Piri Keşif Aracı

Ek Bilgiler

Kaydet

DOI : 10.1016/s1474-4422(10)70296-9

ISSN: 1474-4422
Sayı: 12
Cilt: 9
Sayfa: 1155

Sınıflandırma :

Tıp ve Halk Sağlığı %78

Nöroloji %41

Genel Pratisyenlik ve Aile Hekimliği %37

Biyotıp %22

Epidemiyoloji %29

2

Response by Ntaios et al to Letter Regarding Article, Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack: Updated Systematic Review and Meta-Analysis.

Dergi Makalesi

Kaynak 1:

PubMed

Dergi:

Stroke

Yazar(lar) :

George Ntaios , Thorsten Steiner , Patrik Michel

Yıl :

2018

Thorsten Steiner

Yayıncı Web Siteleri

Piri Tam Metin Bulucu Ek Bilgiler

Kaydet

Kaynak 1:

https://www.ncbi.nlm.nih.gov/pubmed/29643262 arayıcılığı görüntüle.
Kaynak 2:

https://www.ncbi.nlm.nih.gov/pubmed/29622622 arayıcılığı görüntüle.

DOI : 10.1161/STROKEAHA.118.021281

Sınıflandırma :

Tıp ve Halk Sağlığı %99

Kardiyoloji %99

3

Medical Versus Surgical Management of Intracerebral Hematomas

Dergi Makalesi

Kaynak :

Springer Link

Dergi:

Current Atherosclerosis Reports

Yazar(lar) :

Johannes Trabert , Thorsten Steiner

Konu :

Cardiology and Cardiovascular Medicine

Yıl :

2012

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Best management of intracerebral hemorrhage (ICH) is subject to controversy. Therapeutic options especially depend on location, severity and complications of ICH. Evidence to distinguish between patients who might benefit from surgical intervention compared with best conservative management alone is still incomplete. This review presents the latest findings and important upcoming trials in respect of general and specific treatment of patients presenting with ICH.

DOI : 10.1007/s11883-012-0259-7

Anahtar Kelimeler : Intracerebral hemorrhage, Medical treatment, Surgical treatment

ISSN: 1523-3804 1534-6242
Sayı: 4
Cilt: 14
Sayfa: 366-372

4

Hemorrhagic Strokes

Kitap Bölümü

Kaynak :

Wiley Online Library

Dergi:

International Neurology

Yayıncı:

Wiley-Blackwell

Yazar(lar) :

Josef Schill , Thorsten Steiner

Yıl :

2010

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

This chapter contains sections titled: IntroductionSpontaneous intracerebral hemorrhageICH caused by arteriovenous malformation (AVM)Subarachnoid hemorrhageFurther reading

DOI : 10.1002/9781444317008.ch10

ISBN:9781405157384
Sayfa: 25-32

5

The Association Between Leukoaraiosis and Poor Outcome in Intracerebral Hemorrhage Is Not Mediated by Hematoma Growth

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of Stroke and Cerebrovascular Diseases

Yayıncı:

Elsevier

Yazar(lar) :

Marek Sykora , Christian Herweh , Thorsten Steiner

Yıl :

2017

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Background The significance of white matter lesions (WMLs) in intracerebral hemorrhage (ICH) remains unclear. We investigated the effects of WML on initial hematoma volume, hematoma growth, intraventricular extension, and clinical outcome in patients with spontaneous ICH. Methods Computed tomography scans of 262 patients included in a placebo arm of a prospective, multicenter trial were used for a semi-quantitative analysis of white matter changes. A logistic regression analysis was used to explore the effects on hematoma volume, volume changes, intraventricular hemorrhage, and clinical outcome after 90 days. Results The degree of WML was not associated with initial hematoma volume, absolute and relative hematoma growth, hematoma growth >33% or >6 mL, or with intraventricular extension. WML significantly increased the odds for poor outcome after 90 days (adjusted OR 1.4, 95% CI 1.1-1.8, P = .02). Conclusions WMLs were not associated with initial hematoma volume, hematoma growth, or intraventricular extension. WMLs were associated with poor outcome independently.

DOI : 10.1016/j.jstrokecerebrovasdis.2017.02.003

Anahtar Kelimeler : Intracerebral hemorrhage, hemorrhage growth, white matter lesions, leukoaraiosis, small vessel disease, outcome

ISSN: 1052-3057
Sayı: 6
Cilt: 26
Sayfa: 1328-1333

Sınıflandırma :

Biyotıp %100

Epidemiyoloji %64

6

Recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 13-15 November 2016.

Dergi Makalesi

Kaynak :

PubMed

Dergi:

Eur Stroke J

Yazar(lar) :

Niaz Ahmed , Thorsten Steiner , Valeria Caso , Nils Wahlgren

Yıl :

2018

Thorsten Steiner

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

About the meeting: The purpose of the European Stroke Organisation (ESO)-Karolinska Stroke Update Conference is to provide updates on recent stroke therapy research and to give an opportunity for the participants to discuss how these results may be implemented into clinical routine. Several scientific sessions discussed in the meeting and each session produced consensus statements. The meeting started 20 years ago as Karolinska Stroke Update, but since 2014, it is a joint conference with ESO. Importantly, it provides a platform for discussion on the ESO guidelines process and on recommendations to the ESO guidelines committee on specific topics. By this, it adds a direct influence from stroke professionals otherwise not involved in committees and work groups on the guidelines procedure. The discussions at the conference may also inspire new guidelines when motivated. The topics raised at the meeting are selected by the scientific programme committee mainly based on recent important scientific publications. The ESO-Karolinska Stroke Update consensus statement and recommendations will be published every 2 years and it will work as implementation of ESO-guidelines.

DOI : 10.1177/2396987317699144

Anahtar Kelimeler : Stroke, cerebral infarct, consensus, guideline, intracerebral haemorrhage, recommendation

Sınıflandırma :

Biyotıp %21

Epidemiyoloji %77

7

Guillain-Barré syndrome and SARS-CoV-2

Dergi Makalesi

Kaynak :

Directory of Open Access Journals (DOAJ)

Dergi:

Neurological Research and Practice

Yazar(lar) :

Anne Lampe , Alexander Winschel , Cornelie Lang , Thorsten Steiner

Yıl :

2020

Thorsten Steiner

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

Abstract Since January 2020, after Chinese health authorities identified a new type of coronavirus (SARS-CoV-2), the virus has spread throughout China and consecutively throughout the whole world. The most common symptoms include fever and respiratory tract symptoms. Nevertheless, some patients show less common symptoms such as gastrointestinal or neurological manifestations. This article presents the case of a 65-years old man who was presumptively infected with SARS-CoV-2 during his ski vacation in Austria in March 2020 and acutely presented with typical symptoms of Guillain-Barré syndrome.

DOI : 10.1186/s42466-020-00066-0

Anahtar Kelimeler : Guillain-Barré syndrome, COVID-19, SARS-CoV-2

ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 3

Sınıflandırma :

Tıp ve Halk Sağlığı %99

Bulaşıcı Hastalıklar %98

8

Hemicraniectomy for massive cerebral infarction: Evoked potentials as presurgical prognostic factors

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of Stroke and Cerebrovascular Diseases

Yayıncı:

Elsevier

Yazar(lar) :

Thorsten Steiner , Marek Jauss , Derk W. Krieger

Yıl :

1998

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

In patients with massive hemispheric infarctions, mortality exceeds 80% with medical therapy alone. In certain conditions hemicraniectomy may result in meaningful survival. We studied presurgical clinical and electrophysiological parameters that may serve as prognostic factors to assess efficacy of decompressive surgery. We evaluated 26 consecutive patients with severe focal neurological deficit, deterioration of consciousness, and massive hemispheric infarction by cranial computerized tomography who underwent hemicraniectomy. Clinical examination included pupillary size and reaction, and determination of level of consciousness on an hourly basis. Median nerve somatosensory evoked potentials and brainstem auditory evoked potentials were obtained before and after hemicraniectomy. Outcome was assessed by using the Barthel Index. Clinical and evoked potential data were correlated with the outcome. Fisher's Exact Test was applied to establish statistical significance. With surgery 18 of 26 patients survived on an average intensive care treatment of 29.6 (±27.5) days. Barthel Index at discharge was 61.7 (±24.4) in survivors. Presurgical pupillary reaction, level of consciousness, and somatosensory evoked potentials were not found to correlate with outcome. In contrast, presurgical brainstem auditory evoked potentials showed a significant correlation with survival (P<.05). All patients with good outcomes (Barthel Index ≥60: n=12, 46.1%) had normal brainstem auditory evoked potentials before surgery. Clinical parameters did not reliably forecast prognosis in patients with massive cerebral infarction treated with hemicraniectomy

DOI : 10.1016/s1052-3057(98)80140-7

Anahtar Kelimeler : Pupillary abnormalities, Massive hemispheric infarction, Intracranial pressure, Decompressive craniectomy, Brainstem auditory evoked potentials, Somatosensory evoked potentials, Coma, Neurocritical care, Cerebral damage, Glasgow Outcome Scale

ISSN: 1052-3057
Sayı: 2
Cilt: 7
Sayfa: 132-138

Sınıflandırma :

Biyotıp %50

Nörokimya %85

Tıp ve Halk Sağlığı %50

Nöroloji %65

9

Non-Vitamin K Oral Anticoagulants Associated Bleeding and Its Antidotes.

Dergi Makalesi

Kaynak :

PubMed

Dergi:

J Stroke

Yazar(lar) :

Thorsten Steiner , Martin Köhrmann , Peter D Schellinger , Georgios Tsivgoulis

Yıl :

2018

Thorsten Steiner

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

Oral anticoagulant-associated intracerebral hemorrhage (OAC-ICH) accounts for nearly 20% of all ICH. The number of patients with an indication for oral anticoagulant therapy (OAT) increases with increasing age. OAT became less complicate with the introduction of non-vitamin K oral anticoagulants (NOAC) OAT because of easier handling, favorable risk-benefit profile, reduced rates of ICH compared to vitamin K antagonists and no need for routine coagulation testing. Consequently, despite a better safety profile of NOAC the number of patients with OAC-ICH will increase. The mortality and complication rates of OAC-ICH are high and therefore they are the most feared complication of OAT. Immediate normalization of coagulation is the main goal and therefore knowledge of pharmacodynamics and coagulation status is essential. Laboratory measurements of anticoagulant activity in NOAC patients is challenging as specific tests are not widely available. More accessible tests such as the prothrombin time and activated partial thromboplastin time have important limitations. In dabigatran-associated ICH 5 g Idarucizumab should be administered. In rivaroxaban and apixaban-associated ICHs administration of andexanet alpha should be considered. Prothrombin complex concentrate may be considered if andexanet alpha is not available or in case of an ICH associated with edoxaban.

DOI : 10.5853/jos.2018.02250

Anahtar Kelimeler : Andexanet alpha, Apixaban, Dabigatran, Edoxaban, Idarucizumab, Rivaroxaban

Sınıflandırma :

Anjiyoloji %94

10

Percutaneous Left Atrial Appendage Occlusion for the Prevention of Stroke in Patients with Atrial Fibrillation: Review and Critical Appraisal.

Dergi Makalesi

Kaynak :

PubMed

Dergi:

J Stroke

Yazar(lar) :

Peter D Schellinger , Georgios Tsivgoulis , Thorsten Steiner , Martin Köhrmann

Yıl :

2018

Thorsten Steiner

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

The authors review the current status of percutaneous left atrial appendage (LAA) occlusion therapy in patients with atrial fibrillation with the goal to prevent ischemic stroke and systemic embolism and to reduce oral anticoagulation associated bleeding. While we cover the historical and also surgical background, and all tested devices, the main focus rests on the single currently U.S. Food and Drug Administration (FDA) approved LAA occluder, the WATCHMAN device, and its approval process. The authors also give a critical appraisal beyond the review of mere facts, trying to put the current data into perspective.

DOI : 10.5853/jos.2018.02537

Anahtar Kelimeler : Atrial appendage occlusion, Atrial fibrillation, Brain ischemia, Intracranial hemorrhage, Stroke

Sınıflandırma :

Anjiyoloji %50

Kalp ameliyatı %45

11

Increased intracerebral pressure following stroke

Dergi Makalesi

Kaynak :

Springer Link

Dergi:

Current Treatment Options in Neurology

Yazar(lar) :

Thorsten Steiner , Ralf Weber , Derk Krieger

Konu :

Clinical Neurology

Yıl :

2001

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Increased intracerebral pressure with lethal herniation still accounts for high mortality rates in patients with massive strokes. Patients that are likely to develop increased intracranial pressure can often be identified within the first few hours after stroke onset. Although medical management seems to fail in most of these patients, early hemicraniectomy and induced moderate hypothermia (32°C to 33°C) represent two novel therapeutic approaches to improve neurologic outcomes and decrease mortality rates.

DOI : 10.1007/s11940-001-0032-7

Anahtar Kelimeler : Middle Cerebral Artery, Middle Cerebral Artery Occlusion, Main Side Effect, Main Drug Interaction, Decompressive Craniectomy

ISSN: 1092-8480 1534-3138
Sayı: 5
Cilt: 3
Sayfa: 441-450

Sınıflandırma :

Tıp ve Halk Sağlığı %66

Genel Cerrahi %49

Biyotıp %34

Hematoloji %91

12

Haematoma expansion and vitamin K antagonist reversal – Authors' reply

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

The Lancet Neurology

Yayıncı:

Elsevier

Yazar(lar) :

Thorsten Steiner , Sven Poli , Johannes Hüsing , Roland Veltkamp

Yıl :

2016

Thorsten Steiner

Ek Bilgiler

Kaydet

DOI : 10.1016/s1474-4422(16)30200-9

ISSN: 1474-4422
Sayı: 11
Cilt: 15
Sayfa: 1117

Sınıflandırma :

Nöroloji %59

13

Autonomic impairment in tetanus: Delayed baroreflex involvement

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of the Neurological Sciences

Yayıncı:

Elsevier

Yazar(lar) :

Marek Sykora , Jennifer Diedler , Roland Veltkamp , Thorsten Steiner

Yıl :

2008

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Autonomic nervous system impairment plays an important role in the clinical course of tetanus and is thought to be responsible for life-threatening complications. It is believed to be associated with predominance of sympathetic activity. Direct baroreflex involvement has not yet been reported. We hypothesized that impaired baroreflex may contribute to the autonomic cardiovascular dysregulation in tetanus. In a patient with tetanus baroreflex sensitivity was measured on the first 5 consecutive days non-invasively using a Finometer device. Baroreflex gain was calculated as sequential cross-correlation between heart rate and blood pressure. Short-time pulse interval standard deviations (SDNN) were derived. Additionally, heart rate and arterial blood pressure were monitored and recorded continuously. Baroreflex gain values and SDNN were compared to a sex- and age-matched control subject. Compared to the control subject the patient with tetanus initially did not show a significant difference in baroreflex gain values (mean 3.68 vs 3.15, p = 0.1). However, in the course of the disease an almost complete baroreflex failure occurred (mean 1.0 vs 3.15 and 0.97 vs 3.15, both p < 0.0001). No correlation was found between the dynamics of baroreflex gain values and blood pressure or heart rate variability expressed by standard deviation and variance. All 5 measurements in the tetanus patient showed decreased short-time SDNN when compared to the control subject and healthy standards. In our patient we found baroreflex impairment as a part of complex autonomic dysfunction in tetanus. Furthermore, baroreflex impairment occurred only delayed. Blood pressure instability could not be explained by baroreflex dynamics. We suggest that a shift towards sympathetic activity possibly overruled the effects of decreased baroreflex sensitivity on blood pressure regulation.

DOI : 10.1016/j.jns.2008.02.008

Anahtar Kelimeler : Tetanus, Baroreflex, Autonomic, Dysautonomia, Heart rate variability

ISSN: 0022-510X
Sayı: 1-2
Cilt: 270
Sayfa: 201-204

Sınıflandırma :

Biyotıp %99

Farmakoloji ve Toksikoloji %68

14

Idarucizumab for Reversal of Dabigatran in Early/Emergency Surgeries: A Case Series

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

The Journal of Emergency Medicine

Yayıncı:

Elsevier

Yazar(lar) :

W. Frank Peacock , James C. Grotta , Thorsten Steiner

Yıl :

2019

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Background Idarucizumab is a humanized, monoclonal antibody fragment used specifically to reverse the anticoagulant effects of dabigatran. Case Reports We discuss 4 cases of patients who were treated with idarucizumab to reverse dabigatran before early/emergency surgery. Two of the patients had subdural hematomas, 1 had a splenic laceration, and 1 had Fournier gangrene. All patients received 5 g of idarucizumab before surgery. Intraoperative blood loss in all patients was normal, no adverse events were reported, and the patients recovered normally. Why Should an Emergency Physician be Aware of This? The case reports presented provide detailed, practical, real-world experience beyond that reported in other case reports and the Reversal Effects of Idarucizumab on Active Dabigatran study. This can help guide clinicians on how idarucizumab can reverse the anticoagulant effect of dabigatran in emergency situations, including patients with subdural hematoma. Our experience suggests that idarucizumab may be a safe and effective antidote to the effects of dabigatran in real-life bleeding situations involving early or emergency surgeries.

DOI : 10.1016/j.jemermed.2019.09.038

Anahtar Kelimeler : Streaming video: Three video clips that accompany this article are available at www.journals.elsevierhealth.com/periodicals/jem., anticoagulation reversal, dabigatran, emergency surgery, idarucizumab, intracerebral hemorrhage, subdural hematoma

ISSN: 0736-4679
Sayı: 6
Cilt: 57
Sayfa: e167-e173

Sınıflandırma :

Anjiyoloji %98

15

Epidemiologic features, risk factors, and outcome of sepsis in stroke patients treated on a neurologic intensive care unit

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of Critical Care

Yayıncı:

Elsevier

Yazar(lar) :

Benjamin Berger , Christoph Gumbinger , Thorsten Steiner , Marek Sykora

Yıl :

2014

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Purpose Because of the immune-suppressive effect of cerebral damage, stroke patients are at high risk for infections. These might result in sepsis, which is the major contributor to intensive care unit (ICU) mortality. Although there are numerous studies on infections in stroke patients, the role of sepsis as a poststroke complication is unknown. Methods We retrospectively analyzed incidence of and risk factors for sepsis acquisition as well as outcome parameters of 238 patients with ischemic or hemorrhagic strokes consecutively admitted to the neurologic ICU in a tertiary university hospital between January 1, 2009, and December 31, 2010. Basic demographic and clinical data including microbiological parameters as well as factors describing stroke severity (eg, lesion volume and National Institute of Health stroke scale score) were recorded and included into the analysis. The diagnosis of sepsis was based on the criteria of the German Sepsis Society. Results We identified 30 patients (12.6%) with sepsis within the first 7 days from stroke onset. The lungs were the most frequent source of infection (93.3%), and gram-positive organisms were dominating the microbiologic spectrum (52.4%). Comorbidities (chronic obstructive pulmonary disease and immunosuppressive disorders) and Simplified Acute Physiology Score II but none of the factors describing stroke severity were independent predictors of sepsis acquisition. Sepsis was associated with a significantly worse prognosis, leading to a 2-fold increased mortality rate during in-hospital care (36.7% vs 18.8%) and after 3 months (56.5% vs 28.5%), but only in the subgroup of supratentorial hemorrhages, it was an independent predictor of in-hospital and 3-month mortality. Other factors significantly associated with death in a multivariate analysis were chronic obstructive pulmonary disease, malignancies (in-hospital mortality only), and Simplified Acute Physiology Score II (3-month mortality only) for ischemia and heart failure (in-hospital mortality only), National Institute of Health stroke scale score (in-hospital mortality only), and stroke volume for hemorrhages, respectively. Conclusions Sepsis seems to be a frequent complication of stroke patients requiring neurologic ICU treatment. Predictors of sepsis acquisition in our study were comorbidities and severity of deterioration of physiological status, but not stroke severity. A better understanding of risk factors is important for prevention and early recognition, whereas knowledge of outcome may help in prognosis prediction. Further studies are needed to clarify the optimal preventive treatment for these patients.

DOI : 10.1016/j.jcrc.2013.11.001

Anahtar Kelimeler : Sepsis, Intensive care unit, Stroke, Epidemiology, Mortality, Outcome

ISSN: 0883-9441
Sayı: 2
Cilt: 29
Sayfa: 241-248

Sınıflandırma :

Biyotıp %100

Epidemiyoloji %98

16

Vojta therapy improves postural control in very early stroke rehabilitation: a randomised controlled pilot trial

Dergi Makalesi

Kaynak :

Directory of Open Access Journals (DOAJ)

Dergi:

Neurological Research and Practice

Yazar(lar) :

Corina Epple , Barbara Maurer-Burkhard , Mari-Carmen Lichti , Thorsten Steiner

Yıl :

2020

Thorsten Steiner

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

Abstract Background It is still unclear, which physiotherapeutic approaches are most effective in stroke recovery. Vojta therapy is a type of physiotherapy that was originally developed for children and adolescents with cerebral palsy. Vojta therapy has been reported to improve automatic control of body posture. Because acute stroke patients are characterised by a disturbance in the ability to adapt to changes in body position, requiring automatic postural adjustment, we decided to investigate Vojta therapy in the early rehabilitation of stroke patients. Aim of the trial was to test the hypothesis that Vojta therapy - as a new physiotherapeutic approach in early stroke recovery - improves postural control and motor function in patients with acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Methods This prospective, randomised controlled trial included patients with imaging-confirmed AIS or ICH, severe hemiparesis and randomly assigned them to Vojta therapy or standard physiotherapy within 72 h after stroke onset. Main exclusion criterion was restricted ability to communicate. Primary endpoint was the improvement of postural control measured by the Trunk Control Test (TCT) on day 9 after admission. Secondary endpoint among others was improvement of arm function (measured with Motor Evaluation Scale for Upper Extremity in Stroke Patients [MESUPES]). Results Forty patients (20 per group) were randomised into the trial. Median age was 75 (66–80) years, 50% were women. The median improvement in TCT within 9 days was 25.5 points (=25.5%) (interquartile range [IQR] 12.5–42.5) in the Vojta group and 0 (IQR 0–13) in the control group (p = 0.001). Patients treated with Vojta therapy achieved a greater improvement in the MESUPES than patients in the control group (20% vs 10%, p = 0.006). Conclusion This first randomised controlled trial of Vojta therapy in acute stroke patients demonstrates improvement of postural control through Vojta therapy compared to standard physiotherapy. Although this trial has some methodical weaknesses, Vojta therapy might be a promising approach in early stroke rehabilitation and should be studied in larger trials. Trial registration ClinicalTrials.gov; Unique identifier: NCT03035968 . Registered 30 January 2017 – Retrospectively registered; http://www.clinicaltrials.gov .

DOI : 10.1186/s42466-020-00070-4

Anahtar Kelimeler : Vojta therapy, Stroke recovery, Postural control, Rehabilitation, Acute stroke, Physiotherapy

ISSN: 2524-3489
Cilt: 2
Sayı: 1
Sayfa: 1 - 11

Sınıflandırma :

Biyotıp %97

Biyomedikal Mühendisliği ve Biyomühendislik %91

17

Dabigatran-related Intracerebral Hemorrhage Resulting in Hematoma Expansion

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of Stroke and Cerebrovascular Diseases

Yayıncı:

Elsevier

Yazar(lar) :

Claus Z. Simonsen , Thorsten Steiner , Anna Tietze , Dorte Damgaard

Yıl :

2014

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Warfarin-related intracerebral hemorrhage carries a particularly high risk of neurologic deterioration and death because of a high rate of hematoma expansion of about 50%. Novel oral anticoagulants (NOACs)—apixaban, dabigatran, and rivaroxaban—have a significantly smaller risk of intracerebral hemorrhage (ICH). However, two facts make this situation complicated: First, the risk of hematoma expansion is unknown for NOACs. Second, there is no specific antidote for neither of the NOACs. We present a case that suggests that hematoma expansion may occur after NOAC-related ICH.

DOI : 10.1016/j.jstrokecerebrovasdis.2013.08.011

Anahtar Kelimeler : Intracerebral hemorrhage, stroke, atrial fibrillation, anticoagulant

ISSN: 1052-3057
Sayı: 2
Cilt: 23
Sayfa: e133-e134

Sınıflandırma :

Biyotıp %62

Hematoloji %90

Tıp ve Halk Sağlığı %38

Nöroşirürji %50

18

Acute ischaemic stroke: revascularizing therapy

Dergi Makalesi

Kaynak :

Springer Link

Dergi:

Journal of Neurology

Yazar(lar) :

Matthias Spranger , Thorsten Steiner , Stefan Schwab , W. Hacke

Konu :

Clinical Neurology, Neurology

Yıl :

1998

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

The principal goals of thrombolytic therapy for stroke are early restitution of cerebral blood flow, reduction of ischaemia, and attenuation of neurological disability through lysis of an occluding thrombus and consequent rapid restoration of circulation in the affected territory. Therapy should be initiated as soon as possible, at least within 4–6 h of stroke onset, to prevent major infarction and to salvage the hypoperfused but potentially viable zone adjacent to the central ischaemic area known as the ischaemic penumbra. This survey focuses on the safety and efficacy of thrombolytic therapy in acute ischaemic stroke in clinical trials. The results of two successful major randomized studies using tissue plasminogen activator (t-PA) were recently published. Intravenous thrombolysis seemed to be effective in improving functional and neurological outcome in a clearly defined subgroup of patients meeting the inclusion criteria of the studies. However, the identification of those patients proved to be difficult and depended on expertise in recognizing the early infarction signs on initial computed tomography. Since treating ineligible patients is associated with an unacceptable risk of intracranial bleeding complications and death, intravenous thrombolysis should only be performed at selected centres in selected patients.

DOI : 10.1007/s004150050247

Anahtar Kelimeler : Key words Stroke, Cerebral, ischaemia, Thrombolysis, Recombinant tissue plasminogen, activator

ISSN: 0340-5354 1432-1459
Sayı: 9
Cilt: 245
Sayfa: 567-572

Sınıflandırma :

Biyotıp %100

Hematoloji %58

19

Prothrombin Complex Concentrates for Perioperative Vitamin K Antagonist and Non-vitamin K Anticoagulant Reversal.

Dergi Makalesi

Kaynak :

PubMed

Dergi:

Anesthesiology

Yazar(lar) :

Jerrold H Levy , James Douketis , Thorsten Steiner , Joshua N Goldstein , Truman J Milling

Yıl :

2018

Thorsten Steiner

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

Vitamin K antagonist therapy is associated with an increased bleeding risk, and clinicians often reverse anticoagulation in patients who require emergency surgical procedures. Current guidelines for rapid anticoagulation reversal for emergency surgery recommend four-factor prothrombin complex concentrate and vitamin K coadministration. The authors reviewed the current evidence on prothrombin complex concentrate treatment for vitamin K antagonist reversal in the perioperative setting, focusing on comparative studies and in the context of intracranial hemorrhage and cardiac surgery. The authors searched Cochrane Library and PubMed between January 2008 and December 2017 and retrieved 423 English-language papers, which they then screened for relevance to the perioperative setting; they identified 36 papers to include in this review. Prothrombin complex concentrate therapy was consistently shown to reduce international normalized ratio rapidly and control bleeding effectively. In comparative studies with plasma, prothrombin complex concentrate use was associated with a greater proportion of patients achieving target international normalized ratios rapidly, with improved hemostasis. No differences in thromboembolic event rates were seen between prothrombin complex concentrate and plasma, with prothrombin complex concentrate also demonstrating a lower risk of fluid overload events. Overall, the studies the authors reviewed support current recommendations favoring prothrombin complex concentrate therapy in patients requiring vitamin K antagonist reversal before emergency surgery.

DOI : 10.1097/ALN.0000000000002399

Sınıflandırma :

Kan Transfüzyon Tıbbı %97

20

Association of intracranial pressure with outcome in comatose patients with intracerebral hemorrhage

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of the Neurological Sciences

Yayıncı:

Elsevier

Yazar(lar) :

Marek Sykora , Sahra Steinmacher , Thorsten Steiner , Sven Poli , Jennifer Diedler

Yıl :

2014

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Background Therapeutic targets for intracranial pressure (ICP) in patients with severe intracerebral hemorrhage (ICH) are approximated from data of traumatic brain injury. However, specific data for ICH are lacking. Here, we aimed to investigate the association between ICP, mortality and functional outcome following severe ICH. Methods We analyzed consecutive comatose patients with ICH in whom ICP monitoring was applied. Outcome at 3 months was assessed using the modified Rankin scale (mRS). Multivariate logistic regression including pre-defined predictors was used in order to identify the effects of ICP on outcome. Results 121 patients with ICH and ICP monitoring were analyzed. Mean ICP (OR 1.2, CI 1.08–1.45, p = 0.003), ICP variability (OR 1.3, CI 1.03–1.73, p = 0.03) and relative frequency of ICP values > 20 mm Hg (OR 1.1, CI 1.02– 1.15, p = 0.008) were independently associated with mortality at 3 months. Relative frequency of ICP values > 20 mm Hg (OR 1.1, CI 1.001–1.3, p = 0.04) was associated also with poor functional outcome at 3 months. Conclusions Our data suggest that in the context of other predictors as age, admission clinical status, hemorrhage volume and intraventricular hemorrhage, average ICP, ICP variability and the frequency of ICP values > 20 mm Hg are independently associated with mortality and poor outcome after ICH. Further studies and prospective validations of ICP thresholds for ICH patients are highly warranted.

DOI : 10.1016/j.jns.2014.05.012

Anahtar Kelimeler : Intracerebral hemorrhage, Outcome, Intracranial pressure, Cerebral perfusion pressure, ICP, CPP

ISSN: 0022-510X
Sayı: 1-2
Cilt: 342
Sayfa: 141-145

Sınıflandırma :

Tıp ve Halk Sağlığı %98

Nöroşirürji %100

21

Prothrombin complex concentrate versus placebo, no intervention, or other interventions in critically bleeding patients associated with oral anticoagulant administration: a protocol for a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.

Dergi Makalesi

Kaynak 1:

PubMed

Kaynak 2:

Directory of Open Access Journals (DOAJ)

Dergi:

Syst Rev

Yazar(lar) :

Christian Ovesen , Jan Purrucker , Christian Gluud , Janus Christian Jakobsen , Hanne Christensen , Thorsten Steiner

Yıl :

2018

Thorsten Steiner

Yayıncı Web Siteleri

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

Acute critical bleeding is one of the most feared complications during treatment with oral anticoagulating agents. As more patients undergo treatment with anticoagulating agents, critically bleeding episodes in patients with vitamin K antagonists, thrombin inhibitor, or factor Xa inhibitor-inducted coagulopathy will be encountered frequently by physicians. Hence, an effective treatment capable of reversing the iatrogenic coagulopathy in the acute setting is needed. In randomised clinical trials and observational studies, prothrombin complex concentrate has been reported to be superior to other acute interventions, and many guidelines recommend prothrombin complex concentrate in treatment of critically bleeding patients. The aim of this systematic review is to synthesise the evidence of the effects of prothrombin complex concentrate compared with placebo, no intervention, or other treatment options in critically bleeding patients treated with oral anticoagulants.

Kaynak 1:

https://www.ncbi.nlm.nih.gov/pubmed/21900088 arayıcılığı görüntüle.
Kaynak 2:

https://doi.org/10.1186/s13643-018-0838-y arayıcılığı görüntüle.

DOI : 10.1186/s13643-018-0838-y

Anahtar Kelimeler : Critical bleeding, Intracranial haemorrhage, Oral anticoagulation, Prothrombin complex concentrate

Sınıflandırma :

Kan Transfüzyon Tıbbı %99

22

Subacute perihematomal edema in intracerebral hemorrhage is associated with impaired blood pressure regulation

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of the Neurological Sciences

Yayıncı:

Elsevier

Yazar(lar) :

Marek Sykora , Jennifer Diedler , Peter Turcani , Andre Rupp , Thorsten Steiner

Yıl :

2009

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Background Perihematomal edema and secondary brain injury may influence the clinical course after intracerebral hemorrhage (ICH). The role of blood pressure (BP) in edema formation in ICH has not been studied sufficiently. We hypothesize that impaired blood pressure regulation (as measured by baroreflex sensitivity) leading to excessive BP fluctuations may enhance perilesional edema. The aims of our study were therefore to explore the effects of impaired baroreflex on edema in acute ICH and to evaluate the effects of perihematomal edema on early neurologic deterioration. Methods In 38 patients with acute intracerebral hemorrhage we assessed baroreflex sensitivity (BRS) within the first 72 h using a time-domain cross-correlation method. Blood pressure was continuously monitored for 72 h after admission. Relative perihematomal edema was calculated from the follow-up scans at 48–72 h from ictus. Possible confounders such as body temperature, inflammation parameters, or glycemia were recorded. Early neurologic deterioration was defined as increase of 4 points at NIHSS within the first 72 h. Results Decreased BRS correlated significantly with increased 72-hour MAP variability (r = − 0.46, p = 0.004). In a stepwise multivariate linear regression model, decreased BRS was an independent predictor for relative edema (p = 0.005). Relative edema (p = 0.009, OR 22.6, CI 2.2–232.5) and body temperature at admission (p = 0.031, OR 0.17, CI 0.04–0.85) independently predicted early neurologic deterioration. Conclusions We found an independent association between decreased baroreflex sensitivity with increased blood pressure fluctuations and relative perihematomal edema in ICH. Moreover, independent effects of relative edema on early neurologic deterioration have been observed.

DOI : 10.1016/j.jns.2009.04.028

Anahtar Kelimeler : ICH, Intracranial hemorrhage, Sympathetic nervous system, Baroreflex sensitivity, Blood pressure variability, Edema, Dysautonomia, Deterioration

ISSN: 0022-510X
Sayı: 1-2
Cilt: 284
Sayfa: 108-112

Sınıflandırma :

Biyotıp %100

Hücresel ve Tıbbi Konular %62

23

Haemostatic therapies for acute spontaneous intracerebral haemorrhage.

Dergi Makalesi

Kaynak :

PubMed

Dergi:

Cochrane Database Syst Rev

Yazar(lar) :

Rustam Al-Shahi Salman , Zhe Kang Law , Philip M Bath , Thorsten Steiner , Nikola Sprigg

Konu :

Acute Disease, Adult, Aminocaproic Acid, Antifibrinolytic Agents, Cerebral Hemorrhage, Disease Progression, Factor VIIa, Hemostasis, Hemostatics, Humans, Plasma, Platelet Transfusion, Randomized Controlled Trials as Topic, Recombinant Proteins

Yıl :

2018

Thorsten Steiner

Piri Tam Metin Bulucu Özet Ek Bilgiler

Kaydet

Outcome after spontaneous (non-traumatic) intracerebral haemorrhage (ICH) is influenced by haematoma volume; up to one-third of ICHs enlarge within 24 hours of onset. Early haemostatic therapy might improve outcome by limiting haematoma growth. This is an update of a Cochrane Review first published in 2006, and last updated in 2009.

DOI : 10.1002/14651858.CD005951.pub4

Sınıflandırma :

Tıp ve Halk Sağlığı %55

Kan Transfüzyon Tıbbı %100

Biyotıp %45

Hematoloji %100

24

Hemostatic Therapies For Acute Spontaneous Intracerebral Hemorrhage.

Dergi Makalesi

Kaynak :

PubMed

Dergi:

Stroke

Yazar(lar) :

Zhe Kang Law , Rustam Al-Shahi Salman , Philip M Bath , Thorsten Steiner , Nikola Sprigg

Yıl :

2018

Thorsten Steiner

Piri Tam Metin Bulucu Ek Bilgiler

Kaydet

DOI : 10.1161/STROKEAHA.118.022071

Anahtar Kelimeler : antifibrinolytic agents, blood clotting factors, cerebral hemorrhage, platelet transfusion, randomized controlled trial

Sınıflandırma :

Biyotıp %86

Hematoloji %100

25

Developing medical educators – a mixed method evaluation of a teaching education program

Dergi Makalesi

Kaynak :

Directory of Open Access Journals (DOAJ)

Dergi:

Medical Education Online

Yazar(lar) :

Marco Roos , Martina Kadmon , Michael Kirschfink , Eginhard Koch , Jana Jünger , Veronika Strittmatter-Haubold , Thorsten Steiner

Yıl :

2014

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Background: It is well accepted that medical faculty teaching staff require an understanding of educational theory and pedagogical methods for effective medical teaching. The purpose of this study was to evaluate the effectiveness of a 5-day teaching education program. Methods: An open prospective interventional study using quantitative and qualitative instruments was performed, covering all four levels of the Kirkpatrick model: Evaluation of 1) ‘Reaction’ on a professional and emotional level using standardized questionnaires; 2) ‘Learning’ applying a multiple choice test; 3) ‘Behavior’ by self-, peer-, and expert assessment of teaching sessions with semistructured interviews; and 4) ‘Results’ from student evaluations. Results: Our data indicate the success of the educational intervention at all observed levels. 1) Reaction: The participants showed a high acceptance of the instructional content. 2) Learning: There was a significant increase in knowledge (P<0.001) as deduced from a pre-post multiple-choice questionnaire, which was retained at 6 months (P<0.001). 3) Behavior: Peer-, self-, and expert-assessment indicated a transfer of learning into teaching performance. Semistructured interviews reflected a higher level of professionalism in medical teaching by the participants. 4) Results: Teaching performance ratings improved in students’ evaluations. Conclusions: Our results demonstrate the success of a 5-day education program in embedding knowledge and skills to improve performance of medical educators. This multimethodological approach, using both qualitative and quantitative measures, may serve as a model to evaluate effectiveness of comparable interventions in other settings.

DOI : 10.3402/meo.v19.23868

Anahtar Kelimeler : faculty development, medical education, medical teacher, educational theory, collaborative feedback

ISSN: 1087-2981
Cilt: 19
Sayfa: 1 - 8

26

Neurosurgical Outcomes After Intracerebral Hemorrhage: Results of the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST)

Dergi Makalesi

Kaynak :

Science Direct

Dergi:

Journal of Stroke and Cerebrovascular Diseases

Yayıncı:

Elsevier

Yazar(lar) :

Thorsten Steiner , Catherine Vincent , Stephen Morris , Stephen Davis , Laura Vallejo-Torres , Michael C. Christensen

Yıl :

2011

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

The value of neurosurgical interventions after spontaneous intracerebral hemorrhage (SICH) is uncertain. We evaluated clinical outcomes in patients diagnosed with SICH within 3 hours of symptom onset who underwent hematoma evacuation or external ventricular drainage (EVD) of the hematoma in the Factor Seven for Acute Hemorrhagic Stroke Trial (FAST). FAST was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. Neurosurgical procedures (hematoma evacuation and external ventricular drainage) performed at any point after hospital admission were prospectively recorded. Clinical outcomes evaluated were post-SICH disability, as assessed by the modified Rankin Scale; neurologic impairment, as assessed by the National Institutes of Health Stroke Scale; and mortality at 90 days after SICH onset. The impact of neurosurgical procedures on clinical outcomes was evaluated using multivariate logistic regression analysis, controlling for relevant baseline characteristics. Fifty-five of 821 patients underwent neurosurgery. Patients who underwent hematoma evacuation or EVD were on average younger, had greater baseline neurologic impairment, and lower levels of consciousness compared with patients who did not undergo neurosurgery. After adjusting for these differences and other relevant baseline characteristics, we found that neurosurgery was generally associated with unfavorable outcomes at day 90. Among the patients who underwent hematoma evacuation, those with lobar ICH had less ICH expansion than those with deep gray matter ICH, and the smaller expansion was associated with lower mortality. ICH volume was substantially decreased in patients who underwent hematoma evacuation between 24 and 72 hours after hospital admission, and this was associated with better clinical outcome. In conclusion, a small number of patients who underwent neurosurgery in FAST exhibited no overall clinical benefit from neurosurgical intervention, although outcomes varied by type of surgery, time of surgery, and hematoma location. Our findings support the need for further research into the value of neurosurgery in patients with SICH.

DOI : 10.1016/j.jstrokecerebrovasdis.2009.12.008

Anahtar Kelimeler : Intracerebral hemorrhage, surgical interventions, clinical outcomes, FAST, rFVIIa

ISSN: 1052-3057
Sayı: 4
Cilt: 20
Sayfa: 287-294

Sınıflandırma :

Biyotıp %99

Hematoloji %38

Epidemiyoloji %27

27

Autonomic Effects of Intraventricular Extension in Intracerebral Hemorrhage

Dergi Makalesi

Kaynak :

Springer Link

Dergi:

Neurocritical Care

Yazar(lar) :

Marek Sykora , Thorsten Steiner , Sven Poli , Andrea Rocco , Peter Turcani , Jennifer Diedler

Konu :

Critical Care and Intensive Care Medicine, Clinical Neurology

Yıl :

2011

Thorsten Steiner

Özet Ek Bilgiler

Kaydet

Autonomic dysfunction after stroke is common and relates to unfavorable outcome. The pathophysiology of autonomic impairment after intracerebral hemorrhage (ICH) is unknown. This study examined the relationship between intraventricular hemorrhage extension (IVH) and autonomic dysregulation after ICH. We examined the autonomic modulation using the cross-correlational time-sequence baroreflex sensitivity (BRS) in 68 ICH patients with and without IVH. Localization and extent of IVH based on the LeRoux score, hydrocephalus, hematoma volume, initial stroke severity and baseline demographic, clinical, and biochemical parameters were included in the analysis. IVH was present in 36 (52.9%) of patients. BRS was significantly lower in patients with IVH compared to those without IVH (BRS 2.35 vs. 3.5 ms/mmHg, P = 0.03). Patients with IVH including third and fourth ventricle had significantly lower BRS than patients with IVH in lateral ventricles (2.1 vs. 5.9 ms/mmg, P = 0.008) or patients without IVH (2.1 vs. 3.5 ms/mmHg, P = 0.003). There was no significant difference in BRS between patients with IVH in the lateral ventricles and patients without IVH (median BRS 5.9 vs. 3.5 ms/mmHg, P = 0.36). The amount of IVH in the third and fourth ventricle inversely correlated with decreased BRS (r = −0.43, P < 0.001). BRS did not correlate with initial hydrocephalus, hemorrhage volume, NIHSS score at admission, etiology of the ICH or parenchymal localization of the ICH. Hematoma extension to the third and fourth ventricle seems to cause profound autonomic dysregulation, possibly contributing to poor outcome. Patients with IVH in this location should be monitored vigorously to prevent and treat complications of autonomic failure.

DOI : 10.1007/s12028-011-9637-1

Anahtar Kelimeler : Intracerebral hemorrhage, Intraventricular, Autonomic, Baroreflex, Outcome

ISSN: 1541-6933 1556-0961
Sayı: 1
Cilt: 16
Sayfa: 102-108

28

Accidental Intoxication with 60 mg Intrathecal Baclofen: Survived

Dergi Makalesi

Kaynak :

Springer Link

Dergi:

Neurocritical Care

Yazar(lar) :

Benjamin Berger , Barbara Vienenkoetter , Mirjam Korporal , Andrea Rocco , Hans-Michael Meinck , Thorsten Steiner

Konu :

Critical Care and Intensive Care Medicine, Clinical Neurology

Yıl :

2012

Thorsten Steiner