Background Management of vascular tumors of the head, neck, and brain is often complex and requires a multidisciplinary approach. Peri-operative embolization of vascular tumors may help to reduce intra-operative bleeding and operative times and have thus become an integral part of the management of these tumors. Advances in catheter and non-catheter based techniques in conjunction with the growing field of neurointerventional surgery is likely to expand the number of peri-operative embolizations performed. The goal of this article is to provide consensus reporting standards and guidelines for embolization treatment of vascular head, neck, and brain tumors.
Summary: Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update
Purpose: In this international multispecialty document, quality benchmarks for processes of care and clinical outcomes are defined. It is intended that these benchmarks be used in a quality assurance program to assess and improve processes and outcomes in acute stroke revascularization.
PREAMBLE: It is essential that the medical profession play a central role in critically evaluating the evidence related to drugs, devices, and procedures for the detection, management, or prevention of disease. Properly applied, rigorous, expert analysis of the available data documenting absolute and relative benefits and risks of these therapies and procedures can improve the effectiveness of care, optimize patient outcomes, and favorably affect the cost of care by focusing resources on the most effective strategies. One important use of such data is the production of clinical practice guidelines that, in turn, can provide a foundation for a variety of other applications such as performance measures, appropriate use criteria, clinical decision support tools, and quality improvement tools.
Alteplase (Actilyse, Boehringer Ingelheim) is a tissue plasminogen activator manufactured by recombinant DNA technology. It activates the production of plasmin from its precursor plasminogen. Plasmin is an enzyme that degrades fibrin clots. The aim of treatment is to reduce the impact of ischaemia by restoring blood flow through the occluded (blocked) artery. A UK marketing authorisation for alteplase to treat acute ischaemic stroke within 3 hours of the onset of symptoms was granted in September 2002. On 14 March 2012 the manufacturer received approval from the Medicines and Healthcare products Regulatory Agency extending the use of alteplase to within 4.5 hours of the onset of symptoms. The current marketing authorisation states that treatment must be started as early as possible within 4.5 hours after onset of stroke symptoms and after exclusion of intracranial haemorrhage by appropriate imaging techniques. Copyright © National Institute for Health and Clinical Excellence, 2012. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE.
The lower urinary tract consists of the urinary bladder and the urethra. Its function is to store and expel urine in a coordinated and controlled manner. The central and peripheral nervous systems regulate this activity. Urinary symptoms can arise due to neurological disease in the brain, the suprasacral spinal cord, the sacral spinal cord or the peripheral nervous system. Damage within each of these areas tends to produce characteristic patterns of bladder and sphincter dysfunction. The nature of the damage to the nervous system is also important. In children the neurological damage is often the result of congenital defects such as spina bifida or sacral agenesis. Conditions may produce a relatively fixed or stable injury to the nervous system (for example, stroke, spinal cord injury and cauda equina compression) or progressive damage (for example, dementia, Parkinson s disease, multiple sclerosis and peripheral neuropathy). Table 1 groups neurological conditions based on the anatomical site of the resulting neurological lesion with the likelihood of disease progression. Copyright © National Institute for Health and Clinical Excellence, 2012. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of NICE.
Cerebral venous thrombosis (CVT) accounts for 0.5 to 1% of all strokes. It is more commonly seen in young individuals with mortality rates that can reach 70%.1 Clinical presentation is variable and can include atypical or thunderclap headaches, symptoms and signs of increased intracranial pressure, seizures, and/or focal neurological deficits. CVT is also often associated with concurrent thromboembolic events and can be the initial manifestation of a prothrombotic state such as protein C and protein S deficiencies. From a therapeutic standpoint, the disease can pose significant challenges. Up to 40%2 of patients can initially present with intracranial hemorrhage, yet still require anticoagulation and/or endovascular therapy. Long term sequelae include development of dural arteriovenous fistulae, idiopathic intracranial hypertension, and the potential for cognitive impairment. Despite the morbidity and complexity of this disease, guidelines for its management have been lacking. Neurosurgery: August 2011 - Volume 69 - Issue 2 - pp N15-N17 doi: 10.1227/01.neu.0000400016.31648.3f. Copyright © by the Congress of Neurological Surgeons
The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628
Background and Purpose—Current US guideline statements regarding primary and secondary cardiovascular risk prediction and prevention use absolute risk estimates to identify patients who are at high risk for vascular disease events and who may benefit from specific preventive interventions. These guidelines do not explicitly include patients with stroke, however. This statement provides an overview of evidence and arguments supporting (1) the inclusion of patients with stroke, and atherosclerotic stroke in particular, among those considered to be at high absolute risk of cardiovascular disease and (2) the inclusion of stroke as part of the outcome cluster in risk prediction instruments for vascular disease. Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628.
This scientific statement is intended for use by physicians and allied health personnel caring for patients with transient ischemic attacks. Formal evidence review included a structured literature search of Medline from 1990 to June 2007 and data synthesis employing evidence tables, meta-analyses, and pooled analysis of individual patient-level data. The review supported endorsement of the following, tissue-based definition of transient ischemic attack (TIA): a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk of early stroke, and their risk may be stratified by clinical scale, vessel imaging, and diffusion magnetic resonance imaging. Diagnostic recommendations include: TIA patients should undergo neuroimaging evaluation within 24 hours of symptom onset, preferably with magnetic resonance imaging, including diffusion sequences; noninvasive imaging of the cervical vessels should be performed and noninvasive imaging of intracranial vessels is reasonable; electrocardiography should occur as soon as possible after TIA and prolonged cardiac monitoring and echocardiography are reasonable in patients in whom the vascular etiology is not yet identified; routine blood tests are reasonable; and it is reasonable to hospitalize patients with TIA if they present within 72 hours and have an ABCD 2 score 3, indicating high risk of early recurrence, or the evaluation cannot be rapidly completed on an outpatient basis. Copyright © 2009 American Heart Association. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628.
Medical errors are the eighth leading cause of death in the United States and are estimated to account for somewhere between 44 000 and 98 000 deaths in the United States each year. An exact number of deaths remains both uncertain and controversial, with arguments that the actual figure may be lower 1 2 or higher. Each year in the United States, the estimated 450 000 preventable medication-related adverse events cost $3.5 billion. In the Health Grades Inc Patient Safety in American Hospitals study, which examined 37 million patient records, it was estimated that 195 000 Medicare patients die due to preventable, in-hospital medical errors annually. Medication errors are the most common type of medical error, and cardiovascular medications prescribed to inpatients account for a large proportion of these errors. An average of 1 medication error occurs per hospitalized patient per day, and one quarter of all medication-related injuries are preventable. The emergency department (ED) and acute hospital setting remain locations at high risk for medication errors. Copyright © 2010 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539.
The purpose of this statement is to provide an overview of cerebral venous sinus thrombosis and to provide recommendations for its diagnosis, management, and treatment. The intended audience is physicians and other healthcare providers who are responsible for the diagnosis and management of patients with cerebral venous sinus thrombosis. Copyright © 2011 American Heart Association. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628.
Intracranial endovascular cerebrovascular interventions treat cerebrovascular diseases by use of minimally invasive intravascular techniques. This area of expertise has made tremendous strides during the past decade, and the rate of progress has accelerated as the discipline has gained increasing clinical acceptance. An Accreditation Council for Graduate Medical Education–approved training curriculum has been developed and approved since 2000, and an increasing body of clinical and scientific evidence demonstrates the application, safety, and efficacy of endovascular techniques for the treatment of cerebrovascular diseases. Several nonneurologically based endovascular subspecialties, such as vascular medicine, vascular surgery, and interventional cardiology, perform carotid artery stent placement with neurorescue via alternative Accreditation Council for Graduate Medical Education pathways, as well as a clinical practice pathway. Copyright © 2009 American Heart Association. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539.
Intracranial aneurysms are common, with a prevalence of 0.5% to 6% in adults, according to angiography and autopsy studies. Most intracranial aneurysms are asymptomatic and are never detected. Some are discovered incidentally in neuroimaging studies and some produce symptoms due to compression of neighboring nerves or adjacent brain tissue. Others are detected only after they have ruptured and caused subarachnoid hemorrhage, a devastating type of stroke associated with 32% to 67% case fatality and 10% to 20% long-term dependence in survivors due to brain damage. Copyright © 2002 American Heart Association. All rights reserved. Print ISSN: 0039-2499. Online ISSN: 1524-4628.
National Collaborating Centre for Chronic Conditions. London: Royal College of Physicians, 2008. Copyright © 2008 Royal College of Physicians of London. All rights reserved. ISBN 978-1-86016-339-5
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