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Instrumental Diagnosis and Treatment of Acute Ischemic Stroke: The Clinician’s Perspective

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Maturation Phenomenon in Cerebral Ischemia III

Abstract

It is difficult to estimate the impact of experimental work on mechanisms of induction and protection of cellular damage in the “real world” of neurological diseases. This is particularly difficult for ischemic stroke, although clinicians are now actively collaborating with basic scientists and technologists in order to implement effective therapeutic strategies for stroke victims. Important tasks for the clinician include: (1) the identification of the most appropriate diagnostic techniques, (2) the set up of organized stroke care, and (3) the design and realization of rigorous clinical trials. In the following pages, we review the current options for instrumental diagnosis and treatment of acute ischemic stroke.

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References

  1. Baird AE, Austin MC, McKay WJ, Donnan GA (1996) Changes in cerebral tissue perfusion during the first 48 h of ischaemic stroke: relation to clinical outcome. J Neurol Neurosurg Psychiatry 61: 26–29

    Article  PubMed  CAS  Google Scholar 

  2. Baird AE, Benfield A, Schlaug G, Siewert B, Lovblad KO, Edelman RR, Warach S (1997) Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 41: 581–589

    Article  PubMed  CAS  Google Scholar 

  3. Barnes RW, Nix L, Rittgers SE (1981) Audible interpretation of carotid doppler signals. Arch Surg 116: 1185–1189

    Article  PubMed  CAS  Google Scholar 

  4. Bastianello S, Pierallini A, Colonnese C, et al. (1991) Hyperdense middle cerebral artery sign. Comparison with angiography in the acute phase of ischemic supratentorial infarction. Neuroradiology 33: 207–211

    Article  PubMed  CAS  Google Scholar 

  5. Clark WM, Warach SJ, Pettigrew LC, Gammans RE, Sabounjian L (1997) A randomized dose-response trial of citicoline in acute ischemic stroke patients. Citicoline Stroke Study Group, Neurology 49: 671–678

    Article  PubMed  CAS  Google Scholar 

  6. De Deyn PP, Reuck JD, Deberdt W, Vlietinck R, Orgogozo JM (1997) Treatment of acute ischaemic stroke with piracetam. Members of the Piracetam in Acute Stroke Study (PASS) Group. Stroke 28: 2347–2352

    Article  PubMed  Google Scholar 

  7. Diener HC (1998) Multinational randomised controlled trial of lubeluzole in acute ischaemic stroke. European and Australian Lubeluzoie Ischaemic Stroke Study Group. Cerebrovasc Dis 8: 172–181

    Article  PubMed  CAS  Google Scholar 

  8. Donnan GA, Davis SM, Chambers BR, Gates PC, Hankey GJ, McNeil JJ, Rosen D, Stewart-Wynne EG, Tuck RR (1996) Streptokinase for acute ischemic stroke with relationship to time of administration: Australian Streptokinase (ASK) Trial Study Group. JAMA 276: 961–966

    Article  PubMed  CAS  Google Scholar 

  9. European Cooperative Acute Stroke Study (ECASS) (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke. JAMA 274: 1017–1025

    Article  Google Scholar 

  10. Fiorelli M, Sacchetti ML, Toni D, et al. (1993) Feasibility and usefulness of conventional spin-echo MR imaging in hyperacute ischemic stroke: a comparison with CT scan. Circ Metabol Cerveau 10: 5–10

    Google Scholar 

  11. Fisher M, Sotak CH, Minematsu K, Li L (1992) New magnetic resonance techniques for evaluating cerebrovascular disease. Ann Neurol 32: 115–122

    Article  PubMed  CAS  Google Scholar 

  12. Furlan M, Marchai G, Viader F, Derlon JM, Baron JC (1996) Spontaneous neurological recovery after stroke and the fate of the ischemic penumbra. Ann Neurol 40: 216–226

    Article  PubMed  CAS  Google Scholar 

  13. Gholkar A, Davis M, Barer D, Mendelow AD (1998) Early computed-tomography abnormalities in acute stroke. Lancet 351: 679

    Article  PubMed  CAS  Google Scholar 

  14. Giubilei F, Lenzi GL, Di Piero V, Pozzilli C, Pantano P, Bastianello S, Argentina C, Fieschi C (1990) Predictive value of brain perfusion single-photon emission computed tomography in acute ischemic stroke. Stroke 21: 895–900

    Article  PubMed  CAS  Google Scholar 

  15. Heiss WD, Grand M, Thiel A, von Stockhausen HM, Rudolf J (1997) Ischaemic brain tissue salvaged from infarction with alteplase. Lancet 349: 1599–1600

    Article  PubMed  CAS  Google Scholar 

  16. Hennerici M, Mohr JP, Rautenberg W, Steinke W (1992) Ultrasound imaging and doppler sonography in the diagnoses of cerebrovascular diseases. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM (eds) Stroke: pathophysiology, diagnosis and management, 2nd edn. Churchill Livingstone, New York pp 241–268

    Google Scholar 

  17. Hessel SJ, Adams DF, Abrams HL (1981) Complications of angiography. Radiology 138: 273–281

    PubMed  CAS  Google Scholar 

  18. Indredavik B, Bakke F, Solberg R, Rokseth R, Haaheim LL, Holme I (1991) Benefit of a stroke unit: a randomized controlled trial. Stroke 22: 1026–1031

    Article  PubMed  CAS  Google Scholar 

  19. Jones TH, Morawetz RB, Crowell RM, Marcoux FW, FitzGibbon SJ, DeGirolami U, Ojemann RG (1981) Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg 54: 773–782

    Article  PubMed  CAS  Google Scholar 

  20. Kalender WA, Polacin A (1991) Physical performance characteristics of spiral CT scanning. Med Phys l8 910–915

    Article  PubMed  CAS  Google Scholar 

  21. Langhorne P, Williams BO, Gilchrist W, Howie K (1993) Do stroke units save lives? Lancet 342: 395–398

    Article  PubMed  CAS  Google Scholar 

  22. Leclerc X, Godefroy O, Salhi A, Lucas C, Leys D, Pruvo JP (1996) Helical CT for the diagnosis of extracranial internai carotid artery dissection. Stroke 27: 461–466

    Article  PubMed  CAS  Google Scholar 

  23. Marchal G, Serrati C, Rioux P, Petit-Taboué MC, Viader F, de la Sayette V, Le Doze F, Lochan P Derlan JM, Orgogozo JM, et al. (1993) PET imaging of cerebral perfusion and oxygen consumption in acute ischaemic stroke: relation to outcome. Lancet 341: 925–927

    Article  PubMed  CAS  Google Scholar 

  24. Mohr JP, Orgogozo JM, Harrison MJG, Hennerici M, Wahlgren NG Gelmers JH, Martinez-Vila E, Dycka J, Tettenborn D (1994) Meta-analysis of oral nimodipine trials in acute ischemic stroke. Cerebrovasc Dis 4: 177–210

    Article  Google Scholar 

  25. Mohr JP, Biller J, Hilal SK, et al. (1995) Magnetic resonance versus computed tomographic imaging in acute stroke, Stroke 26: 807–812

    Article  PubMed  CAS  Google Scholar 

  26. Multicentre Acute Stroke Trial-Italy (MAST-I) Group (1995) Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 346: 1509–1514

    Google Scholar 

  27. Otis S, Rush M, Boyajian R (1995) Contrast-enhanced transcranial imaging: results of an American phase-two study. Stroke 26: 203–209

    Article  PubMed  CAS  Google Scholar 

  28. Patel MR, Edelman RR, Warach S (1996) Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke 27: 2321–2324

    Article  PubMed  CAS  Google Scholar 

  29. Powers WJ, Zivin J (1998) Magnetic resonance imaging in acute stroke: not ready for prime time. Neurology 50: 842–843

    Article  PubMed  CAS  Google Scholar 

  30. Sacchetti ML, Toni D, Fiorelli M, Argentina C, Fieschi C (1997) The concept of combination therapy in acute ischemic stroke. Neurology 49 [Suppl 4]: 570-S74

    Google Scholar 

  31. Strand T, Asplund K, Eriksson S, Hegg E, Lithner F, Wester PO (1985) A non intensive stroke unit reduces functional disability and the need for long term hospitalization. Stroke 16: 29–34

    Article  PubMed  CAS  Google Scholar 

  32. Stroke Unit Trialists’ Collaboration (1997) Collaborative systematic review of the randomised trials of organised inpatient (stroke unit) care after stroke. BMJ 314: 1151–1159

    Article  Google Scholar 

  33. Stroke Unit Trialists’ Collaboration (1997) How do stroke units improve patient outcomes? A collaborative systematic review of the randomized trials. Stroke 28: 2139–2144

    Article  Google Scholar 

  34. Tarr R, Taylor CL, Selman WR, Lewin JS, Landis D (1996). Good clinical outcome in a patient with a large CT scan hypodensity treated with intra-arterial urokinase after an embolic stroke. Neurology 47: 1076–1078

    Article  PubMed  CAS  Google Scholar 

  35. The European Ad Hoc Consensus Group (1998) Neuroprotection as initial therapy in acute stroke. Cerebrovasc Dis 8: 59–72

    Article  Google Scholar 

  36. The NINDS rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333: 1581–1587

    Article  Google Scholar 

  37. The Multicenter Acute Stroke Trial-Europe Study Group (1996) Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med 335: 145–150

    Article  Google Scholar 

  38. Rong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME (1998) Corrleation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke. Stroke 50: 864–870

    Google Scholar 

  39. Ueda T, Hatakeyama T, Kumon Y, Sakaki S, Uraoka T (1994) Evaluation of risk of hemorrhagic transformation in local intra-arterial thrombolysis in acute ischemic stroke by initial SPECT. Stroke 25: 298-[Font:ZapfDingbats]z[ZapfDingbatsEnde]30312

    Google Scholar 

  40. von Kummer R, Bozzao L, Manelfe C (1995) Early CT diagnosis of hemispheric brain infarction. Springer, Berlin Heidelberg New York

    Book  Google Scholar 

  41. von Kummer R, Weber I (1997) Brain and vascular imaging in acute ischemic stroke: the potential of computed tomography. Neurology 49 [Suppl 4]: S52–S55

    Article  Google Scholar 

  42. Warach S, Dashe JF, Edelman RR (1996) Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab 16: 53–59

    Article  PubMed  CAS  Google Scholar 

  43. Wildermuth S, Knauth M, Brandt T, Winter R, Sartor K, Hacke W (1998) Raie of CT angiography in patient selection for thrombolytic therapy in acute hemispheric stroke. Stroke 29: 935–938

    Article  PubMed  CAS  Google Scholar 

  44. Zanette EM, Fieschi C, Bozzao L, et al. (1989) Comparison of cerebral angiography and transcranial doppler in acute stroke. Stroke 20: 899–903

    Article  PubMed  CAS  Google Scholar 

  45. Zanette EM, Roberti C, Mancini G, et al. (1995) Spontaneous middle cerebral artery reperfusion in ischemic stroke. Stroke 26: 430–433

    Article  PubMed  CAS  Google Scholar 

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© 1999 Springer-Verlag Berlin Heidelberg

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Fieschi, C. et al. (1999). Instrumental Diagnosis and Treatment of Acute Ischemic Stroke: The Clinician’s Perspective. In: Ito, U., Fieschi, C., Orzi, F., Kuroiwa, T., Klatzo, I. (eds) Maturation Phenomenon in Cerebral Ischemia III. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-58602-6_34

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  • DOI: https://doi.org/10.1007/978-3-642-58602-6_34

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-65023-2

  • Online ISBN: 978-3-642-58602-6

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