摘要:

The morphologic description and measurements of endarterectomy specimens are usually believed to be accurate and are used as the gold standard against which the findings of diagnostic procedures are judged. Pathology data on 289 endarterectomy specimens from five participating centers and the corresponding angiography and B‐mode ultrasonography data provided a basis for scrutinizing the validity of using the morphologic measurements as a standard. Discrepancies of > 1 mm between pathology and angiography measurements of minimum residual lumen occurred in 35% of the cases and between pathology and B‐mode ultrasonography measurements in 64% of the cases. Discrepancies of > 1 mm between pathology‐and angiography‐measured lesion width occurred in 81% of the cases and between pathology and B‐mode ultrasonography measurements in 64% of the cases. The cases representing mismatches of > 1 mm at one participating center were subjected to a rigorous review, with remeasurement of all morphologic features, in an attempt to explain the discrepancies. Various types of artifactual distortion of the specimens, the presence of slit‐like and occluded lumens that were likely related to loss of perfusion pressure, and an inability to match planes of interrogation used in angiography and B‐mode ultrasonography with pathology planes contributed significantly to the existence of mismatches. On the other hand, fixation and decalcifkation produced minimal and insignificant distortional changes. We conclude that the acquisition of quantitative data from endarterectomy specimens and the acceptance of morphologic data as a standard are limited by a number of problems that can be defined but have been difficult to resolve. (Stroke1988; 19:289–296)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Three patients with a clinical diagnosis of pontine infarction probably due to basilar artery occlusion were studied with magnetic resonance imaging within 24 hours after onset or latest progression of symptoms. The earliest changes on magnetic resonance images were an absence of signal void in the basilar artery suggestive of severe reduction of blood flow or occlusion (flow‐void phenomena). The presumed basilar artery thrombosis was best demonstrated as a linear structure isointense orhyperintense with the brainstem in the pontine cistern on Tl‐weighted parasagittal images and as eitherabsence of flow‐void phenomena or higher signal intensity at various levels corresponding to the course of the basilar artery on the axial T2‐weighted images. Brainstem parenchyma! changes characteristic of infarction were not obvious for at least 12 hours after onset or 90 minutes after latest progression of symptoms and were best shown by both axial and coronal T2‐weighted images. Recognition of these magnetic resonance imaging findings may allow earlier diagnosis and treatment of acute ischemia in the vertebrobasilar system. (Stroke1988; 19:297–306)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The possibility that intra‐arterial local infusion of fibrinolytic agents may achieve recanalization of previously occluded carotid territory arteries in acute stroke was tested in a prospective angiographybased open pilot study at two centers. Fifteen of 20 patients with acute symptoms (mean treatment‐onset interval 7.6 hours) demonstrated complete recanalization; 10 of the 15 patients exhibited clinical improvement of varying degree by the time of hospital discharge. Four of the 20 patients suffered hemorrhagic transformation of the infarcted territory without clinical deterioration or demise. Because of the study format and the limited number of patients, dose responses for recanalization and risk relations were not established. We conclude that local intra‐arterial fibrinolytic therapy may lead to cerebral arterial recanalization in acute carotid territory thrombotic stroke. The particular implications and limitations of this approach are discussed. (Stroke1988; 19:307–313)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We studied the effects of nifedipine, chlorpromazine, reserpine, furosemide, and thiopental on the mean arterial blood pressure, mean intracranial pressure, and cerebral perfusion pressure in 38 patients with increased intracranial pressure resulting from either hemorrhagic cerebrovascular disease or systemic hypertension. These agents are widely used in neurosurgical practice for the treatment of systemic hypertension. Patients were assigned to two groups on the basis of their mean intracranial pressure. Group I comprised 20 patients with a mean intracranial pressure of 20–40 mm Hg (moderately increased ICP group), and Group II consisted of 18 patients with a mean intracranial pressure of >40 mm Hg (severely increased ICP group). Nifedipine, chlorpromazine, and reserpine reduced mean arterial blood pressure by 18–20% in both groups (p< 0.05 in each). In Group I these agents raised mean intracranial pressure by 10–35% and decreased cerebral perfusion pressure by 20–32% (p< 0.05 for both), but in Group II these changes were more marked: mean intracranial pressure increased 38–64% and cerebral perfusion pressure decreased 40–54% (p< 0.01 for both). Furosemide did not significantly reduce mean arterial blood pressure but slightly reduced mean intracranial pressure in each group. Thiopental reduced both mean arterial blood pressure and intracranial pressure in both groups. The effect on intracranial pressure was pronounced in Group II, in which mean arterial blood pressure fell by 18% (p< 0.05) and mean intracranial pressure decreased 50% (p< 0.01), whereas in Group I mean arterial blood pressure was reduced by 16% and mean intracranial pressure dropped 23% (p< 0.05 in each). Our results suggest that barbiturates are preferable in the treatment of systemic hypertension in patients with increased, especially severely increased, intracranial pressure to agents that act as calcium channel blockers or a‐adrenergic blockers. (Stroke1988;19:314–321)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Seventeen separate xenon‐enhanced computed tomographic images were performed in seven patients with hypertensive putaminal hemorrhage. Regional cerebral blood flow maps were then computed and assessed. All patients were categorized as being of good recovery potential, with moderate‐sized hematomas, and all were treated conservatively. The regional cerebral blood flow assessments were scheduled within 4 days after, 2 weeks after, and >25 days after the ictus. The initial decrease in hemispheric blood flow ipsilateral to the side of the hematoma was calculated as the ratio of ipsilateral to contralateral hemispheric blood flow and was correlated with the size of the hematoma; that is, the larger the hematoma, the greater the decrease in the ratio of ipsilateral to contralateral hemispheric blood flow. The decrease persisted for 1 month. The mean of the ratio at 2 weeks after onset was 70%, the lowest during follow‐up. All cases examined within 4 days after onset demonstrated perihematomatous focal hyperemia, or “luxury perfusion,” which accounted for the delayed decrease. The same tissue that had previously shown hyperemia showed decreased regional cerebral blood flow 2 weeks after onset. Our results demonstrate that the luxury perfusion syndrome caused the secondary brain damage even in the cases that were in relatively good condition. The feasibility of treatment can be assessed by considering these results. (Stroke1988;19:322–325)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We describe a patient who experienced focal cerebral and brainstem ischemia in the setting of postpartum eclampsia. Cerebral angiography showed spasm of large‐and medium‐caliber arteries. This case provides rare documentation that vasospasm may account for cerebral ischemia in eclamptic women with focal signs. This observation suggests that in such patients cerebral angiography may be informative and useful. (Stroke1988; 19:326–329)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cerebrovascular disease mortality in France during the period 1968–1978 was compared with cardiovascular and all other causes of death. Our study demonstrated a 25% decline in the age‐adjusted cerebrovascular disease mortality rates in both sexes and particularly in the middle‐aged groups. This decline is greater than that of the general causes of mortality, which was on the order of 20%. It parallels the decline in congestive heart failure mortality but differs from that of ischemic heart disease. Nevertheless, despite the increase in the proportion of elderly people in the population, the total number of deaths from cerebrovascular diseases has remained almost unchanged, although the deaths occur at a higher age than previously. If this trend is confirmed, cerebrovascular diseases will remain one of the more frequent causes of death in the elderly and thus a social problem of crucial importance. (Stroke1988;19:330–334)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We used a computer program to test response time among stroke patients in a clinical setting. Visual stimuli were presented to 82 hospitalized stroke patients, to 21 hospitalized controls, and to 76 nonhospitalized controls. Stroke patients had longer mean response times than controls. Patients with right hemispheric lesions had longer response times than those with left hemispheric lesions when the stimuli were presented on the left. The corresponding phenomenon of longer response times in patients with left hemispheric lesions to stimuli presented on the right was not observed. Patients with right hemispheric lesions with visual hemineglect had a longer mean response time than those without visual hemineglect when the stimuli were presented on the left or centrally, whereas the patients with right hemispheric lesions without neglect had a mean response time similar to that of patients with left hemispheric lesions. (Stroke1988; 19:335–339)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The ability of the nonglucocorticoid 21‐aminosteroid U74006F, a potent inhibitor of iron‐dependent lipid peroxidation, to antagonize progressive brain hypoperfusion after a 5‐minute episode of global brain ischemia was examined in α‐chloralose‐anesthetized cats. Immediately after a 5‐minute episode of near‐total tourniquet‐induced brain ischemia, cortical blood flow returned to normal or above normal. Thereafter, cortical blood flow fell progressively to a level 71.7% below normal by 3 hours after ischemia. In contrast, in cats that received 1 mg/kg i.v. U74006F 15 minutes after the ischemlc episode, cortical blood flow remained significantly greater than that seen in vehicle‐treated cats. At 3 hours, cortical blood flow had declined by only 45.7% (p< 0.04 compared with vehicle). In addition, U74006F treatment significantly improved postischemic maintenance of blood pressure and recovery of somatosensory evoked potentials and reduced postischemic arterial blood acidosis. U74006F had no effect on cortical blood flow, somatosensory evoked potentials, or blood pressure in nonischemic cats. Our results suggest that U74006F may be useful in the early treatment of global cerebral ischemia. (Stroke1988;19:340–344)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Using transesophageal echocardiography, cardiac structures can be imaged with high resolution. The aim of our study was to evaluate whether transesophageal echocardiography is superior in detecting mitral valve prolapse and other cardiac abnormalities compared with transthoracic echocardiography in an age‐matched control group and in young patients with cerebral ischemic events (patient group). Forty patients with cerebral ischemic events (mean age 35.2 years) and 29 controls (mean age 30.4 years) were examined using both methods. Transthoracic and transesophageal echocardiography showed a significantly higher incidence of mitral valve prolapse in the patient group compared with the control group (p< 0.001). By means of transesophageal echocardiography, it was possible to measure highly significant bulging in both the anterior and the posterior mitral leaflet in the patient group compared with the control group (p< 0.001), and the thickness of the mitral leaflets was significantly higher in the patient group. In 9 of 20 (45%) patients with normal transthoracic echocardiograms, transesophageal echocardiography showed pathologic findings. We found transesophageal echocardiography to be a sensitive method for detecting mitral valve prolapse as well as valve changes and other cardiac abnormalities not detectable by conventional echocardiography. Our study underlines the role of mitral valve prolapse in young stroke patients as a relevant risk factor and emphasizes the importance of changed mitral valve morphology. (Stroke1988;19:345–348)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID