ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We examined characteristics associated with a high risk of mortality within 3 years after a stroke. Analyses are based on data from a population‐based register of stroke events that occurred in Auckland (total population 829,545), New Zealand during a 1‐year period in 1981–1982 and a 3‐year follow‐up study of all survivors (97% complete) Statistical techniques that allow for the simultaneous evaluation of multiple factors indicated that retention of consciousness, decreasing age, and place of residence at the onset of the stroke were the strongest predictors of survival over 3 years. The survival rate for those living at home at the onset of the stroke who did not lose consciousness was 58% compared with 5% for people in institutional care who lost consciousness. Marital status, history of stroke, and ethnic group also predicted survival. Most of the important prognostic factors we identified in our study cannot be modified, testifying to the importance of the prevention of stroke in the first place. (Stroke 1988;19:669–673)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Blood flow velocity of the middle cerebral artery was monitored daring cardiopulmonary bypass procedures by means of transcranial Doppler ultrasonography. Our investigation was carried out in a group of 16 patients with severe carotid stenosis or occlusion and in a control group of 42 patients with no or stenosis of < 50% local diameter reduction. After onset of cardiopulmonary bypass, both groups showed a short unstable phase followed by increased blood flow velocity (10% increase ipsilateral to the obstruction, 27% increase in the control group) Just before rewarming, blood flow velocity was still comparable to (control group −3%) or higher than (ipsilateral to obstructions +14%) prebypass values. Analysis of three patients with postoperative diffuse encephalopathy did not reveal reduced blood flow during cardiopulmonary bypass as a relevant factor. Two of the three showed luxury perfusion. Reduced perfusion due to carotid obstruction was not observed during cardiopulmonary bypass and therefore cannot be considered a significant risk factor for the development of intraoperative stroke. (Stroke 1988;19:674–680)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Thrombi defined as intraluminal filling defects detected by angiography were identified in 30 patients (29 in the carotid system, one in the vertebral artery) Stroke was the presentation ipsilateral to the thrombus in 22 patients (12 had previous transient ischemic attacks), transient ischemic attacks occurred alone in seven cases, and one patient was asymptomatic. Angiography revealed a severe stenosis in association with the thrombus in 23 patients, a moderate stenosis in four patients, and, in the three patients with only minimal stenosis presumably due to atherosclerosis, there was evidence for a coagulopathy. Sixteen of the 30 patients were operated on urgently, 10 within 24 hours of detection of the thrombus. Twelve of these 16 surgical patients were given anticoagulation before surgery. At endarterectomy, thrombus was identified in 11 of the 14 surgical patients in whom the thrombus was accessible; the other two surgical patients had intracranial thrombus only. In this group, four of 11 surgical patients with accessible thrombi suffered perioperative episodes of new or larger infarction. Fourteen of the 30 patients initially received medical management with no complication. Eight of these 14 medical patients had repeat angiography; seven exhibited complete resolution of thrombus, and six of these seven patients subsequently underwent delayed endarterectomy for the stenosis. No thrombus was identified at surgery in any of the six. One of the six delayed surgery patients suffered a perioperative stroke. Although these numbers are small, reflecting the rarity of thrombus demonstrated by angiography, undetected thrombus is often found at endarterectomy. Its presence may increase operative risk. This increased risk could possibly be countered with a preoperati ve period of anticoagulation and a delay of days or weeks before surgery. (Stroke 1988;19:681–687)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Neurogenically caused cardiac arrhythmias and their correlation to lesions within the central nervous system were examined prospectively in 54 patients with spontaneous intracerebral hemorrhage. All patients were examined neurologically dally for 3 weeks, with special attention given to signs of brainstem compression resulting from transtentorial herniation. Electrocardiograms were continuously recorded over an average of 5 days. A significant correlation was established between the clinical manifestations of brainstem compression and sinus arrhythmias, multifocal premature ventricular contractions, couplets, and ventricular tachycardias. An explanation for this correlation may be found in the localization of the autonomous cardiovascular centers in the hypothalamus and brainstem. Transtentorial herniation frequently leads to a bilateral lesion of these structures. However, the cardiac arrhythmias are only a partial phenomenon within a complex cardiovascular reaction. (Stroke 1988;19:688–692)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Seven anesthetized dogs treated with prostaglandin I2, indomethacin, and heparin were compared with 12 controls to test the hypothesis that the salutary effect of treatment on recovery of neuronal function and cerebral blood flow (CBF) after ischemia is coupled to the inhibition of platelet accumulation. In this model of right hemisphere multifocal ischemia, cortical somatosensory evoked response (CSER) amplitude, 14C autoradtographic blood flow, and111In‐labeled platelet accumulation were measured. The ratio of injured to noninjured hemispheric111In activity (cpm/g) provided an index of platelet accumulation. Treatment improved CBF of the injured hemisphere compared with control after 4 hours of reperfusion (74 ± 17 versus 53 ± 13 ml/100 g/min, p < 0.05), and it enhanced recovery of CSER amplitude (percent of baseline) after 1 hour of reperfusion compared with control (27.1 ±4.7% [treatment] versus 15.5 ±2.8% [control], p < 0.05) However, the effect on CSER was not sustained after 4 hours of recovery. Despite these effects on CSER and CBF, treatment failed to inhibit111In‐labeled platelet accumulation in the injured hemisphere (1.7 ±0.3% [treatment] versus 1.5±0.1% [control], p>0.05). Platelets may adhere to damaged endothelinm despite aggressive platelet antiaggregant therapy.(Stroke 1988;19:693–699)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The effects of low daily oral doses of aspirin (40 mg/day) on platelet aggregability and serum thromboxane B, concentrations were studied in 19 poststroke patients. Although platelet aggregation was reduced significantly after 1 week, there was wide individual variation in the inhibition of platelet function in spite of marked decreases of serum thromboxane B2 concentrations by >90% (from 224 ± 58 to 8 ± 8 ng/ml) There was no correlation between collagen‐induced platelet aggregability and serum thromboxane B, concentration before aspirin administration in the range 100–350 ng/ml, but after 1 week of repeated administration of aspirin, there was a correlation between platelet aggregability and serum thromboxane B, concentrations of < 25 ng/ml (r = 0.68, p < 0.01) However, platelet inhibition was insufficient even In some patients with markedly decreased thromboxane B, concentrations (< 5 ng/ml). Our results suggest that individual variation of platelet aggregability in response to low‐dose aspirin may be due to variation not only hi the degree of inhibition of thromboxane A, production but also in the relative dependence of platelet aggregation on extra‐arachidonic pathways.(Stroke 1988;19:700–703)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Migraine is associated with increased platelet activity and an incidence of cerebrovascular ischemicevents. Because cerebrovascular events might result from platelet aggregation, enhancing platelet activity further in the treatment of migraine is not desirable.β‐Adrenoceptor blockers effective in migraine prophylaxis include propranolol (nonselective) and metoprolol (β1,‐selective), but it is uncertain how βreceptor subtype selectivity might influence platelet behavior in migraine. In 29 patients, comparable clinical responses were obtained with therapeutic doses during 1 month of treatment with propranolol, metoprolol, and the β2‐selective LJ 32–468.Propranolol increased and metoprolol decreased platelet aggregation and ATP release, and the effect of LJ 32–468 could be related to that of propranolol. These actions can be largely explained in terms of what is known of platelet β‐receptors and therefore can be generalized to other effective β‐blockers. Since altered platelet activity does not account for the efficacy of these agents in migraine, the actions of β‐blockers on platelets should be considered as side effects. Those (β‐blockers inhibiting platelet activity should be preferred in migraine treatment, assuming equal efficacy, which implies the use of (β1‐selective blockers. Stroke 1988;19:704–708)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Quantitative assessment of patient data is a pertinent part of controlled clinical studies. When several centers are involved, the degree of agreement between different observers becomes important. Therefore, in addition to developing a multicenter study on acute ischemic stroke, we have estimated the interobserver agreement expressed in terms of K statistics. Twelve patients suffering from neurologic deficits due to acute ischemic stroke were examined by four investigators, and the results were assessed using the Mathew scale. Considerable interobserver variability was found. Agreement on items based on subjective information from the patient was low, and it is also possible that this information changes with time. It is advised that in the development of assessment scales, items with low interobserver agreement should be avoided. (Stroke 1988;19:709–711)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The risk of embolic stroke during sick sinus syndrome before cardiac pacemaker insertion is substantial, but stroke after pacemaker insertion has not been well studied. We observed 10 sick sinus syndrome patients who developed an ischemic stroke 4 days to 112 months after pacemaker insertion. Nine patients represented 6% of the 156 ischemic stroke patients observed during a 30‐month period. Eight had a ventricular‐demand pacemaker, one had a dual‐chamber pacemaker, and one had an atrial‐inhlbited pacemaker. Six patients were in atrial fibrillation at stroke onset, but none had atrial fibrillation when the pacemaker was inserted. Six patients were taking aspirin, and one was anticoagulated when stroke occurred. Stroke in sick sinus syndrome after pacemaker insertion is not rare, and pacing does not appear to be protective. Sick sinus syndrome patients who convert to atrial fibrillation or who have a ventricular‐demand pacemaker might represent high‐risk groups for stroke. (Stroke 1988;19:712–715)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID