摘要:

The clinical findings in 64 patients with transient symptoms of unilateral carotid system ischemic disease (amaurosis fugax or transient focal cerebral ischemic attacks or both) were reviewed in an effort to determine the value of the neurovascular examination in predicting the presence and extent of roentgenographically demonstrated ipsilateral extracranial internal carotid artery disease. Amaurosis fugax seems to be a highly specific indicator of disease, being associated with 4% of normal vessels as compared to 27% for patients with transient focal cerebral ischemic attacks alone. In patients with transient symptoms, the incidence of a normal, ipsilateral carotid artery was 36% in the absence of any positive neurovascular findings, 15% in the presence of an ipsilateral carotid bruit, 6% in the presence of ipsilateral retinal embolic events, 5% in the presence of ipsilateral reduction in superficial temporal or carotid (or both) pulse, 4% in the presence of an ipsilateral reduction in retinal artery pressure, and 3% when more than one of these findings were noted. The neurovascular examination appears to be a useful adjunct in detecting the presence or absence of ipsilateral carotid disease. However, no combination of symptoms or signs would, in all cases, allow one to accurately determine whether a vessel was abnormal, stenotic, or occluded.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Dexamethasone and a placebo were compared as treatment for 40 patients with intracerebral hemorrhage. Of 19 patients receiving dexamethasone, 17 (89.5%) died during their hospital admission. Of 21 patients receiving a placebo, 16 (76.2%) died. The mortality rate was 100% in 15 patients in the dexamethasone-treated group who were in coma or deep stupor on admission, and the mortality rate was 92% in 12 patients with similar levels of consciousness who received a placebo.Several parameters of the neurological examination showed an improved quality of survival in the Decadron®-treated group, but this was found only at certain days in the study. No overall statistically significant difference was found between the two therapies.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Fifty-four patients with acute cerebral infarction were included in a double-blind study to evaluate Decadron® as therapy. When comparison of patients with similar levels of consciousness was made, there was no significant difference between those patients receiving Decadron® and those receiving placebo therapy.Three patients developed gastrointestinal tract bleeding in the placebo group, but there were none in the Decadron®-treated group.There was no good correlation between the clinical state of the patient and the CSF pressure, either on admission or during the 14-day course of the study.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The technique of hydrogen clearance by an inhalation method is discussed.The electronic instrumentation necessary to secure stability and reproducibility from the recordings is described.Clearance rates in gray matter of about 80 ml/100 gm per minute in the cortex and putamen have been obtained, and of about 20 ml/100 gm per minute in white matter. Clearance curves have invariably been monoexponential in character in white matter, and in over half the cases in the putamen. In the remainder of the putamen curves and in 60% of the cortical clearance curves, the curves could be resolved into only two exponentials. Using bicompartmental analysis, the fast-clearing components of biexponential curves in both cortex and deep nuclei gave the same figures as clearance curves of an entirely monoexponential character from these two tissues.The importance of recirculation time, concentration of hydrogen inhalation, and verification of the tissue placement by subsequent dissection are discussed. The capacity of the method to detect sudden changes in flow during clearance is described.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Fifty patients with severe cerebral apoplexy were treated with artificial hyperventilation of three days' duration facilitated by general anesthesia (barbiturates and muscle relaxants) and instituted within the first day after onset of the attack. After a classification according to carotid angiographical findings, degree of consciousness and focal symptoms, a random allocation was performed so that 24 patients were subjected to moderate hypocapnia (PaCO2about 25 mm Hg) and 26 patients to normocapnia (PaCO2about 40 mm Hg). Afterward, 21 comparable patients not receiving ventilatory treatment were studied. The clinical course and the mortality rate showed no statistically significant differences between the three groups. All patients studied disclosed a longstanding (12 days) spontaneous hyperventilation.The ventilation treatment was followed by a low cerebral perfusion pressure and a high rate of pulmonary complications. Autopsies from all groups studied typically showed tentorial herniation and pathological lung changes.In 32 of the patients without occlusion of the carotid artery the regional cerebral blood flow was measured before hyperventilation treatment was applied. A low mean flow and focal abnormalities (ischemia, hyperemia, vasoparalysis) typically were found and in good correlation to the autopsy findings. In six of 13 patients tested an “inverse steal syndrome” following aminophylline was disclosed.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

CSF acid-base changes and intracranial pressure (ICP) were studied in 50 patients with cerebral apoplexy (stroke) in the acute phase. Thirty-three of the patients were treated afterward with artificial hyperventilation for 72 hours (15 hypocapnic [PaCO225 mm Hg] and 18 normocapnic). The remaining 17 patients were breathing spontaneously throughout. Arterial PCO2, CSF lactate, pyruvate and bicarbonate and ICP were followed during the course.Compared to a control group initial mean values showed significant increases of CSF lactate (2.36 mmol per liter) and pyruvate (0.183 mmol per liter) but with a normal lactate/pyruvate ratio (13.3), a reduced bicarbonate (22.0 mmol per liter), and reduced PaCO2(34 mm Hg), indicating spontaneous hyperventilation. No correlation between the degree of initial hyperventilation or CSF lactate and the mortality rate was found. ICP averaged initially 15 mm Hg.The untreated patients had almost unchanged CSF values and PaCO2during the following six days. During induced and sustained hypocapnia and normocapnia, CSF bicarbonate slowly followed changes in PaCO2with CSF pH tending to return toward normal. The time course of this CSF pH adaptation had an estimated half-time of about six hours, and was complete within 30 hours. A similar time course of changes induced in ICP by ventilation was observed.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The reactivity of cortex, putamen and white matter to changes in arterial CO2tension has been assessed. There was no significant difference between the CO2reactivity obtained for the three tissues which were in the region of 2% to 3.5% increase over basal blood flow per mm Hg PCO2increase. The data suggested a somewhat greater reactivity for white matter than for gray matter, though differences were not significant.Excellent autoregulation to altered perfusion pressure, induced either by hemorrhage or by raising the intracranial pressure with cisternal infusion, was found in gray matter of cortex and putamen and in white matter. With reduction of perfusion pressure by both techniques, it appeared that zero blood flow could be more readily induced in white matter than in gray matter.Autoregulatory curves to change in perfusion pressure obtained by either method seemed identical, suggesting that the mechanisms involved in the maintenance of cerebral blood flow in the face of reduced arterial pressure or rising intracranial pressure are the same.Hyperemia was observed in all three areas of the cerebral circulation examined following the restoration of perfusion pressure after a period of reduction. No significant differences in the degree of hyperemia induced by similar stimuli were observed in these three sites.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Four hundred six patients with ischemic thrombotic cerebrovascular disease (ITCVD) and 115 age-matched controls were studied to select risk factors which would identify ITCVD-prone individuals from a healthy population. The following factors were evaluated: soluble fibrin, plasminogen, plasminogen activator, fibrinogen, partial thromboplastin time, generation of thromboplastin, fibrin degradation products, triglycerides, type IV hyperlipoproteinemia, and cholesterol. Discriminate function analyses were used to select those risk factors which best separate and classify the ITCVD and control subjects. The primary risk factors are the activated partial thromboplastin time, soluble fibrin, fibrinogen, and plasminogen activator. Utilizing only these four primary risk factors in a discriminate function, 93.2% of the patients were correctly classified. Consideration of other variables increased still further the discriminate function.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The rate of complications was studied following measurements of regional cerebral blood flow (rCBF) with the intra-arterial133Xenon technique. The investigation was based upon reports of rCBF measurements in close to 4,000 patients, carried out at 18 European and American centers. Two fatalities were reported. The overall rate of complication was found to be 1.3% with permanent neurological sequelae in 0.2%.Almost all complications were reported in patients with arterial or intracranial disease. The complication rates found are equal to, or lower than, corresponding rates following cerebral angiography with carotid puncture. Based upon the experiences reported, some factors are enumerated which appear important in order to keep the rate of complication low.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The prognosis on 144 patients with transient ischemic attacks was determined over a minimum period of three years by quantitating, at intervals, the number of attacks and also the neurological disability by means of a disability score. No patients had neurological disability at the initiation of the study. Total cervicocephalic angiography was performed on 93 patients. Seven of the 144 patients were deceased at the end of the three-year period, five of them due to strokes. Seventeen patients (15.6%) developed persistent neurological disability during the three years, with the mean disability score being much higher for the patients with carotid attacks than those with basilar attacks. The cumulative number of attacks in both carotid and basilar groups rose steadily in the first 18 months, with a much larger number of attacks occurring in the basilar group. The attack rate leveled off after 18 months in the carotid group. Attacks tended to be consistent in nature over a period of time. Twenty-eight percent of those patients with basilar attacks and 12.5% of those patients with carotid attacks showed carotid stenosis on angiography. Study of carotid stenosis associated with subsequent neurological disability revealed that increased risk occurred only when carotid stenosis was more than 70%

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID