摘要:

From a study of the evolution of atherothrombotic brain infarction (ABI) in the Framingham cohort of 5,209 men and women over 18 years of follow-up, it has been ascertained that hypertension is the most common and most powerful precursor. Atherothrombotic brain infarction developed in hypertensive patients seven times more often than in normotensive patients, and the risk was proportional to the blood pressure throughout its range. Various components of blood pressure, including systolic and diastolic blood pressure, pulse pressure, lability of pressure, mean arterial pressure and tension-time index, were analyzed in relation to ABI incidence. While all measures were associated with ABI incidence, the simple casual systolic pressure emerged as good a predictor of ABI incidence as any other component of the pressure. The other measures added very little to risk.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Surgery without confirmatory radiological contrast studies has been advocated in patients suspected of having a cerebellar hemorrhage. To determine the reliability of the clinical evaluation, records were reviewed of 33 patients in whom the diagnosis of cerebellar hemorrhage was initially suspected or subsequently confirmed. In 13 patients the correct diagnosis had been made initially by clinical evaluation, but in ten patients the correct diagnosis was not suspected at the initial evaluation. The remaining ten patients had typical backgrounds, symptoms, and signs of a spontaneous cerebellar hemorrhage, but radiological contrast studies and clinical observation indicated that other neurological lesions were responsible. Thus, utilizing solely the clinical evaluation, the diagnosis of cerebellar hemorrhage may be made only with difficulty and not with the certainty required for emergency surgery.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Plasma fibrinogen chromatography is a method for quantification of high molecular weight fibrinogen complexes (HMWFC), native fibrinogen and other fibrinogen derivatives in plasma. Enhanced formation of fibrin, intravascular coagulation, thrombus formation, etc., are reflected by elevation of plasma HMWFC, and the method distinguishes between subjects with nor-mal and pathological rates of fibrin formation.Serial standard blood coagulation assays, including plasma fibrinogen chromatography, and neurological studies were performed on 220 patients admitted to a stroke unit.Findings from patients with cerebral infarction were compared against those of three control groups: (1) normals, (2) a stroke con-trol group and (3) a stroke risk factor group. Plasma HMWFC findings were significantly (p < 0.001) higher in the stroke risk factor group than in the normals. Plasma HMWFC values were significantly higher (p < 0.001) in the cerebral infarction patients than in any of the control groups, and plasma fibrinogen, plasminogen, alpha,-antitrypsin and alpha^macroglobulin also were significantly higher (p < 0.001) in the patients. The greater the degree of initial neurological deficit, the greater were plasma HMWFC values (p < 0.001), and high HMWFC values were associated with poor clinical outcome.Plasma HMWFC values were significantly higher (p < 0.001) in patients with intracerebral hemorrhage, subarachnoid hemorrhage and cerebral embolism. These findings document the fact that a high proportion of stroke patients have coagulopathy, characterized by pathological enhance-ment of fibrin formation.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Anastomosis of the extracranial superficial temporal artery to the intracranial middle cerebral artery offers an additional source of blood to the cerebral circulation in patients with transient ischemic episodes. Fourteen cases are reported. Two representative cases with three anastomoses demonstrate the use of this technique in occlusion of the internal carotid artery, occlusion of the middle cerebral artery and stenosis of the middle cerebral artery. Indications and contraindications of the procedure are discussed.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

To detect stenosis in the carotid artery with a bidirectional continuous-wave Doppler ultrasound device, the following noninvasive procedure, applied on 800 patients and compared with 249 angiograms of 186 patients, has proved to be about 90% reliable. Measurements of flow signals were taken over the terminal branches of the ophthalmic artery (supratrochlear and supraorbital arteries) and averaged. Compression of superficial temporal and facial arteries revealed flow direction and common carotid artery compression revealed the supplying blood vessel and the effectiveness of the circle of Willis. Measurements over the common carotid arteries were used to evaluate peripheral resistance. A set of eight criteria was used; the diagnostic value of each criterion was calculated by comparing 138 pathological Doppler findings in 123 patients with the angiograms. If reverse flow direction in supratrochlear or supraorbital artery was used alone, only 43% correct diagnoses would have resulted. A more severe stenosis is not necessarily correlated with a more weighted criterion; a subset of criteria is less efficient than the combination of all criteria. Application during 32 extracranial endarterectomies on 28 patients informed the surgeon immediately about the hemodynamic effect of the surgical intervention. Rethrombosis was diagnosed in two patients by postoperative Doppler examination.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A transoral noninvasive procedure in the oropharynx using local anesthesia was applied to detect flow in the vertebral arteries with a bidirectional continuous-wave Doppler ultrasound system. Common carotid artery compression was used to identify the vertebral artery. Flow direction, amplitude of flow signals, diastolic flow, and reaction of flow on common carotid artery compression served as diagnostic parameters. The procedure was applied in 90 patients of whom 42 underwent angiography. The method has proved to be 82% accurate. It was most reliable in the diagnosis of occlusion or aplasia, subclavian steal and normalcy, and was less reliable in the detection of stenosis or hypoplasia of a vertebral artery. Eleven patients with subclavian steal, five patients with a missing vertebral artery, three patients with hypoplasia or stenosis, and 15 patients with normal angiographical findings were correctly diagnosed by Doppler; normal Doppler findings were present in three patients with a missing or stenosed vertebral artery. Those patients (five) with Doppler indications of subclavian steal (one patient), missing vertebral artery (two patients), or stenosis (two patients) had normal angiograms. Application of the Doppler procedure, after 11 subclavian endarterectomies, informed the surgeon immediately about the hemodynamic effect of surgical intervention. Rethrombosis was diagnosed in two patients by postoperative Doppler examination.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

A computer-controlled 14-channel pulsed Doppler ultrasound instrument was used as a noninvasive means to evaluate instantaneous velocity profiles and flow in the common carotid arteries of 22 healthy persons and in 22 patients. Of the latter, 13 had severe obstructions of the extracranial portion of the carotid artery, four had obstruction of the intracranial portion, and five had severe aortic valve insufficiency (AI), with more than 60% regurgitation in all cases. Measurements could be performed within an accuracy of about ± 20% under clinical conditions and revealed perfusion values of 5 to 8 ml per second (300 to 480 ml per minute) in healthy persons. Of the patients, values less than 3 ml per second (180 ml per minute) were detected in nine, between 3 and 5 ml per second (180 to 300 ml per minute) in four, and normal values in another four, while significant backflow was observed only in patients with severe AI. Consecutive blood flow profiles were recorded every 4 msec; these demonstrated that, for a period lasting from 40 msec to 280 msec after the initial systolic peak, blood flowdecelerated more rapidly in the central portion of the vessel lumen than near the wall. This situation was present in all healthy persons and in most patients with pathological flow. In patients with AI, flow reinversion from reverse to normal began near the vessel wall, while in the middle third of the vessel lumen, blood was still flowing backward. These phenomena seem to be in agreement with the theoretical and experimental findings of Wormersly, MQIIer, and others. The AI patients who underwent artificial valve implantation were studied ten days after operation and showed no or little backflow in the common carotid artery at that time.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

The records of 628 patients admitted to the Joint Study of Extracranial Arterial Occlusion with transient symptoms of carotid system ischemic disease were examined to determine the accuracy of predicting disease of the extracranial internal carotid artery on the basis of clinical information alone. A patient with a history of episodes of amaurosis fugax is more likely to have a lesion of the internal carotid artery on the same side than if he were having only transient cerebral ischemic attacks. In patients with transient symptoms and a carotid bruit on the appropriate side, the incidence of an angiographically normal carotid artery was 15%. In those patients with transient symptoms and no palpable pulsation in the cervical region on the appropriate side, the incidence of an angiographically normal carotid artery was zero.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Thirty-three of 129 patients who incurred isolated ophthalmic migraine had monocular attacks of scotomatous visual field loss. Fifteen of 33 patients with monocular attacks had immediate or remote evidence of vascular disease. Four patients had carotid bruits on the same side as the monocular attacks and low ophthalmodynamometer readings. One patient had ischemic optic neuropathy and two had atheromatous disease (advanced stage in one patient). Forty-five percent of the patients with monocular attacks and only 13% of the remaining patients with homonymous attacks had vascular complications. This represents an important finding even in such a small group of patients. It is felt that, whether the vascular problems are trigger mechanisms or coexistence pathology to the migraine-type attack, one should strongly suspect such an association when a patient describes a monocular attack and one should look for a possible vascular explanation other than migraine.

ISSN:0039-2499    

出版商:OVID    

年代:1976

数据来源: OVID