Combined therapy in acute ischemic cerebral stroke - case report

BACKGROUND AND PURPOSE: Stroke remains the third most common cause of death in industrialized nations, and the single most common reason for permanent disability. Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA, Alteplase) for the treatment of acute ischemic stroke within 3 hours of onset become, a worldwide conventional standard of care. Thrombolytic stroke therapy is based on the "recanalization hypothesis," that reopening of occluded vessels improves clinical outcome in acute ischemic stroke through regional reperfusion and salvage of threatened tissues. However, intravenous thrombolysis is successful in approximately one third of patients. Thromboaspiration through either a microcatheter, or a guiding catheter may be an option for a fresh nonadhesive clot. The use of mechanical thrombectomy devices in patients experiencing ischemic stroke and reoclusion after intravenous thrombolysis can now gain approval on the basis of recanalization.CASE DESCRIPTION: We describe a case of a 51-year-old man who presented with ischemic stroke (right-sided hemiparesis and sensomotor aphasia) and sudden onset on 06.50h. He was hospitalised in Neuro intensive Care Unit on 08.10h with NIHSS 8 points. The CT of the head was normal and on 8.40h. began an intravenous rtPa by protocol: body weight 70 kg x 0,9 mg rtPA- 63 mg ACTILYSE with 10% bolus and i.v. infusion for 60 min. After beginning it was a significant improvement with neurological deficite NIHSS 5 points. After the end of the fibrinolysis the patient was with severe deterioration of the symtoms (right-sided hemiplegia and aphasia) - NIHSS 15 points. The patient underwent control CT of the head to exclude intracerebral haemorrhage - was normal. On the digital subtraction angiography there was total thrombosis of the left internal carotid artery. Through a guiding catheter was done thrombo aspiration with effective reperfusion with reversal of neurological deficits - NIHSS 3 points.CONCLUSIONS: This case represents a valuable example of two recanalization therapies in acute ischemic stroke to improve clinical outcome by restoring anterograde perfusion and salvaging ischemic brain

Text and Discourse in a Semiotic Relationship

The text and discourse are very closely related to each other, the text can be perceived as a sign of discourse in semiotic terms. This means that the text turns into a discourse in the semiosis, i.e. a symbolic situation where the addressee understands (at least minimally) the information in the text as a result of reading or listening and is exposed to a pragmatic effect. From this it can be concluded that any text is a potential discourse, and discourse is an updated text with the addressee (or addressees), who understood the content of discourse interaction, functioning as a means of achieving certain goals. As soon as the text is being to be perceived by the addressee at the time of reading, it turns into a discourse that transforms the reader or the state of affairs in the world. The concept of intertextuality entails the concept of mega-text as the totality of all texts on the same topics. In a similar way, we can talk about mega-discourse as the totality of all discourses devoted to one conceptual theme, with mega-discourse consisting of separate discourses recorded in the literature or folklore. The initial calculation of discourses can be started from discourses on one conceptual theme, for example, discourses on love, discourses on happiness, discourses on work, etc. Such discourses can be systematized by taking into account the principle of historicism, that is to start with the first discourse on a certain subject and to continue this line of development and formation of mega-discourse to the latest period, the discourse on the same conceptual theme that has emerged recently

Understanding the Meaning of a Sentence and Text

Thanks to the concept of G.P. Melnikov, the technology of text’s meaning understanding is clarified. In simple cases of understanding in the linguistic consciousness of a person, a group of mental actors plays out a small drama of a sentence / utterance, the script of which is set by a predicate (Seshe - Tenier). Here, understanding is equal to seeing the situation (mise en scene) and is the initial stage. At the second stage, what is seen is equated with a life metaphor or gestalt (Lakoff and Johnson). I.A. Melchuk and his Linguistic-combinatorial dictionary (created jointly with A. Zholkovsky) made up the third part of the theory of understanding, the fourth part of which should be considered the concept of speech actions by Austin and Searle. All these linguistic concepts agree well in the spirit of G.P. Melnikov’s systemology and form a theory of understanding as a whole. The problem of the multiple layers of the text is perfectly visible in the literary texts of Ch. Aimatov, whose 95th Anniversary coincided with a similar anniversary of G.P. Melnikov

Transient monocular visual loss due to multiple CNS vascular pathology: report of two cases

BACKGROUND: The frequency of the transient monocular visual loss (TMVL), lasting minutes or longer, varies from a single to many episodes, which are usually followed by complete recovery of vision. TMVL is related most commonly o occlusive carotid disease. The therapy of patients with TMCL is divided into surgical and medical.CASE1: A55-year-old female was admitted to the clinic, with 4 months history of TMVL of the right eye, lasting 2-3 minutes, followed by complete recovery. Neuro-ophthalmological examination was normal. Neuro imaging investigations revealed proximal part right internal carotid artery (ICA) stenosis of 70%, left ICA stenosis of 40%, King-King in the middle segment of ICA, causing stenosis of 14%, and incidental aneurysms of the intracranial part of right ICA andin M2 segment of right middle cerebral artery.CASE2: A 74-year-old female was admitted to the clinic, with 1 year history of TMVL of the right eye, lasting 4-5 minutes, followed by complete recovery. Neuro-ophthalmological examination was normal. Duplex scaning showed hemodynamically significant stenosis of the right ICA, with King-Kingintheleft. MRI reveale diffuse vascular pathology.CONCLUSION: These cases demonstrated a co-occurrence of hemodynamically significant carotid artery occlusion with multiple or diffuse vascular pathology in patients with TMVL. We suggest that the detailed history, neuro-ophthalmological, and neuroimaging examinations might be useful to determine the correct etiologic diagnosis and discuss the most effective therapeutic strategy in TMVL patients.Scripta Scientifica Medica 2011;43(2):83-8

CLINICAL AND NEUROPHYSIOLOGICAL CORRELATION IN PATIENTS WITH ISCHAEMIC CEREBROVASCULAR DISEASE

The aim of this study is to objectify the functional state of the brain in Ctnegative cases with clinical diagnosis of acute cerebrovascular disease (CVD). The CT scan, cerebral SPECT, brainstem auditory evoked potential (BAEP) and EEG with quantitative analysis (qEEG) were performed in 20 patients with ischaemic CVD. Of them, 6 were with transitory ischaemic attack (TIA), 8 with ischaemic stroke (IS) in the territory of the middle cerebral artery and 6 with brainstem infarction (BI). The zones with increased slow-wave activity described by the brain maps showed a good correlation (r=0,47) with the revealed decreased radiotracer uptake. The investigation of brain perfusion by SPECT alone cannot objectify the brainstem stroke. In these cases, the data from BAEP can help the topical diagnosis. Our results confirm the clinical importance of the qEEG for diagnosis of acute CVD, especially in relation with other electrophysiological and neuroimaging methods

Use of the GATE Monte Carlo package for dosimetry applications

6 pages, 3 figures - submitted to NIM A, presented by D. VisvikisInternational audienceOne of the roles for MC simulation studies is in the area of dosimetry. A number of different codes dedicated to dosimetry applications are available and widely used today, such as MCNP, EGSnrc and PTRAN. However, such codes do not easily facilitate the description of complicated 3D sources or emission tomography systems and associated data flow, which may be useful in different dosimetry application domains. Such problems can be overcome by the use of specific MC codes such as GATE, which is based on Geant4 libraries, providing a scripting interface with a number of advantages for the simulation of SPECT and PET systems. Despite this potential, its major disadvantage is in terms of efficiency involving long execution times for applications such as dosimetry. The strong points and disadvantages of GATE in comparison to other dosimetry specific codes are discussed and illustrated in terms of accuracy, efficiency and flexibility. A number of features, such as the use of voxelised and moving sources, as well as developments such as advanced visualisation tools and the development of dose estimation maps allowing GATE to be used for dosimetry applications are presented. In addition, different examples from dosimetry applications with GATE are given. Finally, future directions with respect to the use of GATE for dosimetry applications are outlined

Electron heat transport in ASDEX Upgrade: experiment and modelling

The electron heat transport is investigated in ASDEX Upgrade using electron cyclotron heating (ECH) combining steady-state and power modulation schemes. Experiments in which the electron heat flux has been varied in the confinement region while the edge was kept constant were performed. They demonstrate that Te and Te/Te can be varied by a factor of 3 and 2, respectively. They allow a detailed determination of the transport characteristics by comparing steady-state and modulation data with modelling. The analyses clearly show the existence of a threshold ( Te/Te)crit above which transport increases. Both steady-state and modulation experiments agree with such a transport model. The experiments have been carried out at low density in the L-mode to ensure low electron–ion coupling and good conditions for studying electron heat transport. The experiments were carried out at two different values of plasma current and show that transport increases at low current, as well-known from global scaling laws for confinement time. In the pure off-axis cases the region inside the ECH deposition is just at the ( Te/Te)crit threshold, which allows it to be measured directly from the profile of Te/Te deduced from the experimental Te profile. Using this technique, it appears that the turbulence threshold agrees with that expected from the trapped electron mode driven turbulence. It has the correct absolute value and seems to have the correct radial dependence that is determined by the trapped electron fraction and by the density gradient. It almost does not vary with other plasma parameters. In contrast, the threshold calculated for electron temperature gradient modes is higher than the experimental values of Te/Te and this turbulence is therefore not expected to be excited under these experimental conditions

ECRH deposition profile in ASDEX Upgrade

The ASDEX Upgrade ECRH systemis designed for very narrow power deposition. We describe different attempts to verify the deposition profile: from switch-on/off events, from modulated heating, and from simulations of pulses