摘要:

Background and PurposeThe clinical pattern of stroke and the angiographic distribution of cerebral atherosclerosis in Chinese are different from those in Caucasians. Pathological data from autopsy studies are lacking.MethodsThe intracranial and extracranial arteries supplying the brains of 114 consecutive Chinese patients undergoing autopsy in a regional general hospital were examined by computer-assisted morphometric analysis under a microscope as well as by macroscopic grading for atherosclerotic narrowing. The severity was correlated with various atherosclerosis-related factors.ResultsAtherosclerosis of the intracranial cerebral vessels was more severe than that of the extracranial vessels. The distal branches of the intracranial vessels were also commonly involved. Hypertension and diabetes mellitus were identified as factors associated only with intracranial atherosclerosis (p<0.001), whereas ischemic heart disease was associated with atherosclerosis in both the intracranial (p<0.001) and extracranial (p=0.012) vessels. Smoking was associated with narrowing of the extracranial vessels only (p=0.0054).ConclusionsCompared with figures from Caucasian and Japanese populations, the extent of intracranial atherosclerosis is much more severe in Hong Kong Chinese, whereas atherosclerotic narrowing of the extracranial carotid artery is less severe in Hong Kong Chinese than in Caucasians.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeWe sought to find an explanation for the geographical variation in the incidence of nonfatal stroke detected in the FINMONICA stroke register during the period 1983–1985.MethodsTwo separate investigations were made. In the first, a sample of approximately 100 nonfatal events drawn from each of the three monitoring areas (North Karelia, Kuopio, and Turku/Loimaa) participating in FINMONICA was recoded by an independent coder. In the second, 29 nonfatal events from Kuopio and 29 from North Karelia were recoded by the neurologist of the other area. Kappa coefficients (k) were calculated to measure the proportion of agreement beyond chance among the different coders.ResultsA good level of agreement with the independent coder was found for each of the three areas; it was best for the cases from Turku/Loimaa (k= 0.896), followed by Kuopio (k= 0.792) and North Karelia (k= 0.616). In the second part of the investigation, agreement was higher for the stroke cases originating from Kuopio (k=0.861) than for those from North Karelia (k=0.563). In the latter there was discrepancy in the classification of the cases originally classified as no stroke.ConclusionsThe results from the first part of the investigation suggest that the lower incidence of nonfatal stroke in Turku/Loimaa was real, confirming findings in previous studies. Differences in data entry, rather than in the interpretation of signs and symptoms of stroke, were the main cause of disagreement in the second part of the investigation, where the disagreement primarily concerned the cases classified as no stroke in North Karelia. The results also indicate that the different proportions of patients submitted to computerized brain tomography conceivably account for a good part of the difference in the incidence rates of nonfatal stroke between Kuopio and North Karelia.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeThe aim of this study was to determine the incidence, type, and prognosis of stroke in young adults in Cantabria, Spain.MethodsWe investigated prospectively all patients aged 50 years or below who were admitted with the diagnosis of a stroke to the University Hospital “Marqués de Valdecilla” from April 1,1986, to March 31, 1988. This is the main hospital of the region to which all patients with neurological problems are referred. These patients underwent a complete clinical and laboratory assessment for stroke and had 1-year mean follow-up.ResultsThe total series included 81 patients. The annual age-specific crude incidence rates of stroke were 17.3 and 10.4 per 100,000 for males and females, respectively. Twenty-four patients (30%) were diagnosed as having nonembolic cerebral infarction, 14 (17%) embolic cerebral infarction, 20 (25%) subarachnoid hemorrhage, 22 (27%) spontaneous cerebral hemorrhage, and one case (1%) cerebral venous thrombosis. Eighteen patients (22%) died within 30 days of the cerebrovascular event, and two others died during the follow-up period. Seventy-nine percent of the survivors recovered and were completely self-sufficient.ConclusionsThe incidence of stroke in the young found in Cantabria is comparable with that in previous studies. The initial hospital mortality was not negligible, but the prognosis among the survivors was favorable.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeThere have been relatively few community-based studies of long-term prognosis after acute stroke. This study aimed to provide precise estimates of the absolute and relative risks of dying in an unselected cohort of patients with a first-ever stroke.MethodsSix hundred seventy-five patients were registered by a community-based stroke register (the Oxfordshire Community Stroke Project) and prospectively followed up for up to 6.5 years. Their relative risk of death was calculated using age- and sex-specific mortality rates for Oxfordshire.ResultsDuring the first 30 days, 129 (19%) patients died. Patients who survived at least 30 days after a first-ever stroke thereafter had an average annual risk of death of 9.1%, 2.3 -fold the risk in people from the general population. Although the absolute (about 15%) and relative (about threefold) risks of death were highest in these 30-day survivors over the first year after the stroke, they were at increased risk of dying over the next few years (range of relative risk for individual years, 1.1-2.9). Predictably, older patients had a worse absolute survival but, relative to the general population, stroke also increased the relative risk of dying in younger patients. During the first 30 days stroke accounts for most deaths; after this time nonstroke cardiovascular disease becomes increasingly important and is the most common cause of death after the first year.ConclusionsThese data highlight the importance of long-term secondary prevention of vascular events in stroke patients, targeted as much at the cardiovascular as at the cerebrovascular circulation.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeWe studied the activities of the coagulation-fibrinolysis system in the chronic stage of poststroke patients and the effect of antiplatelet medication on the system.MethodsWe determined fibrinogen, antithrombin III, thrombin-antithrombin III complex, tissue plasminogen activator antigen, plasminogen activator inhibitor-1, plasmin-α2plasmin inhibitor complex, and D-dimer in plasma from 153 poststroke patients in the chronic phase (i e, 33 patients not receiving antiplatelet medication, 78 patients receiving 200 mg/d ticlopidine, and 42 patients receiving 40 mg/d aspirin), and compared the results in control subjects and among the treatment groups.ResultsThe concentrations of fibrinogen, thrombin-antithrombin in complex, antithrombin III, plasmin-α2plasmin inhibitor complex, and tissue plasminogen activator were slightly but significantly increased in all treatment groups compared with control subjects (P<.01) but did not differ among the treatment groups. The plasminogen activator inhibitor-1 levels were significantly elevated in patients not receiving antiplatelet medication compared with control subjects (P<.01), whereas they were in the normal range and significantly lower in patients receiving ticlopidine or aspirin than in patients not receiving antiplatelet medication (P<.01). The plasminogen activator inhibitor-1 levels were significantly lower in patients whose platelet aggregation was inhibited by antiplatelet medication than in patients with uninhibited platelet aggregability (P<.05).ConclusionsThese findings suggest that coagulation-fibrinolysis markers are mildly increased in poststroke patients in the chronic phase and that antiplatelet medication is effective in reducing the elevated plasminogen activator inhibitor-1 levels.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeThe aim of this study was to determine if circulating levels of pituitary hormones are altered by stroke and, if so, whether these alterations offer insight into specific neurochemical pathways in the region of the central nervous system injury.MethodsTwenty-eight consecutive postmenopausal women undergoing computed tomographic imaging of the brain for evaluation of clinical evidence of stroke underwent blood sampling for determination of serum levels of luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone, triiodothyronine, prolactin, estradiol, and sex hormone-binding globulin.ResultsIn stroke involving the caudate, serum levels of luteinizing hormone and follicle-stimulating hormone were reduced to 16% and 24% of concentrations found in those with stroke outside of the basal ganglia (p< 0.03 andp< 0.01, respectively). Levels of estradiol, sex hormone-binding globulin, thyroid-stimulating hormone, and prolactin were similar in all stroke groups. Nonspecific biochemical effects of stress that might influence hormone concentrations were assessed by measurement of serum triiodothyronine, the level of which is a sensitive biochemical correlate of disease severity. These levels were not different between stroke groups.ConclusionsStroke involving the caudate nucleus may interrupt neurotransmitter pathways involved in control of secretion of gonadotropins. Peripheral levels of these hormones may serve as a marker for central neurochemical disturbances associated with stroke in specific brain regions.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeAfter admission to the hospital of patients with aneurysmal subarachnoid hemorrhage, we assessed the predictive value of the extent of the hemorrhage on computed tomography in addition to that of clinical grading scales for poor outcome, infarction, and rebleeding.MethodsWe studied 471 consecutive patients with aneurysmal subarachnoid hemorrhage and used logistic regression with step-wise forward selection of variables.ResultsOn admission, poor outcome was predicted by a low Glasgow Coma Scale score (odds ratio, 0.8; 95% confidence interval, 0.7-0.9); treatment with fluid restriction (2.5; 1.6-4.0); age over 52 (2.6; 1.7-3.9); loss of consciousness at ictus (1.7; 1.1-2.6); or a large amount of subarachnoid blood (2.0; 1.3-3.1). Delayed infarction was predicted by a large amount of subarachnoid blood (1.8; 1.2-2.6) or treatment with tranexamic acid (1.6; 1.1-2.4). Rebleeding was predicted by treatment with tranexamic acid (0.4; 0.3-0.7; protective effect); age over 52 (1.9; 1.2-3.0); loss of consciousness at ictus (1.7; 1.1-2.7); or admission to a neurosurgery service (0.6; 0.3-0.9; protective effect). Comparison of the observed and predicted outcome events showed that inclusion of the amount of subarachnoid blood into a predictive model added little to the prediction of poor outcome in general, but much to the prediction of delayed cerebral ischemia.ConclusionsThe total amount of subarachnoid blood on the initial computed tomogram has independent predictive power for the occurrence of delayed cerebral ischemia.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeWe sought to identify the use of duplex and transcranial Doppler sonography in the noninvasive diagnosis of vertebral dissection.MethodsTen patients with a diagnosis of symptomatic vertebral artery dissection confirmed by cerebral angiography were retrospectively analyzed.ResultsComputed tomographic scanning and magnetic resonance imaging together delineated lateral medullary or cerebellar infarcts in 7 patients. Angiography documented a total of 21 vertebral artery lesions (16 stenoses and 5 occlusions), with 7 of 10 patients having multiple sites of vertebral artery dissection. Vertebral Doppler was abnormal in 8 of the 10 patients. A high resistance signal in the relevant vertebral artery was found in 6 patients, no flow in a well-imaged vertebral artery in 1, and bilateral retrograde vertebral artery flow in 1 patient. Transcranial Doppler was abnormal in only 2 patients, with reduced pulsatility index in 1 and high resistance vertebral signal in another. A hyperintense intramural signal of the affected vertebral artery by magnetic resonance imaging was documented in 1 patient in whom Doppler sonography was nondiagnostic.ConclusionsVertebral artery dissection can be detected and monitored by noninvasive vertebral Doppler and magnetic resonance imaging in the setting of a clinically suggestive presentation.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Background and PurposeThe two objectives of this study were to assess the potential of BAY U 3405 to prevent arterial thrombosis in response to vessel wall injury and to determine the ability of BAY U 3405 to prevent thrombotic reocclusion after thrombolysis with anisoylated plasminogen streptokinase activator complex.MethodsDogs were instrumented with a carotid flow probe, stimulating electrode, and a stenosis. Current (150 μUA) was applied to the intimal surface of the right carotid artery, and time to occlusive thrombus formation was noted. BAY U 3405 was administered, and the procedure for thrombus formation was repeated for the left carotid artery.ResultsBAY U 3405 administration prevented occlusive arterial thrombosis formation. Ex vivo platelet aggregation was inhibited, bleeding time increased, and thrombus weight reduced after BAY U 3405 treatment. In a second group, thrombi were formed initially in both carotid arteries, BAY U 3405 was administered as before, and anisoylated plasminogen streptokinase activator complex was infused in the right carotid artery proximal to the occlusive thrombus. BAY U 3405 did not alter the incidence of rethrombosis compared with the lytic agent alone.ConclusionsBAY U 3405 prevented primary arterial thrombosis, corresponding to inhibition of platelet aggregation, and increased bleeding times. BAY U 3405, however, did not prevent rethrombosis after successful thrombolysis with anisoylated plasminogen streptokinase activator complex, despite the fact that platelet reactivity was inhibited. The data are consistent with the concept that the residual thrombus represents a more effective thrombogenic stimulus as compared with arterial wall injury alone and that the mechanisms associated with primary versus secondary thrombus formation may require separate therapeutic approaches.

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1993

数据来源: OVID