摘要:

New treatments for stroke demand an aggressive approach to diagnosis and hyperacute decision making. Is it a stroke? Is it ischemic or hemorrhagic? What is the stroke mechanism? History (including from witnesses and first responders), physical and neurologic examination, and stat computed tomography (CT) findings facilitate formulating clear preliminary answers to these questions, guiding initial management. Stroke onset isabrupt, symptoms and signs arefocal, andnegativefindings predominate over positive. Differential diagnosis and stroke mechanism are discussed in terms of these principles.

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Stroke is the most common cause of adult disability and the third leading cause of death in America. In the past 10 years, several medical and surgical treatments for stroke were proven effective. Carotid endarterectomy should be considered after TIA or minor stroke in patients with greater than 70% stenosis. Antiplatelet agents remain the mainstay for primary and secondary stroke prevention. Patients in atrial fibrillation should be considered for anticoagulation. If prevention therapy fails, the patient may present to the ED with acute stroke; the only accepted treatment for stroke, thrombolysis, is effective if used according to protocol. Proper use of thrombolysis begins with an accurate diagnosis, including evaluation for stroke mimics. Urgent evaluation is facilitated by establishing a code stroke team similar to the trauma team. Unproven therapy, including steroids, hyperbaric oxygen, and intraluminal stents, should generally be used in the setting of a controlled clinical trial.

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Transient ischemic attacks (TIAs) are a symptom of underlying cerebral vascular disease. Many patients who experience TIAs will progress to suffer the debilitating effects of a stroke. Patients experiencing a TIA should be evaluated for the etiology of the ischemia. The treatment options for patients with transient cerebral vascular ischemia can be determined once the factors causing the ischemia are characterized. The evaluation of the patient experiencing a TIA and the current treatment options currently in use are discussed.

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Traumatic brain injury is a significant cause of death and disability. Most injuries result from blunt force and range from a simple concussion to severe intracranial hemorrhage. Subdural and epidural hematomas are associated with significant underlying brain injury. Penetrating injuries are extremely morbid and carry a high mortality rate. After the initial injury, cerebral edema can cause a secondary brain insult, which compounds the severity of injury and worsens the prognosis for recovery. Blunt vascular injury of the carotid or vertebral arteries is uncommon but can cause cerebral ischemia. Successful management of traumatic brain injury is based on initial stabilization, rapid diagnosis, and prompt treatment. Airway management is the first and most important priority. Prompt computed tomography (CT) of the brain and neurosurgical consultation are essential. The outcome is determined by the severity of the initial injury, the rapidity of diagnosis and treatment, and the successful control of cerebral edema.

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Imaging is necessary for evaluating patients with acute brain injury. Computed tomography (CT) scanning is the primary tool for evaluating patients with acute head injuries, stroke, and intracranial hemorrhage, and it is the most cost-effective modality used in diagnosing neurosurgical emergencies. Magnetic resonance imaging (MRI) plays an important complementary role in many situations when CT scans are interpreted as normal or equivocal. Advances in emergent stroke therapy will undoubtedly require an increasing use of MRI techniques such as diffusion-weighted imaging (DWI) and MRI perfusion scans. This article addresses the indications for each modality and describes classical radiologic signs seen with acute brain injuries.

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Cardiovascular Involvement in Acute StrokeCardiovascular issues are important in both the etiology and outcome of stroke. The evaluation and triage of the stroke victim must include proper diagnosis and determination of the cause of the event. Establishing stable cardiac rhythm and hemodynamics is the first step for the Emergency Department (ED) doctor and is often complicated by underlying disease. Careful consideration of cardiovascular and neurologic issues guides the choice of optimal therapy. The most common arrhythmia in stroke patients is atrial fibrillation, which requires stabilization and long-term management to prevent further embolization. Thrombolytic therapy may be effective and can be used for both stroke and myocardial infarction within specific parameters. Evaluation of embolic stroke in hospitalized patients should include consideration of recent invasive procedures.

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0164-2340    

出版商:OVID    

年代:2001

数据来源: OVID