longitudinal monitoring or averaging.
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Kneihsl, Markus, Thomas Gattringer, Egbert Bisping, Daniel Scherr, Reinhard Raggam, Harald Mangge, Christian Enzinger, et al. "Blood Biomarkers of Heart Failure and Hypercoagulation to Identify Atrial Fibrillation–Related Stroke." Stroke 50, no. 8 (August 2019): 2223–26. http://dx.doi.org/10.1161/strokeaha.119.025339.
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Background and Purpose— Occult atrial fibrillation (AF) causes a relevant proportion of initially cryptogenic stroke (CS), but prolonged rhythm monitoring is difficult to apply to all such patients. We hypothesized that blood biomarkers indicating heart failure (NT-proBNP [N-terminal pro-brain natriuretic peptide]) and hypercoagulability (D-dimer, AT-III [antithrombin-III]) were associated with AF-related stroke and could serve to predict the likelihood of AF detection in CS patients early on. Methods— Over a 1-year period, we prospectively applied a defined etiologic work-up to all ischemic stroke patients admitted to our stroke unit. If no clear stroke cause was detected (CS), patients underwent extended in-hospital cardiac rhythm monitoring (≥72 hours). Blood to determine biomarker levels was drawn within 24 hours after admission. Results— Of 429 patients, 103 had AF-related stroke. Compared with noncardiac stroke patients (n=171), they had higher NT-proBNP (1867 versus 263 pg/ml) and D-dimer levels (1.1 versus 0.6 µg/ml), and lower AT-III concentration (89% versus 94%). NT-proBNP ≥505 pg/ml distinguished AF-related from noncardiac stroke with a sensitivity of 93% and a specificity of 72%. D-dimer and AT-III cutoffs had lower sensitivities (61% and 53%) and specificities (58% and 69%) for AF-related stroke. Of all initially 143 CS patients, 14 were diagnosed with AF during in-hospital monitoring. The preidentified NT-proBNP cutoff ≥505 pg/ml correctly predicted AF in 12 of them (86%, negative predictive value: 98%), while D-dimer and AT-III cutoffs were noncontributory. Conclusions— This study supports the association of NT-proBNP and to a lesser extent of hypercoagulation markers with AF-related stroke. NT-proBNP seems helpful in selecting CS patients for immediate extended cardiac rhythm monitoring to detect occult AF whereby levels <505 pg/ml seem to have a high-negative predictive value.
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Thornhill, Jim, and Dale Corbett. "Therapeutic implications of hypothermic and hyperthermic temperature conditions in stroke patients." Canadian Journal of Physiology and Pharmacology 79, no. 3 (March 1, 2001): 254–61. http://dx.doi.org/10.1139/y00-119.
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Brain temperature is an important variable in determining the outcome of cerebral ischemia; increases in core temperature escalate neural damage whereas decreases in core temperature reduce damage. Fever induction often occurs in patients prior to or as a direct or indirect result of the ischemic insult, with a worsened stroke outcome, compared with non-febrile ischemic patients. Most importantly, post-ischemic hypothermia reduces long term neural damage and associated behavioral deficits in animals studied for up to a year after the ischemic insult. This review discusses the importance of monitoring the brain temperature of stroke patients and implemention of therapeutic thermoregulatory strategies to reduce the temperature of ischemic patients.Key words: hypothermia, neuroprotection, fever, neural and behavioral outcomes.
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Rodriguez-Duarte, David O., Jorge A. Tobon Vasquez, Rosa Scapaticci, Lorenzo Crocco, and Francesca Vipiana. "Assessing a Microwave Imaging System for Brain Stroke Monitoring via High Fidelity Numerical Modelling." IEEE Journal of Electromagnetics, RF and Microwaves in Medicine and Biology 5, no. 3 (September 2021): 238–45. http://dx.doi.org/10.1109/jerm.2020.3049071.
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Scapaticci, Rosa, Jorge Tobon, Gennaro Bellizzi, Francesca Vipiana, and Lorenzo Crocco. "Design and Numerical Characterization of a Low-Complexity Microwave Device for Brain Stroke Monitoring." IEEE Transactions on Antennas and Propagation 66, no. 12 (December 2018): 7328–38. http://dx.doi.org/10.1109/tap.2018.2871266.
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Liu, LiXu, WeiWei Dong, XunMing Ji, LiHua Chen, Ling Chen, Wei He, and JianPing Jia. "A new method of noninvasive brain-edema monitoring in stroke: cerebral electrical impedance measurement." Neurological Research 28, no. 1 (January 2006): 31–37. http://dx.doi.org/10.1179/016164106x91843.
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Martín, Abraham, Emilie Macé, Raphael Boisgard, Gabriel Montaldo, Benoit Thézé, Mickael Tanter, and Bertrand Tavitian. "Imaging of Perfusion, Angiogenesis, and Tissue Elasticity after Stroke." Journal of Cerebral Blood Flow & Metabolism 32, no. 8 (April 11, 2012): 1496–507. http://dx.doi.org/10.1038/jcbfm.2012.49.
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Blood flow interruption in a cerebral artery causes brain ischemia and induces dramatic changes of perfusion and metabolism in the corresponding territory. We performed in parallel positron emission tomography (PET) with [15O]H2O, single photon emission computed tomography (SPECT) with [99mTc]hexamethylpropylene-amino-oxime ([99mTc]HMPAO) and ultrasonic ultrafast shear wave imaging (SWI) during, immediately after, and 1, 2, 4, and 7 days after middle cerebral artery occlusion (MCAO) in rats. Positron emission tomography and SPECT showed initial hypoperfusion followed by recovery at immediate reperfusion, hypoperfusion at day 1, and hyperperfusion at days 4 to 7. Hyperperfusion interested the whole brain, including nonischemic areas. Immunohistochemical analysis indicated active angiogenesis at days 2 to 7, strongly suggestive that hyperperfusion was supported by an increase in microvessel density in both brain hemispheres after ischemia. The SWI detected elastic changes of cerebral tissue in the ischemic area as early as day 1 after MCAO appearing as a softening of cerebral tissue whose local internal elasticity decreased continuously from day 1 to 7. Taken together, these results suggest that hyperperfusion after cerebral ischemia is due to formation of neovessels, and indicate that brain softening is an early and continuous process. The SWI is a promising novel imaging method for monitoring the evolution of cerebral ischemia over time in animals.
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Santos, Daniel Paes de Almeida dos, Parthasarathy Deenadayalan Thirumala, Gautama Reddy, Daniel Ferreira de Barros, Vinicius Naves Rezende Faria, Varun Shandal, and Pedro Kurtz. "Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review." Arquivos de Neuro-Psiquiatria 80, no. 12 (December 2022): 1196–203. http://dx.doi.org/10.1055/s-0042-1758648.
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Abstract Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54–2.98; p < 0.0001).
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Bernstein, Richard A., Vincenzo Di Lazzaro, Marilyn M. Rymer, Rod S. Passman, Johannes Brachmann, Carlos A. Morillo, Tommaso Sanna, et al. "Infarct Topography and Detection of Atrial Fibrillation in Cryptogenic Stroke: Results from CRYSTAL AF." Cerebrovascular Diseases 40, no. 1-2 (2015): 91–96. http://dx.doi.org/10.1159/000437018.
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Background: Insertable cardiac monitors (ICM) have been shown to detect atrial fibrillation (AF) at a higher rate than routine monitoring methods in patients with cryptogenic stroke (CS). However, it is unknown whether there are topographic patterns of brain infarction in patients with CS that are particularly associated with underlying AF. If such patterns exist, these could be used to help decide whether or not CS patients would benefit from long-term monitoring with an ICM. Methods: In this retrospective analysis, a neuro-radiologist blinded to clinical details reviewed brain images from 212 patients with CS who were enrolled in the ICM arm of the CRYptogenic STroke And underLying AF (CRYSTAL AF) trial. Kaplan-Meier estimates were used to describe rates of AF detection at 12 months in patients with and without pre-specified imaging characteristics. Hazard ratios (HRs), 95% confidence intervals (CIs), and p values were calculated using Cox regression. Results: We did not find any pattern of acute brain infarction that was significantly associated with AF detection after CS. However, the presence of chronic brain infarctions (15.8 vs. 7.0%, HR 2.84, 95% CI 1.13-7.15, p = 0.02) or leukoaraiosis (18.2 vs. 7.9%, HR 2.94, 95% CI 1.28-6.71, p < 0.01) was associated with AF detection. There was a borderline significant association of AF detection with the presence of chronic territorial (defined as within the territory of a first or second degree branch of the circle of Willis) infarcts (20.9 vs. 10.0%, HR 2.37, 95% CI 0.98-5.72, p = 0.05). Conclusions: We found no evidence for an association between brain infarction pattern and AF detection using an ICM in patients with CS, although patients with coexisting chronic, as well as acute, brain infarcts had a higher rate of AF detection. Acute brain infarction topography does not reliably predict or exclude detection of underlying AF in patients with CS and should not be used to select patients for ICM after cryptogenic stroke.
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Nogueira, Adriano B., Ariel B. Nogueira, José C. Esteves Veiga, and Manoel J. Teixeira. "Multimodality Monitoring, Inflammation, and Neuroregeneration in Subarachnoid Hemorrhage." Neurosurgery 75, no. 6 (July 18, 2014): 678–89. http://dx.doi.org/10.1227/neu.0000000000000512.
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Abstract Background: Stroke, including subarachnoid hemorrhage (SAH), is one of the leading causes of morbidity and mortality worldwide. The mortality rate of poor-grade SAH ranges from 34% to 52%. In an attempt to improve SAH outcomes, clinical research on multimodality monitoring has been performed, as has basic science research on inflammation and neuroregeneration (which can occur due to injury-induced neurogenesis). Nevertheless, the current literature does not focus on the integrated study of these fields. Multimodality monitoring corresponds to physiological data obtained during clinical management by both noninvasive and invasive methods. Regarding inflammation and neuroregeneration, evidence suggests that, in all types of stroke, a proinflammatory phase and an anti-inflammatory phase occur consecutively; these phases affect neurogenesis, which is also influenced by other pathophysiological features of stroke, such as ischemia, seizures, and spreading depression. Objective: To assess whether injury-induced neurogenesis is a prognostic factor in poor-grade SAH that can be monitored and modulated. Methods: We propose a protocol for multimodality monitoring-guided hypothermia in poor-grade SAH in which cellular and molecular markers of inflammation and neuroregeneration can be monitored in parallel with clinical and multimodal data. Expected Outcomes: This study may reveal correlations between markers of inflammation and neurogenesis in blood and cerebrospinal fluid, based on clinical and multimodality monitoring parameters. Discussion: This protocol has the potential to lead to new therapies for acute, diffuse, and severe brain diseases.
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Yoon, Cindy W., Eungseok Lee, Byung-Nam Yoon, Hee-Kwon Park, and Joung-Ho Rha. "A Case of Turner Syndrome with Multiple Embolic Infarcts." Case Reports in Neurology 8, no. 3 (September 15, 2016): 199–203. http://dx.doi.org/10.1159/000449282.
Full textAbstract:
Only a few cases of Turner syndrome (TS) with ischemic stroke have been reported. Various arteriopathies of the cerebral arteries, including fibromuscular dysplasia, congenital hypoplasia, moyamoya syndrome, and premature atherosclerosis have been assumed to be the cause of ischemic stroke in TS. There has been no case report of a TS patient presenting with an embolic stroke pattern without any cerebral arteriopathy. A 28-year-old woman with TS was referred to our hospital because of abnormal brain magnetic resonance imaging (MRI) findings. She underwent brain MRI at the referring hospital because she experienced sudden-onset diffuse headache. Diffusion-weighted imaging revealed multiple acute embolic infarcts in different vascular territories. Intracranial and extracranial arterial disease was not detected on cerebral magnetic resonance angiography and carotid sonography. Embolic source workups, including transthoracic and transesophageal echocardiography, Holter monitoring, and transcranial Doppler shunt study, were all negative. Hypercoagulability and vasculitis panels were also negative. Our patient was diagnosed with cryptogenic embolic stroke. This is the first report of a TS patient with an embolic stroke pattern. Our case shows that ischemic stroke in TS could be due to embolism as well as the various cerebral arteriopathies documented in previous reports.
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Giammello, Fabrizio, Domenico Cosenza, Carmela Casella, Francesca Granata, Cristina Dell’Aera, Maria Carolina Fazio, Paolino La Spina, et al. "Isolated Insular Stroke: Clinical Presentation." Cerebrovascular Diseases 49, no. 1 (2020): 10–18. http://dx.doi.org/10.1159/000504777.
Full textAbstract:
The symptoms related to insular ischemia have been the object of several studies in patients affected by stroke, although they are often accompanied by other ischemic alteration of adjacent brain structures supplied by the middle cerebral artery (MCA). The insula is vulnerable because of an ischemia due to thromboembolic vascular occlusion of the M1 MCA segment and the 2 main MCA branches (M2), mainly when they abruptly arise from the principal stem at a right angle. This topographical and anatomical peculiarity could enable an embolic formation, especially due to atrial fibrillation (AF), to occlude the transition pathway between M1 and M2, while the proximal origin of vascular supply protects the insula from ischemia due to hemodynamic factors. The aim of the study is to characterize the clinical aspects of acute ischemic strokes as a first event in the insular territory with specific attention to atypical manifestation. We have considered 233 patients with a first event stroke involving the insular territory and 13 cases of isolated insular stroke (IIS), from the stroke registry of the Policlinico “G.Martino”, University of Messina, between the February 10, 2014 and the February 7, 2018. IIS patients showed CT/MRI lesions restricted to the insular region. Exclusion criteria were coexisting neurological diseases, structural brain lesions, extension to the subinsular area >50% of the total infarct volume. We identified 13 IIS patients (mean age 74 years), with an isolated symptom or a combination of typical and atypical aspects. Furthermore, we observed high frequency detection of cardiac disturbances. To our knowledge, just a few previous studies have described IIS; their incidence is still not well defined. IIS manifested with a combination of deficits including motor, somatosensory, speaking, coordination, autonomic and cognitive disturbances. After an ischemic stroke, AF manifestation could follow briefly the major event and its duration could be very short, as an autonomic dysfunction due to an insular infarction. This clinical condition requires a continuous cardiac monitoring for this dangerous occurrence.
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Lenz, Maximilian, Amelie Eichler, and Andreas Vlachos. "Monitoring and Modulating Inflammation-Associated Alterations in Synaptic Plasticity: Role of Brain Stimulation and the Blood–Brain Interface." Biomolecules 11, no. 3 (February 26, 2021): 359. http://dx.doi.org/10.3390/biom11030359.
Full textAbstract:
Inflammation of the central nervous system can be triggered by endogenous and exogenous stimuli such as local or systemic infection, trauma, and stroke. In addition to neurodegeneration and cell death, alterations in physiological brain functions are often associated with neuroinflammation. Robust experimental evidence has demonstrated that inflammatory cytokines affect the ability of neurons to express plasticity. It has been well-established that inflammation-associated alterations in synaptic plasticity contribute to the development of neuropsychiatric symptoms. Nevertheless, diagnostic approaches and interventional strategies to restore inflammatory deficits in synaptic plasticity are limited. Here, we review recent findings on inflammation-associated alterations in synaptic plasticity and the potential role of the blood–brain interface, i.e., the blood–brain barrier, in modulating synaptic plasticity. Based on recent findings indicating that brain stimulation promotes plasticity and modulates vascular function, we argue that clinically employed non-invasive brain stimulation techniques, such as transcranial magnetic stimulation, could be used for monitoring and modulating inflammation-induced alterations in synaptic plasticity.
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Ambresh, Ayyali, and Madhu K R. "Clinical profile of acute ischemic stroke in type 2 diabetes mellitus." IP Indian Journal of Neurosciences 7, no. 3 (September 15, 2021): 237–40. http://dx.doi.org/10.18231/j.ijn.2021.042.
Full textAbstract:
Stroke is the second leading causes of death worldwide and approximately 80% of strokes are due to ischemic cerebral infarction and 20% due to brain haemorrhage. Diabetes Mellitus is a very common metabolic disorder and it is an independent risk factor for stroke. Glucose intolerance in a stroke patient may or may not reflect glycemia prior to the event. This study is to assess the clinical profile of Acute Ischemic stroke in type 2 Diabetes Mellitus.To evaluate the clinical profile of acute ischemic stroke in type 2 Diabetes Mellitus. This a cross sectional descriptive study. This is an cross sectional study including 64 patients.Maximum number of patients were in the age group of 60 – 69 years, with mean age of 63.59±12.59 years.The male to female of 1.37:1. There were 25 patients (39.1%) well controlled Diabetes patients, 16(25.0%) fairly controlled and 23 (35.9%) were poorly controlled Diabetic patient. The common risk factors were Diabetes mellitus, hypertension, smoking, dyslipidemia, Rheumatic heart disease and Retroviral disease.HbA1c should be considered as an independent risk factor for poor clinical outcome and worse prognosis.Early diagnosis and treatment of diabetes including lifestyle modification and periodic monitoring of HbA1c levels may reduce the development of stroke and morbidity and mortality associated with it. Commonest clinical presentation was motor weakness (100%), cranial nerve dysfunction(45.3%), altered sensorium (29.7%), language disturbances (45.3%), sensory impairment(26.6%).