Stroke Caused by Atherosclerosis of the Major Intracranial Arteries

Survivors don't want discussions, they want  cures for their disabilities.

Stroke Caused by Atherosclerosis of the Major Intracranial Arteries

Chirantan Banerjee

and

Marc I. Chimowitz

Originally published3 Feb 2017https://doi.org/10.1161/CIRCRESAHA.116.308441Circulation Research. 2017;120:502–513

Abstract

Our goal in this review is to discuss the pathophysiology, diagnosis, and treatment of stroke caused by atherosclerosis of the major intracranial arteries. References for the review were identified by searching PubMed for related studies published from 1955 to June 2016 using search terms intracranial stenosis and intracranial atherosclerosis. Reference sections of published randomized clinical trials and previously published reviews were searched for additional references. Intracranial atherosclerotic disease is a highly prevalent cause of stroke that is associated with a high risk of recurrent stroke. It is more prevalent among blacks, Hispanics, and Asians compared with whites. Diabetes mellitus, hypertension, metabolic syndrome, smoking, hyperlipidemia, and a sedentary lifestyle are the major modifiable risk factors associated with intracranial atherosclerotic disease. Randomized clinical trials comparing aggressive management (dual antiplatelet treatment for 90 days followed by aspirin monotherapy and intensive management of vascular risk factors) with intracranial stenting plus aggressive medical management have shown medical management alone to be safer and more effective for preventing stroke. As such, aggressive medical management has become the standard of care for symptomatic patients with intracranial atherosclerotic disease. Nevertheless, there are subgroups of patients who are still at high risk of stroke despite being treated with aggressive medical management. Future research should aim to establish clinical, serological, and imaging biomarkers to identify high-risk patients, and clinical trials evaluating novel therapies should be focused on these patients.

Introduction

Atherosclerosis in major intracranial arteries leads to changes ranging from minor wall thickening to hemodynamically significant luminal stenosis and is one of the most common causes of stroke worldwide.¹ Intracranial atherosclerotic disease (ICAD) may occur concomitantly with systemic atherosclerosis involving other arterial beds, such as extracranial, coronary, or peripheral arteries, or may occur in isolation.^2,3 The middle cerebral arteries (MCAs) are the most common site, followed by the basilar artery, the internal carotid arteries, and the intracranial vertebral arteries.^4,5 ICAD is highly prevalent in black, Asian (China, Japan, South Korea, and India), and Hispanic populations.¹ As these populations are major drivers of global population growth, the global stroke burden from ICAD is expected to rise over time.

Clinical trials in the last decade have improved our understanding of the high stroke recurrence rate in ICAD, risk factors, and neuroimaging biomarkers associated with recurrence, as well as ushered in therapeutic changes. In this study, we review the epidemiology, risk factors, pathophysiology, diagnosis and management of ICAD.

 

Rehabilitation robots: a compliment to virtual reality

We don't need useless crapola like discussion or descriptions. We need stroke protocols that provide 100% recovery. WHEN THE HELL WILL YOU GET THERE?  This just completely proves once again that survivors need to be in charge.

Rehabilitation robots: a compliment to virtual reality

J.V.G. Robertson
1, 2
 , N. Jarrassé
3
 , A. Roby-Brami
1, 2, 4

1
Laboratoire Neurophysique et physiologie, Université Paris Descartes, CNRS UMR 8119. 45 rue des Saints Pères, Paris 75006.
2
Service MPR, Hôpital Raymond Poincaré, 92380 Garches.
3
Institut Systèmes Intelligents et Robotique, Université Pierre et Marie Curie, CNRS UMR 7222, 4 place Jussieu, 75252 ParisCedex 05
.

4
Institut fédératif de recherche sur le Handicap (IFR25).
The aim of this paper is to discuss the use of robots for upper limb rehabilitation following strokes
in adults. We describe the main robots currently being developed and the results of clinical studies
that have been carried out. The association of virtual reality interfaces and the robotic rehabilitation programs providing therapy in the form of games with a view to helping therapists increase the duration of rehabilitation exercise.
Le but de cet article est de discuter l’apport de la robotique pour la rééducation du membre supé-
rieur à la suite d’un accident vasculaire cérébral chez les adultes. Les principaux robots qui ont été développés sont décrits en relation avec les résultats des évaluations cliniques. Le couplage
entre des interfaces de réalité virtuelle et les programmes de rééducation utilisant les robots offre
des ouvertures thérapeutiques sous forme de jeux en vue d’aider les thérapeutes à accroître ladurée des exercices de rééducation.
Introduction
Over the past fifteen years, a plethora of rehabilitation robots in many shapes and forms have
popped out from laboratories all over the world. Many have not yet got beyond the stage of feasibility tests. However, a few have begun to be evaluated in clinical trials and today
we are beginning to have an idea of the effects of robotic therapy on recovery of motor
function, even though many questions remain unanswered. Robots have been developed
to compensate for loss of motor capacity [ROB 02], for retraining gait [HES 06, MAY 07]


78
Schedae
, 2010, prépublication n° 6 (fascicule n° 1, p. 77 - 94).http://www.unicaen.fr/services/puc/ecrire/preprints/preprint0062010.pdf
and for upper limb rehabilitation. Robots are highly complementary to virtual reality for
therapy as they can provide a haptic interface and/or support and assistance. The aim of
this paper is to discuss the use of robots for upper limb rehabilitation following stroke in
adults. Firstly we will describe the main robots currently being developed and the results of clinical studies which have been carried out. We will then go on to discuss the perspectives for this type of rehabilitation.

Much more at link, I'm not reading it.
 

Motor imagery and stroke rehabilitation: a critical discussion

So 9 pages of discussion resulting in absolutely NO PROTOCOLS. Useless. Although you can look up the one use of the word protocol if you want. 

Motor imagery and stroke rehabilitation: a critical discussion

Motor disorders are a frequent consequence of stroke and much effort is invested in the re-acquisition of motor control. Although patients often regain some of their lost function after therapy, most remain chronically disabled. Functional recovery is achieved largely through reorganization processes in the damaged brain. Neural reorganization depends on the information provided by sensorimotor efferent-afferent feedback loops. it has, however, been shown that the motor system can also be activated ”offline” by imagining (motor imagery) or observing movements. the discovery of mirror neurones, which fire not only when an action is executed, but also when one observes another person performing the same action, also show that our action system can be used ”online” as well as offline. It is an intriguing question as to whether the information provided by motor imagery or motor observation can lead to functional recovery and plastic changes in patients after stroke. this article reviews the evidence for motor imagery or observation as novel methods in stroke rehabilitation. Key words: motor imagery, mirror neurones, rehabilitation, stroke.

J Rehabil Med 2007; 39: 5–13 Correspondence address: Sjoerd de Vries, Centre for Human Movement Sciences, University Medical Center Groningen, University of Groningen, PO Box 196, NL-9700 AD Groningen, The Netherlands. E-mail: s.j.de.vries@rug.nl Submitted August 24, 2006; accepted October 31, 2006