摘要:

Anticoagulation clearly benefits patients at risk of stroke from cerebral embolism. Conversely, patients with completed ischemic stroke are not benefited, and may show a higher mortality and morbidity because of hemorrhagic complications. Technical advances in the early, accurate diagnosis of cerebral hemorrhage, the constant infusion of heparin, and closer monitoring of anticoagulation have continued to reduce the risk of hemorrhage in treated patients. In patients with TIA, alternative therapy with anti-platelet agents, which appears to prevent stroke at less bleeding risk, is under study. Current results show no differences between the two therapies, but only historical controls are available for evaluation of benefit. Whether or not anticoagulation prevents progression of neurologic deficit in patients with strokes-in-evolution remains an unanswered question, which can be resolved only by prospective, randomized, controlled trials.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The role of Atrial Fibrillation (AF) as a precursor of stroke was examined in the Framingham cohort based on 30 years of follow-up during which time 501 strokes occurred. There were 59 persons who sustained stroke in association with AF excluding those with rheumatic heart disease. AF increased the risk of stroke five-fold and the excess risk was found to be independent of the frequently associated cardiac failure and coronary heart disease. The contribution of AF to stroke risk was also at least as powerful as that of the other cardiovascular precursors. Stroke associated with AF was not only independent and substantial but also imminent. There was a distinct clustering of stroke events at the time of onset of the AF. Thirty day case-fatality rates were no different in those with strokes accompanied by AF than not at 17% versus 19% respectively. Recurrences in those with AF were only slightly more frequent, 25% versus 20%, a difference that was not statistically significant. Stroke recurrence in the first 6 months following initial stroke was more than twice as common (47% versus 20%) in the AF group.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A randomized trial of immediate versus delayed anticoagulation of patients with cardiogenic embolic brain infarction was carried out in a multi-centered study. Patients who were within 48 hours of onset of deficit and who had no evidence of hemorrhage on computed tomography (CT) were randomized to receive either immediate heparinization or no anticoagulants for the initial 14 days following Stroke. There were 63 patients with embolic stroke identified during the study period. Eighteen patients were not randomized because of specific exclusion criteria or delayed identification more than 48 hours after Stroke. Of 45 patients who were randomized, 44 patients (98%) completed the initial week of the protocol: 24 were immediately heparinized at an average of 32 hours after stroke, 21 received no immediate anticoagulation. Two patients developed delayed hemorrhagic infarction and two patients experienced early recurrent embolism, all among the nonanticoagulated group. Of all patients with embolic stroke who were not receiving coumadin at onset of stroke, only two of 56 (4%) had hemorrhagic infarction on initial CT. Follow-up CT in 40 of these patients showed late developing hemorrhagic infarction in two additional patients (5%). All four hemorrhagic infarctions occurred in 18 non-anticoagulated patients with large infarcts. There were no major complications associated with immediate heparinization of 24 unselected patients with all sizes of embolic infarction. A trend toward reduction of early recurrent embolism was apparent. These data support immediate anticoagulation of nonhypertensive patients with embolic brain infarction who have no evidence of hemorrhage on CT performed 24–48 hours after Stroke.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Treatment with an anticoagulant (AC) or acetylsalicylic acid (ASA), chosen at random, was given to 241 patients with symptoms of carotid transient attacks of ischemia, some of whom recovered completely within 24 hours (TIA) while the others had slight residual symptoms (TIA-IR). Cerebral infarction was recorded in 4 patients in each of these treatment groups during a mean follow-up period of 20 months. The incidences of TIA and TIA-IR were also similar in the two groups. Severe hemorrhage occurred more often in the AC group, whereas other side reactions, including gastrointestinal disorders, were more common in the ASA group. Recurrent cerebral ischemic events were significantly more common among the patients that had had greater than or equal to 2 TIAs in the 14 days immediately preceding randomization, and in those with a history of CVS symptoms more than 14 days before randomization, or those with a carotid bruits. In the group experiencing greater than or equal to 2 TIAs in the 14 days prior to randomization the incidence of recurrent cerebral ischemic events was the same for the two types of treatment.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A prospective analysis of 421 patients undergoing coronary artery bypass graft (CABG) surgery as the sole cardiac procedure was carried out to assess the frequency of central nervous system (CNS) complications. In all, 451 variables were assessed in each patient. Stroke occurred in 5.2% but was severe in only 2%. Prolonged encephalopathy occurred in 11.6% but usually resolved before discharge. No statistically significant pre- or intraoperative risk variables for CNS complications were found; specifically, age or pump times in excess of two hours were not significant factors. Postoperative use of an intraaortic balloon pump and pressor agents were significantly correlated with prolonged encephalopathy. The frequency of CNS injury in CABG surgery is similar to that in other forms of open heart surgery, and there has been little change in the frequency of CNS complications over the past seven years. Possible mechanisms of CNS damage during CABG surgery are discussed.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Nonvalvular atrial fibrillation (NVAF) can be a source of cardiogenic brain embolism. We retrospectively reviewed the clinical features of 56 patients with acute brain infarction and NVAF. Based on clinical criteria, 35 infarcts (63%) were classified as probably embolic, 13 infarcts (23%) as probably nonembolic and 8 infarcts (14%) as of indeterminate pathogenesis. Among the 35 patients with presumed embolic infarcts, 12 patients were immediately anticoagulated without hemorrhagic complications. Of 23 patients who did not receive immediate anticoagulation, three (13%) experienced recurrent embolism (one each to brain, kidney and leg) within 10 days of initial embolism. There were no early recurrent emboli in patients receiving immediate anticoagulation or patients in the nonembolic or indeterminate category. Five additional patients experienced probable brain or systemic emboli within the 11 days prior to the marker stroke event. Including these patients, 20% (8 of 40) of all NVAF patients who were not immediately anticoagulated experienced recurrent embolism within 11 days of the initial embolus. Early recurrent emboli are common in NVAF patients who experience embolic Stroke.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

One hundred consecutive patients (67 men, 33 women) aged from 15–55 with acute ischemic brain infarction verified by computed tomography and/or angiography and/or brain scanning were studied. In 40 cases the onset of symptoms was preceded within 24 hours by ethanol intoxication. Ethanol intoxication preceding brain infarction was 4–7 times as common in men and 6–15 times as common in women as ethanol intoxication in the general Finnish population of the same age and sex. Nineteen of the patients were heavy drinkers. Heavy drinking was twice as common in men and 5 times as common in women as heavy drinking in the general Finnish population of the same age and sex. Both occasional ethanol intoxication and regular heavy drinking seem to carry an increased risk of ischemic brain infarction. The ethanol-induced risk was highest in middle-aged women and young men.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

This study, compared survivorship for first episodes of cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage which occurred in residents of Rochester, Minnesota during 5-year periods from 1945–49 through 1975–79. The progressive improvement in long-term survival following cerebral infarction which occurred between 1945–49 and 1970–74 was such that a higher proportion of patients survived for six years in 1970–74 (45%) than survived for three years in 1945–49 (42%). A modest improvement in short-term survival following cerebral infarction occurred up to 1975–79 but a marked improvement in 30-day survival following intracerebral hemorrhage was noted. The reasons for the improvement in survival have not been established, but possible changes in the diagnosis and management of stroke which might have been contributory factors are discussed.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Scanning 3000 cases admitted for rehabilitation after cerebrovascular accident over a 20 year period produced a sample of 1369 subjects, without age restrictions, admitted within six months of a first stroke of thrombotic etiology. In this sample, survival rates showed no significant difference between men and women. Age at onset, however, clearly influenced survival changes; the expected mean survival was 6 years at 40 and 2 at age 80; average loss of life was 14 years for the whole sample, meaning a vital prognosis two to three times worse than that of the general population. At least 86% of the sample presented one or more of five etiological antecedents to stroke: hypertensive heart disease, peripheral vascular disease, diabetes mellitus, myocardial infarction and atrial fibrillation. In 87% of those, HHD and/or PVD were present. Presence of hypertension significantly lowered life expectancy and so did PVD; their influence is felt from the earliest stages. In contrast, diabetes mellitus, the next most common factor, has a late influence, starting about the fifth year after Stroke. MI and AF were present in relatively fewer patients, but they contributed towards a considerable decrease in life expectancy, evident from the first stages, the more drastic reduction being observed in the AF group.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The incidence of carotid artery disease and cerebrovascular symptoms were determined in 102 consecutive patients with peripheral arterial disease. Symptoms were correlated with risk factors of age, hypertension, smoking and diabetes and with the extent of disease at the carotid bifurcation. The incidence of stroke with permanent neurological deficit was twice as high in diabetics as in non-diabetics with equivalent atherosclerotic vascular disease (p less than .05). In women, the incidence of stroke was three times higher in diabetics (p less than .02). The number of transient ischemic attacks was significantly higher in non-diabetics (p less than .02). The total number of ischemic episodes in diabetics and non-diabetics was equivalent. This indicates that diabetics are more prone to irreversible destruction of ischemic brain tissue regardless of the nature of the circulatory disturbance.

ISSN:0039-2499    

出版商:OVID    

年代:1983

数据来源: OVID