Neuro Archives

Blood Pressure Management in Stroke

Blood Pressure Management in Stroke PM&R News • June 2021 Goals: A balance of cerebral perfusion and ischemia BP <140/90 mmHg Antihypertensives restarted in neurologically stable patients ~24-48 hrs UTD recommendation: after large artery stenosis is excluded and after vascular imaging performed For large artery: timeframe is 7-14 days Timeframe goal: few days – few weeks Ischemic rtPA not administered: do not lower BP in first 24 hrs unless it exceeds 220/120 OR active: ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, or pre-eclampsia/eclampsia Prior to rtPA administration: BP <185/110 After rtPA administration: BP < 180/105 for 24 hours. Monitoring: 1st 2 [...]

Blood Pressure Management in Strokeashpt2021-06-19T23:21:57+00:00

Neuroimaging

Neuroimaging - A Review PM&R News • March 2021 Imaging Description Pros Cons Identifies/Utilized in the following: CT (computed tomography) head w/o contrast Analyzes residual radiation waves emitted from the body via a radiographic tube that is rotated axially. Utilizes mathematical algorithms of images to reconstruct a cross-sectional image. Fast Not sensitive to motion Widely available Primary choice: acute/emergent situations Radiation exposure = increased lifelong risk of cancer (minimal) “may impair long-term cognitive function”(UTD) Identifies calcifications Hemorrhagic CVA Intracranial hematoma (<12 hrs) Infraction Bony/air space abnormalities Edema, herniations, fx, hypoxic-ischemia injury, mass, hydrocephalus ASPECTS score: assists to determine tx Superior over MRI [...]

Neuroimagingashpt2021-04-22T02:51:15+00:00

Transient ischemic attack

Transient ischemic attack (TIA) PM&R News • February 2021 Anatomy/Etiology: Disruption of circulatory system: Large artery disease, carotid stenosis, small vessel disease (lipohyalinosis), cryptogenic (unknown origin), embolus, atherosclerosis, inflammation, amyloid (protein associated with certain diseases) deposition, arterial dissection, developmental malformation, aneurysmal dilation, or thrombosis. Secondary to: atrial fibrillation, decreased perfusion pressure, or increased blood viscosity. That leads to ischemia in any of the following: brain, spinal cord, or retina. Pathophysiology TIA definition (UTD): “Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction” or injury to tissues. Highest risk of CVA in the first 2 days. [...]

Transient ischemic attackashpt2021-04-23T10:59:51+00:00

How are you annual eval’ing?

How are you annual eval'ing? PM&R News • March 2018 The annual evaluation for patients with spinal cord injury (SCI) was a groundbreaking service that led to the decrease in mortality for these patients. Gone are the days where the leading cause of death in long term spinal cord injury was kidney disease, however, are the recommendations perfected yet? In this study by Skelton et al, they evaluate whether routine urine testing at the annual evaluation leads to unnecessary antibiotic use. As physiatrists, we have learned through our training not to treat asymptomatic bacteriuria but all providers are not as familiar with the [...]

How are you annual eval’ing?David Impastato, MD2018-03-07T04:16:24+00:00

First CTE Case in Living Ex-NFL Player

CTE - Identify in the Living? PM&R News • November 2017 The ability to finally identify chronic traumatic encephalopathy (CTE) in a living person now seems to be a possibility on the horizon. New technology may help to identify CTE, which was only previously able to be diagnosed after death. Dr. Bennet Omalu led the team of researchers who developed a new modality for identifying CTE in ex-NFL player Fred McNeil. Fifty-two months prior to his death, Dr. Omalu performed an in vivo [F-18] FDDNP-PET scan assessing for patterns of tau and amyloid proteins that are seen with CTE. At [...]

First CTE Case in Living Ex-NFL PlayerJacques Courseault, M.D., CAQSM2017-11-25T13:57:08+00:00