摘要:

The primary effort of neurosurgery over the past two or three decades has been to deal effectively with cerebral aoeurysms surgically. Concomltantly with aggressive medical treatment, considerable progress has occurred in the prevention of early rebleeding and the treatment of the Ischemlc syndrome, the most serious features of the natural history of a ruptured aneurysm. The major problem now becoming evident is that in spite of this progress, the majority of patients are not seen by physicians and there has been only a small impact on the overall morbidity. It is dismaying to realize that many patients go unrecognized, at least until a massive brain-destroying hemorrhage has occurred. Only a small fraction of the patients are seen after the initial bleed when the greatest therapeutic reward would occur.The challenge for the future, then, will be the early recognition of the initial bleeding, thewarning bleeding. It will require public education about the problem in a continuing fashion, as well as continuing emphasis on it for students and physicians. The potential for prevention of death or dreadful disability is large for thousands in the prime of life each year.While delayed surgery is safe, a significant amount of rebleeding and ischemia with vasospasm still occur, resulting in an unsatisfactory overall morbidity. A collaborative study is desirable to determine with sufficient patients whether very early modern operation in many hands will reduce this morbidity.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A rapidly rotating single-photon emission tomograph was used to study regional cerebral blood flow by123Xeoon inhalation. Using a rotation speed of 180°/5 sec a tomographic picture of the arerage Xenon concentration in 3 slices is obtained. By taking a sequence of 4 one-minute tomograms during and after a oneminute123Xenon inhalation period, a flow-dependent variation in local isotope concentration is seen. This sequence is used for calculating CBF by a deconvolution procedure. The CBF maps hare a spatial resolution of approximately 1.7 cm (FWHM).This preliminary study comprises normal subjects and 10 unselected patients with stroke. The CBF tomograms localized appropriate ischemic areas in all 10 patients. In one patient the conventional x-ray tomogram was negative, while the flow toraogram clearly showed a decreased flow in consonance with the clinical findings.Regional cerebral blood flow measured tomographically by123Xenon inhalation circumvents the extracranial contamination and the superposition of intracranial tissues that hamper123Xenon inhalation flow studies using stationary detectors.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The clinical diagnosis of the type of acute cerebrovascular diseases is often considered unreliable, although this has not been validated prospectively in representative patients. The accuracy of bedside diagnostics was, therefore, tested in 206 patients consecutively admitted to the Stroke Unit of the Serafimerlasarettet in Stockholm. Bedside diagnosis turned out to be correct in 69%. In 24% the diagnoses were altered after hospital investigation and in the remaining 7% no defined preliminary and/or final diagnosis could be made. When the diagnoses were considered “fairly certain” they were accurate in 87%, compared to 53% when regarded as only “probable". The diagnostic accuracy improved during the period studied. Sensitivity In identifying hemorrhages was much lower (39%) than for cerebral infarctions (83%). It is suggested that new investigations] methods should be compared with what can be accomplished with bedside methods alone.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The incidence of subarachnoid hemorrhage (SAH) in Middle-Finland during 1976-78 was 19.4/100,000/year. The incidence increased consistently with age. The early prognosis was similar to that in earlier studies, with 25% dying on the first day, and 49% during the first 3 months after the initial bleeding. The fatality rate decreased sharply after the bleeding: of all deaths during the first 3 months, the weekly fatality rate was 65% during the 1st week, 12% during the 2nd, and 4% during the 3rd. Thereafter the weekly fatalities up to 3 months averaged 1.6%.Only 20% of the patients of the entire series were assessed as being eligible for neurosurgical treatment. Intercurrent fatal rebleeds further reduced this number. The chances of increasing the number of SAH patients suitable for neurosurgery are discussed. The timing of surgery should be earlier than in the present study (median 15 days after the bleeding) in order to avoid frequently fatal recurrences. Vertebral angiograms should be obtained from patients with no aneurysms found by bilateral carotid angiography. The upper age limit of 60 years should be abolished. By these means the proportion of SAH patients potentially eligible for neurosurgery could be increased to about 40%.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Sixty-five male gerbils, divided into 3 groups, were used in this study, in which focal brain specific gravity, taken as a measure of edema, was compared to the corresponding focal cerebral blood flow using the hydrogen washout technique. Extracranlal unilateral or bilateral carotid ligation was performed and one hour later toe animal was sacrificed. When focal blood flow was less than 20 ml/100 g/mln, edema developed and increased with progressive ischemia, reaching maximal values at 5-7 ml/100 g/mln. In the zero flow situation there was no edema. Pretreatment of the other 2 groups with indomethacin or dexamethasone, did not prevent edema formation at flows of 20-12 ml/100 g/min, but considerably reduced the edema previously noted at low flows (5-7 ml/100 g/min). The drugs did not affect the decreased flow in the iscbemic area. We conclude that prostaglandins, released by membrane disruption, are involved in the development of ischemic edema.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The natural history of cerebrorascular disease (CBVD) was evaluated In 169 non-treated patients followed for at least 12 years after aortocenical angiography. The outcome was related to type and location of atherosclerotic changes in the neck vessels. At the time of angiography, 108 patients had completed strokes, 20 had transient ischemic attacks (TIAs), and 41 had angiography for reasons other than acute CBVD. In patients with stroke, non-stenotic lesions as well as stenoses/occlusions were associated with a better long-term survival when they affected the vertebral territory than when the carotid arteries were involved. Patients with normal angiograms had no better prognosis than those with non-stenotic atherosclerosis. Only 2 of 12 deaths in patients with lesions in the vertebral artery were caused by cerebrovascular accidents. In all other groups (normal, carotid lesions only, changes in both carotid and vertebral arteries) the majority of deaths were attributed to CBVD. Rates of recurrent stroke were relatively low in patients with changes in the vertebral arteries and in subjects with non-stenotic lesions in one carotid artery. Intermediate rates were observed when the angiograms were normal, high rates when compound lesions had been demonstrated at angiography.Results show that in patients with stroke the location of atherosclerotic changes to different vessel territories appears to predict the clinical course better than the extent of the leslon(s). No specific angiographic finding was associated with a high initial and a low rate of stroke recurrencies. Therefore, drug therapy to prevent recurrent stroke must probably be life-long in all patients with CBVD not treated by surgery.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Twenty-fire mongrel dogs bad Intracranial internal carotid and proximal middle cerebral artery occlusions. The animals were followed for one week and subsequently sacrificed. This method of clipping produced a mean drop in cortical cerebral blood flow of 48.4% as measured by the MKr washout technique. Cerebral blood flow was not affected by the brain retraction necessary for clip placements. Mortality in the first week was 16% and neurological deficits were obserred In 73% of the animals. Infarction was present in 80% of the animals, and the mean percent infarction of the affected hemisphere was 17.00 ± 3.98SE.This is a useful stroke model in an animal which is easily available, inexpensive, and suitable for microvascular intracranial surgery research.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

One hundred and eight patients were studied with fluid-Ailed oculoplethysmography and carotid phonoangiography (OPG-CPA) and by arteriography. Thirty-two patients also had “Doppler evaluation” of supraorbital arterial flow. The OPG-CPA correctly predicted the degree of occlusion in 76% of the involved vessels, including the degree of ocdusion of each carotid for each patient (63%). The OPG-CPA identified at least one obstructing carotid lesion in 51 of the 56 (91%) patients with obstructing lesions demonstrated by arteriography. On a per patient basis, which requires that both carotids be correctly assessed, the OPG-CPA had a false negative rate of 9.6% and false positive rate of 50%. The supraorbital artery “Doppler evaluation” had an accuracy rate of 66%, a per patient false negative rate of 50%, and a per patient false positive rate of 12%.The OPG-CPA and supraorbital artery “Doppler evaluation" are adjunctive tests for evaluating patients with cerebral vascular insufficiency and should not, at present, replace arteriography in symptomatic patients or in certain asymptomatic patients.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A non-invasive Doppler velocity index that is specific for carotid artery stenosis is presented. The index is both non-dimensional (maximum/minimum velocity to remove within artery Doppler signal variability) and normalized (larger over smaller carotid maximum/minimum ratio to minimize between patient variability). Of 260 normal patients 94% had a maximum/minimum index between 1.00 and 1.25 and 97.5% had an index between 1.00 and 1 JO. In 136 patients undergoing selective carotid arteriography the overall accuracy of the maximum/minimum index in predicting carotid stenosis was 85-87%. When 1 JO is taken as the maximum normal index value the test is 96.5% specific and 76% sensitive. The receiver operating characteristic curve indicates that patients with a maximum/minimum index greater than 1.4 have a 99% probability of significant carotid stenosis.

ISSN:0039-2499    

出版商:OVID    

年代:1981

数据来源: OVID