Management of acute stroke

Acute stroke is a medical emergency. The outcome is influenced by the rapidity and quality of initial care, which is best delivered by specialists with appropriate facilities, including 24 h access to computed tomography. Stroke management requires attention to simple details and has been summarised in clinical guidelines. General measures include control of blood glucose concentration, temperature, fluid balance, and oxygenation. Blood-pressure management is a matter for continuing research. Aspirin should be started early in ischaemic stroke, but heparin has doubtful value; antiembolism stockings may be preferable. Thrombolysis has a substantial benefit in selected circumstances, and trials continue to examine a wider role. Neuroprotection remains experimental, though magnesium is potentially of interest. Early neurosurgery has a role limited to decompression of lesions in the posterior fossa but is under trial for large hemispheric infarcts and moderate intracerebral bleeds.     

Management of acute ischemic stroke

Stroke is the third leading cause of death and the leading cause of disability in the United States. This article summarizes the management of acute ischemic stroke, including conventional and novel therapies. The article provides an overview of the initial management, diagnostic work-up, treatment options, and supportive measures that need to be considered in the acute phase of ischemic stroke.     

小脑中风与急性胃粘膜病变的临床研究

目的探讨小脑中风患者与急性胃粘膜病变的关系。方法采用前瞻性研究１４例小脑中风患者的血清胃泌素及胃镜改变，并与大脑半球非丘脑区中风患者相比较。结果（１）小脑中风患者血清胃泌素值明显高于大脑半球非丘脑区中风患者；（２）胃镜所见胃溃疡及急性胃粘膜糜烂的发生率也显著高于后者。结论小脑中风患者比大脑半球非丘脑区中风患者易发生急性胃粘膜病变     

Hemispatial neglect in cerebellar stroke

Cognitive deficits can be associated with cerebellar injury. The purpose of this study is to learn 1) if unilateral cerebellar injury might also cause hemispatial neglect, and if so, 2) if there is a left versus right asymmetry, 3) if the neglect is contralesional (CN) or ipsilesional (IN), and 4) if cerebellar injury might induce neglect by disruption of cerebellar-cortical networks. Participants were 28 patients with unilateral cerebellar stroke who were assessed for neglect within 2 months after the onset of stroke. To investigate if the cerebellar-cerebral network dysfunction induced neglect, 12 patients received perfusion single photon emission computed tomography (SPECT). Eight of the participants demonstrated neglect (28.6%), four with left cerebellar strokes (three with CN and one with IN) and four with right cerebellar strokes (three with IN and one with CN). Among five patients with neglect who had undergone SPECT, only one with ipsilesional neglect showed crossed cerebello-cerebral diaschisis. Neglect induced by cerebellar stroke might be more common than previously reported. Based on the cerebellar-cerebral network hypothesis we expected neglect to be more common with left than right cerebellar injury, but there was an equal number of patients with neglect from right and left sided strokes and the SPECT scan did not provide support of this hypothesis. Thus, this hypothesis cannot also explain the equal number of subject with ipsi- and contralesional neglect and in future studies alternative hypotheses such as vestibular hypothesis will have to be explored.     

Superior cerebellar artery territory stroke

Objectives– The purpose of this study was to clarify etiologic factors, prior symptoms and clinical features of isole superior cerebellar artery (SCA) territory infarcts. Methods– All data were collected from consecutive 21 patients with isole SCA infarcts involved on computerized tomography. Results– The risk factors including hypertension, cardiopathy and rhythm disturbances, hyperlipidemia, diabetes mellitus, abnormality in homeostasis, smoking, oral contraceptive have been identified. Headache, nausea-vomiting, vertigo, gait imbalance and diplopia were the most common complaints at onset. During the clinical course, the most common findings have been found as dysmetria and dysdiadochokinesia, dysarthria, ataxia and vertigo. Although 19 patients were improved in different degrees, 2 patients died because of cardiorespiratory arrest. Classical syndrome of SCA was only seen in 2 patients. Conclusion– According to our findings, SCA territory infarcts have multiple risk factors, and various clinical features as well as the syndrome of SCA are usually rare and incomplete.     

Dementia after surgery for cerebellar stroke: an unrecognized complication of acute hydrocephalus?

Three patients became demented after surgery for cerebellar hemorrhage or infarction with acute hydrocephalus. All were inattentive, perseverative, and disoriented. They had difficulty with memory, and trouble solving arithmetic problems or copying geometric figures. None showed aphasia, apraxia, or agnosia, although one had word-finding difficulty. One improved substantially in 6 months; one improved slightly in 1 year, and one did not change. None had persistent hydrocephalus. Acute hydrocephalus may have damaged the periventricular white matter to cause the dementia.     

Management of acute stroke: impact of registration studies

Stroke is a life-threatening or life-changing disease that is expensive in health care costs and lost productivity. Stroke also is a leading cause of human suffering. While the risk of stroke may be reduced with advances in prevention, recent advances in acute care can limit the consequences of stroke. In particular, the success of reperfusion therapies including intra-arterial interventions and intravenous administration of thrombolytic agents means that some patients with stroke may be cured. Still, the time window for effective treatment of stroke is relatively short. As a result, modern stroke management requires the close collaboration of the public, health care providers, administrators, insurance companies, and the government. Potential strategies to extend modern stroke care to as many patients as possible include 1) educational programs to train community emergency medical service personnel and physicians, 2) development of stroke care plans at community hospitals, 3) an integrated community-comprehensive stroke center program based on consultation, and telemedicine. The goal is to have a highly integrated approach to provide emergency treatment of the stroke that provides key emergency treatment, including intravenous administration of thrombolytic medications, at a community hospital (primary stroke center) with evacuation to a comprehensive stroke center that has resources and expertise that are not available in the primary stroke center. Taiwan is an ideal location for the development of such regional stroke programs.     

Management of arterial hypertension in patients with acute ischemic stroke

PURPOSE: We aimed with study to assess the current clinical practice about the management of high blood pressure in patients in the acute phase of ischemic stroke. We also comment some topics of ischemic stroke treatment. METHODS: A case report of a patient admitted 8 hours after onset of ischemic stroke and with blood pressure of 186 x 110 mmHg was presented to 120 surgeons and clinician. They were asked to decide the best therapeutic option: to increase, decrease or maintenance blood pressure. RESULTS: Thirty-eight physicians (31.7%) considered decreasing blood pressure the best therapeutics, 82 (68.3%) considered maintenance and none decided to increase it (p < 0.05). There was no difference between the two specialties conduct. The physicians, with more than 10 years of graduation, had a tendency to decrease the blood pressure (p < 0.05). CONCLUSION: The maintenance of blood pressure may present a sufficient blood support to compensate brain flow. A high percentage of the physicians (31.7%) do not know about the current concepts of therapeutics considering hypertension in acute ischemic stroke. The development on special units to treat these patients ("stroke units") may eventually decrease the morbimortality rates of ischemic stroke.     

Crossed cerebellar diaschisis after acute ischemic stroke detected by intravoxel incoherent motion magnetic resonance imaging

Neurological Sciences - To study the value of 3.0&nbsp;T magnetic resonance imaging with intravoxel incoherent motion (IVIM) in the diagnosis of the crossed cerebellar diaschisis (CCD) after...     

Crossed cerebellar hypoperfusion in hyperacute ischemic stroke

OBJECTIVE: In chronic stage of cerebral hemispheric infarction, contralateral cerebellar blood flow and metabolism are depressed, which is known as crossed cerebellar diaschisis (CCD). The present study was performed to elucidate (1) whether the diaschisis occurs in hyperacute stage of ischemic stroke when computed tomography (CT) scans is not able to identify infarction, and (2) which site of lesion in the cerebrum is responsible for the depression in contralateral cerebellar blood flow. METHODS: Single photon emission computed tomography was performed in 21 patients with middle cerebral artery (MCA) embolic infarction within 6 h of the onset (3.2+/-1.1 h, mean+/-S.D.). Regions of interest (ROIs) were symmetrically located in the cerebral hemispheres including cerebral cortex and subcortex, and in the cerebellar hemispheres. RESULTS: The side-to-side ratio of cerebellar blood flow ipsilateral to that contralateral to cerebral infarct was significantly increased compared with that in normal control (P<0.001), indicating that contralateral cerebellar blood flow was significantly depressed. In hyperacute stage, the ratio of cerebellar blood flow appeared to be associated with the ratio of cerebral blood flow in whole hemispheres (r=0.44, P<0.05), in anterior frontal lobe (r=0.44, P<0.05) and in anterior temporal lobe (r=0.58, P<0.01), but not in infarct areas (r=0.26, P=0.3). Stepwise regression analysis revealed that the ratios in cerebellar hemispheres were associated with those in anterior temporal lobe (multiple regression analysis, r=0.58, P<0.01). CONCLUSIONS: Crossed cerebellar diaschisis occurs at hyperacute stage of stroke of the MCA infarction. It may be related to the hypoperfusion in the anterior frontal and anterior temporal lobes of the cerebrum where regional blood flow is decreased by ischemic infarction per se or by ipsilateral hemispheric depression from infarct area (diaschisis mechanism).     

Eye-movement disorders in brain-stem and cerebellar stroke

Vertebrobasilar strokes can yield varied disturbances of eye movements, by affecting specific centers and pathways contained in the brain stem and cerebellum. Unique disorders combining supranuclear, nuclear, and infranuclear syndromes may occur. Some eye-movement abnormalities are useful localizing signs (eg, gaze palsies, rotatory nystagmus, and ipsilateral saccadic bias), but many others are not. The use of techniques such as magnetic resonance imaging may provide new insights in clinicotopographic correlations in patients with good recovery, in the absence of pathologic verification.