Double-Blind Evaluation of Glycerol Therapy in Acute Cerebral Infarction

Nt, Mathew; Rivera, VictorM; Meyer, J; Charney, JonathanZ.; Hartmann, A.

doi:10.1016/s0140-6736(72)92775-4

Cited by 233 publications

(85 citation statements)

References 7 publications

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“…No evidence indicates that hyperventilation, corticosteroids in conventional or large doses, furo-semide, mannitol, or glycerol or other measures that reduce intracranial pressure improve outcome in patients with ischemic brain swelling. [681][682][683][684][685][686][687][688][689][690] Mannitol is typically used at 0.25 to 0.5 g/kg IV administered over 20 minutes, lowers intracranial pressure, and can be given every 6 hours. 691 The usual maximal dose is 2 g/kg.…”

Section: A Ischemic Brain Swellingmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,123

483

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Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Methods-Members of the panel were appointed

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Section: A Ischemic Brain Swellingmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams

Zoppo²,

Alberts

et al. 2007

Stroke

2,123

483

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“…Demographics, baseline characteristics of pa-tients, main workup findings, in-hospital events, and therapies administered before and during hospitalization were prospectively collected by stroke neurologists as part of the Downtown Barcelona Stroke Registry. 15 Neurological impairment was measured at baseline and at hospital discharge or death with the use of the Mathew Stroke Scale 16 (normal examinationϭ100, deathϭ0), whose specific value has been established. 17 Routine blood tests, ECG, and a baseline brain CT scan were performed in all patients on hospital arrival.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Significance of Uric Acid Serum Concentration in Patients With Acute Ischemic Stroke

Chamorro

Obach

Cervera

et al. 2002

Stroke

226

167

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Background and Purpose-We sought to assess in 881 consecutive patients with acute ischemic stroke the clinical relevance in regard to functional outcome of the natural antioxidant uric acid measured at hospital admission. Methods-Patients had serum uric acid (mg/dL) measured by standard procedures 18.2Ϯ15.5 hours from clinical onset.At hospital discharge (11.0Ϯ6.0 days), neurological impairment was classified as moderate/severe (Mathew score Յ75; nϭ304) or mild/absent (Mathew score Ͼ75; nϭ577). Demographics, atherosclerotic risk factors, history of organ disease, baseline neurological score, stroke subtype, infarction size, renal function, aspirin use before stroke, stroke therapy, diuretic use, and laboratory markers, including erythrocyte sedimentation rate, were analyzed in both outcome groups with the use of backward logistic regression. Results-Increased uric acid values were found in men, hypertensives, alcohol drinkers, and patients with coronary, pulmonary, or renal diseases. Diabetic patients had lower uric acid levels on admission. Uric acid was directly associated with hematocrit (Pϭ0.001), sodium (Pϭ0.001), creatinine (Pϭ0.001), and triglycerides (Pϭ0.001) and inversely related with nonfasting glucose (Pϭ0.001) levels. Neurological impairment on admission (Pϭ0.001) and final infarction size on CT/MRI (Pϭ0.01) were also inversely associated with uric acid. A logistic regression adjusted for confounders confirmed the following independent (odds ratio, 95% CI) good outcome predictors: age (0.97, 0.96 to 0.99), Mathew score on admission (1.14, 1.12 to 1.17), erythrocyte sedimentation rate (0.98, 0.97 to 0.99), infarction volume (0.98, 0.98 to 0.99), and uric acid (1.12, 1.00 to 1.25). Conclusions-In patients with acute ischemic stroke, there is a 12% increase in the odds of good clinical outcome for each milligram per deciliter increase of serum uric acid. This finding reinforces the relevance of oxidative damage in ischemic stroke.

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“…With the large doses of steroids which have been used, infective complications and elevation of plasma glucose or exacerbation of diabetes are frequent (Poungvarin et al, 1987). Despite many studies with intravenous glycerol there is no consensus on its effect on stroke (Bayer et al, 1987;Fawer et al, 1978;Frei et al, 1987;Gilsanz et al, 1975;Larsson et al, 1976;Mathew et al, 1972;Meyer et al, 1975). In an overview of the published trials, Sandercock (1987) concluded that the 6 week mortality in stroke patients after glycerol may fall by 36% compared with placebo, but that the 95% confidence limits for this improvement range from 4%-58%.…”

Section: Anti-oedema and Other Agentsmentioning

confidence: 99%

Therapeutic interventions in acute stroke.

Lees

1992

Brit J Clinical Pharma

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1. Potential therapies for ischaemic stroke include agents to reduce oedema, to improve cerebral perfusion, to reduce excitotoxic damage, to minimise free‐radical induced injury and to reduce complications such as deep venous thrombosis. 2. Of the anti‐oedema drugs, steroids are ineffective and possibly dangerous; intravenous glycerol is unproven. 3. Haemodilution to reduce whole blood viscosity and improve perfusion is ineffective. Thrombolytic drugs have not been adequately tested but several randomised multicentre trials are now commencing. Early treatment and CT scanning are essential. 4. Anticoagulants and antiplatelet drugs may have wide applicability but have not been tested in the acute phase of stroke. A multi‐centre trial will address this issue. 5. Neuronal cytoprotection offers exciting prospects for acute stroke treatment. Antagonists of glutamate at the NMDA receptor, calcium and sodium channel blocking agents and free radical scavenging drugs have potent effects experimentally. Several agents are now reaching clinical trials. The calcium antagonist nimodipine has been disappointing in large scale trials but some studies were flawed by late treatment. 6. Successful treatment of acute stroke is likely to combine several approaches. 7. Therapeutic trials in stroke must include CT scanning, early treatment and a multicentre approach to achieve large numbers of patients.

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Double-Blind Evaluation of Glycerol Therapy in Acute Cerebral Infarction

Cited by 233 publications

References 7 publications

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Adults With Ischemic Stroke

Prognostic Significance of Uric Acid Serum Concentration in Patients With Acute Ischemic Stroke

Therapeutic interventions in acute stroke.

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