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  • ISSN: 2334-2307
    Early Online
    Volume 4, Issue 2
    Review Article
    Brian Fazzone, Gabrielle Morris, Leigh-Ann Black, Jessica-Ashley Williams, Rodney Leacock, Shannon Sternberg, Dawn Blackhurst, Afred Nelson, and Thomas I. Nathaniel*
    Background: Many of the exclusiveand inclusivecontraindications for recombinant tissue plasminogen activator (rt-PA) in the treatment of acute ischemic strokeare based on safety. While some contraindications have strongly been supported by both scientific and clinical data, including the clear benefit of rt-PA, there are several clinical controversies about others. We examined clinical characteristics related to rt-PAtreated versus non-treated patients according to specific contraindications in a stroke population.
    Methods: We utilized data from the Greenville Health System (GHS) stroke registry on rt-PA administration between January 2010 and December 2013. We evaluated patients who received rt-PA within 4.5 hours following the onset of acute ischemic stroke symptoms. Our analysis compared the clinical characteristics and demographics of eligible patients receiving rt-PA with those not receiving rt-PA.
    Results: A total of 663 ischemic stroke patients were eligible to receive rt-PA. Out of the 663, 241 received t-PA and 422 did not. A significant (P<0.05) number of patients with acute myocardial infarction in the 3 months prior to stroke,uncontrolledhypertensionwere excluded from rt-PA when compared to the few that received rt-PA. A significant (P<0.05) numberof patients with history of smoking receivedrt-PA when compared to the patient population who did not receive rt-PA. A combination of old age, and baseline NIHSS is important in making a decision about whether to administer rt-PA to patients with a combined prior history of stroke and diabetes mellitus.
    Conclusion: The study provides a basis to generate a hypothesis that could be investigated to allow more eligible patients to be considered for rt-PA for the treatment of acute ischemic stroke.
    Zhen He1*, Li Cui, Sherry A. Ferguson, and Merle G. Paule
    Epidural steroid injections (ESIs) as minimally invasive procedures have been widely used for the relief of neck, arm, back, and leg pain potentially due to spinal stenosis, spondylolysis, or disc herniation. In rare instances, ESI therapy may cause clinical complications, some of which can be catastrophic. The surgical procedure itself including needle penetration the potential use of contrast media, the injected medications (i.e., conventional steroids), or a combination of these in association with the original cause of the targeted pain which may include local inflammation, may account for such adverse complications. Nevertheless, there is increasing evidence indicating that ischemia and/or hemorrhage (stroke) in the brain and/or spinal cord, following accidental intra - arterial injection of the medication is a primary contributor to the severe neurologic events. Descriptions of experimental intra - arterial injections simulating the noted catastrophic outcomes associated with ESI therapy are very limited in the literature. Identifying and describing the cause of severe ESI complications will likely rely on the establishment of new experimental models simulating intra - vertebral artery or intra-radiculomedullary artery steroid injections.
    Jun Wang*, Jian Pei, Jie Chen, Qin Hui Fu, Xiao Cui, and Yi Song
    Autophagy and inflammation play a key role in the pathogenesis of ischemic stroke; the latest research shows that autophagy and inflammation are seen as a double-edged sword. Insufficient or excessive autophagy will cause nerve damage, promote cell death, while the moderately autophagy has a neuroprotective effect. After the occurrence of ischemic stroke, the inflammatory response activates anti-inflammatory mediators and proinflammatory mediators, breaking the dynamic balance between proinflammatory response and anti-inflammatory response, causing detriment to the brain, affecting brain function recovery. The main purpose of this article is to systematically summarize the recent studies on autophagy and inflammatory responses in acute ischemic stroke, a brief analysis the roles of autophagy and inflammatory responses in the pathophysiology of ischemic stroke, investigate the correlation between both. To build a foundation for research on how to make autophagy and proinflammatory and anti-inflammatory responses achieve the desired balance at different stages of the stroke, in order to provide research directions for acute ischemic stroke and to form new and effective therapeutic strategies.
    Case Report
    Armando Sanchez-Jordan* and Carlos Gerardo Cantú-Brito
    Granulomatosis with polyangiitis is a systemic vasculitis with uncommon central nervous system involvement. Stroke, which is the primary manifestation in this subgroup, presents with a wide clinical spectrum depending on its location. The plus-minus lid syndrome consists of unilateral ptosis and contralateral eyelid retraction following a lesion of the midbrain affecting the third nerve fascicle. We present a patient with granulomatosis with poliangiitis who developed a pontine hemorrhagic stroke probably secondary to vasculitis activity, which extended to the midbrain affecting the third nerve fascicle with a consequent plus-minus lid syndrome. This is the first case in literature reporting both entitites.
    Ronald C. Pearlman*, and Bryan Steinberg
    A 59-year-old HIV positive female presented with cardiac symptomatology. Cardiology workup included a cardiac catheterization during which a carotid angiogram was performed demonstrating a 90% stenosis of the right carotid artery. The stenosis was the result of lymphoid hyperplasia with pseudo - obstruction of the right carotid artery. Patients who have acquired human immunodeficiency virus (HIV) may have enlarged neck lymph tissue impinging on other anatomical structures causing displacement or stenosis, including the carotid artery.
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