March 2011
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March 2011 posts

Same Old...Same Old

I can’t belive a month has gone by since my last post. Time flies when you are not paying attention and losing focus can derail your progress. Time to dig in the heels, I’ve got a two month clock that just started counting down, I’m going to a professional conference in June and I want to show off the new me!

Multiple Sclerosis Center 2nd Annual Art Show 2011

The Multiple Sclerosis Center at Swedish Neuroscience Institute is hosting its Second Annual Multiple Sclerosis Center Art Show at the Bellevue Arts Museum on Saturday and Sunday, June 18 & 19, 2011 from 11:00am to 5:00pm. There will be an ‘Artist Only Meet ‘n’ Greet, Sunday June 19th from 3pm – 5pm

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Advances in thrombolysis

 Washington State has one of the high est stroke mortality rates in the nation. To improve this situation, acute intervention al therapies for stroke are being employed to restore circulation to ischemic brain tissue that surrounds areas of completed infraction, while avoiding risk of hemor rhage due to reperfusion of large areas of infracted brain tissue.

Urgent thrombolysis with intrave nous alteplase is the only therapy known to improve clinical outcomes following acute stroke. Unfortunately, alteplase has had limited usage because many patients arrive in an emergency department after the three-hour treatment window. The FDA has also approved two clot removal devices based on the ability to restore circulation. These devices are used up to eight hours after symptom onset. Several approaches to improved acute stroke care are now under way, including extension of the thrombolysis window to 4.5 hours, identification of safer thrombolytic agents and research identifying brain at risk of in farction following a stroke.

A recent European study demonstrat ed the efficacy of alteplase up to 4.5 hours after ischemic stroke in patients younger than age 80 years who have neither dia betes mellitus or prior stroke. The safety profile during this longer window for these patients appears similar to that at three hours.

Another promising advance employs a new thrombolytic agent called des moteplase.

Resources for those concerned about radiation from Japan

Potential Affiliation with Olympic Medical Center, Jefferson Healthcare and Forks Hospital

Swedish Orthopedic Institute Surgeons Perform Knee Resurfacing Surgery Online

 

Detecting cerebral microemboli with transcranial doppler

Since its introduction in 1982, transcranial doppler ultrasound (TCD) has evolved into a por­table, multimodality, noninvasive method for real-time imaging of intracranial vasculature.

The detection of cerebral microemboli is among the more remarkable capabilities of TCD. Emboli create countable signals in the ultrasound display due to the higher reflection of sound waves compared to the blood cells. Experimental mod­els have shown a high sensitivity and specificity for detection of a variety of substrates, including thrombotic, platelet and atheromatous emboli.

Microembolic signals (MES) within the in­tracranial vasculature are most frequently identi­fied in patients with large-vessel atherosclerotic disease, such as carotid stenosis. They have also been reported in intracranial arterial stenosis, ar­terial dissection, cardiac disease and atheroaortic plaque. Additionally, they have been seen in arter­ies distal to coiled aneurysms.

There is strong evidence that MES detection predicts future ipsilateral stroke risk in patients with symptomatic carotid stenosis (Markus HS, et al.; King A, et al.). A recent study of patients with asymptomatic carotid stenosis demonstrated that MES predicted subsequent ipsilateral stroke and TIA, and also ipsilateral stroke alone, and that it is helpful in selecting patients who will benefit from carotid endarterectomy (Markus, HS et al.).

Identification of active embolization provides crucial patho­physiological information to the neurologist and can also aid in the selection of tailored therapy aimed at reducing the risk of stroke. Emboli from different sources have unique compositions and re­quire specific therapy, such as antiplatelet agents for emboli from large artery atherosclerotic plaque and anticoagulants for cardiac emboli.

Future advances in TCD technology will permit full automa­tion and better identification of the composition and size of circu­lating embolic materials, thus improving its value for patients with cerebrovascular disease.

Contact Colleen Douville, RVT, at colleen.douville@swedish.org or 206-320-4080, for more information about TCD for detec­tion of cerebral microemboli.

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