Moždana vazomotorna reaktivnost i okluzivna bolest karotidnih arterija

Cerebral autoregulation is a mechanism that enables relatively constant cerebral blood flow during variations of cerebral perfusion pressure. The differences between cerebral blood flow at rest and after administration of a potent vasodilatory stimulus test such as hypercapnia reflect cerebral vasomotor reactivity defined as the vasodilation capacity of cerebral arterioles to external stimuli, providing important information about the cerebral hemodynamic status. Cerebral vasomotor reactivity provides important information about the cerebral hemodynamic status. In this article, cerebral vasomotor reactivity assessment tests are presented, with emphasis on transcranial Doppler, as well as the use of transcranial Doppler in assessing cerebral vasomotor reactivity in carotid stenosis, occlusion, and the importance of cerebral vasomotor reactivity for carotid surgery.Moždana autoregulacija je mehanizam koji omogućava relativno ustaljeni moždani protok krvi za vrijeme promjena tlaka prokrvljenosti mozga. Razlike između moždanog protoka krvi u mirovanju i nakon testa snažne vazodilatacijske stimulacije poput hiperkapnije odražavaju moždanu vazomotornu reaktivnost definiranu kao vazodilatacijski kapacitet moždanih arteriola za vanjske poticaje, pružajući važne podatke o moždanom hemodinamskom statusu. Moždana vazomotorna reaktivnost daje važne informacije o statusu moždane hemodinamike. U članku se prikazuju testovi za procjenu moždane vazomotorne reaktivnosti s naglaskom na transkranijski Doppler, te primjena transkranijskog Dopplera u procjeni moždane vazomotorne reaktivnosti kod karotidne stenoze, okluzije, kao i važnost moždane vazomotorne reaktivnosti za kirurgiju karotidnih arterija

Transient ischemic attack (TIA) is an emergency

Transient ischemic attack (TIA) is a warning sign of stroke, and stroke is one of the leading causes of morbidity and mortality in the world. The assessment and management of TIAs can be difficult even for an experienced neurologist. The purpose of this article is to increase the awareness and establish a diagnostic and therapeutic approach to patientswith TIA. In terms of therapy, patients with TIA share the same recommendations as those with acute ischemic stroke. Based on the etiology, therapeutic measures for secondary prevention after a TIA include antithrombotic, antihypertensive, statins therapy, aswell as carotid intervention as appropriate. Itwas shown that early evaluation following appropriate treatment after TIA reduces the risk of the first and early recurrent stroke by about 80%, therefore TIA should be considered as an emergency and should be treated as such

Duretovo krvarenje: rijetka komplikacija ishemijskog moždanog udara u području središnje moždane arterije - Prikaz slučaja

We report on an unusual case of brainstem Duret hemorrhage after ischemic stroke in the anterior circulation. The patient showed a clinical and neuroradiological picture of an acute and malignant middle cerebral artery infarct with increased intracranial pressure followed by a brainstem hemorrhage. The report suggests that the descending transtentorial herniation of any etiology might be complicated by a Duret hemorrhage.Opisuje se rijedak slučaj Duretova krvarenja moždanoga debla nakon ishemijskog moždanog udara u prednjem krvotoku. Bolesnik je pokazivao kliničku i neuroradiološku sliku akutnog i zloćudnog infarkta središnje moždane arterije uz povišen intrakranijski tlak, nakon čega je uslijedilo krvarenje u moždanom deblu. Ovaj prikaz ukazuje na to da se Duretovo krvarenje može pojaviti kao komplikacija kod silazne transtentorijske hernijacije bilo koje etiologije

Pre-hospital stroke monitoring past, present, and future: a perspective

Integrated brain-machine interface signifies a transformative advancement in neurological monitoring and intervention modalities for events such as stroke, the leading cause of disability. Historically, stroke management relied on clinical evaluation and imaging. While today’s stroke landscape integrates artificial intelligence for proactive clinical decision-making, mainly in imaging and stroke detection, it depends on clinical observation for early detection. Cardiovascular monitoring and detection systems, which have become standard throughout healthcare and wellness settings, provide a model for future cerebrovascular monitoring and detection. This commentary reviews the progression of continuous stroke monitoring, spotlighting contemporary innovations and prospective avenues, and emphasizes the influential roles of cutting-edge technologies in shaping stroke care

One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

BACKGROUND Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. METHODS We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. RESULTS From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan–Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan–Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD2 score of 6 or 7 were each associated with more than a doubling of the risk of stroke. CONCLUSIONS We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD2 score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.)Supported by an unrestricted grant from Sanofi and Bristol-Myers Squibb

Selected acute phase CSF factors in ischemic stroke: findings and prognostic value

<p>Abstract</p> <p>Background</p> <p>Study aimed at investigation of pathogenic role and prognostic value of several selected cerebrospinal fluid acute phase factors that can reflect the severity of ischemic brain damage.</p> <p>Methods</p> <p>Ninety five acute ischemic stroke patients were investigated. Ischemic region visualized at the twenty fourth hour by conventional Magnetic Resonance Imaging. Stroke severity evaluated by National Institute Health Stroke Scale. One month outcome of disease was assessed by Barthel Index. Cerebrospinal fluid was taken at the sixth hour of stroke onset. CSF pro- and anti-inflammatory cytokines were studied by Enzyme Linked Immunosorbent Assay. Nitric Oxide and Lipoperoxide radical were measured by Electron Paramagnetic Resonance. CSF Nitrate levels were detected using the Griess reagent. Statistics performed by SPSS-11.0.</p> <p><b>Results</b></p> <p>At the sixth hour of stroke onset, cerebrospinal fluid cytokine levels were elevated in patients against controls. Severe stroke patients had increased interleukin-6 content compared to less severe strokes (P < 0.05). Cerebrospinal fluid Electron Paramagnetic Resonance signal of nitric oxide was increased in patients against controls. Severe stroke group had an elevated Electron Paramagnetic Resonance signal of lipoperoxiradical compared to less severe stroke. Cerebrospinal fluid nitrate levels in less severe stroke patients were higher than those for severe stroke and control. Positive correlation was established between the initial interleukin-6 content and ischemic lesion size as well as with National Institute Health Stroke Scale score on the seventh day. Initial interleukin-6 and nitrate levels in cerebrospinal fluid found to be significant for functional outcome of stroke at one month.</p> <p><b>Conclusion</b></p> <p>According to present study the cerebrospinal fluid contents of interleukin-6 and nitrates seem to be the most reliable prognostic factors in acute phase of ischemic stroke.</p

Latin American Consensus Statement for the Use of Contrast-Enhanced Transcranial Ultrasound as a Diagnostic Test for Detection of Right-to-Left Shunt

Background: The role of patent foramen ovale is a field of debate and current publications have increasing controversies about the patients' management in young undetermined stroke. Work up with echocardiography and transcranial Doppler (TCD) can aid the decision with better anatomical and functional characterization of right-to-left shunt (RLS). Medical and interventional strategy may benefit from this information. Summary: a group of experts from the Latin American participants of the Neurosonology Research Group (NSRG) of World Federation of Neurology created a task force to review literature and describe the better methodology of contrast TCD (c-TCD). All signatories of the present consensus statement have published at least one study on TCD as an author or co-author in an indexed journal. Two meetings were held while the consensus statement was being drafted, during which controversial issues were discussed and voted on by the statement signatories. The statement paper was reviewed and approved by the Executive Committee of the NSRG of the World Federation of Neurology. The main objective of this consensus statement is to establish a standardization of the c-TCD technique and its interpretation, in order to improve the informative quality of the method, resulting in expanding the application of TCD in the clinical setting. These recommendations optimize the comparison of different diagnostic methods and encourage the use of c-TCD for RLS screening and complementary diagnosis in multicenter studies

Characterization of patients with embolic strokes of undetermined source in the NAVIGATE ESUS randomized trial

Background: The New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial vs. ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial is a randomized phase-III trial comparing rivaroxaban versus aspirin in patients with recent ESUS. Aims: We aimed to describe the baseline characteristics of this large ESUS cohort to explore relationships among key subgroups. Methods: We enrolled 7213 patients at 459 sites in 31 countries. Prespecified subgroups for primary safety and efficacy analyses included age, sex, race, global region, stroke or transient ischemic attack prior to qualifying event, time to randomization, hypertension, and diabetes mellitus. Results: Mean age was 66.9 ± 9.8 years; 24% were under 60 years. Older patients had more hypertension, coronary disease, and cancer. Strokes in older subjects were more frequently cortical and accompanied by radiographic evidence of prior infarction. Women comprised 38% of participants and were older than men. Patients from East Asia were oldest whereas those from Latin America were youngest. Patients in the Americas more frequently were on aspirin prior to the qualifying stroke. Acute cortical infarction was more common in the United States, Canada, and Western Europe, whereas prior radiographic infarctions were most common in East Asia. Approximately forty-five percent of subjects were enrolled within 30 days of the qualifying stroke, with earliest enrollments in Asia and Eastern Europe. Conclusions: NAVIGATE-ESUS is the largest randomized trial comparing antithrombotic strategies for secondary stroke prevention in patients with ESUS. The study population encompasses a broad array of patients across multiple continents and these subgroups provide ample opportunities for future research