Stroke is the primary cause of morbidity and disability throughout the world, mainly because of its effect on cognitive functions. After stroke, individuals can recover from physical disability, but might be unable to return to their previous occupation or independent living because of cognitive impairments. Cognitive dysfunction encompasses all deficits, which range from local ones resulting directly from the area of infarction or from hypoperfusion of the adjacent tissue, to more global cognitive impairment that is usually related to other underlying subclinical cerebrovascular disease, such as white matter disease or subclinical infarcts. Researchof cognitive dysfunction after stroke is complicated because of its varying definitions and lack of cognitive function measurement before stroke. Additionally, stroke can affect white matter connectivity, so newer imaging techniques, such as diffusion tensor imaging and magnetisation transfer imaging, which can be used to assess subclinical damage are important tools for better assessment of cognitive dysfunction following stroke. Recent and current studies are increasingly focused on the role of preventable risk factors in the development of dementia. Since stroke is one such preventable risk factor, its role is a!new issue that requires attention and treatment
COBISS.SI-ID: 269413888
Background Endovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. Methods A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. Results The mean age of the patients was 63.1 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.519). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS 2) 30 days after stroke. Overall, significant neurological improvement (4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of 4 or death occurred in three (5 %) patients. Conclusions The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.
COBISS.SI-ID: 31021529
The knowledge about safety and efficacy of thrombolysis in paediatric stroke is limited, especially for very young children. We present an infant with cardioembolic stroke treated with alteplase. He had hypoplastic left heart syndrome since birth. He underwent Norwood operation, followed by bidirectional cavopulmonary anastomosis at 3 months. On aspirin therapy he waswell until heart failure developed at the age of 9 months with 2 thrombi inthe right ventricle. During the course of enoxaparin therapy sudden acute left-sided haemiplegia occurred. The emergency brain CT scan was normal. Informed consent was obtained from parents after explaining the alteplase treatment protocol and possible complications. Alteplase was administered i.v.according to standard adult stroke regimen. A control CT scan obtained 24 h later was negative for intracranial haemorrhage but the hypodense area in insula, internal capsule and subcortical area of the right parietal region were indicative of ischaemic stroke. Anticoagulation therapy was continued. Herecovered hand functions after 5 days and full repertoire of movements on his left side 3 weeks later. A neurological examination performed 2 months after indicated mild residual haemiparesis and a modified Rankin scale score of 1. Three months later, the patient died of progressive heart failure. An international multicentre prospective trial is ongoing to investigate the safety and appropriate dose of alteplase for paediatric ages 2-17 years. The aim of this paper is to report safe use of alteplase even in a very young child
COBISS.SI-ID: 795564