Intracerebral

The U.S. standard pertussis vacciae is used to standardize the potency of the whole ceU pertussis vacciae. The number of protective units Hi the vaccine is estimated for each lot from the results of simultaneous intracerebral mouse-protection tests of the vaccine being studied and the U.S. reference standard (14,17). The potency of the aceUular vaccines is estimated by then abUity to produce antibodies to the proteins Hi the vaccine Hi a mouse model. These vaccines also undergo a series of animal safety tests to ensure that the iaactivation and toxoiding steps were carried out correctiy (14,17). 

Melarsoprol, a trivalent organic melaminophenyl arsenic compound, kills intracerebral parasites of both T. brucei gambiense and T. brucei rhodesiense. Melarsoprol accumulates via an adenosine/adenine transporter in trypanosomes and is believed to inhibit glycolytic enzymes. Melarsoprol leads to a rapid lysis of trypanosomes. Melarsoprol is highly toxic to humans. 

Braida D, Pozzi M, Cavallini R, et al Intracerebral self-administration of the cannabinoid receptor agonist CP 55,940 in the rat interaction with the opioid system. EurJ Pharmacol 413 227-234, 2001... 

Inexperienced users or individuals who are exposed to the drug unexpectedly (e.g., who unknowingly consume PCP-adulterated cannabis) may develop severe anxiety and panic because of the intensity and variety of symptoms. Perceptual distortions have sometimes led to extremely violent behavior, accidents, or self-damaging acts. An especially high risk of violent behavior has been reported in acutely intoxicated PCP users who have a history of psychiatric problems. Intoxication with doses in excess of 150 mg may lead to convulsions, coma, and death from respiratory arrest. Other complications include hypertensive crisis, intracerebral hemorrhage, and renal failure (Table 6-5). 

FIGURE 10 Effect of bethanechol on memory in lesioned rats. Be-thanechol was released from PCPP-SA 50 50 implanted intracerebrally in rats. The effect of the bethanechol released on the performance of lesioned rats in a radial maze test was performed as described in the text. 

R., Chasin, M., Tamargo, R., and Colvin, O, M., The intracerebral delivery of BCNU with surgically implanted biodegradable polymers A quantitative autoradiographic study, Proc. 

Howard, M. A., Gross, A., Grady, M. S., Langer, R., Mathiowitz, E., Winn, H. R., and Mayberg, M. R., Intracerebral drug delivery in rats reverses lesion-induced memory deficits,... 

Weber KS, von Hundelshausen P, Clark-Lewis 1, Weber PC, Weber C (1999) Differential immobilization and hierarchical involvement of chemokines in monocyte arrest and transmigration on inflamed endothelium in shear flow. Eur J Immunol 29(2) 700-712 Wesselingh SL, Power C, Glass JD, Tyor WR, McArthur JC, Farber JM, Griffin JW, Griffin DE (1993) Intracerebral cytokine messenger RNA expression in acquired immunodeficiency syndrome dementia. Ann Neurol 33(6) 576-582... 

The modern period in the history of stroke began in the 1960s when C. Miller Fisher described detailed clinical and pathological observations on the features of lacunar strokes, carotid artery disease, transient ischemic attacks, and intracerebral hemorrhage. His student Louis Caplan established one of the first stroke registry... 

Kidwell CS, Chalela JA, Saver XL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 2004 292 1823-1830. 

Anonymous. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NBSfDS t-PA Stroke Study Group. Stroke 1997 28 2109-2118. 

Tanne D, Kasner SE, Demchuk AM, Koren-Morag N, Hanson S, Grond M, Levine SR. Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice The Multicenter rt-PA Stroke Survey. Circulation. 2002 105 1679-1685. 

TABLE 4.2 Management of Symptomatic Intracerebral Hemorrhage after Intraarterial Thrombolysis. 

The efficacy of IV thrombolysis in patients with moderate-to-severe strokes due to proximal arterial occlusions is restricted by several factors, including the relatively short therapeutic window, poor recanalization rates as the clot burden increases, restrictive eligibility criteria, and the risk of intracerebral hemorrhage. Endovascular techniques improve the rates of recanalization in this patient population, and appear to increase the likelihood of a good functional outcome. Intravenous thrombolysis... 

Greer DM, Koroshetz WJ, Cullen S, Gonzalez RG, Lev MH. Magnetic resonance imaging improves detection of intracerebral hemorrhage over computed tomography after intra-arterial thrombolysis. Stroke 2004 35 491 95. 

The timing of CEA after ischemic stroke has been a controversial issue. In 1969, the Joint Study of Extracranial Arterial Occlusion reported 42% mortality after CEA in patients with neurological deficits of less than 2 weeks duration, compared with 5% mortality in patients with more than 2 weeks of symptoms. Early evidence also demonstrated an increased risk of intracerebral hemorrhage after early CEA in patients with acute stroke. This led to the conclusion that most complications occurred with early surgical intervention, and resulted in a traditional 4-6 week delay for CEA after an acute stroke. In retrospect, however, there were major problems with patient selection in these earlier reports. Many of the patients... 

Caplan LR, Skilhnan J, Ojemann R, Eields WS. Intracerebral hemorrhage following carotid endarterectomy a h3fpertensive complication Stroke 1978 9 457-460. 

Placebo-Controlled Trials ofUFH, LMWH, and Heparinoids The International Stroke Trial (1ST) was a randomized, placebo-controlled trial of UFH (5000 or 12,500 lU twice daily) and aspirin (300 mg) in 19,435 unselected patients with acute stroke within 48 hours of symptom onset. Because of limited availability of neuroimaging, 33% of participants were enrolled with suspected but not proven ischemic stroke, some of whom may have suffered primary intracerebral hemorrhage (ICH). 

Corticosteroids have been evaluated in several types of cerebral injury, including cerebral infarction. Corticosteroids reduce vasogenic edema, such as that associated with neoplasms, but not cytotoxic edema, the type associated with ischemic stroke. A large meta-analysis found no benefit to the use of corticosteroids in ischemic stroke (or intracerebral hemorrhage), and their use is not recommended, except to treat concomitant conditions that mandate it (e.g., COPD flare). 

Other methods for ICP monitoring include Camino ICP monitors, which are positioned into the brain parenchyma, but do not transverse the hemisphere nearly to the degree that EVDs do, and are associated with a lower risk of intracerebral hemorrhage. The ICP is measured by a fiberoptic transducer at the tip of the cathe-ter. ° ICP monitors, however, are subject to inaccuracy over time, so-called drift, and thus may become less reliable after the first few days post-insertion. Epidural and subarachnoid bolts/catheters are the least invasive, placed external to or just within the dura, thereby carrying a much lower risk of hemorrhage and infection, but with unfortunately compromised accuracy. 

Demchuk AM, Morgenstem LB, Krieger DW, Linda Chi T, Hu W, Wein TH, Hardy RJ, Grotta JC, Buchan AM. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Stroke 1999 30(l) 34-39. 

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