recuperare cerebrala

7/25/2019 RECUPERARE CEREBRALA

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RECUPERARE CEREBRALAHEMIPLEGIE STANGA -

HEMIPLEGIE DREAPTA

Instalarea hemiparezei poate impie!i"ata !oar printr-o rea"tie prompta#ma$im%m & ore !e la primele semne' prin pro"e!%ri !e %r(enta )as"%lara in"lini"i pre(atite sa primeas"a si sa trateze ast*el !e "az%ri+ ,!ata instalatahemipareza sa% hemiple(ia se trateaza si se poate )in!e"a in timp prin e$er"itiizilni"e a"ti)e !e re"%perare ne%rolo(i"a si zioterapie spe"i"a a"estei a*e"ti%ni+

STR,E este "%)ant%l "are !en%meste in en(leza .ATACUL. "ere/ral+

A""i!ent )as"%lar "ere/ral0 !e asemenea 0 "%nos"%t s%/ n%mele !e a""i!ent)as"%lar "ere/ral #A1C'0 ins%lta "ere/ro)as"%lare #C1I'0 sa% ata" "ere/ral0 esteat%n"i "2n! s3ra"i 4%$%l !e s2n(e la "reier rez%ltatele la moartea "el%lelor +E$ist3 !o%3 tip%ri prin"ipale !e a""i!ent )as"%lar "ere/ral5 is"hemi"e0 !in "a%zalipsei !e 4%$%l !e san(e0 si hemora(i" 0 !in "a%za san(erare+ Ele a)ea "a rez%ltato parte a "reier%l%i "are n% *%n"6ioneaz3 "ore"t+ 789 Semne si simptome ale %n%ia""i!ent )as"%lar "ere/ral poate in"l%!e 0 la in"apa"itatea !e a m%ta sa% sim6i pe!e o parte a "orp%l%i0 pro/leme !e :n6ele(ere sa% )or/in! 0 sentiment%l "a l%mease in)arte 0 sa% pier!erea )izi%ne :ntr - o parte 0 printre altele+ 7;9 7&9 Semnele <isimptomele apar a!esea la s"%rt timp !%p3 a""i!ent )as"%lar "ere/ral a a)%t lo"+Da"3 simptomele :n"3r"a6i mai m%lt !e %na sa% !o%3 ore0 este "%nos"%t "a %nata" is"hemi" tranzitor #AIT'+ 7&9 Prin %rmare 0 a""i!ente )as"%lare "ere/ralehemora(i"a poate aso"iat3 "% o se)er3 !%rere !e "ap + 7&9 Simptomele %n%ia""i!ent )as"%lar "ere/ral poate permanent+ 789 "ompli"atii pe termen l%n( potin"l%!e pne%monia sa% pier!erea "ontrol%l%i )ezi"ii %rinare + 7&9

Prin"ipal%l *a"tor !e ris" pentr% a""i!ent )as"%lar "ere/ral este tensi%ne arterial3

ri!i"at3 + 7=9 Alti *a"tori !e ris" in"l%! *%mat%l 0 o/ezitatea 0 "olesterol%l ri!i"at 0!ia/et%l zaharat 0 AIT anterior0 9 %n a""i!ent )as"%lar "ere/ral hemora(i" este "a%zat !e s2n(erare 0 e!ire"t :n "reier sa% :n spa6i%l !in ?%r%l "reier%l%i + 7>9 7@9 S2n(er3rile pot s3 apar3!in "a%za %n%i ane)rism "ere/ral + 7>9 Dia(nosti"%l este :n mo! tipi" "% ima(isti"ame!i"ala 5 "%m ar o tomo(rae "omp%terizata a$iala #CT' sa% ima(isti"a prinrezonanta ma(neti"a #IRM' 0 s"anare alon(ith %n e$amen zi" + Alte teste5 "%mar pentr% ele"tro"ar!io(ram3 + #ECG' <i analizele !e s2n(e s%nt e*e"t%ate la*a"torii !e ris" ai mei !eterministe <i e$"l%!e alte "a%ze posi/ile !e zah3r !in

s2n(e s"3z%t + Poate pro)o"a simptome similare 79

Pre)enirea in"l%!e *a"torii Mi"sorarea !e ris" pre"%m si posi/il aspirina 0 statine 0inter)entii "hir%r(i"ale pentr% a !es"hi!e arterele la ni)el%l "reier%l%i in "ele "%pro/lemati"e :n(%starea <i ar*arin3 la "ei "% /rilatie atriala + 7;9 Un a""i!ent)as"%lar "ere/ral ne"esita a!esea !e in(ri?ire !e %r(enta+ 789 La a""i!ent)as"%lar "ere/ral is"hemi"0 !a"3 este !ete"tat3 :n termen !e trei p2n3 la patr%

ore si ?%matate0 pot tratate "% %n me!i"ament *a"%t poate r%pe :n ?os "hea( +Aspirina a sho%l!erstan! %tilizat+ Unele a""i!ente )as"%lare "ere/ralehemora(i"e /ene"iaz3 !e o inter)en6ie "hir%r(i"al3 + Tratament%l pentr% a :n"er"a re"%perarea *%n"6iei pier!%te se n%me<te rea/ilitare a""i!ent )as"%lar"ere/ral <i are lo" :n mo! i!eal :ntr - o %nitate !e a""i!ent )as"%lar "ere/ral T,TUSI0 sinteza n% s%nt !isponi/ile :n mare parte a l%mii+ 7;9

n ;8& Apro$imati) @0F milioane !e oameni a% a)%t %n a""i!ent )as"%lar"ere/ral is"hemi" <i !e &0= milioane !e oameni a% a)%t %n a""i!ent )as"%lar"ere/ral hemora(i"+ 79 n ;80 a% e$istat apro$imati) && !e milioane !e oameni"are a% a)%t anterior %n a""i!ent )as"%lar "ere/ral <i era% :n"3 :n )ia63+ ntre8FF <i ;80 n%m3r%l !e a""i!ente )as"%lare "ere/rale "are a% a)%t lo" :ne"are an a s"3z%t "% apro$imati) 8 !in l%mea !ez)oltat3 <i a "res"%t "%8 0 in l%mea in "%rs !e !ez)oltare+ 7F9 n ;8&0 a""i!ent )as"%lar "ere/ral "eea"e a !o%a "a%za "ea mai *re")enta !e !e"es !%pa /oala arterelor "oronare 0reprezent2n! @0= milioane !e !e"ese #8; !in total'+ 789 Apro$imati) &0&milioane !e !e"ese rez%ltate !in a""i!ent )as"%lar "ere/ral is"hemi" :n timp "e&0; milioane !e !e"ese rez%ltate !in a""i!ent )as"%lar "ere/ral hemora(i"+ 789Apro$imati) ?%matate !in persoanele "are a% a)%t %n a""i!ent )as"%lar "ere/ral

)i% mai p%tin !e %n an+ 7;9 :n (eneral0 !o%3 treimi !in a""i!ente )as"%lare"ere/rale a% a)%t lo" :n "ei peste @> !e ani+ 7F9

"%prins 7 As"%n!ere 9

8 Clasi"are 8+8 !eni6ie8+; is"hemi"a

8+& hemora(i"3

; Semne si simptome ;+8 Re"%noa<terea timp%rie

;+; s%/tip%ri

;+& simptome aso"iate

& "a%ze &+8 a""i!ent )as"%lar "ere/ral trom/oti"

&+; a""i!ent )as"%lar "ere/ral em/oli"e

Hipoper*%zia "ere/ral3 &+&

&+= trom/oz3 )enoas3

&+> hemora(ie intra"ere/ral3

&+@ a""i!ent )as"%lar "ere/ral Silent

= iziopatolo(ie =+8 is"hemi"a

=+; hemora(i"3

> Dia(nosti" E$aminarea zi"3 >+8

>+; ima(isti"a

>+& Ca%za !e /az3

@ Pre)enirea @+8 a"tori !e ris"

@+; *emei

@+& a""i!ent )as"%lar "ere/ral sa% AIT

Gestionarea +8 a""i!ent )as"%lar "ere/ral is"hemi"

a""i!ent )as"%lar "ere/ral +; hemora(i"3

Unitatea !e +& a""i!ent )as"%lar "ere/ral

+= rea/ilitare

Pro(noz3

F Epi!emiolo(ie

8 Istori"%l

88 Cer"etare 88+8 An(ioplastia <i stentarea

88+; throm/e"tomJ me"ani"e

88+& Ne%roprote"6ia

8; A se )e!ea 0 !e asemenea 0

8& Re*erin6e

8= Bi/lio(rae

8> Le(3t%ri e$terne

"lasi"are

, *elie !e "reier !e la a%topsie a %nei persoane "are a a)%t o a"%ta a arterei"ere/rale mi?lo"ii #MCA' a""i!ent )as"%lar "ere/ral

StroKes pot "lasi"ate :n !o%3 "ate(orii ma?ore5 is"hemi" <i hemora(i"+ 7889a""i!ente )as"%lare "ere/rale is"hemi"a s%nt "a%zate !e :ntrer%perea aliment3rii"% s2n(e a "reier%l%i0 in timp "e a""i!ent )as"%lar "ere/ral hemora(i" rez%lta !inr%pt%ra %n%i )as !e s2n(e sa% a str%"t%rii )as"%lare anormale+ Apro$imati) !in a""i!ente )as"%lare "ere/rale is"hemi"e0 rest%l in! hemora(i"+ S2n(er3riipot !ez)olta zone interioare !e is"hemie0 o a*e"6i%ne "%nos"%t3 s%/ n%mele !e.trans*ormare hemora(i"a+. N% se <tie "2t !e m%lte a""i!ente )as"%lare"ere/rale hemora(i"e De *apt 0 :n"epe a""i!ente )as"%lare "ere/rale is"hemi"e+7;9

!eni6ie

In 8F0 ,r(anizatia Mon!iala a Sanatatii %n a""i!ent )as"%lar "ere/ral !enit "a%n .!e"it ne%rolo(i" !in "a%za "ere/ro)as"%lar3 a% persista !in"olo !e ;= !e oresa% este :ntrer%pt3 !e moarte :n termen !e ;= !e ore.0 78;9 De<i "%)2nt%l.a""i!ent )as"%lar "ere/ral. este )e"hi !e se"ole+ A"east3 !eni6ie0 "are artre/%i s3 re4e"te re)ersi/ilitatea lezi%ni tis%lare <i "are a "on"ep%t pentr% s"op%l0"% inter)al%l !e timp !e ;= !e ore0 in! ales :n mo! ar/itrar+ Limita !e ;= !e ore

imparte %n a""i!ent )as"%lar "ere/ral !e la ata"%l is"hemi" tranzitor 0 toate "areeste %n sin!rom le(at !e simptome !e a""i!ent )as"%lar "ere/ral a% rezol)at

"omplet Apel :n termen !e ;= !e ore+ 7;9 C% !isponi/ilitatea !e tratamente "arepot re!%"e se)eritatea a""i!ent )as"%lar "ere/ral n "az%l a!ministr3rii pre"o"e0m%l6i pre*er3 a"%m o terminolo(ie alternati)30 5 "%m ar ata"%l "ere/ral sisin!rom%l "ere/ro)as"%lare is"hemi" #mo!elat !%p3 ata" !e "or! si sin!rom"oronarian a"%t 0 respe"ti)'0 pentr% a re4e"ta %r(en6a simptomelor a""i!ent

)as"%lar "ere/ral <i !e ne"esitatea !e a a"6iona rapi!+ 78&9

is"hemi"3

Arti"ole prin"ipale5 in*ar"t "ere/ral <i is"hemie Brain

ntr-%n a""i!ent )as"%lar "ere/ral is"hemi"0 aport%l%i !e s2n(e la o parte a"reier%l%i este re!%s30 "eea "e !%"e la !is*%n"tii ale tes%t%l%i "ere/ral0 zona !ass+E$ist3 patr% moti)e pentr% "are a"est l%"r% s-ar p%tea :nt2mpla5

8+ Trom/oza #o/str%"6ie a %n%i )as !e s2n(e !e "3tre %n "hea( !e s2n(e la ni)ello"al'

;+ Em/olism #o/str%"6ie !in "a%za a em/oliilor !in alta parte a "orp%l%i0 a se)e!ea mai ?os'0 7;9

&+ hipoper*%zie sistemi"3 #s"3!ere (eneral3 a aliment3rii "% s2n(e0 !e e$empl%0

:n stare !e <o" ' 78=9

=+ "ere/ral trom/oza sin%s%l%i )enos + 78>9

A""i!ent )as"%lar "ere/ral0 *ara o e$pli"atie e)i!enta este sa n%mit."rJpto(eni". #!e ori(ine ne"%nos"%t3' a"easta "onstit%ie &-= !in total%la""i!ente )as"%lare "ere/rale is"hemi"e+ 7;9 78@9

E$ist3 !i)erse sisteme !e "lasi"are pentr% %n a""i!ent )as"%lar "ere/ralis"hemi"+ Clasi"area ,$*or! "om%nitar StroKe Pro?e"t #,CSP0 !e asemenea0"%nos"%t s%/ n%mele !e "lasi"are Bam*or! sa% ,$*or!'0 :n prim%l r2n! pe Se/azeaz3 simptomele ini6iale /azat pe amploarea simptomelor0 episo!%l a""i!ent)as"%lar "ere/ral este "lasi"at "a total%l in*ar"t%l%i anterior !e "ir"%la6ie #TACI'0par6ial in*ar"t anterior !e "ir"%la6ie #PACI'0 in*ar"t la"%nar #LACI' sa% in*ar"tposterior !e "ir"%la6ie #Po"i'+ A"este patr% entitati prezi"e (ra!%l !e a""i!ent)as"%lar "ere/ral0 zona a "reier%l%i a este a*e"tat0 "a%za prin"ipala0 iarpro(nosti"%l+ 789 789 toast%l #Trial !e ,r( 88; in a"%ta A""i!ent )as"%lar"ere/ral Tratament%l' Clasi"area se /azeaz3 pe "lini"3 simptome pre"%m <i

rez%ltatele in)esti(a6iilor %lterioare pe a"east3 /az30 %n a""i!ent )as"%lar"ere/ral este "lasi"at "a in! !atorat #8' 0 trom/oz3 sa% em/olie !in "a%za

"omprima alte str%"t%ri+ Cele mai m%lte *orme !e a""i!ent )as"%lar "ere/ral n%s%nt aso"iate "% !%reri !e "ap 0 :n a*ar3 !e hemora(ie s%/arahnoi!ian3 <itrom/oza )enoas3 "ere/ral3 <i 0 o"azional 0 intra"ere/ral3 hemora(ie+

re"%noaterea timp%rie

Di)erse sisteme a% *ost prop%se pentr% a "re<te re"%noa<terea !e a""i!ent)as"%lar "ere/ral+ Di*erite "onstat3ri s%nt :n m3s%r3 s3 prezi"3 prezen6a sa%a/sen6a !e a""i!ent )as"%lar "ere/ral la !i*erite (ra!e+ sl3/i"i%ne *e6ei /r%s"3!e/%t0 !eri)3 /ra6 #!e e$empl%0 :n "az%l :n "are o persoan30 C2n! a "er%t s3ri!i"e am/ele /ra6e0 e$e"%t3 in)ol%ntar %n /ra6 :n !eri)3 :n ?os' +>At%n"i "2n! "el p%6in %na !intre sintez3 este prezent'+ n mo! similar0 At%n"i"2n! toate "ele trei sinteze s%nt a/sente0 pro/a/ilitatea !e a""i!ent )as"%lar"ere/ral este s"3z%t semni"ati) #- raport%l pro/a/ilitate + De 8;5&F' 7;89 n timp"e "on"l%ziile tezei n% s%nt per*e"te pentr% !ia(nosti"area a""i!ent )as"%lar"ere/ral0 *apt%l thattheJ poate E)al%ate relati) rapi! <i %<or *a"e ele *oarte)aloroase :n *aza a"%t3+

Sistemele prop%se in"l%! AST #*ata0 /rat0 )or/ire0 <i timp'0 7;;9 0 ast*el "%m

s%s6in%t3 !e Departament%l !e Sanatate #Re(at%l Unit al Marii Britanii' siAso"iatia A""i!ent )as"%lar "ere/ral 0 Aso"iatia Ameri"an StroKe0 National StroKeAsso"iation #SUA'0 "ea !in Los An(eles prespitali"e<ti S"reen a""i!ent )as"%lar"ere/ral #LAPSS' 7;&9 0 iar StroKe s"ale Cin"innati prespitali"e<ti #CPSS'+ 7;=9Utilizarea !e "2ntare !e sintez3 este re"oman!at3 !e (hi!%rile pro*esionale+ 7;>9

Pentr% persoanele "are se *a"e re*erire !e la "amera !e %r(en63 0 re"%noa<tereatimp%rie a A1C este "onsi!erat3 important3 0 !eoare"e a"easta poate a""elerateste !e !ia(nosti"are si tratamente+ Un sistem !e notare n%mit R,SIER

#re"%noa<terea !e a""i!ent )as"%lar "ere/ral in "amera !e %r(enta' estere"oman!at pentr% a"est s"op a"easta se /azeaz3 pe "ara"teristi"ile !inistori"%l me!i"al si e$amen%l zi"+ 7;>9 7;@9

s%/tip%ri

n "az%l :n "are zona a "reier%l%i a*e"tate "on6ine %na !intre "ele trei

proeminente "ai ale sistem%l%i ner)os "entral -,RAUL tra"t%l%i spinotalami" 0

tra"t%l%i "orti"ospinal <i "oloana !orsal3 # lemnis"%s me!ial3 '0 simptomele potin"l%!e5

hemiple(ie <i sl3/i"i%ne m%s"%lar3 a *e6ei

amor6eal3

re!%"ere a senza6iei senzoriale sa% )i/ratoare

ini6ial inm%iere #ton%s m%s"%lar re!%s'0 :nlo"%it !e spasti"itate #"re<tereaton%s%l%i m%s"%lar'0 re4e$e e$"esi)e 0 <i siner(ii o/li(atorii+ 7;9

In "ele mai m%lte "az%ri0 simptomele a*e"teaz3 !oar o parte a "orp%l%i# %nilateral '+ UNCIE !in partea "reier%l%i a*e"tate0 !e*e"t%l !in "reier este !eo/i"ei pe partea op%s3 a "orp%l%i+ Tot%<i0 !eoare"e mo!alit36i !e sintez3 0 prin

%rmare 0 !eplasare :n m3!%)a spin3rii <i ori"e lezi%ne 0 prin %rmare 0 se poatepro!%"e simptome !e sintez30 prezen6a ori"3reia !intre simptomele tezei n%in!i"3 neap3rat %n a""i!ent )as"%lar "ere/ral+

Pe l2n(3 "3ile CNS mai s%s0 tr%n"hi%l "ere/ral !3 na<tere la "ele mai m%lte !intre"ele !oispreze"e ner)i "ranieni + Un a""i!ent )as"%lar "ere/ral A*e"teaz3tr%n"hi%l "ere/ral si "reier%l ACEEA poate pro!%"e simptome re*eritoare la!e"itele :n teza !e ner)i "ranieni5

miros alterat0 (%st0 a%z0 sa% )e!ere #total3 sa% par6ial3'

molesit pleoapelor # ptoza ' <i sl3/i"i%nea m%<"hilor o"%lari

A s"3z%t re4e$e5 (a(0 :n(hi6i0 ele) rea"ti)itate la l%min3

A% s"3z%t senza6ie <i sl3/i"i%ne m%s"%lar3 a *e6ei

pro/leme !e e"hili/r% <i nista(m%s

respira6ie alterat3 <i ritm%l "ar!ia"

sl3/i"i%ne :n m%<"hi sterno"lei!omastoi!ian 0 "% in"apa"itatea !e a trans*orma"ap%l :ntr - o parte

sl3/i"i%ne :n lim/a #in"apa"itatea !e a s"oate :n a*ar3 lim/a <i O sa% m%ta6i-l!intr-o parte :n alta'

n "az%l :n "are "orte$%l "ere/ral este impli"at0 "3ile SNC pot !in no% a*e"tate0a"est l%"r% 0 !ar poate pro!%"e %rm3toarele simptome5

a*azie #!i"%ltate "% e$primare )er/al30 :n6ele(ere a%!iti)30 "itire <i O sa% s"riere Bro"a sa% zona erni"Ke tipi" impli"ate'

!izartrie # t%l/%r3ri !e )or/ire "% motor Rez%lt2n! !in lezi%ni ne%rolo(i"e'

apra$ia #alterat3 mi<"3rile )ol%ntare'

"2mp )iz%al !e*e"t !e

!e"ite !e memorie #impli"area lo/%l%i temporal '

hemine(le"t #impli"area lo/%l%i parietal '

(2n!ire !ezor(anizat30 "on*%zie0 se$%ale hiper - (est%ri #"% impli"area lo/%l*rontal'

lipsa !e :n6ele(ere a l%i sa% a ei Bentoni"e0 !e o/i"ei 0 a""i!ent )as"%lar "ere/ralle(ate0 !iza/ilitate

n "az%l :n "are "ere/el%l este impli"at0 pa"ient%l poate a)ea %rm3toarele5

alterat3 !e mers pe ?os !e mers

"oor!onare mo!i"at3 "ir"%la6ie

)erti? <i sa% !eze"hili/re

simptomele aso"iate

Pier!erea "on<tien6ei 0 !%reri !e "ap <i )3rs3t%ri De o/i"ei apar mai !es :na""i!ent )as"%lar "ere/ral hemora(i" !e"at in trom/oza Din "a%za Cre<tereapresi%nii intra"raniene !in san(e s"%r(eri Comprimarea "reier+

n "az%l :n "are simptomele s%nt ma$imale la !e/%t0 "a%za este mai pro/a/il sae o hemora(ie s%/arahnoi!ian3 sa% a""i!ent )as"%lar "ere/ral em/oli"e+

"a%ze

a""i!ent )as"%lar "ere/ral trom/oti"

Il%strare a %n%i a""i!ent )as"%lar "ere/ral em/oli"0 prezent2n! %n /lo"a? :ntr-%nlo!(e! )as !e s2n(e+

ntr -%n a""i!ent )as"%lar "ere/ral trom/oti" %n trom/%s 7;9 #"hea( !e s2n(e'De o/i"ei se *ormeaza in ?%r%l ateros"leroti"e pla"i+ Deoare"e /lo"area artereieste (ra!%al0 !e/%t%l a""i!ent )as"%lar "ere/ral trom/oti" simptomati"e este mailent !e"2t "el al %n%i a""i!ent )as"%lar "ere/ral hemora(i"+ Un trom/%s :n sine#"hiar !a"3 a"easta n% "heam3 "omplet /lo"a )as%l !e san(e' poate !%"e la %na""i!ent )as"%lar "ere/ral em/oli" la #)ezi mai ?os' 0 :n "az%l :n "are trom/%l ser%pe si se !eplaseaza in 4%$%l san(%in0 moment :n "are este "hemat la em/ol%s +E$ista !o%a tip%ri !e trom/oza poate pro)o"a %n a""i!ent )as"%lar "ere/ral5

Boala )as mare 1izeaz3 "om%ne <i interne arterele "aroti!e ACESTEA 0 artera)erte/ral3 0 <i Cer"%l !e illis + 7;F9 Bolile a% pot *orma trom/i :n )asele mariin"l%! #:n in"i!en63 !es"res"3toare'5 ateros"leroza0 )aso"onstri"6ie # !e str2n(erea arterei' aorti"a 0 "aroti!a sa% !ise"6ia arterei )erte/rale 0 !i)erse /oliin4amatorii ale peretel%i )as%l%i !e s2n(e # TaKaJas% arteritei 0 arterita "% "el%le(i(ant 0 )as"%lite '0 )as"%lopatie nein4amatorie0 /oala MoJamoJa si !isplazia/rom%s"%lar3 +

Boala )aselor mi"i 1izeaz3 arterele mai mi"i in interior%l "reier%l%i5 ram%ri ale"er"%l%i l%i illis 0 arterei "ere/rale me!ii0 t%lpina0 si artere "are !e"%r( !in)erte/rale !istal <i artera /azilar3 + 7&9 Boli *a"%t pot *orma trom/i :n )asele mi"i

0 se n%m3r3 #:n in"i!en63 !es"res"3toare'5 lipohJalinosis #/%il!-%p !e materiehialin (rase in )as !e san(e 0 "a %rmare a tensi%nii arteriale <i a :m/3tr2nirii' <i!e(enerare /rinoi!3 #%n a""i!ent )as"%lar "ere/ral "are impli"3 na)e !e tez3s%nt "%nos"%te "a %n a""i!ent )as"%lar "ere/ral la"%nare ' <i mi"roatheroma#mi"i pl3"i ateros"leroti"e' + 7&89

si"lemie 0 "are poate pro)o"a "el%le san(%ine pentr% a str2n(e :n (r%p%ri <i s3/lo"heze )asele !e san(e0 prin %rmare 0 poate !%"e la %n a""i!ent )as"%lar

"ere/ral+ Un a""i!ent )as"%lar "ere/ral este a !o%a "a%za !e !e"es lapersoanele s%/ ; !e ani0 "% si"lemie+ 7&;9 Pol%area aer%l%i poate 0 ast*el 0 "re<teris"%l !e a""i!ent )as"%lar "ere/ral+ 7&&9

a""i!ent )as"%lar "ere/ral em/oli"

Un a""i!ent )as"%lar "ere/ral em/oli"e Se re*era la la arterial em/olie #%n /lo"a?al %nei artere' Printr - %n em/ol 0 o parti"%l3 "are "3l3tore<te sa% rest%ri :n 4%$%l

san(%in arterial "are pro)in !in alte p3r6i+ Un em/ol este "el mai *re")ent %ntrom/%s0 !ar 0 prin %rmare 0 a"esta poate %n n%m3r !e alte s%/stan6e 0 in"l%si)

(r3simi # !e e$empl%0 !in m3!%)a osoas3 :ntr - %n os r%pt '0 aer0 "an"er%l"el%lelor sa% smo"%ri !e /a"terii # !e o/i"ei !e la in*e"6ioase en!o"ar!it3 '+ 7&=9

Din "a%za em/oliei pro)ine !in alt3 parte0 terapia lo"al3 rezol)3 n%mai pro/lemape "are temporar+ AA0 s%rsa em/ol%l tre/%ie s3 e i!enti"ate+ Deoare"e/lo"a?%l em/oli"e este /r%s"a !e/%t0 simptomele s%nt !e o/i"ei ma$im la pornire+A<a "30 simptomele pot tranzitorii "a em/ol%l este par6ial resor/it <i se m%t3 :ntr-o alt3 lo"a6ie sa% !isipeaza "% tot%l+

Em/oli apar "el mai *re")ent !in inim3 #mai ales :n /rila6ie atrial3 ' 0 !ar potpro)eni !in alte p3r6i ale ar/orel%i arterial+ n em/olie para!o$al 0 o trom/oz3)enoas3 pro*%n!3 em/olizes p2n3 la atrial sa% !e*e"t septal )entri"%lar :n inim3

:n "reier+ 7&=9

Ca%zele !e a""i!ent )as"%lar "ere/ral le(ate !e inima poate !istin(e :ntre ris"s"3z%t ri!i"at <i5 7&>9

ris" ri!i"at5 /rilatie atriala si /rilatie atriala paro$isti"a 0 /oli re%mati"e alemitral3 sa% )al)a aorti"a /oala0 )al)e "ar!ia"e arti"iale 0 "%nos"%t s%/ n%mele!e trom/%s "ar!ia" a atri%l%i sa% a )entri"%l%l%i0 sin!rom !e sin%s /olna) 0s%s6in%t 4%tter atrial 0 in*ar"t mio"ar!i" re"ent0 in*ar"t%l mio"ar!i" "roni" 0

:mpre%n3 "% *ra"6ie !e e?e"6ie Q; la s%ta0 simptomati"3 ins%"ien63 "ar!ia"3"on(esti)3 0 "% *ra"6ie !e e?e"6ie Q& la s%ta0 "ar!iomiopatie !ilatati)3 0 Li/man-Sa"Ks en!o"ar!ita 0 Maranti" en!o"ar!ita 0 en!o"ar!it3 in*e"6ioas3 0/roelastoma papilar 0 a p3r3sit mi$om atrial3 <i /Jpass "oronarian "hir%r(ie#/Jpass'+

ris" s"3z%t O poten6ial5 "al"i"area ann%l%s #inel' a )al)ei mitrale0 *oramen o)alepatent #P,'0 ane)rism septal atrial0 ane)rism septal atrial "% *oramen o)alepatent0 ane)rism )entri"%lar st2n( 0 *3r3 a trom/%l%i0 izolat atrial st2n( .*%m. lae"o"ar!io(rae #*ara stenoza mitral3 sa% /rila6ie atrial3'0 aterom "omple$3 :naorta as"en!ent3 sa% ar"%l pro$imal+

hipoper*%zia "ere/ral3

hipoper*%zie "ere/ral3 este re!%"erea 4%$%l%i san(%in la toate partile "reier%l%i+Re!%"erea ar p%tea o an%mit3 parte a "reier%l%i UNCIE as%pra "a%zei+ Este"el mai *re")ent !in "a%za ins%"ien6ei "ar!ia"e !e la stop "ar!ia" sa% aritmii0sa% !e la re!%"erea !e/it%l%i "ar!ia" "a %rmare a in*ar"t%l%i mio"ar!i" 0 em/olie

p%lmonar3 0 peri"ar!i" sa% s2n(erare+ 7 Ne"esit3 "itare 9 hipo$emie #"on6in%t%l !eo$i(en !in san(e' poate pre"ipita hipoper*%zie + Deoare"e re!%"erea 4%$%l%i

san(%in este la ni)el mon!ial0 toate parti ale "reier%l%i pot a*e"tate0 mai ales!ra(oste )%lnera/ile zone ./azinelor hi!ro(ra"e. - re(i%nile !in zona !e*rontier3 %rnizat !e arterele "ere/rale ma?ore+ Un a""i!ent )as"%lar "ere/ral !e"otit%r3 se re*er3 la starea At%n"i "2n! alimentarea "% s2n(e a tezei !omenii este"ompromis3+ l%$%l !e san(e pentr% teza zone n% se opre<te neap3rat0 !ar :n

s"him/ poate re!%"e p2n3 la p%n"t%l :n "are se poate pro!%"e lezi%ni ale"reier%l%i+

trom/oz3 )enoas3

Cere/ral trom/oza sin%s%rilor )enoase "on!%"e la %n a""i!ent )as"%lar "ere/ral!in "a%za presi%nii )enoase "res"%t3 la ni)el lo"al0 "are e$"e!e presi%nea

(enerat3 !e artere+ In*ar"te s%nt mai s%s"epti/ile !e a s%*eri trans*orm3rihemora(i"e #s"%r(eri !e s2n(e :n zona a*e"tat3' !e"2t alte tip%ri !e a""i!ent)as"%lar "ere/ral is"hemi"+ 78>9

hemora(ie intra"ere/ral3

Ea rali% (ena apare in artere mi"i sa% arteriolelor <i se !atoreaz3 :n mo! o/i<n%itla hipertensi%ne0 7&@9 mal*orma6ii )as"%lare intra"raniene #in"l%si) an(iom"a)ernos sa% mal*orma6ii arterio '0 "ere/ral3 an(iopatie amiloi!3 0 sa% in*ar"te :n"are a a)%t lo" hemora(ie se"%n!ar3+ 7;9 Alte "a%ze poten6iale s%nt tra%m30t%l/%r3ri !e s2n(erare 0 an(iopatie amiloi!3 0 "ons%m%l%i ili"it !e !ro(%ri # !ee$empl%0 am*etamine sa% "o"ain3 '+ Hematom%l e$tin!e p2n3 "e presi%nea !in6es%t%l :n"on?%r3tor limiteaz3 "re<terea0 sa% p2n3 "2n! se !e"omprim3 prin(olirea :n sistem%l )entri"%lar 0 LCR sa% s%pra*a6a Pial+ , treime !in s2n(erareintra"ere/ral3 este :n )entri"%li "reier%l%i+ ICH are o rata a mortalitatii !e == las%ta 0 !%pa & !e zile0 mai mare !e"2t %n a""i!ent )as"%lar "ere/ral is"hemi"sa% hemora(ie s%/arahnoi!ian3 #Care p%n"t !e )e!ere tehni" poate 0 prin%rmare 0 "lasi"at "a in! %n tip !e a""i!ent )as"%lar "ere/ral 7;9 '+

a""i!ent )as"%lar "ere/ral silen6ios

Un a""i!ent )as"%lar "ere/ral t3"%t este %n a""i!ent )as"%lar "ere/ral a *a"%t n%are ni"i %n simptom e$terior0 iar pa"ien6ii n% s%nt "on<tien6i :n mo! tipi"theJha)e a a)%t %n a""i!ent )as"%lar "ere/ral+ In "i%!a n% pro)oa"a simptomei!enti"a/ile0 %n a""i!ent )as"%lar "ere/ral t3"%t !a%ne t3"%t "reier0 si plaseaza

pa"ient%l la ris" pentr% a "res"%t at2t ata" is"hemi" tranzitor <i a""i!ent )as"%lar"ere/ral ma?ore :n )iitor+ Pe !e alt3 parte 0 "ei "are a% a)%t %n a""i!ent )as"%lar

"ere/ral ma?ore s%nt 0 prin %rmare 0 la ris"%l !e a a)ea a""i!ente )as"%lare"ere/rale silen6ioase+ 7&9 ntr - %n st%!i% ampl% :n 8FF morethan 88 milioane!e oameni a% *ost estimate s3 s%*erit %n a""i!ent )as"%lar "ere/ral in StateleUnite+ Apro$imati) + !e a""i!ente )as"%lare "ere/rale tezei a% *ostsimptomati" <i 88 milioane a% *ost prima )reo!ata in*ar"te RMN silen6ioase

hemora(iilor + a""i!ente )as"%lare "ere/rale silen6ioase pro)oa"3 :n mo!o/i<n%it lezi%ni "are s%nt !ete"tate prin %tilizarea ne%roima(isti"e5 "%m ar RMN- %l + a""i!ente )as"%lare "ere/rale silen6ioase s%nt estimate s3 ai/3 lo" la "in"iori mai mare !e"2t rata !e a""i!ente )as"%lare "ere/rale simptomati"e+ 7&9 7&F9Ris"%l !e a""i!ent )as"%lar "ere/ral "rete silen6ioase 0 "% )2rsta0 !ar 0 prin%rmare 0 ar p%tea a*e"ta a!%l6i tineri <i "opii0 !ra(oste :n spe"ial "ei "% a"%taanemie + 7&9 7= 9

ziopatolo(ia

is"hemi"3

Mi"ro(rae prezent2n! ne"roza pse%!olaminar "orti"ala 0 o "onstatare )az%t ina""i!ent )as"%lar "ere/ral !e pe ima(isti"a me!i"ala si la a%topsie + H E pataBM +

Mi"ro(rae a s%per"iale "orte$%l "ere/ral "are arat3 pier!erea ne%ron <iastro"itele rea"ti)e :ntr - o persoan3 a a a)%t %n a""i!ent )as"%lar "ere/ral+ H Epata BM +

Is"hemi"a A""i!ent )as"%lar "ere/ral se pro!%"e !in "a%za %nei pier!eri aalimentarii "% san(e la o parte a "reier%l%i0 "are ini6iaz3 "as"a!a is"hemi" + 7=89

es%t "ere/ral :n"eteaz3 s3 *%n"6ioneze !a"3 lipsit !e o$i(en pentr% mai m%lt !e@ la F !e se"%n!e0 iar !%p3 apro$imati) trei ore )or s%*eri %n pre?%!i"i%ire)ersi/il "are poate !%"e la moartea 6es%t%l%i0 <i an%me0 in*ar"t%l + #A"esta estemoti)%l pentr% "are /rinoliti"e5 "%m ar alteplaza s%nt !ate n%mai p2n3 la treiore !e la !e/%t%l a""i!ent )as"%lar "ere/ral+' Ateros"leroza poate :ntrer%pe

alimentarea "% s2n(e prin :n(%starea l%men%l%i )aselor !e san(e "are !%" la ore!%"ere a 4%$%l%i san(%in0 !etermin2n! *ormarea !e "hea(%ri !e s2n(e :ninterior%l )as%l%i0 sa% prin eli/erarea a)erse !e mi"i em/oli prin !ezinte(rareapl3"ilor ateros"leroti"e+ 7=;9 in*ar"t%l em/oli"e inter)ine C2n! em/oli ,RMEAalte p3r6i ale sistem%l%i "ir"%lator0 :n mo! tipi" :n inim3 0 "a %rmare a /rila6ieiatriale0 sa% :n arterele "aroti!e0 r%pe0 s3 intre :n "ir"%la6ia "ere/ral30 apoi se!ep%ne <i /lo"a )asele !e s2n(e ale "reier%l%i+ Din moment "e )asele !e san(e!in "reier s%nt a"%m /lo"ate0 "reier%l !e)ine s"3z%t :n ener(ie0 <i a *%(it ast*elre"%r(e la %tilizarea meta/olism%l%i anaero/ :n interior%l re(i%nii 6es%t%l%i"ere/ral a*e"tat !e is"hemie+ Meta/olism%l anaero/3 pro!%"e mai p%6in

a!enozin tri*os*at #ATP' 0 !ar eli/ereaz3 %n pro!%s !e n%mit a"i! la"ti" + A"i!%lla"ti" este %n iritant "are ar p%tea !istr%(e "el%lele0 !eoare"e a"esta este %n a"i!<i pert%r/3 e"hili/r%l normal !e a"i!-/az3 :n "reier+ ona !e is"hemie estemen6ionat3 !e la5 "a .is"hemi" pen%m/ra +. 7=&9

Ca o$i(en sa% (l%"oz3 !eple6iei :n 6es%t%l "ere/ral is"hemi"0 pro!%"6ia !e *os*at"% ener(ie ri!i"at3 "omp%<i5 "%m ar a!enozina tri*os*at #ATP' e<%eaz30 "eea "e!%"e la e<e"%l pro"eselor !epen!ente !e ener(ie #"%loare5 "%m ar pompareion' ne"esare pentr% s%pra)ie6%irea "el%lelor tis%lare+ A"est l%"r% sta/ile<te o

serie !e e)enimente inter!epen!ente a a)%t "a rez%ltat %n pre?%!i"i% "el%lare si!e moarte+ , "a%za ma?ora a pre?%!i"i%l%i ne%ronale este eli/erarea !e (l%tamatne%rotransmitator e$"itator+ Con"entra6ia !e (l%tamat :n a*ara "el%lelorsistem%l%i ner)os este :n mo! normal men6in%t s"3z%t !e a<a-n%mi6ii p%rt3tori !ea/sor/6ie0 "are s%nt alimentate !e (ra!ien6ii !e "on"entra6ie a ionilor # :nprin"ipal Na V' prin mem/rana "el%lar3+ T,TUI0 a""i!ent )as"%lar "ere/ral taiealimentarea "% o$i(en <i (l%"oz3 "are alimenteaz3 ion%l pompele Men6inerea(ra!ienti tezei+ Ca rez%ltat0 (ra!ien6ii transmem/ranar !e ioni r%la :n ?os0 iartransportatorii (l%tamat in)ersa !ire"6ia lor0 eli/erarea !e (l%tamat :n spa6i%le$tra"el%lar+ Gl%tamat%l a"tioneaza as%pra re"eptorilor !in "el%lele ner)oase #in

spe"ial re"eptori NMDA'0 "are pro!%" pe in4%$ !e "al"i% pe "are enzimele a%!i(era ACTI1ATES "el%lele proteine0 lipi!e <i materiale n%"leare+ Prin %rmare 0in4%$%l !e "al"i% poate !%"e la e<e"%l mito"on!rii 0 "eea "e poate !%"e mai!eparte spre ep%izarea ener(iei <i poate !e"lan<a moartea "el%lelor !in "a%zamor6ii "el%lare pro(ramate + 7==9

Is"hemia in!%"e ast*el pro!%"erea !e ra!i"ali li/eri !e o$i(en <i a altor spe"ii !eo$i(en rea"ti)e + A"estea rea"6ioneaz3 "% <i !eteriora %n n%m3r !e elemente"el%lare F + M%n"a la ni)el%l en!oteli%l%i <i n% :n "reier per se

ra!i"alilor li/eri De"i 0 ini6iaz3 :n mo! !ire"t elemente ale "as"a!a !e moarte"el%lar3 pro(ramat3 prin interme!i%l re!o$ !e semnalizare + 7=>9

A"este pro"ese s%nt a"elea<i pentr% ori"e tip !e 6es%t is"hemi" <i s%nt !en%mite!e "ole"ti) "as"a!a is"hemi"3+ T,TUSI0 6es%t%l "ere/ral este !ra(oste !eose/it!e )%lnera/il3 la is"hemie 0 !eoare"e are rezer)e p%6in3 respiratorie <i este"omplet !epen!ent3 !e apel la meta/olism%l aero/ 0 spre !eose/ire !ema?oritatea "elorlalte or(ane+

In pl%s *ata !e e*e"tele !a%natoare as%pra "el%lelor "reier%l%i0 is"hemie <i in*ar"tpoate !%"e la pier!erea inte(rit36ii str%"t%rale a )aselor !e s2n(e ale 6es%t%l%i"ere/ral <i0 :n parte 0 prin eli/erarea !e metaloproteaze !e matri"e0 "are s%nt

enzime <i !e "al"i%-zin" - !epen!ente !e "ola(en a r%pt :n ?os0 a"i! hial%roni" <ialte elemente ale 6es%t%l%i "on?%n"ti) + Ast*el :n"2t alte proteaze "ontri/%ie laa"est pro"es+ Pier!erea rez%ltatelor )as"%lare a inte(rit36ii str%"t%rale :ntr - o!e*al"are a prote"tor /ariera hematoen"e*ali"3 a *a"%t Contri/%ie la r3sp2n!ireae!em "ere/ral 0 "eea "e poate !%"e la pro(resia se"%n!ara a pre?%!i"i%l%i a"reier%l%i+ 7 Ne"esit3 "itare 9

hemora(i"a

S2n(erare :n interior%l "a)it36ii "rani%l%i poate aparea !in !i)erse "a%ze+S%/!%ral <i epi!%ral3 s2n(erare s%nt :n mare parte rez%ltat%l %nei tra%me+ 7=@9a""i!ente )as"%lare "ere/rale hemora(i"e apar !e s2n(erare :n paren"him%l"ere/ral sa% spa6iile intra)entri"%lar3 <i s%nt "lasi"ate pe /aza patolo(iei lor !e/aza+ C2te)a e$emple !e a""i!ent )as"%lar "ere/ral hemora(i" s%nt hemora(iehipertensi)i 0 r%pt%ra !e ane)rism 0 r%pt%rii st%le A1 0 trans*ormarea in*ar"t%l%iis"hemi" :nainte0 <i in!%s3 !e me!i"amente s2n(erare+ 7=9 Ei !%"e la lezi%nitis%lare prin "a%zarea !e "ompresie !e tes%t !e la e$tin!erea hematom sa%hematoame+ A"est l%"r% se poate !e*orma <i r3ni 6es%t%l+ In pl%s0 presi%nea

poate !%"e la o pier!ere a alimentarii "% san(e a tes%t%l%i a*e"tat "% Rez%lt2n!in*ar"t0 iar s2n(ele eli/erat prin hemora(ie "ere/ral3 pare a a)ea e*e"te to$i"e!ire"te as%pra tes%t%l%i "ere/ral si )as"%larizatia+ 7&;9 7=9 In4ama6ia "ontri/%iela se"%n!ar lezi%ni "ere/rale !%p3 hemora(ie+ 7=9

!ia(nosti"

Un CT "are prezint3 semne timp%rii ale %n%i a""i!ent )as"%lar "ere/ral arterei"ere/rale me!ii "% pier!erea !eni6iei a (Jri <i limita !e al/ (ri

Dens semn mass-me!ia la %n pa"ient "% in*ar"t arterei "ere/rale me!ii a<ate :nst2n(a+ ima(ine !reapta !%p3 ore+

A""i!ent )as"%lar "ere/ral este !ia(nosti"at prin mai m%lte tehni"i5 %n e$amenne%rolo(i" #5 "%m ar NIHSS '0 s"aneaza CT #"el mai a!esea *ara im/%natatiri !e"ontrast' sa% s"anarea RMN 0 e"o(rae Doppler si arterio(rae + Dia(nosti"%l !ea""i!ent )as"%lar "ere/ral in sine este "lini"0 "% asistenta !in tehni"ileima(isti"e+Prin %rmare0 tehni"ile ima(isti"e AYUTA !eterminist3 s%/tip%rile )ersionsi minerit !e a""i!ent "ere/ral "a%za )as"%lare+ In"a n% e$ista %tilizate*re")enttest !e san(epentr% Dia(nosti"%l !e a""i!ent )as"%lar "ere/ral :n sine0!e testele Desi San(e pot !e a?%tor Intr - %n %n a4a "a%za pro/a/il3 )as"%lar

"ere/ral a""i!ent%l%i+ 7=F9

"ontrol%l me!i"al

,NU e$amen zi"0 Prin In"l%si)e a!optarea Un%iistori" me!i"alAl si on%simptomelor ne%rolo(i"e Stat%t0 AYUTA la o !a o E)al%are o Si a lo"atiei (ra)it36iia""i!ent )as"%lar "ere/ral Un%i+ A"esta !a on% "rasnii stan!ar! 0 !e e$empl% 0

SC,R0s"ara a""i!ent )as"%lar "ere/ral NIH +

Ima(isti"a

Pentr% !ia(nosti" a""i!ent )as"%lar "ere/ral zona is"hemi"3 !e setareaURGENTA5 7>9

CT s"aneaza # *ara im/%natatiri !e "ontrast'



sensi/ilitate Z 8@

spe"i"itate Z F@

S"anare RMN

Z & sensi/ilitate

Z F spe"i"itate

Pentr% zona !e !ia(nosti" a""i!ent )as"%lar "ere/ral in hemora(i"e !e URGENTAsta/ilirea5

CT s"aneaza # *ara im/%natatiri !e "ontrast'

Z F sensi/ilitate

spe"i"itate Z 8

S"anare RMN

Z 8 sensi/ilitate

spe"i"itate Z 8

Pentr% !ete"tarea hemora(iilor "roni"e0 S"anare RMN - %l mai sensi/il Este+ 7>89

Pentr% a""i!ent !e sta/il E1ALUAREA )as"%lar "ere/ral0 me!i"inala SPECT siN%"leara s"aneaza PET O CT pot !e a?%tor+ Do"%mente SPECT "ere/ral si l%$%lsan(%in "% PET - DG izotop%l %n Meta/oli"a A"ti)itatea ne%ronilor+

"a%za prin"ipala



8; )erti"alizare ECG %n pa"ient "% Un%i a""i!ent )as"%lar "ere/ral on%0 :n(ri?ireArata mari pro*%n! r3st%rnatT-)al%ri+ Di)erse )as ECG Mo!i"ari la Persoanele "%ap3rea a""i!ente )as"%lare "ere/rale si )e"hi ale t%l/%rari "reier%l%i+

At%n"i "an! on% a""i!ent )as"%lar "ere/ral a !ia(nosti"at ost0 !i)erse oal3 )e"hiSt%!ii e*e"t%ate pentr% o mea !eterministe "a%za prin"ipala+ C% tratament%lreal I op6i%nile !e !ia(nosti"are Disponi/ile0 Este !e o IMP,RTANTA a mea!eterministe spe"iala DACA e$ista o S%rsa Peri*eri"a !e em/olii+ Sele"6ia !e Testare "rasnii 1aria0 !e a""i!ent !eoare"e "a%za )as"%lar "ere/ral 1ariaz3 "%1arsta0"omor/i!it36i+ I Clini"a Prezentarea Urmatoarele S%nt *re")ent %tilizatetehni"i5

pe %ltras%nete st%!i% O !oppler al arterelor "aroti!e #Pentr% a !ete"ta stenoza"aroti!ian3 ' Sa% !ise"6ia pre"ere/ral arterelor

pentr% ele"tro"ar!io(ram3 #ECG' I e"o"ar!io(rama #Pentr% a i!enti"a aritmiisi!e "hea(%ri rez%ltanta in Inima pe !e :n(ri?ire se "rasnii rasari la )asele "reier%l%iimp l%$%l san(%in'

on% monitor Holter !e %n st%!i% pentr% INTERMITENTE i!enti"a ritm "ar!ia"anormal

z(omot an(io(raa)as"%larizatiei "ere/ral3 #:n prin"ipal Caz%l !e in(ri?ire in o SECREDE o s2n(erare !e pro)enit la laane)rism s"roa*3 mal*ormatii arterio -)enoase '

Teste !e s2n(e pentr% o mea !eterminist3 DACA"olesterol%l !in s2n(e este mare0n :n(ri?ire Caz%l )ersion e$ista o anormal3ten!in63 !e s2n(erare0 IAR )ersionCaz%l :n :n(ri?irea %nele rare pro"ese0 "%m ar 5hemo"istin%rie ar impli"aRe"lamatia a+

prola$ie

A)ans )ersion Po)ar3 Bolii !e 1e!ere a""i!ente )as"%lare "ere/rale0 pre)enireaEste !e importanta on% s3n3tate p%/li"3:n(ri?orare+ 7>;9 Pre)enirea primar3 Estemai p%tin e"a"e DECAT Pre)entia se"%n!ar3 #"a !e Y%!e"ate n%m3r%l ne"esarpentr% a tratapentr% o pe pre)eni on% a""i!ent )as"%lar "ere/ral pe'+ 7>;9orient3ri re"ente !etaliaz3 Do)ezi pentr% Pre)entia PRIMARA %n a""i!ent%l%i

)as"%lar "ere/ral+ 7>&9 )ersion CEI :n(ri?ire S%nt sanatosi ALTEL0 aspirina N% Par[BENEICA Si a *%(it0 Prin %rmare0 mentionate N% este re"oman!ata + 7>=9 La



:n(ri?ire a% on% Persoanele A)%t !e in*ar"t mio"ar!i" la Sa% ri!i"at"ar!io)as"%lare "% on% CEI RISC0 %nele *%rnizeaz3+ A""i!ent Un%i PR,TECTIEmpotri)a prim )as"%lar "ere/ral 7>>9 7>@9 )ersion !e :n(ri?ire a% A)%t CEIanterioare on% a""i!ent )as"%lar "ere/ral0 "% tratament%l me!i"a mente5 "%m araspirina + "lopi!o(rel I !ipiri!amol+ Poate /ene"3 7>>9 !in SUA a ser)i"iilor

!e pre)enire tasK or"e #USPST' mpotri)a Re"oman!a s"reenin( - %l pentr%artera "aroti!a stenozain *ara Simptome CEI+ 7>9

!e ris" a"tori

Cei mai importanti a"tori !e ris" mo!i"a/il pentr% a""i!ent )as"%lar "ere/ralS%nt hipertensi%nea arteriala si /rilatie atriala #C% Toate C ma(nit%!inea

a"est%i e*e"t Este mi"5 !o)ezile Este DIN St%!iile "lini"e Resear"h Co%n"il *a"%t&& !e Pa"ienti TREBUIE sa %* tratate Timp !e 8 pe0 pentr% o pre)eni a""i!ent)as"%lar "ere/ral ,NU 7>9 7>F9 '+ Altimetr% !e a"tori ris" mo!i"a/ili in"l% %ll Time Ni)el%l "olesterol%l%i )ersion s2n(e0 !ia/et zaharat0 *%mat%l 7@9 7@89 0#ACTI1A I pasi)a' (rele0"ons%m%l !e al"ool 7@;9 Si a "ons%m%l%i !e Dro(%ri0 7@&90 !e Lipsaa"ti)itate zi"3 + o/ezitatea 0 pro"esata "arne rosieCons%m%l 7@=9 IAlimenta6ia nes3n3toas3+ 7@>9 Cons%m%l !e al"ool ar la on% Re"lamatia apre!isp%ne a""i!ent is"hemi" "ere/ral )as"%lar0 si si intra"ere/ralas%/arahnoi!ian3 hemora(ie0 Prin interme!i%l %nor Me"anisme m%ltiple #!eE$empl%0 Prin interme!i%l hipertensi%nii arteriale0 /rilatie atriala0 !e

re)eniretrom/o"itoza I a(re(area trom/o"itelor I !e "oa(%laret%l/%r3rile'+ 7@@9Dro(%ri0 "el mai *re")ent am*etamine I Co"aina0 "rasnii in!%"e on% a""i!ent)as"%lar "ere/ral0 imp ale 1aselor !e lezi%ni s2n(e DIN "reier Si O Sa%hipertensi%ne a"%ta+ 7@9 7@9

N% e$ista St%!ii !e Calitate a% !emonstrat inalta e"a"itatea inter)en6iilor!estinat3 :n re!%"erii (re%t36ii0 re(lementeaz3 promo)area e$er"itiilor izi"e0 !ere!%"erea "ons%m%l%i al"ool Sa%ren%n6area la *%mat+ 7@F9 C% Toate a"estea0A)ans )ersion 1e!ere !e mare Corp%l "ir"%mstan6iale Do)ezi0 "el mai /%n !e

mana(ement me!i"al pentr% a""i!ent )as"%lar "ere/ral in"l%! Consi(liere "%Pri)ire la Dieta+0 E$er"itii zi"e0 *%mat%l !e "ons%m%l I al"ool 79 Me!i"a MenteSa%!ro(%ri terapie Este mai Com%na CEA !e pre)enire "ere/ral3 Meto!a !ea""i!ent )as"%lar0 en!artere"tomie "aroti!ian3Poate o Utila !e Meto!a"hir%r(i"al3 !e pre)enire a""i!ent%l%i )as"%lar "ere/ral+

tensi%ne arteriala

Hipertensi%nea#Tensi%ne arteriala ri!i"ata' reprezint3 &>-> a ris"%l%i !e"ere/ral a""i!ent )as"%lar+ 789 Re!%"erea tensi%nii arteriale !e 8 mmH( aarteriale sistoli"e tensi%nii Sa% > mmH( !iastoli"e Re!%"e ris"%l "% )as"%lar"ere/ral a""i!ent !e \ =+ 7;9 S"3!erea tensi%nii a !emonstrat arteriale :nmo! ost "on"l%!ent3 pentr% o pre)eni "ere/ral3 Am/ele a""i!ente )as"%lare

is"hemi"e I hemora(i"e+ 7&9 7=9 Este la LE !e important3 :n Pre)entiase"%n!ar3+ 7>9 Chiar I pa"ien6ii "% 1arsta !e Peste ani si "% CEIizolathipertensi%ne sistoli"3!e pe /ene"ia + Urma tratament%l%i antihipertensi) 7@979 79 !o)ezile N% Disponi/ile Mari Arata !i*erente )as"%lare "ere/ralePre)entia a""i!ent%l%i me!i"a mente Dintre -there*ore antihipertensi)e0 ALTIa"tori5+ 0 C%m ar Prote"tia mpotri)a altor *orme !e Boli "ar!io - )as"%lare si %n"ost%rilor ar tre/%i Sa e l%ate )ersion "onsi!erare 7F9 79 %tilizarea !e R%tina%n/eta-/lo"ante%n C] %rmare UNEI a""i!ent )as"%lar "ere/ral AIT Sa% a% !o)e!ito hasnt ""a A)ea Rez%ltat /ene"ii+ 789

DIN San(e lipi!elor

De Ni)el%rile ri!i"ate "holesterol a% ost in"onse")ent "% on% Aso"iate !ea""i!ent )as"%lar "ere/ral #is"hemi"'+ 7=9 7;9 Statineles - a% !o)e!it a re!%"eris"%l !e a""i!ent )as"%lar "ere/ral "% apro$imati) 8>+ 7&9 Deoare"eAnterioare meta ale altor analizeme!i"amente !e re!%"ere a lipi!elorN% %n on%Prezinta ris" s"az%t0 7=9 statine s - ar e$er"ita E*e"t%l "er%le Re"lamatia a imp

"er%le Altele DECAT !e e*e"tele %nei s"a!ere + lipi!elor Me"anisme 7&9

zaharat !ia/et%l

Dia/et%l zaharat!e a""i!ent Creste ris"%l )as"%lar "ere/ral "% ; la & P^na ori+ In"e on% Timp !e "ontrol !e intens ahar DIN San(e a ost !e !emonstrat ore!%"ere a ale mititei "ompli"a6ii 1aselor !e s2n(e0 "%m ar 5lezi%ni renale Ilezi%ni ale retinei o"hi%l%iea sa !o)e!it o hasnt re!%"e mari ale "ompli"a6ii

1aselor !e s2n(e5+ 0 C%m ar a""i!ent )as"%lar "ere/ral 7>9 7@9

Me!i"a Mente anti"oa(%lare

oral anti"oa(%lant5 "%m ar ar*arinaa% prin"ipal%l a""i!ent ost !e pilon%l)as"%lar !e "ere/ral pre)enire > !e Peste ani+ Aspirina Tot%<i0 mai m%lte st%!iia% aratat si Me!i"a Mente *a"%t S%nt e$trem !e antipla"hetare e"iente

)ersionpre)en6ia se"%n!ar3a""i!ent )as"%lar D%pa on% "ere/ral is"hemi"tranzitor Sa% ATAC+ 7>>9 A6ipire !e mititei aspirina #!e >-8> m( E$empl%' S%nt



la LE !e e"a"e C] mo63ie mari0 reprezinta a% mai p%tine laterala E*e"te + MaiMi"3 0 CEA Doza e"a"e Ramane ne"%nos"%ta 7 9 tienopiri!ine # "lopi!o(rel +ti"lopi!in3 ' Ar PUTIN mai Re"lamatia a E"ient a% DECAT I UN Aspirina !e ris"s"3z%t s2n(erare (astro - intestinal30 Reprezinta S%nt mai s"%mpe+ 79Clopi!o(rel s%nt mai p%tine E*e"te se"%n!are DECAT ti"lopi!in3+ 79

Dipiri!amol%lPoate A!a%(at la terapia "% aspirina pentr% o o*eri on% mi"/ene"i% s%plimentar l%mea !in "are am DACA !%rerea !e "ap Este on% e*e"tse"%n!ar Com%n+ 7F9 !oze mi"i !e aspirina Este atat !e E"ient pentr%Pre)enirea a""i!ent )as"%lar "ere/ral0 in(ri?ire !%pa a% mio"ar!i" in*ar"t ,NU+7>@9

"% Cei /rilatie atrialaa% on% > on% ris" !e a !e a""i!ent )as"%lar "ere/ral0 IARACEST RISC Este mai mare in "% /rilatie atriala CEI )al)%lar3+ 7F9 prin"ipal n !eris"%l !e %n"tie a""i!ent )as"%lar "ere/ral0 anti"oa(%larea "% me!i"a mente5"%m ar ar*arinaSa% pentr% UTIL Este aspirina Pre)enirea+ 7F89 "% "% e$"ep6iapersoanelor /rilatie atriala0anti"oa(%lante oraleN% pentr% Pre)entia S%ntRe"oman!ate )as"%lar "ere/ral a""i!ent%l%i -ori"e Este /ene"i% !e "ompensat3!e ris"%l s2n(erare+ 7F;9

Prin"ipal n Pre)entia PRIMARA T,TUI0 me!i"a mente antipla"hetare N% a re!%"eis"hemi" a""i!ent !e ris"%l )as"%lar "ere/ral0 reprezint3 %n "res"%t ris"%l !es2n(erare Ma?ore+ 7F&9 7F=9 S%nt ne"esare st%!ii s%plimentare pentr% o

in)esti(a6ie Posi/il on% e*e"t prote"tor !e aspirina mpotri)a a""i!ent )as"%lar"ere/ral is"hemi" la *emei+ 7F>9 7F@9

"hir%r(ie

en!artere"tomie "aroti!ian3 Sa% "aroti!3 an(ioplastia Poate %tilizat pentr% aelimina %n :n(%starea ateros"leroti"e arterei "aroti!e+ N% e$ista Do)ezi )ersionspri?in%l a"estei Pro"e!%ri )ersion "az%rile sele"tate+ 79 En!artere"tomJ pentr%

o stenoza semni"ati)3 a ost !o)e!it a %til )ersion Pre)enirea a""i!ente)as"%lare "ere/rale s%plimentare la CEI !e :n(ri?ire a% A)%t ![?] UNUL+ 7F9Artera "aroti!a stentin( hasnt sa !o)e!it %n la LE !e UTIL+ 7F9 7FF9 ,ameniiS%nt sele"tate pentr% o iNTER1ENTIE "hir%r(i"al3 )ersion UNCTIE !e 12rst30 se$0Gra!%l !e stenoza0 Timp0 !eoare"e simptomele I pre*erin6ele persoanei+ 79 Tratament%l "hir%r(i"al Este "el mai E"ient at%n"i "an! N% este :nt2rziat ,NUris" !e -,RAUL ment prea a""i!ent )as"%lar "ere/ral INTR re"%rente - in(ri?irepa"inet s%nt on% o stenoz3 !e + > mai mare Sa% ; Pana la > ani !%pa0 estere!%"erea en!artere"tomie ACEST RISC la apro$imati) > N%mar%l !e Pro"e!%ripentr% ne"esare o :n(ri?ire pa"inet > pentr% on% trata o iNTER1ENTIE "hir%r(i"al3

pre"o"e #:n Termen !e Do%3 a""i!ent ini6ial !%pa saptamani )as"%lar "ere/ral'0reprezint3 8;> z3/o)it m%lt DACA !e 8; saptamani+ 789 7889



S"reenin( - %lpentr% hasnt Artera "aroti!a :n(%starea sa !o)e!it %n !e test on%UTIL )ersion Pop%la6ia (eneral3+ 78;9 St%!ii !e inter)entie "hir%r(i"ala pentr%stenoza arterei "aroti!e *ara Simptome a% ar3tat Doar o Mi"3 s"a!ere a ris"%l%i

!e "ere/ral a""i!ent )as"%lar+ 78&9 78=9 Sa e BENEICA0 !e rata "ompli"atie ainter)en6iilor "hir%r(i"ale TREBUIE Sa e men6in%t s%/ - =+ Chiar I at%n"i0pentr% 8 !e "hir%r(i"ale inter)entii0 > Pa"ienti "ere/ral in %rma /ene"ia !ea""i!ent e)itarea )as"%lare0 & 1A !ez)olta on% a""i!ent )as"%lar "ere/ral inCi%!a inter)entiei "hir%r(i"ale0 & 1A ,NU !ez)olta a""i!ent )as"%lar "ere/ral Sa%mor DIN "a%za inter)en6iei "hir%r(i"ale )ersion sine0 :nainte !e a F I on%Ramane !e a""i!ent )as"%lar "ere/ral li/er0 reprezinta %rmare imp0 S - ar *a"%tACEST LUCRU iNTER1ENTIE *3r3+ 79

re(im alimentar

N%tri6ie0 !e "onstr%"6ii!ieta stil me!iteranean0 S%nt !e Poten6ial%l !e %nre!%"erea ris"%l%i !e a""i!ent on% )as"%lar A)ea "ere/ral "% mai m%lt !e Y%matate+ 78>9 ACEASTA N% o t%n!e *a"%t !e s"a!erea ni)el%l%ihomo"isteina "%a"i! *oli"!e "ere/ral a*e"teaza ris"%l !e a""i!ent )as"%lar+ 78@9 789

*emei

, serie !e REC,MANDRI SPECIICE A% ost a"%te pentr% *emei aspirina l%areain"l%si)e !%pa %n 88 -a S3pt3m:na !e Sar"ina0 DACA e$ista %n ante"e!ent !e Tensi%ne arteriala ri!i"ata "roni"e si l%an! Me!i"a Mente %n tensi%nii arteriale)ersion Timp%l sar"inii0 n Caz%l :n :n(ri?irea tensi%nea arteriala Este mai mare !e8> mm H( a tensi%nii arteriale sistoli"e mai mare Sa% 8 mmH( !iastoli"3DECAT+ In a% A)%t !e :n(ri?ire a ICE anteriorpree"lampsiaaltimetr% !e a"tori ris"ar tre/%i sa %* mai AGRESI1 tratate+ 789

a""i!ent )as"%lar "ere/ral AIT Sa%

Se Re"oman!a s%/ - men6inerea tensi%nii arteriale 8=OF mmH(+ 78F9Anti"oa(%larea "rasnii "ere/ral3 pre)eni a""i!ente )as"%lare is"hemi"ere"%rente+ Printre "% /rilatie atriala Persoanele non)al)%lar0 anti"oa(%lareaa""i!ent )as"%lar re!%"e "rasnii "% "ere/ral !e @0 iar :n Timp "e pot re!%"e

antipla"hetari A(en6i !e a""i!ent )as"%lar "ere/ral "% ;+ 7889 T,TUI0 ore"enta meta-analizeaz s%(ereaz3 ,NU pre?%!i"i% !e anti-"oa(%lare a in"ep%t

mai !e)reme !%pa o em/oli"e !e "ere/ral a""i!ent )as"%lar+ 78889 tratament%l!e pre)enire a a""i!entelor )as"%lar "ere/ral pentr% /rilatie atriala Este Apelan!!eterministe al%minat lasistem%l CHADS O CHADS;+ anti"oa(%lant mai %tilizat pes"ara pentr% %n Lar(a pre)eni on% a""i!ent )as"%lar "ere/ral la pa"ientii "%trom/oem/oli"e /rilatie atriala non)al)%lar Este a(ent !e oralaar*arin3 )ersion

"e on% Timp N%mar !e noi in"l%si)e A(en6i ete$ilatalternati)e S%nt0 !e :n(ri?ireN% Ne"esitatimp%l !e protrom/in3!e monitorizare+ 78F9

Anti"oa(%lantele0 At%n"i "an! Este %tilizat on% a""i!ent )as"%lar "ere/ral !ein(ri?ire %rmeaza0 ar tre/%i S3 N% %* pentr% pro"e!%rile !entare oprit+ 788;9

n :n(ri?irea prin"ipal n Caz%l St%!iile "aroti!ian3 Arata stenoza0 s%nt o persoana

IAR UNCTIE )ersion rezi!%al3 Partea a*e"tat30 en!artere"tomia "aroti!ei #oin!epartarea "hir%r(i"ala stenoza' "rasnii re!%"e ris"%l !e re"%ren63 a% ostDACA a""i!ent on% "ere/ral e*e"t%ate )as"%lar rapi! !%pa+

A!ministrare

a""i!ent )as"%lar "ere/ral is"hemi"

Re!%"e !e aspirina ris"%l re"%ren63 la ni)el mon!ial "% 8&0 "% o mai mare !e/ene"i% timp%ri%+ 788&9 Terapia "% si(%ran63 :n minere% s%nt ""a Cate)a Primele/ar! Prin eliminarea /lo"a?%l%i r%perea "hea( )ersion ?os #trom/oliz3 ' Sa% l%i Prinin!epartarea Me"hani"allJ # trom/e"tomie'+ Premisa !e :n(ri?ire loso"3 sta laBaza !e a""i!ent rapi! importan6ei inter)en6iei )as"%lar "ere/ral0 :n(ri?ire %nRez%mat ""a Timp%l Este "reier%l_ La Anilor 8FF+ In"ep%t%l 788=9 Cati)a ani maitarzi%0 o i!ee *a"%t A"eeasi0 a% !e Rez%ltate rapi!e resta%rare a 4%$%l%i san(%in"ere/ral :n "el%lele "reier%l%i mai p%tine pe moarte0 %n ost I !o)e!it

"%anti"ate+ 788>9

%n "ontrol al ,NU stri"t !e zah3r DIN s2n(e )ersion Primele Cate)a minere% N% :m/%n3t36e<te Rez%ltatele I DAUNE oal3 pro)o"a+ 788@9 Hipertensi%nea arterialaEste0 Prin %rmare0 nU %n REDUS AR :n mo! o/isn%it ACEST hasnt sa !o)e!it a !e a?%tor+ 7889 788 9

trom/oliza

Trom/oliza 05 C%m ar "% re"om/inant a"ti)ator !e plasmino(en tis%lar+ #RtPA' 0 :n a"%t3 is"hemi"3 A1C0 A!ministrat )ersion !e"%rs !e Prepelea" minere% !esimptom !e !e/%t Rez%ltate intr - /ene"i% ,NU (lo/al !e 8 a63 !e 1ia63 *3r3in)ali!itate 788F9 78;9 N% *ata0 t,TUI0 pentr% o + m/%n3t36i <ansele !es%pra)ie6%ire 7 88F9 Bene"i%l Este mai mare "at mai !e)reme Este *olosit+ 78;89

Intre Prepelea" I P3tr% minere%l I Y%matate e*e"tele S%nt mai p%tin Clara+ 78;;978;&9 78;=9 o Re)iz%ire ;8= a (asit o CRESTERE !e > a n%m3r%l%i !e :n(ri?irepersoane tRAIESC *3r3 !iza/ilitati la Prepelea" p^na la SASE l%ni Tot%<i0 %ne$istat on% ris" "res"%t "% ; !e !e"es pe Termen a4%en63+ 78;9 !%pa P3tr% Itrom/oliza minere% I Y%matate a(ra)eaz3 Rez%ltatele+ 78;;9 A"este /ene"ii Sa%Lipsa !e /ene"ii %n A)%t lo" !e In!i*erent 1arsta persoanei tratate+ 78;>9 N%e$ista Ni"i o Mo!alitate !e Si(%ra a mea !eterministe !e :n(ri?ire a illha)e laon% Tratament post - hemora(ie intra"ranian30 a63 !e :n(ri?ire N% se + 1A 78;@9

Utilizarea a"est%ia !e APR,BAT Este C3tre Ameri"an Heart Asso"iation siA"a!emia Ameri"ana !e Ne%rolo(ie""a Tratament re"oman!at pentr% a"%t3)as"%lar "ere/ral a""i!ent Termen !e minere% Prepelea" !e la !e/%t%lsimptomelor0 atata Timp CA n% e$ista )e"hi "ontrain!i"a6ii #5 "%m ar 1alori !eanormale la/orator0 Tensi%ne arteriala ri!i"ata0 SAU re"ent o INTER1ENTIE"hir%r(i"al3'+ ACEASTA Pozitie pentr% TPA se /azeaz3 pe Rez%ltatele a Do%aSt%!ii !e C3tre on% (r%p !e in)esti(atori 78;9 CEEA CE a *a"%t TPAm/%n3t36e<te Shoe! <ansele pentr% on% ne%rolo(i"3 /%n Rez%ltat+ At%n"i "an!Este a!ministrat3 )ersion Primele Trei minere% !e trom/oliza Im/%natatesteRez%ltat *%n"tional *ara o a*e"ta mortalitate+ 78; 9 @0= "% a""i!ente Dintre

Persoanele mari "ere/ral )as"%lare !ez)oltat o hemora(ie s%/stantiala "reier%l%i""a o !e o "ompli"a6ie !at %n TPA *%(it0 Prin %rmare0 o Parte DIN pentr% moti)%lpe Cresterea mortalit36ii Termen a4%en63+ 78;F9 n pl%s0A"a!emia Ameri"ana !eMe!i"ina !e %r(entaa% stat Do)ezi ,/ie"ti)e "a%zei pri)in! e"a"itatea0 pentr% alSi(%ran6ei I on% TPA apli"a/ilitatea a""i!ent )as"%lar "ere/ral a"%t is"hemi"Este pentr% %n ins%"ient sa "a ?%sti"are "lasi"areastan!ar! !e in(ri?ire+ 78&9/rinoliza intra-arterial0 n Caz%l )ersion !e :n(ri?ire a ,NU Cateter Este pe Arterain "reier Tre"%t0 IAR Este me!i"ament%l !e in?e"tat la L,CUL trom/oza0 o pentr%%n ost (asit la Rez%ltatele im/%natati "ere/ral is"hemi" "% Persoanele a""i!ent)as"%lar+ 78&89

"hir%r(ie

Trom/e"tomia"rasnii se im/%natati Rez%ltatele DACA *a"e mai !e)reme0 )ersion"el mare "% CEI anterioara !e tira? "hea( Artera+ 78&;9 A"esta T,TUSI N% mo!i!e ris"%l !e"es+ 78&&9

a""i!ent )as"%lar "ere/ral mari oal3 teritori% pro)o"a %n %m4area semni"ati)e"reier%l%i "% lezi%ni "ere/rale se"%n!are )ersion 6es%t%l :n"on?%r3tor+ ACESTenomen Este0 !e prin"ipal intalnite "ere/ral )ersion ale a""i!ente )as"%lare"ere/rale me!ii teritori%l%i arterei0 si0 Prin %rmare0 Este n%mit .in*ar"t "ere/ralmali(n3. !eoare"e pro(nosti" s%m/r% al ,NU poarta+ U<%rarea "rasnii

presi%nea "% me!i"a mente :n"er"at30 reprezint3 Ne"esita%nelehemi"ranie"tomJ0 , in!epartarea "hir%r(i"al3 temporar3 pe o "rani%l%i oParte "ap%l%i+ ACEST LUCRU re!%"e ris"%l !e !e"es0 "% Toate UNII ,ameni mai CMULI "% !iza/ilitati s%pra)ie6%ies"0 !e :n(ri?ire ar m%rit Alt*el+ 78&=9

a""i!ent )as"%lar "ere/ral hemora(i"e

"% Persoanele hemora(ie intra"ere/ral3 Ne"esita ne%ro"hir%r(i"al3!e e)al%arepentr% o !ete"ta I trata "a%za hemora(iei Desi mai m%lte N% ar Re"lamatia aA)ea Ne)oie !e o INTER1ENTIE "hir%r(i"al3+ Anti"oa(%lantele I antitrom/oti"e0or!s )ersion pasit zona !e a""i!ent )as"%lar "ere/ral is"hemi"0 "rasnii se"on*r%nt3 "% s2n(erare mai RAU+ ,amenii S%nt monitorizate pentr% Mo!i"ari aleni)el%l%i !e "on<tien630 Si o arteriale "er%le tensi%nii0 !e zah3r DIN s2n(e0 si s%ntla on% o$i(enare men6in%te Ni)el optim+ 7Ne"esit3 "itare 9

)as"%lar "ere/ral %nitate !e a""i!ent

n mo! - a% i!eale !e in(ri?ire a""i!ent A)%t ,amenii on% )as"%lar "ere/ral la oS%nt a!mise .%nitate !e a""i!ent )as"%lar "ere/ral.0 o Se"tie o Sa% onaDe!i"ata Spital0 "% *ormat personal me!i"ale si DIN asistente terape%ti "%e$perienta in tratament%l !e "ere/ral a""i!ent )as"%lar+ S - a ar3tat ,amenia!mise la o %nitate !e a""i!ent )as"%lar "ere/ral %n A)%t o Sansa mai mare !es%pra)ie6%ire DECAT Cele a!mise )ersion "ere/ral a""i!ent )as"%lar Alt3 ParteSpital l%mea !in "are am DACA a"estea S%nt :n(ri?i6i !e Me!i"i *ara e$perienta in+7;9 78&>9

At%n"i "an! a""i!ent )as"%lar "ere/ral a"%ta !e istorie Este /3n%it I IICE$amen%l0 !e e)al%are o/ie"ti)%l !e %n !arK Este mea !eterminist "a%za+ Tratament%l "a%zei 1ariaz3 Apelan! %n Prin"ipal` )as"%lar "ere/ral a""i!ent%l%i0trom/em/oli"e #is"hemi"' Sa% hemora(i"e+

rea/ilitare

rea/ilitare a""i!ent )as"%lar "ere/ralEste Pro"es%l !e in(ri?ire imp ICE "%a""i!ente )as"%lare "ere/rale !iza/ilitante S%nt s%p%se Un%i Tratament pentr%%n Le AYUTA S3 Re)ina la o 1iata normala CA mai m%lt Posi/il Prin re"2<ti(area IRein)atam a/ilit36ile !e Trai !e zi "% zi+ Ast*el0 this s%nt Drept /ar! S3 a?%teS%pra)iet%itor%l S3 se :n6elea(3 Si Sa a!apteze la !i"%lt36i0 Pre)enirea

"ompli"a6iilor se"%n!are Si Sa !e!%"e Mem/rii amiliei S3 ?oa"e on% !e lei Spri?in+

, E"hipa !e rea/ilitare Este De m%lti!is"iplinar3 o/i"ei0 !eoare"e !e Este 1or/apersonal3 "% :n(ri?ire A/ilit36i Di*erite l%"reaz3 pentr% o AYUTA mpre%napa"ient%l+ A"estea in"l%!e me!i"ale in Me!i"ina instr%iti !e rea/ilitare0*arma"isti"lini"e0 A Personal%l%i me!i"al0zioterape%6i + er(oterape%6i + lo(opezi I ortezare+Prin %rmare0 pot Einsatz(r%ppen in"l%! %nelepsiholo(i I asisten6i so"iali 0 DatALI "el p%tin o C DIN Treime Mani*esta Persoanele post - a""i!ent )as"%lar"ere/ral !epresie+ Instr%mente0 "%m ar 5 1ali!ates"ara BarthelPoate pentr% o%tilizat3 !e E1ALUARE a""i!ent pa"inet Un%i pro/a/ilitatea ALI )as"%lar "ere/ralCAPABIL De %n Gestiona A"as30 "% sa% *ara Spri?in prin"ipal n Urma zona e$tern3!in spital+

B%na in(ri?ire me!i"ala Este in mentinerea !e *%n!amentala in(ri?ire a pielii0Hranire0 hi!ratare0 !e Pozitionare0 Si monitorizareasemnelor )itale5+ C%m ar Temperat%ra0 tensi%nea arteriala I P%ls%l rea/ilitare a""i!ent )as"%lar "ere/ralIn"epe IMEDIAT Aproape+

Pentr% "ei mai MULI "% )as"%lar "ere/ral ,ameni a""i!ent0 terapie zi"a #PT'0terapie o"%pa6ional3 #1T' I patolo(ie lim/a !e )or/ire#SLP' S%nt !e Pietrelor alepro"es%l%i !e temelie rea/ilitare+ De m%lte ori0tehnolo(ie !e asistenta 5 C%m ar s"a%ne "% rotile0 Pietoni I !e /astoane oal3 lemn /ene"i%+ M%lte !ePro/lemele Dintre Mo/ilitate pot :m/%n3t36ite !e Prin %tilizareaorteze pi"ior(lezna+ 78&@9 PT I 1T a% Domenii !e :n(ri?ire a EWPERTI SE s%prap%n0 T,TUIPT SE "on"entreaza PE Domeni%l Com%n !e Mis"are S !e P%tere sa/loae*e"t%area !e e$er"itii S re-:n)36are SARCINI *%n"tionale5 "%m ar mo/ilitatea

pat0 inel !e trans*er0 mers%l pe Yos )e"hi mari I "% %n"tii motorii+ zioterape%6i"rasnii0 Prin %rmare0 !e LUCRU "% o pentr% pa"ientii :m/%n3t36i "on<tientizarea I%tilizareahemiple(i"laterale+ Rea/ilitarea 1izeaz3 !e LUCRU pe !e "apa"itatea%n%i pro!%s !e "al"%lator *r%mos mi<"3ri !e Sa% "apa"itatea %n%i e*e"t%a sar"ininormale *olosin! mo!ele+ Se p%ne a""ent%l Este "on"entra6 a!esea As%pra Si asar"inilor *%n"tionale o/ie"ti)elor pa"ient%l%i+ Un ar E$empl% an(a?a zioterape%tipentr% o PR,M,1A:n)36area motorie 1izeaz3 terapia "% mi<"are in!%se !e"onstr2n(ere+ Prin pra"ti"a Contin%a o pa"ient%l%i relearns !e o %tilizare ! I !e ase A!apta la %ll Time Ni)el%l mem/relor hemiple(i"3 )ersion Timp%l a"ti)it36ilor*%n"tionale pentr% %n CREA o D%rata !e S"him/ari permanente+ 78&9 1T Este

impli"at :ntr -o *orm3 zon3 pentr% %n AYUTA la re:n)e6e a"ti)itatile Un !e zi "% zi 0"a "%nos"%tea"ti)itatile !e )iata !e zi "% zi#ADLs'5 "%m ar man"area0 /a%t%ra0

!ressin(0 /aie0 !e (3tit0 !e"itire I s"riere 0 Sb toiletin(+ lo(ope!ieEste pentr%Persoanele "% A!e")at !e t%l/%r3ri pro!%"tie !e )or/ire5!isartrie 78&9 Iapra$ie!e )or/ire0 78&F9 a*azie0 78=9 !e"iente "o(niti)e-"om%ni"are Si O Sa%pro/leme"% in(hitire +

,al3 pro/leme Pa"ientii A1EA parti"%lare0 "%m ar 5!is*a(ia 0 In(ri?ire "rasniiin(hitite pro)o"a Materiale pentr% o in plamani si tre"e "a%za pne%monie !easpira6ie+ Con!itie "% "rasnii im/%natati Timp%l0 reprezinta ntre Timp 0 on%t%/naso(astri"Poate p%/li"itate0 !e :n(ri?ire S3 permit3 li"hi!e alimentare Sa e)ersion !ire"t3 la stoma" a!ministrat3+ prin"ipal n :n :n(ri?irea Caz%l Este :n(hi6ire silen6ios "onsi!erata nesi(%r30 on% apoiper"%tanat3 !e (astrostomieen!os"opi"a"a!3 #PEG' Este I ACEST LUCRU "rasnii Tre"%t pe Ramane Termennelimitat+

Tratament%l !e spasti"itate le(at%l !e a""i!ent )as"%lar "ere/ral 1izeaz3 a!eseamo/ilizari pre"o"e0 e*e"t%ate *re")ent !e II,TERAPEUT %n0 "om/inat "% oal%n(ire a m%<"hilor spasti"i I s%s6in%t30 se intin!e imp Di*erite pozi6ion3ri+ 7;9Do/2n!irea !e :m/%n3t36ire initiala )ersion inter)al%l !e Mis"are Este a!esearealizate imp mo!ele !e rota6ie ritmi"e aso"iat3 "% mem/r%l a*e"tat+ 7;9 !%paGama "ompleta a ost Realizat !e C3tre terape%t0 mem/r%l sho%l!erstan! S3 %*pozi6ionat )ersion pozi6iile al%n(ite pentr% a pre)eni mpotri)a "ontra"t%rilor%rtherirt0 !e*al"are )ersion piele0 Si ne:ntre/%in6are %n mem/r%l%i "% %tilizarea

atele Sa% %n instr%mente Altor pentr% %n )ersion sta/iliza Com%n+ 7;9 0 la s%/ -*orma !e re"e :mpa"het3ri !e Ghea63 Sa% !e pa"hete Gheata ha)e/een re!%"epe o !o)e!it spasti"itatea a4%en630 inhi/2n! tEMP,RAR !e Ratele ne%ronale !e*o"+ 7;9 stim%larea ele"tri"3%n %n Sa% m%<"hilor anta(oni<ti )i/ra6iilor a ost0Prin %rmare0 Este %tilizat C% ,NU s%""es oare"are+ 7;9

rea/ilitare a""i!ent )as"%lar "ere/ralsho%l!erstan! mai S3 :n"eap3 CA Repe!ese Posi/il I "rasnii n"ar"3 !e ori%n!e la zile la peste Cate)a on% o+ Cea maimare o renta/ilitate Este )ersion )az%ta %n"6iei Primele Cate)a l%ni0 IAR apoi "%

im/%natatirea s"a!e .*ereastra. (ri?%li% mo! )ersion o"ial !e C3trestat !inSUAUnitati !e rea/ilitare si altele :n(ri?ire %rmeaza Sa e n"hise D%pa SASE l%ni0"% p%tine Sanse !e :m/%n3t36ire )ersion "ontin%are+ T,TUI0 pa"ien6ii ha)e/een"%nos"%t pentr% o "ontin%a Sa se :m/%n3t36eas"3 !e ani !e zile0 re!o/2n!irea I"onsoli!area a/ilit36ilor !e S"ris0 "%m ar 0 Mers%l PE ?os0 :n(ri?ire r%leaz30 si)or/in!+ E$er"i6ii !e rea/ilitare sho%l!erstan! zilni"3 "ontin%a S3 ACA DIN R%tinaParte !e pa"ient%l%i "ere/ral a""i!ent )as"%lar+ Re"%perarea "ompleta esteneo/i<n%it30 este imposi/il n%0 IAR :nainte !e a :m/%n3t36i ma?oritatea pa"ien6ilorINTR- , oare"are mas%ra5 o !iet3 si a!e")ata S%nt "%nos"%te e$er"itiile pentr%izi"e o AYUTA la "reier pentr% a re"%pera+

Meto!e !e Unele terapie a"t%ale I in"l% 1iitoare %tilizarearealit36ii )irt%aleI ?o"%ri )i!eo !e pentr% rea/ilitare+ A"este *orme !e poten6ial ,*erta !e rea/ilitarepentr% zona moti) pa"ientilor pentr% a e*e"t%a sar"ini SPECIICE !e terapiethatmanJ )e"hi *orme N% *a" ACEST LUCRU+ 78=89 M%lte "lini"i I Spitale S%ntA!optarea %tilizarea sintezei oc-pl%ta Dispoziti)e !e e$er"itare0 intera"6i%ne

So"iala si !e rea/ilitare0 !eoare"e a"estea S%nt la pret%ri a""esi/ile0 pot a""esi/ile I %tilizate )ersion Ca!r%l I "lini"ii A"as3+ 78=89

1e"hi !e noi meto!e rea/ilitare S%nt non-in)azi)e 0 :n prezent :n "%rs !eDez)oltare pentr% %n Spori pentr% o terapie izi"a :m/%n3t36i %n %n"tia motorie"% pa"ien6ilor a""i!ent )as"%lar "ere/ral "%m ar 05stim%larea ma(neti"atrans"raniana #TMS' I stim%lare !ire"t3 "%rent trans"ranian#TDCS' 78=;9 siterapiiro/otizate+ 78=&9

Prin %rmare0 ,NU a""i!ent "rasnii )as"%lar "ere/ral re!%"e !e potri)ire (eneralaa ,amenilor+ 78==9 !e sala !e tness re!%s3 Poate re!%"e "apa"itatea !erea/ilitare pre"%m I Starea (eneral3 !e SNTATE+ 78=>9 , Re)iz%ire Sistemati"aa (asit thatthere S%nt Disponi/ile !ata S%"ient pe Termen ment "% Pri)ire lae*e"tele !e e$er"itii si !e ormare "% Pri)ire la moarte0 !epen!en63 I !ein)ali!itate !%pa a""i!ent )as"%lar "ere/ral ,NU+ 78==9 Insa antrenament"ar!iorespirator A!a%(at la pro(rame !e mers pe Yos Rea/ilitare "rasnii :m/%n3t36i 1iteza0 Toleranta I In!epen!enta )ersion Timp%l mers%l%i+ 7 8==9

pro(noza

A*e"teaz3 !e in)ali!itate !e > a a""i!entelor Dintre s%pra)iet%itori )as"%lareS%"ient "ere/ral pentr% o re!%"e <ansele !e an(a?are+ 78=@9 A""i!ent )as"%lar"ere/ral "rasnii a*e"ta persoane IIC0 mental0 emo6ional0 SAU o Com/inatie %nPrepelea" Celor+ Rez%ltatele !e a""i!ent )as"%lar "ere/ral )ariaz3 oarte m%lt)ersion UNCTIE !e marimea I lo"alizarea lezi%nii+ 78=9 Dis*%n"6iile miez!ipoziti) DIN thatha)e zonelor "reier se !eterioreze ost+

Unele a% Dintre !iza/ilit36ile on% izi"e a""i!ent )as"%lar "ere/ral "rasnii DINin"l% rez%lta sl3/i"i%ne m%s"%lara0 amor6eal30es"are + pne%monie + in"ontinen63 +apra$ia#De in"apa"itatea %n%i e*e"t%a mi<"3ri :n)36ate' :n(ri?ire !i"%lt36i!es*3<oar3a"ti)it36i !e zi "% zi0 De Pier!erea po*tei man"are0pier!ere !e )or/ire +pier!erea )e!erii I !%rere+ Prin"ipal n Caz%l :n :n(ri?irea C%rsa !e Este S%"ientSe)era0 SAU INTR - o lo"atie ""a ale An%mite e$aminate pl%ri"olori "ere/ral3tr%n"hi%l%i0"om3Sa% "a !e"es "rasnii A)ea Rez%ltat+



Pro/leme emo6ionale Urma a""i!ent )as"%lar "ere/ral Un%i DIN "rasnii "a%za!ire"t3 la DAUNE emo6ional3 DIN Centrele !e "reier Sa% la *r%strare !e I!i"%ltatea a!aptare la Noilor limite+ Post-a""i!ent )as"%lar "ere/ral !i"%ltatiemotionale in"l%an$ietate + ata"%ri !e pani"3 + a*e"teaz3 plat#De in"apa"itatea%n%i -Si EWPRIMA emo6iile'manie + apatie si psihoza+ ,al3 )e"hi se n%m3r3 o

!i"%lt36i Capa"itate !e s"az%ta a Com%ni"a Prin interme!i%l e$presiei emo6iile*a"iale0 lim/a?%l Corp%l%i I )o"e+ 78=9

Pert%r/3rile !e prin"ipal n a%to i!entitate0 "% Rela6iile Ceilalti0 Si "rasnii RE!%"e6i/%n3starea emo6ional3 la a""i!ent "onse"in6e so"iale !%pa )as"%lar "ere/ral DIN"a%za lipsei !e "apa"it36ii %n%i Com%ni"a+ n(ri?ire M%lti a% ,ameni !e e$perienta!e"iente Com%ni"are0 !%pa a""i!ent )as"%lar "ere/ral on% "onsi!e mai Di"ilEste C !e o *ata a63 pro/lemelor so"iale0 mai !e(ra/3 DECAT !e"iente izi"e+Aspe"tele (enerale ale :n(ri?irii TREBUIE Sa se a!reseze emotional ins%"ienta !e)or/ire !e impa"t s%nt As%pra !e in(ri?ire a persoanelor se "on*r%nt3 "% !i"%lt36i!e )or/ire0 !%pa a""i!ent%l on% )as"%lar "ere/ral+ 78=F9 Cei !e :n(ri?ire se "%"on*r%nt3 a""i!ent )as"%lar "ere/ral on% S%nt la ris" !eparalizie!e :n(ri?ire arA)ea ""a Re"lamatia a Rez%ltat o ima(ina %n Corp%l%i !e sine pert%r/at30 Prin%rmare0 CEEA CE "rasnii RE!%"e6i a la )e"hile pro/leme so"iale+ 78>9

& la > DIN a""i!ent )as"%lar s%*erit s%pra)iet%itori "ere/ral on% a""i!ent)as"%lar "ere/ral post - !epresie0 Toate se intereseaz3 letar(ie "ara"terizeaza

imp0 irita/ilitate0t%l/%r3ri !e somn0 A REDUSstima !e sine!e I retra(ere+ 78>89Depresia Poate re!%"e moti)a6ia I a(ra)a rez%ltat%l0 reprezint3 oal3 "% tratateanti!epresi)e +

la/ilitate emo6ional3, Alt3 "onse"in63 )as"%lar "ere/ral a a""i!ent%l%i0Determina pentr% o persoana rapi!a ma$imele "om%ta emo6ional3 ntre IMiniMe Si Sa -Si E$prime mo! )ersion emo6iile ne"oresp%nz3tor0 !e E$empl%0 "%"el mai mare !e plan !e r2s Sa%0 "% Sa% P%tin !elo" Pro)o"are+ Prin"ipal n Timp"e e$presiile !e SINTEA ale Emotie !e o/i"ei !ipoziti) "ore emotiile persoanei l%i

ale reale0 o *orma mai Se)era o la/ilit36ii emo6ional3 Determina persoanaa*e"tat3 S3 Ra!a Si Sa pl2n(3 mor*opatolo(i"0 *3r3 %n tine "ont !e "onte$t%l Sa%!e Emotie+ 78=@9 UNII ,ameni Arata op%s%l a CEEA "e theJ*eel0 plan%l !e at%n"i"an! s%nt E$empl% a"estea *ERICITI+ 78>;9 la/ilitatea la apro$imati) emo6ional3apare !e ; a% !e :n(ri?ire a""i!ent A)%t Dintre ICE on% )as"%lar "ere/ral+

"o(niti)e !e :n(ri?ire De"it DIN a""i!ent )as"%lar "ere/ral rez%lt3 in"l% !et%l/%r3ri per"ep6ie0a*azie0 78>&9 !emen630 78>=9 Pro/leme I C% Ca!o%ri 78>>9 Imemorie+ 78>@9 Un s%*erin! !e a""i!ent )as"%lar "ere/ral "rasnii !e "onstient

)anzare propriile !iza/ilitati0 o a*e"ti%ne n%mit3anoso(nosie+ Intr - o a*e"ti%ne



n%mit3ne(li?are hemispa6iale0 Persoana a*e"tat3 mentionate N% este )ersionmas%ra la S3 parti"ipe pe nimi" pentr% Spati% Partea op%s3 emis*era !eteriorat+

Rez%ltat%l a""i!ent%l%i "o(niti) I Psiholo(i" on% D%pa )as"%lar "ere/ral "rasnii!e la a*e"tata !e :n(ri?ire %n 1arsta a""i!ent !e on% lo" A)%t )as"%lar "ere/ral0!e pre-a""i!ent )as"%lar "ere/ral !e *%n"6ion3rii intele"t%ale Baza0 ante"e!ent Ipsihiatri"e DACA IL Cara(iale pre-"reier%l%i e$istente patolo(ia+ 78>9

Pana la 8 Dintre a""i!ent Persoanele Urma Un%i )as"%lar "ere/ral se!ez)olta"on)%lsii0 Cel mai *re")ent )ersion S3pt3m:na prin"ipal n UrmaE)eniment%l%i + A""i!ent )as"%lar "ere/ral Gra)itatea CrEsTe Crize UNEIpro/a/ilitatea 78>9 78>F9

Epi!emiolo(ie

an in"apa"itatii !e )ia63pentr% Boala la 8+ )as"%lar3 "ere/ral3 !e lo"%itori :n ;=+ 78@9

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A""i!ent )as"%lar "ere/ral "e o CEEA Do%a mai *re")enta "a%za !e CEA la !e"esNi)el Mon!ial :n ;88 0 reprezent2n! @0; Milioane !e De"ese #88 DIN \ total'+78@89 Apro$imati) 8 Milioane !e ,ameni a% A)%t a""i!ent )as"%lar "ere/ral ,NU :n ;8 0 && !e I Milioane !e ,ameni a% A)%t anterioare a""i!ent%l%i )as"%lar"ere/ral on% a% I in"as :n ost 1iata+ 7F9 ntre 8FF ;8 I N%mar%l !ea""i!ente )as"%lare "ere/rale "% SCAD apro$imati) 8 :n l%mea !ez)oltat3 Si a"res"%t "% 80 :n l%mea :n "%rs !e Dez)oltare+ 7F9 0 :n (eneral0 Do%3 Treimi !INa""i!ente )as"%lare "ere/rale a% A)%t lo" )ersion CEI Peste @> !e ani+ 7F9 Asiati"i!e S%! a% on% ris" !eose/it !e ri!i"at pentr% a""i!ent )as"%lar "ere/ral0reprezent2n! = !IN a""i!ent De"ese )as"%lar "ere/ral la mon!ial Ni)el+ 78@;9

Este pe L,CUL !%pa Bolile !e Inima si inainte !e "an"er+ 7;9 A""i!ent :n )as"%lar"ere/ral Statele Unite ale Ameri"ii Este o "a%za prin"ipala !e han!i"ap IARre"enta a s"3z%t !e la Al Treilea :n(ri?ire RE!%"e6i la o patra "a%za !e !e"es+78@&9 !isparitatilor in in"i!enta !e (eo(ra"e a""i!ent )as"%lar "ere/ralha)e/een o/ser)ate0 in"l%si) :n e$isten6a UNEI ."ent%r3 !e a""i!ent )as"%lar

"ere/ral. prin"ipal ns%! - est%l statelor Unite 0 Reprezinta "a%zele e$istente Tezei!i*eren6elor N% a% *ost e$pli"ate .+

In"i!en6a !e a""i!ent )as"%lar "ere/ral "re<te e$ponen6ial !e la & !e ani0 Sietiolo(ia1ariaz3 )ersion UNCTIE !e 12rst3+ 78@=9 A)ansat 1arsta Este UNULDintre CEI mai importanti a"tori !e ris" !e "ere/ral a""i!ent )as"%lar+ F> DINa""i!ente )as"%lare "ere/rale APAR la Persoanele "% 1arsta !e => si mai in1arsta0 si Do%a Treimi DIN a""i!ente )as"%lare "ere/rale APAR )ersion CEI "%1arsta !e Peste @> !e ani 7&;9 78>89 ris"%l %NEI persoane !e o M%ri DACA el Sa%ea s%nt on% a""i!ent )as"%lar "ere/ral0 ast*el CrEsTe "% 1arsta+ T,TUSI0a""i!ent%l "rasnii "ere/ral )as"%lar ap3rea La ori"e 12rst3 in"l%!in( in0 Copilarie+

Mem/rii oal3 amiliei o A)ea !e a""i!ent Geneti"a ten!inta )as"%lar "ere/ral !e%n Sa% parta?a stil on% !e 1iata a *a"%t la on% a""i!ent )as"%lar "ere/ral haioase+Ni)el%ri mai ri!i"ate !e*a"tor%l )on ille/ran!S%nt mai REC1ENTE )ersionr2n!%l persoanelor !e :n(ri?ire a% A)%t on% "ere/ral is"hemi" a""i!ent )as"%lar0pentr% prima !ate+ 78@>9 Rez%ltatele a"est%i st%!i% a "onstatat %n *a"%t !e *a"tor

(eneti" pe sin(%r%l semni"ati) !e :n(ri?ire !e persoanatip%l !e san(e+ D%pa "e%n a""i!ent )as"%lar "ere/ral ,NU A)%t :n m%lt oarte Tre"%t Creste Cele ris"%l!e a""i!ente )as"%lare "ere/rale 1iitoare+

Bar/atii S%nt "% ;> mai m%lte Sanse !e o s%*eri a""i!ente )as"%lare "ere/raleDe"at emeile0 7&;9 INCA @ DIN !e"esele )as"%lar "ere/ral !e in(ri?ire emeilela a""i!ent !e + 78>;9 Din moment !e "e emeile traies" mai m%lt0 a"estea S%ntMAI 12rst30 )ersion C<i theJha)e Me!ie "ere/ral a""i!ente )as"%lare Si a *%(it0ast*el0 o UCI mai a+ 7&;9 UNII !e a"tori ris" pentr% a""i!ent )as"%lar "ere/ral se

APLICA Doar emeilor+ primar S%nt Printre Sinteza Sar"ina0 Nasterea0menopa%za 0IAR tratament%l a"estora # HRT '+

istorie

Hippo"rateo pentr% !es"ris la prima Br%s"a %n paralizia *a"%t Este "ere/ral "%a!esea Aso"iat a""i!ent )as"%lar+

Episoa!e !e a""i!ent )as"%lar "ere/ral a""i!ent )as"%lar "ere/ral si AMILIALAha)e/een !e al ; raportat - tapi Mileni% i+Hr+ mai !eparte :n Mesopotamia Anti"aI Persiei+ 78@@9 Hipo"rate#=@-& i+Hr+'0 !e :n(ri?ire 0 :n mar(ine pentr% %nPrim%l !e Br%s"a !es"rie *enomen%lparalizie o Este "% a!esea Aso"iat is"hemie +Apople$ie0 De la(re"es"n(ri?ire C%)2nt%l inseamna %n . lo)it )ersion ?os "%)iolenta. Apar%t pentr% prima hipo"rati"e a !atelor :n s"rierile pentr% o ACESTenomen !es"rie+ 78@9 78@9 C%)2nt%l )as"%lar "ere/ral a""i!ent !e :n(ri?ire a*olosit "a sinonim pentr% aplople"ti"se"hestr%In"a DIN 8>FF 78@F9 I Este !e!est%l tra!%"ere literal3 a termen%l%i (re"es"+

8@> in prin"ipal n l%"rarea sa apople$ie 0Yohann Ya"o/ ep*er#8@;-8@F>' ai!enti"at "a%zahemora(i"a""i!ent )as"%lar "ere/ral El "an! a s%(erat %n *a"%ta% !e :n(ri?ire ,AMENIm%rit!e apople$ie san(erat :n "er%le "reierele+ 7&;9 78@9ep*er0 ast*el i!enti"at prin"ipaleleartere "reier%l *%rnizoare0 )erte/rale I"aroti!earterelor0 Si a i!enti"at "a%za s*at !e Un%iis"hemi" a""i!ent )as"%lar"ere/ral "a on% "%nos"%t in*ar"t "ere/ralEl a C<i *a"%t s%(eratapople$iear "a%zate !e Re"lamatia a ,NU nat%ra ACEST,R /lo"a?+ 7&;9 R%!ol* 1ir"hoopentr% !es"ris la prima !e me"anism%ltrom/oem/olism""a *a"tor ma?or al ,NU+789

Termen%l !e a""i!ent )as"%lar "ere/ral 0 :n(ri?ire %n Intro!%s :n 8F; 0 re4e"t2n!.!e Cresterea (ra!%l%i "onstientizare !e S a""eptare a teoriilor +++ Si #)as"%lare'"a%zei re"%noa<terea s2nilor "onse"in6elor %nei :ntrer%peri UNEI apro)izion3rii%nei )as"%lare "reier%l%i.+ 7889 Utilizarea sa Este a"%m !es"%ra?at printr - on%N%m3r !e man%ale !e ne%rolo(ie0 ra6ionament %n *a"%t "onota6ia l%i*ort%ito%sness p%rtate !e C%)2nt%l a""i!ent%l%i s"oate )ersion e)i!enta )ersionmo! ins%"ient mo!ia/ilitJ *a"torilor !e ris" !e :n(ri?ire (em la + Baza 78;978&9 78=9 ins%lt3 "ere/ro)as"%lar3 "rasnii %tilizat )ersion mo!

inters"him/a/il + 78>9

Termen%l "ere/ral ATAC 0 :n(ri?ire %n Intro!%s pentr% o %tilizate pentr% %n a"%tal Cara"ter%l Apelan! s%/linia a""i!ent )as"%lar "ere/ral laAso"iatia A""i!ent)as"%lar "ere/ral ameri"an0 78>9 0 !e :n(ri?ire0 !in 8FF S - a% *olosit termen%l078@9 I Este %tilizat "olo")ial pentr% a se re*eri la am/ele is"hemi"e "ere/ralehemora(i"e pre"%m I a""i!ent )as"%lar+ 789

Cer"etare

An(ioplastia zona stent I

An(ioplastia I stentareaa% in"ep%t Sa e pri)ite ""a posi/ile op6i%ni !etratament%l )ia/ile )as"%lar )ersion "ere/ral is"hemi"+ a""i!ent zona !e stentintra-"ranian3 )ersion stenoza intra"raniene arteriala simptomati"30 rata !eS%""es tehni" #la re!%"erea !e stenoza Q>' 0 %n 1ariat !e la F-F0 IAR rata"ompli"a6iilor Ma?ore peripro"e!%rale o 1ariat =-8+ Ratele !e restenozei Si OSa% a""i!ent )as"%lar "ere/ral In Urma a% tratament%l%i !e aTAT ost *a)ora/ile+A"este !ata a% on% s%(ereaz3st%!i% "lini" ran!omizat 0 "ontrolatEste pentr% oNe"esar apel mai "omplet !e E1ALUARE A)anta? terape%ti" al posi/il%l a"esteiM%ssoorie pre)enti)3+ 789

throm/e"tomJ me"ani"e

MERCI Retrie)er L>+

Prin in!epartarea "hea( Poate :n"er"at )ersion Cele :n :n(ri?irea inter)ine INTR -1AS on% mare !e San(e si "rasnii o ,PTIUNE Pentr% "ei !e :n(ri?ire %* N% S%ntELIGIBILE pentr% Sa% N% se :m/%n3t36es" "% a!ministrare intra)enoas3 !e + Trom/oliti" 78F9 "ompli"a6ii semni"ati)e APAR la apro$imati) + 789

ne%roprote"6ia

Me!i"amente %n s"a)en(e spe"ii rea"ti)e !e o$i(en 0 inhi/3 moartea "el%lelorpro(ramate0 Sa% ne%rotransmi63tori e$"itatori ha)e/een inhi/a e$perimentale!emonstrat0 pentr% o re!%"e lezi%nile !e is"hemie "a%zate 6es%t%l%i+ n(ri?ireAGENTI l%"reaz3 S%nt mo! )ersion ACEST0 !e ""a ALI ne%roprote"tor + Pan3 !e"%ran!0 %manest%!iile "lini"e "% ne%roprote"tori a% e<%at A(en6i0 "% e$"ep6ia%n%i pro/a/il3 pro*%n!a "om3 /ar/it%rat+ Tot%<i0 re"ent MAI0NWX->F0 Deri)at%l!is%l*onil al phenJl/%tJlnitrone ra!i"al-p%r?at0 Este raportat o ne%roprote"tor in

)as"%lar "ere/ral a""i!ent+ 7889 A(ent ACEST Par[ S3 l%"reze la %ll Time Ni)el%lm%"oasei 1aselor san()in3 Sa% %n en!oteli%l%i+ Din pa"ate0 !%pa o/6inerea %nor



Rez%ltate *a)ora/ile )ersion St%!i% "lini" !e o s"ara Lar(a0 on% al D,ILEA N% %nst%!i% *a)ora/ile !emonstrat Rez%ltate+ 7&;9 Bene"i%l NWX->F Este !is"%ta/il3+78;9

Terapia "% o$i(en hiper/ari"o "a o Posi/il3 ost st%!iata !e mas%ra prote"tie0este mentionate N% este )ersion prezent %n C,NSIDERAII /ene"i%+ 78&9

A se )e!ea 0 !e asemenea 0

Sin!rom%l De?erine-Ro%ssJ

%n"6ional3 M3s%ra In!epen!en6a

Lipoproteina #a'Sin!rom%l l%i e/er

Me"anism%l !e !epolarizare ano$i"e in "reier

re*erinte

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meta/oli"e Y%rnal%l ,"ial al So"ietatii Internationale !e Cere/ral Bloo! lo siMeta/olism ;8 #8'5++ ;-8= Doi 5 8+8F O =@=- ;0880-; + PMID888=F@@= +

=@+ Y%mp %p Lon(o0 e! Dan L+ Lon(o +++ 7et+ <i "ola/+ Prin"ipiile l%i Harrison !eme!i"ina interna+ #;8;'+ #E!i6ia a 8+'+ Ne XorK5 M"Gra-Hill+ pp+ Capitol%l &+ISBN F-8=F@ +

=+ Y%mp %p Lon(o0 e! Dan L+ Lon(o +++ 7et+ <i "ola/+ Prin"ipiile l%i Harrison !eme!i"ina interna+ #;8;'+ #E!i6ia a 8+'+ Ne XorK5 M"Gra-Hill+ pp+ Capitol%l &+ISBN F-8=F@ +

=+ Y%mp %p to5 A / an( Y #!e"em/rie ;8'+ .Pre"lini"e si "lini"e pe in4amatie!%pa hemora(ie intra"ere/ral3. + Pro(+ + Ne%ro/ial F; #='5+ =@&- Doi 5 8+88@ O ?+pne%ro/io+;8++8 + PMC ;FF8= + PMID ;8&8;@ +

=F+ Y%mp %p Hill MD #noiem/rie ;>'+ ./iomarKeri !e !ia(nosti" pentr%a""i!ent )as"%lar "ere/ral5 perspe"ti)a %n%i ne%rolo( a""i!ent )as"%lar "ere/ral.Chimia "lini"a >8 #88' 5+ ;8-;+ Doi 5 8+8&& O "lin"hem+;>+>@&; + PMID8@;==;@ +

>+ Y%mp %p Chalela YA0 i!ell CS0 Nenti"h LM0 L%/J M0 B%tman YA0 Dem"h%K

AM0 Hill MD0 Patronas N0 Lato%r L0 ara"h S #ian%arie ;'+ .Ima(isti"a prinrezonanta ma(neti"a si tomo(rae "omp%terizata in e)al%area !e %r(enta a

pa"ientilor "% s%spi"i%ne a"%ta a""i!ent )as"%lar "ere/ral5 o "omparatieprospe"ti) . + Lan"et &@F #F>>'5 ;F&-+ !oi 5 8+88@ O S8=-@&@ #' @8>8-;+ PMC 8>F>> + PMID 8;>@@F +

>8+ Y%mp %p i!ell CS0 Chalela YA0 Sa)er YL0 StarKman S0 Hill MD0 Dem"h%K AM0

B%tman YA0 Patronas N0 Al(er YR0 Lato%r LL0 L%/J ML0 Bair! AE0 LearJ MC0 TremelM0 ,)/ia(ele B0 re!ie% A0 S%z%Ki S0 1illa Blan"a YP0 Da)is S0 D%nn B0 To!! Y0Ezze!!ine MA0 HaJmore Y0 LJn"h Y0 Da)is L0 S ara"h #o"tom/rie ;='+.Compararea RMN si CT pentr% !ete"tarea hemora(iei intra"ere/rale a"%te. YAMA;F; #8>' 5+ 8;&-8&+ Doi 5 8+88 O ?ama+;F;+8>+8;& + PMID 8>=F=>F +

>;+ Y%mp %p to5 A / Stra%s SE0 Ma?%m!ar SR0 M"Alister A #septem/rie - ;;'+.Noi !o)ezi pentr% pre)en6ia a""i!ent%l%i )as"%lar "ere/ral5 analiza stiinti"a. YAMA ; #88' 5+ 8&-8&F>+ Doi 5 8+88 O ?ama+;+88+8& + PMID 8;;&=;&& +

>&+ Y%mp %p Gol!stein LB0 A!ams R0 Al/erts MY0 Appel LY0 alama LM0 B%shnell

CD0 C%le/ras A0 De(ra/a TY0 Goreli"K PB0 G%Jton YR0 Hart RG0 Hoar! G0 ellJ-HaJes M0 Ni$on Y10 Sa""o RL #i%nie ;@ '+ .Pre)enirea primara !e a""i!ent)as"%lar "ere/ral is"hemi"5 %n (hi! !e la Ameri"an Heart Asso"iation O ameri"ana""i!ent )as"%lar "ere/ral StroKe Asso"iation Consili%l5 "osponsore! !e /oala)as"%lar3 Gr%p%l !e l%"r% inter!is"iplinar ateros"leroti"a peri*eri" Car!io)as"%larN%rsin( Consili%l Clini" Consili%l !e Car!iolo(ie0 N%tri6ie0 a"ti)itate zi"30 <iConsili%l meta/oli"e <i "alitatea asistentei me!i"ale si a rez%ltatelor !e "er"etareGr%p%l !e l%"r% inter!is"iplinare 5+ A"a!emia Ameri"ana !e Ne%rolo(ie arma)aloarea a"estei linii !ire"toare .a""i!ent )as"%lar "ere/ral & #@'5+ 8>&-@&&!oi 5 8+88@8 O 8+STR+;;&=+8&+8 + PMID 8@@>; +

>=+ Y%mp %p Cer"etare0 Centr%l !e E)al%are a Me!i"ament%l%i si+ .In*orma6iipentr% "ons%matori #!ro(%ri' - Utilizarea !e aspirina pentr% pre)enirea primara!e ata" !e "or! si a""i!ent )as"%lar "ere/ral. +*!a+(o) ++ A!%s !e ;8>-88-8@+

>>+ Y%mp %p to5 A / " SEN Pres"rierea Pra"ti"a Re)ie ==5 antitrom/o"itele <ianti"oa(%lante :n pre)en6ia a""i!ent%l%i )as"%lar "ere/ral #;F'+ Disponi/il lanps+or(+a%

>@+ Y%mp %p to5 A / Cola/orare antitrom/oti"e Trialists # !in ian%arie ;;'+ . In

"ola/orare meta-analiza a st%!iilor ran!omizate !e terapie antipla"hetare pentr%pre)en6ia mor6ii0 in*ar"t mio"ar!i"0 a""i!ent )as"%lar "ere/ral si la pa"ientii "%ris" ri!i"at. BMY &;= #&;F'+ 8-@+ Doi 5 8+88&@ O /m?+&;=+&;F+8 + PMC@=>& + PMID 88@=>8 +

>+ Y%mp %p Yonas0 Daniel E+ eltner0 CJnthia Ami"K0 Sala R+ Sheri!an0 Sta"eJhen(0 hi-Yie at*or!0 Daniel Y+ Carter0 Yamie L+ Roe0 Cassan!ra Y+ Harris0R%ssell # i%lie ;8='+ .S"reenin( - %l pentr% asimptomati"3 "aroti!ei ArterJStenoza 5+ , re)iz%ire sistemati"a si meta-analiza pentr% Pre)enti)a Ser)i"ii TasKor"e !in SUA. Annals o* Internal Me!i"ine 8@85 &&@+ Doi 5 8+&;@ O M8=->& +PMID ;>=8@F +

>+ Y%mp %p Parti!%l Me!i"al Resear"h Co%n"il !e l%"r% #i%lie 8F>'+ .MRCpro"es !e tratament al hipertensi%nii arteriale %<oar35 prin"ipalele rez%ltate.British Me!i"al Yo%rnal ;F8 #@='5++ F-8= Doi 5 8+88&@ O /m?+;F8+@=+F +PMC 8=8@;@ + PMID ;@8 +

>F+ Y%mp %p Thomson R #;F'+ .P%nerea :n apli"are /azat3 pe !o)ezi !einter)entii "omple$e. BMY &&F 5+ B&8;=+ Doi 5 8+88&@ O /m?+/&8;= + PMID8F@>8 +

@+ Y%mp %p HanKeJ GY #a%(%st 8FFF'+ .%mat%l si ris"%l !e a""i!ent )as"%lar"ere/ral. Yo%rnal o* ris" "ar!io)as"%lar @ #=' 5+ ;-88+ PMID 8>8; +

@8+ Y%mp %p annamethee SG0 Shaper AG0 hin"%p PH0 alKer M #i%lie 8FF>'+.Ren%n6area la *%mat si ris"%l !e a""i!ent )as"%lar "ere/ral la /ar/ati !e )arstami?lo"ie. YAMA ;= #;' 5+ 8>>-@+ Doi 5 8+88 O ?ama+;=+;+8>> + PMID >F@= +

@;+ Y%mp %p ReJnol!s 0 Leis B0 Nolen YD0 inneJ GL0 SathJa B0 El Y0 Leis BL#*e/r%arie ;&'+ .Cons%m%l !e al"ool si ris"%l !e a""i!ent )as"%lar "ere/ral5 ometa-analiza. YAMA ;F #>' 5+ >F-+ Doi 5 8+88 O ?ama+;F+>+>F + PMID8;>=F8 +

@&+ Y%mp %p Sloan MA0 ittner SY0 Ri(amonti D0 Pre6 TR #septem/rie - 8FF8'+.Apari6ie !e a""i!ent )as"%lar "ere/ral aso"iat "% %tilizarea O a/%z%l !e !ro(%ri.Ne%rolo(ie =8 #F' 5+ 8&>-8&@=+ Doi 5 8+8;8; O NL+=8+F+8&> + PMID 8F88 +

@=+ Y%mp %p Larsson SC0 1irtamo Y0 olK A #;88'+ + .Cons%m%l !e "arne ro<ie <iris"%l !e a""i!ent )as"%lar "ere/ral la /3r/a6i s%e!ez. Ameri"an Yo%rnal o*

Clini"al N%trition F= #;' 5+ =8-=;8 Doi 5 8+&F=> O a?"n+888+8>88> + PMID;8@>& +

@>+ Y%mp %p .a"tori !e ris". a""i!ent )as"%lar "ere/ral + Ameri"an HeartAsso"iation + Din ;+ A""esat ;; ian%arie ;+

@@+ Y%mp %p Goreli"K PB #8F'+ .Al"ool%l si a""i!ent )as"%lar "ere/ral.a""i!ent )as"%lar "ere/ral+ %n ?%rnal al "ir"%la6iei "ere/rale 8 #8'5 ;@-8+ !oi 58+88@8 O 8+STR+8+8+;@ + PMID &8@& +

@+ Y%mp %p Prin"ipiile l%i Harrison !e me!i"ina interna+ Al+90 E!+ L+ Dan

Lon(o +++ 7et #;8;'+ #E!i6ia a 8+'+ Ne XorK5 M"Gra-Hill+ pp+ Capitol%l &+ ISBN8=FW +

@+ Y%mp %p esto)er AN0 M"Bri!e S0 HaleJ R #aprilie ;'+ .A""i!ent)as"%lar "ere/ral la a!%lti tineri "are a/%z%l !e am*etamine sa% "o"aina5 %nst%!i% !e pop%latie pe /aza !e pa"ienti spitalizati. Ar"hi)es o* General PsJ"hiatrJ@= #='+5+5 =F>->; D,I 5 8+88 O ar"hpsJ"+@=+=+=F> + PMID 8==8;@ +

@F+ Y%mp %p EzeKoitz YA0 Stra%s SE0 Ma?%m!ar SR0 M"Alister A #!e"em/rie;&'+ .StroKe5 strate(ii !e pre)enire primara. me!i" ameri"an amilie @ #8;' 5+;&F-@+ PMID 8=>>@ +

+ Y%mp %p to5 A / " ! E!erle Y0 Bron MM #o"tom/rie ;@'+ .Do)ezile pentr%me!i"ina )ers%s inter)entie "hir%r(i"ala pentr% stenoza "aroti!ian30. E%ropean Yo%rnal o* Ra!iolo(ie @ #8' 5+ &-+ Doi 5 8+88@ O ?+e?ra!+;@+>+;8 + PMID8@F;&8& +

8+ Y%mp %p hisnant YP #8FF@'+ .E"a"itatea )ers%s e"a"itatea tratament%l%ihipertensi%nii arteriale pentr% pre)enirea a""i!ent%l%i )as"%lar "ere/ral0.Ne%rolo(ie =@ #;' 5+ &8-+ Doi 5 8+8;8; O NL+=@+;+&8 + PMID @8==> +

;+ Y%mp %p Le(ea MR0 Morris Y0 al! NY #8F mai ;F'+ .Utilizarea !eme!i"amente "are s"a! in pre)enirea /olilor "ar!io)as"%lare tensi%nii arteriale5meta-analiza a 8= !e st%!ii "lini"e ran!omizate :n "onte$t%l a<tept3rilor !inst%!ii epi!emiolo(i"e prospe"ti)e. BMY #+ "lini" e! "er"etare' && 5+ /8@@>+ !oi 58+88&@ O /m?+/8@@> + PMC ;@=> + PMID 8F=>=& +

&+ Y%mp %p PsatJ BM0 L%mleJ T0 %r/er( CD0 S"hell "opa" G0 Pahor M0

Al!erman MH0 eiss NS #;&'+ .Rez%ltatele !e sanatate aso"iate "% !i)erseterapii antihipertensi)e %tilizate "a a(en6i !e prim3 linie5 o retea meta-analiza. YAMA ;F #8F' 5+ ;>&=-==+ Doi 5 8+88 O ?ama+;F+8F+;>&= + PMID 8;>F&;> +

=+ Y%mp %p to5 A / ."olesterol%l%i0 a tensi%nii arteriale !iastoli"e0 si !ea""i!ent )as"%lar "ere/ral5 8&+ !e lo)it%ri in =>+ !e oameni in => !epotentiali "ohorte prospe"ti) st%!ii !e "ola/orare+. Lan"et &=@ #FF8-FF;' 8@=-8@>&++ 8FF>+ !oi 5 8+88@ O S8=-@&@ #F>' F;&@- + PMID >>8; +

>+ Y%mp %p G%eJker 0 Boissel YP0 Bo%titie 0 S Po"o"K0 Coope Y0 Y C%tler0EK/om T0 a(ar! R0 rie!man L0 erliKosKe 0 PerrJ M0 Prineas R0 S"hron E

#8FF'+ .E*e"t%l tratament%l%i antihipertensi) la pa"ien6ii "are a% s%*erit !e?a !ela a""i!ent )as"%lar "ere/ral Cole"tarea pro/elor INDANA #Analiza !atelorin!i)i!%ale ale st%!iilor !e inter)entie antihipertensi)i' Proie"t%l Cola/oratori ++.a""i!ent )as"%lar "ere/ral ; #8;' 5+ ;>>-@;+ Doi 5 8+88@8 O 8+STR+ ;O8;O;>>+ PMID F=8;@=F +

@+ Y%mp %p G%eJker 0 B%lpitt C0 Boissel YP0 S"hron E0 EK/om T0 a(ar! R0Casi(lia E0 erliKosKe0 Coope Y #8FFF'+ .!ro(%ri antihipertensi)3 oameni *oarte)e"hi5 %n s%/(r%p meta-analiz3 a st%!iilor "lini"e "ontrolate ran!omizate INDANAGro%p+. Lan"et &>& #F8>>' F&-@++ Doi 5 8+88@ O S8=-@&@ #F' 8;-@ +

PMID 8=>FF@ +

+ Y%mp %p Staessen YA0 GasosKi Y0 an( YG0 Thi?s L0 Den Hon! E0 Boissel YP0Coope Y0 EK/om T0 G%eJker 0 Li% L0 erliKosKe 0 S Po"o"K0 a(ar! RH #;'+.Ris"%rile hipertensi%nii arteriale sistoli"e izolate netratate > #F;' 0 @>-;+ Doi 5 8+88@ OS8=-@&@ #FF' &&-= + PMID 8>;8 +

+ Y%mp %p Be"Kett NS0 Peters R0 let"her AE0 Staessen YA0 Li% L0 D%mitra<"%D0 StoJano)sKJ 10 AntiKainen RL0 NiKitin X0 An!erson C0 Belhani A0 orette 0Ra?K%mar C0 Thi?s L0 BanJa 0 B%lpitt CY #; '+ .Tratament%l hipertensi%nii

arteriale la pa"ientii !e !e ani sa% mai :n )2rst3+. N+ ++ En(l Y Me! &> #8'58-8F+ Doi 5 8+8>@ O NEYMoa8&@F + PMID 8&>8F +

F+ Y%mp %p Neal B0 Ma"Mahon S0 Chapman N #;'+ .E*e"tele inhi/itorilorECA0 anta(oni<ti !e "al"i% @ #F;=@' 8F>>-8F@=++ Doi 5 8+88@ OS8=-@&@ #' &&-F + PMID 888&>;& +

+ Y%mp %p The ALLHAT ,6erii <i "oor!onatori pentr% ALLHAT in "ola/orareResear"h Gro%p0 #;;'+ .Rez%ltatele ma?or la pa"ien6ii hipertensi)i "% ris" ri!i"atran!omizate pentr% inhi/itor al enzimei !e "on)ersie a an(iotensinei sa% /lo"antal "analelor !e "al"i% )s !i%reti"5 antihipertensi)e si tratament pentr% a pre)eniHeart Atta"K Trial #ALLHAT' !e re!%"ere a lipi!elor. YAMA ; #;&' 5+ ;F8-F+!oi 5 8+88 O ?ama+;+;&+;F8 + PMID 8;=F@& +

8+ Y%mp %p De Lima0 LG Sa"onato0 H Atallah0 AN !a Sil)a0 EM #8> o"tom/rie;8='+ ./eta-/lo"ante pentr% pre)enirea re"%ren6ei a""i!ent%l%i )as"%lar"ere/ral+. Baza !e !ate Co"hrane !e re"enzii sistemati"e 85++ CDF D,I 58+8; O 8=@>8>+CDF+p%/& + PMID ;>&8F +

;+ Y%mp %p Iso H0 Ya"o/s DR0 entorth D0 Neaton YD0 Cohen YD #8FF'+.Ni)el%rile "olesterol%l%i seri" +F /ar/ati e"ranate pentr% pro"es m%ltipl% *a"tor !e ris" !einter)en6ie+. N+ ++ En(l Y+ Me! &; #8='5+ F=-8 Doi 5 8+8>@ ONEYM8FF=@&;8=> + PMID ;@8F& +

&+ Y%mp %p to5 A / ,Re(an C0 % P0 Arora P0 Perri D0 Mills EY #;'+ .Terapia"% statine :n pre)en6ia a""i!ent%l%i )as"%lar "ere/ral5 o meta-analiza "are impli"a

8;8+ !e pa"ienti. Am++ Y+ Me! 8;8 #8'5++ ;=-&& Doi 5 8+88@ O ?+am?me!+;+@+&& + PMID 88 +

=+ Y%mp %p He/ert PR0 Gaziano YM0 HenneKens CH #8FF>'+ ., tre"ere :n re)ist3a st%!iilor !e s"a!ere a "olesterol%l%i si a ris"%l%i !e a""i!ent )as"%lar "ere/ral.+Ar"h+ Intern+ Me! 8>> #8'5++ >-> Doi 5 8+88 O ar"hinte+8>>+8+> + PMID;>; +

>+ Y%mp %p .Control%l intensi)-(l%"ozei !in san(e 0 "% s%l*onil%ree sa% "%ins%lin3 n "ompara6ie "% tratament%l "on)entional si ris"%l !e "ompli"atii lapa"ientii "% !ia/et zaharat !e tip ; #UPDS &&' U Prospe"ti)e Dia/etes St%!J

#UPDS' Gro%p+. Lan"et &>; #F8&8'+ &->&+ 8FF+ !oi 5 8+88@ O S8=-@&@#F' 8F-@ + PMID F=;F@ +

@+ Y%mp %p Dorman!J YA0 Char/onnel B0 E"Klan! DY0 Er!mann E0 Massi-Bene!etti M0 Mo%les I SKene AM0 Tan MH0 Le*e/)re PY0 M%rraJ GD0 Stan!l E0il"o$ RG0 ilhelmsen L0 Betteri!(e Y0 BirKelan!0 GolaJ A 0 Heine RY0 or^nJi L0M LaaKso0 MoKan M0 A NorK%s0 Pira(s 10 Po!ar T0 S"heen A0 S"her/a%m 0S"hernthaner G0 S"hmitz ,0 SKrha Y0 Smith U0 Taton Y #;>'+ .Prola$ia se"%n!ar3a e)enimentelor ma"ro)as"%lare la pa"ien6ii "% !ia/et zaharat !e tip ; 0 in st%!i%lPR,a"ti)e #pio(litazona !in st%!ii "lini"e prospe"ti) n e)enimentema"ro)as"%lar'5 %n st%!i% "lini" ran!omizat 0 "ontrolat. The Lan"et &@@ #F=F&'8;F-8;F++ Doi 5 8+88@ O S8=-@&@ # >' @>;-F + PMID 8@;8=>F +

+ Y%mp %p Yohnson ES0 Lanes S0 entorth CE0 Satterel! MH0 A/e/e BL0Di"Ker L #8FFF'+ ., analiz3 a e*e"t%l%i metare(ression !oz3-r3sp%ns !e aspirinape ata" "ere/ral.+ Ar"h+ Intern+ Me! 8>F #88'5++ 8;=-8;>& Doi 5 8+88 Oar"hinte+8>F+88+8;= + PMID 8&8;&= +

+ Y%mp %p to5 A / S%!lo0 Cathie Lm Mason0 Gillian Ma%ri"e0 Yames B+e!!er/%rn0 Catherine Y+ HanKeJ0 Graeme Y+ #8 ian%arie ;F'+ .Deri)a6i !etienopiri!in3 "omparati) "% aspirina pentr% pre)enirea altor e)enimente)as"%lare (ra)e a""i!ent )as"%lar "ere/ral si la pa"ientii "% ris" )as"%lar.Co"hrane Baza !e !ate a Re"enzii sistemati"e #=' 5+ CD8;=@+ D,I 5 8+8; O8=@>8>+CD8;=@+p%/; + ISSN 8=@F-=F&W + PMID 8F;8;& +

F+ Y%mp %p HalKes PH0 )an Gi?n Y0 Capela LY0 o%!staal PY0 Al(ra A #;@'+.Aspirina pl%s !ipiri!amol "omparati) "% aspirina :n monoterapie !%p3 is"hemie"ere/ral3 !e ori(ine arterial3 #ESPRIT'5 st%!i% ran!omizat 0 "ontrolat. Lan"et &@#F>;&' 8@@>-8@&++ Doi 5 8+88@ O S8=-@&@ #@' @&=-> + PMID 8@8=8 +

F+ Y%mp %p ol* PA0 A//ott RD0 annel B #8F'+ .i/rilatie atriala5 %n *a"torma?or !e a""i!ent )as"%lar "ere/ral la )2rstni"i St%!i%l ramin(ham+. Ar"h ++Intern+ Me! 8= #F'5++ 8>@8-= Doi 5 8+88 O ar"hinte+8=+F+8>@8 + PMID &@&;8@=+

F8+ Y%mp %p %ster 10 RJ!en LE0 CANN,M DS0 Cri?ns HY0 C%rtis AB0 "ot%ri A0Halperin YL0 Le He%zeJ YX0 aJ GN0 Loe YE0 ,lsson SB0 PrJstosKJ EN0 Tamar(o YL0C2n! S0 Smith SC0 Ya"o/s A0 A!ams CD - %ri0 An!erson YL0 Antman EM0 Halperin YL0 H%nt SA0 Nishim%ra R0 ,rnato YP0 Pa(ina RL0 Rie(el B0 Priori SG0 Blan" YY0 B%!a?

A0 Camm AY0 Dean 10 De"Kers Y0 Despres C0 Di"Kstein 0 LeKaKis Y0 M"Gre(or0Metra M0 Y Morais0 ,sterspeJ A0 Tamar(o YL0 amorano YL #;@'+ .ACC O AHA OESC ;@ Liniile !ire"toare pentr% tratament%l pa"ientilor "% /rilatie atriala5 %nraport al Cole(i%l%i Ameri"an !e Car!iolo(ie O Ameri"an Heart Asso"iation TasKor"e pri)in! Ghi!%rile !e pra"ti"3 <i So"ietatea E%ropean3 !e Comitet%lCar!iolo(ie pentr% Ghi!%ri Pra"ti"e #Comitet%l !e s"riere pentr% re)iz%irea ;8Linii !ire"toare pentr% mana(ement%l pa"ientilor "% /rilatie atriala'5 !ez)oltat in"ola/orare "% Aso"iatia E%ropeana !e ritm "ar!ia" -&>=+ !oi 5 8+88@8 O CIRCULATI,NAHA+8@+8;F; +PMID 8@F8 +

F;+ Y%mp %p HalKes PH0 )an Gi?n Y0 Capela LY0 o%!staal PY0 Al(ra A #;'+.anti"oa(%lante orale !e intensitate me!ie "omparati) "% aspirina !%p3 is"hemie"ere/ral3 !e ori(ine arterial3 #ESPRIT'5 %n st%!i% "lini" ran!omizat 0 "ontrolat+.Lan"et Ne%ral @ #;'5+ 88>-;= Doi 5 8+88@ O S8==-==;; #@' @>- + PMID8;&FF +

F&+ Y%mp %p Hart RG0 Halperin YL 0 M"Bri!e R0 Bena)ente ,0 Man-Son-Hin( M0ronmal RA #;'+ .Aspirina pentr% pre)enirea primara !e a""i!ent )as"%lar"ere/ral si a altor e)enimente )as"%lare ma?ore5 meta-analiza si ipoteze. Ar"h ++ +Ne%ral > #&'5+ &;@-&; Doi 5 8+88 O ar"hne%r+>+&+&;@ + PMID 88=@> +

F=+ Y%mp %p Bartol%""i AA0 Hoar! G+ #;@'+ .Meta-analiza !atelor !in "ele<ase st%!ii !e pre)en6ie primar3 a e)enimentelor "ar!io)as"%lare *olosin!

aspirina.+ Am+ + Y+ Car!iol F #@'5+ =@-> Doi 5 8+88@ O ?+am?"ar!+;@+=+8; +PMID 8@F>8@ +

F>+ Y%mp %p Ber(er YS0 Ron"a(lioni MC0 A)anzini 0 Pan(razzi I0 To(noni G0 DLBron #;@'+ + .Aspirina pentr% pre)en6ia primar3 a e)enimentelor

"ar!io)as"%lare la *emei #&'5+ &@-8& Doi 5 8+88 O ?ama+;F>+&+&@ + PMID 8@=8=@@ +

F@+ Y%mp %p Xerman T0 Gan 0 Sin DD #;'+ .In4%en6a se$%l%i as%prae*e"telor aspirinei in pre)enirea in*ar"t%l%i mio"ar!i". BMC Me! + >5 ;F+ !oi 58+88@ O 8=8-8>->-;F + PMC ;8&8=F + PMID 8F=F=F +

F+ Y%mp %p Rothell PM0 Eliaszi M0 G%tniKo) SA0 o$ AY0 TaJlor D0 MaJ/er(MR0 arlo CP0 Barnett HY #;&'+ .Analiza !atelor "ole"tate !in st%!ii "lini"eran!omizate "ontrolate !e en!artere"tomie pentr% stenoza "aroti!ian3

simptomati"30. Lan"et &@8 #F&>;' 8-8@++ Doi 5 8+88@ O S8=-@&@ #&'8;;;-& + PMID 8;>&8> +

F+ Y%mp %p RINGLEB PA0 Chatellier G0 Ha"Ke 0 a)re YP0 Bartoli YM0 E"KsteinHH0 Mas YL #;'+ .Si(%ran6a tratament%l%i en!o)as"%lar al stenoza arterei"aroti!e Comparati) "% tratament%l "hir%r(i"al5 o meta-analiz3 a . Y ++ 1as"+ S%r= #;'5++ &>-> Doi 5 8+88@ O ?+?)s+;+8+&> + PMID 8;=8>F +

FF+ Y%mp %p Bonati0 LH LJrer0 P E!erle0 Y eatherstone0 R Bron0 MM #8;septem/rie ;8;'+ .An(ioplastie per"%tanat3 transl%minal3 "% /alon si stentareapentr% stenoza !e artera "aroti!a+. Baza !e !ate Co"hrane !e re"enzii

sistemati"e F5++ CD>8> PMID ;;F;= +

8+ Y%mp %p Rothell PM0 Eliaszi M0 G%tniKo) SA0 arlo CP0 Barnett HY#;='+ + .En!artere"tomia pentr% stenoza "aroti!ian3 simptomati"3 :n raport "%s%/(r%p%ri "lini"e si "alen!ar%l !e "hir%r(ie. Lan"et &@& #F=8&'5+ F8>-;= Doi 58+88@ O S8=-@&@ #=' 8>>-8 + PMID 8>=&F> +

88+ Y%mp %p airhea! Y0 Mehta 0 Rothell PM #;>'+ .St%!i% pe /aza !eintarzieri in ima(isti"a "aroti!a si inter)entii "hir%r(i"ale si ris"%l !e a""i!ent)as"%lar "ere/ral re"%rent. Ne%rolo(ie @> #&' 5+ &8->+ Doi 5 8+8;8; O

8+nl+8&@+;=@+/= + PMID 8@F +8;+ Y%mp %p US Pre)enti)e Ser)i"es TasK or"e #;'+ .S"reenin( - %l pentr%stenoza !e artera "aroti!a5 US Pre)enti)e Ser)i"es TasK or"e !e"lara6iere"oman!are. 0 Ann++ Intern+ Me! 8= #8;'5++ >=-F Doi 5 8+&;@ O &-=8F-8=-8;-;8;8-> + PMID 8>@ +

8&+ Y%mp %p Halli!aJ A0 Mansel! A0 Marro Y0 Peto C0 Peto R0 Potter Y0 ThomasD #;='+ .Pre)enirea !eza"ti)area ;++ Doi 5

8+88@ O S8=-@&@ #=' 8@8=@-8 + PMID 8>8&>>F= +

8=+ Y%mp %p Cham/ers BR0 Donnan GA #;>'+ Cham/ers0 Brian R0 e!.en!artere"tomia "aroti!ei pentr% stenoza "aroti!ian3 asimptomati"3. Co"hraneBaza !e !ate SJst Re) #='5+ ++ CD8F;& D,I 5 8+8; O8=@>8>+CD8F;&+p%/; + PMID 8@;&>;F +

8>+ Y%mp %p Spen"e YD #;@'+ + A""i!ent )as"%lar "ere/ral .N%tri6ie <ia""i!ent )as"%lar "ere/ral !e pre)enire. %n ?%rnal al "ir"%la6iei "ere/rale & #F'5;=&->+ !oi 5 8+88@8 O 8+STR+;&@@&&+=8@+ee + PMID 8@&8; +

8@+ Y%mp %p ho% XH0 Tan( YX0 % MY0 L% Y0 ei W0 in XX0 an( C0 W% Y0 El Y#;88'+ ri(ht0 Yames M0 e!+ 0 .E*e"t%l s%plimentarea "% a"i! *oli" as%prarez%ltatelor "ar!io)as"%lare5 o re)iz%ire sistemati"a si meta-analiza. PLoS ,NE @#F' 5+ E;>8=;+ Bi/"o!e 5 ;88PLoS, +++ @;>8=; + Doi 5 8+8&8 O ?o%rnal+pone+;>8=; + PMC &8;8F + PMID ;8F& + !e -

8+ Y%mp %p ClarKe R0 HalseJ Y0 Lein(ton S0 Lonn E0 Armita(e Y0 Manson YE0

Bnaa H0 Spen"e YD0 NJ(r! ,0 Yamison R0 Gaziano YM0 G%arino P0 Bennett D0 I 0Peto R0 Collins R #,"t 880 ;8'+ .E*e"tele !e re!%"ere a ni)el%l%i homo"isteinei"% )itaminele B 0 pri)in! /olile "ar!io)as"%lare0 "an"er%l0 persoane. Ar"hi)es o* Internal Me!i"ine 8 #8'5 ++ 8@;;-8@&8 !oi 58+88 Oar"hinternme!+;8+&= + PMID ;F&F8F +

8+ Y%mp %p B%shnell C+ M"C%llo%(h LD0 Aa! IA0 Chirea% M10 e!!er N0%rie L0 Hoar! 1Y0 Li"htman YH0 Lisa/eth LD0 Pia IL0 Ree)es MY0 Re$ro!e M0SaposniK G0 Sin(h 10 To(hi A0 1a""arino 10 alters MR #;8='+ + .Linii

!ire"toare pentr% pre)enirea a""i!ent%l%i )as"%lar "ere/ral la *emei5 o !e"laratiepentr% pro*esionistii !in !omeni%l sanatatii !in Ameri"an Heart Asso"iation OAso"iatia Ameri"an StroKe. a""i!ent )as"%lar "ere/ral %n ?%rnal al "ir"%la6iei"ere/rale => #>'5 8>=>-8>+ !oi 5 8+88@8 O 8+str+==;F+@@@&+= + PMID;=>&@& +

8F+ Y%mp %p to5 A / ernan N0 ,)/ia(ele B0 ne(r% HR0 Bra)ata DM0Chimoitz MI0 EzeKoitz MD0 an( MC0 isher M0 %rie L0 D1 spate0 Yohnston SC0asner SE0 ittner SY0 Mit"hell PH0 Ri"h M0 Ri"har!son D 0 S"hamm LH0 ilson YA #MaJ 80 ;8='+ .Linii !ire"toare pentr% Pre)enirea a""i!ent%l%i )as"%lar"ere/ral la pa"ientii "% a""i!ent )as"%lar "ere/ral si ATAC tranzitor is"hemi"5 ,

,rientare pentr% Pro*esionistii DIN + Domeni%l Sanatatii De la Ameri"an HeartAsso"iation O Aso"iatia A""i!ent )as"%lar "ere/ral ameri"an.+ A""i!ent )as"%lar"ere/ral on% YURNAL al "ir"%la6iei "ere/rale => # '5 ;8@-;&@+!oi5 8+88@8 OSTR+;= +PMID ;=F@ +

88+ Sari Hart RG0 Pear"e LA0 A(%ilar MI #;'+ .Meta-analizeaz5 pentr% %nantitrom/oti"e Terapia on% pre)eni a""i!ent )as"%lar "ere/ral la pa"ientii !e :n(ri?ire a% /rilatie atriala non)al)%lar.+ Ann+ Intern+ Me!+ 8=@ #8;'5+ >-@Doi58+&;@ O &-=8F-8=@-8;-;@8F- +PMID 8>> +

888+ Sari )ersion s%s Pa"iaroni M0 A(nelli G0 Mi"heli S0 Caso 1 #;'+.E"a"itatea SI :n A1C anti"oa(%lant al Si(%ran6ei tratament%l%i a"%t"ar!ioem/oli"e5 o meta-analizeaz %n st%!iilor ran!omizate "ontrolate.+ A""i!ent

)as"%lar "ere/ral & #;'5+ =;&-&Doi5 8+88@8 O 8+STR+;>=@+F;F>+8*+PMID 8;=@8 + ACP YC Sinopsis

88;+ Sari Armstron( MY0 Grnseth G0 An!erson DC0 Biller Y0 C%""hiara B0 Da*erR0 Gol!stein LB0 S"hne"K M0 SR MESSE #; mai ;8&'+ .Rez%mat%l orient3rii

/azate pe Do)ezi5 Mana(ement%l Peripro"e!%ral !e me!i"a mente antitrom/oti"e)ersion pa"ien6ii "% Boala "ere/ro)as"%lar3 is"hemie5 Raport%l !e Dez)oltare,rient ona A"a!emiei S%/"omisia !e Ne%rolo(ie ameri"ane . + Ne%rolo(ie #;;'5+ ;@>-;@F!oi5 8+8;8; O NL+/8&e&8;F=/&;! +PMC &8@= +PMID;&8&@ +

88&+ Sari )ersion s%s Rothell0 Peter M0 Al(ra0 Ale0 Chen hen(min(0 Diener0Hans-Christoph0 Norr)in(0 Bo0 Mehta0 iJah #Mai ;8@'+ .E*e"tele !e aspirinaAs%pra ris"%l%i I se)eritatea A1C re"%rent pre"o"e !%pa ata" is"hemi" tranzitorI A""i!ent%l )as"%lar "ere/ral is"hemi"5 analizeaz )ersion Timp %n ran!omizatest%!iilor .+ Lan"et +Doi5 8+88@ O S8=-@&@ #8@' &=@- +

88=+ Sari Gomez CR5_ Timp%l Este "reier%l Y a""i!ent )as"%lar "ere/ral siCere/ro)as" Dis &5 8-; + 8FF& Timp%l s%plimentar

88>+ Sari )ersion s%s Sa)er YL #;@'+ .Timp%l Este "reier%l - "%anti"at. +A""i!ent )as"%lar "ere/ral & #8'5 ;@&-@+Doi5 8+88@8 O8+STR+8F@F>+>>F;+a/ +PMID 8@&&F=@ +

88@+ Sari )ersion s%s Bellolio0 M0 Gilmore0 RM Ganti0 L #;& ian%arie ;8='+.Pentr% Ins%lina la Control%l (li"emi" on% a""i!ent )as"%lar "ere/ral is"hemi"+.+Baza !e !ata !e Co"hrane Re"enzii sistemati"e 8 5+ CD>&=@PMID ;==>&;& +

88+ Sari )ersion s%s Bath0 PM0 rishnan0 #; o"tom/rie ;8='+ .Pentr%Inter)en6ii o mo!i"area !eli/erat3 tensi%nii arteriale la on% a"%t !e a""i!ent)as"%lar "ere/ral+.+ Baza !e !ata !e Co"hrane Re"enzii sistemati"e 8 5+CD&FD,I5 8+8; O 8=@>8>+CD&F+p%/& +PMID ;>&>&&;8 +

88+ Sari )ersion s%s Lee0 M0 ,)/ia(ele0 B0 Hon(0 S0 %0 IL0 Lee0 YE0 Rao0 NM0en(0 + E"onomizor0 YL #; mai ;8>' .E*e"t%l !e Re!%"ere a tensi%nii arterialein EarlJ A""i!ent )as"%lar "ere/ral is"hemie5 meta-analizeaz .++ a""i!ent )as"%lar"ere/ral on% YURNAL al "ere/ral3 "ir"%la6iei =@ 5 8&-F+!oi5 8+88@8 O

STR,EAHA+88>+F>>; +PMID ;@;;@&@ +88F+ Sare Pan` la5 a / ar!la0 YM M%rraJ0 10 M%n6ii0 E0 !el oppo0 GY #;Fi%lie ;8='+ .Trom/oliza pentr% on% a""i!ent is"hemi" "ere/ral )as"%lar+.+ Baza!e !ata Co"hrane !e Re"enzii sistemati"e 5 CD;8& +D,I5 8+8; O8=@>8>+CD;8&+p%/& +PMID ;>;>; +

8;+ Sare Pan` la5 a / Em/erson0 Y Le<ii0 R0 LJ!en0 P0 Bla"Kell0 L0 Al/ers0 GBl%hmKi0 E0 Brott0 T0 Cohen0 G0 Da)is0 S0 Donnan0 G Grotta0 Y Hoar!0 G Casta0M0 o(a0 M0 !%rere0 R Lans/er(0 M0 Lin!leJ0 RI0 M%rraJ0 G ,li)ot0 YM0 Parsons0 M0 TilleJ0 B0 Toni0 D0 ToJo!a0 ahl(ren 0 N0 ar!la0 Y hiteleJ0 0 Del oppo0 GY0

Bai(ent0 C0 San!er"o"K0 P0 MA0 + pentr% C,LAB,RARE a""i!ent trom/oliz3)as"%lar "ere/ral Trialists0 Gr%p%l #> a%(%st ;8=' 0 .E*e"t%l !e intarziere !e



Tratament0 si A1C 1arsta "% se)eritatea Pri)ire la e*e"tele trom/olizei )e"hi "%plaza intra)enoase pentr% a""i!ent )as"%lar "ere/ral is"hemi"+ o meta-analizeazo /ere Datelor in!i)i!%ale pa"ien6ilor DIN St%!ii "lini"e ran!omizate .+ Lan"et&= 5 8F;F-8F&>+Doi5 8+88@ O S8= -@&@ #8=' @>=-> +PMID ;>8@@& +

8;8+ Sari )ersion s%s ar!la0 YM M%rraJ0 10 M%n6ii0 E0 !el oppo0 GY #;F i%lie;8='+ .Trom/oliza pentr% on% a""i!ent is"hemi" "ere/ral )as"%lar+.+ Baza !e!ata !e Co"hrane Re"enzii sistemati"e 5 CD;8&+D,I5 8+8; O8=@>8>+CD;8&+p%/& +PMID ;>;>; +

8;;+ Sare Pana la5 on% / .trom/oliti" pentr% on% a"%t !e a""i!ent )as"%lar"ere/ral. + DJname! + 8> septem/rie ;8= + A""esat "% = ,"tom/rie Noiem/rie"% ;8= + .La &-=0> minere%l%i !e la a""i!ent )as"%lar "ere/ral !e/%t%l t-PA !eCreste ris"%l intra"ranian3 hemora(ie simptomati"30 reprezint3 E*e"t%l As%prain"onsisten63 Este rez%ltatelor *%n"tionale.

8;&+ Sari )ersion s%s .Trom/oliza A1C a"%t is"hemi" )ersion5 pentr% ore(2n!ire Timp%l.+ BMY &> #h8>'+ 8 martie ;8>+!oi5 8+88&@ O /m?+h8> +

8;=+ Sari .Aso"iatia "ana!iana a Me!i"ilor !e URGENTA Pozitia De"laratiepri)in! A""i!ent )as"%lar is"hemie a"%ta "ere/ral3. #PD' + Caep+"a + ;8>> + Dea!% aprilie l%na )ersion an%l ;8> + De 1eri"a6i )alorile prezentate !ate :n5 g!ate Z #help '

8;>+ Sari + ar!la YM0 M%rraJ 10 M%ntii E0 !el oppo G0 San!er"o"K P0 Lin!leJRL0 Cohen G #;& mai ;8;' .A"ti)ator re"om/inant al plasmino(en%l%i tis%lar3pentr% a""i!ent )as"%lar is"hemi" "ere/ral5 o analizeaz Sistemati"a a"t%alizata I

meta-analizeaz . + Lan"et + linia Prima #F&='5+ ;&@=-;Doi5 8+88@ O S8=-@&@ #8;' @&- +PMC &&@=F= +PMID ;;@&;F +

8;@+ Sari hiteleJ N0 Slot B0 ernan!es P0 P San!er"o"K0 ar!la Y #Noi;8;'+ .a"torii !e ris" pentr% hemora(ie intra"ranian3 la pa"ien6ii "% A1Cis"hemi" trata6i "% 6es%t a"ti)ator re"om/inant al plasmino(en%l%i5 o analizeazSistemati"a si meta-analizeaz %n >> !e + st%!ii . a""i!ent )as"%lar "ere/ral on% YURNAL al "ere/ral3 "ir"%la6iei =& #88'5 ;F=-F+!oi5 8+88@8 OSTR,EAHA+88;+@@>&&8 +PMID ;;FF@F>F +

8;+ Sari Instit%t%l National !e T%l/%rari ne%ro - lo(i"e si a""i!ent )as"%lar"ere/ral RT-Pa StroKe St%!J Gro%p0 #8FF>'+ .A"ti)ator tis%lar3 al plasmino(en%l%ipentr% on% a""i!ent )as"%lar "ere/ral is"hemi"+ Instit%t%l National !e T%l/%rarine%ro - lo(i"e si a""i!ent )as"%lar "ere/ral rt-PA a""i!ent )as"%lar "ere/ralGr%p%l !e st%!i% . + Ne En(lan! Yo%rnal o* Me!i"ine &&& #;='5 8>8-+!oi58+8>@ O NEYM8FF>8;8=&&&;=8 +PMID =8F; +

8;+ Sari )ersion s%s ar!la0 YM M%rraJ0 10 M%n6ii0 E0 !el oppo0 GY #;F i%lie;8='+ .Trom/oliza pentr% on% a""i!ent is"hemi" "ere/ral )as"%lar+.+ Baza !e!ata !e Co"hrane Re"enzii sistemati"e 5+ CD;8&PMID ;>;>; +

8;F+ Sari )ersion s%s D%/insKJ R0 Lai SM #;@'+ .C% Mortalitatea pa"ien6ilora""i!ent )as"%lar "ere/ral "% trom/oliza tratati5 analizeaz la stationar pro/ei +



Nationale Ni)el. Ne%rolo(ie @@ #88'5+ 8=;-8==Doi5 8+8;8; O8+nl+;8&@+&>@8+& +PMID 8@@FF>& +

8&+ Sari .De"laratia !e Pozitie "a%zei pri)in! %tilizarea Terapia trom/oliti"3 :nintra)enoas3 tratament%l )as"%lar "ere/ral a""i!ent%l%i. + A"a!emia Ameri"ana

!e Me!i"ina !e Ur(enta + A!% !e ;-8-;> +8&8+ Sari )ersion s%s + Lee M0 Hon( S0 Sa)er YL #Mai ;8' .E"a"itatea/rinoliza intra-arterial pentr% a""i!ent is"hemi" "ere/ral )as"%lar5 meta-%nanalizeaz ran!omizate "ontrolate st%!iilor.+ A""i!ent )as"%lar "ere/ral =8 #>'5+F&;-Doi5 8+88@8 O STR,EAHA+8F+>=&&> +PMID ;&@>=F +

8&;+ Sari )ersion s%s Sar!ar0 P Chatter?ee0 S0 Giri0 Y %n!%0 A0 Tan!ar0 A0 Sen0P0 Nairooz0 R0 H%ston0 Y0 RJan0 YY0 Bashir0 R0 PariKh0 SA0 Al/0 CY0 MeJers0 PM0M%Kher?ee0 D0 Ma?ersiK0 YY0 Gri0 A #8; i%nie ;8>'+ .Terapia en!o)as"%lare pentr%on% a""i!ent is"hemi" "ere/ral )as"%lar5 o Analiza Sistemati"a si meta-analizeaz

%n ++ ran!omizate st%!iilor. E%ropean Heart Yo%rnal &@ 5+ ;&&-Doi5 8+8F& Oe%rheart? O eh); +PMID ;@8>FF +

8&&+ Sari )ersion s%s Ba!hiala0 YH Nassiri0 0 Alhazzani0 Selim0 MHarroKhJar0 0 Lan"i0 Y %lKarni0 A10 Sin(h0 S0 Alahtani0 A0 Ro"her(0 B0Alshahrani0 M M%rtJ0 N Alhazzani0 A0 Xaras"a)it"h0 B0 Re!!J0 0 ai!at0 ,,Almenaer0 SA #& noiem/rie ;8>'+ .Throm/e"tomJ en!o)as"%lare pentr%a""i!ent )as"%lar "ere/ral a"%ta is"hemie+ , meta-analizeaz.+ YAMA &8= #8' 5+8&;-8=&!oi5 8+88 O ?ama+;8>+8&@ +PMID ;@>;F8@8 +

8&=+ Sari Simar! YM0 Sah%%illo Y0 Sheth CN0 ahle T0 BP al"ott #aprilie

;88'+ .Gestion ona mali(n3 "ere/ral3 in*ar"t%l%i. + C%rr Tratati ne%ronale,p6i%ni 8& #;'5+ ;8-;FDoi5 8+8 O s88F=-8- 88-F +PMC &;=&F>& +PMID;88FF +

8&>+ Sari .spitalizare or(anizata #%nitate !e a""i!ent )as"%lar "ere/ral' !eINGRIYIRE pentr% on% a""i!ent )as"%lar "ere/ral.+ Baza !e !ata Co"hrane Re)ie- sistemati"e %ri + 88 septem/rie ;8&+!oi5 8+8; O 8=@>8>+CD8F+p%/& +

8&@+ Sari )ersion s%s http5OO+stroKe+s"ot+nhs+%KO!o"sOUse,*AnKle-oot,rthosesolloin(StroKe+p!*

8&+ Sari ,S%lli)an ; 0 pp+ =80 ==0 &0 =

8&+ Sari Ma"Kenzie C #aprilie ;88'+ .Dizartrie :ntr -%n a""i!ent )as"%lar"ere/ral5 o o narati)3 Re)iz%ire )2nzare I !es"rierii rez%ltat%l inter)en6iei.+ Int YSpee"h Lan( Pathol 8& #;' 5+ 8;>-&@!oi5 8+&8F O 8>=F>+;88+>;=F= +PMID;8=F +

8&F+ Sari )ersion s%s 1est C0 HesKeth A0 1ail A0 Boen A #;>'+ 1est0 CarolJn0e! .pentr% apra$ie !e Inter)en6ii a""i!ent !e e$primare !%pa )as"%lar "ere/ral. ++Co"hrane Baza !e !ata SJst Re) #='5+ CD=;FD,I5 8+8; O8=@>8>+CD=;F+p%/; +PMID 8@;&>&> +



8=+ Sari )ersion s%s Bra!J0 MC0 ellJ0 H Go!in0 Y En!er/J0 P #8@ Mai ;8;'+.Terapia !e )or/ire I lim/a? pentr% a*azie a""i!ent !%pa )as"%lar "ere/ral+.+Baza !e !ata Co"hrane !e Re"enzii sistemati"e > 5+ CD=;>PMID ;;>F;@; +

8=8+ Sare Pana la5 a / B+ + Lan(e0 S+ lJnn A+ Rizzo0 B0 + lJnn0 S 5 + Rizzo0 A+

#;F' + E1ALUAREA .!e Gra!%l initiala Utilizare %n oc-the-pl%t3 !e "onsol3 !e ?o"%ri pentr% lm ?o" CLINICA rea/ilitare pe motorie Baza . Terapie zi"a ,pinii8= #>'5+ &>>-&@;Doi5 8+88F O 8&&8FFW8;=@@88;> +

8=;+ Sari re(ni 0 Pas"%al-Leone A #;'+ .Insi(ht Tehnolo(ie5 stim%larea"reier%l%i in ne%rolo(ie-nein)azi) perspe"ti)a al As%pra RTMS Poten6ial%lterape%ti" si tDCS.+ Nat%ra Ne%rolo(ie Pra"ti"i "lini"e & #'5+ &&-&F&Doi58+8& O n"pne%ro>& +PMID 8@88= +

8=&+ Sari )ersion s%s Balas%/ramanian S0 lein Y0 B%r!et E #;8'+ .De ro/ot!e Rea/ilitare asistata !e %n %n"6iei Mana+. C%rrent ,pinion in Ne%rolo(ie ;&

#@'5+ @@8-Doi5 8+8F O C,+/8&e&;&&eFFa= +PMID ;>;=;8 +

8==+ Sare Pan` la5 a / " Sa%n!ers0 DH San!erson0 M0 Brazzelli0 M0 Grei(0 CA0hi!romel0 GE #;8 o"tom/rie ;8&'+ .ormare !e sala !e tness izi"e pentr%pa"ientii "% "ere/ral a""i!ent )as"%lar+.+ Baza !e !ata Co"hrane !e Re"enziisistemati"e 8 5+ CD&&8@PMID ;=8=;=F; +

8=>+ Sari Instit%t%l pentr% Calitate si EICIENTA in Sanatate #IiG'+ .A""i!entD%pa on% )as"%lar "ere/ral5 S%nt tnesstrainin( si im/%natati Sanatatea(enerala mo/ilitatea. + n "%nostinta !e sanatate on - line + Instit%t%l pentr%Calitate si EICIENTA in Sanatate #IiG' + A!% !e ; l%na i%nie "% ;8& +

8=@+ Sare Pana la5 a / CoceJ C+ E!ar! C%mmin(s YecreJ L0 0 StarKsteinSer(io + Ro/inson Ro/ert #;' - A""i!ent )as"%lar "ere/ral Ameri"an PsJ"hiatri"Press Te$t/ooK o* Geriatrie Ne%ropsihiatrie #a e! + Do%a'+ ashin(ton DC5Ameri"an PsJ"hiatri" Press+ pp+ @8-@8+

8=+ Sari Spital%l Stan*or! si "lini"i+ .Boli "ar!io - )as"%lare5 a""i!ent )as"%lar"ere/ral E*e"tele. + ;> A""esat +

8=+ Sari e!itori0 Tom A+ S"heizer0 R+ Ma"!onal! Lo"h0 #;8='+ Conse"in6ele!e a""i!ent "ere/ral "omportamentale )as"%lar + Ne XorK0 NX 7%a95 Sprin(er+ pp+

88F-8&&+ ISBN F-8-=@8=-@8-F +

8=F+ Sari )ersion s%s Ma"Kenzie0 Catherine #;88'+ .Dizartrie a""i!ent )as"%lar"ere/ral )ersion5 , 0 o narati)3 Re)iz%ire )2nzare I !es"rierii rez%ltat%linter)en6iei+. International Yo%rnal o* patolo(ie Spee"h-Lan(%a(e 5 8;>-8&@+

8>+ Sari )ersion s%s A"KleJ0 BettJ0 La!i(0 Gail B0+ elleJ0 Helen #;8'+Dia(nosti"%l man%al N%rsin(5 %n (hi! pentr% /azat pe Do)ezi !e plani"areaIn(ri?ire - #F+ E!+' MarJlan! Hei(hts0 M,5+ Mos/J+

8>8+ Sare Pana la5 a / + Seneli"K Ri"har! C+0 Rossi0 Peter +0 Do%(hertJ0 arla

#8FF=' Con!i6ii !e 1iata "% a""i!ent )as"%lar "ere/ral5 Un (hi! pentr% *amilii +Carti "ontemporane0 Chi"a(o+ISBN -F;-;@-& + ,CLC =>@ +



8>;+ Sare Pana la5 a / 1illarosa0 Lin!a0 Sin(leton0 La*aJette0 Yohnson0 irK A+#8FF&'+ Ne(r% !e Ghi!%l Bi/liote"ii sanatate la a""i!ent )as"%lar "ere/ral + Ne XorK5 HenrJ Holt an! Co+ISBN ->-;;F-F + ,CLC ;@F;F> +

8>&+ Sari Hamilton RH0 ChrJsiKo% CE0 Coslett B #;88 i%lie'+ .De Re"%perare

a*azie Me"anisme !e a""i!ent )as"%lar "ere/ral !%pa !e rol%l I stim%lare"ere/rala nein)azi). + Brain Lan( 88 #8-;'5+ =->Doi5 8+88@ O ?+/an!l+;88+;+> +PMC &8F +PMID ;8=>F=; +

8>=+ Sari )ersion s%s LeJs D0 Henon H0 Ma"KoiaK-Cor!oliani MA0 Pas%ier #noiem/rie ;>'+ .Post a""i!ent )as"%lar "ere/ral Dementa.+ Lan"et ne%ronale= #88'5+ >;-FDoi5 8+88@ O S8==-==;; #>' ;;8- +PMID 8@;&F8; +

8>>+ Sari Co%lthar! E0 Sin(h "%rrJ 10 H%sain M #!e"em/rie ;@'+ .Tratament%l!e !e"itar Atentie in ne%ro t%l/%rari lo(i"e+. C%rrent ,pinion in Ne%rolo(ie 8F#@'5+ @8&-Doi5 8+8F O 8+"o+;=@>+>>@+Fa +PMID 88;; +

8>@+ Sari )ersion s%s Lim C0 Ale$an!er MP #!e"em/rie ;F'+ .A""i!ent)as"%lar "ere/ral si t%l/%rari !e memorie episo!i"3.+ Ne%ropsJ"holo(ia = #8='5+&=>->Doi5 8+88@ O ?+ne%ropsJ"holo(ia+;F++; +PMID 8F@@@& +

8>+ Sari )ersion s%s M%rraJ ED0 B%ttner N0 Pret BH #;8;'+ .Depresia sipsihozei la ne%ro - lo(i"e pra"ti"a.+ Prin"ipal n Bra!leJ G0 Daroc RB0 eni"helGM0 YanKo)i" Y+ ne%rolo(ie Bra!leJ pra"ti"a "lini"a+ 8 #@ e!+' + Phila!elphia0 PA5Else)ier O Sa%n!ers+ pp+ 8-8+ ISBN 8-=&-=&=-= +

8>+ Sari + Reith Y0 Yr(ensen HS0 NaKaJama H0 Raas"ho% H,0 ,lsen TS #a%(%st

8FF' .Crize "on)%lsi) :n a"%t "ere/ral a""i!ent )as"%lar+ Pre!i"tori si !esemni"atie !e pro(nosti" la a""i!ent )as"%lar "ere/ral !e st%!i% Copenha(a. +StroKe ; #'5+ 8>>-FDoi5 8+88@8 O 8+STR+;++8>> +PMID F;>F>& +

8>F+ Sari B%rn Y0 Dennis M0 Bam*or! Y0 San!er"o"K P0 a!e D0 C arlo #DIN!e"em/rie 8FF'+ .Crizele !e epilepsie a""i!ent !%pa prima on% )as"%lar"ere/ral5 a""i!ent )as"%lar "ere/ral ,$*or!shire Proie"t%l Com%nitar. + BMY &8>#8;;'5 8>;- + !oi5 8+88&@ O /m?+&8>+8;;+8>; +PMC ;8;F& +PMIDF=&;@ +

8@+ Sari .Boala si estimari ,MS o tara pre?%!i"i%l%i. + ,r(anizaqia o Mon!iala

Sanatatii + ;F+ Arhi)at !in ori(inal 0 la 88 noiem/rie ;F + A!% !e 88Noiem/rie l%na0 an%l ;F +

8@8+ Sari .Top 8 !e !e"es Ca%ze. + Mon!ial3 a S3n3t36ii+

8@;+ Sari Aso"iatia In!ian Heart De "e Asiati"i !e S%! e/ apte+ mai ;8>+http5OOin!ianheartasso"iation+or(OhJ-in!ians-hJ-so%th-asiansOo)er)ieO

8@&+ Sari )ersion s%s + To(hi Un Sa)er YL #a%(%st ;88' .a""i!ent )as"%lar"ere/ral !e s"a!e la %n Treia la %n patra !e "on!%"ere !e !e"es !in "a%za StateleUnite5 Perspe"ti)a istori"3 I pro)o"3rile 1iitoare. + StroKe =; #'5+ ;&>8->Doi5

8+88@8 O STR,EAHA+888+@;8F= +PMID ;8==> +



8@=+ Sari ElleK?aer H0 Holmen Y0 In!re!a)iK B0 Terent A #8 noiem/rie )ersion 08FF'+ .Epi!emiolo(ie !e a""i!ent )as"%lar "ere/ral la Innherre!0 Nor)e(ia08FF=-8FF@5 & zile In"i!en6a I rata Ca%za !e"es. + A""i!ent )as"%lar "ere/ral ;#88'5 ;8-;8=+!oi5 8+88@8 O 8+STR+;+88+;8 +PMID F&@>@8 + A!% !e;-8-;; +

8@>+ Sari + Bon(ers TN0 !e Maat MP0 ML )an Goor0 Bha(an/ali 10 )an 1lietHH0 Gmez Gar"ba EB0 Dippel D0 Lee/eeK #;@' .a"tor ri!i"at %ll TimeNi)el%l )on ille/ran! Creste ris"%l !e a""i!ent )as"%lar "ere/ral Prim%lis"hemi"5 in4%enta ADAMTS8& 0 in4ama6iei I )aria/ilitatea Geneti"a .+ A""i!ent)as"%lar "ere/ral & #88'5+ ;@;-Doi5 8+88@8 O 8+STR+;==@+&FF@;+*+PMID 8@FF>8 +

8@@+ Sari Ashraan H #;8'+ .A""i!ent )as"%lar "ere/ral a"%m amilial3 ;!e ani.+ StroKe =8 #='5+ E8Doi5 8+88@8 O STR,EAHA+8F+>&8 +PMID;8> +

8@+ Sare Pana la5 a / Thompson YE #o a%(%st 8FF@'+ .E1,LUTIA pentr%tratament%l "hir%r(iei I )as"%lare "ere/rale Pre)enirea a""i!ent%l%i illisC%rs+. + StroKe ; #'5+ 8=;-8=&=Doi5 8+88@8 O 8 STR+;++8=; +PMID888> +

8@+ Sari )ersion s%s opito0 Yec #;8 septem/rie' I + .Un a""i!ent )as"%lar"ere/ral :n timp. + MERGINET+"om @ #F'+ 7 LinK mort 9

8@F+ Sari )ersion s%s R+ Barnhart0 e!+ Etimolo(i" Barnhart Con"is Di"6ionar%l#8FF>'

8+ Sari S"hiller #aprilie 8F'+ .1as"%lar "ere/ral !e Con"epte !e a""i!ent0inainte si !%pa 1ir"ho. + Me! Hist 8= #;'5+ 88>-&8Doi5 8+88 OS;>;&8>&;> +PMC 8&=&= +PMID =F8=@& +

88+ Sari StanleJ S%nPhoto0 ranois Boller0 + enneth L+ TJler #;8'Han!/ooK o* Clini"al Ne%rolo(ie + +-Nor!%l ,lan!ei P%/lishin( CompanJ P+ Patr%s%te %n%ISBN F--===->;F- + A!% !e 8 ,"tom/rie Noiem/rie "% ;8& +

8;+ Sari Yohn + S"a!!in( #!e"em/rie ;88'0 + Clini"a !e Ne%rolo(ie + CRCPress+ P+ =thISBN F--&=-FF-= + A!% !e 8 ,"tom/rie Noiem/rie "% ;8&

+

8&+ Sari )ersion s%s Yoseph I+ Sir)en + Bar/ara L+ malam%t #;' 0 Clini"a !eNe%rolo(ie %n )arstni" + + illiams ilKins Lippin"ott P+ ;=& !e aniISBN F--8-@F=-8 + A!% !e 8 ,"tom/rie Noiem/rie "% ;8& +

8=+ Sari )ersion s%s Da)i! a%*man MJlan!0 Y + MarK Milstein #> !e"em/rie;8;' Clini"a !e Ne%rolo(ie a%*man pentr% psihiatrii + + Else)ier Health S"ien"esP+ F;n!ISBN F-8-=>>-==- + A!% !e 8 ,"tom/rie Noiem/rie "% ;8& +

8>+ Sare Pana la5 a / Mos/J Me!i"al Di"tionarJ0 e!i6ia a -a+ Else)ier+ Din

;F+

8@+ Sari )ersion s%s .Ce este on% a""i!ent )as"%lar "ere/ral O Brain Atta"Kf.#PD' + Aso"iatia Nationala A""i!ent )as"%lar "ere/ral + A!% !e ; l%na *e/r%arie"% ;8= +

8+ Sari Bine"%)2ntarea Me!i"al !i"6ionar + arle$0 In" DIN !in ;8+

8+ Sari )ersion s%s Der!eJn CP0 Chimoitz MI Chimoitz #a%(%st ;'+.An(ioplastia si pentr% stentarea intra"ranian3 ateros"leroti"3 Stenoza5 "lini"a Y%sti"area Un%i Trial ran!omizat. + + Ne%roima(isti"e Clin N+ Am+ 8 #&'5+ &>>-@&0)iii-i$Doi5 8+88@ O ?+ni"+;+>+8 +PMC ;=88F +PMID 8;@@& +

8F+ Sari )ersion s%s tensionarea MS0 Amar AP0 Ma"K Y0 Amar0 Ma"K #;88!e"em/rie'0 + .Throm/e"tomJ a""i!ent is"hemi" pentr% me"ani"e )as"%lar"ere/ral+ olosin! Retrie)er MERCI I Sisteme !e aspiratie Pen%m/ra.ne%ro"hir%r(ia L%mea @ #@ S%ppl'5+ S8@-;&Doi5 8+88@ O ?+ne%+;88++&+PMID ;;8;;@ +

8+ Sari ,rte(a-Lopez X0 Llanos-Men!ez A #;8'+ .7Trom/e"tomia "%me"ani"a MERCI Dispoziti)+ A""i!ent "ere/ral is"hemi" )as"%lare9. + A(entiapentr% An!al%z E1ALUAREA tehnolo(iei Me!i"ale +

88+ Sari )ersion s%s Lees R0 i)in YA0 Ashoo! T0 Da)alos A0 Da)is SM0Diener HC0 Grotta Y0 LJ!en P0 Sh%ai/ A0 Hr!emarK HG0 asiesKi i)in0Ashoo!0 Da)alos0 Da)is0 sl%?itor0 Grotta LJ!en Sh%ai/0 Hr!emarK0asiesKi0 + a""i!ent )as"%lar is"hemie "ere/ral3-a"%ta NWX Tratament%l #SAINTI' An"hetatorii Trial #*e/r%arie ;@' .NWX->F pentr% on% a""i!ent is"hemi""ere/ral )as"%lar+. Ne En(lan! Yo%rnal o* Me!i"ine &>= #@'5+ >-@Doi5

8+8>@ O NEYMoa>;F +PMID 8@=@>=@ +

8;+ Sari )ersion s%s oziol YA0 en( AC en( #o"tom/rie ;@'+ .C% Pri)ire laanalizeaz I interpreta zona rez%ltatelor m3s%rilor A""i!ent :n )as"%lar "ere/ralSt%!iile "lini"e n)363minte !esprinse DIN st%!i%l SAINT I-NWX >F pentr% on%+A""i!ent )as"%lar a"%t "ere/ral is"hemi". a""i!ent )as"%lar "ere/ral on% YURNAL!e Cir"%latie "ere/rala & #8'5+ ;@==-!oi5 8+88@8 O8+STR+;=88@+8;F&+;/ +PMID 8@F=@8> +

8&+ Sari )ersion s%s Bennett0 MH ei/el0 S0 asiaK0 Y S"hna/el0 A0 *ran"eza0

C + Bolna)0 P #8; noiem/rie ;8=' .Terapia "% o$i(en hiper/ari" pentr% on% ++A""i!ent )as"%lar "ere/ral is"hemi". Baza !e !ata Co"hrane !e Re"enziisistemati"e 88 5 CD=F>=+D,I5 8+8; O 8=@>8>+CD=F>=+p%/& +PMID;>&FF; +

Le"t%ri s%plimentare

YP Mohr0 Dennis Choi0 Yames Grotta0 Philip ol* #;='+ A""i!ent )as"%lar"ere/ral5 iziopatolo(ie0 !ia(nosti"0 =&=F +



Charles P+ arlo0 Yan )an Gi?n0 Martin S+ Dennis0 Yoanna M+ ar!la0 Yohn M+Bam*or!0 Graeme Y+ HanKeJ0 Peter AG San!er"o"K0 Ga/riel RinKel0 Petr%Lan(horne0 Cathie S%!lo0 Peter Rothell #;'+ A""i!ent )as"%lar "ere/ral5Mana(ement%l pra"ti" #&r! e!+'+ ileJ-Bla"Kell+ISBN 8-=>8-;@@-W +

LinK-%ri e$terne

iKime!ia Commons "ontine materiale le(at%l m%ltime!ia !ea""i!ent )as"%lar"ere/ral +

A""i!ent )as"%lar "ere/ral laDM,

SC,R DRAG,N pentr% post-Throm/olJsis

THRI1E SC,R pentr% a""i!ent )as"%lar "ere/ral rez%ltat%l

.1ia6a on% D%pa a""i!ent )as"%lar "ere/ral5 in4%enta Aptit%!inile I izi"ee$er"i6iile izi"e. + Cer"etare Impa"t - Stiinte Umane I Stiinte so"iale5 %n "hip oDi*erenta + Cole(i%l !e Stiinte Umane 0 Stiinte So"iale I0 Uni)ersitatea !inE!in/%r(h+ ;8@ + A!% "% = N% sta )ersion lo" ;8@ + .No%a :n Cer"etare E$er"iti%Este !a antrenament a""i!ent )as"%lar "ere/ral s%pra)iet%itori !e Sansa %n%i -Si :m/%n3t36i Calitatea 1ie6ii+.

A"elasi te$t in en(leza #netra!%s in romana' http5OOen+iKipe!ia+or(OiKiOStroKe

Ghi! !e mana(ement al a""i!ent%l%i )as"%lar "ere/ral is"hemi" si a""i!ent%l%iis"hemi" http5OO+eso-stroKe+or(Op!*OES,G%i!elinesRomanian+p!*

Proto"ol%l !e re"%perare ne%rolo(i"a a A1C

http5OO+me!i"a+roOre)isteme!O!onloa!One%rolo(ieO;@+=ONe%roNr-=;@Art-@+p!*



Baza ziolo(i"a a re*a"erii in hemiple(ie si hemipareza5 NEUR,PLASTICITATEA

http5OO+s*at%lme!i"%l%i+roOA*e"ti%ni-ale-ner)ilor-peri*eri"iO%n-mira"ol-n%mit-ne%roplasti"itate&@&

Intre/ari

8+ Este ne)oie !e impli"area #e*ort%l' pa"ient%l%if

DA Este esential+ 1alori"area ma$ima a posi/ilitatilor tine in prim%l ran! !eimpli"are+

;+ Cat !%reaza tratament%lf

Pana la re*a"ere+

,ri"e pro(res este *oarte important+

Uneori pa"ient%l%i ii este s%"ient !oar sa a?%n(a in!epen!ent la toaleta0 alteorisa mear(a la "%mparat%ri0 iar0 !ar in realitate toti isi !ores" o re*a"ere "ompleta0spre e$empl% pentr% a p%tea "on!%"e masina in si(%ranta+

&+ Cat !%reaza o se!intaf

Cir"a > !e min%te sa% atat "at pa"ient%l rasp%n!e e"ient "% pro(res+

=+ Ritm%lf



Tratament%l se poate *a"e zilni" sa%0 !a"a a"est l%"r% n% este posi/il0 la "ate)azile+

E)al%area si primele se!inte pot (rat%ite+

=+ Un!e se *a"e tratament%lf

8' la "lini"a #internare'

;' la "a/inet0 am/%lator sa% hotel #poate asi(%rat transport%l'

&' la !omi"ili%+

recuperare cerebrala

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