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258 results of 25 texts with exact phrase : 'outcome'.

1. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Vol. 1, 2005 , , ,

Age, intracranial pressure, autoregulation, and outcome after brain trauma.
6, Czosnyka M, Balesteri M, Steiner L, Smielewski P, Hutchinson PJ, Matta, B, Pickard JD. Age, intracranial pressure, autoregulation, and outcome after brain trauma.
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2. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 1, 2005, No. 2 , , ,

Although their design was similar, differences in inclusion and exclusion criteria, methods of determining degree of stenosis and definitions of outcome events existed.
In 1954 the first endarterectomy has been performed in a patient with symptomatic carotid artery stenosis. Over the years it evolved and became a routine surgical treatment for carotid stenosis although no adequate clinical trials confirmed its benefits. In 1998, two large randomized controlled trials of endarterectomy versus medical treatment published their final results. Although their design was similar, differences in inclusion and exclusion criteria, methods of determining degree of stenosis and definitions of outcome events existed. The Veterans Affairs Trial was the third trial and was stopped when initial results of the two large trials were published in 1991.
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Carotid and Vertebral Artery Transluminal Angioplasti Study (CAVATAS) showed no difference in major outcome events between endovascular treatment and carotid endarterectomy, but 30-day death and stroke rate of carotid surgery was higher than desirable – 10% versus 9.9% of CEA [12].
To better define the indications for CAS versus CEA several randomized prospective trials have been designed. Carotid and Vertebral Artery Transluminal Angioplasti Study (CAVATAS) showed no difference in major outcome events between endovascular treatment and carotid endarterectomy, but 30-day death and stroke rate of carotid surgery was higher than desirable – 10% versus 9.9% of CEA [12]. This study also reported that high grade carotid restenosis was more frequent one year after CAS then after carotid surgery. In SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endearterectomy) study, 334 patients were included (96 symptomatic and 219 asymptomatic) [13]. This trial suggested that stenting with protection is not inferior and may be superior to CEA in terms of a combined end point including stroke, myocardial infarction and death.
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Neurological and psychosocial outcome 4 to 7 years after subarachnoid hemorrhage.
Ogden JA, Utley T, Mee EW. Neurological and psychosocial outcome 4 to 7 years after subarachnoid hemorrhage.
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Venous stasis retinopathy in symptomatic carotid artery occlusion: prevalance,cause and outcome.
Klijn C, Kapelle L, Schooneveld M, et al. Venous stasis retinopathy in symptomatic carotid artery occlusion: prevalance,cause and outcome.
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Indications and outcome
Mukherji S, Kurli M, Sandramouli S. Indications and outcome
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3. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2006, No. 2 , , ,

To evaluate cerebrovascular reserve capacity in patients with acute ischemic stroke and to predict stroke outcome and dementia.
To evaluate cerebrovascular reserve capacity in patients with acute ischemic stroke and to predict stroke outcome and dementia.
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The benefit of STL development concerns therapeutic window above 3 hours, quick revascularization of the affected cerebral zones, smaller amounts of t-PA with reduced risk of symptomatic hemorrhage, simple noninvasive application in many patients, improvement of neurologic deficit and final stroke outcome.
) has better mechanical TL efficacy but potentially more side effects compared to diagnostic US technique that is more safe. Accelerated clot dissolution with the help of diagnostic US could be a practical alternative for the patients who are unsuitable for t-PA treatment. Early improvement of brain circulation in the acute stroke, complete recanalization and dramatic clinical recovery are feasible goals of the future STL. The benefit of STL development concerns therapeutic window above 3 hours, quick revascularization of the affected cerebral zones, smaller amounts of t-PA with reduced risk of symptomatic hemorrhage, simple noninvasive application in many patients, improvement of neurologic deficit and final stroke outcome.
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Association and outcome with early stroke treatment: polled analysis of ATLANTIS, ECASS and NINDS rt-PA stroke trials.
Hacke W, Donnan G, Fieschi et al. Association and outcome with early stroke treatment: polled analysis of ATLANTIS, ECASS and NINDS rt-PA stroke trials.
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Two patients who underwent craniocerebral gunshot injuries with direct damage of venous sinuses and venous sinuses thrombosis with good outcome are presented.
Two patients who underwent craniocerebral gunshot injuries with direct damage of venous sinuses and venous sinuses thrombosis with good outcome are presented. CT angiography is of great value for diagnosis of CVO and estimation of the cerebral venous system as far as for evolution of effectiveness of the anticoagulant therapy.
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4. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 1 , , ,

Irrespective of the type and the amount of applied therapy certain biological processes, characterized as “spontaneous neurological recovery”, are supposedly responsible for the final functional outcome after stroke.
(3) compensatory strategy (behavioral substitution, i.e. patients learn to compensate for their deficit). At present, there are strong indications that all these mechanisms are potentially involved in the process of recovery after brain injury, however, the ability of human adult brain to reorganize itself remains more or less restricted. Irrespective of the type and the amount of applied therapy certain biological processes, characterized as “spontaneous neurological recovery”, are supposedly responsible for the final functional outcome after stroke. The final outcome has been shown to be determined within a limited time window during the acute phase of brain injury if recovery is seen early after stroke onset, better outcomes may be expected six months later although motor recovery may continue over a period of years in some individuals with appropriate rehabilitation. The present review summarizes the recent theories and hypotheses for brain reorganization of motor control after unilateral stroke.
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The final outcome has been shown to be determined within a limited time window during the acute phase of brain injury if recovery is seen early after stroke onset, better outcomes may be expected six months later although motor recovery may continue over a period of years in some individuals with appropriate rehabilitation.
(3) compensatory strategy (behavioral substitution, i.e. patients learn to compensate for their deficit). At present, there are strong indications that all these mechanisms are potentially involved in the process of recovery after brain injury, however, the ability of human adult brain to reorganize itself remains more or less restricted. Irrespective of the type and the amount of applied therapy certain biological processes, characterized as “spontaneous neurological recovery”, are supposedly responsible for the final functional outcome after stroke. The final outcome has been shown to be determined within a limited time window during the acute phase of brain injury if recovery is seen early after stroke onset, better outcomes may be expected six months later although motor recovery may continue over a period of years in some individuals with appropriate rehabilitation. The present review summarizes the recent theories and hypotheses for brain reorganization of motor control after unilateral stroke.
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J. Measurement of motor recovery after stroke: outcome assessment and sample size requirements.
J. Measurement of motor recovery after stroke: outcome assessment and sample size requirements.
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Stroke outcome research.
Gresham GE. Stroke outcome research.
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Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months.
Heald A, Bates D, Cartlidge NE, et al. Longitudinal study od central motor conduction time following stroke. 2. Central motor conduction measured within 72 h after stroke as a predictor of functional outcome at 12 months.
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5. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 3, 2007, No. 2 , , ,

In a Cochrane analysis [10], antiplatelet therapy during and after CEA reduced the outcome of stroke.
ing the 2-year follow-up in ESPS2 2, NNT=33). The results of a multicenter study ESPRIT [8] confimed the results of ESPS2 about the superiority of ASA+DP over ASA alone. Clopidogrel may be a suitable alternative for those who can not tolerate aspirin or dipyridamole. In a Cochrane analysis [10], antiplatelet therapy during and after CEA reduced the outcome of stroke. When carotid endarterectomy is considered, antiplatelet therapy should always be started before surgery. ASA should be given before, during and following endarterectomy [11]. Clopidogrel should be terminated 5 days before surgery. A combination of clopidogrel plus Aspirin should be initiated prior to carotid stenting and continued for 3 months
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6. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 1 , , ,

Incidence and outcome of cervical dissection; a population-based study.
Lee VH, Brown R, Mandrekar J, Mokri B. Incidence and outcome of cervical dissection; a population-based study.
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7. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 4, 2008, No. 1 , , ,

3-year clinical outcome in 55 consecutive patients.
Breteau G. Cerebral venous thrombosis. 3-year clinical outcome in 55 consecutive patients.
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U. Cerebral venous flow velocity predicts poor outcome in subarachnoid hemorrhage.
U. Cerebral venous flow velocity predicts poor outcome in subarachnoid hemorrhage.
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Intracranial venous hemodynamics is a factor related to a favorable outcome in cerebral venous thrombosis.
Stolz E, Gerriets T, Budeker RH, Hьgens-Penzel M, Kaps M. Intracranial venous hemodynamics is a factor related to a favorable outcome in cerebral venous thrombosis.
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Influence of recanalization on outcome in dural sinus thrombosis: A prospective study.
Stolz E, Trittmacher S, Rahimi A, Gerriets T, Ruttger C, Siekmann R, Kaps M. Influence of recanalization on outcome in dural sinus thrombosis: A prospective study.
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Outcome in patients with stroke associated with internal carotid artery occlusion.
Paciaroni M, Caso V, Venti M, Milia P, Kappelle LJ, Silvestrelli G, Palmerini F, Acciarresi M, Sebastianelli M, Agnelli G. Outcome in patients with stroke associated with internal carotid artery occlusion.
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8. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 1 , , ,

Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study.
EC Jr, Lewandowski CA, Kwiatkowski. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study.
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Outcome in patients with symptomatic
Klijn CJ, van Buren PA, Kappelle LJ, Tulleken CA, Eikelboom BC, Algra A, van Gijn J. Outcome in patients with symptomatic
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The NINDS study demonstrated that TL with rt-PA used within three hours after stroke onset significantly improves outcome in patients with AIS [30, 64].
Several multicentral trials demonstrate the benefit from TL in AIS, more important of which are the NINDS, the ECASS I and II, and the ATLANTIS. The NINDS study demonstrated that TL with rt-PA used within three hours after stroke onset significantly improves outcome in patients with AIS [30, 64]. Even within 3-hour therapeutic window, earlier treatment leads to better results [30]. Odds ratios were 2.8 (95%
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An absolute improvement of 7.2% for the rt-PA group, with an adjusted OR of favourable outcome (mRS 0-1) of 1.42, 1.02-1.98.
The Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) was a multicentre, multinational observational study which confirmed that rt-PA, compared to placebo, is as effective and safe in the routine clinical practice as it was reported by previous large randomised controlled trials [63, 65, 68]. TL for selected patients presenting with AIS between 3 and 4.5 hours was currently also included in the European labelling [modified January 2009], on the bases of ECASS-III study results [31]. Eligible patients with AIS for the ECASS-III were between 18 and 80 years of age. An absolute improvement of 7.2% for the rt-PA group, with an adjusted OR of favourable outcome (mRS 0-1) of 1.42, 1.02-1.98. Mortality rates did not differ significantly (7.7% versus 8.4%) between the groups. Cerebral hemorrhage was not observed with increased risk after rt-PA application (2.4% vs 0.2%) [31].
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The stroke centre director has to maintain a database/register, documentation on steps taken to improve outcome measures, costs.
a high-standard centre stroke treatment it is essential to combine medical expertise from different disciplines together (neurology, cardiology, radiology, emergency, neurosurgery, etc.) and provide synergism in the management of patients [43]. The leadership of the PSC could be documented on an ongoing basis, with written administrative acknowledgments, stroke team meeting documentation, patients’ files, personnel training and expertise accreditations, available resources and budget [43]. The stroke centre director has to maintain a database/register, documentation on steps taken to improve outcome measures, costs.
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Optimization of these factors is a prerequisite for a better clinical outcome and sparing of long-term social expenses.
In conclusion, TL may be beneficial but not for all stroke patients. The strict selection of the eligible patient is essential. The three main factors for success are the start time of TL, the high-standard organization of the acute stroke care, and the funding. Optimization of these factors is a prerequisite for a better clinical outcome and sparing of long-term social expenses.
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Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S. ATLANTIS Trials Investigators, ECASS Trials Investigators, NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
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Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST).
Wahlgren N, Ahmed A, Eriksson N, Aichner F, Bluhmki E, Dávalos A, Erilä T, Ford GA, Grond M, Hacke W, Hennerici M, Kaste M, Köhrmann M, Larrue V, Lees KR, Machnig T, Roine RO, Toni D, Vanhooren G, for the SITSMOST investigators. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST).
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Ischaemic stroke in young adults: predictors of outcome and recurrence.
Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, Schroth G, Remonda L, Sturzenegger M, Fischer U, Baumgartner RW. Ischaemic stroke in young adults: predictors of outcome and recurrence.
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The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome.
Herrmann N, Black SE, Lawrence J, Szekely C, Szalai JP. The Sunnybrook Stroke Study: a prospective study of depressive symptoms and functional outcome.
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9. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 6, 2010, No. 2 , , ,

Trends in prevalence and outcome of heart failure with preserved ejection fraction.
Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction.
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A prospective study of depressive symptoms and functional outcome.
Herrmann N, Black SE, Lawrence J, Szekely C, Szalai JP. The Sunnybrook Stroke Study. A prospective study of depressive symptoms and functional outcome.
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Two-year longitudinal study of poststroke mood disorders: diagnosis and outcome at one and two years.
Robinson RG, Bolduc PL, Price TR. Two-year longitudinal study of poststroke mood disorders: diagnosis and outcome at one and two years.
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10. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 1 , , ,

Longitudinal PET Evaluation of Cerebral Metabolic Decline in Dementia: A Potential Outcome Measure in Alzheimer‘s Disease Treatment Studies.
Alexander GE, Chen K, Pietrini P, Rapoport SI, Reiman EM. Longitudinal PET Evaluation of Cerebral Metabolic Decline in Dementia: A Potential Outcome Measure in Alzheimer‘s Disease Treatment Studies.
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Mild cognitive impairment: clinical characterization and outcome.
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome.
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Relationship between ALS and the degree of cognitive impairment, markers of neurodegeneration and predictors for poor outcome.
Rusina R, Ridzon P, Kulist‘ak P, Keller O, Bartos A, Buncova M, Fialova L, Koukolik F, Matej R. Relationship between ALS and the degree of cognitive impairment, markers of neurodegeneration and predictors for poor outcome. A prospective study.
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Evaluation of methods to predict early longterm neurobehavioral outcome after coronary artery bypass grafting.
nburg M. Evaluation of methods to predict early longterm neurobehavioral outcome after coronary artery bypass grafting.
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Can early neurosonology predict outcome in acute stroke?
Stolz E, Cioli F, Allendoerfer J, Gerriets T, Del Sette M, Kaps M. Can early neurosonology predict outcome in acute stroke? : a metaanalysis of prognostic clinical effect sizes related to the vascular status.
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11. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 7, 2011, No. 2 , , ,

Two large, phase 3 trials – TRANSFORMS and FREEDOMS demonstrated that fingolimod improved the clinical outcome for MS patients – reduced the annualized relapse rate, decreased the risk of confirmed disability progression and reduced the number and volume of brain lesions on MRI images.
(fingolimod), is the first oral drug licensed by the European Medicines Agency as a single disease modifying therapy in highly active relapsing remitting multiple sclerosis (MS). Fingolimod mediates its therapeutic effects through the immune system and directly on the central nervous system (CNS). Fingolimod reduces the recirculation of auto-reactive central memory Tcells and their infiltration in the CNS, where they would cause neurodegeneration. Peripheral lymphocyte count reduction is reversible and reflects the reversible retention of circulating lymphocytes in lymph nodes, but not their depletion. Two large, phase 3 trials – TRANSFORMS and FREEDOMS demonstrated that fingolimod improved the clinical outcome for MS patients – reduced the annualized relapse rate, decreased the risk of confirmed disability progression and reduced the number and volume of brain lesions on MRI images.
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12. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 8, 2012, No. 1 , , ,

Early activation of intracranial collateral vessels influences the outcome of spontaneous internal carotid artery dissection.
Silvestrini M, Altamura C. Early activation of intracranial collateral vessels influences the outcome of spontaneous internal carotid artery dissection.
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Central motor conduction measured within 72 hours after stroke as a predictor of functional outcome at 12 months.
Heald A, Bates D, Cartlidge NEF, French JM, Miller S. Longitudinal study of central motor conduction time following stroke: 2. Central motor conduction measured within 72 hours after stroke as a predictor of functional outcome at 12 months.
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Applying hypothermia in acute period of brain injury enhances the clinical outcome.
The technological progress in Medicine and Neurorehabilitation allows introduction of new approaches for stimulation of the processes of regeneration, brain plasticity and reorganization. Applying hypothermia in acute period of brain injury enhances the clinical outcome. Amphetamine may improve recovery after stroke when
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Relation of executive functioning to pragmatic outcome following severe traumatic brain injury.
Douglas JM. Relation of executive functioning to pragmatic outcome following severe traumatic brain injury.
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13. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 2, 2012, No. 2 , , ,

Etiological diagnosis is important for defining the therapeutic approach and illness outcome.
coagulopathies, more rare conditions, such as antithrombin III deficiency, protein C, antiphospholipid syndrome and others. Etiological diagnosis is important for defining the therapeutic approach and illness outcome.
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Final clinical outcome depends on complex interrelation between the etiology, localization, severity and evolution of vascular process, the applied therapy and the existing co-morbidity [3, 4].
In conclusion, the diagnosis of cerebral venous pathology is difficult. Final clinical outcome depends on complex interrelation between the etiology, localization, severity and evolution of vascular process, the applied therapy and the existing co-morbidity [3, 4]. The combined use of neurosonographic and neuroimaging methods contributes for the prompt diagnosis and long
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Influence of recanalization on outcome in dural sinus thrombosis: A prospective study.
Stolz E, trittmacher S, Rahimi A, Geriets t, Ruttger C, Siekmann R, kaps M. Influence of recanalization on outcome in dural sinus thrombosis: A prospective study.
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55% of patients in the group treated with hypothermia in the European study had positive outcome compared to 39% in the group received a standard care.
24 hours after initiation of the hypothermia. 55% of patients in the group treated with hypothermia in the European study had positive outcome compared to 39% in the group received a standard care. For comparison in the Australian study the correlation was: 49% for patients in the hypothermic group and 25% in the group of standard care. Meanwhile both studies were focused on a specific population of patients – witnessed cardiac
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The potential benefit of this non-specific therapy is based on the observation that hypothermia reduces brain metabolism and energy consumption which might be feasible for improving the outcome of the injury [2, 19].
The aim of the treatment of brain and/or spinal cord injuries is the recovering of adequate perfusion; surgical evacuation of hematomas (if necessary) and oedema prophylaxis. Animal studies show the positive effect of hypothermia in central nervous system injuries. Basic science evidence also suggests that cooling affects many secondary biochemical cascades that are activated after acute injury. The potential benefit of this non-specific therapy is based on the observation that hypothermia reduces brain metabolism and energy consumption which might be feasible for improving the outcome of the injury [2, 19]. Comparing with the pharmacologic treatment which acts to a single neurochemical process, hypothermia interferes and inhibits multiple pathological processes simultaneously acting non-specifically. The results from the studies in humans are quite controversial and inconsistent. The results are difficult to interpret due to the limited number of patients, lack of controls, concomitant surgical procedures or concomitant use of drugs etc. [2, 6, 19]. So far, there are no sufficient data from controlled studies in humans about the benefits of hypothermia in treatment of brain injuries in term to improve outcome and reduce mortality.
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So far, there are no sufficient data from controlled studies in humans about the benefits of hypothermia in treatment of brain injuries in term to improve outcome and reduce mortality.
The potential benefit of this non-specific therapy is based on the observation that hypothermia reduces brain metabolism and energy consumption which might be feasible for improving the outcome of the injury [2, 19]. Comparing with the pharmacologic treatment which acts to a single neurochemical process, hypothermia interferes and inhibits multiple pathological processes simultaneously acting non-specifically. The results from the studies in humans are quite controversial and inconsistent. The results are difficult to interpret due to the limited number of patients, lack of controls, concomitant surgical procedures or concomitant use of drugs etc. [2, 6, 19]. So far, there are no sufficient data from controlled studies in humans about the benefits of hypothermia in treatment of brain injuries in term to improve outcome and reduce mortality.
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The body temperature at admission is considered to be an independent predictor of the short-term outcome and long-term mortality after stroke [9, 13].
There is a correlation related to body temperature of patients with ischemic stroke or brain trauma, measured at admission to the Intensive Care Unit (ICU) – patients with normal body temperature after the incident have a better prognosis than the others with febrility regardles the time of occurrence. The body temperature at admission is considered to be an independent predictor of the short-term outcome and long-term mortality after stroke [9, 13]. Many studies show that elevated temperature is associated with a worse outcome in patients with acute ischemic stroke [9]. Clinical trials in patients with severe closed head injury demonstrate the benefits of moderateTH. Hypothermic therapy in early stages after the incident when body temperature is kept low for a longer period could be a long-lasting neuroprotective measure but the hypothesis should be proved in further controlled clinical trials [9, 13].
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Many studies show that elevated temperature is associated with a worse outcome in patients with acute ischemic stroke [9].
There is a correlation related to body temperature of patients with ischemic stroke or brain trauma, measured at admission to the Intensive Care Unit (ICU) – patients with normal body temperature after the incident have a better prognosis than the others with febrility regardles the time of occurrence. The body temperature at admission is considered to be an independent predictor of the short-term outcome and long-term mortality after stroke [9, 13]. Many studies show that elevated temperature is associated with a worse outcome in patients with acute ischemic stroke [9]. Clinical trials in patients with severe closed head injury demonstrate the benefits of moderateTH. Hypothermic therapy in early stages after the incident when body temperature is kept low for a longer period could be a long-lasting neuroprotective measure but the hypothesis should be proved in further controlled clinical trials [9, 13].
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Mild hypothermia to improve the neurologic outcome after cardiac arrest.
Holzer, M. Mild hypothermia to improve the neurologic outcome after cardiac arrest.
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From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.
Oddo M, Schaller M, Feihl F, Ribordy V, Liaudet L. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.
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Mild Resuscitative Hypothermia to Improve Neurological Outcome After Cardiac Arrest.
Mild Resuscitative Hypothermia to Improve Neurological Outcome After Cardiac Arrest.
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As it is shown in a model of intracerebral hemorrhage with no application of autologous blood or collagenases that hypothermia reduces the brain edema and stabilizes blood-brain barrier with no significant effect on the outcome of the disease.
The effect of hypothermia for treatment of hemorrhagic stroke is less investigated. As it is shown in a model of intracerebral hemorrhage with no application of autologous blood or collagenases that hypothermia reduces the brain edema and stabilizes blood-brain barrier with no significant effect on the outcome of the disease. The early cooling is associated with worsening of the patient’s condition however the reason for that is still not well investigated [10, 14, 25].
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The hemorrhage is the most common cause for fatal outcome following the fibrinolysis.
Currently, the only approved therapy for the acute ischemic stroke (within the therapeutic window of 4.5 hours) is a recombinant tissue plasminogen activator (rt-PA) [1, 6]. The hemorrhage is the most common cause for fatal outcome following the fibrinolysis. Thus the therapeutic searches are focused on the possible combination of thrombolytic therapy and TH.
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on the functional outcome at 3 months after the beginning of the ischemic stroke.
on the functional outcome at 3 months after the beginning of the ischemic stroke. According to the protocol it is planned to enroll 1500 patients who are 18 years of age or above after an incident of acute ischemic stroke (NIHSS from 6 to 18); treated with or without thrombolysis and eligible for starting of TH within 6 hours of the incident. TH will be initiated as additional to the main treatment intravenous infusion of 4°C saline solution, dosed 20 ml/kg over 30–60 minutes, followed by either surface or endovascular cooling to 34-35°C and maintained for 24 hours. The primary outcome assessed 90 days after the stroke is the functional deficit on the modified Rankin scale. Secondary outcome measures include the infarct volume, quality of life and serious adverse events. The end of the study is expected to be in 2017.
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The primary outcome assessed 90 days after the stroke is the functional deficit on the modified Rankin scale.
on the functional outcome at 3 months after the beginning of the ischemic stroke. According to the protocol it is planned to enroll 1500 patients who are 18 years of age or above after an incident of acute ischemic stroke (NIHSS from 6 to 18); treated with or without thrombolysis and eligible for starting of TH within 6 hours of the incident. TH will be initiated as additional to the main treatment intravenous infusion of 4°C saline solution, dosed 20 ml/kg over 30–60 minutes, followed by either surface or endovascular cooling to 34-35°C and maintained for 24 hours. The primary outcome assessed 90 days after the stroke is the functional deficit on the modified Rankin scale. Secondary outcome measures include the infarct volume, quality of life and serious adverse events. The end of the study is expected to be in 2017.
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Secondary outcome measures include the infarct volume, quality of life and serious adverse events.
on the functional outcome at 3 months after the beginning of the ischemic stroke. According to the protocol it is planned to enroll 1500 patients who are 18 years of age or above after an incident of acute ischemic stroke (NIHSS from 6 to 18); treated with or without thrombolysis and eligible for starting of TH within 6 hours of the incident. TH will be initiated as additional to the main treatment intravenous infusion of 4°C saline solution, dosed 20 ml/kg over 30–60 minutes, followed by either surface or endovascular cooling to 34-35°C and maintained for 24 hours. The primary outcome assessed 90 days after the stroke is the functional deficit on the modified Rankin scale. Secondary outcome measures include the infarct volume, quality of life and serious adverse events. The end of the study is expected to be in 2017.
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HASA. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
HASA. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
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14. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 1 , , ,

Data has been published that increased hsCRP level is associated with the severity of neurological deficit and the clinical outcome of stroke [7, 24, 28].
Data has been published that increased hsCRP level is associated with the severity of neurological deficit and the clinical outcome of stroke [7, 24, 28]. We have also found higher serum hsCRP level in patients with more severe neurological and cognitive deficit at discharge. Our study results confirm previous studies that enhanced serum hsCRP concentration in the acute period is correlated to cognitive impairment at discharge [29, 38].
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In our study, however, the location of the lesion was not identified as a significant variable, probably due to the fact that most of the patients (83%) had supratentorial hemispheric infarctions, mild to moderate deficit and good functional outcome.
It is well known that cognitive dysfunctions in acute cerebral ischemia are basically determined by the location and volume of the lesion [6, 26, 30]. In our study, however, the location of the lesion was not identified as a significant variable, probably due to the fact that most of the patients (83%) had supratentorial hemispheric infarctions, mild to moderate deficit and good functional outcome.
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Hyperglycemia worsens functional outcome of cerebral ischemia and influences negatively the cognitive state of patients in the acute phase of ischemic stroke [3] by impairing mainly the executive functions [18].
Hyperglycemia is often found in acute stroke, even in cases without a history of diabetes mellitus [3]. It causes lactic acidosis, tissue acidosis and exerts direct neurotoxicity. Hyperglycemia worsens functional outcome of cerebral ischemia and influences negatively the cognitive state of patients in the acute phase of ischemic stroke [3] by impairing mainly the executive functions [18]. According to our results baseline hyperglycemia was a significant determinant of cognitive impairment at discharge due to its positive correlation with systolic arterial hypertension (Rs=0.358; p=0.016).
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Persistent post-stroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome.
Baird T, Parsons M, Phanh T, Butcher K, Desmond P, Tress, B, Colman P, Chambers B. Persistent post-stroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome.
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Hyperglycemia and cognitive outcome after ischemic stroke.
Kruyt ND, Nys GM, van der Worp HB, van Zandvoort MJ, Kappelle LJ, Biessells GJ. Hyperglycemia and cognitive outcome after ischemic stroke.
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15. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 9, 2013, No. 2 , , ,

Assessment of cerebral autoregulation using TCD blood flow velocity has been previously validated to be predictive of outcome following traumatic brain injury.
TCD findings compatible with the diagnosis of brain death include systolic spikes without diastolic flow or with diastolic reversed flow, and no demonstrable flow in a patient in who flow had been clearly documented on a previous examination. Assessment of cerebral autoregulation using TCD blood flow velocity has been previously validated to be predictive of outcome following traumatic brain injury.
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Rapid restoration of vascular flow is the primary goal of acute stroke treatment, while improvement in patient’s outcome is the ultimate benefit of such treatments.
Rapid restoration of vascular flow is the primary goal of acute stroke treatment, while improvement in patient’s outcome is the ultimate benefit of such treatments. Among different treatment schemes, sonothrombolysis has been used in in vitro tests, in preclinical trials and to a lesser extent in clinical trials, even though the exact underlying mechanism has not been fully clarified.
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more recanalizations and better clinical outcome, with no effect on mortality.
more recanalizations and better clinical outcome, with no effect on mortality. The ultras study is a pilot study aiming at defining efficacy of ST in acute ischemic stroke.
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Review of literature demonstrate that TCD is valid in predicting the patient's outcome of 6 months and correlates significantly with intracranial pressure when it is performed in the first 24 hours after event.
Review of literature demonstrate that TCD is valid in predicting the patient's outcome of 6 months and correlates significantly with intracranial pressure when it is performed in the first 24 hours after event. Recently, there have been many research results in early judgment of PTV, and TCD studies are particularly prominent in this area. The prognosis is affected severely with regard to quality of life of patients, and earlier determination of the PTV becomes very important. TCD is non-invasive, fast, and reliable as an efficient ultrasound technology, especially in critically ill patients with PTV in an urgent examination. This means it that TCD has greater value and helps to improve the management of patients with TBI. Too often, the first sign is a neurologic deficit, which may be too late to reverse.
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Stenoses of intracranial arteries (IAS)are responsible for 10% 15% of all ischemic strokes.The purpose of the present study was to retrospectively identify the outcome of endovascular treatments of IAS with Stent-PTA performed at the University Hospital Graz during the period of 2003 to 2012.
Stenoses of intracranial arteries (IAS)are responsible for 10% 15% of all ischemic strokes.The purpose of the present study was to retrospectively identify the outcome of endovascular treatments of IAS with Stent-PTA performed at the University Hospital Graz during the period of 2003 to 2012.
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Technical success, clinical outcome, the rate of instent restenosis (ISR) and recurrent stroke as well as prognosis were defined as primary objectives.
Data from all patients who underwent interventional procedures during the period 2003–2012, caused by a symptomatic (transient ischemic attack or stroke) stenosis of a major intracranial artery, were extracted from a stent data base. Technical success, clinical outcome, the rate of instent restenosis (ISR) and recurrent stroke as well as prognosis were defined as primary objectives. Examinations were at 24 hours and 6 months after the procedure, as well as the last consultation of the stroke outpatient clinic.
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After a mean follow up time of 2.6 years, 78.8% showed a good clinical outcome according to the modified Rankin Scale (mRS) scores of 0–2, while 15.7% were disabled (mRS 3–5).
89 patients (20 female, 69 male; mean age 67.3 years) with 93 symptomatic intracranial stenoses were treated by interventional procedures. Technical success rate was 98,9%. After a mean follow up time of 2.6 years, 78.8% showed a good clinical outcome according to the modified Rankin Scale (mRS) scores of 0–2, while 15.7% were disabled (mRS 3–5). 5.6% deceased, none of them within the first 30 days after the initial intervention. A 24-hours post procedure ISR – rate of 7.5% (7 patients), a 6-months rate of 16.5% (14 patients) and a long-term rate of 13.0% (12 patients) was diagnosed. Ipsilateral stroke or transient ischemic attack occurred in 3.2% during the first 24 hours, in in 6.5% within 30 days, and in 15.1% until 12 months after intervention.
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Clinical outcome on the 30-th day of sICH was evaluated by the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS).
We examined 88 patients with sICH admitted to the Neurology clinic of UMHAT “Dr Georgi Stranski”, Pleven within 48 hours after the symptoms onset. The neurological deficit was assessed by the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS) on admission. Clinical outcome on the 30-th day of sICH was evaluated by the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS). Hemorrhage volume was measured on computed tomography (CT) by a simplified formula for the volume of an ellipsoid, (AxBxC)/2. All the patients underwent ultrasound examination of the carotid arteries.The statistical analysis was performed with the Statistical Package for Social Sciences version 19.0 (SPSS) and Statgraphics plus 4.1 for
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We found that neurological deficit assessed on admission by GCS and NIHSS, hematoma volume and location are significantly correlated with the clinical outcome on the 30-th day of the sICH onset.
We found that neurological deficit assessed on admission by GCS and NIHSS, hematoma volume and location are significantly correlated with the clinical outcome on the 30-th day of the sICH onset. Age, vascular risk factors and ultrasound parameters were not significant factors for the clinical outcome. Male patients had better outcome on the 30th day as compared with the female ones.
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Age, vascular risk factors and ultrasound parameters were not significant factors for the clinical outcome.
We found that neurological deficit assessed on admission by GCS and NIHSS, hematoma volume and location are significantly correlated with the clinical outcome on the 30-th day of the sICH onset. Age, vascular risk factors and ultrasound parameters were not significant factors for the clinical outcome. Male patients had better outcome on the 30th day as compared with the female ones.
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Male patients had better outcome on the 30th day as compared with the female ones.
We found that neurological deficit assessed on admission by GCS and NIHSS, hematoma volume and location are significantly correlated with the clinical outcome on the 30-th day of the sICH onset. Age, vascular risk factors and ultrasound parameters were not significant factors for the clinical outcome. Male patients had better outcome on the 30th day as compared with the female ones.
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GCS and NIHSS scores on admission, hematoma volume and location are reliable predictors of clinical outcome on the 30-th day of the sICH that could be used for patient stratification and optimization of the individual therapeutic approach.
GCS and NIHSS scores on admission, hematoma volume and location are reliable predictors of clinical outcome on the 30-th day of the sICH that could be used for patient stratification and optimization of the individual therapeutic approach.
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neuroimaging, outcome, sICH.
neuroimaging, outcome, sICH.
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Clinical outcome was assessed according to NIHSS and mRS on day 1, 30 and 90.
Two men and one woman, mean age of 61.6, two with MCA occlusion and one with posterior AIS, were treated. Clinical outcome was assessed according to NIHSS and mRS on day 1, 30 and 90. Neuroimaging included non-contrast CT or MRI, diffusion and angio MRI. All patients underwent cerebral angiography and met criteria for endovascular TL. Transcranial duplex scanning was used for haemodynamic assessment of the occlusion and recanalization. Actiyse was infused supraselectively via microcatheter in a mean dose of 38.3 mg. TICI score was documented at the end of the procedure.
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We observed excellent early ultrasound results and clinical outcome in 2 patients, as well as mild to moderate in one.
Important determinants for success were time to IAT, stroke severity, and age. We observed excellent early ultrasound results and clinical outcome in 2 patients, as well as mild to moderate in one. No serious complications were noted despite non-consensus type of treatment. Future research and protocol improvement of IAT is needed to validate the best individual treatment approach.
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Good outcome was observed in 26 patients in the target group (45,6%) as compared with 19 patients in the controlgroup (37,3%).
A total of 108 patients were enrolled to receive continuous ultrasonography (57 patients) or placebo (51 patients). The mean age was 64 in TCD group and 63 years in control group. Mean NIHSS score at admission was 13 in TCD group and 17 in control group. Good outcome was observed in 26 patients in the target group (45,6%) as compared with 19 patients in the controlgroup (37,3%). A favorable outcome occurred in 25 patients in the target group (43.9%) as compared with 15 patients in control group (29.4%).
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A favorable outcome occurred in 25 patients in the target group (43.9%) as compared with 15 patients in control group (29.4%).
A total of 108 patients were enrolled to receive continuous ultrasonography (57 patients) or placebo (51 patients). The mean age was 64 in TCD group and 63 years in control group. Mean NIHSS score at admission was 13 in TCD group and 17 in control group. Good outcome was observed in 26 patients in the target group (45,6%) as compared with 19 patients in the controlgroup (37,3%). A favorable outcome occurred in 25 patients in the target group (43.9%) as compared with 15 patients in control group (29.4%).
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The outcome of patients was considered favorable as the clinical improvement or stabilization of symptoms (87% and 88% of the patients with or without duroplasty respectively).
69% of patients CSF flow presented above 3 cm/s and were not submitted to duraplasty. 6% of patients submitted to duroplasty developed CSF leaks. The outcome of patients was considered favorable as the clinical improvement or stabilization of symptoms (87% and 88% of the patients with or without duroplasty respectively).
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In 152 surgeries (69.4%) a total resection was achieved and in 6 cases (2.7%) with low-grade astrocytoma – a supratotal resection with perfect functional outcome.
Results: Metastases (90 pts) and glial tumors (90 pts) prevailed among the oncologic cases, followed by meningiomas (24 pts). In 152 surgeries (69.4%) a total resection was achieved and in 6 cases (2.7%) with low-grade astrocytoma – a supratotal resection with perfect functional outcome. Among the vascular diseases, 6 out of 8 aneurysms were successfully clipped and one was “trapped”. All of the AVMs (2 pts) were totally excised. The complication rates were comparatively low with mostly
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The goal of this paper is to evaluate whether early physiotherapy intervention (EPI) that started immediately after birth has a positive outcome for premature neonates with hypoxic impairments of the central nervous system (CNS) who are at risk of developing motor disorders.
The goal of this paper is to evaluate whether early physiotherapy intervention (EPI) that started immediately after birth has a positive outcome for premature neonates with hypoxic impairments of the central nervous system (CNS) who are at risk of developing motor disorders.
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16. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 1 , , ,

As shown in other studies this treatment improves early and late functional outcome after stroke, has a good safety profilе and low level of hemorrhagic complications [26].
Our current study confirms the good therapeutic effect of intravenous thrombolysis with rt-PA, applied up to 4.5 hours from the onset of AlS. As shown in other studies this treatment improves early and late functional outcome after stroke, has a good safety profilе and low level of hemorrhagic complications [26].
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The SITS VISTA study with 30,000 patients determines that treated with thrombolysis patients have better clinical outcome regardless of their age [28].
The SITS VISTA study with 30,000 patients determines that treated with thrombolysis patients have better clinical outcome regardless of their age [28]. It is established that a favorable outcome, evaluated by mRS 3 months after the treatment, is more probable after early thrombolytic onset and in lighter neurological deficit estimated with NIHSS. The ECASS, NINDS, ATLANTIS and
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It is established that a favorable outcome, evaluated by mRS 3 months after the treatment, is more probable after early thrombolytic onset and in lighter neurological deficit estimated with NIHSS.
The SITS VISTA study with 30,000 patients determines that treated with thrombolysis patients have better clinical outcome regardless of their age [28]. It is established that a favorable outcome, evaluated by mRS 3 months after the treatment, is more probable after early thrombolytic onset and in lighter neurological deficit estimated with NIHSS. The ECASS, NINDS, ATLANTIS and
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Systematic Review of Outcome After lschemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous + Intra-Arterial Trombolysis.
Mullen M, Pisapia J, Tilwa Sh. Systematic Review of Outcome After lschemic Stroke Due to Anterior Circulation Occlusion Treated With Intravenous, Intra-Arterial, or Combined Intravenous + Intra-Arterial Trombolysis.
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Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profle in randomized controlled trials: Safe lmplementation of Thrombolysis in Stroke-Monitoring Study (SlTS-MOST).
hrmann M, Larrue W, Lees K, Machnig T, Roine R, Toni D, Vanhooren G. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profle in randomized controlled trials: Safe lmplementation of Thrombolysis in Stroke-Monitoring Study (SlTS-MOST).
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The outcome of the decompressive craniectomy depends on procedure complications: insufficient decompression, infection, hemorrhage and development of contralateral cerebrospinal fluid collection [12, 14].
results and is life-saving in some patients. The outcome of the decompressive craniectomy depends on procedure complications: insufficient decompression, infection, hemorrhage and development of contralateral cerebrospinal fluid collection [12, 14]. Advanced age, more severe motor deficit, longer duration of intensive therapy and prolonged mechanical ventilation are associated with a worse prognosis and quality of life of these patients [2, 3, 16, 18].
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One-year outcome after decompressive surgery for nondominant hemispheric infarction.
Carter BS, Ogilvy CS, Candia GJ. One-year outcome after decompressive surgery for nondominant hemispheric infarction.
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Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age.
Arac A, Blanchard V, Lee M, Steinberg GK. Assessment of outcome following decompressive craniectomy for malignant middle cerebral artery infarction in patients older than 60 years of age.
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Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
Foerch C, Lang JM., Krause J, Raabe A, Sitzer M, Seifert V, Steinmetz H, Kessler KR. Functional impairment, disability, and quality of life outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction.
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The present review article provides contemporary perspectives on the sudden cardiac arrest and presents the modern concepts and approaches for successful outcome after cardiopulmonary resuscitation.
The present review article provides contemporary perspectives on the sudden cardiac arrest and presents the modern concepts and approaches for successful outcome after cardiopulmonary resuscitation. lt is focused on prognostic factors of survival and determination of an adequate multidisciplinary therapeutic approach.
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The survival rate after CА is assessed in analyses considering: time; demographic data; types of CА; risk factors and assessment of CPR outcome (quantitative and qualitative parameters).
For that purpose retrospective analyses, meta-analyses and prospective studies have been performed and a lot of data had been collected, grouped by different parameters. The survival rate after CА is assessed in analyses considering: time; demographic data; types of CА; risk factors and assessment of CPR outcome (quantitative and qualitative parameters).
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Quantitative assessment of CPR outcome
Quantitative assessment of CPR outcome
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Аccording to the opinion of some authors the factors during the reanimation have greater impact on the CPR outcome than the comorbidity factors before CА [6].
isformedbasedonindependentriskfactors. Morbidity factors before CА having negative impact onCPRoutcomeare:obesity;cardiovascular diseases more frequently than those with surgical orrespiratoryetiology.Concomitantneurologic disease,traumaorelectrolytedisbalanceare associated with better survival rate [17]. Аccording to the opinion of some authors the factors during the reanimation have greater impact on the CPR outcome than the comorbidity factors before CА [6]. Risk factors during reanimation predicting the poor outcome of CPR are: initiation of CPR later than 3 min after СА; CPR duration over 15 min; СА with asystole or PЕА in adults over 75 y/a and unwitnessed СА [28]. А correlation is observed between the high levels of blood glucose after reanimationduetocardiacarrestandthe severity of the neurological deficiency. In a large randomized trial in patients admitted to a general intensive care unit the conventional glucose control (�10mmol/L) is compared with the intensive one (4,5-6.0 mmol/L). The 90-day mortality is higher in the group of patients with intensive glucose control [10]. Аccording to the recent guidelines for adult patients after ROSC the level of blood glucose shouldbekept�10mmol/L andtheintensive glucose control should be avoided due to the risk of hypoglycemia.
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Risk factors during reanimation predicting the poor outcome of CPR are: initiation of CPR later than 3 min after СА; CPR duration over 15 min; СА with asystole or PЕА in adults over 75 y/a and unwitnessed СА [28].
isformedbasedonindependentriskfactors. Morbidity factors before CА having negative impact onCPRoutcomeare:obesity;cardiovascular diseases more frequently than those with surgical orrespiratoryetiology.Concomitantneurologic disease,traumaorelectrolytedisbalanceare associated with better survival rate [17]. Аccording to the opinion of some authors the factors during the reanimation have greater impact on the CPR outcome than the comorbidity factors before CА [6]. Risk factors during reanimation predicting the poor outcome of CPR are: initiation of CPR later than 3 min after СА; CPR duration over 15 min; СА with asystole or PЕА in adults over 75 y/a and unwitnessed СА [28]. А correlation is observed between the high levels of blood glucose after reanimationduetocardiacarrestandthe severity of the neurological deficiency. In a large randomized trial in patients admitted to a general intensive care unit the conventional glucose control (�10mmol/L) is compared with the intensive one (4,5-6.0 mmol/L). The 90-day mortality is higher in the group of patients with intensive glucose control [10]. Аccording to the recent guidelines for adult patients after ROSC the level of blood glucose shouldbekept�10mmol/L andtheintensive glucose control should be avoided due to the risk of hypoglycemia. Нyperthermia is common during the first 48 hours of IRS and associates with poor outcomes.
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of CPR outcome
of CPR outcome
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No index or scale is available in order to be used in the practice in countries where a decision for "do" or "do not" resuscitate is defined by the locally acting regulation which requires searching for more reliable predictors of CPR outcome.
Pre Arrest Morbidity (РАМ) index was developed in 1989 including the following parameters which are associated with higher in-hospital mortality rate: pneumonia, hypotension, renal insufficiency, cancer and sedentary lifestyle; it has a negative relation with survival until discharge. During the hospitalization and 0 score of the index, the survival rate is up to 50.6% and the patients die with a score above 8 [3, 11]. Prognostics After Resuscitation (PAR index) is developed in 1992 by modification of PAM index based on a metaanalysis of 14 studies (2643 patients) assessing the in-hospital survival after CPR. The modified index is a better predictor of ineffective CPR [8, 23]. The reliability of PAR index as a predictor of CPR failure has not been sufficiently clinically proven and some controversial results have been reported [23, 24, 27]. No index or scale is available in order to be used in the practice in countries where a decision for "do" or "do not" resuscitate is defined by the locally acting regulation which requires searching for more reliable predictors of CPR outcome.
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Qualitative assessment of CPR outcome
Qualitative assessment of CPR outcome
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Prognostic factors for poor neurological outcome are based on: electroencephalographic data; somatosensory evoked potentials; bispectral index (BIS); increased pressure of the cerebrospinal fluid; biochemical markers: neuron-specific enolase (NSE) and S-100
СА is a complex of diagnostic methods for prognosis of neurologycal status, cardiologycal status and respiration. Prognostic factors for poor neurological outcome are based on: electroencephalographic data; somatosensory evoked potentials; bispectral index (BIS); increased pressure of the cerebrospinal fluid; biochemical markers: neuron-specific enolase (NSE) and S-100
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Cerebral Performance Categories and Glasgow Outcome Scoring System are scales developed for assessment of neurologycal functions after CA, however they are not applicable in the first hours/ days after SCA [22, 27].
; sonography for cerebral circulatory arrest; Computed Tomography; CT angiography; digital subtraction angiography; isotope angiography and isotope scanning of brain [2, 22, 27]. A reliable prognosis could not be done based on only clinical signs, electrophysiological tests and biomarkers. Cerebral Performance Categories and Glasgow Outcome Scoring System are scales developed for assessment of neurologycal functions after CA, however they are not applicable in the first hours/ days after SCA [22, 27].
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Създадените скали (Cerebral Performance Categories и Glasgow Outcome Scoring System) за оценка на неврологичните функции след СА не са приложими в първите часове/дни след вСК [22, 27].
, сонография за мозъчен циркулаторен арест, компютърна томография, КТ ангиография, дигитална субтракционна ангиография, изотопна ангиография и изотопно скениране на мозъка [2, 22, 27]. Към момента не може да се направи надеждна прогноза само на база нa клинични признаци, електрофизиологични изследвания и биомаркери. Създадените скали (Cerebral Performance Categories и Glasgow Outcome Scoring System) за оценка на неврологичните функции след СА не са приложими в първите часове/дни след вСК [22, 27].
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Validation of Factors Affecting the Outcome of Cardiopulmonary Arrest in a Large, Urban, Academic Medical Center.
Koldobskiy D, Groves S, Scharf S, Cowan M. Validation of Factors Affecting the Outcome of Cardiopulmonary Arrest in a Large, Urban, Academic Medical Center.
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Predicting neurological outcome and survival after cardiac arrest.
Temple А, Porter R. Predicting neurological outcome and survival after cardiac arrest.
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17. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 10, 2014, No. 2 , , ,

There is also evidence that strokes in patients with AF are more severe and the outcome is markedly worse compared with strokes in patients with normal sinus rhythm, as was shown in the Copenhagen Stroke Study [18].
There is also evidence that strokes in patients with AF are more severe and the outcome is markedly worse compared with strokes in patients with normal sinus rhythm, as was shown in the Copenhagen Stroke Study [18].
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Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a populationbased study.
Marini C, De Santis F, Sacco S, Russo T, Olivieri L, Totaro R, Carolei Al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a populationbased study.
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The impaired cerebral vasodilatory mechanism together with atherosclerosis may influence stroke occurrence and outcome in chronic smokers [12].
was also found to be associated with chronic cigarette smoking in otherwise healthy, young subjects. The impaired cerebral vasodilatory mechanism together with atherosclerosis may influence stroke occurrence and outcome in chronic smokers [12].
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Dynamic cerebral autoregulation associates with infarct size and outcome after ischemic stroke.
Reinhard M, Rutsch S, Lambeck J, Wihler C, Czosnyka M, Weiller C, Hetzel A. Dynamic cerebral autoregulation associates with infarct size and outcome after ischemic stroke.
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Mild cognitive impairment: clinical characterization and outcome.
Petersen RC, Smith G, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome.
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One challenge is to predict the language outcome for stroke patients with aphasia.
One of the most devastating consequences of stroke is aphasia. Communication problems after stroke can severely impair the patient's quality of life and make even simple everyday tasks challenging. One challenge is to predict the language outcome for stroke patients with aphasia. The new therapeutic approaches are based on non invasive focal electrical stimulation. The current review reveals that repetitive magnetic stimulation (rTMS) with or without conventional rehabilitation has positive effects on post-stroke aphasia.
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Why is it difficult to predict language impairment and outcome in patients with aphasia after stroke?
Charidimou A, Kasselimis D, Varkanitsa M, Selai C, Potagas C, Evdokimidis I. Why is it difficult to predict language impairment and outcome in patients with aphasia after stroke?
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Outcome measure in these patients was walking ability.
This syllabus discusses the usefulness of navigated transcranial magnetic stimulation (TMS) as a brain imaging tool in stroke patients. TMS assessment of the motor tract function and walking ability over time in stroke patients with poor or non-existent initial gait is in the focus. Main data is derived from twenty-seven patients, first assessed one week post-stroke, and followed up for six months. Outcome measure in these patients was walking ability. Motor evoked potentials (MEP) in lower limbs early on predicted better physical functioning at 3 weeks and at 6 months in all patients (p
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Brain lesion size and location: effects on motor recovery and functional outcome in stroke patients.
Chen CL, Tang FT, Chen HC, Chung CY, Wong MK. Brain lesion size and location: effects on motor recovery and functional outcome in stroke patients.
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In clinical practice,outcome measurements would generally be recorded in line with the WHO International Classification of Functioning, Disability and Health [16].
The different improvements visible in Figure 2 relate to the movement requirements necessary for performing the different tasks. The ipsilateral and contralateral tasks challenged the elbow extension, but not the shoulder flexion. Participants were able to control their shoulder flexion and elbow extension so this may have reduced the degrees of freedom allowing the participants to forcus (focus) on their wrist extension. The far reach task challenged all joints, but was the only task to require index finger extension to complete the task; repetitive practice resulted in the most significant improvement in index finger extension. The highlight switch task challenged participants repeatedly in terms of their shoulder flexion, and this is where the changes in movement occurred. In clinical practice,outcome measurements would generally be recorded in line with the WHO International Classification of Functioning, Disability and Health [16]. However clinical outcomes generally do not measure incremental changes in movements, but solely provide a pre-post perspective. It can be oberved from the graphs that although the trend is in an overall direction, the day to day fluctuations could mean that a prepost measurement could present a misleading picture of what the participant is achieving. Additionally, feedback is known to be an important factor in rehabilitation, and this type of system
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Predicting outcome on the basis of expected neurological and associated functional recovery helps for planning the appropriate neurorehabilitation [17].
Since the impairment of gait is responsible for a long-term disability and handicap in many chronic stroke patient, the restoration of gait becomes a major goal in neurorehabilitation [24]. Approximately 65% of stroke survivors with initial motor deficits of the lower extremities show some degree of motor recovery. Predicting outcome on the basis of expected neurological and associated functional recovery helps for planning the appropriate neurorehabilitation [17].
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Motor outcome after unilateral supratentorial stroke is known to depend on the location of the brain lesion and the total number of residual descending fibers in the cerebral peduncles [48].
Motor outcome after unilateral supratentorial stroke is known to depend on the location of the brain lesion and the total number of residual descending fibers in the cerebral peduncles [48]. Bilateral impairments and different diaschisis phenomena are observed in unilateral hemispheric lesions while the common course of restoration of motor function consists of a regular sequence following a general pattern of reflex changes and ability for voluntary movement [46]. A complex functional reorganization involving more or less clinically "healthy" side is related to motor recovery after stroke utilizing those residual descending motor pathways, which are unaffected by the lesion and are bilaterally organized [19, 33].
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Irrespective of the type and the amount of applied therapy certain biological processes, characterized as the “spontaneous neurological recovery”, are supposedly responsible for the functional outcome after stroke.
At present there are strong indications that all these mechanisms are potentially involved in the recovery process after brain injury, however the ability of human adult brain to reorganize itself remains more or less restricted. Irrespective of the type and the amount of applied therapy certain biological processes, characterized as the “spontaneous neurological recovery”, are supposedly responsible for the functional outcome after stroke. The final outcome has been shown to be determined within a limited time window during the acute phase of brain injury – if recovery is seen early after stroke onset, better outcomes may be expected six months later although motor recovery may continue over a period of years in some individuals with appropriate rehabilitation [17].
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The final outcome has been shown to be determined within a limited time window during the acute phase of brain injury – if recovery is seen early after stroke onset, better outcomes may be expected six months later although motor recovery may continue over a period of years in some individuals with appropriate rehabilitation [17].
At present there are strong indications that all these mechanisms are potentially involved in the recovery process after brain injury, however the ability of human adult brain to reorganize itself remains more or less restricted. Irrespective of the type and the amount of applied therapy certain biological processes, characterized as the “spontaneous neurological recovery”, are supposedly responsible for the functional outcome after stroke. The final outcome has been shown to be determined within a limited time window during the acute phase of brain injury – if recovery is seen early after stroke onset, better outcomes may be expected six months later although motor recovery may continue over a period of years in some individuals with appropriate rehabilitation [17].
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Orthotic devices are common in cases with reduced distal motor outcome with severe peroneal muscle deficit where the ankle on the AS needs to be stabilized.
The patients with chronic hemiparesis use different strategies of reciprocal muscle activation and types of ankle movements depending on the severity of leg muscle paresis, the degree of gait recovery and the use of orthotic devices. A larch variability of EMG patterns during walking have been described by several studies – based on abnormal leg muscle activation [20], synergy exhibited by the NS [37], primitive patterns of mass extension and flexion [30], reciprocal ankle (TA/ TS) muscle inhibition [40] and co-activation [22] – fig. 6 B, C, D. These findings confirm that the gait alterations after stroke affect both legs and the motor system contralateral to the brain lesion appear to be relatively disinhibited with co-activation significantly elicited during swing phase on the AS. Thus even in present of motor deficit both legs act in a co-operative manner, each limb affecting muscle activation and temporal behaviour of the other. Orthotic devices are common in cases with reduced distal motor outcome with severe peroneal muscle deficit where the ankle on the AS needs to be stabilized. However, in presence of motor deficit the relationship between gait performance and plantar flexor strength appered to be more complex and secondary to the brain reorganisation following stroke.
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Rehabilitation programs focus on gait training at sub-acute and chronic stroke patients where the rehabilitation outcome is strongly associated with cognitive function (attention, motor adaptation, learning and ability for re-learning), the degree of motivation and the engagement of the patient and his/her family [6].
Restoration of motor functions after stroke is a complex process involving spontaneous recovery and appropriate therapeutic interventions. Its primary goals are stroke patients to be able to walk independently and to manage to perform daily activities. Rehabilitation programs focus on gait training at sub-acute and chronic stroke patients where the rehabilitation outcome is strongly associated with cognitive function (attention, motor adaptation, learning and ability for re-learning), the degree of motivation and the engagement of the patient and his/her family [6].
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As general, patients with better functional outcome (higher gait velocity, higher Barthel Index and more symmetry in swing and stance duration) at the start of rehabilitation obtained higher gait capability at the end of rehabilitation.
ter rehabilitation. Most of the studies report for improved preferred walking speed as a result of rehabilitation with variations between the subtypes of stroke. As general, patients with better functional outcome (higher gait velocity, higher Barthel Index and more symmetry in swing and stance duration) at the start of rehabilitation obtained higher gait capability at the end of rehabilitation. However, it has been observed that in chronic post-stroke hemiparesis the 3-weeks intensive neurorehabilitation is effective to improve the kinetic gait performance but appears insufficient to change the central programming of gait footfall patterns [43, 45].
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Most of the studies confirm the significant association of recovery with younger age, better functional outcome (higher preferred gait velocity, Barthel Index and more gait symmetry at the start of rehabilitation), severity of stroke and brain ability for neuroplasticity (location and extent of damange, activation of secondary and contralateral areas, individual genetic abilities for brain reorganization) and better motivated and moving patients [6, 21, 32].
Knowledge for predictors of gait recovery after stroke can contribute to more appropriate selection of the rehabilitation strategy when different techniques in gait training are considered. Most of the studies confirm the significant association of recovery with younger age, better functional outcome (higher preferred gait velocity, Barthel Index and more gait symmetry at the start of rehabilitation), severity of stroke and brain ability for neuroplasticity (location and extent of damange, activation of secondary and contralateral areas, individual genetic abilities for brain reorganization) and better motivated and moving patients [6, 21, 32].
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The individual variability on the final motor outcome among the patients suggests the important role of the natural post-stroke recovery combined with therapeutic intervention and the personal human ability for functional brain reorganization.
The individual variability on the final motor outcome among the patients suggests the important role of the natural post-stroke recovery combined with therapeutic intervention and the personal human ability for functional brain reorganization. Thus, the accurate predictive models for walking recovery remain elusive as many factors (external and internal) may influence this process.
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The aim of this lecture is to give an overview of the clinical applications of ultrasound in the assessment of intracranial stenoses in order to improve outcome and abate stroke risk.
The aim of this lecture is to give an overview of the clinical applications of ultrasound in the assessment of intracranial stenoses in order to improve outcome and abate stroke risk.
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In fact TCD/TCCS can provide real-time information on collateral flow and in case of vessel obstruction, activation of collateral pathways is very important for the clinical outcome of the patient.
Once the anatomical diagnosis of an intracranial stenosis is made, it is crucial to understand the functional significance and the hemodynamic effects of the stenosis. Transcranial ultrasound can surely help by studying collaterals, testing for vasomotor reactivity and detecting emboli. In fact TCD/TCCS can provide real-time information on collateral flow and in case of vessel obstruction, activation of collateral pathways is very important for the clinical outcome of the patient. A complete circle of Willis and the possibility to activate primary collaterals (anterior communicating artery, posterior communicating artery) or secondary collaterals (ophthalmic artery, leptomeningeal arteries) reduces the risk of hemodynamic ischemic stroke. Sometimes we see a compensatory increase of blood flow velocity in the donor vessel due to recruitment of collaterals by vasodilation in tissues with compromised perfusion. This is called flow diversion and represents a natural steal by vessels distal to an arterial occlusion.
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A recent Cochrane Review of all the randomized studies published on ST reported significantly more recanalizations and better clinical outcome, with no effect on mortality.
Sonothrombolysis (ST) can increase the penetration of circulating tPA into the thrombus, promote the breaking and cleaving of the fibrin polymers, and improve the binding affinity of tPA to fibrin. A recent Cochrane Review of all the randomized studies published on ST reported significantly more recanalizations and better clinical outcome, with no effect on mortality. Two ongoing multicenter studies are verifying the efficacy and safety of ST in acute ischemic stroke. In both studies, endpoints will be clinical and sonological. ST is a promising tool for ischemic stroke treatment. Ongoing studies will provide us further data to be added to previous study and basis for more efforts in this promising direction.
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1), better clinical outcome (Fig.
[16] reported stimulating results: there were more recanalizations (Fig. 1), better clinical outcome (Fig. 2), with no effect on mortality (Fig. 3). An increase of asymptomatic and symptomatic hemorrhages was mainly due to the concomitant use of microbubbles (Fig. 4) [16, 17, 18, 19, 20], further enhancing clot lysis and blood brain barrier (BBB) disruption. Nevertheless, other studies reported no effect of US on BBB and did not show any increase of apoptosis and markers of tissue damage outside the infarcted area [21]. The possible usefulness of microbubbles is a promising field for researchers and for drugs development.
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canalization and on clinical outcome [22].
canalization and on clinical outcome [22]. It is a multicenter, interventional, controlled, randomized study. Another ongoing trial is the “CLOTBUSTER”, where an “Hand-free” helmet provides US administration, in a randomized design with a sham procedure, that has proven to be safe and applicable [23].
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Association of outcome with
Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP,Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S, ATLANTIS Trials Investigators, ECASS Trials Investigators, NINDS rt-PA Study Group Investigators. Association of outcome with
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In patients with carotid stenoses and cerebral infarctions and also in other diseases the estimation of the VMR is important for evaluating the pathogenetic mechanisms and the clinical outcome and for selecting the therapeutic behavior in these patients.
The cerebral vasomotor reactivity (VMR) indicates the ability of the cerebral arterioles to change their vascular tone under external stimuli. Greatest influence on the VMR exert age, endothelial functions and blood rheological properties. The most frequent influences are inhalatory induced changes in the partial pressure of carbon dioxide and infusion of acetazolamide. The alterations in the cerebral circulation are examined mainly with transcranial Doppler sonography or magnetic resonance imaging. In patients with carotid stenoses and cerebral infarctions and also in other diseases the estimation of the VMR is important for evaluating the pathogenetic mechanisms and the clinical outcome and for selecting the therapeutic behavior in these patients.
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The evaluation of the VMR by measurement of the vasomotor capacity of the cerebral arteries and the effectiveness of the collateral circulation in patients with carotid pathology and cerebral infarctions and also in other diseases is important for the estimation of their pathogenetic mechanisms, choosing the therapeutic behavior and estimating the disease outcome in these patients.
The evaluation of the VMR by measurement of the vasomotor capacity of the cerebral arteries and the effectiveness of the collateral circulation in patients with carotid pathology and cerebral infarctions and also in other diseases is important for the estimation of their pathogenetic mechanisms, choosing the therapeutic behavior and estimating the disease outcome in these patients.
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18. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 1 , , ,

There are no national data about the effects of the treatment on the outcome of the disease and its complications.
In Bulgaria there is no official national register of patients with acute ischemic stroke in whom thrombolytic or endovascular treatment has been conducted. There are no national data about the effects of the treatment on the outcome of the disease and its complications.
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Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke
Ahmed N, Wahlgren N, Brainin M. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke
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Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST).
hrmann M, Larrue V, Lees KR, Machnig T, Roine RO, Toni D, Vanhooren G. For the SITS-MOST investigators. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials; Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST).
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19. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 11, 2015, No. 2 , , ,

The final outcome of this textbook is achieved by the perfect printing execution of the University publishing house “St.
Ekaterina Titianova, PhD, DSc, has a remarkable academic career in several universities. This ensures concordant and consistent presentation of the neurological information in assent with the rich traditions of the Bulgarian neurological school. A warranter of the merits of this textbook on neurology are the reviewers – Prof. Dr. Lyudmil Mavlov, PhD, DSc, professor of neurology and neuropsychology and Prof. Dr. Hristo Chuchkov, PhD, DSc, professor of anatomy, histology and cytology. The final outcome of this textbook is achieved by the perfect printing execution of the University publishing house “St. Kliment Ohridski” – Sofia.
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Although the organization in health service is considered to be of utmost importance for treating stroke patients with thrombolysis it appears that there are many other factors contributing to better or worse outcome in these patients.
Although the organization in health service is considered to be of utmost importance for treating stroke patients with thrombolysis it appears that there are many other factors contributing to better or worse outcome in these patients.
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There are no national data about the effects of the treatment on the outcome of the disease and its complications.
Over the past 30 years stroke is a leading cause of mortality and disability in Bulgaria. Although the number of venous thrombolyses for the period 2007–2014 as a specific treatment of acute ischemic stroke in Bulgaria is growing, their frequency remains significantly lower than the recommended minimum of 1–2% annually and represents less than 0.4% of the new stroke cases per year. The endovascular procedures in hemorrhagic stroke are also very low – approximately 0.1% per year. In Bulgaria there is no official national register of patients with acute ischemic stroke in whom thrombolytic or endovascular treatment has been conducted. There are no national data about the effects of the treatment on the outcome of the disease and its complications. Since 2011 the University Hospital for Active Treatment "St. Marina” – Varna participates in the International Register for the treatment of patients with stroke "Safe Implementation of Treatments in Stroke” (SITS). By the end of 2013 eight centers in Bulgaria had been included in SITS register with only four active now.
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To conduct a prospective study of treatment outcome in patients with acute ischemic stroke with/without TL hospitalized in the Second Clinic of Neurology for the period 2009–2013.
To conduct a prospective study of treatment outcome in patients with acute ischemic stroke with/without TL hospitalized in the Second Clinic of Neurology for the period 2009–2013.
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The data about the outcome after treatment with TL during hospitalization from our center, compared to other centers in the registry show a higher percentage of patients with good or very good treatment outcome – 70%.
The data about the outcome after treatment with TL during hospitalization from our center, compared to other centers in the registry show a higher percentage of patients with good or very good treatment outcome – 70%. The percentage of patients worsened after treatment is relatively the same (around 7%), and deaths registered during the hospital stay – about 6.6%. Significant changes are observed in the mortality on the third month. On the third month the mortality is increased to about 24%, in contrast to the mortality rate in other centers of the International Registry (about 14%).
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Mortality rate was comparatively high (5.2%), although most of the deaths could be attributed to the patient’s poor preoperative condition (average KPS of patients with poor outcome was 50).
Gross-total resection was achieved in nearly all patients (98%). Major postoperative complications were observed in 14.6% of patients, most of them surgical (8.3%). Mortality rate was comparatively high (5.2%), although most of the deaths could be attributed to the patient’s poor preoperative condition (average KPS of patients with poor outcome was 50). Local recurrence rate was 5.2%. In few cases considerable brain shift was observed only by ultrasound neuronavigation.
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20. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 1 , , ,

The clinical efficacy associated with the outcome of the disease has been analyzed in 240 patients treated from 2005 to 2011 by mechanical thrombectomy (initially using Merci system and later stent retrievers) alone or in addition to intravenous thrombolysis (IVT).
The clinical efficacy associated with the outcome of the disease has been analyzed in 240 patients treated from 2005 to 2011 by mechanical thrombectomy (initially using Merci system and later stent retrievers) alone or in addition to intravenous thrombolysis (IVT). Three months after the symptoms onset an improvement in the stroke outcome by using the Rankin scale (mRS 0-2) was reported in 50% of patients [6].
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Three months after the symptoms onset an improvement in the stroke outcome by using the Rankin scale (mRS 0-2) was reported in 50% of patients [6].
The clinical efficacy associated with the outcome of the disease has been analyzed in 240 patients treated from 2005 to 2011 by mechanical thrombectomy (initially using Merci system and later stent retrievers) alone or in addition to intravenous thrombolysis (IVT). Three months after the symptoms onset an improvement in the stroke outcome by using the Rankin scale (mRS 0-2) was reported in 50% of patients [6].
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It is shown that a lot of factors influence the stroke outcome – the process of recanalization, time to the beginning of the thrombectomy, presence of combined cerebrovascular pathology (thrombosis of MCA and ipsilateral occlusion of the BCA), patient's age and type of anesthesia during the intervention.
uence outcomes [4, 14]. It is shown that a lot of factors influence the stroke outcome – the process of recanalization, time to the beginning of the thrombectomy, presence of combined cerebrovascular pathology (thrombosis of MCA and ipsilateral occlusion of the BCA), patient's age and type of anesthesia during the intervention.
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The increased time to reperfusion was associated with a decreased probability of good functional outcome (mRS 0-2). These
in performing thrombectomy up to 3.5 hours from the symptoms onset and decreasing with time. The increased time to reperfusion was associated with a decreased probability of good functional outcome (mRS 0-2). These
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The choice of anesthesia in mechanical thrombectomy is also important for the disease outcome.
The choice of anesthesia in mechanical thrombectomy is also important for the disease outcome. A retrospective analysis of patients received either general anesthesia or conscious sedation showed that conscious sedation had a better clinical outcome [19]. Patients received general anesthesia had signi
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A retrospective analysis of patients received either general anesthesia or conscious sedation showed that conscious sedation had a better clinical outcome [19].
The choice of anesthesia in mechanical thrombectomy is also important for the disease outcome. A retrospective analysis of patients received either general anesthesia or conscious sedation showed that conscious sedation had a better clinical outcome [19]. Patients received general anesthesia had signi
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The analysis of the thrombectomy patients in MR CLEAN showed better functional three-month outcome in the absence of general anesthesia, but the patients were not randomized to the type of anesthesia.
cantly higher inhospital mortality (25%) and pneumonia (17%) compared to patients received conscious sedation (12% and 9.3%, respectively) but similar rates of SICH [14, 19]. The analysis of the thrombectomy patients in MR CLEAN showed better functional three-month outcome in the absence of general anesthesia, but the patients were not randomized to the type of anesthesia. The issue of general anesthesia vs. sedation has been currently studied in four randomized trials [8]. An expert consensus of the Neurointerventional Surgery and the Neurocritical Care Society recommends the use of general anesthesia for patients with severe agitation, low level of consciousness (GCS
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The experience at the Karolinska Hospital shows a 57% rate of good functional outcome, with about 21% mortality [12].
less than 100 patients have shown good functional outcomes after thrombectomy of the basilar artery, ranging from 30% to 48% [2, 3]. The experience at the Karolinska Hospital shows a 57% rate of good functional outcome, with about 21% mortality [12].
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A multicenter analysis of 165 patients, the vast majority of whom underwent endovascular or intravenous recanalization treatment, showed perfusion CT as an independent prognostic value for the clinical outcome.
A multicenter analysis of 165 patients, the vast majority of whom underwent endovascular or intravenous recanalization treatment, showed perfusion CT as an independent prognostic value for the clinical outcome. The importance of recanalization was particularly important in patients with large penumbra volumes [10, 20].
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Imaging techniques for determining infarct and penumbra sizes can be used for patient selection and correlate with functional outcome after mechanical thrombectomy (Level 1, Grade B);
Imaging techniques for determining infarct and penumbra sizes can be used for patient selection and correlate with functional outcome after mechanical thrombectomy (Level 1, Grade B);
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Acute basilar artery occlusion: Outcome of mechanical thrombectomy with solitaire stent within 8 hours of stroke onset.
Baek JM, Yoon W, Kim SK. Acute basilar artery occlusion: Outcome of mechanical thrombectomy with solitaire stent within 8 hours of stroke onset.
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Threshold for NIH stroke scale in predicting vessel occlusion and functional outcome after stroke thrombolysis.
Cooray C, Fekete K, Mikulik R. Threshold for NIH stroke scale in predicting vessel occlusion and functional outcome after stroke thrombolysis.
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Diffusion-weighted imaging score of the brain stem: a predictor of outcome in acute basilar artery occlusion treated with the solitaire FR device.
Mourand I, Machi P, Nogue E. Diffusion-weighted imaging score of the brain stem: a predictor of outcome in acute basilar artery occlusion treated with the solitaire FR device.
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Improved clinical outcome after acute basilar artery occlusion since the introduction of endovascular thrombectomy devices.
Nagel S, Kellert L, Mohlenbruch M. Improved clinical outcome after acute basilar artery occlusion since the introduction of endovascular thrombectomy devices.
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Outcome of stroke with mild or rapidly improving symptoms.
Nedeltchev K, Schwegler B, Haefeli T. Outcome of stroke with mild or rapidly improving symptoms.
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Impact of the ASPECT scores and distribution on outcome among patients undergoing thrombectomy for acute ischemic stroke.
Spiotta AM, Vargas J, Hawk H. Impact of the ASPECT scores and distribution on outcome among patients undergoing thrombectomy for acute ischemic stroke.
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Outcome of prenatally diagnosed agenesis of the corpus callosum.
Fratelli, N, Papageorghiou AT, Prefumo F, Bakalis S, Homfray T, Thilaganathan B. Outcome of prenatally diagnosed agenesis of the corpus callosum.
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Internal carotid artery stenting in patients with near occlusion: 30-day and longterm outcome.
lez A, Gil-Peralta A, Mayol A, Gonzalez-Marcos JR, Moniche F, Aguilar M, Gutierrez I. Internal carotid artery stenting in patients with near occlusion: 30-day and longterm outcome.
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21. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 12, 2016, No. 2 , , ,

Long-term outcome of vertebral artery origin stenosis in patients with acute ischemic stroke.
Kim YJ, Lee JH, Choi JW, Roh HG, Chun YI, Lee JS, Kim HY. Long-term outcome of vertebral artery origin stenosis in patients with acute ischemic stroke.
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On the same day we performed a control СT of the brain and orbits which was in compliance with the US findings and the good early clinical outcome.
MRl is sensitive even in early stages of the disease, and is recommended when there is a suspicion of SOVT or cavernous sinus thrombosis. MRl may demonstrate a dilated SOV, and extraocular muscle enlargement [2, 9]. ln our case, orbital MR examination was of crucial importance for the diagnosis. Some authors suggest Doppler imaging with ultrasound to confirm the lack of flow in the SOV [6]. We performed an US Doppler examination on the 6th day of treatment introduction which helped us in establishing the definitive diagnosis of SOVT and also monitoring the positive therapy effects. On the same day we performed a control СT of the brain and orbits which was in compliance with the US findings and the good early clinical outcome. ln the early stages a mildly enlarged SOVT may be missed on СT scans, and decreased blood flow through the SOV and cavernous sinus may not be apparent [9]. However, six days after LMWH and antibiotics were started, the СT scan was very indicative of SOVT.
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Within 90 minutes of symptom onset, the number needed to treat for 1 excellent outcome is 4.5; the number is 9 between 91 and 180 minutes and 14 be-
In stroke thrombolysis, onset to treatment time can be divided into onset-to-door and door-to-needle time (DTN). The latter can be influenced by streamlining of all parts of the inhospital thrombolysis process and improves with center experience. The benefits of intravenous tissue plasminogen activator (tPA) in patients with acute ischemic stroke (AIS) are time dependent and guidelines recommend DTN time of 60 minutes or less. However, studies have found that only 11–30% of patients are treated within this time window, as per different stroke registries. Randomized placebo-controlled trials have shown time-dependent benefits of tPA: early treatment is associated with better outcomes. Within 90 minutes of symptom onset, the number needed to treat for 1 excellent outcome is 4.5; the number is 9 between 91 and 180 minutes and 14 be-
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There are no national data about the effects of the treatment on the outcome of the disease and its complications.
In Bulgaria there is no official national register of patients with acute ischemic stroke in whom thrombolytic or endovascular treatment has been conducted. There are no national data about the effects of the treatment on the outcome of the disease and its complications. In 2015 the eight centers in Bulgaria had been included their data in SITS register for one month. We present the benchmarking data.
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Assessment of cerebral autoregulation using TCD blood flow velocity has been previously validated to be predictive of outcome following traumatic brain injury.
It has been frequently employed for the clinical evaluation of cerebral vasospasm following subarachnoid hemorrhage (SAH). To a lesser degree, TCD has also been used to evaluate cerebral autoregulatory capacity, monitor cerebral circulation during cardiopulmonary bypass and carotid endarterectomy, to diagnose brain death and for monitoring of cerebral hemodynamics in neurotrauma. TCD is a suitable bedside method for daily assessment of the changes of intracranial pressure (ICP) by continuous monitoring of the changes of blood flow velocities and pulsatility index (PI), reflecting decreases in cerebral perfusion pressure due to increases in ICP. Growing body of literature demonstrates the usefulness of transbulbar B-mode sonography of the optic nerve for detecting increased ICP in patients requiring neurocritical care. TCD findings compatible with the diagnosis of brain death include systolic spikes without diastolic flow or with diastolic reversed flow, and no demonstrable flow in a patient in who flow had been clearly documented on a previous examination. Assessment of cerebral autoregulation using TCD blood flow velocity has been previously validated to be predictive of outcome following traumatic brain injury. The commonly used bedside methods of determining the status of autoregulation include the transient hyperemic response test, the leg-cuff deflation test and reaction to spontaneous blood pressure fluctuations. TCD PI has emerged as a surrogate marker for ICP. The measurement of PI is also an useful adjunct to guide the use of hyperosmolar therapy in various conditions with intracranial hypertension.
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22. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 1 , , ,

In fact, there is evidence that cerebral hemodynamic status can predict the outcome of ICA occlusion.
In our opinion, somewhat frequent cases of deep white matter infarctions may be the result of hypoperfusion by carotid steno-occlusive disease. The reason of the deep white matter diffuse and focal changes may be hypoperfusion of corticomedullar arteries and transformation of their supply area in the “deep border-zone” [3, 10, 12]. In fact, there is evidence that cerebral hemodynamic status can predict the outcome of ICA occlusion. Anterior and posterior communicating arteries are considered the primary collateral pathways; the ophthalmic artery and blood flow via leptomeningeal vessels are considered the secondary pathways. Our study shows that the most important compensatory path in patients with unilateral ICA occlusion is collateral flow from contralateral ICA via AComA. CDUS shows that the mean BFV in the contralateral ICA is increased almost by 55%. The results of our study are in overall agreement with previously published results. On the other hand, our data show that the mean net flow volume in the VAs is increased by almost 18% when compared with the control ones, confirming that the vertebrobasilar circulation is also important in collateral supply in cases of ICA occlusion.
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M. Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity.
M. Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity.
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These conditions dramatically influence early and late outcome of acute ischemic stroke.
These conditions dramatically influence early and late outcome of acute ischemic stroke. That is why early recognition and adequate treatment of hypertension, hyperglycemia and hyperthermia are very important.
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showed that both high blood pressure and low blood pressure were independent prognostic factors for poor outcome of AIS, relationships that appear to be mediated in part by increased rates of early recurrence and death resulting from presumed cerebral edema in patients with high blood pressure and increased coronary heart disease events in those with low blood pressure.
Despite the prevalence of arterial hypertension following stroke, its optimal management has not been established [5]. However, it should be mentioned that there are a lot of deleterious effects of high blood pressure. There is an increased risk of hemorrhage into the infarcted area, malignant cerebral edema, recurrent stroke and hypertensive encephalopathy. On the other hand, low blood pressure can lead to shift of the cerebral auto regulation curve in chronically hypertensive patients, loss of normal cerebral auto regulation in ischemic brain, and extension of ischemic damage by hypoperfusion [5]. Leonardi-Bee et al. showed that both high blood pressure and low blood pressure were independent prognostic factors for poor outcome of AIS, relationships that appear to be mediated in part by increased rates of early recurrence and death resulting from presumed cerebral edema in patients with high blood pressure and increased coronary heart disease events in those with low blood pressure. This study was performed on 17 398 patients from the International Stroke Trial with confirmed ischemic stroke [6]. So, the question still remains, what is good for the patient? On the one side, the study of Oliveira-Filho et al. showed that blood pressure reduction in the first 24 h after stroke onset is independently associated with poor outcome after 3 months [7], and some studies suggest that induced hypertension is a treatment option in acute stroke. Denny-Brown was probably the first to note that improvement of neurological function following a brain ischemic episode is often associated with a rise in blood pressure [8].
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showed that blood pressure reduction in the first 24 h after stroke onset is independently associated with poor outcome after 3 months [7], and some studies suggest that induced hypertension is a treatment option in acute stroke.
Leonardi-Bee et al. showed that both high blood pressure and low blood pressure were independent prognostic factors for poor outcome of AIS, relationships that appear to be mediated in part by increased rates of early recurrence and death resulting from presumed cerebral edema in patients with high blood pressure and increased coronary heart disease events in those with low blood pressure. This study was performed on 17 398 patients from the International Stroke Trial with confirmed ischemic stroke [6]. So, the question still remains, what is good for the patient? On the one side, the study of Oliveira-Filho et al. showed that blood pressure reduction in the first 24 h after stroke onset is independently associated with poor outcome after 3 months [7], and some studies suggest that induced hypertension is a treatment option in acute stroke. Denny-Brown was probably the first to note that improvement of neurological function following a brain ischemic episode is often associated with a rise in blood pressure [8]. In one study, Wise et al. administered vasopressor drugs (antihypotensive agents) to 13 patients soon after the development of focal brain ischemia even though there was no significant decrease in their blood pressure. The neurological function of five patients improved following an increase in their blood pressure. After this treatment was discontinued, significant recovery was maintained in three patients.
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However, a larger efficacy trial on candesartan therapy conducted on 2004 in randomly allocated AIS patients with a similar study design showed a mean systolic blood pressure reduction of 7 mmHg and mean dyastolic blood pressure of 5 mmHg at day 7 and no improvement in functional outcome.
However, a larger efficacy trial on candesartan therapy conducted on 2004 in randomly allocated AIS patients with a similar study design showed a mean systolic blood pressure reduction of 7 mmHg and mean dyastolic blood pressure of 5 mmHg at day 7 and no improvement in functional outcome. Favorable outcomes after 6 months, however, were less likely with candesartan than with placebo [16].
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Similar to the high blood pressure, there are several detrimental effects of hyperglycemia, such as tissue acidosis, increased blood–brain barrier permeability, decreased vascular reactivity, and risk of hemorrhagic transformation, which are most probably pathophysiological substrates of poor outcome in stroke patients with hyperglycemia.
Hyperglycemia is common during AIS. Several studies have shown that admission blood glucose is elevated in over 40% of patients with AIS, most commonly among patients with a history of diabetes mellitus [22]. Recent observational studies have found that admission and in-hospital hyperglycemia have worse clinical outcomes than admission and in-hospital normoglycemia [23]. Also, several studies have found an association between AIS hyperglycemia and worse outcomes defined by magnetic resonance imaging infarct volume [24]. Although multiple observational studies consistently found this association, on the basis of such studies it cannot be determined whether this is a cause and effect relationship [20]. Similar to the high blood pressure, there are several detrimental effects of hyperglycemia, such as tissue acidosis, increased blood–brain barrier permeability, decreased vascular reactivity, and risk of hemorrhagic transformation, which are most probably pathophysiological substrates of poor outcome in stroke patients with hyperglycemia. First studies considering the effect of hyperglycemia on stroke outcome have been conducted on animal models [25]; there are many studies and much evidence that acute hyperglycemia predicts increased risk of in-hospital mortality and poor functional recovery after AIS in non-diabetic stroke survivors. This conclusion has been made by Capes and his colleagues, after a literature review of 32 studies [23, 26]. However, currently there is no clinical evidence that targeting the blood glucose to a particular level during AIS will improve outcomes. The main risk from aggressive hyperglycemia correction is the possible hypoglycemia. Avoidance of hypoglycemia requires frequent glucose monitoring; in many hospitals this necessitates admission to an intensive care unit, which may otherwise not be needed
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First studies considering the effect of hyperglycemia on stroke outcome have been conducted on animal models [25]; there are many studies and much evidence that acute hyperglycemia predicts increased risk of in-hospital mortality and poor functional recovery after AIS in non-diabetic stroke survivors.
Several studies have shown that admission blood glucose is elevated in over 40% of patients with AIS, most commonly among patients with a history of diabetes mellitus [22]. Recent observational studies have found that admission and in-hospital hyperglycemia have worse clinical outcomes than admission and in-hospital normoglycemia [23]. Also, several studies have found an association between AIS hyperglycemia and worse outcomes defined by magnetic resonance imaging infarct volume [24]. Although multiple observational studies consistently found this association, on the basis of such studies it cannot be determined whether this is a cause and effect relationship [20]. Similar to the high blood pressure, there are several detrimental effects of hyperglycemia, such as tissue acidosis, increased blood–brain barrier permeability, decreased vascular reactivity, and risk of hemorrhagic transformation, which are most probably pathophysiological substrates of poor outcome in stroke patients with hyperglycemia. First studies considering the effect of hyperglycemia on stroke outcome have been conducted on animal models [25]; there are many studies and much evidence that acute hyperglycemia predicts increased risk of in-hospital mortality and poor functional recovery after AIS in non-diabetic stroke survivors. This conclusion has been made by Capes and his colleagues, after a literature review of 32 studies [23, 26]. However, currently there is no clinical evidence that targeting the blood glucose to a particular level during AIS will improve outcomes. The main risk from aggressive hyperglycemia correction is the possible hypoglycemia. Avoidance of hypoglycemia requires frequent glucose monitoring; in many hospitals this necessitates admission to an intensive care unit, which may otherwise not be needed
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One elegant study, in which 63 acute stroke patients were prospectively evaluated with serial diffusion-weighted and perfusionweighted magnetic resonance imaging and acute blood glucose measurements, showed that acute hyperglycemia increases brain lactate production and facilitates conversion of hypoperfused at-risk tissue into infarction, which may adversely affect stroke outcome [27].
[20]. Multiple studies have found an association between AIS hyperglycemia and worse outcomes defined by magnetic resonance imaging infarct volume [27, 28]. One elegant study, in which 63 acute stroke patients were prospectively evaluated with serial diffusion-weighted and perfusionweighted magnetic resonance imaging and acute blood glucose measurements, showed that acute hyperglycemia increases brain lactate production and facilitates conversion of hypoperfused at-risk tissue into infarction, which may adversely affect stroke outcome [27].
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They showed an association between body temperature and initial stroke severity, infarct size, mortality and outcome [38].
It is well known that ischemic damage as well as cerebral infarct size are dependent on body temperature [37]. In 1996, Reith et al. conducted a prospective and consecutive study with 390 stroke patients. They showed an association between body temperature and initial stroke severity, infarct size, mortality and outcome [38]. Similarly, Prasad and Krishnan conducted a meta-analysis involving 2986 patients. This meta-analysis suggested that fever within the first 24 h of hospitalization in patients with AIS is associated with a doubling of the odds of mortality within 1 month of the onset of stroke [39]. On the other hand, experimental evidence and clinical experience showed that hypothermia protects the brain from damage during ischemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke [40]. Also, a favorable effect of hypothermia has been recognized in patients with cardiac arrest.
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There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke [40].
conducted a prospective and consecutive study with 390 stroke patients. They showed an association between body temperature and initial stroke severity, infarct size, mortality and outcome [38]. Similarly, Prasad and Krishnan conducted a meta-analysis involving 2986 patients. This meta-analysis suggested that fever within the first 24 h of hospitalization in patients with AIS is associated with a doubling of the odds of mortality within 1 month of the onset of stroke [39]. On the other hand, experimental evidence and clinical experience showed that hypothermia protects the brain from damage during ischemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke [40]. Also, a favorable effect of hypothermia has been recognized in patients with cardiac arrest. In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurological outcome and reduced mortality [41].
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In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurological outcome and reduced mortality [41].
Similarly, Prasad and Krishnan conducted a meta-analysis involving 2986 patients. This meta-analysis suggested that fever within the first 24 h of hospitalization in patients with AIS is associated with a doubling of the odds of mortality within 1 month of the onset of stroke [39]. On the other hand, experimental evidence and clinical experience showed that hypothermia protects the brain from damage during ischemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke [40]. Also, a favorable effect of hypothermia has been recognized in patients with cardiac arrest. In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurological outcome and reduced mortality [41].
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Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome.
Baird TA, Parsons MW, Phanh T et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome.
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Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study.
Parsons MW, Barber PA, Desmond PM et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study.
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Hyperglycemia and stroke outcome: vindication of the ischemic penumbra.
Ginsberg MD. Hyperglycemia and stroke outcome: vindication of the ischemic penumbra.
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Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome.
rgensen HS, Pedersen PM et al. Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome.
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Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.
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23. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 13, 2017, No. 2 , , ,

The main outcome assess was the occurrence of fatal or nonfatal stroke.
A meta-analysis of green and black tea consumption and risk of stroke [1] included data from 9 studies involving 4378 strokes among 194 965 individuals. The main outcome assess was the occurrence of fatal or nonfatal stroke. The summary effect associated with consumption of
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We present a prospective cohort study: comparative evaluation of the outcome of the acute stroke treatment in patients hospitalized at the Second Neurological Clinic of the St Marina University Hospital – Varna, between 2011 and 2016, treated with/without intravenous thrombolysis.
Cerebrovascular diseases are a global medical and social problem because of their high morbidity, mortality and disability rate. Modern treatment in the first hours of the ischemic stroke onset is directed at early recanalization of arterial thrombus, prevention of an infarct zone formation or its limitation via reestablishment of brain perfusion within the area of the so-called ischemic penumbra (a borderline zone of decreased blood flow between the viable and the necrotic tissue). Nowadays, recanalization is achieved via venous infusion of recombinant tissue plasminogen activators (rt–PAs) up to 4.5 hours after the stroke onset, as well as via endovascular treatment including intraarterial thrombolysis, thrombaspiration, etc. We present a prospective cohort study: comparative evaluation of the outcome of the acute stroke treatment in patients hospitalized at the Second Neurological Clinic of the St Marina University Hospital – Varna, between 2011 and 2016, treated with/without intravenous thrombolysis.
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Therefore, there is no possibility to perform a national analysis of the impact of different treatments on the outcome of the
Currently in Bulgaria there is no an official national registry of acute ischemic stroke patients who underwent thrombolytic treatment. Therefore, there is no possibility to perform a national analysis of the impact of different treatments on the outcome of the
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The possibility for comparing the results of the treatments would lead to optimization of the process at the individual centers with the aim of decreasing mortality and improving the functional outcome in AIS patients.
The possibility for comparing the results of the treatments would lead to optimization of the process at the individual centers with the aim of decreasing mortality and improving the functional outcome in AIS patients.
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We present a comparative evaluation of the treatment outcome of acute ischemic stroke
We present a comparative evaluation of the treatment outcome of acute ischemic stroke
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Table 2 shows the comparative results of the outcome after thrombolytic treatment during hospital stay or on the seventh day after the beginning of the treatment.
Table 2 shows the comparative results of the outcome after thrombolytic treatment during hospital stay or on the seventh day after the beginning of the treatment.
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In regard to the outcome of treatment in patients with TL during hospitalization, the data from our center, as compared to the other centers in the registry, reveal the largest percentage of patients with very good to good outcome – about 70%.
In regard to the outcome of treatment in patients with TL during hospitalization, the data from our center, as compared to the other centers in the registry, reveal the largest percentage of patients with very good to good outcome – about 70%.
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The treatment outcome on the 90
The treatment outcome on the 90
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Results of the outcome of treating patients with TL during hospitalization
Results of the outcome of treating patients with TL during hospitalization
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Clinical outcome Sveta Marina Varna (BGSVE) Second NC Data from international centers *
Clinical outcome Sveta Marina Varna (BGSVE) Second NC Data from international centers *
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Outcome (24h)
Outcome (24h)
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Outcome (7d)
Outcome (7d)
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Patient outcome on the third month after stroke
Patient outcome on the third month after stroke
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The absence of any significant difference in the disease outcome on the third month in both groups (with/without TL treatment) can be explained with the reorganization of the brain.
The absence of any significant difference in the disease outcome on the third month in both groups (with/without TL treatment) can be explained with the reorganization of the brain. Significant differences are observed in the mortality rate. While in dehospitalized patients who underwent TL treatment, it is about 6.6% and coincides with the data from the other centers in the registry, on the 3
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Mortality on the third month of the disease onset is relatively the same in both groups, but the data cannot be interpreted because of absence of exact information about the reasons, which have led to the fatal outcome.
Early mortality at dehospitalization is significantly lower in the group with TL therapy (9%), while in patients without TL it is 19%. Mortality on the third month of the disease onset is relatively the same in both groups, but the data cannot be interpreted because of absence of exact information about the reasons, which have led to the fatal outcome.
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The study of the disease outcome in acute ischemic stroke patients reveals that an early implementation of intravenous thrombolysis leads to a better functional outcome in the first three months after the disease onset.
The study of the disease outcome in acute ischemic stroke patients reveals that an early implementation of intravenous thrombolysis leads to a better functional outcome in the first three months after the disease onset. The comparison of the evaluated criteria on the third month of the onset supports the hypothesis for spontaneous recovery and brain reorganization.
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Functional outcome 3 months after stroke predicts long-term survival.
nt A, Stegmayr B. Functional outcome 3 months after stroke predicts long-term survival.
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Clinical studies have identified multiple factors associated with higher mortality and worse outcome in ICH.
Clinical studies have identified multiple factors associated with higher mortality and worse outcome in ICH. Older age and lower Glasgow coma scale (GCS) score at presentation have been almost uniformly reported as independent negative prognostic predictors [5, 9, 32, 58]. Other important factors independently associated with unfavorable outcome are ICH volume [5], hematoma growth [10], intraventricular
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Other important factors independently associated with unfavorable outcome are ICH volume [5], hematoma growth [10], intraventricular
Clinical studies have identified multiple factors associated with higher mortality and worse outcome in ICH. Older age and lower Glasgow coma scale (GCS) score at presentation have been almost uniformly reported as independent negative prognostic predictors [5, 9, 32, 58]. Other important factors independently associated with unfavorable outcome are ICH volume [5], hematoma growth [10], intraventricular
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This comparison between “intensive” (as achieved in INTERACT) and “very intensive” blood pressure lowering did not result in a statistically significant difference in clinical outcome, even a trend was not observed.
i.v. nicardipine. Another important difference between INTERACT and ATACH is that in ATACH II, although the blood pressure targets were defined similarly as in INTERACT, the actual achieved levels in the control group were similar to the intensive management arm in INTERACT, whereas the intensive arm in ATACH was at mean levels of 120 mmHg systolic blood pressure. This comparison between “intensive” (as achieved in INTERACT) and “very intensive” blood pressure lowering did not result in a statistically significant difference in clinical outcome, even a trend was not observed. There were, however, significantly more severe adverse events in the treatment arm. After ATACH II was published in 2016, most experts did not see a necessity to change the current recommendations for the clinical routine again based on this trial. ATACH, however, opened more space for discussion on blood pressure lowering in ICH, especially with respect to possible harms beyond a “sweet spot” of a safe target value. Those discussions are reinforced by recent findings of MRI in patients with ICH. A retrospective study by Prabhakaran and colleagues [44] described distant small ischemic lesions (areas of restricted diffusion on DWI imaging) and found a correlation between those lesions, extensive blood pressure reduction, and worse clinical outcome.
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A retrospective study by Prabhakaran and colleagues [44] described distant small ischemic lesions (areas of restricted diffusion on DWI imaging) and found a correlation between those lesions, extensive blood pressure reduction, and worse clinical outcome.
This comparison between “intensive” (as achieved in INTERACT) and “very intensive” blood pressure lowering did not result in a statistically significant difference in clinical outcome, even a trend was not observed. There were, however, significantly more severe adverse events in the treatment arm. After ATACH II was published in 2016, most experts did not see a necessity to change the current recommendations for the clinical routine again based on this trial. ATACH, however, opened more space for discussion on blood pressure lowering in ICH, especially with respect to possible harms beyond a “sweet spot” of a safe target value. Those discussions are reinforced by recent findings of MRI in patients with ICH. A retrospective study by Prabhakaran and colleagues [44] described distant small ischemic lesions (areas of restricted diffusion on DWI imaging) and found a correlation between those lesions, extensive blood pressure reduction, and worse clinical outcome. Those findings were recently confirmed in a larger prospective cohort from the ERICH study [25], demonstrating that roughly a quarter of all spontaneous ICH patients show such lesions on MRI. Summarizing those trials, 140 mmHg seems to remain a safe target for blood pressure management in acute ICH and avoiding strong variability of blood pressure seems also to be very important in such patients. Future studies should include MRI imaging in order to estimate the role of DWI lesions and their association with blood pressure lowering.
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This was the primary outcome measure chosen for that trial.
reduce hematoma growth, as compared to placebo. This was the primary outcome measure chosen for that trial. The study was even able to show a significant benefit in terms of mortality and functional outcome associated with use of rfVIIa, despite a 5% increase in arterial thromboembolic events [37]. Therefore, the result of the phase III clinical trial (FAST) was disappointing, for it could not find a significant difference in the primary outcome measure death or severe disability, despite of confirming the effect of hemorrhage growth reduction and the safety profile of rfVIIa considering thromboembolic events [38]. A second look at the data from the FAST trial however raises hope that a selected subset of patients may anyway benefit from rfVIIa treatment. A post-hoc analysis, from which patients known to be at high risk for poor outcome at baseline were excluded (ICH >60 ml, IVH >5 ml, age
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The study was even able to show a significant benefit in terms of mortality and functional outcome associated with use of rfVIIa, despite a 5% increase in arterial thromboembolic events [37].
reduce hematoma growth, as compared to placebo. This was the primary outcome measure chosen for that trial. The study was even able to show a significant benefit in terms of mortality and functional outcome associated with use of rfVIIa, despite a 5% increase in arterial thromboembolic events [37]. Therefore, the result of the phase III clinical trial (FAST) was disappointing, for it could not find a significant difference in the primary outcome measure death or severe disability, despite of confirming the effect of hemorrhage growth reduction and the safety profile of rfVIIa considering thromboembolic events [38]. A second look at the data from the FAST trial however raises hope that a selected subset of patients may anyway benefit from rfVIIa treatment. A post-hoc analysis, from which patients known to be at high risk for poor outcome at baseline were excluded (ICH >60 ml, IVH >5 ml, age
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Therefore, the result of the phase III clinical trial (FAST) was disappointing, for it could not find a significant difference in the primary outcome measure death or severe disability, despite of confirming the effect of hemorrhage growth reduction and the safety profile of rfVIIa considering thromboembolic events [38].
reduce hematoma growth, as compared to placebo. This was the primary outcome measure chosen for that trial. The study was even able to show a significant benefit in terms of mortality and functional outcome associated with use of rfVIIa, despite a 5% increase in arterial thromboembolic events [37]. Therefore, the result of the phase III clinical trial (FAST) was disappointing, for it could not find a significant difference in the primary outcome measure death or severe disability, despite of confirming the effect of hemorrhage growth reduction and the safety profile of rfVIIa considering thromboembolic events [38]. A second look at the data from the FAST trial however raises hope that a selected subset of patients may anyway benefit from rfVIIa treatment. A post-hoc analysis, from which patients known to be at high risk for poor outcome at baseline were excluded (ICH >60 ml, IVH >5 ml, age
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A post-hoc analysis, from which patients known to be at high risk for poor outcome at baseline were excluded (ICH >60 ml, IVH >5 ml, age
reduce hematoma growth, as compared to placebo. This was the primary outcome measure chosen for that trial. The study was even able to show a significant benefit in terms of mortality and functional outcome associated with use of rfVIIa, despite a 5% increase in arterial thromboembolic events [37]. Therefore, the result of the phase III clinical trial (FAST) was disappointing, for it could not find a significant difference in the primary outcome measure death or severe disability, despite of confirming the effect of hemorrhage growth reduction and the safety profile of rfVIIa considering thromboembolic events [38]. A second look at the data from the FAST trial however raises hope that a selected subset of patients may anyway benefit from rfVIIa treatment. A post-hoc analysis, from which patients known to be at high risk for poor outcome at baseline were excluded (ICH >60 ml, IVH >5 ml, age
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>70 years, treatment later than 2.5 hours), could show a strong trend towards improved outcome and a twofold reduction in hematoma growth in the selected collective treated with rfVIIa [39].
>70 years, treatment later than 2.5 hours), could show a strong trend towards improved outcome and a twofold reduction in hematoma growth in the selected collective treated with rfVIIa [39]. On that basis the routine use of rfVIIa for treatment of ICH cannot be recommended. Currently, several ongoing clinical trials investigate the use of hemostasis in spontaneous ICH using other agents, e.g. tranexamic acid.
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The primary endpoint of this trial was the clinical outcome (Glasgow Outcome Scale Extended – GOSE) 6 months after the event, evaluated by using a prognosis-based method in order to consider important strong prognostic predictors as age, GCS and initial ICH volume.
On that basis the STICH II trial was conducted in order to compare surgical with initial medical treatment in this subgroup of patients. Unfortunately, some major methodological issues as the “uncertainty principle”, were kept in this trial, which was recently published [41]. STICH II included patients with superficially located lobar ICH with a volume between 10-100 ml and symptom onset within 48 hours before randomization. Patients with IVH were excluded. Early hematoma removal within 12 hours after randomization was compared with initially conservative management. The primary endpoint of this trial was the clinical outcome (Glasgow Outcome Scale Extended – GOSE) 6 months after the event, evaluated by using a prognosis-based method in order to consider important strong prognostic predictors as age, GCS and initial ICH volume. Mortality was analyzed as a secondary endpoint. Of totally 601 included patients, 307 were randomized into the early surgery group. As in STICH, the percent of patients from the control group that were later subjected to surgery, most often due to secondary deterioration, was relatively high (62 of 294, 21%). Craniotomy was the most frequently used surgical method (in 98% of patients). STICH II also did not bring up a significant result. The
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There was also a trend towards improvement of clinical outcome.
program was recently published [18] and showed optimistic results considering safety issues. There was also a trend towards improvement of clinical outcome. The phase III MISTIE trial started in December 2014 and has already recruited a very large proportion of the planned sample size of 500 patients. The results of this trial are eagerly expected and will probably be made available in 2018.
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A smaller clinical study showed that continuous hypertonic saline may reduce edema and improve outcome in patients with ICH treated in neurological ICU [62].
The use of osmotic agents for treatment of cerebral edema is based on the assumption that osmotically active substances could facilitate the transfer of water from the interstitium into the bloodstream thereby reducing the spaceoccupying effect of perihemorrhagic edema. Osmotic agents routinely used in neurocritical care include mannitol, glycerol, and hypertonic saline. To date there are no high quality data in support of those treatment options in patients with ICH. A smaller clinical study showed that continuous hypertonic saline may reduce edema and improve outcome in patients with ICH treated in neurological ICU [62]. A post-hoc analysis of the INTERACT 2 trial showed no convincing effects of mannitol on the clinical course after ICH [64].
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Low quality data from small, mostly nonrandomized clinical trials on IVF in patients with IVH that have accumulated over the past few decades show trends of reduction of mortality and improvement of clinical outcome, as compared to EVD alone or conservative treatment (no EVD) [48].
EVD alone is often not sufficient, because especially in more severely affected patients the catheter is frequently obstructed by blood clots [1]. Although it seems paradoxical at first glance to treat a hemorrhage with fibrinolytics, the concept of intraventricular fibrinolysis (IVF) has been tested in the experimental setting since the 1980s and first successful treatments in clinical cases have been reported in the early 1990s [48]. The rationale of this treatment consists in the degradation of the ventricular clot by injection of low dosed fibrinolytic substances (e.g. rtPA or urokinase) into the EVD at a time point, where the bleeding has already stopped and the clot is consolidated. This way the functionality of the drain can be kept and the degradation and drainage of the intraventricular clot can be fastened. Low quality data from small, mostly nonrandomized clinical trials on IVF in patients with IVH that have accumulated over the past few decades show trends of reduction of mortality and improvement of clinical outcome, as compared to EVD alone or conservative treatment (no EVD) [48]. A large phase III randomized, blinded, placebo-controlled clinical trial (CLEAR III) investigated the efficacy of IVF in 500 patients with IVH and acute obstructive hydrocephalus [17]. The study finished recruiting patients in 2014 and was recently published. The primary outcome of the trial, namely the difference in the proportion of patients with good functional outcome (mRS 0-3) 180 days after the event, showed no statistically significant difference between intraventricular rtPA and placebo. There was, however, a significant reduction in mortality (absolute risk reduction of 10%, p=0.006) in favor of the rtPA group. In a subgroup analysis patients with more severe IVH (>20 ml) from which
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The primary outcome of the trial, namely the difference in the proportion of patients with good functional outcome (mRS 0-3) 180 days after the event, showed no statistically significant difference between intraventricular rtPA and placebo.
rtPA or urokinase) into the EVD at a time point, where the bleeding has already stopped and the clot is consolidated. This way the functionality of the drain can be kept and the degradation and drainage of the intraventricular clot can be fastened. Low quality data from small, mostly nonrandomized clinical trials on IVF in patients with IVH that have accumulated over the past few decades show trends of reduction of mortality and improvement of clinical outcome, as compared to EVD alone or conservative treatment (no EVD) [48]. A large phase III randomized, blinded, placebo-controlled clinical trial (CLEAR III) investigated the efficacy of IVF in 500 patients with IVH and acute obstructive hydrocephalus [17]. The study finished recruiting patients in 2014 and was recently published. The primary outcome of the trial, namely the difference in the proportion of patients with good functional outcome (mRS 0-3) 180 days after the event, showed no statistically significant difference between intraventricular rtPA and placebo. There was, however, a significant reduction in mortality (absolute risk reduction of 10%, p=0.006) in favor of the rtPA group. In a subgroup analysis patients with more severe IVH (>20 ml) from which
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The available data are however not sufficient to estimate the possible impact of the combination of IVF and early LD on functional outcome.
incidence of permanent hydrocephalus and ventriculo-peritoneal shunts in patients with ICH and severe IVH, as shown in a prospective case series and confirmed in a randomized controlled trial [50, 51]. This effect is possibly explained by the rapid clot resolution using IVF, but also by early washout of blood and blood breakdown products from the site of CSF resorption via LD, namely the subarachnoid space. Considering the high malfunction, complication and revision rates of ventriculo-peritoneal shunts [42], prevention of their usage is certainly a benefit for those patients. The available data are however not sufficient to estimate the possible impact of the combination of IVF and early LD on functional outcome.
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Death and functional outcome after spontaneous intracerebral hemorrhage.
Daverat P, Castel JP, Dartigues JF, Orgogozo JM. Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis.
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Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage.
Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, Begtrup K, Steiner T. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage.
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Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage.
Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage.
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Early presentation of hemispheric intracerebral hemorrhage: prediction of outcome and guidelines for treatment allocation.
Lisk DR, Pasteur W, Rhoades H, Putnam RD, Grotta, JC. Early presentation of hemispheric intracerebral hemorrhage: prediction of outcome and guidelines for treatment allocation.
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The influence of hypothermia on outcome after intracerebral hemorrhage in rats.
MacLellan CL, Davies LM, Fingas MS, Colbourne F. The influence of hypothermia on outcome after intracerebral hemorrhage in rats.
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Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial.
Manning L, Hirakawa Y, Arima H, Wang X, Chalmers J, Wang J, Lindley R, Heeley E, Delcourt C, Neal B, Lavados P, Davis SM, Tzourio C, Huang Y, Stapf C, Woodward M, Rothwell PM, Robinson TG, Anderson CS. Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial.
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Mannitol and Outcome in Intracerebral Hemorrhage: Propensity Score and Multivariable Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 Results.
Wang X, Arima H, Yang J, Zhang S, Wu G, Woodward M, Munoz-Venturelli P, Lavados PM, Stapf C, Robinson T, Heeley E, Delcourt C, Lindley RI, Parsons M, Chalmers J, Anderson, CS. Mannitol and Outcome in Intracerebral Hemorrhage: Propensity Score and Multivariable Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 Results.
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ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage.
ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage.
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Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex,
Van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex,
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Transcranial sonographic localization of deep brain stimulation electrodes is safe, reliable and predicts clinical outcome.
Walter U, Kirsch M, Wittstock M, et al. Transcranial sonographic localization of deep brain stimulation electrodes is safe, reliable and predicts clinical outcome.
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In 2007 our group assessed the outcome of adding US to electrodiagnosis in patients affected by mononeuropathies and atypical clinical and neurophysiological presentation [7].
In 2007 our group assessed the outcome of adding US to electrodiagnosis in patients affected by mononeuropathies and atypical clinical and neurophysiological presentation [7]. In these
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Clinical characteristics and management outcome in the burning mouth syndrome.
Gorsky M, Silverman S, Chinn H. Clinical characteristics and management outcome in the burning mouth syndrome. An open study of 130 patients.
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Outcome measures included the Oswestry disability index (ODI) and the Visual analog scale for pain (VAS).
Forty patients voluntarily attended and treated in the Department of Neurosurgery of the University Hospital Sofiamed, Sofia were randomly divided into two groups (CG n=20) and (EG n=20). The assessment was made on the day of the discharge and one month after surgery. Outcome measures included the Oswestry disability index (ODI) and the Visual analog scale for pain (VAS). The CG was on the standard physical therapy program. A written patient’s guide with exercises was given to the patients of EG.
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written patient’s guide leads to a better outcome one month after spinal surgery.
written patient’s guide leads to a better outcome one month after spinal surgery.
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Implementation and outcome of thrombolysis with alteplase 3-4.5 h after an acute stroke: an updated analysis from SITS-ISTR.
Ahmed N, Wahlgren N, Grond M, Hennerici M, Lees KR, Mikulik R, Parsons M, Roine RO, Toni D, Ringleb P. Implementation and outcome of thrombolysis with alteplase 3-4.5 h after an acute stroke: an updated analysis from SITS-ISTR.
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Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
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Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials.
Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials.
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Thrombolysis and clinical outcome in patients with stroke after implementation of the Tyrol Stroke Pathway: a retrospective observational study.
Willeit J, Geley T, Schoch J, Rinner H, Tur A, Kreuzer H, Thiemann N, Knoflach M, Toell T, Pechlaner R, Willeit K, Klingler N, Praxmarer S, Baubin M, Beck G, Berek K, Dengg C, Engelhardt K, Erlacher T, Fluckinger T, Grander W, Grossmann J, Kathrein H, Kaiser N, Matosevic B, Matzak H, Mayr M, Perfler R, Poewe W, Rauter A, Schoenherr G, Schoenherr HR, Schinnerl A, Spiss H, Thurner T, Vergeiner G, Werner P, Woll E, Willeit P, Kiechl S. Thrombolysis and clinical outcome in patients with stroke after implementation of the Tyrol Stroke Pathway: a retrospective observational study.
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24. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 1 , , ,

A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture.
Kent KC, McArdle CR, Kennedy B, Baim DS, Anninos E, Skillman JJ. A prospective study of the clinical outcome of femoral pseudoaneurysms and arteriovenous fistulas induced by arterial puncture.
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Risk factors and 3-month outcome were assessed separately for single and multiple artery involvement.
Data of 25 patients admitted to the Neurology Department, clinically presented with CCAD, during a two-year period were analyzed. Risk factors and 3-month outcome were assessed separately for single and multiple artery involvement. Descriptive statistics was used to present clinical characteristics, risk factors and other comorbidities from medical history, as well as clinical outcome. Intergroup comparison was performed.
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Descriptive statistics was used to present clinical characteristics, risk factors and other comorbidities from medical history, as well as clinical outcome.
Data of 25 patients admitted to the Neurology Department, clinically presented with CCAD, during a two-year period were analyzed. Risk factors and 3-month outcome were assessed separately for single and multiple artery involvement. Descriptive statistics was used to present clinical characteristics, risk factors and other comorbidities from medical history, as well as clinical outcome. Intergroup comparison was performed.
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All patients had favorable outcome (mRS
Multiple artery involvement accounted for 8/25 patients. Arterial hypertension was the most common risk factor for all patients. Migraine and thyroid abnormalities (hyperthyreosis, remote thyroidectomy) were the most common abnormalities in the group of patients with multiple artery involvement. Hypertension and hyperlipidemia were the most common risk factor for carotid dissection. All patients had favorable outcome (mRS
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Data of the functional outcome after 3 months using the modified Rankin Scale (mRS) were used.
>7 mmol/l during non-acute phase, or use of antidiabetic therapy), smoking status, body mass index, and migraine [4]. Other risk factors were included in the analysis: trauma during the preceding month, infection during the preceding month, fibromuscular dysplasia based on the vascular imaging finding, remote head or neck surgery, anemia, thrombophilia, presence of Factor V Leiden, MTHFRC677T genotype, psoriasis, thyroid abnormalities, increased circulation IgG and IgM complex, atrial fibrillation, familial occurrence of subarachnoid hemorrhage. Data of the functional outcome after 3 months using the modified Rankin Scale (mRS) were used. A moderate-to-severe handicap was defined by a mRS ≥3. The record of major complications within the first 3 months was retrieved from the
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Descriptive statistics was used to present clinical characteristics, risk factors and other comorbidities from medical history, as well as clinical outcome for each group.
Descriptive statistics was used to present clinical characteristics, risk factors and other comorbidities from medical history, as well as clinical outcome for each group.
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After 3 months patients in all groups had favorable outcome (modified Rankin Scale 7 mmol/l извън острата фаза или пациенти на антидиабетна терапия), тютюнопушене, индекс на телесна маса и мигрена [4].
After 3 months patients in all groups had favorable outcome (modified Rankin Scale 7 mmol/l извън острата фаза или пациенти на антидиабетна терапия), тютюнопушене, индекс на телесна маса и мигрена [4]. В анализа са включени и други рискови фактори, като травма или инфекция през предходния месец, фибромускулна дисплазия, доказана чрез съдови образни изследвания, анамнеза за хирургична намеса на главата или шията, анемия, тромбофилия, наличие на фактор V Leiden, генотип MTHFRC677T, псориазис, тироидни аномалии, повишен процент циркулираши IgG и IgM комплекси, предсърдно мъждене и фамилност за субарахноиден кръвоизлив.
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Three-month outcome in the cohort of 25 patients with craniocervical artery dissection
Three-month outcome in the cohort of 25 patients with craniocervical artery dissection
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3 Months outcome
3 Months outcome
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Favorable outcome after 3 months was observed in all patients.
Favorable outcome after 3 months was observed in all patients. The presence of multiple, rather than single CCAD had no effect on functional outcome in CADISP study [2], mRS of
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The presence of multiple, rather than single CCAD had no effect on functional outcome in CADISP study [2], mRS of
Favorable outcome after 3 months was observed in all patients. The presence of multiple, rather than single CCAD had no effect on functional outcome in CADISP study [2], mRS of
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Cervical-artery dissections: predisposing factors, diagnosis, and outcome.
Debette S. Cervical-artery dissections: predisposing factors, diagnosis, and outcome.
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Incidence and outcome of cervical artery dissection: a population-based study.
Lee VH, Brown RD Jr, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study.
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25. NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, vol. 14, 2018, No. 2 , , ,

We formed a specific risk patient group with low MMSE results at the first days after stroke onset, for early cognitive rehabilitation and evaluation of medical outcome risk.
day are due to the severe clinical picture and not to initial symptom worsening. Some cognitive improvement is found only for patients examined at the first stroke day. The MMSE test performed at day 2 and 3 after IS is a good predictor for cognitive dysfunction at the first 3 months after the incident. Low MMSE is a risk factor for low quality of life and poor functional recovery [24, 38, 40] and independent factor for clinical worsening, death and late dementia [1]. We formed a specific risk patient group with low MMSE results at the first days after stroke onset, for early cognitive rehabilitation and evaluation of medical outcome risk. Patients with low MMSE results and
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Five-year outcome of a stroke cohort in Martinique, French West Indies: Etude R
Chausson N, Olindo S, Cabre P, Saint-Vil M, Smadja D. Five-year outcome of a stroke cohort in Martinique, French West Indies: Etude R
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Functional outcome of elderly survivors of ischemic stroke: a retrospective study comparing nonhypercholesterolemic and hypercholesterolemic patients.
Mizrahi EH, Waitzman A, Arad M, Adunsky A. Functional outcome of elderly survivors of ischemic stroke: a retrospective study comparing nonhypercholesterolemic and hypercholesterolemic patients.
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Impact of cognitive impairment on functional outcome in stroke.
D, Kaya B, Dere C. Impact of cognitive impairment on functional outcome in stroke.
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The outcome treatment results are followed up for a period from three months to five years for some patients.
The clinical presentation and neurological topical diagnosis are analyzed in the context of the relevant differential diagnosis, use of advanced neuroimaging methods and role of emergency neurosonographic evaluation. The importance of the time-window organization in the acute neurological settings, criteria for choosing one or another neuro-interventional approach or thrombolytic therapy are stressed. The outcome treatment results are followed up for a period from three months to five years for some patients.
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Impaired somatic sensation is known to be a significant predictor for poor rehabilitation outcome in cerebrovascular stroke patients.
Impaired somatic sensation is known to be a significant predictor for poor rehabilitation outcome in cerebrovascular stroke patients. A number of neurorehabilitation treatment strategies have been aimed to stimulate mechanisms of sensory cortical plasticity with results showing improvements in sensorimotor deficits following treatments. In attempts to understand cortical sensory plasticity in humans my research group has investigated automatic sensory processing of non-nociceptive and
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Special treatment is initiated through early recanalization (intravenous and intraarterial thrombolysis, endovascular stenting and/or mechanical thrombectomy) at the acute stage of ischemic stroke (AIS) and its impact on the final outcome of the disease.
In recent decades Bulgaria ranks at one of the top places in the EU on stroke death. The presentation shows the main trends in the course of stroke morbidity and mortality in the country. Special treatment is initiated through early recanalization (intravenous and intraarterial thrombolysis, endovascular stenting and/or mechanical thrombectomy) at the acute stage of ischemic stroke (AIS) and its impact on the final outcome of the disease. Despite the fact that there is a steady tendency to increase the relative part of the specific treatment in AIS, its incidence is still very low
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Anticipatory mechanisms – knowledge of the result (of outcome): what is needed to do a task; кnowledge about performance: what it takes to achieve quality in the movement;
Anticipatory mechanisms – knowledge of the result (of outcome): what is needed to do a task; кnowledge about performance: what it takes to achieve quality in the movement;
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The appropriate choice of diagnostic methods and therapeutic behavior in patients with dissection of the ICA is of great importance for the outcome of IS or TIA at young age.
The appropriate choice of diagnostic methods and therapeutic behavior in patients with dissection of the ICA is of great importance for the outcome of IS or TIA at young age.
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Color-coded Duplex Sonography of vessels is an important and indispensable part of the overall assessment of haemodynamics in the case of coronary-subclavian style syndrome as well as for following up the therapeutic outcome.
Color-coded Duplex Sonography of vessels is an important and indispensable part of the overall assessment of haemodynamics in the case of coronary-subclavian style syndrome as well as for following up the therapeutic outcome.
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