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1.
Klein M Koedel U Pfefferkorn T Zeller G Woehrl B Pfister HW 《Critical care (London, England)》2011,15(6):R281-7
Introduction
Intracranial vascular complications are an important complication of acute bacterial meningitis. Ischemic stroke in meningitis is reported as a result of vasculitis, vasospasm, endocarditis or intraarterial thrombosis. The aim of the study was to identify the value of measuring cerebral blood flow velocity (CBFv) on transracranial doppler (TCD) in the identification of patients at risk for meningitis-associated stroke. 相似文献2.
Anouk Lamontagne Joyce Fung Bradford J McFadyen Jocelyn Faubert 《Journal of neuroengineering and rehabilitation》2007,4(1):22-8
Background
Walking speed, which is often reduced after stroke, can be influenced by the perception of optic flow (OF) speed. The present study aims to: 1) compare the modulation of walking speed in response to OF speed changes between persons with stroke and healthy controls and 2) investigate whether virtual environments (VE) manipulating OF speed can be used to promote volitional changes in walking speed post stroke. 相似文献3.
Transcranial Doppler in stroke. 总被引:6,自引:0,他引:6
Transcranial Doppler (TCD) has been extensively used in various clinical situations, and in the last two decades has established its role in the management of patients with cerebrovascular disease and stroke. Based on the Doppler principle, it uses ultrasound waves to insonate the blood vessels supplying the brain to obtain hemodynamic information. Anatomic abnormalities of vascular occlusion, stenosis and spasm can be indirectly derived. Intracranial arterial disease is an important cause of ischemic stroke and TCD can detect these with a fair amount of sensitivity and specificity. In hemodynamically significant extracranial internal carotid artery disease, TCD shows significant abnormalities in flow dynamics of the anterior circulation and abnormalities of cerebral vasomotor reactivity. A distinct advantage of TCD is the ability to monitor blood flow in a blood vessel over prolonged periods of time, which has shown microembolic signals in acute ischemic stroke, carotid artery disease, atrial fibrillation and during angiography. In acute ischemic stroke, TCD can be used to elucidate stroke mechanisms, plan and monitor treatment, and determine prognosis. In an era when stroke is increasingly being recognized as an emergency requiring immediate treatment, TCD may be capable of providing rapid information about the hemodynamic status of the cerebral circulation, within the time frame of the rather small 'therapeutic window'. TCD predicts vasospasm with a high degree of sensitivity and specificity and because of its non-invasive nature repeated assessments can be performed after subarachnoid hemorrhage. 相似文献
4.
Treger I Aidinof L Lutsky L Kalichman L 《Archives of physical medicine and rehabilitation》2010,91(11):1737-1740
Treger I, Aidinof L, Lutsky L, Kalichman L. Mean flow velocity in the middle cerebral artery is associated with rehabilitation success in ischemic stroke patients.
Objective
To evaluate the association between mean flow velocity (MFV) in the middle cerebral artery (MCA) measured by using transcranial Doppler (TCD) and functional and neurologic impairment change during rehabilitation after acute stroke.Design
Cross-sectional observational study.Setting
Acute neurologic rehabilitation department.Participants
Consecutive patients (N=67; 53 men, 14 women; mean ± SD age, 61.54±8.92y) referred to the rehabilitation center during the first 6 months of 2006 for a first ischemic stroke in the MCA area.Interventions
Not applicable.Main Outcome Measures
All subjects were evaluated on admission and at discharge by using the National Institutes of Health Stroke Scale (NIHSS) and the FIM. TCD measurements of MFV of the ipsilateral and contralateral MCA were performed on admission (during the first 20 days after stroke) and a few days before discharge.Results
Contralateral MFV at admission was associated significantly with all indexes of functional rehabilitation success (FIM score at discharge [β=.169; P=.010], change in FIM score [β=.554; P=.010], relative improvement in FIM score [β=.783; P=.003]). No significant association was found between indexes of NIHSS change and ipsilateral or contralateral MFV.Conclusions
Ipsilateral or contralateral MFV measured at admission did not change during the 2-month rehabilitation period. Our data showed a significant association between blood flow velocity in the contralateral MCA and functional rehabilitation parameters of patients after first ischemic stroke in the MCA area. 相似文献5.
6.
Ada Tang Kathryn M Sibley Mark T Bayley William E McIlroy Dina Brooks 《Journal of neuroengineering and rehabilitation》2006,3(1):23-8
Background and purpose
The Six-Minute Walk Test (6MWT) has been employed as a measure of functional capacity, but its relationship to cardiorespiratory fitness in stroke is not well established. Gait speed measured over short distances is commonly used as an index of walking competency following stroke. We evaluated the relationship between the 6MWT, aerobic fitness (VO2peak) and walking competency in sub-acute stroke. 相似文献7.
Berthold Bein Patrick Meybohm Erol Cavus Peter H Tonner Markus Steinfath Jens Scholz Volker Doerges 《Critical care (London, England)》2005,10(1):R18
Introduction
The present study was designed to compare cerebral hemodynamics assessed using the blood flow index (BFI) derived from the kinetics of the tracer dye indocyanine green (ICG) with transcranial Doppler ultrasound (TCD) in an established model of hemorrhagic shock. 相似文献8.
Pelin Batur MD Meng Yao BS MS Julia Bucklan DO Payal Soni MD Aarushi Suneja MD Ruth Farrell MD MA Maryann Mays MD 《Headache》2023,63(6):813-821
Objective
To clarify how factors such as estrogen dose and migraine history (including migraine subtype) impact ischemic stroke risks associated with combined hormonal contraceptive (CHC) use.Background
CHC use in those with migraine with aura has been restricted due to concerns about stroke risk.Methods
We conducted a case-control analysis of stroke risk associated with estrogen dose and migraine history among CHC users in a large tertiary care center. All women aged 18–55 who used a CHC between January 1, 2010, and December 31, 2019, were identified. Those with a stroke diagnosis were identified using ICD codes and confirmed via chart and imaging review. Details of personal and family medical history, stroke evaluation, ethinyl estradiol dosing (EE; ≥30 vs. <30 μg), and demographics were collected. From a random sample of 20,000 CHC users without stroke, a control cohort (n = 635) was identified and matched based on patient characteristics, medical and family histories, as well as stroke risk factors, to assess association between migraine diagnosis, migraine subtype, estrogen dose, and stroke.Results
Of the 203,853 CHC users in our cohort, 127 had confirmed stroke (0.06%; CI 0.05%, 0.07%). In unadjusted analyses, a higher number of patients in the case cohort had a diagnosis of migraine (34/127, 26.8%) compared to controls (109/635, 17.2%; p = 0.011). Stroke risk was higher with ≥30-μg EE doses compared to those using a <30-μg dose (OR, 1.52; CI 1.02, 2.26; p = 0.040). Compared to no migraine, personal history of migraine increased the odds of stroke (OR, 2.00; CI 1.27, 3.17; p = 0.003). Compared to no migraine, stroke risk was not significantly increased in those with migraine with aura, but migraine without aura increased the risk (OR, 2.35; CI 1.32, 4.2; p = 0.004).Conclusions
Overall stroke risk in our cohort of CHC users was low. When CHCs are used in those with migraine, formulations containing ≤30 μg EE are preferred. Shared decision-making should include discussions about ischemic stroke risks in patients with migraine, even those without aura. 相似文献9.
Background
There is a need to develop cost-effective, sensitive stroke assessment instruments. One approach is examining kinematic measures derived from goal-directed tasks, which can potentially be sensitive to the subtle changes in the stroke rehabilitation process. This paper presents the findings from a pilot study that uses a computer-assisted neurorehabilitation platform, interfaced with a conventional force-reflecting joystick, to examine the assessment capability of the system by various types of goal-directed tasks. 相似文献10.
背景经颅多普勒超声能无创性检测颅内动脉的血流信号,较为客观的反映脑血流动力学改变,有助于了解血管闭塞及狭窄的程度、部位、范围、侧支循环以及闭塞后再通的情况,对缺血性脑血管疾病的早期诊断、病情判断、预后评估具有重要价值.目的通过对缺血性脑卒中急性期的经颅超声多普勒动态观察,与脑电图、脑电图地形图、头颅计算机断层扫描等进行对比研究,以探讨经颅超声多普勒对缺血性脑卒中早期评估的价值,观察经颅超声多普勒与脑电图、脑电图地形图及神经功能缺损评分之间的相关性以判断病情指导治疗.设计病例-对照实验.单位昆明医学院第二附属医院神经内科.对象选择2001-10/2002-03在昆明医学院第二附属医院神经内科接受住院治疗的缺血性脑卒中23例患者及同期选择年龄性别相匹配的门诊健康体检者30人为对照组.方法①所有患者均于入院即刻行床旁经颅多普勒超声检查,并于入院后第2,4,7天复查,所有正常对照者均于体检当天行经颅多普勒超声检查.②所有患者均在入院当天行床旁脑电图及脑电图地形图检查.③所有患者于入院后即刻,入院后第3,4,7天进行神经功能缺损评分(最高得分45分,最低得分0分,0~15分为重度神经功能缺损,16~30分为中度神经功能缺损,31~45分为轻度神经功能缺损).主要观察指标①全部被试对象经颅多普勒超声检查结果.②缺血性脑卒中患者神经功能缺损评分、脑电图描记、脑电图地形图描记、头颅计算机断层扫描检查结果.结果缺血性脑卒中患者23例和30名健康体检者均进入结果分析.①入院当天经颅多普勒超声异常率91.3%,高于脑电图(65.2%)、脑电图地形图(78.3%)及头颅计算机断层扫描(17.4%).入院当天经颅多普勒超声表现为病侧大脑中动脉平均血流速度降低(34.92±13.25)cm/s(P<0.01).病侧大脑前动脉平均血流速度升高(65.47±16.69)cm/s(P<0.01).②大脑中动脉流速不对称指数(不对称指数)与神经功能缺损评分成正相关(P<0.01),与脑电图地形图慢波相对功率值成正相关(P<0.01~0.05),与α波相对功率值成负相关(P<0.01).动态观察发现经治疗病侧大脑中动脉平均血流速度逐渐恢复并出现流速增高,而病侧大脑前动脉平均血流速度随之下降,提示血管再通,但各自再通时间不同.结论在缺血性脑卒中急性期经颅多普勒超声可发现与闭塞血管相关的血流动力学异常,异常率高于脑电图地形图、脑电图及头颅计算机断层扫描.其异常程度与病情严重程度相关,动态观察有助于发现血管再通情况. 相似文献
11.
Amelia Nelson Gregory Kelly Richard Byyny Catherine Dionne Candice Preslaski Kevin Kaucher 《The American journal of emergency medicine》2019,37(2):344-348
Introduction
Acute ischemic stroke is a leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.Objective
This review evaluates literature and utility of tenecteplase for treatment of acute ischemic stroke.Discussion
Tenecteplase is modified, third generation fibrinolytic with greater specificity for fibrin bound clots. Current data in acute myocardial infarction suggest decreased bleeding events compared to alteplase. Multiple trials have investigated superiority of tenecteplase compared to tPA for treatment of acute ischemic stroke. Current guidelines designate tenecteplase as an alternative treatment for mild acute ischemic stroke patients based on recent literature.Conclusion
Recent emerging literature and limited recommendation guidance from governing medical societies leave many emergency medicine providers to weigh benefit versus risk of fibrinolytic therapy and tenecteplase's place in therapy. This review evaluates the available literature regarding tenecteplase and its utility in the treatment of acute ischemic stroke patients. 相似文献12.
Thijs Krabben Birgit I Molier Annemieke Houwink Johan S Rietman Jaap H Buurke Gerdienke B Prange 《Journal of neuroengineering and rehabilitation》2011,8(1):15
Background
The majority of stroke survivors have to cope with deficits in arm function, which is often measured with subjective clinical scales. The objective of this study is to examine whether circle drawing metrics are suitable objective outcome measures for measuring upper extremity function of stroke survivors. 相似文献13.
Filippo Molinari William Liboni Gianfranco Grippi Emanuela Negri 《Journal of neuroengineering and rehabilitation》2006,3(1):16-13
Background
Breath – holding (BH) is a suitable method for inducing cerebral vasomotor reactivity (VMR). The assessment of VMR is of clinical importance for the early detection of risk conditions and for the follow-up of disabled patients. Transcranial Doppler ultrasonography (TCD) is used to measure cerebral blood flow velocity (CBFV) during BH, whereas near-infrared spectroscopy (NIRS) measures the concentrations of the oxygenated (O 2 Hb) and reduced (CO 2 Hb) hemoglobin. The two techniques provide circulatory and functional-related parameters. The aim of the study is the analysis of the relationship between oxygen supply and CBFV as detected by TCD and NIRS in healthy subjects performing BH. 相似文献14.
Purpose
Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. In part due to the availability of more aggressive treatments, increasing numbers of patients with AIS are being admitted to the intensive care unit (ICU). Despite the availability of consensus guidance for the general management of AIS, there is little evidence to support its ICU management. The purpose of this article is to provide a contemporary perspective, and our recommendations, on the ICU management of AIS.Methods
We reviewed the current general AIS guidelines provided by the European Stroke Organisation, the American Stroke Association, and the UK National Institute for Health and Care Excellence, as well as the wider literature, for the data most relevant to the ICU management of AIS.Results
There are four interventions in AIS supported by class I evidence: care on a stroke unit, intravenous tissue plasminogen activator within 4.5 h of stroke onset, aspirin within 48 h of stroke onset, and decompressive craniectomy for supratentorial malignant hemispheric cerebral infarction. However, robust evidence for specific AIS management principles in the ICU setting is weak. Management principles currently focus on airway and ventilation management, hemodynamic and fluid optimization, fever and glycemic control, management of anticoagulation, antiplatelet and thromboprophylaxis therapy, control of seizures and surgical interventions for malignant middle cerebral artery and cerebellar infarctions.Conclusions
We have provided our recommendations for the principles of ICU management of AIS, based on the best available current evidence. Encouragement of large-scale recruitment of patients with AIS into clinical trials should aid the development of robust evidence for the benefit of different interventions in the ICU on outcome. 相似文献15.
目的 对比观察醒后卒中(WUS)与时间窗明确卒中(OCS)患者的多模态CT表现。方法 纳入因急性缺血性卒中而接受多模态CT检查的36例WUS患者(WUS组)与41例OCS患者(OCS组,起病时间<6 h),均经头颈部CT血管造影证实存在前循环大血管闭塞。采用Alberta卒中项目早期CT评分(ASPECTS)评价平扫CT所示早期脑缺血改变。将CT灌注(CTP)存在脑血流量(CBF)与脑血容量(CBV)不匹配区域认定为缺血半暗带,采用ASPECTS评价异常灌注范围(CBF-ASPECTS、CBV-ASPECTS)。结果 WUS组与OCS组平扫CT中位ASPECTS均为8.0分,差异无统计学意义(P>0.05)。27例(27/36,75.00%) WUS患者、30例(30/41,73.17%) OCS患者CTP存在缺血半暗带。WUS组与OCS组中位CBF-ASPECTS分别为3.0分及2.0分,CBV-ASPECTS均为6.0分,差异均无统计学意义(P均>0.05)。结论 WUS与起病6 h内OCS的多模态CT表现相似。 相似文献
16.
Konings MK Grundeman PF Goovaerts HG Roosendaal MR Hoefer IE Doevendans PA Rademakers FE Buhre WF 《Critical care (London, England)》2011,15(4):R165-8
Introduction
Recently, a non-invasive, continuous ventricular stroke volume monitoring system using skin electrodes has been developed. In contrast to impedance-based methods, the new technique (ventricular field recognition) enables measurement of changes in ventricular volume. A prototype using this new method was built (the hemologic cardiac profiler, HCP) and validated against a reference method in a pig model during variations in cardiac output. 相似文献17.
Treatment of stroke on an intensive stroke unit: a novel concept 总被引:26,自引:0,他引:26
18.
Kathleen L. Bagot PhD Tara Purvis MSc Shaun Hancock Henry Zhao PhD Skye Coote BN Damien Easton PhD Bruce C. V. Campbell PhD Steve M. Davis PhD Geoff A. Donnan PhD Shane Foster Francesca Langenberg BR Karen Smith PhD Michael Stephenson BHlthSci Stephen Bernard MD Sharon McGowan MBA Bernard Yan DMedSc Peter Mitchell MMed Sandy Middleton PhD Dominique A. Cadilhac PhD 《Journal of evaluation in clinical practice》2023,29(3):495-512
Rationale
Mobile stroke units (MSUs) are increasingly being implemented to provide acute stroke care in the prehospital environment, but a comprehensive implementation evaluation has not been undertaken.Aim
To identify successes and challenges in the pre- and initial operations of the first Australian MSU service from an interdisciplinary perspective.Methods
Process evaluation of the Melbourne MSU with a mixed-methods design. Purposive sampling targeted key stakeholder groups. Online surveys (administered June–September 2019) and semistructured interviews (October–November 2019) explored experiences. Directed content analysis (raters' agreement 85%) and thematic analysis results are presented using the Interactive Sociotechnical Analysis framework.Results
Participants representing executive/program operations, MSU clinicians and hospital-based clinicians completed 135 surveys and 38 interviews. Results converged, with major themes addressing successes and challenges: stakeholders, vehicle, knowledge, training/education, communication, work processes and working relationships.Conclusions
Successes and challenges of establishing a new MSU service extend beyond technical, to include operational and social aspects across prehospital and hospital environments. 相似文献19.
William H Gage Karl F Zabjek Kathryn M Sibley Ada Tang Dina Brooks William E McIlroy 《Journal of neuroengineering and rehabilitation》2007,4(1):41-10
Background
There is an important need to better understand the activities of individual patients with stroke outside of structured therapy since this activity is likely to have a profound influence on recovery. A case-study approach was used to examine the activity levels and associated physiological load of patients with stroke throughout a day. 相似文献20.
Wolfgang Schramm 《Journal of clinical monitoring and computing》2010,24(3):213-217