摘要:

The prevalence of carotid and lower extremity arterial disease was assessed in a healthy population of 56 elderly adults with isolated systolic hypertension. Duplex scans were performed to determine the extent of carotid disease, and postexercise ratios of ankle to arm systolic blood pressure were measured to assess lower extremity arterial disease. Internal carotid stenosis was found in 38% (21 of 56) of subjects and lower extremity arterial disease in 42% (23 of 55). The strongest predictor of internal carotid stenosis was lower extremity arterial disease. Independent risk factors for lower extremity arterial disease were smoking, internal carotid stenosis, and age. A measure of extent of carotid plaque was found to correlate with age, carotid stenosis, male sex, history of smoking, and total cholesterol. The high prevalence of peripheral vascular disease in this population may be related to their age and blood pressure. The high correlation between carotid stenosis and lower extremity arterial disease suggests that persons with peripheral vascular disease should be assessed and treated for atherosclerotic disease in general. (Stroke 1987;18:817–822)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The 30‐day mortality as well as morbidity for stroke and myocardial infarction were determined by review of the charts for every carotid endarterectomy (iV = 389 operations on 356 patients) performed at Wake Forest University Medical Center from 1979 through 1983 to ascertain whether the 16% morbidity and 6% mortality documented in our previous report of 1978 had changed over time. For endarterectomies performed on asymptomatic patients (n = 155), major morbidity included 2 myocardial infarctions and 1 stroke (1.9%). There were 3 fatalities — 2 myocardial infarctions and 1 stroke (1.9%). For the symptomatic group (n = 234), major morbidity was 2.1%, mortality 2.6%. The combined morbidity for asymptomatic and symptomatic carotid stenosis was 2%, mortality 2.3%. Perioperative stroke rate (morbidity plus mortality) was 2.6%, 9 ipsilateral to the carotid endarterectomy, suggesting distal embolism as its probable cause. We contend that quality control measures implemented to correct the unacceptable rates reported in 1978 have contributed to dramatic and sustained reductions in complication rates. (Stroke 1987;18:823–829)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Medical records of all residents of Rochester, Minnesota, who had a first stroke in 1975–1979 were reviewed to determine level of disability, disposition, and use of rehabilitation services. Of the 292 persons with a first stroke, 251 (86%) (mean age 70 years) survived >1 week. The mean Rankin disability score (Grade 1, no disability, through Grade 5, severe disability) changed from 1.7 before stroke to 2.8 in survivors at hospital discharge; 29% of those discharged required further institutional care. The level of disability in survivors remained relatively constant from 6 months after stroke through 5 years of observation. Of the 112 patients with an admission score of 5,40 (36%) were alive at 1 year and only 5 of those (13%) improved to relative independence (Rankin scores of 1 or 2). The most common comorbidity contributing to disability was cardiovascular disease (31%). After the first 18 months, the mortality in patients with stroke was similar to that in a normal population having the same age and sex distribution. Of the 2511‐week survivors, 132 (53%) had rehabilitation (physiatrist) evaluations, 127 (51%) received physical therapy, 103 (41%) received occupational therapy, and 33 (13%) received speech therapy. Thirty—four of the 132 patients (26%) referred for rehabilitation evaluations were transferred to the rehabilitation unit. (Stroke 1987; 18:830–836)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

As part of a prospective study of mood disorders in stroke patients, interviews were obtained from 37 patients at 1 year and 48 patients at 2 years follow—up. In—hospital evaluations for these 65 follow—up patients found that 9 patients (14%) had symptom clusters of major depression, 12 patients (18%) had symptom clusters of dysthymic or minor depression, and 44 patients (68%) did not meet the DSM in diagnostic criteria for depression. Although overall prevalence of depression did not change significantly over time, the prognosis for individual patients, depending on diagnostic group, was different.All of the follow—up patients with major depression in—hospital were improved by 2 years, with a significant reduction in their mean depression scores and improvement in their activities of daily living, whereas only 30% of follow—up patients with dysthymic depression improved by this time. There was no significant improvement in their mean depression scores or mean activities of daily living score. Of the patients followed up who were not depressed in—hospital, 34% had developed major or minor depression by 2 years, and their mean depression scores were significantly increased. These data suggest that the prevalence of depression among the follow—up patients remains high (between 30 and 40%) for the first 2 years after stroke, but that untreated poststroke major depression has a natural course of about 1–2 years, with associated improvement in activity of dairy living scores, whereas the prognosis for poststroke dysthymic depression is frequently unfavorable and often persists for >2 years. (Stroke 1987; 18:837–843)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

During a 20‐year follow—up of 1,621 men and women aged 40 and over in Hisayama, Japan, 18 were found to have suffered transient cerebral ischemic attacks (TIAs) determined by clinical symptoms based on criteria proposed by the US Joint Committee for Stroke Facilities. The average annual incidence rate for the first TIA was 0.56 per 1,000 residents. Age and high blood pressure were strong determinants of TIAs for men. Nine of the 18 cases with TIAs (50%) subsequently developed cerebral infarction, an incidence significantly higher than that in the 1,603 subjects without TIAs (10.9%).Lacunar infarcts were most commonly found on pathologic examination of patients with TIAs who had had a subsequent stroke. (Stroke 1987;18:844–848)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Using clinical and computed tomography (CT) criteria, an analysis of 2,000 consecutive stroke unit patients from 1977 to 1984 revealed 30 patients with cerebellar infarction. The case fatality rate was 23%, higher than for any other location of brain infarction studied over the same period. Death was most often due to concomitant brainstem infarction. Obstructive hydrocephalus occurred in 4 patients (13%), and in 2 cases diagnosis, facilitated by urgent CT scanning, allowed early surgical intervention that was life saving. Patients who survived the acute phase were followed for an average of 21 months, and over that time 22% sustained further brainstem infarction, representing a 13% stroke rate per year. Over the latter 3 years of the clinical study, an autopsy survey revealed 11 cases of cerebellar infarction that had been clinically unrecognized. None of these died as a direct result of their infarction. Mechanisms of infarction inferred from autopsy included in situ thrombosis, embolism, watershed, and lacunar infarction, with in situ thrombosis being the most common. We conclude that the case fatality rate of cerebellar infarction is greater than of any other form of brain infarction, but it may be reduced by prompt recognition of those patients who will benefit from surgical decompression. In survivors, a high risk of subsequent hindbrain stroke exists. More attention needs to be paid to this entity in terms of early diagnosis and prevention of subsequent stroke. (Stroke 1987;18:849–855)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Patient records in 36 consecutively identified patients with typical echocardiographic findings of atrial septal aneurysm were reviewed. Ten of the 36 (28%) had cerebrovascular events. Of these 10, 5 had completed strokes of definite embolic origin on the basis of clinical, angiographic, and computed tomographic findings; 2 had transient ischemic attacks of probable embolic origin. One of the 36 patients had a definite peripheral vascular embolus. Thus, 6 of 36 consecutively identified patients with atrial septal aneurysm (17%) had definite embolic events and 8 of 36 (22%) had definite or possible embolic events. The cause of the association between atrial septal aneurysm and emboli is unknown. While aneurysm—associated thrombus has been suggested, the high proportion (90%) of patients with interatrial shunting demonstrated by contrast echocardiography in this study suggests paradoxical embolization as a potential cause. Whatever its mechanism, the high prevalence of embolic events in this series strongly supports the premise that atrial septal aneurysm is a cardiac abnormality with embolic potential. (Stroke 1987; 18:856–862)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The clinical outcome of 40 cases with middle cerebral artery (MCA) occlusion was examined in relation to the site of occlusion and the findings on computed tomography (CT). Patients were treated conservatively without surgery. A few had decompressive craniotomy when necessary. Outcome in 7 (18%) was good, in 6 (15%) moderate, and in 15 (38%) severe; 12 (30%) died by the follow—up at 3 months. In cases with occlusion at the origin of the MCA, hypodensity on CT scan was usually localized to the basal ganglia, presumably because of collateral circulation through the anterior cerebral arteries; the outcome in these patients was not always favorable. Cases with occlusion of the trunk or branch vessels always showed marked CT hypodensity, and clinical outcome was poor. To assess quantitatively the extent of collateral circulation, the conduction time of contrast medium from the intracranial siphon (IC) to the insular portion of the MCA (M2) through the anterior cerebral arteries was calculated on serial carotid angiograms obtained within 24 hours after stroke onset. An IC—M2 time of 5 seconds was a critical indicator of whether extensive CT hypodensity would develop (the rule of 5 seconds). Furthermore, this method predicted the appearance and extent of infarction before CT revealed hypodensity. The significance of acute reconstructive surgery is also discussed. (Stroke1987;18:863–868)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Oxygen free radicals generated during reoxygenation after cardiac arrest may impair recovery of cerebral blood flow and function. In a randomized study in vivo, we tested the following anti—free radical combination therapy administered at the beginning of cardiopulmonary resuscitation after apnea—induced cardiac arrest of 7 minutes: 1) ventilation with 100% nitrogen for 30 seconds to allow the delivery of therapy before oxygen, 2) 10 mg/kg i.a. superoxide dismutase followed by 10 mg/kg i.v. over 1 hour to scavenge the superoxide anion radical, and 3) 20 mg/kg i.v. deferoxamine over 1 hour to prevent membrane lipid peroxidation. We evaluated the effects of this combined treatment on the recovery of cardiovascular variables, cerebral blood flow and oxygen consumption, and somatosensory evoked potentials in 20 dogs 6 hours after resuscitation. Compared with standard treatment (n = 10), the combined treatment (n = 10) did not affect cardiovascular variables, significantly mitigated cerebral blood flow changes after cardiac arrest, and enhanced recovery of somatosensory evoked potentials. We conclude that oxygen free radicals play a role in the pathogenesis of the arrestrelated derangements of cerebral blood flow and function that are effectively reduced by this combined treatment; we recommend evaluation of its components in outcome studies. (Stroke 1987;18:869–878)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To investigate the association between carotid plaque hematoma and symptoms of cerebral ischemia a retrospective review of 200 consecutive carotid endarterectomies at the Neurological Institute of New York was carried out. Data analyzed included cerebral ischemic symptoms, angiographic findings, preoperative use of antithrombotic agents, and microscopic pathology of endarterectomy specimens. No association was found between ischemic symptoms ipsilateral to the endarterectomy and presence, size, or age of plaque hematomas. Plaque hematomas were less common among patients who took antithrombotic agents preoperatively than among those who did not. The presence of plaque hematoma was associated with angiographic carotid cross—sectional area stenosis of >75%. Patients with stenosis of < 75% were more likely than those with stenosis of >75% to have ischemic symptoms ipsilateral to the endarterectomy, suggesting that criteria for surgical treatment of carotid atherosclerosis differ for those who are symptomatic vs. those who are asymptomatic. These results demonstrate the limitation of using a surgical series to extend causal inferences about the relation between plaque hematoma and cerebral ischemic symptoms to the general population of people with carotid atherosclerosis. (Stroke 1987;18:879–881)

ISSN:0039-2499    

出版商:OVID    

年代:1987

数据来源: OVID