Brain Circulation最新文献

In 2016, the American Physical Therapy Association Neurology Section published clinical practice guidelines titled "Vestibular Rehabilitation (VR) for Peripheral Vestibular Hypofunction." These guidelines recommend that physicians should provide VR to individuals with peripheral vestibular hypofunction, emphasizing its importance in managing dysfunctions of the vestibular system. Previous systematic reviews or studies on vestibular function have concluded that VR has positive effects on central vestibular disorders. More recently, a systematic review has found that there are positive effects of VR on ambulatory performance in stroke patients. Evidence is consistently being added regarding the positive impact of VR in patients with a history of stroke who are currently living with dizziness, balance, and gait impairments. However, there are still many unanswered questions in this area. Most studies lack complementary quantitative vestibular function testing and uniform standards for the timing and frequency of the VR. Furthermore, the methods of VR are carried out in a general fashion without catering to the individual, resulting in a lack of understanding of the mechanisms of various VR approaches. In future, much work needs to be done to solve these questions. The objective of this review is to investigate and validate the impact of VR on stroke patients while assessing the associated methodologies for determining its effectiveness. In particular, this review aims to offer a thorough evaluation of the advantages and drawbacks of employing VR in stroke rehabilitation.

Despite dramatic improvements in diagnosis and antimicrobial treatment of bacterial meningitis over the last few decades, adverse postinfective sequelae and mortality remain exceedingly high in adults. Of note, the unfavorable clinical outcome is usually attributable to the presence of intracranial complications during the acute phase of infection, such as cerebral edema and increases in intracranial pressure and cerebral blood flow disturbances. Involvement of the cerebral vasculature during bacterial meningitis is overwhelmingly clear from clinical and laboratory evidence highlighting cerebral blood flow alterations with the use of Doppler blood flow analysis, angiographic studies of cerebral vessel wall structural irregularities and computed tomography/magnetic resonance imaging recording of cerebral infarctions. With the widespread agreement of cerebrovascular involvement in bacterial meningitis, very few studies have documented histopathological observations of cerebral vessel irregularities affecting the various layers of the vascular wall. In an attempt to understand the arterial wall changes that take place before the occurrence of cerebral ischemic consequences in bacterial meningitis, we have investigated the sequential changes affecting the arterial vasculature, beginning with early reflexive modifications of the adventitia and culminating in late proliferative lesions of the intima.

Cerebral venous thrombosis (CVT) is a rare cause of cerebral infarction, accounting for <1% of stroke cases worldwide. The pathophysiology of CVT is multifactorial, encompassing the direct effects of thrombosis, interference with the blood-brain barrier and development of cerebral edema. Several genetic and acquired risk factors of CVT have been identified, more recently this includes the pro-thrombotic effects of coronavirus disease of 2019 infection. CVT can present with wide variation of clinical characteristics, with headache being the most common clinical manifestation. Diagnosis is based on radiological imaging. The mainstay of CVT management is prompt initiation of anti-coagulation. Failure to recognize insidious symptoms of CVT, will lead to a delay in diagnosis and consequently treatment which eventually lead to significant complications, including neurological disability and death. The aim of this narrative review is to consolidate the existing knowledge on CVT, a rare condition with a challenging diagnosis and treatment.