Transcranial Doppler ultrasonography in pre-hospital management of stroke: can make a difference?

: The aim of this paper is to discuss the use of transcranial doppler in the pre-hospital management of stroke. In the pre-hospital organization, neurological defect scales are used, but they are often indicative the occlusions of anterior circulation and not of posterior circulation. Patients with posterior circulation stroke are sometimes not diagnosed and clinically treated. In the pre-hospital phase, the transcranial doppler may identify an occlusion of the large cerebral vessels and be useful for stroke patients, in particular those with posterior occlusions, for a more precise diagnosis and consequently for adequate treatment in the excellence centers for stroke.

The level of interleukin-6 in acute ischemic stroke: effect on the rate of recovery in patients and on the severity of neurological defect

Interleukin 6 (IL-6) plays an important role in the pathogenesis of ischemic stroke (IS), exerting a modulating effect on a number of processes that determine the outcome of this disease. Objective: to investigate the peripheral blood levels of IL-6 in patients in the acute period of different IS pathogenetic subtypes and its effect on recovery rates. Patients and methods. The study enrolled 155 patients (74 men and 81 women; mean age, 63.8 years). A control group consisted of 28 people without IS. Pathogenetic subtype II was established in accordance with the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria on the basis of their clinical picture and the data of computed tomography or magnetic resonance imaging and ultrasonography of the main arteries of the head. The severity of a patient's condition and a focal neurological defect and the time course of clinical changes after stroke were determined using the National Institutes of Health Stroke Scale (NIHSS). An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. An enzyme immunoassay (EIA) was used to measure IL-6 levels on days 1, 7, and 21 after onset of IS. Results. In the acute period of IS, there were significantly elevated levels of IL-6. The latter reached its highest values on day 7 in patients with the atherothrombotic pathogenetic subtype of IS. On day 7 of the study, the peak concentration of IL6 was typical for patients with all subtypes of IS, except for lacunar stroke. After its increase on day 1 of the study, the IL6 level in patients with lacunar stroke did not change significantly in all other periods. In acute IS, the concentration of IL-6 was significantly influenced by the following cardiovascular risk factors: hypercholesterolemia of days 1, 7 (p<0.01) and 21 (p<0.05), hypertension in day 1 (p<0.05), diabetes mellitus on days 1 and 7 (p<0.05), and coronary heart disease in all the study periods (p<0.01). The IL-6 concentration significantly correlated with the severity of neurological defect, but did not significantly affect the rate of recovery in the patient with acute IS. Conclusion. IL-6 was established to be of prognostic value for the outcome of acute IS on day 7. The rate of recovery can be used to identify targets for therapeutic intervention.

Specific speech and language impairments in children: assessments, diagnostics, classification and outcome

Specific Language Impairment (SLI) is an heterogeneous disorder characterized by an inadequate development that cannot be explained by an auditory sensory defect, a motor-neurological defect, a general cognitive impairment nor an unwillingness to communicate. There are many subtypes of SLI, both in severity and type that may be associated with a different outcome. Although many of these children recover clinically, the majority will maintain minor language impairments leading to a poor school achievement and learning difficulties. A proportion of cases remain severely impaired causing social isolation and an occupations/professional handicap. The origin of these syndromes is probably genetic. Although the are assumed to reflect a dysfunctional of the neuronal networks subserving the comprehension,, elaboration and production of language, they are not due to evident focal brain lesions, but are associated with atypical patterns of cerebral dominance and specialization for language. A variety of language processing impairments have been described in these children, namely a difficulty in analyzing rapidly changing speech sounds, acquiring language morphology and grammar and a poor phonological memory. Therapeutic intervention in these children must be individualized and interdisciplinary (speech therapy, alternative forms of communication, psychological support and special education). This is essential to prevent social isolation, low self-esteem, emotional and behavioral symptoms and educational problems. DOI: http://dx.doi.org/10.17575/rpsicol.v16i1.467

Parity of level neuron-specific enolase and a brain blood-groove at hemispheric ischemic stroke

An inspection is conducted 60 patients with hemispheric ischemic stroke in age from 51 to 69 years, part on the degree of expressed of neurological deficit in obedience to the Scandinavian scale (19,0 ± 1,9) – I group (27), (41,1 ± 3,5) is II a group (33). The comparative analysis of neurological deficit is given, level neuron-specific enolase (NSE) in blood, hemodynamic indexes, character of atherosclerotic name-plates, exposed on the basis of ultrasonic duplex research of main arteries of cerebrum in a dynamics. Dependence is exposed between expressed of neurological defect, degree of damage of fabric of brain, characterized by the change of level of NSE and degree of disturbances of hemodynamic. Clear dependence is marked between a neurological defect and decline (p < 0,05) of high systole speed in a poststenotic area. Character of atherosclerotic name-plates reflected pathogenic of ischemic stroke.

Pathological potential of astroglia

The pathological potential of glial cells was recognized already by Rudolf Virchow, Santiago Ramon y Cajal and Pio Del Rio-Ortega. Many functions and roles performed by astroglia in the healthy brain determine their involvement in brain diseases; as indeed any kind of brain insult does affect astrocytes, and their performance in pathological conditions, to a very large extent, determines the survival of the brain parenchyma, the degree of damage and neurological defect. Astrocytes being in general responsible for overall brain homeostasis are involved in virtually every form of brain pathology. Here we provide an overview of recent developments in identifying the role and mechanisms of the pathological potential of astroglia.

Beyond Baby Doe: Does Infant Transplantation Justify Euthanasia?

Recent advances in medical technology have made it possible to transplant organs into infants with severe heart and kidney disease, but the need for these organs exceeds the presently available supply. Some have suggested that infants born with the severe neurological defect of anencephaly might be used as organ donors, even if these infants do not meet the criteria for brain death. Current criteria for brain death are reviewed and it is concluded that this proposal represents active euthanasia or medical killing of infants with anencephaly. Justification of active euthanasia is discussed in medical, ethical, and historical terms. Recently developed protocols to obtain organs for transplantation from infants with anencephaly after brain death has been determined are described and their ethical implications are discussed. It is argued that active euthanasia of infants with anencephaly is undesirable and should be prohibited in order to safeguard the rights of all persons with severe neurological disabilities.