ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Using the registry method, 1,538 stroke patients were detected in one district of Moscow between January 1, 1972, and December 31, 1974. Of the 965 patients who survived the acute stage of stroke (the first 3 weeks after onset), 941 (505 women and 436 men) were followed for the next 7 years. We analyzed incidence and types of recurrent strokes. During this 7‐year follow‐up, we recorded 32.1% of the patients as having recurrent strokes, most of which developed in the first 3 years and especially during the first year after the index stroke. The majority of recurrent strokes were of the same type as the index stroke and were localized in the same area of the brain. The cumulative mortality rates for the initial 1,538 patients were 37.3% dead by 3 weeks, 63.6% dead by 3 years, 72.1% dead by 5 years, and 76.5% dead by 7 years. In the first 3 months (excluding the first 3 weeks), most patients who died died of pulmonary thromboembolism. The mortality rate from recurrent strokes and pneumonia was higher than that from cardiovascular mortality. Transient ischemic attacks occurred in 49.5% of all patients and myocardial infarction in 16.4%. Functional prognosis was determined mainly by age, motor function, and concomitant diseases. After 1 year, 68.2% of the surviving patients were fully independent, while 81% of those surviving 7 years had reached this level. A significant number of patients were capable of returning to their previous work. (Stroke1988;19:942–949)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Temple University Hospital participated in a multicenter acute stroke trial but enrolled only one patient out of 192 screened over 2 years; other centers had similar difficulty in patient recruitment. We analyzed our screening data to determine which enrollment criteria created difficulties in recruitment and whether the problem was attributable to any single criterion or to combinations of criteria. Six individual criteria were frequent causes for exclusion; however, >80% of the patients were excluded for multiple reasons. Consequently, modifying or eliminating any single criterion did not appreciably increase patient accrual. Only 17 of 210 possible pairs of criteria occurred with statistically significant frequency (p< 0.05), and these were most likely random associations. Therefore, only by minimizing the number and stringency of enrollment criteria will patient accrual be at a level that allows the study to be completed in a timely manner with a fiscally reasonable number of centers. (Stroke1988;19: 950–954)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A retrospective analysis of 54 patients with atrial fibrillation presenting with symptoms of cerebral ischemia between 1980 and 1985 was performed. Seven patients (13%) had computed tomographic evidence of previous, clinically silent cerebral infarction. In a control group of 168 persons (studied prospectively) in sinus rhythm presenting with symptoms of cerebral ischemia, seven (4%) had computed tomographic evidence of previous, clinically silent cerebral infarction (p< 0.05). In those patients with atrial fibrillation all infarcts were peripheral and consistent with embolism, while in three of the seven patients in sinus rhythm the asymptomatic infarcts were lacunes. (Stroke1988;19:955–957)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To determine the hemodynamic and clinical consequences of an atherosclerotic obstructive lesion of the innominate artery on the cerebral circulation, 20 patients with an innominate artery lesion underwent neurologic examination and ultrasonic duplex scanning before and after right arm exercise. The patients were divided into two groups: Group 1, 12 patients with 40–80% stenosis and Group 2, eight patients with 80–100% stenosis. A significant difference between the groups was noted in both the hemodynamic and clinical manifestations. All 12 Group 1 patients compensated for the increased demand for blood of the right arm through the innominate artery itself, and only one showed symptoms of vertebrobasilar insufficiency associated with right arm exercise. In all eight Group 2 patients, compensation through the innominate artery failed; six (75%) showed symptoms of vertebrobasilar insufficiency after exercise. Dynamic duplex scanning is well suited to investigate stenotic lesions of the innominate artery, the effects of arm exercise on the development of cerebral symptoms, and the source of blood flow to the arm. Dynamic duplex scanning proved to be useful in selecting patients who may be candidates for direct arterial surgery. (Stroke1988;19:958–962)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To evaluate the CO2‐induced vasomotor reactivity of the cerebral vasculature, relative changes of blood flow velocity within the middle cerebral artery were measured by transcranial Doppler ultrasonography during normocapnia and various degrees of hypercapnia and hypocapnia. We studied 40 normal individuals and 40 patients with unilateral and 15 patients with bilateral internal carotid artery occlusions. When blood flow velocity changes as percent of normocapnic values were plotted against end‐tidal CO2volume percent, a biasymptotic curve (a tangenthyperbolic function) gave the best fit of the scattergram. The distance between the upper and lower asymptotes was defined as cerebral vasomotor reactivity. In the normal individuals, mean±SD vasomotor reactivity was 85.63 ±15.96%. In patients with internal carotid artery occlusions, vasomotor reactivity was significantly lower than normal on both the occluded (mean 45.2%, median 50.4%;p< 0.0001) and the nonoccluded (mean±SD 67.7 + 13.3%,p< 0.01) sides in the unilateral group and on both sides (mean±SD 36.6 ±15.9% and 44.9±24.6%,p< 0.0001) in the bilateral group. The difference between vasomotor reactivity for symptomatic and asymptomatic unilateral occlusions was also highly significant (mean 37.6% and 62.9%,p< 0.006). Vasomotor reactivity was also significantly lower in patients with low‐flow infarctions on computed tomography than in patients with normal scans (mean ± SD 36.7 ±25% and 60.2 ± 16.9%, p < 0.008). A striking association of low‐flow infarctions, ischemic ophthalmopathy, and hypostatic transient ischemic attacks was found with vasomotor reactivities of < 34% or even paradoxical reactions. Transcranial Doppler ultrasonographic evaluation of cerebral vasomotor reactivity is a new, feasible, noninvasive, and reproducible technique that allows selection and quantification of patients with true cerebrovascular insufficiency. (Stroke1988;19:963–969)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In patients suffering from aortic dissection, persistent perfusion of the false lumen distal to the implanted graft is frequent. Postoperative follow‐up examinations of the carotid arteries of these patients were performed by duplex scanner and correlated with clinical symptoms. Thirty‐nine patients who survived the surgical treatment of acute type A aortic dissection had duplex sonography of both common carotid arteries after an average postoperative follow‐up of S3 months. In 21 cases a composite graft and in 18 cases a supracoronary prosthetic vascular graft were implanted. No sign of residual dissection of the common carotid arteries was seen in 23 patients; in nine there was a dissection of both common carotid arteries, and seven patients had a unilateral carotid dissection (five right, two left). There were nine symptomatic patients with the following symptoms: transient ischemic attack (four), amaurosis fugax (four), stroke with incomplete recovery (one). Two symptomatic patients had a corresponding dissection. The generally good prognosis of all these patients suggests a conservative nonoperative treatment. (Stroke1988;19:970–976)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A population‐based study specifically addressing stroke in young adults (aged 15–44 years) was conducted in Florence, Italy, from 1983 to 1985. We identified 47 cases of first stroke by means of a daily check of the medical facilities of the city and nearby towns and a review of death certificates. Patients were assessed by a neurologist shortly after the onset of the stroke, and computed tomography or autopsy was performed in 96%. The average annual incidence rate for all stroke (cases per 100,000 population per year) was 9.0 (95% confidence interval 5.8–13.4) for males and 8.7 (95% confidence interval 5.5–13.0) for females. The average annual incidence rates for the pathologic types of stroke were 3.4 for cerebral infarction, 3.2 for subarachnoid hemorrhage, and 1.9 for intracerebral hemorrhage. The case‐fatality ratio was 23.4% at 1 month. Among patients with ischemic strokes, atherosclerosis and cardiac disease accounted for 50% of the cases. Based on angiography or autopsy findings, aneurysm or arteriovenous malformation were demonstrated in 88% of the patients with subarachnoid hemorrhage. In 50% of the patients with intracerebral hemorrhage, no cause of bleeding was detected. Our study may supply information about stroke pathologic types in an unselected series of young adults. (Stroke1988;19:977–981)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Etiology, neuropsychological deficits, aphasia type, and recovery were retrospectively studied in 254 young adults with stroke. Cardiac embolism was the most common cause of stroke in patients younger than 40, while atherosclerosis was the most frequent etiology among those aged 41–50 years. In 166 aphasic patients, Broca's aphasia was the most common while Wernicke's and transcortical aphasias were rare. Compared with an older aphasic population, young patients had significantly more nonfluent aphasias and fewer comprehension deficits. These differences were related to stroke localization: the majority of infarcts localized by computed tomography in 37 patients involved either the entire middle cerebral artery territory or its superior or deep branches, explaining the preponderance of nonfluent aphasia. Prognosis of aphasia in our patients was better than has been reported for non‐age‐selected aphasia populations. Roughly one third of our patients recovered completely, one third improved, and one third had an unresolved language deficit. Complete recovery and significant improvement were observed even >6 months after stroke. In some patients, recovery was much better than might have been predicted from lesion site and size depicted on computed tomograms. (Stroke1988;19:982–986)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We studied the relations of age, sex, hypertension, alcohol consumption, liver dysfunction, and thrombocyte count to the volume of the hematoma in 141 patients with spontaneous putaminal hemorrhage. Hematomas were significantly larger in men, regular alcohol consumers, those with liver dysfunction, and those with low platelet counts. Our findings reflect the fact that almost all of the alcohol consumers were men, most of them had liver disorders, and the volume of hematoma in such patients was relatively large. (Stroke1988; 19:987–990)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID