Clinical Neuroscience

[Thrombolytic therapy in acute ischemic stroke (preliminary report)]

HAFFNER Zsolt1, HORVÁTH Erzsébet1, HORVÁTH Éva1, PAPP Gabriella1, EGERVÁRI Ágnes1, LIPÓTH Sarolta1, CSÁNYI Attila1, TUKA Andrea1

MAY 20, 1996

Clinical Neuroscience - 1996;49(05-06)

[Intravenous stretiokinase infusion therapy was performed on four patients in acute occulsive cerebrovascular disease (hemorrhage was rxcluded by CT scan). The thrombolytic therapy was started not later than six hours after the onset of the first symptoms. Kabikinase (1 250 000 IU) was administered in intravenous infudion during two hours. After thrombolysis no prolonged anticoagulant therapy was applied. Improvement of the neurological symptoms was impressive and convincing: in two cases immadiate. Ino one case we could be observed during the treatment (2 hours) nor after it. The possibility of thromolytic therapy in acute occulsiv stroke should be take into consideration. So far as we are aware this is the first time that thromolysis is occulsive stroke according to a protocol like this has been used in Hungary.]

AFFILIATIONS

  1. Petz Aladár Megyei Kórház, Győr, Neurológiai Osztály

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Somatic defects and pain manifested at adults' drawings of a man]

GRYNAEUS Tamás

[The outhor observed that “draw-a-man tests” of mentally retarded or demented adult patients may truly reflect their somatic defects or painful disorders. Drawings of mentally intact patients could also exhibit their somatic illness if it causes pain or the compensating mechanisms are insufficient. A brief discussion is given on the possible mechanisms, in connection with the body-schema.]

Clinical Neuroscience

[Topographic pattern of spike-waves in absence seizures]

CLEMENS Béla

[Topography of generalized ictal spike-wave patterns (absence seizures) have been investigated by voltage mapping analysis. The 31 patients investigated in this study belonged to a wide variezy of epileptic syndromes with absence seizures. Previously described different topographic patterns of the spike and the wave components have been confirmed in this study.]

Clinical Neuroscience

[The effect os levodopa in Parkinson's disease ]

MECHLER Ferenc, DIÓSZEGHY Péter, GLAUB Theodóra, HIDASI Eszter, JOSE Rosa

[The effect of carbidopa/levodopa on clinical signs and laboratory data was studied in 21 patients with Parkinson's disease during a follow-up period of 7-12 months. The Columbia and Webster scales were used for analysis. The improvement was significant already in the first weeks of the treatment. The drug did not influence the laboratory data and the side effects were found to be insignificant. The changes due to the drug were analysed by electrophysiological methods. Certain peak amplitudes and the area of visually evoked responses increased significantly during the treatment suggesting facilitation in the function of visual pathways. On stimulating the motor system by transcranial and spinal magnetic stimulation, the motor latencies and the duration of silent period showed normalization. ]

Clinical Neuroscience

[The prognostic relevance of apoptosis in medulloblastoma]

SCHUBERT EO Thomas, CERVOS-NAVARRO Jorge

[Apoptosis is known to be a phenomenon of prognostic significance in certain neoplasms. Several previous studies have indicated that the prognosis of desmoplastic medulloblastoma is better than that of classical medulloblastoma. We studied 5 desmoplastic and 5 classical medulloblastomas by in situ end labelling of DNA strand breaks to see whether there is any difference in amount or pattern of apoptosis in these subtypes, correlating to the different prognostic behaviour. We found no significant difference neither in amount nor in pattern of apoptosis between the two subtypes. Our results indicate that apoptosis may not be a relevant variable in the prognosis of medulloblastoma.]

Clinical Neuroscience

[Glaucomatous optic nerve disease]

ÁGNES Boros, JOHN Bryan Fenton, IVAN Bodis-Wollner

[Glaucomatous optic nerve disease (GOND) is the axonal neuropathy of the optic nerve and this diagnosis should enter the differential diagnosis of patients complaining of progressive diminution of vision. A positive family history is one of the major risk factors. Current theories regard the elevation of intractor pressure only a risk factor of GOND, not as its cause. The pathophysiology of ganglion cell dam- age in GOND in some respect parallels processes in other neurodegenerative disease. Current therapy aims at reducing the intraocular pressure and new forms of therapy, to prevent neuronal death are being developed. ]

All articles in the issue

Related contents

Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke

FINNSDÓTTIR Herdis, SZEGEDI István, OLÁH László, CSIBA László

Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

[Relationships between COVID-19 disease, nutritional status, and dysphagia, particularly in stroke patients ]

KOVÁCS Andrea, SZABÓ Pál Tamás, FOLYOVICH András

[The new coronavirus, SARS-CoV-2, which causes the COVID-19 disease can lead to severe acute respiratory distress syndrome (ARDS). It poses a serious challenge to the health care system, especially intensive care. Neurological patients, usually of advanced age and with a myriad of comorbidities, are at particular risk through the impact of the new coronavirus on their condition and nutritional capacity. Stroke is a leader in morbidity and mortality data, with a focus on dysphagia and its complications due to COVID-19 disease and acute cerebrovascular accident. In the acute phase of stroke, 30-50% of patients suffer from dysphagia, which still shows a prevalence of 10% six months later. Dysphagia results in decreased or insufficient fluid and nutrient uptake, supp­lemented by inactivity, leading to malnutrition and sarcopenia, which worsens overall condition, outcome, and rehabilitation efficiency. Screening and early detection of swallowing disorders is a fundamental issue in order to develop a personalized and timely-initiated nutritional therapy strategy. Nutritional therapy plays a key role in frequent intensive care due to COVID-19 disease, where it increases the chances of recovery and reduces the length of stay in the intensive care unit and mortality. This is especially true in critically ill patients requiring prolonged ventilation. In COVID-19 diagnosed patients, screening for dysphagia, bedside assessment, and instrumental examination, followed by swallowing rehabilitation, are of paramount importance. Stroke can also be a complication of the COVID-19 infection. Care for cerebrovascular patients has also adapted to the pandemic, “triazination” has become systemic, and dysphagia screening for stroke patients and nutritional therapy adapted to it have also shed new light. ]

Lege Artis Medicinae

[The history of acute stroke care in Hungary ]

BERECZKI Dániel

[Stroke is one of the most frequent causes of death and the most important cause of permanent disability worldwide and also in Hungary. The Hungarian medical literature has mentioned this disease and has been giving recommendations for its treatment since 1690. Initially folk medicines, herbal preparations and phlebotomy were used as standard therapy. Later, cooling the head joined these methods. Pharmacy preparations emerged at the middle of the 19th century. From the middle of the 20th century, products of the pharmaceutical industry like blood flow enhancers and neuroprotective drugs were in the frontline of the acute care. Anti­hy­per­ten­sive, antithrombotic and lipid-lowering medications became part of stro­ke prevention. Imaging techniques – mainly computer tomography of the brain and ultrasound examination of the cervical large arteries – have radically changed the diagnostics of cerebrovascular diseases from the middle of the 1980s. Since the 1990s, diagnostic and therapeutic decisions are based on reliable evidence from good quality clinical trials. Since the beginning of the 21st century, reperfusion treatments (intravenous thrombolysis and mechanical thrombectomy) re­present the most effective emergency care. The current direction is the extension of the therapeutic time-window of reperfusion treatments based on sophisticated neruoimaging. This review provides a brief summary of the development of stroke care in the last three and a half centuries as reflected in the Hungarian medical literature. ]

Clinical Neuroscience

[The role of intravenous thrombolysis before mechanical thrombectomy in the treatment of large vessel occlusion strokes ]

KALMÁR Péter János, TÁRKÁNYI Gábor, KARÁDI Zsófia Nozomi, BOSNYÁK Edit, NAGY Csaba Balázs, CSÉCSEI Péter, LENZSÉR Gábor, BÜKI András, JANSZKY József, SZAPÁRY László

[The efficacy of intravenous thrombolysis (IVT) is moderate in the proximal vascular segments of intracranial arteries, as opposed to mecha­nical thrombectomy (MT). In the management of acute ischemic stroke (AIS) caused by large vessel occlusions (LVO), IVT prior to MT is highly recommended based on the latest guidelines, but the necessity of IVT has been questioned by the latest studies of the past years. The aim of our study was to investigate and compare the efficacy and safety of direct mechanical thrombectomy (dMT) and combined therapy (CT) for patients who suffered an AIS with LVO and were treated in our department. We investigated patients with AIS caused by LVO who were admitted up to 4.5 hours after symptom onset and underwent MT in our department between November 2017 and August 2019. Patients’ data were collected in our stroke register. Patients enrolled in our study were divided into two groups depending on whether dMT or CT was used. Our primary outcome was the 30- and 90- day functional outcome measured by modified Rankin Scale (mRS). Mortality at 30- and 90- day, successful recanalization rates, and symptomatic intracranial hemorrhage were considered as secondary outcomes. A total of 142 patients (age: 68.3 ± 12.6 years, 53.5% female) were enrolled in our study, including 81 (57.0%) dMT cases, and 61 (43.0%) patients who received CT. The vascular risk factors and comorbidities were significantly higher in the dMT-treated group. At day 30, the rate of favorable functional outcomes was 34.7% in dMT vs. 43.6% among those who received CT (p = 0.307), by day 90 this ratio changed to 40.8% vs. 46.3% (p = 0.542). Mortality rates at day 30 were 22.2% and 23.6% (p = 0.851), and at day 90 33.8% and 25.9% (p = 0.343). The rate of effective recanalization was 94.2% for dMT-treated patients and 98.0% for CT-treated patients (p = 0.318). Symptomatic intracranial hemorrhage was detected in 2.5% of dMT-treated patients and 3.4% of CT-treated group (p = 0.757). Our results suggest that CT is associated with a moderately better outcome compared to dMT. IVT prior to MT did not increase the risk of symptomatic intracranial hemorrhages.]

Clinical Neuroscience

[Systemic thrombolysis and endovascular intervention in postpartum stroke]

BERECZKI Dániel Jr., NÉMETH Beatrix, MAY Zsolt, SZAKÁCS ZOLTÁN, GUBUCZ István, SZIKORA István, SZILÁGYI Géza

[Introduction - There are no previously published cases about intravenously applied recombinant tissue plasminogen activator in acute ischemic stroke during puerperium. Case presentation - We report a 40-year-old woman with postpartum acute ischemic stroke caused by multiple cervical artery dissections treated by systemic thrombolysis and endovascular intervention. Discussion - There are only limited data regarding thrombolytic treatment in acute stroke during pregnancy and puerperium. Current acute stroke treatment guidelines - while considering pregnancy as a relative exclusion criterion - do not deal with the postpartum state. Conclusion - As the condition is rare, randomized controlled trials are not feasible, therefore further reports on similar cases could eventually help us suggest guidelines or at least propose recommendations for the acute thrombolytic treatment of strokes occurring in pregnancy and puerperium.]