Vascular Disorders

Stroke current issue

Electrical Stimulation of the Cerebral Cortex Exerts Antiapoptotic, Angiogenic, and Anti-Inflammatory Effects in Ischemic Stroke Rats Through Phosphoinositide 3-Kinase/Akt Signaling Pathway [Original Contributions]
Baba, T., Kameda, M., Yasuhara, T., Morimoto, T., Kondo, A., Shingo, T., Tajiri, N., Wang, F., Miyoshi, Y., Borlongan, C. V., Matsumae, M., Date, I. Background and Purpose— Neuroprotective effects of electric stimulation have been recently shown in ischemic stroke, but the underlying mechanisms remain poorly understood. Methods— Adult Wistar rats weighing 200 to 250 g received occlusion of the right middle cerebral artery for 90 minutes. At 1 hour after reperfusion, electrodes were implanted to rats on the right frontal epidural space. Electric stimulation, at preset current (0 to 200 µA) and frequency (0 to 50 Hz), was performed for 1 week. Stroke animals were subjected to behavioral tests at 3 days and 1 week postmiddle cerebral artery and then immediately euthanized for protein and immunohistochemical assays. After demonstration of behavioral and histological benefits, subsequent experiments pursued the mechanistic hypothesis that electric stimulation exerted antiapoptotic effects through the phosphoinositide 3-kinase-dependent pathway; thus, cortical stimulation was performed in the presence or absence of specific inhibitors of phosphoinositide 3-kinase (LY294002) in stroke rats. Results— Cortical stimulation abrogated the ischemia-associated increase in apoptotic cells in the injured cortex by activating antiapoptotic cascades, which was reversed by the phosphoinositide 3-kinase inhibitor LY294002 as reflected behaviorally and immunohistochemically. Furthermore, brain levels of neurotrophic factors (glial cell line-derived neurotrophic factor, brain-derived neurotrophic factor, vascular endothelial growth factor) were upregulated, which coincided with enhanced angiogenesis and suppressed proliferation of inflammatory cells in the ischemic cortex. Conclusions— These results suggest that electric stimulation prevents apoptosis through the phosphoinositide 3-kinase pathway. Consequently, the ischemic brain might have been rendered as a nurturing microenvironment characterized by robust angiogenesis and diminished microglial/astrocytic proliferation, resulting in the reduction of infarct volumes and behavioral recovery. Electric stimulation is a novel and potent therapeutic tool for cerebral ischemia.
Induced Spreading Depression Evokes Cell Division of Astrocytes in the Subpial Zone, Generating Neural Precursor-Like Cells and New Immature Neurons in the Adult Cerebral Cortex [Original Contributions]
Xue, J.-H., Yanamoto, H., Nakajo, Y., Tohnai, N., Nakano, Y., Hori, T., Iihara, K., Miyamoto, S. Background and Purpose— New immature neurons appear out of the germinative zone, in cortical Layers V to VI, after induced spreading depression in the adult rat brain. Because neural progenitors have been isolated in the cortex, we set out to determine whether a subgroup of mature cells in the adult cortex has the potential to divide and generate neural precursors. Methods— We examined the expression of endogenous markers of mitotic activity, proliferating cell nuclear antigen, and vimentin as a marker for neuronal progenitor cells, if any, in the adult rat cortex after spreading depression stimulation. Immunohistochemical analysis was also performed using antibodies for proliferating cell nuclear antigen, for vimentin, and for nestin. Nestin is a marker for activity dividing neural precursors. Results— At the end of spreading depression (Day 0), glial fibrillary acidic protein-positive cells in the subpial zone and cortical Layer I demonstrated increased mitotic activity, expressing vimentin and nestin. On Day 1, nestin+ cells were found spreading in deeper cortical layers. On Day 3, vimentin–/nestin+, neural precursor-like cells appeared in cortical Layers V to VI. On Day 6, new immature neurons appeared in cortical Layers V to VI. Induced spreading depression evokes cell division of astrocytes residing in the subpial zone, generating neural precursor-like cells. Conclusions— Although neural precursor-like cells found in cortical Layers V to VI might have been transferred from the germinative zone rather than the cortical subpial zone, astrocytic cells in the subpial zone may be potent neural progenitors that can help to reconstruct impaired central nervous system tissue. Special caution is required when observing or treating spreading depression waves accompanying pathological conditions in the brain.
Defeating Normal Thermoregulatory Defenses: Induction of Therapeutic Hypothermia [Comments, Opinions, and Reviews]
Sessler, D. I. Therapeutic hypothermia may be useful in various circumstances including stroke. However, core body temperature is normally tightly regulated. Even mild hypothermia in conscious subjects thus provokes vigorous thermoregulatory defenses which are potentially harmful in fragile patients. Furthermore, thermoregulatory responses are effective, which reduces the rate at which hypothermia can be induced. Drugs are thus often given to blunt normal thermoregulatory defenses. General anesthetics profoundly impair thermoregulatory control, but prolonged general anesthesia is rarely practical or appropriate. A variety of other drugs have therefore been evaluated. Most opioids only slightly impair thermoregulatory defenses, but meperidine is considerably more effective than equipotent doses of other opioids. The central -2 agonists clonidine and dexmedetomidine are also useful. However, the best overall approach to inducing thermal tolerance appears to be a combination of buspirone and meperidine, which reduces the core temperature triggering shivering to about 33.5°C in doses that maintain adequate ventilation.
Interventions in the Management of Serum Lipids for Preventing Stroke Recurrence [Cochrane Corner]
Manktelow, B. N., Potter, J. F.
Surgery for Primary Supratentorial Intracerebral Hematoma: A Meta-Analysis of 10 Randomized Controlled Trials [Cochrane Corner]
Prasad, K., Mendelow, A. D., Gregson, B.
Overground Physical Therapy Gait Training for Chronic Stroke Patients With Mobility Deficits [Cochrane Corner]
States, R. A., Pappas, E., Salem, Y. Background and Purpose— Overground gait training can be defined as a physical therapists’ observation and cueing of the patient’s walking pattern along with related exercises, but does not include high-technology aids such as functional electric stimulation or body weight support. This systematic review investigated the effects of overground physical therapy gait training on walking ability for chronic stroke patients with mobility deficits. Methods— A comprehensive literature search was performed as per the Cochrane group guidelines. Only randomized controlled trials that compared overground physical therapy gait training to a placebo intervention or no treatment for chronic stroke patients with mobility deficits were included. Results— Nine studies involving 499 participants matched the inclusion criteria and had moderate methodological quality. Results were mixed with no significant effect on the primary variable, gait function. Small effects for several performance variables were found: gait speed increased by 0.07 meters per second (95% confidence interval [CI]=0.05 to 0.10) based on 7 studies with 396 participants, timed up-and-go (TUG) test improved by 1.81 seconds (95% CI=–2.29 to –1.33) based on 3 studies and 118 participants, and 6-minute-walk test (6MWT) increased by 26.06 meters (95% CI=7.14 to 44.97) based on 4 studies with 181 participants. No significant differences in adverse events were found. Conclusions— There is insufficient evidence to determine whether overground gait training directly benefits broad measures of gait function. Results from recent studies, however, suggest that specific training protocols may provide limited benefits for more uni-dimensional performance variables like gait speed, TUG test, and 6MWT.

 

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Acute Stroke Toolbox - Guidelines, pathways, sample admission orders, and complementary tools, courtesy of the Brain Attack Coalition--a nonprofit alliance whose mission is to reduce the occurrence and impact of stroke.

Ahealthyme.com: Stroke: An Animated Guide - Visual introduction to ischemic and hemorrhagic strokes, revealing the fundamental processes involved in each type of brain attack.
Meta Description: [ aHealthyme.com provides information on health and wellness, along with daily health news, full-text journal and magazine articles, personalized newsletters and e-mail reminders, shopping, and more. ]

Artists Recovering from Stroke - Submit your artwork for inclusion in an online gallery, view samples from an Australian exhibition, and learn more about post-stroke conditions that may influence works of art.

Ask the Doctor - The Stroke Rehab Forum - Interactive medical question-and-answer board covering all aspects of stroke rehabilitation. Responses are provided by medical professionals from The Comprehensive Pain and Rehabilitation Center.
Meta Description: [ Interactive medical question and answer format about all aspects of stroke rehabilitation. Extensive library and archive of articles. ]

Believe In Miracles - Online home of James Bradley, stroke survivor and author of Elvis Was My Speech Therapist.
Meta Description: [ Stroke rehabilitation and recovery secrets revealed by stroke survivor James Bradley. Elvis Was My Speech Therapist is James Bradley's inspiring story of determination and hope. After a near-fatal accident, he suffered a stroke and became paralysed throughout his body. Through some simple strateg... ]

Brain Stem Stroke: Joe and Jackie - Reaching out to other families who have been affected by brain stem stroke, with a personal story of survival and links to helpful resources.
Meta Description: [ A couple's story of survival and life after a massive brain stem stroke resulting in a rare condition called 'locked in syndrome' ]

Caregiver-Information.com - Fact sheets, adapted leisure ideas, relaxation tips, news, and other resources for those who are caring for loved ones with stroke or another neurological condition.
Meta Description: [ Domain name renewal and affordable web hosting packages from Network Solutions ]

Constraint-Induced Movement Therapy: Online Publications - Reading list featuring reports on CIMT--a massed practice approach to limb weakness. Intended as a research aid for stroke survivors, medical professionals, and others who wish to investigate the therapy online.
Meta Description: [ Listings for online Constraint-Induced Movement Therapy publications, provided by the Stroke Information Directory. ]

Depression and Stroke - National Institute of Mental Health fact sheet relating the symptoms of post-stroke depression and the importance of obtaining treatment.

eMedicine Health: Stroke - Consumer health resource center, providing information on the causes, symptoms, and urgent treatment of stroke.
Meta Description: [ Stroke is a brain attack. It is much like a heart attack, only it occurs in the brain. Like a heart attack, stroke is a medical emergency. Do not wait ... ]

Family Centered Community Stroke Program - An Ottawa-based study that is designed to gather information about needed community services for stroke survivors and their families.
Meta Description: [ The purpose of the study is to gather information from the participants in the study with regards to what services they need in the community, the strengthening of supportive relationships within the family and community. ]

General Practice Notebook: Stroke - Clinical reference on ischemic and hemorrhagic strokes. Covered topics include differential diagnosis, etiological determination, radiologic investigations, and management of patients within the National Service Framework.

HealthAtoZ: Stroke - Learn how to decrease your stroke risk, and look into available treatments and questions that you should ask your physician if you've just had a stroke.
Meta Description: [ Understand how to decrease your risk of a stroke and the signs of stroke. Also find out what types of questions you should ask your doctor. ]

Hobbies After a Stroke - Created by a brain-stem-stroke survivor who hopes to encourage others to get involved in recreational activities. Her post-stroke hobbies include embroidery and outings on a motorized scooter.
Meta Description: [ This website shows just what an invalid can achieve after suffering a stroke - celebro vascular accident - and after a period of rehabilitation. The hobbies since disability are embroidery and cycling ]

Interact Reading Service - Providing a professional, live, interactive reading service for stroke patients in hospitals and stroke clubs in the London area.

Internet Stroke Center at Washington University in St. Louis - A stroke resource for medical professionals and consumers, alike. Educational information, directories of clinical trials and stroke centers, and a calendar of major stroke conferences are among the site's many offerings.
Meta Description: [ The leading university-based site for information on stroke care and research. ]

Interventional Radiology Procedures for Treatment and Prevention of Stroke - Educational resource from the Society of Interventional Radiology. Covered procedures include intra-arterial thrombolysis, aneurysm embolization, and carotid stenting.
Meta Description: [ The Society of Interventional Radiology (SIR) is a professional society for physicians who specialize in interventional or minimally invasive procedures, SIR is a non-profit, national scientific organization deeply committed to its mission to improve health and the quality of life through the pra... ]

JennyStroke.com - Online home of Jenny Broome, a young brain-stem-stroke survivor sharing perspectives on recovery.
Meta Description: [ Site dedicated to young stroke victim Jenny Broome ]

Lou's Stroke - Link collection and personal story of Louis Albert, a survivor with diabetes and aphasia who has used assistive technology to create his site.
Meta Description: [ In 1983 I began using insulin for my Type-2 DIABETES. In May of 1995 I had a severe stroke. Because of the stroke and the resulting aphasia, I am totally disabled. ]

MerckSource: Stroke - Find background information about stroke--and quick links to online versions of The Merck Manual - Home Edition and Dorland's Medical Encyclopedia--through MerckSource.
Meta Description: [ Find information on Stroke at MerckSource. Learn more about Stroke, A stroke is an interruption of the blood supply to any part of the brain. ]

Neurotransplantation for Patients with Paralysis After Stroke - Overview of the University of Pittsburgh's study of neuronal cell transplantation for the treatment of stroke. Updates on the research program are provided.
Meta Description: [ Study to evaluate neuron cell transplantation for patients who have suffered a stroke. ]

NHS Direct Online Health Encyclopaedia: Stroke - Fundamental stroke information, provided at the companion site to the National Health Service's advice hotline.

NINDS Stroke Information Page - Introduction to stroke, with pointers to related fact sheets concerning symptoms, prevention, and rehabilitation. Presented by the National Institute of Neurological Disorders and Stroke, a division of the National Institutes of Health.
Meta Description: [ Stroke information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS). ]

Physiotherapy for Strokes - An overview of the role of physical therapy in stroke rehabilitation, provided by Heads Up!--a specialist neurological physiotherapy practice based in Surrey, England.
Meta Description: [ An information and resource guide for people recovering from strokes. ]

Post Stroke Help - Articles and webcasts concerning post-stroke spasticity, uncontrollable muscle tightness or cramps that cause pain and affect movement. Created in cooperation with Healthology and supported by unrestricted educational grants from Allergan and Medtronic.
Meta Description: [ Stroke recovery information. Learn about leg cramps, muscle cramps, muscle spasms, post stroke rehabilitation and Baclofen or Botox treatments. ]

Separating Myth and Fact: Women and Stroke - Article exploring women's special stroke risks.
Meta Description: [ You probably don't worry too much about it. But maybe you should. Find out why and what you can do. ]

Stroke - From the staff of the Mayo Clinic, a nine-page, consumer-oriented guide to stroke. Topics include risk factors and prevention, screening and diagnosis, treatment, and coping skills.
Meta Description: [ Stroke — Comprehensive overview covers symptoms, causes, treatment of interruption of brain's blood supply. ]

Stroke and Aphasia Information - Resources for stroke recovery, including home therapy tips and survivors' stories. Presented by Bungalow Software, a provider of rehabilitation programs.
Meta Description: [ Stroke information in PLAIN-ENGLISH ]

Stroke and Cerebrovascular Diseases: A Guide for Patients and Their Families - From the stroke specialists at Stanford University's School of Medicine, a nine-part guide featuring information about stroke types, prevention, emergency treatment, and rehabilitation.

Stroke Recovery: Regaining Quality of Life - Discusses the goals of stroke recovery and rehabilitation: to improve quality of life and counteract morbidity
Meta Description: [ Discusses the goals of stroke recovery and rehabilitation: to improve quality of life and counteract morbidity. ]

Stroke Survivors - Maintained by and for stroke survivors and their families to provide information about rehabilitation options, sources of support, and new equipment.

Stroke Survivors Canada Ottawa - Supporting affected families with information about stroke causes, acute care, rehabilitation, financial issues, local services, and Web-based resources.

Stroke Survivors: The Site for Cerebellar Stroke Victims - Developed and maintained by survivor John d'Arcy to support individuals who are dealing with cerebellar stroke. Resources include his personal story, a fact sheet on the condition, a message board, and contact details for related organizations in the United Kingdom.
Meta Description: [ Stroke Survivors is a website for stroke victims, particularly Cerebellar stroke victims who are in a minority. However any stroke victim should find some useful information, at least that is my intention. The site was developed and is maintained by myself; John D'Arcy ]

Stroke-TIA.org - An educational resource focusing on the prevention and treatment of stroke and transient ischemic attacks. Features articles and webcasts of interviews with medical professionals.
Meta Description: [ An educational resource for information on stroke and TIA. Included in this website is information on the treatment, risk factors, symptoms, and prevention of stroke and transient ischemic attack ]

StrokeGene - An international research programme, aiming to discover new treatments for stroke through a genomic approach. Funded by the European Commission.
Meta Description: [ StrokeGene : An international research programme, funded by the European Commission, aiming to discover new treatments for stroke through a genomic approach. ]

StrokeHelp.com - Workshops and video-based courses focusing on stroke rehabilitation. Presented by International Clinical Educators.
Meta Description: [ Continuing education home study DVD & Video programs (CEUs), plus Workshops with Jan Davis for Physical Therapists and Occupational Therapists. Functional treatment and NDT training to improve the quality of care for stroke survivors. ]

StrokeMatters.com - Multi-lingual stroke survey, seeking respondents from Canada, Europe, and the United States. The results will be used to help advance stroke education and care internationally.
Meta Description: [ Thank you for taking the time to complete our multi-lingual Stroke survey. It will be used to assess levels of disease awareness. The information gathered from your responses will help to benefit the advancement of stroke prevention and treatment in the future. Stroke is the leading cause of disa... ]

StrokePage/Slagsiden - Home to the StrokePost news pages and numerous other resources for stroke survivors and their loved ones. Content is presented in both English and Norwegian.
Meta Description: [ Slag, Slaganfall,cerebral infarkt, Hjärnskada, Hjerneskade, Hjerneslag, Stroke, apopleksi, Brain stroke, Traumatic Brain Injury, Neurologisk sjukdom ]

Terri's Stroke Recovery - Story of stroke and continuing recovery, from the rehab unit to independent living. Written in support of other survivors who are on the long journey back from stroke.
Meta Description: [ My 5 years of recovery from a stroke ]

The New England Journal of Medicine: Stroke Collection - From the archives of the journal, literature covering topics such as antithrombotic therapy, cerebral thrombosis, and carotid stenosis.
Meta Description: [ The Stroke collection covers topics such as antithrombotic therapy, cerebral thrombosis, and carotid stenosis and includes research articles, case reports, reviews, and editorial commentary. ]

Transient Ischemic Attack - Information sheet on TIAs (which are also known as mini strokes). Published by National Institute of Neurological Disorders and Stroke.
Meta Description: [ Transient Ischemic Attack (TIA) information sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS). ]

Veritas Medicine: Stroke - Personalized trial listings, fundamental information, and treatment reviews pertaining to stroke.
Meta Description: [ Clinical trial listings and in-depth treatment information for serious illnesses. Perform a personalized search to find ongoing clinical trials that match your needs. Research treatments using high-quality original content written by top doctors. ]

Stroke current issue - Stroke RSS feed -- current issue

Stroke current issue - Stroke RSS feed -- current issue