摘要:

Fifty-nine patients with onset of moderate to severe unimproving paralysis of less than 24 hours' duration were randomized into treatment (Dextran 40) and control groups, managed similarly except for the dextran. A strict effort to study a uniform cerebral process by rejecting patients with hypertension, insulin-dependent diabetes, potential emboli, and pulmonary or renal disease resulted in a small sample. Most patients considered for the study had begun to improve before the initial examination. All patients had spinal tap prior to the decision to randomize. Results were evaluated independently by the three authors over a three-week interval and tabulated after three years. A greater percentage of dextran-treated patients improved with respect to consciousness and strength in upper and lower extremities, but showed less restoration of language than the untreated patients. The differences in the two groups were not significant. One of 30 patients given dextran may have had a reaction.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Atherosclerosis in the arteries of the circle of Willis was studied in European populations using a coding technique developed by Baker and his associates. Results from six countries (Finland, Germany, Greece, Norway, Italy, and Poland) were compared with results from Minnesota. The material from the first four countries was coded by the Minnesota team, whereas the material from Italy and Poland was coded by their respective investigators. Thefrequencyof cerebral atherosclerosis was highest in the German and Finnish populations and was lowest in the Polish population. The Norwegian, Greek and Italian populations showedfrequenciesof cerebral atherosclerosis quite similer to those in the Minnesota material.The average amountof cerebral atherosclerosis was established by determining the median vessel scores by ten-year age groups for the material coded by the Minnesota team. The Finnish population had the highest average involvement; the Finnish, German, and Greek populations all showed higher average vessel scores for cerebral atherosclerosis than the Minnesota population.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Hydrogen clearance using the tissue polarographical electrode appears to be a potentially useful technique for intermittent measurements of rCBF in relatively small areas. Both chronic and acutely implanted electrodes were placed at different depths in rabbit cerebrum including cortex and subcortical gray and white matter. Polarographical electrodes, oppositely charged, sensing oxygen availability (O2a) also were implanted proximately for comparison of both rCBF response and O2a under conditions of normocapnia and hypercapnia. No functional difference was discerned between chronic and acute electrodes. Generally rates of blood flow were faster in gray matter than in white. Both monoexponential and biexponential curves, representing one and two compartments of blood flow, respectively, were observed in both gray and white matter. Some three-compartment curves also were seen. Hypercapnia generally induced faster rCBF in all compartments as well as increased O2a. Occasionally a change in compartmentalization was recorded from a single electrode during hypercapnia, and two instances of paradoxical decrease in rCBF were observed. A multicompartmental model with an arteriovenous thoroughfare shunt was postulated to account for the wide range of blood flow values recorded: from 5.2+ to 0.2 ml per gram per minute.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

The clinical diagnosis of an ulcerated plaque at the bifurcation of the common carotid artery is based on: mid-carotid bruit, cholesterol or platelet emboli in the retina, transient ischemic attacks particularly with amaurosis fugax, and a reversible neurological deficit.In this series, thrombosis in situ was the final phenomenon in the natural history of the ulcerated plaque.In certain unusual instances it appears that the pathogenesis of a transient ischemic attack is a decrease in cardiac output (fall in systemic blood pressure) leading to a disproportionate decrease in cerebral blood flow in that portion of the arterial system distal to a pathologically narrowed artery.The ultimate diagnosis of an ulcerated plaque depends upon the radiological description at arteriography and upon direct visualization by the surgeon.Surgical treatment at the present time is the therapy of choice.Ulcerated carotid plaques may be bilateral, and, occasionally, are found at other levels than the bifurcation of the common carotid; however, ulcerated plaques were not seen in the intracranial vessels.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A thermal diffusion flow probe gave a quantitative dynamic recording of cerebral blood flow (CBF) during bleeding and transfusion in experimental animals. Autoregulation was readily demonstrated in nine of 12 animals and was found only with gradual hypotension. After autoregulation was lost, no increase in CBF could be obtained with carbon dioxide inhalation. Reactive hyperemia was demonstrated consistently following compromised CBF and, again, no increase in CBF with hypercarbia could be obtained until the hyperemia had subsided. Once hyperemia ceased, autoregulation could be demonstrated again in the same animal.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Fatality rates in 527 consecutive stroke patients were compared by nine different criteria: age, sex, each of four risk factors or the absence of all, type of lesion, and initial level of consciousness. In the 527, the only significant increases (P < 0.01) in fatality rate were in older patients compared to younger patients (48% versus 34%), hemorrhages compared to infarctions (85% versus 33%), and patients with depressed sensoriums compared to alert ones (65% versus 19%). When the series was split by age (≤ 65 years, ≥ 66 years), younger hypertensives had more fatalities than normotensives (39% versus 24%, P < 0.02), while older hypertensives fared better than normotensives (45% fatalities versus 50%, not significant). For infarction alone, younger hypertensives had 21% fatalities, normotensives 16%; of older hypertensives, 39% died compared to 44% of the normotensives. These differences are not significant (P<0.25).In this series, it appears that (1) age, initial sensorium, and type of lesion are good discriminant factors in the prognosis for life after stroke, (2) age-specific analysis may highlight other factors operating only in a certain age group, and (3) hypertension may have relatively benign associations among more elderly patients.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Of 527 unselected stroke patients (98% black) in a city hospital, 80 (17%) had nonaneurysmal intracranial hemorrhages, with a fatality rate of 85%. Of 216 inhospital deaths 37% were due to such hemorrhages. In patients aged 65 and less, 52% of 90 fatal events were hemorrhagic. Only in patients below age 46, however, did cerebral hemorrhage account for more deaths than infarction. The incidence of hemorrhage and the proportion of inhospital deaths from it were higher than in three white American and lower than in one black African series. The differences were not major, and could be explained by varying definitions and hospital use. The mean age of patients with fatal hemorrhage was 61 years. When the inhospital mortality is extrapolated into annual mortality estimates, the following conclusions may be drawn about spontaneous nonaneurysmal intracranial hemorrhage in New York City blacks: (1) above age 45, it does not account for more deaths than infarction, (2) it is not much more common or more lethal in blacks than in whites, and (3) it does not occur more predominantly at earlier ages in blacks than in whites.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Medical records of 455 acute stroke patients admitted to six community hospitals between October and April, 1969 through 1970 and 1971 through 1972, were surveyed. Data were obtained for: demography, diagnosis and management, complications, patient status and outcome variables (discharge status, disposition, length of stay, mortality and survival time), for one year before and after establishment of acute neurovascular care units (NCUs) in three of the hospitals. Patient status on admission based on a self-care scale was the most accurate measure used in predicting outcome (except when secondary complications occurred). There was a significant decline in mortality for nonhemorrhagic strokes for all patients, due to reduction in complication-related deaths among younger and less impaired persons. Forty-one percent of complication-related deaths for both surveys occurred during the first nine hospital days. Complications significantly lengthened hospitalization, increased the risk of late complication-related deaths, and decreased home discharges. Complication-related deaths were reduced in the second survey. Hospitals with NCUs showed a 50% reduction in secondary complications; hospitals without NCUs showed no reduction. Frequency of complications is an excellent measure of the quality of care. The acute NCU appears to be a practical method for achieving such quality.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A detailed clinicopathological study of the causes and locations of massive nontraumatic brain hemorrhage in 144 patients is reported. A cause of the hemorrhage, such as an aneurysm, angioma, arteritis, neoplasm or a blood dyscrasia (leukemia, hemophilia), was proved in two-thirds (95) of these patients. Twelve normotensive patients had no cause found to explain their hemorrhage. Systemic hypertension, generally mild, defined as a pre-ictal pressure of > 140/90 or by excessive heart weight, was present in 58 of the 144 patients. Twenty-one of these 58 hypertensive patients had a clear discernible cause for their brain hemorrhage (i.e., leukemia, metastatic carcinoma, angioma, aneurysm), whereas no satisfactory morphological cause could be found in only 37. Thus, in only about one-fourth of our patients could any serious claim be made that hypertension was the cause of the hemorrhage. Our data would indicate the need for a critical study of the causes of intracranial hemorrhages, and re-evaluation of the true relationship of systemic hypertension to such strokes. The widespread dogma that hypertension is the outstanding cause of nontraumatic brain hemorrhage no longer seems warranted.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A method of jugular bulb cannulation is discussed which is quick and easy to perform, ensures accurate placement of the catheter tip and causes minimal discomfort to the patient. Advantages of this technique are discussed.

ISSN:0039-2499    

出版商:OVID    

年代:1973

数据来源: OVID