摘要:

The plasma concentration of the platelet-specific protein beta-thromboglobulin (beta-TG) was measured in 39 normal subjects and 568 patients of neurological diseases. The beta-TG RIA commercially available KIT was also evaluated. Abnormally high plasma levels of beta-TG were demonstrated in groups of ischemic or obstructive cerebrovascular diseases as compared with that of normal subjects. The highest concentrations were found in 8 patients with Moya-Moya disease, (mean concentration of beta-TG was 204.4 ng/ml), completed stroke at an acute stage was next (mean beta-TG level was 194.8 +/− 70.8 ng/ml). On the other hand, many hemorrhagic cerebro-vascular diseases or other neurological diseases such as brain tumors, hydrocephalus, etc. do not show elevated beta-TG levels. In many patients with ischemic or obstructive cerebro-vascular diseases treated with anti-platelet drugs such as Aspirin, Dipyridamole, Bencyclane or Ticlopidine, a significant fall in plasma concentration of beta-TG was chronologically demonstrated. The measurement of plasma beta-TG concentration may be useful not only in the diagnosis of ischemic or obstructive cerebro-vascular disorders but also in judging the efficacy of anti-platelet therapies and prognosis.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Serum high density lipoprotein (HDL) cholesterol and other lipoproteins were measured in 27 TIA-patients with a mean age of 49 +/− 10 years before and during phenytoin therapy. The pretreatment concentrations of HDL-cholesterol (mmol/l, mean +/− SD) were lower (p less than 0.001) in male (1.03 +/− 0.25) and in female patients (1.15 +/− 0.44) than in healthy male (1.28 +/− 0.34) and female controls (1.52 +/− 0.31) respectively. After one month's phenytoin therapy HDL cholesterol concentrations reached normal levels (men 1.33 +/− 0.38, women 1.61 +/− 0.27) and after 9 months of therapy even surpassed them (men 1.47 +/− 0.27, p less than 0.05; women 1.91 +/− 0.33, p less than 0.01). Percent increase of HDL cholesterol after 9 months of therapy was 42 +/− 25 in men and 68 +/− 46 in women. There was a positive correlation (r = 0.43, p less than 0.05) between serum phenytoin level and increase of HDL cholesterol. HDL/LDL cholesterol ratio increased (p less than 0.01) also during 9 months of therapy (men from 0.26 +/− 0.05 to 0.36 +/− 0.10, women from 0.26 +/− 0.07 to 0.43 +/− 0.13) and showed a positive correlation (r = 0.91, p less than 0.001) with increase of serum HDL cholesterol. The HDL cholesterol levels achieved have been maintained with a mean serum phenytoin level of 5.6 +/− 3.6 mg/l. Phenytoin induced increase in serum HDL levels should not yet be equated with protection against atherosclerosis.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Infarction secondary to cerebral embolism was diagnosed in 127 (23.5%) of 540 patients in the Michael Reese Stroke Registry. Coronary artery disease, atrial fibrillation, valvular heart disease, mitral annulus calcification, and cardiomyopathy were the commonest etiologies. Echocardiography documented a potential embolic source in 7 patients without previously known heart disease, and clarified the cardiac pathology in many of the patients with known heart disease. The left anterior circulation was affected in 48%, right anterior in 37%, and posterior circulation in 15% of patients. CT was abnormal in 71% of the patients, and was approximately equally helpful in all locations. Nineteen percent of emboli presented with a deficit that was other than maximal at onset. Concurrent systemic embolism was unusual (2.3%). Prognosis was somewhat worse than in thrombotic stroke. Grouping of patients according to embolic source (intra-arterial, cardiac, and uncertain source) showed no differences in activity at onset, early course, or in subsequent course of the illness.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

One-hundred-forty patients with atrial fibrillation (AF) due to non-rheumatic, non-valvular heart disease (NVHD) who suffered a cerebral infarct were identified. Fifty-three (38%) died of the initial stroke. The surviving patients were followed up to 9 years without anticoagulant therapy. In the 59 patients available for follow-up, the risk of recurrent cerebral ischemia remained at approximately 20% per year throughout the 9 year observation period. The recurrence rate was the same regardless of age, sex, previous myocardial infarction, or whether chronic AF or intermittent AF were present. Only 7 (12%) died from a second stroke, however. The high annual rate of recurrence and lack of controlled therapeutic trials in this population of patients warrant a prospective study to define the benefits and relative risks of anticoagulant therapy in AF due to NVHD.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In the study of cardiac abnormalities responsible for the development of cerebral embolism two-dimensional echocardiography was performed on 350 patients with ischemic cerebrovascular disease. The results were compared with those obtained from 350 controls without any history of stroke. Atrial fibrillation was detected on ECG in 115 cases (33%) of the patients and in 35 cases (10%) of the controls (p less than 0.001). The structural cardiac diseases observed in stroke patients were: rheumatic heart disease (RHD) in 37, congestive cardiomyopathy (CCM) in 7, hypertrophic cardiomyopathy (HCM) in 19, mitral annulus calcification (MAC) in 29, mitral valve prolapse (MVP) in 9, and myocardial infarction (MyI) in 10 patients. Controls were found to have these lesions in 11, 2, 3, 12, 4 and 9 patients respectively. RHD (p less than 0.001), HCM (p less than 0.01) and MAC (p less than 0.01) were significantly more frequent in patients with ischemic cerebrovascular disease, but not MyI, CCM or MVP. Intracardiac thrombi were diagnosed in 29 cases of patients and in 4 cases of controls (p less than 0.001). Our data suggested that nonrheumatic heart diseases such as MAC and HCM could also be considered as causes of embolic stroke. The reasons for the variable frequencies of cardiac abnormalities reported in the literature for stroke patients are discussed.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To determine the impact of echocardiography in management of patients with systemic embolism, we retrospectively reviewed medical records and echocardiograms of 191 consecutive patients with suspected systemic embolism. One hundred sixteen patients had two dimensional echocardiograms and 75 patients had M-mode echocardiograms only. Patients were divided into three groups: Group 1 had no cardiovascular disease; Group 2 had cardiovascular disease, and Group 3 had hypertension only. Changes in therapy following echocardiogram were defined as initiation or discontinuation of anticoagulants or antiplatelet agents, cardioversion, or surgical intervention. M-mode echocardiogram did not identify any heart as a likely source of systemic embolism. Two dimensional echocardiogram defined 13 hearts as likely sources of emboli. All of these patients had known cardiovascular disease. Four of 13 patients (30.7%) whose hearts were likely sources of emboli had a change in therapy compared with 42 of 126 patients (33.3%) with low probability echocardiograms. We conclude that M-mode echocardiogram has no role in evaluation of patients with systemic emboli. Two dimensional echocardiogram may identify the heart as a source of emboli in patients with cardiovascular disease but does not alter early management.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In an attempt to elucidate the mechanism by which hypertension acts as a risk factor for major non-haemorrhagic stroke, its effect on the prevalence of carotid atheroma has been studied angiographically. The carotid angiograms of 269 patients with cerebral tumours have been reviewed for evidence of coincidental atheromatous change. The prevalence of signs of arterial disease at the carotid bifurcation proved to be greater amongst patients with an elevated casual blood pressure reading, though the effect was small and confined to subjects over 50 years of age. It is argued that other factors must contribute to the connection between hypertension and the risks of cerebral infarction.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We measured the MCAP (middle cerebral artery pressure)/MSBP (mean systemic blood pressure) ratio in 76 patients who underwent an EIAB (extracranial-intracranial arterial bypass). Patients were divided into groups on the basis of angiographic findings. We found a definite correlation between increasing angiographic cerebral vascular occlusive disease and lower MCAP/MSBP ratios. Six of 32 patients with a preoperative neurologic deficit demonstrated mild but definite postoperative neurologic improvement. The mean MCAP/MSBP ratio in these six patients was significantly lower than that for the remainder of this group (p less than .05). Finally, postoperative filling of the middle cerebral artery territory through the graft was found to correlate in an inverse linear relationship with MCAP/MSBP. Evidence is presented that hypoperfusion produced by occlusion of major cranial vessels plays an important role in temporary and permanent neurological deficits seen in patients with cerebrovascular disease.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A rabbit spinal cord ischemia model was used to study the effects of focal ischemia on the tissue concentrations of serotonin, 5-hydroxyindole acetic acid, and norepinephrine. Ischemia induced by abdominal aorta occlusion caused both serotonin and norepinephrine concentrations to decline in the most ischemic areas of the spinal cord by 55 minutes. In marginally perfused adjacent areas, serotonin concentrations transiently declined at 14 and 20 min. After the onset of ischemia and then returned to normal. The minimum was reached at the same time when previous studies showed damage had become irreversible in more ischemic regions. Concentrations of 5-hydroxyindole acetic acid did not change at any time and norepinephrine declined only in the most ischemic areas after damage was irreversible. Thus, permanent serotonin and norepinephrine decreases occur only in areas destined to be destroyed by infarction, but the serotonin returns to normal in marginal tissue that remains viable. These studies suggest that serotonin may be involved in the early stages of irreversible changes during central nervous system ischemia.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Tissue water and rCBF from the same area of brain was measured in gerbils with cerebral ischemia. In one experiment we related the severity of ischemia that developed after one hour of carotid occlusion to the amount of edema which formed. In a second experiment brain made ischemic for one hour was reperfused for one hour to assess the effect of reperfusion of ischemic tissue upon edema formation. We identified a critical threshold (10–14 ml × 100g-1 min-1) for the reversibility of the ischemic process, above which edema can resolve upon reperfusion. When postocclusion rCBF was less than 10 ml × 100g-1 min-1, edema was maximal at the end of occlusion and did not resolve with reperfusion. Autoregulation was preserved in ischemic tissue in which the edema process resolved with reperfusion.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID