Stroke restoration

The body temperature limits for health in terms of internal or core temperature are fairly limited. The limits are basically related to the function of nervous tissue. Body temperatures around 28 °C or less can result in cardiac fibrillation and arrest. Temperatures of 43 °C and greater can result in heat stroke, brain damage, and death. Often, too high a temperature causes irreversible shape changes to the protein molecules of nervous tissue. That is, cooling overheated tissue to normal temperatures may not restore its original function. 

The MERCI trial was a prospective single-arm, multicenter trial designed to test the safety and efficacy of the MERCI clot retrieval device to restore the patency of intracranial arteries in the first 8 hours of an acute stroke. All patients were ineligible for IV rt-PA. The occlusion sites were the intracranial vertebral artery, basilar... 

Congestive heart failure In myocardial insufficiency, the heart depends on a tonic sympathetic drive to maintain adequate cardiac output. Sympathetic activation gives rise to an increase in heart rate and systolic muscle tension, enabling cardiac output to be restored to a level comparable to that in a healthy subject. When sympathetic drive is eliminated during p-receptor blockade, stroke volume and cardiac rate decline, a latent myocardial insufficiency is unmasked, and overt insufficiency is exacerbated (A). 

Secondary hypotension is a sign of an underlying disease that should be treated first. If stroke volume is too low, as in heart failure, a cardiac glycoside can be given to increase myocardial contractility and stroke volume. When stroke volume is decreased due to insufficient blood volume, plasma substitutes will be helpful in treating blood loss, whereas aldosterone deficiency requires administration of a mineralocor-ticoid (e.g., fludrocortisone). The latter is the drug of choice for orthostatic hypotension due to autonomic failure. A parasympatholytic (or electrical pacemaker) can restore cardiac rate in bradycardia. 

Oral - For the control of clinical spasticity resulting from upper motor neuron disorders such as spinal cord injury, stroke, cerebral palsy, or multiple sclerosis. It is of particular benefit to the patient whose functional rehabilitation has been retarded by the sequelae of spasticity. Such patients must have presumably reversible spasticity where relief of spasticity will aid in restoring residual function. 

Restoration of sinus rhythm in atrial fibrillation may dislodge thrombi that have developed as a result of stasis in the enlarged left atrium. The risk of stroke and systemic arterial embolism is decreased by anticoagulation in such patients. 

Schallert T, Fleming SM, Woodlee MT. 2003. Should the injured and intact hemispheres be treated differently during the early phases of physical restorative therapy in experimental stroke or parkinsonism Phys Med Rehabil 14 S27-46. 

Hesse S. Recovery of gait and other motor functions after stroke novel physical and pharmacological treatment strategies. Restor Neurol Neurosci. 2004 22 359-369. 

Recombinant human t-PA is now produced by recombinant DNA technology. Injected within the first hours after a heart attack, it dissolves the clot blocking the coronary artery, restoring blood flow before the heart muscle becomes irreversibly damaged. It is also used in treatment of ischaemic stroke. 

Approximately 25% of patients with TIA have cerebral infarction with transient signs in which DWI positivity corresponds to cytotoxic edema this progresses to permanent parenchymal injury and increased tissue water content visible as a lesion on T2-weighted MRI. Approximately 20% of patients have early DWI abnormality but no evidence of later T2-weighted abnormality. This suggests reversibility of the initial DWI abnormality if blood flow is restored early enough to prevent permanent parenchymal injury, as seen in patients with stroke in whom the DWI-detected lesion may regress with reperfusion. 

Stroke rehabilitation attempts to restore patients to their previous physical, mental and social capability (Langton Hewer 1990 Brandstater 2005). Rehabilitation approaches include restoration of previous function, compensation by increasing function for a given impairment, environmental modification, prevention of complications such as recurrent stroke or shoulder pain, and maintenance or prevention of deterioration. Achieving optimal... 

Currently, the only treatment of patients with acute ischemic stroke is thrombolysis and restoration of blood flow [3,6,7]. Only a fraction of stroke patients benefits from this therapy [3,6,7], Therapeutic recanalization of an occluded cerebral artery is a risky option that can be applied only in the case of selected patients. The main limitation of cerebral thrombolysis is the narrow, 3-hour therapeutic window during which the thrombolytic agent has to be administered to be effective. Beyond this time limit, its effectiveness is neutralized by the high risk of cerebral hemorrhage [7], In acute stroke, only a small fraction of patients benefit from intravenous administration of recombinant tissue plasminogen activator, which is the only drug with proven effectiveness in reducing the size of infarct in humans [6],... 

Oxygen deprivation follows when blood flow is compromised by a local, temporary circulatory blockade that may occur naturally as a result of stenosis, stroke, or a myocardial infarction (heart attack) or may accompany therapeutic interventions, such as percutaneous transluminal coronary angioplasty (PTCA). Packed RBCs are not useful for restoration of oxygen delivery in these situations, because they are too large to traverse the constricted vessels or too viscous and fragile to be pumped through a perfusion balloon catheter. A number of preclinical studies in this area are summarized below. 

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