ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Although US blacks are known to have an excess stroke mortality compared with US whites, little is known about the stroke burden of the Hispanic white population. This report will provide estimates of the relative burden of stroke mortality in the US black and Hispanic population relative to the white population and examine the consistency of this relation across age.MethodsData were from participants aged >45 years from the National Longitudinal Mortality Study. There were 1844 stroke deaths among 239 734 non-Hispanic whites, 46 deaths among 12 527 Hispanic whites, and 234 deaths among 23 468 black participants. Standard statistical methods were used to examine the ethnic differences in stroke mortality.ResutsThe hazard ratios for black men and women (relative to non-Hispanic whites) were nearly identical, at >4.0 at age 45 but marginally <1.0 by age 85. For both Hispanic men and women, the hazard ratios (relative to non-Hispanic whites) were approximately 1.0 at age 45 but were marginally significantly <1.0 at older ages. The ethnic differences in stroke death rates reveal differences in age distributions of age at fatal stroke between these groups. Approximately 6% of fatal strokes for non-Hispanic whites occurred before age 60, whereas > 15% occurred in both Hispanic whites and blacks.ConclusionsThese results suggest that (1) for Hispanics, stroke risk is similar to that for non- Hispanic whites at young ages but is marginally lower at older ages, (2) the excess stroke mortality in blacks mainly occurs at younger ages (between 45 and 55 years), and (3) the relation between stroke risk for blacks and Hispanics relative to whites is similar by sex. The impact of age on relative stroke mortality would argue against simple age adjustment for describing ethnic differences in stroke mortality. Finally, proportionally, more strokes occur at older ages in non-Hispanic whites than in either US blacks or Hispanic whites.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study was conducted to determine if blacks hospitalized for cerebrovascular events had more severe cerebrovascular events than whites similarly hospitalized.MethodsData from the Maryland Health Services Cost Review Commission were used to determine incidence of coma, death rates, age at death of those who died, and length of stay for acute hemorrhagic and occlusive stroke in hospitalized blacks and whites after adjusting for sex and, if appropriate, age.ResultsWith a single exception (number of patients with hemorrhagic stroke who died during short-term hospitalization), all indices indicated that blacks incurred more severe cerebrovascular events than whites (P<.05 or less).ConclusionsMaryland state data from hospitalized patients indicate that blacks had more severe strokes than whites.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

As part of the recruitment efforts for the National Institutes of Health Tissue Plasminogen Activator Pilot Study, public education and awareness campaigns were conducted to encourage early hospital arrival. We evaluated the change in arrival times during the course of the study for all stroke patients, including those who were not entered into study.MethodsData were gathered on all patients presenting within 24 hours of stroke onset to all of the study hospitals. Coincident with the start of the study, educational and promotional programs, which stressed signs and symptoms of stroke and the need to call 911, were presented to physicians, paramedical personnel, and the public. The study was divided into four quartiles to analyze differences in time to hospital arrival and use of 911.ResultsOf 2099 patients screened, time data were available on 1116. During the course of the study, the mean time from symptom onset to hospital arrival declined significantly (3.2 hours versus 1.5 hours). Patients arrived for treatment sooner at community hospitals than at university/teaching hospitals. The use of 911 increased from 39% in the first quartile of the study to 60% in the fourth quartile. This was a consistent finding in all study sites. Increased use of 911 was seen almost exclusively in patients with nonhemorrhagic stroke.ConclusionsTimes from stroke onset to hospital arrival decreased significantly during the course of the National Institutes of Health Tissue Plasminogen Activator Pilot Study. Significantly increased use of 911 was the likely major explanation for the shortened arrival times. The decrease in arrival times may be a consequence of the public and professional education programs conducted at all study sites.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Transcranial Doppler can detect cerebral microemboli. These emboli may be a risk factor for embolic stroke. We studied the prevalence of microemboli in patients referred for echocardiography.MethodsForty-two patients were evaluated. Patients were studied with continuous monitoring over one middle cerebral artery for 30 minutes, and the number of microemboli was recorded. Patients were divided into three groups, those with prosthetic heart valves (group A, n = 15), atrial fibrillation (group B, n=14), and no major cardiac risk factor (group C, n=14).ResultsSeventeen percent (7 of 42) of all patients had microemboli. In group A, 5 of 15 (33%) had microemboli. In group B, 2 of 13 (15%) patients had microemboli. Twenty-five percent (7 of 28) of patients in groups A and B combined (A+B) had microemboli. No patients (0 of 14) in group C had microemboli. Groups A and A+B had significantly more emboli than group C (P<.05). Prosthetic heart valve patients with emboli more commonly had a history of prior stroke than valve patients without emboli (3 of 5 versus 2 of 10). The number of emboli seen per 30-minute monitoring session was greater in patients with a prior history of stroke than in patients without (10 microemboli versus 3).ConclusionsMicroemboli can be found in a significant percentage of selected patients referred for echocardiography. The prevalence of microembolism is greater in patients with a known high risk of embolization (eg, prosthetic valves) and less in patients with a lower risk of embolization (eg, atrial fibrillation). These microemboli may be associated with an increased prevalence of previous stroke in patients with prosthetic valves.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Abnormalities of hypothalamopituitary- adrenocortical axis function have been observed frequently in stroke patients. The aim of this study was to investigate plasma β-endorphin and cortisol 24-hour secretory patterns in patients early after stroke and in the convalescent period to evaluate a possible influence of brain damage on hormonal circadian pattern.MethodsPatients (n=15; age, 46 to 75 years) were evaluated in the first 24 hours and 10 days after hospital admission for ischemic cerebral stroke and compared with 15 age- and sex-matched normal subjects. Blood samples for β-endorphin and cortisol determination were drawn every 4 hours from 8 AM to 8 PM and every 2 hours from midnight to 6 AM.ResultsMean 24-hour β-endorphin and cortisol levels, recorded in the acute phase, were significantly (P<.05) higher than those recorded in normal subjects; circadian rhythm was not demonstrable for either hormone. In the convalescent period, plasma cortisol 24-hour mean values and circadian rhythm returned to the normal range, whereas the plasma β-endorphin 24-hour mean values and circadian rhythm did not.ConclusionsCerebral stroke induces abnormalities of β-endorphin and cortisol circadian secretion. Whereas cortisol abnormalities are transient, those of β-endorphin last longer. The dissociation between β-endorphin and cortisol 24-hour secretory patterns might potentially serve as a marker of psychoneurological abnormalities occurring after stroke.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Patients-with ischemic or hemorrhagic stroke are at risk for systemic complications. The reasons why gastrointestinal bleeding occurs after stroke are unknown and have intuitively been attributed to stress ulcers. No study to date has addressed causes of gastrointestinal hemorrhage in stroke.MethodsBetween 1976 and 1994, 17 patients identified from the Mayo Clinic medical record system as having gastrointestinal hemorrhage and ischemic stroke (n=14) or intracerebral hemorrhage (n=3) were reviewed for presentation, associated causes, and outcome. Results of the endoscopic procedures were compiled, and available gastric biopsies were reviewed.ResultsIn 17 patients with gastrointestinal bleeding after stroke, sudden hematemesis, a decrease in hemoglobin level, or orthostatic hypotension was found as a presenting feature. One patient presented with massive hematemesis, exsanguination, and cardiac arrest. Endoscopic findings were available in 14 patients and included gastroesophageal erosions, hemorrhagic gastritis, and gastric ulcer. In one patient, an adenocarcinoma of the gastric cardia was found. Putative pathogenetic agents were found in 16 of 17 patients and included a long history of nonsteroidal anti-inflammatory drugs (n=6), acetylsalicylic acid (n=3), grossly prolonged anticoagulation (n=4),Helicobacter pylori(n=2), and corticosteroids (n=1).ConclusionsGastrointestinal bleeding after stroke is rarely severe and may not contribute significantly to mortality. Medication- induced gastrointestinal hemorrhage may be underappreciated in this setting.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Platelet aggregation plays an important role in the pathogenesis of thromboembolic cerebrovascular disease. Leukocytes can efficiently stimulate as well as inhibit platelet aggregability. We studied the influence of leukocytes on collagen-induced platelet aggregation in patients with acute ischemic stroke.MethodsWe investigated 23 patients within 2 days after stroke and 23 healthy age- and sex-matched control subjects and determined collagen-induced platelet aggregation in platelet-rich plasma with or without addition of polymorphonuclear or mononuclear leukocytes.ResultsPlatelet aggregation without leukocytes tended to be lower in patients than in control subjects (P=.06). Mononuclear leukocytes reduced (P=.018) and polymorphonuclear leukocytes tended to reduce (P=.06) platelet aggregation in patients. Leukocytes did not significantly alter platelet aggregation in control subjects. In the presence of either mononuclear or potymorphonuclear leukocytes, platelet aggregation was significantly lower in patients than in control subjects (P=.004 andP=.008). The ratio of polymorphonuclear leukocytes to platelets in venous blood was higher in patients than in control subjects (P<.001).ConclusionsMononuclear-and less clearly polymorphonuclear -leukocytes possess a platelet aggregation-inhibiting potential in the early stages after ischemic stroke, a feature with possible antithrombotic effects.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Sickle cell disease is associated with cerebral hyperemia, which is therapeutically reduced by transfusion; however, the process of transfusion-induced cerebral perfusion changes has heretofore not been observed.MethodsWe document the acute changes of intracranial arterial velocity in 10 patients (7 with strokes, 3 without) undergoing transfusion therapy using transcranial Doppler ultrasonography. Middle cerebral artery velocities were bilaterally measured every 30 minutes for the duration of transfusion (4 to 5 hours). Regional cerebral blood flow was quantified in 5 of these patients before the transfusion and 24 hours later by the133Xe technique.ResultsVelocities in stroke-associated vessels (6433 ±18.65 cm/s; n=6) were significantly lower than in uninfarcted territories (99.54±27.39 cm/s; n=13), and both types of vessels showed a robust reduction of blood flow velocities during transfusion. The rates of reduction were not significantly different as a function of prior stroke but did correlate with pretransfusion velocities and with the rise in hematocrit (multipler=.887,P<.001). These reductions occurred rapidly within the first 3 hours of transfusion. Velocities attained at the end of transfusion were maintained in the hour after transfusion and the next day.ConclusionsWe conclude that transfusion induces rapid changes in cerebral hemodynamics that are related to pretransfusion velocities and a rise in hematocrit. Transcranial Doppler provides a safe, simple, and noninvasive technique of monitoring these changes and may provide a means of making therapeutic decisions regarding transfusion therapy in patients with sickle cell anemia.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Present criteria for the diagnosis of moyamoya disease emphasize the use of conventional cerebral angiography as an indispensable requirement. However, magnetic resonance angiography (MRA) is fast becoming a reliable diagnostic modality for occlusive cerebrovascular diseases. The purpose of this study is to assess the accuracy of MRA compared with conventional angiography.MethodsThirty-nine patients (23 children and 16 adults) with moyamoya disease confirmed by conventional angiography (78 side views) were examined with MRA (three-dimensional time-of-flight technique with a 256×256 or 256×512 matrix). T1- and T2-weighted MR images were also taken.ResultsThe stenotic or occlusive change at the carotid fork was clearly revealed by MRA, which correlated well with conventional angiography (83% good correlation, 17% overestimation). Apparent moyamoya vessels were clearly shown as a signal void on the MR image and fine unusual vessels on MRA, particularly in children with moyamoya disease (82%). However, small moyamoya vessels were poorly shown on both MR images and MRA, particularly in adults (63%).ConclusionsMRA can be an alternative to conventional angiography in typical moyamoya disease cases (the bilateral type of moyamoya disease in children). However, in the early or the end stages of moyamoya disease, diagnosis by means of MRA should be carefully evaluated.

ISSN:0039-2499    

出版商:OVID    

年代:1994

数据来源: OVID