Early recurrent ischemic stroke in stroke patients undergoing intravenous thrombolysis

BACKGROUND: We assessed the incidence of early recurrent ischemic stroke in stroke patients treated with intravenous tissue-type plasminogen activator (tPA) and the temporal pattern of its occurrence compared with symptomatic intracranial hemorrhage (ICH). METHODS AND RESULTS: Prospectively collected, population-based data for 341 consecutive acute stroke patients (62% men; mean age, 66 years) treated with tPA according to the National Institute of Neurological Disorders and Stroke study protocol at 8 medical centers in Switzerland (3 academic and 5 community) between January 2001 and November 2004 were retrospectively analyzed. The primary outcome measure was neurological deterioration > or = 4 points on the National Institutes of Health Stroke Scale occurring within 24 hours of tPA treatment and caused either by recurrent ischemic stroke (defined as the occurrence of new neurological symptoms suggesting involvement of initially unaffected vascular territories and evidence of corresponding ischemic lesions on cranial computed tomography scans, in the absence of ICH) or by ICH. Early recurrent ischemic stroke was diagnosed in 2 patients (0.59%; 95% confidence interval, 0.07% to 2.10%) and symptomatic ICH in 15 patients (4.40%; 95% confidence interval, 2.48% to 7.15%). Both recurrent ischemic strokes occurred during thrombolysis, whereas symptomatic ICHs occurred 2 to 22 hours after termination of tPA infusion. CONCLUSIONS: Recurrent ischemic stroke is a rare cause of early neurological deterioration in acute stroke patients undergoing intravenous thrombolysis, with a different temporal pattern compared with that of symptomatic ICH.

Prior statin use, intracranial hemorrhage, and outcome after intra-arterial thrombolysis for acute ischemic stroke

BACKGROUND AND PURPOSE: There are only limited data on whether prior statin use and/or cholesterol levels are associated with intracranial hemorrhage (ICH) and outcome after intra-arterial thrombolysis. The purpose of this study was to evaluate the association of statin pretreatment and cholesterol levels with the overall frequency of ICH, the frequency of symptomatic ICH, and clinical outcome at 3 months. METHODS: We analyzed 311 consecutive patients (mean age, 63 years; 43% women) who received intra-arterial thrombolysis. RESULTS: Statin pretreatment was present in 18%. The frequency of any ICH was 20.6% and of symptomatic ICH 4.8%. Patients with any ICH were more often taking statins (30% versus 15%, P=0.005), more often had atrial fibrillation (45% versus 30%, P=0.016), had more severe strokes (mean National Institute of Health Stroke Scale score 16.5 versus 14.7, P=0.022), and less often good collaterals (16% versus 24%, P=0.001). Patients with symptomatic ICH were more often taking statins (40% versus 15%, P=0.009) and had less often good collaterals (0% versus 24%, P<0.001). Any ICH or symptomatic ICH were not associated with cholesterol levels. After multivariate analysis, the frequency of any ICH remained independently associated with previous statin use (OR, 3.1; 95% CI, 1.53 to 6.39; P=0.004), atrial fibrillation (OR, 2.5; CI, 1.35 to 4.75; P=0.004), National Institutes of Health Stroke Scale score (OR, 1.1; CI, 1.00 to 1.10; P=0.037), and worse collaterals (OR, 1.7; CI, 1.19 to 2.42; P=0.004). There was no association of outcome with prior statin use, total cholesterol level, or low-density lipoprotein cholesterol level. CONCLUSIONS: Prior statin use, but not cholesterol levels on admission, is associated with a higher frequency of any ICH after intra-arterial thrombolysis without impact on outcome.

Cell replacement therapy for intracerebral hemorrhage

Intracerebral hemorrhage (ICH), for which no effective treatment strategy is currently available, constitutes one of the most devastating forms of stroke. As a result, developing therapeutic options for ICH is of great interest to the medical community. The 3 potential therapies that have the most promise are cell replacement therapy, enhancing endogenous repair mechanisms, and utilizing various neuroprotective drugs. Replacement of damaged cells and restoration of function can be accomplished by transplantation of cells derived from different sources, such as embryonic or somatic stem cells, umbilical cord blood, and genetically modified cell lines. Early experimental data showing the benefits of cell transplantation on functional recovery after ICH have been promising. Nevertheless, several studies have focused on another therapeutic avenue, investigating novel ways to activate and direct endogenous repair mechanisms in the central nervous system, through exposure to specific neuronal growth factors or by inactivating inhibitory molecules. Lastly, neuroprotective drugs may offer an additional tool for improving neuronal survival in the perihematomal area. However, a number of scientific issues must be addressed before these experimental techniques can be translated into clinical therapy. In this review, the authors outline the recent advances in the basic science of treatment strategies for ICH.

Subarachnoid hemorrhage and intracerebral hematoma: incidence, prognostic factors, and outcome

OBJECTIVE: To analyze the incidence and impact of an intracerebral hematoma (ICH) on treatment and outcome in patients with aneurysmal subarachnoid hemorrhage. METHODS: Data of 585 consecutive patients with subarachnoid hemorrhage from June 1999 to December 2005 were prospectively entered in a database. ICH was diagnosed and size was measured by computed tomographic scan before aneurysm occlusion. Fifty patients (8.5%) presented with an ICH larger than 50 cm3. The treatment decision (coil, clip, or hematoma evacuation) was based on an interdisciplinary approach. Patients were stratified into good (Hunt and Hess Grades I-III) versus poor (Hunt and Hess Grades IV and V) grade, and outcome was assessed according to the modified Rankin Scale at 6 months. RESULTS: Overall, 358 patients presented in good grade, with 4 of them having ICH (1.1%); and 227 patients presented in poor grade, with 46 of them having ICH (20.3%, P < 0.01). In good-grade patients with an ICH (n = 4), a favorable outcome (modified Rankin Scale score of 0-2) was achieved in 1 patient (25%), and in 246 patients (75%) without an ICH (P = 0.053; odds ratio, 0.11). A favorable outcome was achieved in 5 poor-grade patients (12.8%) with an ICH and in 40 patients (23.7%) without an ICH (P = 0.19; odds ratio, 0.47). Time to treatment was significantly shorter in patients with an ICH than without an ICH (median, 7 versus 26 h; P < 0.001) and shortest in patients with favorable outcome (3.5 hours; P < 0.01). CONCLUSION: The current data confirm that the presence of an ICH is a predictor of unfavorable outcome. However, despite large ICHs, a significant number of patients have a good outcome. To achieve a favorable outcome, ultra-early treatment with hematoma evacuation and aneurysm obliteration seems to be mandatory.

History of Art in the Digital Age: Problems and Possibilities

Ziel der vorliegenden Arbeit ist, einen allgemeinen Überblick über die Wirkung von Computern auf die Kunstgeschichte zu geben. Zu Beginn der Arbeit wird der Charakter der informationstechnologischen Revolution untersucht, einschließlich seiner schon oft festgestellten Parallelen mit der "Gutenberg"- Revolution, deren Ausgangspunkt in der Entwicklung der Druckerpresse liegt. Wie auch bei Gutenberg, ist die Entwicklung der Informationstechnologie technologisch bedingt. Jedoch führt sie durch ihren Schwerpunkt auf Flexibilität und Verbreitung an ein anderes Ziel. Diese Flexibilität ist zweischneidig: während sie viele neue Möglichkeiten eröffnet, scheint sie auch einen bruchstückhafteren, iterativen Ansatz zur Untersuchung des Vorzugs von Information vor Wissen anzuregen. Es bleibt jedoch offen, ob dieser Ansatz als notwendige Konsequenz der Struktur dieser vorhandenen neuen Technologie betrachtet werden kann, oder ob er eher als Produkt eines allgemeinen intellektuellen Wandels, angeregt durch das Aufkommen des postmodernen Diskurses, beschrieben werden soll. Ich werde in dem vorliegenden Artikel für den zweitgenannten Grund argumentieren. Ich bin außerdem der Meinung, dass der in der neuen Technologie enthaltenen Tendenz zur Fragmentierung entgegengewirkt werden kann - vorausgesetzt der Wunsch besteht. Die Entwicklung des Computers hängt eng mit der Nachfrage des Konsumenten zusammen. Aus diesem Grund kann ein neuer Trend in der Nachfrage die Art der Ausweitung und Modifizierung technologischer Vorgänge mitbestimmen.Des weiteren werden in der vorliegenden Arbeit Problemstellungen diskutiert, die speziell Auswirkungen auf die Untersuchung von Bildern haben. Hierbei wird sowohl das Potential digitaler Bilder für neue Formen der Erforschung und Analyse diskutiert, als auch die vielen neuen Möglichkeiten im Zeitalter des Internets.

Kanon und Hysterie: Primavera, Mona Lisa und die Sixtina im Chaos der Deutungen

Unter dem Titel »Kanon und Hysterie« vertrete ich die These, dass bei den Spitzenstücken die öffentliche Rezeption eines Werkes zusammen mit dem Verhalten der Forschung in fast irrationale Verhaltensweisen abgleitet, die hier provisorisch mit dem nicht klinisch-pathologisch gemeinten Begriff der ›Hysterie‹ umschrieben werden. Das zeigt sich etwa dann, wenn sowohl von der Forschung als auch in der öffentlichen Wahrnehmung die Erkenntnisse der Quellenkritik sowie der Gattungs- und Funktionsgeschichte ebenso wie die der politischen Ikonographie sowie auch Fragen klassischer Inhaltsdeutung beinahe vollkommen ignoriert werden. Fallbeispiele für den Vortrag sind Sandro Botticellis Primavera, Leonardo da Vincis Mona Lisa und Michelangelos Deckenfresko in der Sixtinischen Kapelle.