Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
Stroke ; 46(11): 3190-3, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26463689

ABSTRACT

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Trials of magnesium treatment starting <4 days after symptom onset found no effect on poor outcome or DCI in SAH. Earlier installment of treatment might be more effective, but individual trials had not enough power for such a subanalysis. We performed an individual patient data meta-analysis to study whether magnesium is effective when given within different time frames within 24 hours after the SAH. METHODS: Patients were divided into categories according to the delay between symptom onset and start of the study medication: <6, 6 to 12, 12 to 24, and >24 hours. We calculated adjusted risk ratios with corresponding 95% confidence intervals for magnesium versus placebo treatment for poor outcome and DCI. RESULTS: We included 5 trials totaling 1981 patients; 83 patients started treatment<6 hours. For poor outcome, the adjusted risk ratios of magnesium treatment for start <6 hours were 1.44 (95% confidence interval, 0.83-2.51); for 6 to 12 hours 1.03 (0.65-1.63), for 12 to 24 hours 0.84 (0.65-1.09), and for >24 hours 1.06 (0.87-1.31), and for DCI, <6 hours 1.76 (0.68-4.58), for 6 to 12 hours 2.09 (0.99-4.39), for 12 to 24 hours 0.80 (0.56-1.16), and for >24 hours 1.08 (0.88-1.32). CONCLUSIONS: This meta-analysis suggests no beneficial effect of magnesium treatment on poor outcome or DCI when started early after SAH onset. Although the number of patients was small and a beneficial effect cannot be definitively excluded, we found no justification for a new trial with early magnesium treatment after SAH.


Subject(s)
Brain Ischemia/prevention & control , Calcium Channel Blockers/administration & dosage , Intracranial Aneurysm , Magnesium Sulfate/administration & dosage , Subarachnoid Hemorrhage/drug therapy , Time-to-Treatment/statistics & numerical data , Vasospasm, Intracranial/prevention & control , Aneurysm, Ruptured/complications , Calcium Channel Blockers/therapeutic use , Early Medical Intervention , Humans , Magnesium Sulfate/therapeutic use , Subarachnoid Hemorrhage/etiology , Treatment Outcome
2.
AJNR Am J Neuroradiol ; 32(6): 1078-81, 2011.
Article in English | MEDLINE | ID: mdl-21493763

ABSTRACT

BACKGROUND AND PURPOSE: Patients with stroke unsuitable for IV thrombolysis may be considered for endovascular revascularization, particularly when baseline imaging suggests proximal cerebral vessel occlusion associated with minimal established infarction. This retrospective review describes the use of a self-expanding retrievable intracranial stent (Solitaire AB) for thrombectomy in acute ischemic stroke. MATERIALS AND METHODS: Twenty-six consecutive patients with stroke treated endovascularly by using the Solitaire stent were identified, followed by detailed review of data extracted from their imaging and clinical records. RESULTS: Recanalization (TIMI grade ≥2) was achieved with Solitaire thrombectomy as the single treatment technique in 16 patients and in combination with urokinase or the Penumbra device in 9 of the remaining 10 patients. Two patients had symptomatic intracranial hemorrhage. A favorable clinical outcome (mRS score of ≤2) was seen in 3 of 5 patients with MCA occlusion, 6 of 11 (55%) patients with ICA occlusion, and 2 of 10 patients with BA occlusion. CONCLUSIONS: Mechanical thrombectomy by using the Solitaire stent appears to be safe and is capable of achieving a high rate of recanalization and favorable clinical outcomes in patients presenting with proximal cerebral vessel occlusion.


Subject(s)
Blood Vessel Prosthesis , Infarction, Middle Cerebral Artery/surgery , Stents , Thrombectomy/instrumentation , Aged , Female , Humans , Infarction, Middle Cerebral Artery/diagnosis , Male , Middle Aged , Retrospective Studies , Treatment Outcome
3.
J Clin Neurosci ; 16(9): 1195-8, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19497750

ABSTRACT

We aimed to compare the inter-rater reliability relating to the volumetric measurement of intracranial aneurysms obtained with three-dimensional rotational angiography (3D-RA) compared with two commonly used mathematical models. Ten randomly selected aneurysms were measured by 3 independent assessors using 3D-RA and 2 mathematical models for the calculation of an ellipsoid: Equation (1), Vab=4/3pi x (a/2)x(b/2)x(a + b/4); and Equation (2), Vabc=(4/3)pi x (a/2)x(b/2)x(c/2). The inter-rater reliability for each method was: 3D-RA, 0.99; Vabc, 0.90; and Vab, 0.89. The 95% confidence interval for the mean difference between 3D-RA and Vabc was not significantly different, whereas there was a significant difference between 3D-RA and Vab. Vab gave consistently higher estimates than 3D-RA. This was especially true for aneurysms with larger volumes. The use of 3D-RA to undertake volumetric measurements of intra-cranial aneurysms is both valid and reproducible for different assessors.


Subject(s)
Cerebral Angiography , Intracranial Aneurysm/pathology , Algorithms , Humans , Magnetic Resonance Angiography , Models, Statistical , Observer Variation , Reproducibility of Results , Retrospective Studies
4.
Interv Neuroradiol ; 14(4): 441-5, 2008 Dec 29.
Article in English | MEDLINE | ID: mdl-20557744

ABSTRACT

SUMMARY: Fenestration of the A2 segment is extremely rare. Cerebrovascular fenestration may be associated with an increased incidence of cerebral aneurysm and other vascular anomalies. Two case reports are presented which identify a fenestration of the A2 segment and other normal variations of the intra-cerebral circulation. A review of the literature has been undertaken to determine the prevalence and embryology of anterior cerebral artery fenestrations, their clinical significance and the association with aneurysm formation and other intracranial vascular anomalies.

5.
Intern Med J ; 35(5): 300-2, 2005 May.
Article in English | MEDLINE | ID: mdl-15845114

ABSTRACT

Several thrombolytic agents for the treatment of acute ischaemic stroke have been examined; however, to date, only the i.v. administration of recombinant tissue plasminogen activator is licensed in Australia. Although no trials directly comparing intra-arterial and i.v. delivery of thrombolytics exist, intra-arterial thrombolysis has several potential advantages, including angiographic assessment of the thrombus and the site of occlusion and collateral circulation, improved recanalization, and delivery of higher local concentrations of thrombolytic agents and extending the therapeutic time window for treatment. We conducted a retrospective audit of our experience with the use of intra-arterial urokinase to treat acute ischaemic stroke at an Australian tertiary-care hospital between June 1993 and June 2003. We examined time from stroke onset to assessment, computerized tomography scan, cerebral angiography and thrombolysis, anatomical classification of intra-arterial thrombus, rates of symptomatic intracerebral haemorrhage, and clinical outcome at 3 months. We believe that in carefully selected individuals in appropriate centres of expertise, intra-arterial thrombolytic therapy holds great promise.


Subject(s)
Brain Ischemia/drug therapy , Cerebral Infarction/drug therapy , Plasminogen Activators/therapeutic use , Stroke/drug therapy , Thrombolytic Therapy/methods , Urokinase-Type Plasminogen Activator/therapeutic use , Adult , Aged , Female , Humans , Infarction, Anterior Cerebral Artery/drug therapy , Infarction, Middle Cerebral Artery/drug therapy , Middle Aged , Vertebrobasilar Insufficiency/drug therapy
6.
Intern Med J ; 33(3): 74-8, 2003 Mar.
Article in English | MEDLINE | ID: mdl-12603578

ABSTRACT

BACKGROUND: Computed tomography pulmonary -angiography (CTPA) plays an increasingly important role in the diagnosis of pulmonary embolism (PE). Although accurate in the detection of large PE, its accuracy in other patient groups is yet to be defined. AIM: To compare CTPA with pulmonary angiography as a second-line investigation in patients with a ventilation/perfusion (VQ) scan indicating an intermediate probability of PE. METHODS: We recruited 25 patients over a 17-month period. Subjects were eligible if they: (i). had clinically suspected PE, (ii). had a VQ scan indicating an intermediate probability of PE and (iii). were referred for pulmonary angiography. Subjects underwent CTPA within 36 h of the VQ scan. CTPA was interpreted without knowledge of the results of the pulmonary angiogram by two of the authors. RESULTS: PE was prevalent (i.e. embolus detected at pulmonary angiography) in seven of 25 subjects (28%). The sensitivity of CTPA was 57% and the specificity was 94%. CONCLUSIONS: In the setting of intermediate-probability VQ scanning, CTPA may be used to clarify the diagnosis of PE. However, a negative CTPA cannot -definitely exclude PE. Conventional pulmonary angiography may be necessary to determine the presence of PE if CTPA is negative.


Subject(s)
Angiography, Digital Subtraction , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Tomography, Spiral Computed , Adult , Contrast Media , Female , Humans , Male , Pulmonary Circulation , Radiopharmaceuticals , Sensitivity and Specificity , Technetium Tc 99m Aggregated Albumin , Ventilation-Perfusion Ratio
7.
Med J Aust ; 1(9): 407-8, 1979 May 05.
Article in English | MEDLINE | ID: mdl-470774

ABSTRACT

An early hydatidiform mole containing a fetal sac is shown in grey scale echograms. It is suggested that all hydatidiform moles can be shown to contain a gestation sac if examined early enough.


Subject(s)
Hydatidiform Mole/diagnosis , Ultrasonography , Uterine Neoplasms/diagnosis , Adult , Female , Humans , Hydatidiform Mole/pathology , Pregnancy , Time Factors , Uterine Neoplasms/pathology
8.
Med J Aust ; 1(8): 313-5, 1979 Apr 21.
Article in English | MEDLINE | ID: mdl-156304

ABSTRACT

A large sonolucent mass was first revealed by the ultrasonic echography examination of a fetus at 18 1/2 weeks' gestation, but was no longer present at 28 1/2 weeks' gestation. The fetus was subsequently born with the "prune belly" syndrome. The case is described, and the possible causes, and possibilities of prevention, of "prune belly" are discussed.


Subject(s)
Abdominal Muscles/abnormalities , Abnormalities, Multiple/diagnosis , Fetal Diseases/diagnosis , Urogenital Abnormalities , Female , Humans , Pregnancy , Syndrome , Ultrasonography
SELECTION OF CITATIONS
SEARCH DETAIL
...