Background: To protect the ischemic penumbra, guidelines have recommended against treating all but the severest elevations in blood pressure during acute ischemic stroke. Objective: To determine how often antihyperten...Background: To protect the ischemic penumbra, guidelines have recommended against treating all but the severest elevations in blood pressure during acute ischemic stroke. Objective: To determine how often antihypertensive agents were used in routine clinical practice and whether this use was consistent with guideline re commendations. Methods: The records of patients discharged with ischemic stroke in 2000 at Baystate Medical Center in Springfield,MA, were reviewed. Adherence was evaluated by examining the use of antihypertensive agents in the context of daily blood pressure recordings during the first 4 days of hospitalization. Therapy was considered appropriate in the setting of severe hypertension (systolic blood pressure of > 220 mm Hg or mean arterial blood pressure of > 130 mm Hg) and potentially harmful in the setting of relative (systolic blood pressure of < 120 mm Hg or mean arterial blood pressure of< 85mmHg) or absolute (systolic blood pressure of < 90mm Hg or mean arterial blood pressure of < 60 mm Hg) hypotension. Results: One hundred (65% ) of the 154 ischemic stroke patients were treated with antihypertensive agents. Forty two percent of those who had received therapy prior to admission had their regimen intensified, and 36% of previously untreated patients had therapy initiated. Sixteen (11% ) patients had hypertension severe enough to warrant treatment upon arrival, and 34 (22% ) had at least one episode of severe hypertension during the first 4 hospital days. Sixty five (65% ) patients developed relative hypotension on a day when antihypertensive agents were administered, and five (5% ) developed absolute hypotension. Conclusions: Most patients with acute ischemic stroke are treated with antihypertensive agents despite the absence of severe hypertension. Although low blood pressure is common among treated patients, frank hypotension is unusual.展开更多
Objective: To report results of a randomized pilot clinical feasibility trial of endovascular cooling in patients with ischemic stroke. Methods: Forty patients with ischemic stroke presenting within 12 hours of sympto...Objective: To report results of a randomized pilot clinical feasibility trial of endovascular cooling in patients with ischemic stroke. Methods: Forty patients with ischemic stroke presenting within 12 hours of symptom onset were enrolled in the study. An endovascular cooling device was inserted into the inferior vena cava of those randomized to hypothermia. A core body temperature of 33 ° C was targeted for 24 hours. All patients underwent clinical assessment and MRI initially, at days 3 to 5 and days 30 to 37. Results: Eighteen patients were randomized to hypothermia and 22 to receive standard medical management. Thirteen patients reached target temperature in a mean of 77 ± 44 minutes. Most tolerated hypothermia well. Clinical outcomes were similar in both groups. Mean diffusion weighted imaging (DWI) lesion growth in the hypothermia group (n = 12) was 90.0 ± 83.5% compared with 108.4 ± 142.4% in the control group (n = 11) (NS).Mean DWI lesion growth in patients who cooled well (n = 8) was 72.9 ± 95.2% (NS). Conclusions: Induced moderate hypothermia is feasible using an endovascular cooling device in most patients with acute ischemic stroke. Further studies are needed to determine if hypothermia improves outcome.展开更多
Objective: The contribution of cortical reorganization to motor recovery after a subcortical stroke is uncertain. The purpose of the study was to investigate the relationship between hanges in motor cortex organizatio...Objective: The contribution of cortical reorganization to motor recovery after a subcortical stroke is uncertain. The purpose of the study was to investigate the relationship between hanges in motor cortex organization, and the degree of motor function after a subcortical stroke. Methods: Transcranial magnetic stimulation mapping of the corticomotor projection to the hand was performed in 27 patients who had suffered a subcortical ischemic stroke resulting in an upper limb motor deficit up to 23 years previously. Corticospinal conduction was assessed by measurements of motor evoked potential latency, amplitude and threshold. Motor function in the upper limb was assessed using the Motor Assessment Scale for Stroke and measurements of grip strength. Results: Motor maps for the hand were displaced on the affected side relative to the unaffected side in 17 patients. In 10 of these patients in whom corticospinal conduction had normalized, there was a strong positive correlation between the magnitude of the map shift and grip strength in the affected hand (r=0.79; P=0.006). In the other seven patients with a map shift, in whom corticospinal conductionwas still impaired, there was a tendency for a larger map area to be associated with better motor function, and in the group as a whole there was a correlation between map area and grip strength (r=0.52; P=0.005). Conclusions: The present findings provide evidence that the cortical plasticity and reorganization that occurs after a subcortical stroke is functionally significant and contributes to motor outcome.展开更多
文摘Background: To protect the ischemic penumbra, guidelines have recommended against treating all but the severest elevations in blood pressure during acute ischemic stroke. Objective: To determine how often antihypertensive agents were used in routine clinical practice and whether this use was consistent with guideline re commendations. Methods: The records of patients discharged with ischemic stroke in 2000 at Baystate Medical Center in Springfield,MA, were reviewed. Adherence was evaluated by examining the use of antihypertensive agents in the context of daily blood pressure recordings during the first 4 days of hospitalization. Therapy was considered appropriate in the setting of severe hypertension (systolic blood pressure of > 220 mm Hg or mean arterial blood pressure of > 130 mm Hg) and potentially harmful in the setting of relative (systolic blood pressure of < 120 mm Hg or mean arterial blood pressure of< 85mmHg) or absolute (systolic blood pressure of < 90mm Hg or mean arterial blood pressure of < 60 mm Hg) hypotension. Results: One hundred (65% ) of the 154 ischemic stroke patients were treated with antihypertensive agents. Forty two percent of those who had received therapy prior to admission had their regimen intensified, and 36% of previously untreated patients had therapy initiated. Sixteen (11% ) patients had hypertension severe enough to warrant treatment upon arrival, and 34 (22% ) had at least one episode of severe hypertension during the first 4 hospital days. Sixty five (65% ) patients developed relative hypotension on a day when antihypertensive agents were administered, and five (5% ) developed absolute hypotension. Conclusions: Most patients with acute ischemic stroke are treated with antihypertensive agents despite the absence of severe hypertension. Although low blood pressure is common among treated patients, frank hypotension is unusual.
文摘Objective: To report results of a randomized pilot clinical feasibility trial of endovascular cooling in patients with ischemic stroke. Methods: Forty patients with ischemic stroke presenting within 12 hours of symptom onset were enrolled in the study. An endovascular cooling device was inserted into the inferior vena cava of those randomized to hypothermia. A core body temperature of 33 ° C was targeted for 24 hours. All patients underwent clinical assessment and MRI initially, at days 3 to 5 and days 30 to 37. Results: Eighteen patients were randomized to hypothermia and 22 to receive standard medical management. Thirteen patients reached target temperature in a mean of 77 ± 44 minutes. Most tolerated hypothermia well. Clinical outcomes were similar in both groups. Mean diffusion weighted imaging (DWI) lesion growth in the hypothermia group (n = 12) was 90.0 ± 83.5% compared with 108.4 ± 142.4% in the control group (n = 11) (NS).Mean DWI lesion growth in patients who cooled well (n = 8) was 72.9 ± 95.2% (NS). Conclusions: Induced moderate hypothermia is feasible using an endovascular cooling device in most patients with acute ischemic stroke. Further studies are needed to determine if hypothermia improves outcome.
文摘Objective: The contribution of cortical reorganization to motor recovery after a subcortical stroke is uncertain. The purpose of the study was to investigate the relationship between hanges in motor cortex organization, and the degree of motor function after a subcortical stroke. Methods: Transcranial magnetic stimulation mapping of the corticomotor projection to the hand was performed in 27 patients who had suffered a subcortical ischemic stroke resulting in an upper limb motor deficit up to 23 years previously. Corticospinal conduction was assessed by measurements of motor evoked potential latency, amplitude and threshold. Motor function in the upper limb was assessed using the Motor Assessment Scale for Stroke and measurements of grip strength. Results: Motor maps for the hand were displaced on the affected side relative to the unaffected side in 17 patients. In 10 of these patients in whom corticospinal conduction had normalized, there was a strong positive correlation between the magnitude of the map shift and grip strength in the affected hand (r=0.79; P=0.006). In the other seven patients with a map shift, in whom corticospinal conductionwas still impaired, there was a tendency for a larger map area to be associated with better motor function, and in the group as a whole there was a correlation between map area and grip strength (r=0.52; P=0.005). Conclusions: The present findings provide evidence that the cortical plasticity and reorganization that occurs after a subcortical stroke is functionally significant and contributes to motor outcome.
