Intensive Care Management of Acute Ischemic Stroke

Burns, Joseph D.; Green, Deborah; Metivier, Kristen; DeFusco, Christina

doi:10.1016/j.emc.2012.05.002

Cited by 21 publications

(8 citation statements)

References 144 publications

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“…Retrospective assessment of zero-degree head positioning in the first 24 h after acute ischemic stroke showed that risk of subsequent aspiration pneumonia is less than 5% [24]. These findings have led to the recommendation of supine positioning as standard care for patients who can tolerate it [6,25,26,27,28,29]. …”

Section: Discussionmentioning

confidence: 99%

Heads Up! A Novel Provocative Maneuver to Guide Acute Ischemic Stroke Management

et al. 2016

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Background: A common dilemma in acute ischemic stroke management is whether to pursue recanalization therapy in patients with large vessel occlusions but minimal neurologic deficits. We describe and report preliminary experience with a provocative maneuver, i.e. 90-degree elevation of the head of bed for 30 min, which stresses collaterals and facilitates decision-making. Methods: A prospective cohort study of <7.5 h of acute anterior circulation territory ischemia patients with minimal deficits despite middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive disease. Results: Five patients met the study entry criteria. Their mean age was 78.4 years (range 65-93). All presented with substantial deficits (median NIHSS score 11, range 5-22), but improved while in supine position during initial imaging to normal or near-normal (NIHSS score 0-2). MRA showed persistent M1 MCA occlusions in 4, critical ICA stenosis or occlusion in 1, and substantial perfusion-diffusion mismatch in all. To evaluate the potential for eventual collateral failure, patients were placed in a head of bed upright posture. Mean arterial pressure and heart rate were unchanged. Two showed no neurologic worsening and were treated with supportive care with excellent final outcome. Three showed worsening, including recurrent hemiparesis and aphasia at the 6th, recurrent aphasia at the 23rd, and recurrent hemineglect at the 15th upright minute. These 3 underwent endovascular recanalization therapies with successful reperfusion and excellent final outcome. Conclusion: The ‘Heads Up' test may be a useful, simple maneuver to assess the risk of collateral failure and guide the decision to pursue recanalization therapy in acute cerebral ischemia patients with minimal deficits despite persisting large cerebral artery occlusion.

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Section: Discussionmentioning

confidence: 99%

Heads Up! A Novel Provocative Maneuver to Guide Acute Ischemic Stroke Management

et al. 2016

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“…[1][2][3] Thrombolytic therapy, as the only treatment proven to improve the outcome of such patients, is accessible in only a minority of clinical settings. [4][5][6] Even in the presence of this medication, more than half of IS patients still remain disabled. 7,8 Despite the limited effectiveness of current standard physical rehabilitation therapies, the possibility of recovery from stroke using pharmacological agents has always been attractive.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial

Oskouie

Sharifipour

Bazargani

et al. 2017

Neurorehabil Neural Repair

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“…As a consequence, the oxygen and glucose levels are reduced which in turn rapidly kills the affected brain tissue; e.g. an estimated loss of almost 2 million neurons per minute takes places for a large-vessel ischemic stroke [3]. Ischemic stroke is the most common type of stroke accounting for about 80% of cases (the proportion varies between countries) [4].…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Automated Segmentation Methods for Use in a Microwave Tomography System for Imaging Intracerebral Hemorrhage in Stroke Patients

Mahmood

Li²,

Fhager

et al. 2015

JEMAA

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Microwave technology offers the possibility for pre-hospital stroke detection as we have previously demonstrated using non-imaging diagnostics. The focus in this paper is on image-based diagnostics wherein the technical and computational complexities of image reconstruction are a challenge for clinical realization. Herein we investigate whether information about a patient's brain anatomy obtained prior to a stroke event can be used to facilitate image-based stroke diagnostics. A priori information can be obtained by segmenting the patient's head tissues from magnetic resonance images. Expert manual segmentation is presently the gold standard, but it is laborious and subjective. A fully automatic method is thus desirable. This paper presents an evaluation of several such methods using both synthetic magnetic resonance imaging (MRI) data and real data from four healthy subjects. The segmentation was performed on the full 3D MRI data, whereas the electromagnetic evaluation was performed using a 2D slice. The methods were evaluated in terms of: i) tissue classification accuracy over all tissues with respect to ground truth, ii) the accuracy of the simulated electromagnetic wave propagation through the head, and iii) the accuracy of the image reconstruction of the hemorrhage. The segmentation accuracy was measured in terms of the degree of overlap (Dice score) with the ground truth. The electromagnetic simulation accuracy was measured in terms of signal deviation relative to the simulation based on the ground Q. Mahmood et al. 153 truth. Finally, the image reconstruction accuracy was measured in terms of the Dice score, relative error of dielectric properties, and visual comparison between the true and reconstructed intracerebral hemorrhage. The results show that accurate segmentation of tissues (Dice score = 0.97) from the MRI data can lead to accurate image reconstruction (relative error = 0.24) for the intracerebral hemorrhage in the subject's brain. They also suggest that accurate automated segmentation can be used as a surrogate for manual segmentation and can facilitate the rapid diagnosis of intracerebral hemorrhage in stroke patients using a microwave imaging system.

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Intensive Care Management of Acute Ischemic Stroke

Cited by 21 publications

References 144 publications

Heads Up! A Novel Provocative Maneuver to Guide Acute Ischemic Stroke Management

Heads Up! A Novel Provocative Maneuver to Guide Acute Ischemic Stroke Management

Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial

A Comparative Study of Automated Segmentation Methods for Use in a Microwave Tomography System for Imaging Intracerebral Hemorrhage in Stroke Patients

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