Neurological Manifestations of Chronic Methadone Maintenance Therapy: A Case Report and Literature Review.

Methadone is a long-acting opioid medication that is used as maintenance therapy for heroin addiction. We present a case of a patient on methadone maintenance therapy for chronic back pain who developed neurological complications. The patient presented with mental status changes and choreiform movements.

The effect of heliox treatment in a rat model of focal transient cerebral ischemia.

Manipulation of inhaled gases during ischemia/reperfusion is a potential novel therapy for acute stroke. We previously found that treatment with a mixture of 70%/30% helium/oxygen (heliox) or 100% oxygen protects the brain against acute focal ischemia-reperfusion injury. This study evaluates the potential neuro-protective effects of delayed heliox treatment and its dose response effects in a rat transient focal cerebral ischemia model.

Therapeutic hypothermia is associated with a decrease in urine output in acute stroke patients.

Aims: It is unclear what effect therapeutic hypothermia may have on renal function, because its effect has so far been primarily evaluated in settings in which there may be possible confounding perturbations in cardiovascular and renal physiology, such deep intraoperative hypothermia, general anesthesia, and post-cardiac arrest. We sought to determine if therapeutic hypothermia affects renal function in awake patients with normal renal function who were enrolled into a clinical trial of hypothermia plus intravenous thrombolysis for acute ischemic stroke.

Methods: Eleven patients with normal renal function were cooled to 33°C for 24 h using an endovascular catheter, and then re-warmed over 12 h to 36.

Distance from home to hospital and thrombolytic utilization for acute ischemic stroke.

Treatment of acute stroke with thrombolytic therapy has been limited because of the narrow treatment window. Distance from home to hospital may affect arrival time and likelihood of receiving thrombolytic therapy for acute stroke. The present study included stroke subjects seen at Barnes Jewish Hospital in 2006-2007, residing in St Louis City/County, who were at home at the time of the stroke (n = 416).

Treatment with tissue plasminogen activator is not associated with increased use of neurosurgery.

Background: Current guidelines of stroke care imply that tissue plasminogen activator (rtPA) should be only used in centers with a neurosurgeon available to manage any intracranial hemorrhage (ICH). Such advice may be difficult to follow with the current US shortage of neurosurgeons. It could also contribute to the underutilization of rtPA in smaller hospitals and might not be justified if, in practice, most ICHs were managed medically.

Blood pressure surge precedes intracerebral hemorrhage.

Introduction: Most patients with acute intracerebral hemorrhage (ICH) have very high blood pressure (BP) on presentation, but it is unclear whether such pressure elevation is the cause or a consequence of the ICH. This controversy could be clarified by determining the exact temporal relationship between the BP elevation and the onset of the ICH. Several case reports have attributed ICH to specific situations in which the BP was inferred to be high.

Effect of testosterone on functional recovery in a castrate male rat stroke model.

Both increased and decreased testosterone levels have been reported to correlate with poor outcome after acute ischemic stroke. The present study focused on the role of testosterone during recovery from neurological deficits in a rat focal ischemia model. Castrate male rats were subjected to behavioral tests after 90 min of middle cerebral artery occlusion (MCAO).

Improving pilot response to in-flight strokes: a randomized controlled trial.

Background: When a passenger suffers an in-flight stroke (IFS), the pilot decides when to expedite access to ground care. Pilot pro-activeness towards IFS could improve outcome and should be promoted. Unfortunately, little is known about a pilot's stroke pro-activeness or limiting factors.