ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The results of large-scale clinical trials of hemodilution therapy and vasodilators for acute stroke have been disappointing. However, interventions involving the manipulation of whole blood viscosity, blood oxygen-carrying capacity, cardiac output, and the resistance properties of cerebral vessels are viable therapeutic modalities currently being investigated. The central aim of all of these therapies is the timely improvement of perfusion and substrate delivery to ischemic brain regions. Better understanding of cerebrovascular flow regulation and the physiology of microvessels may give rise to more effective therapies. In the past, overemphasis on hematocrit reduction and cerebral vasodilators has obscured the potential risks of reducing blood oxygen content and vascular resistance during acute stroke and the importance of optimizing oxygen delivery by other means, in particular by cardiac output augmentation and manipulation of plasma properties. A broader approach to therapeutic strategies for acute stroke includes not only increasing cerebral blood flow, but also interventions that will create favorable changes in the humoral microenvironment and promote overall substrate delivery to the brain.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Cytoprotective strategies continue to be intensively investigated in animal models of focal and global ischaemia. New classes of pharmacological agents are still being identified which are effective in reducing the severity of ischaemic damage when administered shortly after the ischaemia. Many such agents reduce neuronal activity and decrease sodium and calcium entry. Later stages in excitotoxic processes can, however, be affected by nitric oxide synthase inhibitors or free-radical scavengers. Different types of compound have different relative potencies against reversible or permanent focal ischaemia, and mild or complete transient ischaemia. Positive results in clinical trials remain elusive. Trial design is improving; the emphasis is on early initiation of therapy and refined criteria for admission and final evaluation. The results of several current trials are eagerly awaited.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Advances in the study of cerebrovascular disease suggest that many risk factors for stroke are under genetic influence. Epidemiologic studies show that parental and sibling histories of cerebral ischemic events are associated with an increased risk of stroke. Explanations for familial stroke aggregation include differential phenotypic expression of apolipoprotein (a) and apolipoprotein E, racial variations in the distribution of vascular disease, identification of the autosomal-dominant disorder cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy, specific point mutations in the mitochondrial-related disorders, and identification of the clinical significance of hereditable coagulopathies. Greater understanding of these factors may lead to early recognition of and intervention in stroke.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The management of patients with acute ischaemic stroke includes treatment of stroke itself, the management of medical problems, and the early initiation of rehabilitation. Current research focuses more on specific stroke treatment, such as reperfusion or prevention of extension of ischaemic brain damage, than on the management of general conditions and the treatment of medical complications associated with acute stroke. At present, a better prognosis of stroke is more often the consequence of good general management than of a specific therapy. General management of stroke includes cardiac and pulmonary care, fluid and ion balance restoration, metabolic maintenance, blood pressure control and prevention of bed sores and phlebitis. Treatment of elevated intracranial pressure and temperature control must also be considered in some cases. Several points, however, remain controversial, such as the treatment of arterial hypertension and the management of cardiac arrhythmia.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Hematologic disorders that induce a thrombotic tendency contribute to overall ischemic stroke risk and may directly cause cerebral ischemia in patients without other risk factors. These disorders include platelet dysfunction, prothrombotic coagulopathies, defective fibrinolysis, abnormal red blood cell-vessel wall interactions, and antiphospholipid antibody syndromes. Multiple mechanisms promoting ischemia may underlie specific hematologic abnormalities. Improved markers for activation of platelets, coagulation and fibrinolysis are now being used to correlate prothrombotic mechanisms with ischemic pathology and, thus, to make therapeutic approaches more precise. Nevertheless, finding the ideal balance between preventing cerebral ischemia and incurring hemorrhagic toxicity remains difficult.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

New technology has made it possible to identify cardiogenic cerebral emboli more easily and reliably. In recent years echocardiography, and in particular transesophageal echocardiography, has become the gold standard for the identification of cardiogenic sources of emboli, whereas transcranial Doppler is an important technique for the detection of cerebral emboli. Treatment strategies are better established and more accurate, if more complex, since the completion of large randomized trials. For primary prevention of stroke in elderly patients with nonvalvular atrial fibrillation, warfarin is generally indicated, yet in patients aged 60–75 years with no risk factors, aspirin may be sufficient. Warfarin is hazardous in older high-risk patients even at the ‘low intensity’ of the anticoagulation regimen; even lower doses are therefore being tested. Heparin and aspirin are indicated for short-term treatment of acute myocardial infarction, whereas for long-term treatment aspirin is still the drug of choice. However, if mobile left ventricular thrombi are present, warfarin is superior and new studies have shown its effectiveness for all myocardial infarction survivors. Combined treatment of warfarin and aspirin appears to be most effective in patients with mechanical prosthetic valves.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Recent advances in understanding the role of inflammatory vascular disorders in the production of ischemic stroke have resulted in improved diagnosis and treatment of this subset of stroke patients. These disorders include collagen vascular diseases, the primary anti-phospholipid antibody syndrome and vasculitic diseases. However, the interest generated in this area has led to an overdiagnosis of vasculitis in stroke patients, some overuse of steroids, and the routine ordering of expensive laboratory tests which do not contribute to the evaluation and treatment of most cases of stroke. Inflammatory vascular disorders are reviewed in relation to the potential mechanisms of ischemic stroke, along with specific diagnostic and therapeutic considerations. The appropriate use of specialized laboratory tests and diagnostic pitfalls are also reviewed.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Research into stroke rehabilitation is an active area of investigation, and ample evidence suggests that patients with moderate deficits benefit from focused rehabilitation programs. Increasing age, stroke severity, and neuropsychological deficits are associated with a poor outcome. In this review we will discuss the most recent literature on stroke rehabilitation, with special emphasis on outcome predictors, motor recovery, and therapeutic strategies for aphasia and neuropsychological deficits.

ISSN:1350-7540    

出版商:OVID    

年代:1995

数据来源: OVID