Stroke evaluation

Other electrolytes of importance include calcium (especially if the patient is receiving a calcium channel blocker, such as nicardipine) and magnesium, as hypomagnesemia may predispose the patient to seizures, further complicating the ICP management. If the patient received intravenous iodinated contrast as part of their stroke evaluation, then careful monitoring of the blood urea nitrogen (BUN) and creatinine levels is necessary to detect contrast nephropathy. 

Johnston RC, Worrall BB. Teleradiology assessment of computerized tomographs online reliability study (tractors) for acute stroke evaluation. Telemed J E Health 2003 9 227-233. 

Neuroprotective Effect of Nitroglycerin in a Rodent Model of Ischemic Stroke Evaluation of Bel-2 Expression... 

Stroke evaluation for late endovascular cerebral thrombolysis with MR (SELECT MR) No Yes Yes... 

Sorensen AG, Buonanno FS, Gonzalez RG et al. (1996). Hyperacute stroke evaluation with comhined multisection diffusion-weighted and haemodynamically weighted echo-planar MR imaging. Radiology 199 391-401... 

This is a thresholding technique to display all pixels with attenuation values greater than a user-specified HU threshold. Bone, opacified vessels, and calcification will be captured with a threshold of 80-100 HU however, most parenchymal structures will be excluded [77]. SSD is not as useful in acute stroke evaluation, as only pixels on the surface are displayed. This limits evaluation for partially occlusive thrombus. It has been most successfully used for surgical planning, such as for paraclinoid aneurysms. 

The acute stroke evaluation should be made available for all patients with a sndden-onset nenrologic deficit, the basis of the stroke syndrome. Though focal neurologic deficits are common in stroke patients, they may not be present in some conditions, for example subarachnoid hemorrhage, or they may reqnire specific sfroke expertise to be elicited, for example top of basilar artery embolus. The most difficult diagnostic problems usually occur in patients with an altered level of consciousness, especially if there are other potential causes of encephalopathy, such as alcohol intoxication, systemic illness, head trauma, etc. There is tremendous variation in the presentation of acute stroke patients. This variation depends on whether the stroke... 

Although poor outcome may occur due to delays in stroke evaluation, it is eqnally important that rapid triage to neurologic evaluation and brain imaging occnr... 

Iwamuro BT, Cruz EG, Connelly LL, Fischer HC, and Kamper DG, Effect of a gravity-compensating orthosis on reaching after stroke Evaluation of the Therapy Assistant WREX, Archives of Physical Medicine and Rehabilitation, vol. 89, pp. 2121-2128,2008. 

Biological/Medical Applications Detecting risk of Alzheimer s disease and stroke evaluating/testing sperm quality identifying bacteria as a substrate for measuring aromatase activity, azoreductase activity, phospholipase activity, proteases activity (caspase activity, cathepsin C activity, elastase activity proteinase activity) " implantable drug-delivery devices ... 

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

Wolpert SM, Bmckmann H, Greenlee R, Wechsler L, Pessin MS, del Zoppo GJ. Neuroradiologic evaluation of patients with acute stroke treated with recomhinant tissue plasminogen activator. The rt-PA Acute Stroke Study Group. Am J Neuroradiol 1993 14 3-13. 

An important part of the evaluation, sometimes overlooked by inexperienced chnicians, is to obtain not only the time that the symptoms were discovered, but also the time when the patient was last known to be free of stroke symptoms. In cases where the onset was not witnessed, it is the latter time that, for practical purposes, must be assumed to be the time of symptom onset. A frequently encountered scenario is one in which a family member reports that the patient s stroke occurred early in the morning, for example, at 7 AM. Specific questioning often reveals that the last time the patient was known to be symptom free was the previous evening, for example, at 10 PM the actual time of stroke onset is therefore unknown but could have been up to 9 hours before discovery, making the patient ineligible for IV rt-PA therapy. 

Fieschi C, Argentine C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L. Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours. J Neurol Sci. 1989 91 311-321. 

Schwamm LH, Rosenthal ES, Hirshherg A, Schaefer PW, Little EA, Kvedar JC, Petkovska I, Koroshetz WJ, Levine SR. Virtual Telestroke support for the emergency department evaluation of acute stroke. Acad Emerg Med. 2004 11 1193-1197. 

Some studies have evaluated the feasibility, safety, and efficacy of combined IV rt-PA at a dose of 0.6 mg/kg with lAT in patients presenting with acute strokes within 3 hours of symptom onset. This approach has the potential of combining the advantages of IV rt-PA (fast and easy to use) with the advantages of lAT (directed therapy, titrated dosing, mechanical aids to recanalization, and higher rates of recanalization), thus improving the speed and frequency of recanalization. 

Alternatives to Plasminogen Activation Other Thrombolytics Thrombolytics currently in the market are plasminogen activators. Therefore, their activity is impacted by the amount of plasminogen in the thrombus. New drugs that do not depend on the availably of plasminogen are currently being evaluated for stroke therapy. 

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