ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Hemodilution by the combination of venesection and dextran 40 administration has previously been reported to enhance neurologic recovery in the acute phase of ischemic stroke. To study this therapeutic principle in its “natural habitat,” a stratified and randomized multicenter trial involving 15 large and small hospitals was performed. Patients with acute ischemic stroke of < 48 hours' duration and with hematocrits of 38–50% on admission were randomized to a hemodilution (183 patients, mean age 72.0 years) or a control group (190 patients, mean age 71.6 years). The two groups did not differ in sex distribution or medical history. Hematocrit, blood pressure, and neurologic score were closely similar at entry. By graded venesection (250–1000 ml) during the first 2 days and dextran 40 infusions (500 ml daily) during 5 days, the mean hematocrit was reduced from 44.2 to 37.1%. Three—month survival expressed as life table product was 0.84 in hemodilution and 0.88 in control patients. In survivors, neurologic score and activities of daily living performance during 3 months of follow—up were not improved by hemodilution. Length of stay in an acute—care hospital and the need for long—term institutional care was not reduced among patients in the hemodilution group. Major cardiovascular events occurred somewhat more often and there was an apparent increase in mortality during the first few days of hemodilution therapy. However, the differences were not significant. We conclude that the present standardized treatment with moderate hemodilution has no overall beneficial effects in genera] patients with acute ischemic stroke. (Stroke1987; 18:691–699)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

As part of a prospective study of the neurologic and neuropsychological complications of coronary artery bypass graft surgery, 312 patients were compared with a control group of 50 patients undergoing major surgery for peripheral vascular disease. The purpose of comparing the 2 groups was to determine to what extent neurologic complications after heart surgery can be attributed to cardiopulmonary bypass. The 2 groups were similar with respect to age, preoperative neurologic and intellectual status, anesthetic methods, duration of operation, perioperative complications, and time spent in the intensive therapy unit. Certain potential risk factors for cerebrovascular disease were more common in the control than the coronary bypass patients. The important difference between the 2 groups was that only the latter group underwent cardiopulmonary bypass. In this group 191 of 312 (61%) and 235 of 298 (79%), respectively, developed early neurologic and neuropsychological complications. By the time of hospital discharge 17% had neurologic disability and 38% had significant neuropsychological symptoms. In the control group 9 of 50 (18%) developed neurologic complications resulting largely from trauma to lower limb sensory nerves. Two patients developed primitive reflexes.Fifteen of 48 (31%) showed neuropsychological impairment on 1 or 2 subtest scores. Moderate or severe intellectual dysfunction was not seen in the control patients in contrast to the 24% thus affected in the coronary bypass group. The difference in frequency and severity of central nervous system complications between the 2 groups is likely to reflect cerebral injury resulting from cardiopulmonary bypass. (Stroke1987;18:700–707)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The radiographic examinations and hospital records of 93 young adult patients (15–45 years of age) with nonhemorrhagic cerebral infarction evaluated at our institution during the past 9 years were reviewed. The angiographic examinations were abnormal in 76% of patients. The most common abnormalities were embolic disease and atherothrombotic disease. Forty—seven patients underwent angiography within 7 days of their event. There were no major neurologic or systemic complications related to early angiography. We believe that angiography performed early in the course of the illness is a high—yield, safe procedure that may significantly alter the management of acute stroke in young adults. (Stroke1987;18:708–711)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Cocaine use has increased rapidly over the past few years. This has led to an increase in the number and variety of cocaine—related conditions for which medical attention is sought. Among these have been several cases of intracranial hemorrhage. Four cases reported in the literature and 6 from our own institution are presented here. They represent different diagnoses including hemorrhage from aneurysms and arteriovenous malformations, hemorrhage into a tumor, and spontaneous hemorrhage with no underlying lesion with and without preexisting hypertension. Analysis of these cases suggests that the hypertension induced by cocaine secondary to sympathetic stimulation may be the common factor. Cocaine may also cause arterial spasm. Although the pathophysiology has not been entirely resolved, the clinical significance of this association is clear. Intracranial hemorrhage should be considered in the differential diagnosis whenever a patient presents with an acute alteration in neurologic examination associated with cocaine use. (Stroke1987;18:712–715)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Carotid bifurcation atherosclerosis was demonstrated in 34 of 108 patients with familial hypercholesterolemia and coronary artery disease by B—scan, continuous—wave Doppler sonography, and intravenous digital subtraction anglography. An intensive combined therapy of diet, colestipol, and nicotinic acid was mounted to control the hypercholesterolemia of these patients. Their serial sonographies and digital subtraction anglography were evaluated independently by technical specialists who served as coinvestigators. The data obtained suggest that 1) extracranial arterial disease can develop concurrently with coronary artery disease in a significant proportion of patients with familial hypercholesterolemia, and 2) amaurosis fugax, transient ischemic attack, cerebral infarction, and myocardial infarction did not recur during 58–72 months of control of familial hypercholesterolemia in this series of patients. (Stroke1987;18:716–721)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Following carotid endarterectomy, early postoperative thrombosis or late restenosis occurs in up to 20% of vessels. Both complications may be related to platelet mechanisms. To assess platelet deposition at endarterectomy sites, we injected indium—Ill labelled platelets in 24 men < 30 minutes after carotid endarterectomy, with subsequent imaging 24–96 hours later. To determine if deposition decreased over time, 12 patients had follow—up studies 0.5–24 months later. For comparison, 2 control groups were studied: 1) patients with noncarotid surgery (n = 6) and 2) normal young subjects without endarterectomy and without evidence of carotid disease (n = 12). Quantitative analysis was performed using a deposition index that compared activity in operated with unoperated sites in surgical patients or activity in the right with left carotid arteries in normal subjects. Patients with recent endarterectomy had a mean deposition index of 1.7 ± 0.5 (range 1.2–3.5) compared with a similarly determined ratio of 1.1 ± 0.1 in normal subjects and 1.2 ± 0.1 in the surgical controls (both p ⩽0.05 vs. acute endarterectomy). At follow—up after endarterectomy, the mean deposition index decreased to 1.0 ± 0.1, documenting reduced platelet deposition over time. We conclude that the arterial injury of carotid endarterectomy results in early platelet deposition, which is no longer present in most patients who are studied late. These findings suggest a reduction in platelet thrombus formation with time and are compatible with reendothelialization of the endarterectomized surface. This model may be useful for the in vivo assessment of therapies designed to reduce platelet accumulation following endothelial injury in humans. (Stroke1987;18:722–727)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The occipital branches of the posterior cerebral artery were examined in 31 human brains. The authors determined the origin, course, and region of supply of each occipital branch: the parietooccipital, calcarine, posterior temporal, and common temporal arteries, as well as the lingual gyrus artery. These vessels were found in all the brains examined except the lingual gyrus artery, which was present in only 8.3%. The occipital branches were noted to supply variable cortical regions. In addition, they sometimes took part in irrigation of deep forebrain structures. It was concluded that occlusion of a certain occipital artery may cause varying clinical signs and symptoms in different patients. The neurologic deficits that may occur following the isolated occlusion of individual occipital branches of the posterior cerebral artery are discussed. (Stroke1987;18:728–732)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We studied ultrastructurally cerebral perforating arteries in 60 stroke—prone spontaneously hypertensive rats (SHRSP), which were sequentially killed at 4–52 weeks of age before showing symptoms of stroke. Another 24 SHRSP were killed soon after they showed symptoms of cerebral infarction. The initial vascular lesions observed in the asymptomatic group included focal cytoplasmic necrosis in the outer layers of the media. This change progressed to widespread medial necrosis with time. In the infarction group, numerous monocytes were seen adhering to the endothelium of the arteries having advanced medial damage. Following the adherence of monocytes to the endothelium, large amounts of plasma components were visible in the arterial wall. The accumulation of the plasma components (especially fibrin) thickened the wall, narrowed the lumen, and resulted in occlusion. These results suggest that monocytes may affect the endothelium, perhaps disturbing the so—called blood—brain barrier to proteins. The monocytes may therefore be closely related to the occurrence of arterial occlusion with resultant cerebral infarction. (Stroke1987;18:733–740)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Secondary motor dysfunction is often observed following ischemic episodes in the central nervous system. To study potential mechanisms of postischemic motor deterioration, we developed a rabbit spinal cord ischemia model that has characteristics similar to the clinical condition termed deteriorating stroke. In this model, 70% of the rabbits regained substantial motor function by 4 hours after complete hindlimb paralysis during lumbar spinal cord ischemia; however, over the next 20 hours motor function steadily declined to the point where only 30% of the rabbits had minimal hopping function. The role of eicosanoids in spinal cord ischemia was studied by radioimmunoassay of several prostaglandins (6—keto—PGFlα, PGE2, and TxB2) in the spinal cord. After 5 minutes of reperfusion, TxB2levels were markedly elevated (p < 0.05) while 6‐keto—PGF1αlevels did not change. The TxB2:6‐keto—PGFia ratio was also significantly increased. After 30 minutes of reperfusion, PGE2levels were also elevated (p < 0.05). Tissue edema measured by microgravimetry was also increased after 30 minutes of reperfusion in both gray and white matter. By 4 hours of reperfusion, rabbits regained near—normal hindlimb motor function while PGE2, 6—keto—PGF1α, TxB2, and tissue water content were back to normal. However, by 18 hours of reperfusion, when hindlimb function was deteriorating, TxB2levels were elevated again, and edema in gray and white matter was increased as was the number of necrotic neurons observed by light microscopy. These results suggest that the secondary deterioration of motor neurologic function was due to the excess formation of TxA2primarily in the late reperfusion phase. However, further studies are necessary to elucidate the relation of TxA2with ischemic neural injury. (Stroke1987;18:741–750)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID