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Source: Seminars in Neurology
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Total 93 results found since Jan 2013.
Today's Approach to Treating Brain Swelling in the Neuro Intensive Care Unit
Semin Neurol 2016; 36: 502-507 DOI: 10.1055/s-0036-1592109Brain swelling is an urgent clinical problem that frequently accompanies ischemic stroke, brain hemorrhage, and traumatic brain injury; it increases morbidity and mortality associated with them. It occurs due to failure of membrane transporters and leakage of the blood–brain barrier (BBB), resulting in combination of cytotoxic, ionic, and vasogenic edema. Currently, decompressive craniectomy and osmotherapy are the mainstays of management, but these therapies do not halt the underlying molecular cascade leading to brain swelling. Recent advances in the molecular u...
Source: Seminars in Neurology - November 30, 2016 Category: Neurology Authors: Shah, Shreyansh Kimberly, W. Taylor Tags: Review Article Source Type: research
Intensive Care Management of the Endovascular Stroke Patient
Semin Neurol 2016; 36: 520-530 DOI: 10.1055/s-0036-1592360Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long durat...
Source: Seminars in Neurology - November 30, 2016 Category: Neurology Authors: B ösel, Julian Tags: Review Article Source Type: research
Neuroprotection in Critical Care Neurology
Semin Neurol 2016; 36: 642-648 DOI: 10.1055/s-0036-1592359Ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury—all have in common early brain injury due to brain tissue destruction, reduced cerebral blood flow and oxygen delivery, and overall substantial morbidity and mortality. The pathophysiology of brain tissue damage likely includes common cellular mechanisms. Neuroprotection has seldom, if ever, been shown to reduce early brain injury. Secondary brain injury develops after these conditions due to macroscopic events such as increased intracranial pressure and reduced cerebral...
Source: Seminars in Neurology - November 30, 2016 Category: Neurology Authors: Germans, Menno R. Boogaarts, Hieronymus D. Macdonald, R. Loch Tags: Review Article Source Type: research
Acute Visual Loss
Semin Neurol 2016; 36: 425-432 DOI: 10.1055/s-0036-1585452Acute visual loss is a frightening experience, a common ophthalmic emergency, and a diagnostic challenge. In this review, the author focusses on the diagnosis of transient monocular blindness and visual loss due to infarction of the retina and/or the optic nerve—the ocular parallel of cerebral stroke. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents | Abstract | Full text
Source: Seminars in Neurology - September 22, 2016 Category: Neurology Authors: Wray, Shirley H. Tags: Review Article Source Type: research
Stroke: New Developments and Their Application in Clinical Practice
Semin Neurol 2016; 36: 317-323 DOI: 10.1055/s-0036-1586261Significant advances have been made in recent years in primary stroke prevention, improved stroke outcomes in high-income populations, emergency stroke therapy, and stroke prevention. In this article, we review recent trends in stroke epidemiology, improvements in delivery of intravenous thrombolysis (via stroke system-wide approaches, application of ‘Lean Principles’ to improve workflow processes, and re-evaluation of exclusion criteria), recent stroke thrombectomy trials, and new developments in stroke prevention, with emphasis on risk prediction in transient ...
Source: Seminars in Neurology - September 18, 2016 Category: Neurology Authors: Kelly, Peter J. Kavanagh, Eoin Murphy, Sean Tags: Review Article Source Type: research
Critical Care Management of Intracerebral Hemorrhage
Semin Neurol 2016; 36: 225-232DOI: 10.1055/s-0036-1581991Spontaneous intracerebral hemorrhage (ICH), the most devastating and debilitating form of stroke, remains a major healthcare concern all over the world. Intracerebral hemorrhage is frequently managed in critical care settings where intensive monitoring and treatment are employed to prevent and address primary and secondary brain injury as well as other medical complications that may arise. Although there has been increasing data guiding the management of ICH in the past decade, prognosis remains dismal. In this article, the authors discuss the risk factors for ICH, t...
Source: Seminars in Neurology - May 22, 2016 Category: Neurology Authors: Morawo, Adeolu O.Gilmore, Emily J. Source Type: research
Blood Pressure Management in Intracerebral Hemorrhage
Semin Neurol 2016; 36: 269-273DOI: 10.1055/s-0036-1583264Intracerebral hemorrhage (ICH) is associated with devastating outcomes. Admission to the intensive care unit has been the only proven course to improve outcomes. All other treatment modalities have failed so far. The majority of patients presenting with ICH have an elevated blood pressure (BP). Initial data on the safety and efficacy of BP treatment in acute ICH have been conflicting. This has led to large prospective and randomized clinical trials to assess the safety and efficacy of early BP lowering in acute ICH. These trials showed safety and a tendency toward im...
Source: Seminars in Neurology - May 22, 2016 Category: Neurology Authors: Mohammad, YousefQureshi, Adnan Source Type: research
Genetic Determinants of Risk, Severity, and Outcome in Intracerebral Hemorrhage
Semin Neurol 2016; 36: 298-305DOI: 10.1055/s-0036-1582134Spontaneous, nontraumatic intracerebral hemorrhage (ICH) is the most severe manifestation of common forms of cerebral small vessel disease. Although ICH represents only 15% of all strokes, it accounts for a large proportion of stroke-related costs and mortality. Preventive and acute treatments remain limited. Because genetic variation contributes substantially to ICH, genomic analyses constitute a powerful tool to identify new biological mechanisms involved in its occurrence. Through translational research efforts, these newly identified mechanisms can become targets...
Source: Seminars in Neurology - May 22, 2016 Category: Neurology Authors: Falcone, Guido J.Rosand, Jonathan Source Type: research
Botulinum Toxin Treatment of Spasticity in Adults and Children
Semin Neurol 2016; 36: 064-072DOI: 10.1055/s-0036-1571847Spasticity is a frequent symptom in stroke, multiple sclerosis, cerebral or spinal trauma, and cerebral palsy that affects and disables a large number of adults and children. In this review, we discuss the pathophysiology and nonpharmacologic and pharmacologic treatments of spasticity with emphasis on the role of botulinum neurotoxins (BoNTs). The world literature is reviewed on double-blind and placebo-controlled clinical trials reporting safety and efficacy of BoNT treatment in adult spasticity and spasticity of children with cerebral palsy. The evidence for effica...
Source: Seminars in Neurology - February 11, 2016 Category: Neurology Authors: Moeini-Naghani, ImanHashemi-Zonouz, TaranehJabbari, Bahman Source Type: research
Acute Care of Ischemic Stroke Patients in the Hospital
Semin Neurol 2015; 35: 629-637DOI: 10.1055/s-0035-1564301Ischemic stroke is a leading cause of death and disability worldwide. Recent advances in acute treatment provide hope that the impact of this disease will be reduced. Rapid assessment for large vessel occlusion is now a key element in acute stroke care given advances in endovascular therapy. Because access to acute therapies is limited, development of systems of care to triage appropriate patients to specialized centers is essential. Acute hospitalization management requires multiple strategies including initiation of secondary prevention measures. In addition to pre...
Source: Seminars in Neurology - November 23, 2015 Category: Neurology Authors: Meisel, Karl M.Thabet, Ahmad M.Josephson, S. Andrew Source Type: research
The Evaluation and Management of Adult Intracerebral Hemorrhage
Semin Neurol 2015; 35: 638-645DOI: 10.1055/s-0035-1564687Intracerebral hemorrhage (ICH) is the most disabling and deadly form of stroke. Although mortality remains high, new data suggest that outcomes can be improved with standardized medical care. In this review, the authors outline the most up-to-date knowledge, including the results of the latest phase III clinical trials on the specialized care needed to treat patients with ICH. They provide an overview on how to achieve rapid diagnosis and the initial steps of intervention to reduce hematoma volume or prevent expansion by modifying potentially treatable conditions, su...
Source: Seminars in Neurology - November 23, 2015 Category: Neurology Authors: Cai, XuemeiRosand, Jonathan Source Type: research
Perioperative Consultation for Patients with Preexisting Neurologic Disorders
Semin Neurol 2015; 35: 690-698DOI: 10.1055/s-0035-1564302As the population ages, the prevalence of many neurologic diseases is increasing. At the same time, older patients are undergoing more surgical procedures. This confluence of events puts neurohospitalists in a unique position to provide both pre- and postoperative guidance to minimize complications, improve clinical outcomes, and decrease health care costs in patients with neurologic comorbidities. Early preoperative consultation is recommended for patients with severe, poorly controlled, or decompensated neurologic disease, a recent stroke, or those undergoing proce...
Source: Seminars in Neurology - November 23, 2015 Category: Neurology Authors: Hudson, Kristen A.Greene, James G. Source Type: research
Inpatient Neurologic Consultation in Solid Organ Transplant Patients
Semin Neurol 2015; 35: 699-707DOI: 10.1055/s-0035-1564683A third of solid organ transplant recipients experience neurologic complications after transplantation. In this article the author reviews common and uncommon complications of the perioperative period including stroke and peripheral neuropathy, neurotoxicity associated with immunosuppressant medications such as calcineurin inhibitors, and opportunistic infections that target the nervous system. A careful clinical history, neurologic examination, and medication review are vital in generating a differential diagnosis that will guide diagnostic testing and decisions reg...
Source: Seminars in Neurology - November 23, 2015 Category: Neurology Authors: Shah, Maulik Source Type: research
Ocular Fundus Photography as a Tool to Study Stroke and Dementia
Semin Neurol 2015; 35: 481-490DOI: 10.1055/s-0035-1563570Although cerebral small vessel disease has been linked to stroke and dementia, due to limitations of current neuroimaging technology, direct in vivo visualization of changes in the cerebral small vessels (e.g., cerebral arteriolar narrowing, tortuous microvessels, blood–brain barrier damage, capillary microaneurysms) is difficult to achieve. As the retina and the brain share similar embryological origin, anatomical features, and physiologic properties with the cerebral small vessels, the retinal vessels offer a unique and easily accessible “window” to study the...
Source: Seminars in Neurology - October 6, 2015 Category: Neurology Authors: Cheung, Carol Y.Chen, ChristopherWong, Tien Y. Source Type: research
Diagnosing Stroke in Acute Vertigo: The HINTS Family of Eye Movement Tests and the Future of the “Eye ECG”
Semin Neurol 2015; 35: 506-521DOI: 10.1055/s-0035-1564298Patients who present to the emergency department with symptoms of acute vertigo or dizziness are frequently misdiagnosed. Missed opportunities to promptly treat dangerous strokes can result in poor clinical outcomes. Inappropriate testing and incorrect treatments for those with benign peripheral vestibular disorders leads to patient harm and unnecessary costs. Over the past decade, novel bedside approaches to diagnose patients with the acute vestibular syndrome have been developed and refined. A battery of three bedside tests of ocular motor physiology known as “HI...
Source: Seminars in Neurology - October 6, 2015 Category: Neurology Authors: Newman-Toker, David E.Curthoys, Ian S.Halmagyi, G. Michael Source Type: research
