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This work aimed to determine the level of some toxic elements (As, Cr, Cd, and Pb) in the water of the Rupsha River, Bangladesh, concerning their potential dangers to human exposure. The elemental concentrations (mg/L) were determined using Atomic Absorption Spectrometer and found to decrease in the order of Cr (0.041) > Pb (0.029) > As (0.004) > Cd (0.002). The level of elements in this river water surpasses various international limits, making it unfit for human consumption. Furthermore, the metal pollution index and contamination index indicated that the water was also unsuitable for this purpose. The elements chosen were persuasive to discern the hazard quotient of non-carcinogenic risk. Moreover, total targeted hazard quotient (TTHQ) values were found for adults and children within acceptable limits (TTHQ −6 to 10−4) of the threshold limit. Due to their high-water consumption per unit of body-weight and physiological development, children were found to be more sensitive than adults. Multivariate analyses demonstrated that human activities were the primary origin of toxic elements in river water. According to the findings, urban and industrial effluents should be treated before being released into rivers. Development along the river bank must be carefully controlled to safeguard the river environment. In the end, this will improve the quality of the water and lower the chance that people will be exposed to metals.

Sediment samples from the Gomti River basin were investigated to determine and evaluate trace metal concentrations, their biological effect, and potential ecological and human health risks for adults and children. The mean concentrations of trace metals were organized in the descending order of mercury (Hg) (0.08 mg/kg) > chromium (Cr) (0.06 mg/kg) > lead (Pb) (0.05 mg/kg) > arsenic (As) (0.02 mg/kg) > cadmium (Cd) (0.01 mg/kg). The current study illustrated that metals were attributed to the area from natural sources and different anthropogenic sources especially from industries. However, the concentration levels were lower than the sediment quality guidelines (SQGs) based on the effect-range classifications of threshold effect concentration (TEC) and probable effect concentration (PEC). Therefore, the concentration of the elements showed no adverse biological effects on aquatic organisms. The evaluated potential ecological risk index also revealed the low toxicity to the aquatic environment. Moreover, the applied sediment quality indices, geo-accumulation index (Igeo), contamination factor (CF), and contamination severity index (CSI) suggested that the contamination levels of the elements were in the acceptable range, and the contamination had not notably impacted on the sediment quality. The risk index (HI) concerning age groups was significantly less than the threshold limit of 1 indicating that the contamination had no non-carcinogenic risk effect. The total carcinogenic risk (TCR) was less than a risk value of 1 × 10−4. Hence, the current study suggests that immediate remediation is not required due to an absence of alarming conditions in the study area. Proper monitoring of the attribution of the metal elements should be done for the betterment of human and environmental health.

Contamination of aquatic ecosystems by various sources has become a major worry all over the world. Pollutants can enter the human body through the food chain from aquatic and soil habitats. These pollutants can cause various chronic diseases in humans and mortality if they collect in the body over an extended period. Although the phytoremediation technique cannot completely remove harmful materials, it is an environmentally benign, cost-effective, and natural process that has no negative effects on the environment. The main types of phytoremediation, their mechanisms, and strategies to raise the remediation rate and the use of genetically altered plants, phytoremediation plant prospects, economics, and usable plants are reviewed in this review. Several factors influence the phytoremediation process, including types of contaminants, pollutant characteristics, and plant species selection, climate considerations, flooding and aging, the effect of salt, soil parameters, and redox potential. Phytoremediation’s environmental and economic efficiency, use, and relevance are depicted in our work. Multiple recent breakthroughs in phytoremediation technologies are also mentioned in this review.

Quantification of four toxic metals (As, Cr, Cd, and Pb) in water and sediments at the Sitakunda ship breaking area in Bangladesh was studied. Along with this, sediment quality and ecological risk were evaluated for the metal intrusion to the study area. A total sample number of 120 (water; n = 60 and sediment; n = 60) were analyzed for both winter and summer seasons using atomic absorption spectrophotometer (AAS). The trace metal concentration in both water and sediment showed decreasing trend as follows; Cr (mean-W: 0.118 mg/L; mean-S:121.87 mg/kg) Pb (mean-W: 0.064 mg/L; mean-S: 65.31 mg/kg) As (mean-W: 0.03 mg/L; mean-S: 32.53 mg/kg) Cd (mean-W: 0.004 mg/L; mean-S: 4.81 mg/kg). However, in both segments, the concentrations of the toxic metals exceeded the recommended acceptable limits. As and Cd showed significant variation (water and sediment) between the seasons, while Pb and Cr had no seasonal impact. Metal pollution index (MPI) and contamination factor (CF) was evaluated and revealed that the study area exhibited the critical score of water quality (MPI 100). The cumulative effect of the metal concentrations was high (CI 3). The assessed mean geoaccumulaiton index (I

The Karnaphuli River is one of the prime and most important streams in the southeastern part of Bangladesh. The favorable water current and the geographic location have rendered the Karnaphuly River estuary a suitable habitat and a breeding ground for diverse fish species. Reversely, this estuary has been polluted by discharges from many point and non-point sources due to its location in the catchment area of a heavily industrialized area, Chattagram port city. However, published research concerning the status of toxic and trace elements in some commercially important benthic and pelagic coastal fish species in Karnaphuli River estuary was not found in the existing literature. Therefore, it's an important field of study on the assessment of toxic and trace elements concentration in the commercially important benthic and pelagic coastal fish species and their health taxation in the Karnaphuli River Estuary. Energy dispersive X-ray fluorescence (ED-XRF) was used to quantify trace metal concentration in edible parts of the fish species. This study revealed that the rank of the trace metals concentration was as follows (mg/kg): Zn (37.1) Mn (16.12) V (11.16) Cu (9.49) Rb (5.62) Pb (2.98) Cr (1.59) Co (1.17). The F-test showed that a significant difference at 95 % confidence level in the distribution pattern of trace metals concentration among the examined fish species in the study area. The metal pollution index (MPI) in the muscle of fishes were found to be in the following order: L. bata P. monodon T. cirratus M. bleekeri O. pabda H. nehereus L. calcarifer P. argenteus P. paradiseus T. toli, and the MPIs for most of the benthic fish species were higher compared to the pelagic fishes. On the other hand, the examined fish species were significantly bio-accumulative with the highest bio-accumulation factor value for benthic species. The multivariate analysis identified that the sources of the trace metals were associated with anthropogenic activities. For the human health risk assessment concern, estimated daily intake, target hazard quotient and cancer-causing risk were estimated. The results for non-cancer hazardous index values were found to be lower than unity. On the other hand, the total cancer risk data ranging from 1.24E-05 to 1.70E-05 were fallen within the range for the threshold values (1.0E-06 to 1.0E-04). However, considering the suggested values set by the environmental and regulatory agencies, it has been recommended that no significant non-carcinogenic and cancer-causing health risk for humans was seen due to the consumption of the studied fish species.

The Meghna River, the largest and the widest river in Bangladesh, is important for navigation, irrigation, fish spawning and shelter, industrial usages, and drinking water sources for millions of people living in nearby areas. The present study illustrated the seasonal variation of some physicochemical parameters and the four heavy metals (Cr, As, Cd, and Pb) distribution in the surface water of Meghna River estuary. It also evaluated the human health risk for adult and children due to directly contact with the surface water through ingestion and dermal pathways. The ranges of metal concentration in the study area were found in the descending order as: Cr (0.036–0.054; mean 0.045 ± 0.005) > As (0.012–0.036; mean 0.024 ± 0.007) > Cd (0.009–0.050; mean 0.018 ± 0.012) > Pb (0.007–0.014; mean 0.009 ± 0.007). In most cases, the concentrations of As, Cr, Pb, and Cd surpassed the guideline limits of human consumption. However, the one-way ANOVA study revealed that the average concentrations of the selected metals in the ten sampling sites were not significantly different at a 95% confidence level. Therefore, it is assumed that the metal contamination in the study area might have been caused due to the anthropogenic sources along with the natural phenomenon. The distribution of the metal contents and the physicochemical parameters in the surface water greatly were significantly different concerning both winter and summer seasons at a 95% confidence level. The evaluated hazard quotient (HQ) and the hazard index (HI) for the investigated metal compounds were in the acceptable limit (–6 to 10–4), and the adults are more susceptible than the children. Although the risk is within the acceptable level, but adequate monitoring aspects should be implemented to control surface water pollution especially for the metal discharge to the river estuary.

Sediment samples were collected from twelve selected sites of the Sangu River estuary and seven metals (As, Cr, Cu, Cd, Pb, Ni, Zn) were analyzed with Inductively Coupled Plasma-mass Spectrometry (ICP-MS) to assess the contamination degree of heavy metals in the Sangu River estuary and to represent it as a reference site. This study revealed the descending order of studied metals (mg/kg) observed in sediment as Zn (88.97 ± 58.97) > Ni (32.75 ± 16.09) > Cu (29.2 ± 10.78) > Cr (25.14 ± 5.20) > Pb (19.57 ± 7.01) > As (2.58 ± 2.55). Cadmium was observed below the detection level. Various indices like geo-accumulation index (Igeo), contamination factor (CF), pollution load index (PLI) suggested that the Sangu River estuary is not contaminated by studied metals excepting Pb. PCA and correlation matrix analysis indicates that Pb and Zn may have anthropogenic sources and As, Ni, Zn, Cu, Cr may come from natural sources.

The study assessed the contamination level of seven heavy metals (Pb, Cd, Cr, Ni, Zn, As, and Cu) along with their potential ecological risks in sediments from the Halda river which is the largest natural carp breeding ground in South Asia. The concentration levels (mg/kg) of seven heavy metals from ten sampling sites were organized in the following descending order: Zn (71.89) > Cr (31.86) > Cu (31.85) > Ni (26.67) > Pb (20.46) > As (2.69) > Cd (0.05). Among the metals, Zn, Cr, Ni, and Cu exceeded some standard limits. Sediment quality guidelines (SQGs) suggested that the concentration of Pb, Cu, and Ni could occasionally cause an adverse effect on the ecosystem. However, the geo-accumulation index (Igeo), contamination factor (CF), and pollution load index (PLI) for heavy metals suggested that the contamination level was low. Moreover, the risk index (RI) and potential ecological risk index ( $$ {E}_r^i $$ ) confirmed the low ecological risk (as RI < 100 and $$ {E}_r^i $$ < 30) from heavy metals for the river ecosystem except for the Pb and Cu. High CF and $$ {E}_r^i $$ values for Pb in one site (S4) are deemed as combining elements of multiple metallic portions used in industrialization. The univariate and multivariate statistical analyses such as correlation matrix, principal component analysis, and cluster analysis of the metals for different sites signified that the metals were originated from similar anthropogenic activities like untreated industrial effluents and wastage disposal to the river system.

Intake of fish contaminated with non-essential hazardous trace elements poses a significant risk to human health. In this study, trace elements (As, Pb, Cd, Cu, Ni, and Zn) were measured in edible tissues of seven commercially important fish and shellfish species (Otolithoides pama, Pseudapocryptes elongatus, Macrobrachium rosenbergii, Liza parse, Notropis atherinoides, Apocryptes bato, and Rhinomugil corsula) from a natural carp breeding basin, Halda river, Bangladesh. The elements were detected by inductively coupled plasma-mass spectrometry (ICP-MS), and the hierarchy of elemental levels (mg/kg) was Zn (61.56) > Pb (30.45) > Ni (26.81) > Cu (21.09) > As (1.49) > Cd (0.24). Among the analyzed elements, Pb, Ni, and Zn for some fish species exceeded the permissible dietary limit, suggested by national and international agencies. In addition, results of bioaccumulation factor (BAF) indicated that most of the studied species were bioaccumulative in nature (BAFs > 1000), and the mean BAF of elements were found in the following order: Zn (3156.74) > Ni (1629.30) > Cu (1566.77) > As (997.14) > Pb (259.98) > Cd (216.52). However, the species, L. parse being omnivorous represented the highest BAF (stored higher concentrations of metals) as compared to other species. The growth pattern of all the species was negatively allometric, and the health condition of the species varied from poor to good state revealed from the estimated Fulton's condition factor (FC). For the evaluation of health hazards, estimated weekly (EWI), target hazard quotient (THQ), and carcinogenic risk (CR) were calculated for both adults and children. Results of EWI showed As, Pb, and Ni surpassed provisional tolerable weekly intake (PTWI)-recommended guidelines. The non-carcinogenic health effect (TTHQ) might not appear for both types of consumers (as TTHQ < 1), and CRs of all consumers were also in acceptable range (10-6 to 10-4). However, the probabilistic distribution through Monte Carlo simulation revealed that children were more vulnerable to non-carcinogenic (67.3%) and carcinogenic risk effect (47.3%) for Pb. Meanwhile, adults obtained the probability of 0.7% and 36% for THQ and CR effect, respectively, interpreting less vulnerable.

Metals tend to accumulate in higher organisms, e.g., fish and human through biomagnification effects in food chain. So, their presence in any component of the environment has become a global ecosystem and health concern. Here, we measured four health concerned metals like As, Cr, Mn, and Hg via inductively coupled plasma-mass spectrometry (ICP-MS) and analyzed applying some chemometrics for the assessment of human health risk through consumption of Puntius ticto, a very commonly consumed small fish in Bangladesh. The average concentration (wet weight) of metals was in the following descending order: Hg (0.006 mg/kg) > Cr (0.004 mg/kg) > Mn (0.003 mg/kg) > As (0.002 mg/kg). Hg level exceeded the provisional tolerable weekly intake (PTWI), and all other metals were within the permissible limit. The estimated daily intake (EDI) index of heavy metals showed that all the concentration levels were under the recommended daily intake (RDA) except Hg. Increased level of Hg is of particular concern to human health due to its biomagnification nature and can cause several neurological and physiological disorders including kidney failure. The total target hazard quotients (TTHQs) and carcinogenic risk (CR) matrices revealed that the intakes of Hg and As through fish consumption were higher than the recommended values, indicating consumers’ remain non-carcinogenic and carcinogenic (THQ > 1; CR > 10−5) health risks for lifetime consumption. Multivariate analyses (cluster and principal component) explained the sources of heavy metals in the study area originating from both anthropogenic and geological origin.

The focus of this study was to determine the depth-wise variability of physicochemical properties (i.e., pH, TOC, TN, and EC), and heavy metals (i.e., Pb, Cu, Zn, As, and Cr) concentration, and the associated biological and ecological risks of the mangrove sediment. The accumulation of metal contents and the phytoremediation and phytoextraction were also investigated in a mangrove species, Acanthus ilicifolius. The mangrove sediment consists of a higher proportion of sand fraction (56.6–74.7%) followed by clay (10–28%) and silt (10.1–15. 7%) fractions. The concentrations (mg/kg) of Pb, Cu, Zn, As, and Cr were ranged from 22.05–34.3, 8.58–22.77, 85.07–114, 5.56–12.91, and 0.98–5.12 in all the sediment layers. The hierarchy of the mean metal concentration in sediment was Zn (102 mg/kg) > Pb (25.6 mg/kg) > Cu (14.8 mg/kg) > As (8.79 mg/kg) > Cr (2.74 mg/kg) respectively. The examined metal concentrations were below the respective average shale values (ASVs). The degree of environmental, ecological, and biological risks was minimal according to various pollution indices like geoaccumulation index (Igeo), contamination factor (CF), and pollution load index (PLI). According to sediment quality guidelines (SQGs), the adverse biological risk effect was not likely to occur. The result of the potential ecological risk index (PERI) demonstrated that the study area was in the low-risk condition as the corresponded RI value Pb (28. 7) > Cu (16.9) > As (11.2) > Cr (4.99) in leaves and Zn (104.32) > Pb (27.02) > Cu (15.29) > As (10.39) > Cr (3.80) in roots. The translocation and bioaccumulation factors of heavy metals suggested that the mangrove plant species, A. ilicifolius can be used for phytoremediation and phytoextraction since the bio-concentration factor and translocation factor > 1. The studied species exhibited the metal tolerance associated with two following strategies, metal exclusion, and metal accumulation. However, excess metal tolerance can impact the surrounding marine environment.

Despite the beneficial aspect of aquatic food's consumption, bioaccumulation of toxic metals in fish can enhance the health risk for the consumers. Heavy metals were measured from editable tissues of some commercial fish species like Latis calcarifer, Silonia silondia, Clupisoma garua, Planiliza subviridis, Otolithoides pama, Tenulosa ilisa, Rhinomugil corsula, and Aila coila in the Meghna river estuary in Noakhali district. Heavy metals such as As, Pb, Cd, Cu, and Cr were detected by ICP-MS, which were significantly different (p ≤ 0.01), and the hierarchy of all mean concentrations were: Cu (5.14 mg/kg) Pb (3.79 mg/kg) As (1.08 mg/kg) Cr (0.78 mg/kg) Cd (0.12 mg/kg). The mean concentration of Cu (6.62 mg/kg) imparted to the maximum level in L. calcarifer, which slightly exceeded the Bangladesh food safety guideline. The mean BAFs of the contaminants were found as: Pb (1042.29) Cr (1036.47) As (934.84) Cd (832.77) Cu (772). Further, L. calcarifer, S. silondia, C. garua, and P. subviridis showed the bioaccumulative status. To assess the health risk effects, estimated daily intake (EDI), target hazard quotient (THQ) and carcinogenic risk (CR) were conducted. THQs for both adult and children consumers were1, indicating that, consumers would not experience the non-carcinogenic health effects. Although children were more susceptible than adults, CR for all the consumers was found in the acceptable range (10

This study describes the distribution of five heavy metals in water of the Gomti River and the evaluation of human health risk for both adults and children. Metal contents were detected using ICP-MS (Inductively Coupled Plasma Mass Spectrometry). Analysis of results revealed that the range of concentrations were arranged as descending order (mg/l) of Hg (0.118−0.125) > Pb (0.022−0.170) > Mn (0.002−0.098) > As (0.014−0.028) > Cd (0.004−0.007). As the level of metals exceeded some international standards, water from this river is not suitable for drinking. However, the selected metals were justified to recognize a non-carcinogenic risk of hazard quotient (HQ). The estimated hazard index (HI) was in the acceptable limit (HI

Samples for sediment and two species of native mangrove plants were collected from seven sampling sites for assessing the level of metal contamination. Results of the studied metals displayed the order of pollution as Fe > Ti > Zr > Rb > Zn > Sr > Pb > Y > Cu > Cr > As accordingly. Geoaccumulation index and contamination factor revealed that the sediment samples were unpolluted to moderately polluted by Zn, Fe, Ti, Rb, Y, and Zr. Ecological risk factor depicted a pollution-free condition in the study areas. PCA, CA, and correlation coefficient indicated that the source of the metals in the environment was anthropogenic. Bioconcentration factor values were found to be below 1 in both plant species. Conversely, transfer factor values for most heavy metals were found to be >1 in both plant species, which reflects the phytoremediation ability of plants.

The Karnaphuli River estuary, located in southeast coast of Bangladesh, is largely exposed to heavy metal contamination as it receives a huge amount of untreated industrial effluents from the Chottagram City. This study aimed to assess the concentrations of five heavy metals (As, Pb, Cd, Cr and Cu) and their bioaccumulation status in six commercially important fishes, and also to evaluate the potential human health risk for local consumers. The hierarchy of the measured concentration level (mg/kg) of the metals was as follows: Pb (13.88) > Cu (12.10) > As (4.89) > Cr (3.36) > Cd (0.39). The Fulton's condition factor denoted that fishes were in better 'condition' and most of the species were in positive allometric growth. The bioaccumulation factors (BAFs) of the contaminants observed in the species were in the following orders: Cu (1971.42) > As (1042.93) > Pb (913.66) > Cr (864.99) > Cd (252.03), and among the specimens, demersal fish, Apocryptes bato appeared to be the most bioaccumulative organism. Estimated daily intake (EDI), target hazard quotient (THQ), hazard index (HI) and carcinogenic risk (CR) assessed for potential human health risk implications suggest that the values were within the acceptable threshold for both adults and children. However, calculated CR values indicated that both age groups were not far from the risk, and HI values demonstrated that children were nearly 6 times more susceptible to non-carcinogenic and carcinogenic health effects than adults.

Myasthenia gravis (MG) is the most common disorder of the neuromuscular junction. Myasthenia crisis, defined as respiratory failure requiring mechanical ventilation in MG, is a common life-threatening complication that occurs in approximately 15% to 20% of patients with MG during their life time. The advent of effective mechanical ventilation, specialized neurointensive care units and the widespread use of immunotherapies have substantially altered the prognosis of myasthenic crisis. Early intubation and mechanical ventilation is perhaps the most important step in the management of myasthenic crisis. The authors favor an orotracheal approach for intubation, and placement of small bore duodenal tubes that may help decrease the risk of aspiration and may be more comfortable than regular nasogastric tubes for the patient. Plasma exchange may be more effective than the intravenous immunoglobulin in the treatment of myasthenic crisis involving respiratory failure. A randomized trial is required to confirm the superior efficacy of plasma exchange compared with intravenous immunoglobulin. In the acute setting, the role of immunosuppression and intravenous/intramuscular pyridostigmine and the newer agents such as tacrolimus remains limited and at times controversial. The therapy should be tailored at an individual basis using best clinical judgment.

Summary: Rapid advances in the field of interventional neurology and the development of minimally invasive techniques have resulted in a great expansion of potential therapeutic applications. We discuss therapeutic interventional neurology as applied in clinical practice in one of the two possible ways: 1) embolization leading to occlusion of blood vessels; and 2) revascularization leading to reopening of blood vessels. These procedures can be applied to a broad range of cerebrovascular diseases. In the first section of this review, we will explore the evolution of these interventions to occlude aneurysms, arteriovenous malformations, neurovascular tumors, and injuries. In the second section, revascularization in acute ischemic stroke, stenosis, and dural venous thrombosis will be discussed.

Objectives: The primary objective of this study was to define the incidence, disability, and death associated with stroke in the Buffalo metropolitan area and Erie County. This area has the highest stroke rate in New York State and therefore represents an ideal site to develop a successful model for prevention and management of stroke. Design: A cross-sectional design to study all new and recurrent strokes that occurred in the calendar year 2000 in the geographical location of Buffalo metropolitan area and Erie County. Patients and Data Collected: A retrospective review of an estimated 5,000 patients with new stroke will be performed at regional hospitals and the coroner’s office to determine the stroke subtypes, cerebrovascular risk factors, diagnostic investigations, treatment provided, and outcome. The total population residing in Buffalo in the year 2000 is available through the recent census. The study will also evaluate the quality of care provided for stroke patients including effectiveness of primary and secondary stroke prevention measures within this geographical region. Conclusions: We believe that this information will assist in allocation of resources and implementation of steps to improve stroke prevention and treatment.

OBJECTIVE Early neurologic deterioration has been studied in patients with intracerebral hemorrhage during hospitalization, but rates and factors associated with prehospital neurologic deterioration (PND) are unknown. We sought to determine the prevalence of PND among patients with intracerebral hemorrhage during Emergency Medical Services transportation to the hospital. DESIGN Historical cohort study. SETTINGS U.S. acute care hospital from 2000 to 2004. PATIENTS Hospitalized patients with a diagnosis of spontaneous intracerebral hemorrhage were identified by codes of the International Statistical Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). METHODS The initial Glasgow Coma Scale score ascertained at the scene by the Emergency Medical Services was compared with the subsequent evaluation in the emergency department to identify neurologic deterioration (defined as a decrease in Glasgow Coma Scale of > or = 2 points). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of the 98 patients with acute intracerebral hemorrhage, 22 patients (22%) showed PND during Emergency Medical Services transport, with a mean decrease in the Glasgow Coma Scale score during transport of 6 points. The patients who demonstrated neurologic deterioration tended to have higher diastolic blood pressure at the scene (p = .045), greater rates of intraventricular extension (p < .0001), and radiologic signs of herniation (p < .0001) on initial computed tomographic scan. There was a statistically significant decrease in diastolic blood pressure between the evaluations of the Emergency Medical Services and the emergency department among both patients with and without PND. CONCLUSIONS PND occurs in nearly one fifth of patients with intracerebral hemorrhage. Higher diastolic blood pressure at the scene, intraventricular extension, and radiologically evident herniation seem to be associated with PND. Prospective studies are needed to evaluate the efficacy of Emergency Medical Services interventions to reduce this early clinical deterioration.

To determine the feasibility and safety of treatment of acute hypertension in patients with intracerebral hemorrhage within 24 hrs of symptom onset. Elevated blood pressure, observed in up to 56% of patients with intracerebral hemorrhage, may predispose to hematoma expansion; on the other hand, reduction of blood pressure may reduce hematoma expansion and subsequent death and disability.Single-center prospective registry supplemented by retrospective chart review.University-affiliated medical center with dedicated stroke service.All patients admitted to the stroke service with spontaneous intracerebral hemorrhage and acute hypertension within 24 hrs of symptom onset.Patients were treated with intravenous nicardipine within 24 hrs of symptom onset to reduce and maintain mean arterial pressure of130 mm Hg. The mean arterial pressure goal was consistent with the American Heart Association guidelines.The primary outcome was the tolerability of the treatment as assessed by achieving and maintaining the mean arterial pressure goals for 24 hrs after initiation of intravenous nicardipine infusion. Other end points ascertained were: neurologic deterioration defined by a decline in Glasgow Coma Scale from pretreatment assessment byor=2 points or increase in National Institutes of Health Stroke Scale score byor=2 points and hemorrhage growth defined as an increase in the volume of intraparenchymal hemorrhage of33% as measured by image analysis on the 24-hr computed tomographic scan compared with the baseline computed tomographic scan. Rates of favorable outcome and death were ascertained at 1 month. Of the total 46 patients admitted with intracerebral hemorrhage in our service, 29 patients were treated. Mean age of the treated patients was 58 +/- 13 yrs; ten were women. Initial National Institutes of Health Stroke Scale ranged from 1 to 38. The primary outcome of tolerability was achieved in 25 of the 29 patients (86%). Neurologic deterioration was observed in 4 of 29 patients. Hematoma enlargement was observed in five patients. Favorable outcome (defined as modified Rankin scale ofor=2) and death at 1-month was observed in 11 (38%) and 9 (31%) of the 29 patients, respectively.We observed a high rate of tolerability among patients with intracerebral hemorrhage who were treated with intravenous nicardipine using mean arterial pressure goals defined by American Heart Association guidelines within 24 hrs of symptom onset.

Study Objective. To determine the proportion of patients in a large metropolitan population who developed ischemic stroke despite having received antiplatelet drug therapy, and their associated characteristics and in-hospital outcomes. Design. Retrospective, cross-sectional study. Setting. Eleven hospitals in western New York State. Patients. One thousand five hundred eighty-two patients with new or recurrent ischemic stroke who were admitted to one of the 11 study hospitals between January 1 and December 31, 2000, and for whom data were available regarding previous drug therapy. Measurements and Main Results. The proportion of patients taking antiplatelet drugs before the onset of stroke was determined. Demographic and clinical characteristics, stroke subtypes, in-hospital bleeding complications, mortality, and discharge drugs were compared between patients with and those without previous antiplatelet drug use. Previous use of antiplatelet drugs was observed in 642 (41%) of the 1582 patients admitted with ischemic stroke. The antiplatelet drugs were aspirin alone (494 patients), clopidogrel alone (70), aspirin and clopidogrel (36), aspirin in combination with other antiplatelet drugs (20), and others (22). Patients with previous use of antiplatelet drugs were older and more likely to have hypertension, diabetes mellitus, hyperlipidemia, and a history of cardiovascular disease. The proportion of patients with large-vessel disease was greater among patients with previous use of antiplatelet drugs. Patients with previous use of antiplatelet drugs were more likely to be discharged with aspirin, clopidogrel, and an aspirin-dipyridamole combination. Conclusion. The relatively high proportion of patients who developed ischemic stroke despite taking antiplatelet drugs observed in this regional hospital-based study mandates clinical trials specifically addressing therapeutic intervention for this group of patients.

Aneurysmal subarachnoid hemorrhage (aSAH) is a common and devastating form of stroke. A large number of patients with aSAH develop angiographic or clinical vasospasm responsible for high morbidity and mortality. Rapid advances in the field of interventional neurology and the development of minimally invasive techniques have resulted in expansion of potential therapeutic applications. Treatment of aSAH has benefited from this rapid advance in the field of endovascular therapies. In the first section of the review, we discuss the therapeutic options and techniques for embolizations of intracranial aneurysms. In the second section, we discuss evolving endovascular treatment methods employed to intervene in delayed complications of cerebral vasospasm in patients with aSAH.

Stroke is a leading cause of death and disability. Recently, there have been advances in the treatment of acute ischemic stroke aimed at re-establishing blood flow to the affected area in an effort to save the ischemic penumbra surrounding the area of infarction. This is achieved by the use of thrombolytics intravenously or intra-arterially. The use of mechanical devices facilitates the function of pharmacological agents used in addition to minimizing the associated risks. In this review, we first discuss the therapeutic potentials and strategies employed in using different thrombolytics in management of acute ischemic stroke. Subsequently, we discuss the recent advances and therapeutic applications of mechanical devices in this field.