摘要:

Patients with acute ischemk stroke were randomized < 24 hours after onset to standard (S) therapy (n= 43) or to hypervolemic hemodilution (HH) with pentastarch (n= 45). The therapeutic goal of hypervolemic hemodilution was to rapidly reduce hematocrit to 33%, to raise cardiac output, and to continue hypervolemic hemodilution for 3 days. A graded neurologic examination was scored by a blinded observer at randomization (baseline), at the end of treatment or after 72 hours, and at a 3‐month follow‐up; each patient was also rated using Barthel's disability scale at the 3‐month follow‐up. Group demographics and results of the graded neurologic examination were similar at baseline, except that the HH group contained twice the number of patients with severe strokes and fewer patients randomized within 12 hours compared with the S group. The HH group improved an average of 7 points in neurologic score from baseline to the end of treatment (the S group deteriorated 1 point) and 24 points by the 3‐month follow‐up (the S group improved 16 points; p = 0.1l). The HH group reached an average Barthel disability scale index of 85 while the S group averaged 70 (p = 0.8). Deaths associated with cerebral edema occurred in five patients with severe stroke (four in the HH group vs. one in the S group, p = 0.36). The following subgroups of HH patients showed better overall improvement In neurologic scores: patients entered within 12 hours after stroke onset, patients with a 15% decrease in hematocrit, and patients with a 10% increase in cardiac output. Based on these results, we conclude that further evaluation of hypervolemic hemodilution using refined patient selection techniques and improved study design is indicated. (Stroke1989; 20:317–323)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We analyzed perioperative strokes in 658 carotid endarterectomies with the purpose of explaining the pathogenesis from the morphologic aspect of the infarct on cerebral computed tomograms. All endarterectomies were performed with continuous electroencephalographic monitoring. Of the 42 ischemic strokes (6.4% of all endarterectomies), 34 could be studied. Seven infarcts were hemodynamically induced (five watershed infarcts, two patients with bilateral ischemia); all seven occurred during surgery. Twenty‐three of the remaining 27 infarcts were within the territory of the middle cerebral artery (20) or anterior cerebral artery (three) and were probably of thromboembolic origin; 13 of these 23 occurred during surgery (57%). If intraoperative stroke was heralded by permanent electroencephalographic changes, these were not related to the moment of cross‐clamping. In four patients the computed tomogram was normal. We believe these facts favor the hypothesis that thromboembolism is the most important factor in the pathogenesis of perioperative stroke associated with carotid endarterectomy under conditions of optimal cerebral monitoring. (Stroke1989;20:324–328)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

To determine the incidence of perioperative silent cerebral infarction, 97 patients who underwent carotid endarterectomy were prospectively studied with preoperative and postoperative computed tomograms. Thirty‐one of 96 patients (32%) had findings of cerebral infarction on preoperative computed tomograms. Silent cerebral infarction was found preoperatively in 17 patients (18%) (lacunar infarction in 10, cortical infarction in five, both cortical and lacunar infarctions in one, and cerebellar infarction in one). Transient ischemic attacks occurred in 10 of the 17 patients with silent cerebral infarction; however, symptoms were appropriate to the site in only five of these 10 patients. Fourteen of the 17 patients with silent cerebral infarction had a hemodynamically significant carotid stenosis, and seven patients had an ulcerated plaque on preoperative angiograin. The incidence of these lesions was similar to that found in the group of 66 patients without cerebral infarction. Endarterectomy specimens revealed a higher but not significantly different incidence of ulcerated plaque in the silent cerebral infarction group. There were no perioperative deaths. Following surgery, one patient (1%) with a preoperative silent cerebral infarction suffered a transient ischemic attack, and two patients (2%) with normal preoperative computed tomograms developed permanent neurologic deficits with new cortical infarctions on postoperative computed tomograms. No new silent cerebral infarctions were found on postoperative computed tomograms in any of the 97 patients. Our data suggest that silent cerebral infarction is a common preoperative finding with an as‐yet unclear etiology and that carotid endarterectomy does not appear to be a cause. (Stroke1989;20:329–332)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The Oxfordshire Community Stroke Project is a prospective register of all new cases of stroke and transient ischemic attack (TIA) in a population of 105,000 residents of Oxfordshire, England. Between November 1,1981, and October 31,1986,184 patients presented for the first time to a general practitioner or hospital with a TIA. The crude annual incidence rate was 0.35/1000, 0.42/1000 standardized to the 1981 population of England and Wales. We estimate that each year approximately 21,000 patients in England and Wales (about half of whom are >70 years old) consult a doctor for the first time with a TIA. Approximately 80% of our 184 patients had TIAs in the carotid distribution; the remainder had TTAs in the vertebrobasilar distribution or TIAs of uncertain vascular distribution. The incidence of TIA increased sharply with increasing age, and the overall incidence in men was very similar to that in women (incidence ratio 1.3). However, in middle age, men were much more likely to suffer a TIA than women (odds ratio 2.6), which probably explains the marked male predominance in most hospitalbased studies and treatment trials in which the elderly, and thus women, are underrepresented. This has important implications for the design and interpretation of clinical trials of treatments for TIAs. (Stroke1989;20:333–339)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We prospectively followed 78 patients with transient ischemic attacks (TIAs) from the carotid artery territory and 45 patients with minor ischemic strokes for 3 years. The mean±SD age of the patients in the TIA group was 66.9±7.9 years compared with 68.8±6.7 in the minor stroke group. Mortality among the TIA patients was significantly higher than that among minor stroke patients (18 of 78 compared with two of 45,p< 0.01); mortality in the minor stroke group was not higher than that in the background population, whereas mortality in the TIA group was almost twice as high. The most common cause of death in the TIA group was myocardial infarction, and morbidity due to myocardial infarction and new TIA was higher in the TIA group than hi the minor stroke group (35 events compared with seven), whereas no difference was found regarding stroke (five strokes compared with eight). Preexisting vascular disease ' implied an increased risk of mortality and morbidity hi the TIA group. We conclude that carotid‐territory TIA indicates a worse prognosis than minor stroke as mortality is higher in TIA patients at the same preexisting vascular disease prevalence and stroke frequency. (Stroke1989;20:340–344)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We evaluated survival following stroke for patients from a five‐county area of rural North Carolina enrolled in either of two community hospital‐based stroke survey programs. In this area, the first program enrolled 843 stroke patients between 1970 and 1973 and the second program enrolled 786 stroke patients between 1979 and 1980. One‐year survival increased from 49% in the first program to 62% in the second for all stroke patients, from 54% to 68% for patients with cerebral infarction, and from 18% to 55% for patients with cerebral hemorrhage. While other reports have attributed declining stroke mortality to a decline in the incidence of stroke, our study suggests that increased survival after stroke may account for a large portion of the decrease in stroke mortality. (Stroke1989;20:345–350)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The destinations of stroke patients after discharge from acute‐care hospitals were studied to ascertain the current use of health care resources. The 1984–1985 acute‐care hospital discharge listings for the province of Quebec were consulted to identify 3,045 adults of the Montreal area who were discharged, deceased or alive, with a primary or secondary diagnosis of stroke. The relation between the length of stay (i.e., the tune to death or discharge to long‐term care, rehabilitation, or home) and the explanatory variables (age, sex, neighborhood socioeconomic status, type of stroke, and university affiliation of the discharging hospital) was assessed using Cox's proportional hazards models. Older patients and those with hemorrhagic strokes had the highest risk of death. However, patients with hemorrhagic strokes were more likely to survive if admitted to a university teaching hospital. Older patients, those with nonhemorrhagic strokes, and those admitted to university teaching hospitals were more likely to be discharged to long‐term care. A greater proportion of patients discharged to rehabilitation centers were young, lived in a high‐socioeconomic‐status neighborhood, and had suffered a nonhemorrhagic stroke. Patients had a significantly higher probability of going home if they were young, had had a nonhemorrhagic stroke, had been admitted to a university teaching hospital, or were male. (Stroke1989;20:351–356)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Thromboembolic brain ischemia was produced in dogs using an autologous blood clot model. The effect of postembolic treatment with flunarizine and streptokinase on hemispheric cerebral metabolic rate for oxygen (CMRO2), oxygen extraction ratio (OER), and cerebral blood flow (CBF) was studied by positron emission tomography (oxygen‐15 technique) 24 hours after the insult. We studied five groups of experimental dogs and compared them with a control group of nonembolized dogs. Group I received no treatment, Group II was treated locally with 500,000 IU streptokinase starting 30 minutes after the insult, Group HI received streptokinase locally 30 minutes after the insult and 0.1 mg/kg i.v. flunarizine immediately after the insult and 2 hours later, Group IV received flunarizine as Group III, and Group V was orally pretreated with 0.S mg/kg/day flunarizine during 2 weeks preceding embolization. Compared with the contralateral hemisphere, in the embolized hemisphere a significant reduction of CMRO2(−25% to −40%) and CBF in normocapnia (−35%) and hypercapnia (−50%) was observed in Groups I, II, and V. In Groups III and IV, CMRO2, OER, and CBF of the embolized hemisphere were within the normal range during normocapnia and hypercapnia; the extent of the ischemic lesions was markedly less than in the other groups of experimental dogs. We conclude that flunarizine treatment after experimental thromboembolic stroke had a favorable influence on brain tissue. Chronic preventive flunarizine treatment failed to have a beneficial effect. (Stroke1989;20:357–361)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We observed the effects of a new thyrotropin‐releasing hormone derivative, YM‐14673 (Nα‐[[(S)‐4‐oxo‐2‐azetidinyl]‐L‐carbonyl]‐L‐histidyl‐L‐prolinamide dihydrate), on behavioral changes in rats for 3 weeks after focal cerebral ischemia. Under halothane anesthesia, the left middle cerebral artery was occluded via a transretro‐orbital approach. YM‐14673 was administered just after the operation and once a day for 3 weeks. Neurologic deficits, including hemiplegia and abnormal posture, and disturbance of passive avoidance learning were present in solvent‐treated control rats for the entire 3 weeks. YM‐14673 at 0.1 or 0.3 mg/kg i.p. or 1 mg/kg p.o. significantly accelerated the recovery of neurologic deficits and ameliorated cognitive disturbance compared with the solvent‐treated controls although the drug at 0.1 and 0.3 mg/kg i.p. did not influence the size of the ischemic infarct. YM‐14673 mitigated the behavioral disturbances in this model of chronic focal cerebral ischemia. We also discuss the suitability of this model for the evaluation of drugs. (Stroke1989;20:362–366)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effects of subarachnoid injection of blood on blood‐brain barrier permeability to albumin was assessed in a rat model. Subarachnoid injection of blood caused a significant sixfold increase in Evans blue extravasation, whereas sham operation or NaCl injection had no effect. In addition, subarachnoid injections of arachidonic acid or FeCl2increased blood–brain barrier permeability to Evans blue 16‐ and 10‐fold, respectively. The capillary permeability after subarachnoid injection of blood was normalized by pretreatment with a novel 21‐aminosteroid, U‐74006F, that has antioxidant and antilipolytic activity. Pretreatment with U‐74006F also reduced the vascular leakage induced by subarachnoid injection of arachidonic acid or FeCl2by 50% and 45%, respectively. We conclude that damage to membrane lipids by peroxidative and or lipolytic processes is involved in the subarachnoid hemorrhage‐induced blood‐brain barrier opening and that U‐74006F protects the blood‐brain barrier against the effects of subarachnoid hemorrhage by preventing or limiting these pathologic membrane lipid changes. (Stroke1989;20:367–371)

ISSN:0039-2499    

出版商:OVID    

年代:1989

数据来源: OVID