摘要:

Stroke is the third leading cause of death and the leading cause of brain damage in adults. Until recently, there has been no treatment for stroke. Thrombolytic therapy is now being used to treat ischemic stroke within 3 hours of onset in selected patients. Clinical trials are underway to determine whether thrombolytics are safe and effective when given 3 to 5 hours after the onset of ischemic stroke. Stroke treatment in the future may include various neuroprotective agents that are currently being studied. Early recognition of stroke symptoms and immediate care in the emergency department are essential for patients to be eligible for treatment. The article presents the underlying mechanisms and pathophysiology of stroke, stages of recognition and current emergency department management, new therapies and research, risk factors, and prevention.

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The early management of stroke has become a recognized neurologic emergency requiring early computed tomographic scanning to determine the presence or absence of hemorrhage. Intervention may include thrombolysis, which requires the rapid deployment of resources to ensure that treatment is performed early and appropriately. In the management of the stroke patient, it is important to avoid excessive use of both glucose and oxygen because these can further damage ischemic brain.

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Successful treatment of acute ischemia requires early and accurate diagnosis. As the first physician to evaluate the patient, the emergency physician must have a thorough understanding of the neuroimaging of stroke. The article presents the diagnosis of stroke using computed tomography and magnetic resonance imaging. Emphasis is placed on the detection of early signs of ischemia and the temporal evolution of the imaging findings to facilitate differentiation of acute, subacute, and chronic infarction. The imaging evaluation of hemorrhagic strokes, including hemorrhagic conversion of ischemic stroke, primary intracerebral hemorrhage, and subarachnoid hemorrhage, is also reviewed. Last, advanced magnetic resonance techniques that enable the differentiation of ischemic tissue from infarcted tissue are introduced. An understanding of these concepts will be critical in the new era of acute intervention for ischemic stroke.

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Thombolytic therapy for acute ischemic stroke is an intuitively attractive idea that has been under investigation since the 1950s. The advent of computed tomography, which allowed reliable differentiation of hemorrhage from ischemic stroke, and an understanding of the disease's pathophysiology led to a proliferation of studies. Data accumulated indicating that thrombolysis may be of benefit. Numerous approaches were investigated, including direct intraarterial infusion, superselective intraarterial infusion, and intravenous administration, with varying degrees of success. Recently, five major trials were undertaken of intravenous administration of either streptokinase (SK) or recombinant tissue plasminogen activator (rt-PA). The three trials of SK all showed an increase in early mortality and were stopped for safety reasons. One of the two rt-PA studies failed to show benefit in its intent-to-treat population but did show benefit for a subgroup, the target population. The other trial, sponsored by the National Institute of Neurological Diseases and Stroke, was actually two consecutive trials. Benefit was demonstrated (at 3 months) in the first trial and was confirmed in the second trial. This led the Food and Drug Administration to approve rt-PA for the treatment of acute ischemic stroke within 3 hours of onset of symptoms as safe and effective therapy. As the first approved treatment for this disease, rt-PA clears the path for future advances in treatment with new drugs and approaches.

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Carotid endarterectomy (CEA) has become an established procedure for the treatment of patients with transient ischemic attacks (TIAs) associated with severe stenosis and/or ulceration in the carotid artery and is the best option in symptomatic patients with 70% to 99% carotid artery stenosis. Percutaneous transluminal angioplasty (PTA) is being extensively and routinely applied to treat arteriosclerotic lesions in pelvic, leg, coronary, and renal arteries. PTA has not been widely accepted for the treatment of supra-aortic lesions, especially carotid artery stenosis, because of the danger of cerebral embolism. More recent technical developments, however, have made PTA feasible under restricted conditions.1Emergency CEA and PTA of carotid stenoses are still controversial. The pros and cons of emergency surgery and PTA for acute stroke, crescendo TIA, and acute carotid dissection are reviewed.

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Experimental focal ischemia is characterized by a severely ischemic core surrounded by a penumbral zone of more moderately impaired perfusion. Tissue in the core dies of primary energy failure, but secondary events occurring in the penumbra determine whether penumbral tissue will survive or die. These events include rapid elevation of extracellular glutamate and intracellular calcium within neurons, which activates a cascade of degradative enzymatic and oxidative injury. While in the microvasculature, ischemic mediators, including eicosanoids, endothelin-1, free radicals, and proinflammatory cytokines, induce vasoconstriction, heightened vascular permeability, edema formation, and leukocyte adhesion, resulting in microvascular obstruction and secondary ischemic injury. Pharmacologic intervention designed to inhibit some of these key events can successfully reduce ischemic damage.

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Recent insights into the neurochemistry of cerebral ischemia and the pathophysiology of stroke have led to the development of novel therapeutic strategies aimed at limiting neuronal injury. Although these approaches are effective in animal models of ischemia, no intervention has been shown to have significant benefit when studied in humans. The rationale for therapy and the discrepancies between experimental and clinical results are discussed.

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0164-2340    

出版商:OVID    

年代:1997

数据来源: OVID