摘要:

Longitudinal measurements of cognitive ability measured by serial testing using the Cognitive Capacity Screening Examination (CCSE) were correlated with cerebral blood flow (CBF) throughout (mean ± SD) 19.9 ± 12.6 months among 57 patients with multi‐infarct dementia, 17 with dementia of the Alzheimer's type, 10 with both, and among 32 age‐matched elderly normal controls. Longitudinal CCSE and CBF measurements among controls yielded stable normative values. Reduced mean CCSE scores correlated directly with CBF reductions in patients with multi‐infarct dementia (p < 0.0005) and dementia of the Alzheimer's type (p < 0.028). Patients with multi‐infarct dementia had CCSE scores with retest variability exceeding those of controls (p < 0.001) and of patients with dementia of the Alzheimer's type (p < 0.003). CCSE scores and CBF changed together 78.6% (jXO.001) of the time in patients with multi‐infarct dementia compared with 66.2% of the time (jKO.Ol) in those with both, 62.9% of the time (/X0.05) in those with dementia of the Alzheimer's type, and 47.7% of the time (NS) in controls. Further analyses indicated that changes in CCSE scores and CBF were predominantly progressive declines in patients with dementia of the Alzheimer's type, whereas the changes were more bidirectional (both increases and decreases) in patients with multi‐infarct dementia; these differences were also significant. Results support the diagnostic usefulness of the Hachinski ischemic scale and confirm that both cognition and CBF fluctuate together among patients with multi‐infarct dementia, whereas patients with dementia of the Alzheimer's type exhibit a more stable course, with progressive declines in cognition and CBF. (Stroke1988;19:163–169)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

During the 5‐year period from 1980 to 1984, the incidence of subarachnoid hemorrhage due only to rupture of aneurysms was investigated in Izumo City, a small city with a population of 79,026. Additionally, to ascertain the relation of incidence to the size of the geographic area and/or population, a similar analysis was made on a larger area of Shimane Prefecture, including Izumo City, with a total population of 789,712. During this 5‐year period, a total of 83 patients with aneurysmal subarachnoid hemorrhage were hospitalized in Izumo City, 548 patients in Shimane Prefecture. Ruptured aneurysms were confirmed in 77 cases (93%) in Izumo City and 466 cases (85 %) in Shimane Prefecture. The crude annual incidences of aneurysmal subarachnoid hemorrhage for Izumo City and Shimane Prefecture were 21.0 and 13.9 per 100,000 population for all ages, and the age‐adjusted annual incidences (adjusted to the 1980 population of Japan) were 18.3 and 11.0 per 100,000 for all ages, respectively. For both Izumo City and Shimane Prefecture, the age‐specific annual incidences peaked at the ages pf 50–69 years, and the highest incidence was 92.3 per 100,000 men from Izumo City in the eighth decade of life. The annual incidence of subarachnoid hemorrhage for Izumo City is the highest reported to date. If a wider area, such as Shimane Prefecture, were studied many patients in poor condition, particularly elderly patients, would be missed. To determine accurately the incidence of aneurysmal subarachnoid hemorrhage, it thus might be better to conduct the study in a small city such as Izumo City. (Stroke1988;19:170–175)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The overall outcome of patients with aneurysmal subarachnoid hemorrhage was investigated in Izumo City and Shimane Prefecture. Of the patients from Izumo City, the clinical grade on admission was Grade I or ll in 41% and Grade IV or V in 31%. Of those from Shimane Prefecture, 49% were graded as Grade I or II and 24% as Grade IV or V. The overall mortality rates 1 year after subarachnoid hemorrhage were 46% for Izumo City and 35% for Shimane Prefecture, while the surgical mortality rates were 18 and 15%, respectively. The mortality rates were particularly high among the elderly over the age of 70 years and among unoperated cases. The leading cause of death in these cases was the effect of aneurysm rupture itself, followed by rebleeding and vasospasm. The 5‐year survival probabilities according to life table analysis were 50% for Izumo City and 59% for Shimane Prefecture, and a significant difference was observed in survival curves between Izumo City and Shimane Prefecture. It is concluded that the smaller the community studied, the less favorable the overall outcome, mainly because of poorer clinical conditions on admission. (Stroke1987;19:176–180)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Mortality rates for stroke in 1971, 1974, 1977, and 1980 were obtained for residents of Allegheny County in western Pennsylvania. Hospital case fatality ratios were also obtained in the same 4 years for those discharged with the diagnosis of stroke (ICD 430–438 of the Eighth and Ninth Revisions of the International Classification of Disease) in two large hospitals (> 400 beds). Age‐adjusted mortality rates per 100,000 population have declined significantly in this period for the whole county as well as for the four sex‐race groups. Case fatality ratio in the two hospitals of the study has decreased from 19.6 to 11 %. A change in the severity of the disease manifested by a reduction in the number of comatose patients has occurred, and this reduction in comatose patients was responsible for > 80% of the decline in case fatality ratio. Coma appears to be the best predictor of mortality among hospitalized stroke cases (r = 0.6, p < 0.00001). The recent introduction of computed tomography for the diagnosis of stroke in the late 1970s was accompanied by a twofold increase in the survivorship of stroke patients. However, this increase in survivorship may reflect selection bias and is based on ecological association. Further studies are needed to examine the role of computed tomography in improving survival. (Stroke1988; 19:181–184)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In a prospective study to correlate admission glucose level with neurologic outcome in stroke, 252 acute stroke patients without prior disability and admitted within 24 hours of onset of ictus were assessed. The stroke was classified into one of three types — cortical infarct, lacunar infarct, or intracerebral hemorrhage — by clinical, computed tomographic, and necropsy findings. Fifty‐one diabetic patients were excluded from the entire cohort to form a nondiabetic category for analysis. We found that admission glucose level showed a significantly higher degree of correlation with mortality and morbidity (measured as arm function, leg function, and activities of daily living) when cortical (n = 118) and lacunar (n = 58) infarcts were pooled compared with when they were assessed separately. For intracerebral hemorrhage (n = 76), admission glucose level correlated with mortality but not morbidity. This trend persisted despite exclusion of diabetic patients. These results are consistent with previous observations of a correlation between a high admission glucose level and the severity of stroke. The importance of segregating cortical from lacunar infarcts, two groups with a different natural history and prognosis, in any future analysis is emphasized. (Stroke1988;19:185–191)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

One hundred four consecutive cases of primary intracerebral hemorrhage hospitalized at the time of stroke were followed until death or for 1 year. All were treated nonsurgically. The 30‐day mortality rate was 30%. Good clinical outcome and complete resolution of the lesion on computed tomography were observed in 49 and 13% of patients, respectively. Age, state of consciousness, and size of the hemorrhage on computed tomography scan were reliable prognostic indicators. The long‐term survival rate, 66%, was higher than that previously reported and should be considered in future trials evaluating medical and surgical treatment of intracerebral hemorrhage. (Stroke1988;19:192–195)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A prospective study of amaurosis fugax was carried out in a Danish community (population 481,000); case ascertainment was based on the collaboration of practicing ophthalmologists and general practitioners. Over a 3‐year period we registered 131 cases; the annual incidence of “first amaurosis fugax episodes coming to medical attention” was 8.6 and 6.2 per 100,000 population for men and women, respectively. On the basis of a comparison of the age‐incidence curves for cerebral and retinal ischemic attacks, the “true” incidence of amaurosis fugax is estimated to be approximately 14/100,000/yr, or 25–30% of the reported Incidence of transient ischemic attacks. Clinical and/or radiologk signs of a carotid lesion on the appropriate side were present in 56% of the patients, and an additional 27% had symptoms or signs of other organic cardiovascular disorders. Forty‐three (68%) of the 63 patients who underwent arteriography had an atheromatous lesion apparently amenable to carotid endarterectomy. In spite of the case‐finding procedures employed in the study, cases of amaurosis fugax suitable for carotid surgery were thus ascertained at a rate of only 3/100,0O0/yr. This suggests that surgical treatment of patients with retinal ischemic attacks is of minor importance as a preventive measure against stroke in the community. (Stroke1988; 19:196–199)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Twenty‐five cases (38%) of ischemic infarction occurred among 65 cases of tuberculous meningitis in patients < 14 years of age. The male female ratio was 1.3:1. The most frequent clinical findings were meningeal signs, fever, alteration of consciousness, cranial nerve involvement, seizures, and focal neurologic deficit. Twenty‐three patients had anterior circulation infarcts, and two more had infarcts in the vertebrobasilar territories. Distribution of infarcts in the anterior circulation was shown by computed tomography in the territories of the following arteries: lenticulostriate, 10 cases unilateral and 6 bilateral; middle cerebral, 3 cases; internal carotid, 1 case; multiple areas, 3 cases. Of the 25 ischemic infarction cases, 23 (92%) had hydrocephalus, 19 (76%) basal exudates, and 2 (8%) tuberculomas. Outcome was poor since no patient with infarction recovered completely. Six died and bilateral subcortical infarcts led to a considerably higher mortality than unilateral ones, whether cortical or subcortical. (Stroke1988; 19:200–204)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The incidence of cerebral amyloid angiopathy in a general population was evaluated in brains of 400 consecutive autopsies of residents of Hisayama, Japan (November 1971‐October 1983). Six samples taken from frontal lobe, parietal lobe, temporal lobe, occipital lobe, hippocampus, and basal ganglia of the same side of each brain were stained with both hematoxylin and eosin and Congo red. The specimens were surveyed microscopically with polarized light for deposition of amyloid in the vascular wall. In 26 cases with brain hemorrhage, the region surrounding the hemorrhagic sites was further examined to study the probable causal relation between cerebral amyloid angiopathy and brain hemorrhage. Cerebral amyloid angiopathy was found in 40 of 218 men (18.3%) and 51 of 182 women (28.0%). The incidence increased with age in both sexes. The frontal lobe was most frequently affected (66 cases), followed by parietal lobe (65), occipital lobe (49), temporal lobe (44), and hippocampus (32); the putamen was never affected. The incidence of cerebral amyloid angiopathy did not correlate with blood pressure or with the severity of cerebral atherosclerosis. Among the 26 cases in which there was brain hemorrhage, only one cerebellar hemorrhage, in an 85‐year‐old man, was attributed to cerebral amyloid angiopathy. This case showed four microaneurysms in vessels, with cerebral amyloid angiopathy surrounding the hemorrhagic site. Thirty similar lesions were observed in eight cases without brain hemorrhage. Cerebral amyloid angiopathy may play an etiologk role in the development of brain hemorrhage through formation of angionecrosis and microaneurysm. (Stroke1988;19: 205–210)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A multicenter double‐blind placebo‐controlled study of cytidine 5′‐diphosphocholine (CDP‐choline) was conducted to evaluate possible clinical benefits of the drug in patients with acute, moderate to severe cerebral infarction. The patients included also suffered from moderate to mild disturbances of consciousness, and all were admitted within 14 days of the ictus. Patients were allocated randomly to treatment with either CDP‐choline (1,000 mg/day i.v. once daily for 14 days) or with placebo (physiological saline). One hundred thirty‐three patients received CDP‐choline treatment, and 139 received placebo. The group treated with CDP‐choline showed significant improvements in level of consciousness compared with the placebo‐treated group, and CDP‐choline was an entirely safe treatment. (Stroke1988; 19:211–216)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID