摘要:

We evaluated 14 patients with acute cardiogenic embolism who underwent open heart surgery soon after the onset to determine the cerebral and cardiac factors that influence neurologic outcome. The mean interval from onset of cerebral embolism to surgery was 5.3 (range 1–16) days. Five of the 14 patients had vegetations from infective endocarditis (including prosthetic valve endocarditis) as embolic sources, eight had intracardiac thrombi, and one had atrial myxoma. The diagnosed site of infarction before surgery was based on computed tomographic and/or angiographic findings. Of the 14 patients, four had infarcts due to major artery occlusion, seven due to cortical branch occlusion, and two due to perforating artery occlusion; one patient presented with a transient ischemic attack without computed tomographic abnormalities. Ten patients (71%) showed no clinical aggravation after open heart surgery; however, two patients died of massive cerebral hemorrhage, one died of deterioration of brain edema, and another became comatose from midbrain hemorrhage immediately after surgery. The four patients with clinical aggravation comprised three with septic embolism and one with aseptic occlusion of a major artery. From these results, infective endocarditis and a large infarct appear to be possible aggravating factors when patients with recent cerebral embolism undergo open heart surgery. (Stroke1989;20:1305–1310)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We studied 177 consecutive male patients aged 16–60 years with brain infarction verified by neuroradiology and analyzed the time of onset of stroke symptoms related to sleep and the role of possible or known risk factors for brain infarction. Brain infarction occurred relatively more often during the first 30 minutes after awakening than at any other time. In multiple stepwise logistic regression analyses, snoring was the only independent risk factor differentiating stroke occurring during sleep and stroke occurring either during sleep or during the first 30 minutes after awakening from stroke occuring at other times of the day. The risk ratios were 2.65 (95% confidence interval 1.32–5.29,p< 0.005) and 3.16 (95% confidence interval 1.61–6.22,p< 0.001), respectively. Other factors tested were age, arterial hypertension, diabetes mellitus, smoking, alcohol consumption, and body mass index. Arterial hypertension seemed to have an additive effect on the independent risk caused by snoring. (Stroke1989;20:1311–1315)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We used transmission electron microscopy to count the organelles (dense bodies, alpha granules, and mitochondria) contained within platelets from 11 acute ischemic stroke patients and 12 healthy controls. We randomly selected for evaluation 25 platelet profiles in ultrathin sections cut from three separate blocks. Compared with those from controls, platelets from stroke patients contained significantly fewer alpha granules (p< 0.001) and mitochondria (p< 0.02) and showed a trend toward fewer dense bodies. Supportive of our previous studies, the amount of adenosine triphosphate secreted following stimulation by collagen also tended to be greater in platelets from stroke patients. These observations support the presence of increased platelet secretion associated with acute cerebral infarction and raise the possibility that platelet secretion may be of separate importance to the mechanical occlusion of blood vessels by platelet aggregates in the pathogenesis of cerebral infarction. (Stroke1989;20:1316–1319)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Survival after stroke and transient ischemic attack was studied in Soderhamn, Sweden, during the periods 1975–1979 and 1983–1987; 640 patients with first‐ever stroke and 97 with first‐ever transient ischemic attack were registered and followed for 1–3 years. Approximately 90% of the patients were treated in the Department of Internal Medicine of Soderhamn Hospital. The protocols for physical rehabilitation and antithrombotic treatment changed between study periods. Between periods, 3‐year survival after stroke increased by 16% (p< 0.003). The 95% confidence intervals of the relative survival rates were 0.524–0.648, 0.435–0.567, and 0.337‐ 0.475 at 1, 2, and 3 years, respectively, during the first period and 0.616–0.728, 0.600–0.732, and 0.576–0.748 during the second period. Fewer patients suffered fatal complications of stroke during the second period. The rate of stroke recurrence was approximately 10%/year during both study periods. Four patients suffered fatal hemorrhages during the first period, but no patient did so during the second period. Observed survival after transient ischemic attack did not differ from that expected in the first 2 years of follow‐up during either study period. The risk for stroke after transient ischemic attack was approximately 5%/year during both periods. The higher survival rates after stroke during the second period seems to be the result of fewer fatal complications rather than of a reduced risk for recurrent stroke. (Stroke1989;20:1320–1326)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A population‐based sample of 478 men aged 69 years living in Malmo, Sweden, underwent Doppler ultrasonic examination of their carotid arteries; cerebrovascular symptoms and signs were recorded independently. Among 471 men with complete examinations, 117 (25%) showed significant abnormalities in carotid blood flow velocity (moderate stenoses [30–60% diameter reduction] in 20%, severe stenosis [>60% reduction] or occlusion in 5%). The latter seemingly formed a group separate from the main distribution curve. Stroke was reported in 28 men (6%), during the year before examination in nine (2%). Carotid transient ischemic attack (TIA) was clinically confirmed in one man during this year, while unconfirmed symptoms were reported in 63 (13%). There was a relation between ipsilateral hemispheric stroke/TIA and severe carotid disease (p< 0.001). Four of seven men with total occlusion had a stroke or a clinically confirmed TIA. Nevertheless, the majority of carotid stenoses (including severe stenoses) were asymptomatic. Cerebrovascular symptoms were not significantly more frequent among the men having moderate stenosis than among those having healthy arteries. (Stroke1989;20:1327–1330)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The extent of carotid atherosclerosis evaluated by B‐mode real‐time ultrasound and the presence of bruits established by carotid phonoangiography were determined in 1,107 patients. Unilateral bruit was associated with increased atherosclerosis compared with no bruit (p < 0.0001). However, there was no association between laterality of the bruit and the degree of atherosclerosis (/7 = 0.66). There was marginal evidence that patients with bilateral bruits had more severe atherosclerosis than patients with unilateral bruit (p = 0.046). The relation between bruit and atherosclerosis categorized by B‐mode ultrasound was not sufficient to reliably predict the presence or absence of disease in an individual patient, though the presence of a bruit should be viewed as a risk factor for, or an indicator of, increased risk of systemic atherosclerosis. (Stroke1989;20:1331–1335)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In a prospective study using a multigate pulsed Doppler system, minor ( < 30% diameter reduction) carotid artery lesions were diagnosed by detecting not only abnormalities in the blood flow pattern, but also local changes in artery wall distensibility. For the diagnosis of more severe lesions, additional information was obtained from disturbances in the Doppler audio spectrum. Biplane arteriography was used as a reference. The observed agreement, sensitivity, and specificity were 86.6%, 90.3%, and 88.6%, respectively, for all lesions and 85.7%, 82.1%, and 88.6%, respectively, when only minor lesions were considered, K (a chance‐corrected measure of agreement) was 81.7%. If only blood flow abnormalities were used to detect minor lesions, 43.5% would be missed. Our results indicate that minor carotid artery lesions can be diagnosed noninvasively more accurately when both local blood flow irregularities and local changes in vessel wall distensibility are taken into account. (Stroke1989;20:1336–1340)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We examined anastomoses among the hypothalamic arteries in 14 human brains using an injection technique, microdissection, and a stereoscopic microscope. Five to 22 anastomoses (mean 10.1) were found in all 14 brains on each side, varying from 20 to 280 (mean 71)/μm in diameter and from 0.1 to 5.3 (mean 1.52) mm long. A single hypothalamic artery may be connected to other vessels by one to 10 anastomoses. The anastomoses were channel‐like or plexiform; both types may be ipsilateral or right‐left. They connected the hypothalamic arteries “end‐to‐end,” “end‐to‐side,” and “side‐to‐side.” The interconnected arteries ranged from 30 to 1,900 (mean 148)/xm in diameter. Anastomoses were most frequent among the commissural arteries and in the distribution of the superior hypophyseal arteries and the tuberoinfundibular branches of the posterior communicating artery. The largest anastomoses were found among the tuberoinfundibular branches of the posterior communicating and internal carotid arteries, as well as among the premamillary arteries and the mamillary branches. We discuss the neurologic, neuroendocrinologic, and neurosurgical significance of the described anastomoses. (Stroke1989;20:1341–1352)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

MICROSTROKE is a prototype expert system designed to categorize and diagnose stroke types based on clinical information. The knowledge base of MICROSTROKE includes information from large stroke registries. The system first queries the physician‐user for details of the patient's history, information about the onset of stroke, accompanying symptoms, and pertinent neurologic findings and then sums the individual data items, factors in the a priori odds, and arrives at the probabilities of different stroke types for a given patient. Specific diagnosis of stroke type includes thrombosis, embolus, lacune, intracerebral hemorrhage, and subarachnoid hemorrhage. Stroke type diagnoses by MICROSTROKE were correct in 72.8% of 250 cases in the Hamburg Stroke Data Bank, MICROSTROKE runs on any MS‐DOS microcomputer and is intended as a practical aid for physicians not fully familiar with the diagnosis of stroke types. (Stroke1989;20:1353–1356)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We investigated the effects of multiple episodes of cerebral ischemia on intracellular brain pH using in vivo phosphorus‐31 nuclear magnetic resonance spectroscopy. Four cats were subjected to two 16‐minute episodes of complete global cerebral ischemia 6 hours apart; the second episode occurred under hyperthermic conditions (mean±SD body temperature 40.8 ±0.4° C). Intracellular pH in these four cats was compared with that in nine cats subjected to a single 16‐minute episode of complete global cerebral ischemia under hyperthermic conditions (mean±SD body temperature 40.6±0.2° C). Intracellular pH during hyperthermic recirculation was significantly (/? < 0.03) greater in cats subjected to a previous ischemic event than that in cats subjected to only a single hyperthermic ischemic event. We speculate that the induction of heat shock proteins by an initial ischemic event may protect brain tissue from further ischemic insult. (Stroke1989;20:1357–1360)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID