Noninvasive Intracranial Pressure Determination in Patients with Subarachnoid Hemorrhage.

Intracranial pressure (ICP) should ideally be measured in many conditions affecting the brain. The invasiveness and associated risks of the measurement modalities in current clinical practice restrict ICP monitoring to a small subset of patients whose diagnosis and treatment could benefit from ICP measurement. To expand validation of a previously proposed model-based approach to continuous, noninvasive, calibration-free, and patient-specific estimation of ICP to patients with subarachnoid hemorrhage (SAH), we made waveform recordings of cerebral blood flow velocity in several major cerebral arteries during routine, clinically indicated transcranial Doppler examinations for vasospasm, along with time-locked waveform recordings of radial artery blood pressure (APB), and ICP was measured via an intraventricular drain catheter.

New avenues for treatment of intracranial hemorrhage.

The mortality and morbidity from intracerebral hemorrhage (ICH) remain high despite advances in medical, neurologic, and surgical care during the past decade. The lessons learned from previous therapeutic trials in ICH, improved understanding of the pathophysiology of neuronal injury after ICH, and advances in imaging and pre-hospital assessment technologies provide optimism that more effective therapies for ICH are likely to emerge in the coming years. The potential new avenues for the treatment of ICH include a combination of increased utilization of minimally invasive surgical techniques with or without thrombolytic usage to evacuate or reduce the size of the hematoma; utilization of advanced imaging to improve selection of patients who are likely to benefit from reversal of coagulopathy or hemostatic therapy; ultra-early diagnosis and initiation of therapy in the ambulance; and the use of novel drugs to target the secondary injury mechanisms, including the inflammatory cascade, perihematomal edema reduction, and hemoglobin degradation products-mediated toxicity.

Transient ischemic attack: omen and opportunity.

A transient ischemic attack (TIA) is not a benign event; it is often the precursor of stroke. As such, every TIA deserves to be taken seriously, and patients who present with a TIA should be promptly evaluated and, if appropriate, started on stroke-preventive therapy.

Diagnosis and misdiagnosis of cerebrovascular disease.

Stroke is the leading cause of disability and the third leading cause of death in the USA. Ischemic and hemorrhagic strokes must be distinguished since treatment is quite different. Ischemic strokes account for 80 % of the total and recent advances in management of brain ischemia have added valuable options to the physicians' armamentarium.

Determinants of white matter hyperintensity volume in patients with acute ischemic stroke.

Background: White matter hyperintensity (WMH) is a common radiographic finding in the aging population and a potent risk factor for symptomatic cerebrovascular disease. It is unclear whether WMH represents a single or multiple biological processes. We sought to investigate the extent and determinants of WMH in patients with acute ischemic stroke (AIS).

Hyperlipidemia and reduced white matter hyperintensity volume in patients with ischemic stroke.

Background And Purpose: White matter hyperintensity (WMH), or leukoaraiosis, is a radiologic finding generally assumed to reflect diseased small cerebral vasculature. WMH has significant functional impact through its relation to cognitive decline and risk of ischemic and hemorrhagic stroke. Accumulating evidence suggests that some manifestations of small-vessel disease such as intracerebral hemorrhage are associated with low levels of cholesterol.

Wake-up stroke: clinical and neuroimaging characteristics.

Background: Approximately 25% of ischemic stroke patients awaken with neurological deficits. In these patients, in whom the time from symptom onset is uncertain, brain imaging is a potential strategy to characterize the ischemia duration and the presence of salvageable brain tissue.

Methods: We prospectively evaluated consecutive patients with acute ischemic stroke.