Ischemic strokes in oncological patients—treatment and challenges: a literature review (original) (raw)
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Current Status of Care in Ischemic Stroke: Literature Review
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Stroke is the second, and in some countries the third cause of mortality in the population and one of the causes of disability in the adult population. According to statistics, in 2018, 15 million cases of stroke and 6 million deaths were diagnosed, The only currently approved treatments for acute stroke are intravenous tissue plasminogen activator (rtPA) and intra-arterial thrombectomy, which are used in less than 10% and 1% of patients, respectively. The literature review is devoted to the pathophysiology and molecular mechanisms of damage in cerebral ischemia. The modern concept of two strategies of cell therapy is discussed: neuroprotection and remodeling; the role of stem cells in reducing local and systemic inflammation, neurogenesis and angiogenesis, increasing neuronal plasticity, and protecting the bloodbrain barrier, the role of paracrine factors and extracellular vesicles is shown. Methods of stem cell delivery are described: direct intracerebral transplantation, intraventricular and intrathecal, intravenous and intraarterial; the number of cells, their type and optimal delivery time depending on the acute, subacute and chronic periods of stroke. We also described recently designed the radially branched deployment (RBD) device and Cleveland multiport catheter for convection-enhanced delivery in which a cell-delivery catheter can be deployed at various angles and depths from a single longitudinal cannula. Finally, data on the completed 15 clinical trials from 2015 to the present, in which 513 patients took part, are presented. A detailed analysis of the efficacy and safety of cell therapy has been carried out.
The phenomenon of ischemic preconditioning at the patients with ischemic and hemorrhagic stroke
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First experience with intravenous thrombolysis in ischemic stroke in Serbia
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Резюме Целта е да се представи адаптирана програма за домашна рехабилитация при пациенти с исхемичен мозъчен инсулт в хроничен период, разработена възоснова на принципите на двигателния контрол, двигателното обучение и съвременните насоки на невростимулиращата терапия (neurodevelopmental treatment (NDT). Рековалесценцията след увреда на централната нервна система е интерактивна работа между пациент, интердисциплинарен тим от специалисти и близко семейство. Адаптираната програма и терапия за пациенти с исхемичен мозъчен инсулт в хроничен период е ориентирана към решаване на целенасочени функционални задачи, с което се търси активно участие от страна на пациента за да придобие личен опит и да се използват възможностите на невропластичните процеси за възстановяване. Пациентът може да научи само доколко е активен в процеса или извършвайки дейности с активно участие и улесняване, в зависимост от неговите функционални въможности. При двигателното обучение, получавайки дори минимално коректен отговор от страна на пациента добре е да се прекрати с мануалната помощ, за да не се възпрепятства в процеса на възстановяване. Търсейки оптимални стратегии, удобни и подходящи за конкретния пациент и неговите способности, имаме за крайна цел да подобриме функционалните двигателни въможности, постуралната стабилност, ортостатичната реактивност и ходенето. Заключение: Програма може да има принос и за обществото, осигурявайки по-голяма информираност, относно възможностите на физическите упражнения в профилактиката и лечението на тази болест заедно с медикаментозната терапия и диетичния режим. Ключови думи: Исхемичен мозъчен инсулт, Невростимулираща терапия, Домашна рехабилитация Summary The purpose is to present the adapted program for independent home rehabilitation for patients with ischemic stroke in chronic period, which is worked out on the basis of principles of motor control, motor learning and the contemporary guidance of neurodevelopmental therapy, (Neurodevelopmental treatment-NDT). Recovery after injury to the central nervous system is an interactive work between the patient, an interdisciplinary team of specialists and close relatives. The adapted program and therapy for patients with ischemic stroke in the chronic period is oriented towards solving focused functional activities, which require active participation by the patient, to get a personal experience and to take advantage of the possibilities of the processеs of neuroplasticity for recovery. The patient can be learned only if he actively participates in the process or performing activities and facilitation, depending on its functional capabilities. In motor learning, gaining even minimally correct response by the patient, it's good to stop with manual assistance, not to hinder the recovery process. Seeking optimal strategies suitable and appropriate for the particular patient and his capabilities, our final purpose is to improve functional motor capabilities, postural stability, postural reactivity and gait. Conclusion: The program can contribute the society, providing more informations about the possibilities of physical exercise in the prevention and treatment of this disease with drug therapy and dietary regime.