ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Tbe cardiac conditions most commonly associated with cerebral embolism are rheumatic heart disease (RHD), atherosclerotic heart disease (myocardlal infarction and atrial arrhythmias) and other kinds of nonvalvular atrial fibrillation (AF). Tbe natural history of cerebral embolism from these cardiac sources is reviewed. Virtually all rheumatic hearts producing emboll hare mitral stenosis, but not all of them are in AF. Of patients with RHD, 10–20% will experience a systemic embolus, and approximately half will hare a recurrence, usually early. Of patients with a myocardial infarction, 5–12% will have a clinically apparent systemic embolus, and one-third to one-half have a recurrence, usually early. As many as 10–20% of patients with nonrheumatic AF have a systemic embolus. Anticoagulation reduces systemic embolism to 10–20% of the natural incidence in RHD, and it reduces embollc recurrences to 10–20% of tbe natural recurrence rate. Anticoagulation diminishes tbe incidence of emboll In myocardial Infarction to 25% of the natural Incidence. It is not known what effect anticoagulation has on the incidence of embolism hi nonrbeumatic AF. Tbe data regarding the effect of valvulotomy and prosthetic valve placement in RHD are briefly reviewed. Recommendations are made for tbe use and timing of anticoagulation based on the available data.

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Cerebral radionuclide angiography with99mTc pertechnetate (RNA) and directional Doppler sonography (DS) were employed to study patients with cerebrovascular disease (CBVD). The 86 patients investigated were divided following radiographic angiography (RGA) into normals (n = 26) and into patients with intracranial (n = 22) and extracranial (n = 38) vascular lesions. Of the patients with anglographically demonstrated CBVD, RNA detected 90%, DS 53.3%. The combined evaluation had a sensitivity of 93.3%. If intracranial arterial disease was excluded, the sensitirity of the studies was 92.1% for RNA and 84.2% for DS and combined evaluation had a sensitirity of 97.4%. The diagnostic accuracy by combined evaluation was 93.8% for the extracranial arterial lesions if the dinical findings were also used in patients with normal RGA pattern. RNA and DS complement each other as RNA contributes to the detection of intracranial blood flow alterations indicating vascular changes in either the extra- or intra-cranial vessels and helps confirm and complete DS findings.

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The extent of recovery from aphasia following ischemic stroke has been evaluated by a quantitative method. The greatest improvement was observed during the first 3 months following onset. The rate of recovery was similar for expression and for comprehension, but comprehension was usually less disturbed than expression. Final prognosis depends on the type of aphasia (the poorest prognosis was found for total or global aphasia) and on the severity of the initial insult.

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A patient developed paraparesis and signs of meningeal irritation spontaneously while on anticoagulant therapy. At autopsy, a subdural hematoma of the thoracic cord and evidence of widespread subarachnoid hemorrhage were found. The possible mechanism for these combined hemorrhages is discussed.

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

This report describes our experiences with a patient who developed delayed recurrent retinal and hemispheric ischemia distal to an old internal carotid artery occlusion in the neck. Fundoscopy and sequential cerebral arteriography documented that recurrent ischemic symptoms in this individual were the result of embolic fragments arising from the “stump” of the occluded internal carotid artery and from a diseased external carotid artery. These emboli traversed the external carotid artery and its orbital and intracranial anastomotic connections to reach the symptomatic eye and hemisphere. Ischemic symptoms in this patient were effectively terminated with anticoagulant therapy.We believe that this patient graphically documents that post-occlusion microembolism via the external carotid artery does indeed occur, and probably accounts for post-occlusion recurrent ischemic attacks more frequently than is currently appreciated. Recognition of this phenomenon is of importance because of its significant therapeutic implications. In these situations treatment modalities which terminate embolic phenomena would appear to have a more rational basis than do surgical procedures designed primarily to augment collateral blood flow to the symptomatic organ(s).

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To study the effect of histamine (HA) on brain blood flow and capillary permeability, bilateral parietal craniectomies were made in cats anesthetized with nitrous oxide and ketamine. The dura was reraored and solutions of HA in mock cerebrospinal fluid (CSF) in varying concentrations ranging from 10−5M to 10−1M were irrigated continuously onto the exposed brain while local cerebral blood flow was determined polarographically by hydrogen clearance. Capillary permeability was assessed by determining HA's effect on the125I-albumin space of the brain. Electrical activity was monitored by eiectrocorticography. HA consistently dilated pial blood vessels and produced within 15 rain a dose-related local hyperemia that subsided 30–60 min after HA was removed. Hyperemia was blocked by cimetidine. HA had no appreciable effect on either the blood-brain barrier to albumin or the electrical activity of the cortex. HA is pharmacologically capable of participating directly in the acute hyperemic response of the brain's microcirculatlon to physiologic and pathologic stimuli but has little effect on cerebrovascular permeability to protein.

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Multiple cerebral petechlae associated with intravascular globules of neutral fat and localized primarily within the white matter are distinctive lesions which secure the pathologic diagnosis of cerebral fat embolism. The abundance of these lesions in an unknown, but presumably small, percentage of cases of fat embolism, along with the even more widespread distribution of embolic fat droplets throughout both white and gray matter, suggest that these lesions and emboli must hare a profound effect on neurologic function. Nevertheless, respiratory insufficiency is by far a more common clinical manifestation of the fat embolism syndrome and the neurologic involvement of such patients is often attributed to the secondary effects of generalized hypoxia. The following patient with orert respiratory and neurologic symptoms re-emphasizes the direct primary effect of fat emboli within the central nervous system as a cause of white matter hemorrhages and neurologic deterioration. Explanations for the selectivity of the lesions for the cerebral white matter are explored.

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The angiographic appearance of the proximal end of internal carotid artery occlusion is reported in 41 patients with acute stroke in the areas of the brain supplied by the carotid artery. All patients had angiography within 6 days of stroke onset, the majority within 24–48 hours.Three angiographic configurations of internal carotid occlusion were found, in descending order of frequency: a sharp, pointed stump; virtual absence of the artery; and a rounded, blunt stump.The results suggest that the angiographic appearance of the proximal occlusion alone may not accurately predict the age of the occlusion within the first 6 days from stroke onset.

ISSN:0039-2499    

出版商:OVID    

年代:1980

数据来源: OVID