ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We evaluated the effects of hematocrit on blood velocity in the middle cerebral artery measured by transcranial Doppler ultrasonography in 45 patients. Hematocrits ranged from 16% to 46%, and systolic blood velocities ranged from 70 to 190 (mean 40 to 140) cm/sec. Decreases in hematocrit correlated with increases in blood velocity in the middle cerebral artery. These results suggest that transcranial Doppler measurements made in the presence of anemia may need correction. (Stroke1988;19:1466–1469)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Polymeric drug delivery systems that allow the application of substances to a localized region for specified periods of time have been developed. A model for intravascular thrombosis in the rat common carotid artery was established using a combination of balloon catheter endothelial injury with 1‐hour occlusion of the vessel. After endothelial injury in 11 Sprague‐Dawley rats, the adventitial surface of the carotid artery was exposed to the polymer polyvinyl alcohol (PVA) containing heparin and was compared with exposure to PVA alone in the contralateral (control) vessel. Subsequent determinations of the coagulation parameters systemic prothrombin and partial thromboplastin times showed no systemic effect of heparin. All 11 control vessels demonstrated complete or partial thrombosis, whereas only one of 11 heparin/PVA‐treated vessels showed a small thrombus. Morphometric analysis of the cross‐sectional thrombus: lumen ratio in 10 rats showed a significant reduction (p< 0.005) in thrombus size for treated vessels (4.1±9.6%) compared with control vessels (60.2±25.8%). Scanning electron microscopy verified the absence of thrombus in the treated vessels despite complete endothelial desquamation. In a second group of eight rats, endothelial injury without occlusion did not cause thrombosis in treated or control arteries. The coagulation parameters for this group of eight unoccluded rats were similarly unaffected by heparin/PVA treatment. Our observations suggest that a localized antithrombotic effect of heparin can be achieved without systemic anticoagulation using a polymeric drug delivery system. This technique may be applied to a variety of surgical and nonsurgical clinical conditions. (Stroke1988;19:1470–1476)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We retrospectively studied 90 patients with postinfarction seizures to determine the clinical features (onset, number, type), prognosis, and electroencephalographic and computed tomographic findings; we included infarctions of all etiologies. Thirty‐three percent of the 90 seizures appeared early (within 2 weeks after the infarction), and 90% of the 30 early seizures appeared within 24 hours after the infarction. Seventy‐three percent of the 90 seizures occurred within the first year, and only 2% occurred >2 years after the infarction. Fifty‐six percent of the 90 seizures were single, and status epilepticus was seen in only 8%. Early‐onset seizures were more likely to be partial (57% of 30); late‐onset seizures were more likely to be generalized (65% of 60). Thirty‐nine percent of the 90 initial seizures recurred, and there was no significant difference in recurrence rate between early‐ or late‐onset initial seizures. Twenty‐two percent of the 90 initial seizures became multiple recurrent seizures, and we could identify a precipitating factor in 86% of the 35 recurrent seizures. The most common electroencephalographic abnormality in the 61 patients so examined was focal slowing (61%), but recurrent seizures occurred in 100% of the four patients with periodic lateralized epileptiform discharges and in 75% of the eight patients with diffuse slowing. Computed tomography in 61 patients showed that large infarctions were associated with early (p< 0.021) and multiple (p< 0.05) seizures. Deep infarctions on computed tomograms (cortical infarctions extending to subcortical structures) tended to cause recurrent seizures (p< 0.057). Seizures in 88% of the 90 patients could be managed with monotherapy. (Stroke1988; 19:1477–1481)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We studied the temporal profile of hemorrhagic transformation in 34 cases with autopsyconfirmed hemorrhagic infarction who died within 15 days following a supratentorial brain infarct, provided they had undergone computed tomography. It appeared that within 4 days, at least 76% (95% confidence interval 39–100%) of 21 cardioembolic strokes had become hemorrhagic. We conclude that if anticoagulation is considered in cardioembolic stroke, such treatment should not be started sooner than at least 4 days after the onset of stroke, provided that computed tomography at that time shows no hemorrhagic infarction. (Stroke1988; 19:1482–1484)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Because of controversies in the cerebrovascular literature regarding the use of an intraluminai shunt in carotid endarterectomy, we report a randomized prospective study of 118 consecutive symptomatic patients receiving surgery within a single neurosurgical practice. Over 4 years, 138 carotid endarterectomies were performed in the 118 patients, 63 operations with intraluminai shunting and 75 without. Standard rationale for surgery included ipsilateral cerebral infarction in 38% of the operations and ipsilateral transient ischemic attacks in 36%. Unilateral angiographic stenosis of > 90% was seen in 58% of the operations; there were no ipsilateral occlusions. Surgery was performed under general anesthesia with barbiturate induction and mild blood pressure elevation. The 30‐day complication rate included a mortality rate of 0.7% with a 5.1% incidence of postoperative neurologic deficit and a 1.4% rate of myocardial infarction. In the 24 hours after surgery there were no cerebral infarctions in the shunted group and six in the unshunted group. This 8% rate in the unshunted group compared with 0% in the shunted group was significant atp= 0.023 with a power of 0.95 by Fisher's exact test andX2analysis. This suggests that in our neurosurgical practice (resident training program) the use of an intraluminai shunt during carotid endarterectomy significantly reduces the risk of intraoperative neurologic deficit without increasing the incidence of other complications. (Stroke1988; 19:1485–1490)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We followed 16 patients who developed depression immediately after a stroke for 6 months. By that time, six patients showed no depression (recovered group), while 10 patients were still depressed (nonrecovered group). There were no significant differences in demographic variables and social functioning between the groups, but the nonrecovered group showed less improvement in cognitive function and more physical impairments. Patients in the nonrecovered group had mainly cortical lesions, while those in the recovered group had mainly subcortical and posterior circulation strokes. (Stroke1988;19:1491–1496)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The natural history of recovery of motor function after stroke is described using data from a 1‐year community‐based study in Auckland, New Zealand. Of 680 patients, 88% presented with a hemiparesis; the proportion of survivors with a persisting deficit declined to 71% at 1 month and 62% at 6 months after the onset of the stroke. At onset, there were equal proportions of people with mild, moderate, and severe motor deficits, but the majority (76%) of those who survived 6 months had either no or only a mild deficit. Recovery of motor function was associated with the stroke severity but not with age or sex; patients with a mild motor deficit at onset were 10 times more likely to recover their motor function than those with a severe stroke. Our results confirm the reasonably optimistic outcome for survivors of stroke and further suggest that recovery of motor function is confined to patients whose motor deficit at onset is either mild or moderate. (Stroke1988; 19:1497–1500)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We estimated the event rates for stroke and transient cerebral ischemic attacks in a prospective community‐based epidemiologic study in a representative segment of the city of Perth, Western Australia, during a 10‐month period in 1986. Of 349 persons with an initial diagnosis of stroke or transient ischemic attack, 154 had suffered a first stroke, 75 a recurrent stroke, and 47 a transient ischemic attack; the remaining 73 persons were thought not to have had an episode of acute cerebrovascular disease. Annual event rates for first stroke (age‐standardized to the “world” population) were 120 per 100,000 for males and 56 per 100,000 for females. The crude case‐fatality ratio at 28 days after the index event for first stroke was 23% and varied from 0% for lacunar infarction to 57% for subarachnoid hemorrhage. (Stroke1988;19:1501–1506)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We mapped average age‐adjusted stroke mortality rates for white men and white women aged 35–74 years for state economic areas (counties or groups of counties) in the continental United States for three 7‐year periods between 1962 and 1982. Despite the decline of national stroke mortality rates, rates in some areas failed to decline between 1962–1968 and 1969–1975. All areas experienced declines in 1976–1982, by which time some rates in the highest decile of the rate distribution were comparable to rates that had been in the lowest decile in 1962–1968. An east‐west gradient of high‐to‐low stroke mortality rates was evident for both white men and white women in all three periods. Within the eastern part of the United States, high rates appeared more commonly in the South, and more so for white men than for white women. The “stroke belt”( area of very high stroke mortality rates in the coastal plain of the South) became less concentrated over the 2 decades, while a clustering of state economic areas with high rates along the Mississippi River and in the Ohio River valley became more pronounced. (Stroke1988;19:1507–1513)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID