摘要:

Background and PurposeThis study examines the geographic distribution of stroke mortality among immigrants and natives of the United States.MethodsNational Center for Health Statistics and Bureau of the Census data were used to determine the geographic distribution of age-adjusted, race-, and race/sex-specific stroke mortality rates among immigrants and natives of the United States for 1979 to 1981.ResultsFor whites and blacks and for each of the respective race/sex groups, immigrants had markedly and highly statistically significantly lower age-adjusted stroke mortality rates than either the entire US-born resident population or the US-born interregional migrant population. The spatial pattern of immigrant rates did not parallel the patterns for US-born populations. Immigrant rates were highest in the West and lowest in the Midwest for whites and highest in the Midwest and lowest in the Northeast for blacks, whereas for both US-born whites and blacks, resident and native rates were highest in the South and lowest in the Midwest. With few exceptions, region-specific immigrant rates for whites and blacks were significantly lower than rates for either US-born regional residents, US-born migrants to the regions, or US-born natives of the regions. In contrast, white immigrants to the West had significantly higher rates than US-born groups in that region.ConclusionsSelection factors strongly influence stroke mortality rates among immigrants to the United States. The aberrantly high rates among white immigrants to the West may in part reflect a bias due to large census undercounts of this population. (Stroke. 1997;28:53-57.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeThe purpose of this study was to investigate in a community-based population the prevalence of both urinary (UI) and fecal (FI) incontinence and to analyze risk factors by means of multivariate analysis.MethodsIncluded were 935 acute stroke patients admitted consecutively during 19 months. We evaluated UI and FI using subscores of the Barthel Index during the hospital stay and at 6-month follow-up.ResultsOn admission, the proportions of patients with full UI, partial UI, and no UI were 36%, 11%, and 53%, respectively (8%, 11%, and 81% at 6-month follow-up). The proportions of patients with full FI, partial FI, and no FI on admission were 34%, 6%, and 60%, respectively (5%, 4%, and 91% at 6-month follow-up). By multivariate analysis, significant risk factors for UI and FI were age, severity of stroke, diabetes, and comorbidity of other disabling diseases.ConclusionsOn admission in the acute state, almost half of an unselected stroke population have UI and/or FI. The proportion declines to one fifth (UI) and one tenth (FI) of the surviving patients at 6 months. Increasing age, stroke severity, diabetes, and other disabling diseases increase the risk of UI as well as FI. (Stroke. 1997;28:58-62.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeBecause no population-based estimates are available for asymptomatic retinal emboli, we aimed to assess prevalence and associations of this sign in a defined older Australian urban population.MethodsA total of 3654 persons aged 49 years or older, representing 82% of residents in an urban area west of Sydney, underwent a detailed eye examination that included medical history, stereo retinal photography, and fasting blood tests including lipids. Retinal emboli were diagnosed clinically and from photographic grading and classified as cholesterol, platelet-fibrin, or calcific in type.ResultsAsymptomatic retinal emboli were found in 51 participants (1.4%; 95% confidence interval [CI], 1.0% to 1.8%). The prevalence was 0.8% in persons aged <60 years, 1.4% for those aged 60 to 69 years, 2.1% for those aged 70 to 79 years, and 1.5% for those aged 80 years or older. Men had a significantly higher prevalence (2.2%) of retinal emboli than women (0.8%, P<.001) after adjustment for age (odds ratio [OR], 2.7; 95% CI, 1.5 to 4.8). Forty-one emboli (80%) were cholesterol type, 7 (14%) were platelet-fibrin, and 3 (6%) were calcific. Significant associations were found after age-sex adjustment, with hypertension (OR, 2.2; 95% CI, 1.2 to 3.8), a combined history of vascular disease (OR, 2.4; 95% CI, 1.3 to 4.4), past vascular surgery (OR, 3.5; 95% CI, 1.4 to 8.5), and current (OR, 2.2; 95% CI, 1.1 to 4.2) or any (OR, 2.6; 95% CI, 1.2 to 4.3) smoking history. These associations persisted after multivariate analysis. There were no significant associations with diabetes, obesity, or fasting blood test findings.ConclusionsThis study provides accurate prevalence rates for asymptomatic retinal emboli in the elderly and confirms associations with hypertension, smoking, and vascular disease. (Stroke. 1997;28:63-66.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposePrevious studies of lesion localization in denial of hemiplegia have often been confounded by factors such as the cerebral etiology, which aspects of the disorder are denied, and whether delusions are present. Our investigation focuses on denial of hemiplegia, without concomitant delusions, after cerebrovascular accident (CVA).MethodsThe CT scans of 30 patients with denial of hemiplegia after acute stroke were compared with those from 10 CVA patients with hemiplegia and visuospatial neglect but no denial. Lesion sites were detailed using the templates of Damasio and Damasio and, for the deep structures, those of Talairach and Tournoux.ResultsAnalysis of the CT scans demonstrated that 26 of 30 denial patients had unilateral right-sided lesions and that this group showed a significantly higher incidence of lesions in deep white matter and the basal ganglia.ConclusionsThe results are discussed in relation to recent ideas regarding the role of the basal ganglia and subcortical circuits in movement and executive function. (Stroke. 1997;28:67-71.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeBy 1992, several prospective trials established the efficacy of anticoagulation (AC) and to some extent antiplatelet (AP) agents in the prevention of stroke in the setting of atrial fibrillation (AF). The objective of this study was to determine whether practice patterns in AF stroke prophylaxis reflect the findings of clinical trials and whether stroke prophylaxis in AF differs between community hospitals and tertiary teaching hospitals.MethodsRetrospectively, 1250 hospital charts were reviewed. After patients who had undergone recent surgery, received treatment for malignancy, or were not in chronic AF on discharge were eliminated, 651 remaining records were analyzed for the presence of 26 clinical factors influencing the selection of thromboembolism prophylaxis. Descriptive statistics and logistic regression were used to analyze the association between clinical and demographic factors and the decision to treat with AC, AP, or no specific antiembolic therapy.ResultsOf the 651 patients in AF, 273 (42%) received no emboli prophylaxis while 219 (34%) were treated with AC (warfarin), 146 (22%) were treated with AP, and 13 (2%) received both agents. Patients discharged in AF from community hospitals were significantly less likely to be treated with either AC or AP agents than patients discharged from tertiary centers. A strong bias against thromboembolism prophylaxis with either AC or AP agents in AF existed with age over 45 years. Multivariate logistic regression indicated that the decision to treat was associated only with the presence of prosthetic value, history of prior stroke, mitral disease, and absence of a recent gastrointestinal bleed or occult blood in stool. Even after adjustment for these factors, a significant bias against treatment with either AC or AP agents with advancing age and discharge from community hospitals remained.ConclusionsThromboembolism prophylaxis with either AC or AP agents is underutilized in the setting of AF. Furthermore, factors known to increase the risk of embolization in AF such as age, hypertension, diabetes, and heart disease were not associated with decisions to treat with either AP or AC agents. This study suggests that the use of clinical guidelines suggested by trials of thromboembolism prophylaxis in AF could reduce the incidence of stroke. (Stroke. 1997;28:72-76.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeIn the carotid bifurcation, atherosclerotic plaques usually develop in the outer wall of the internal carotid artery. The aim of this study was to analyze the expression of the cell adhesion molecules intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin in the carotid bifurcation. These molecules play a role in inflammatory cell recruitment and atherosclerosis.MethodsWe examined the expression of ICAM-1, VCAM-1, and E-selectin in 22 human carotid bifurcation specimens by means of immunohistochemistry. Double immunostaining was performed with antibodies against CD-3, CD-31, CD-68, and alpha-smooth muscle actin combined with each of the cell adhesion molecule antibodies. In situ hybridization for ICAM-1 was performed in selected specimens.ResultsA profound focal expression of ICAM-1 in the outer wall of the internal carotid artery could be demonstrated (86% of all specimens). This focal expression could be shown in histologically normal appearing bifurcations of young adults. ICAM-1 was expressed by subsets of macrophages and smooth muscle cells and by endothelial cells. VCAM-1 and E-selectin showed no focal expression and were not found in normal carotids. In advanced plaques all three adhesion molecules-ICAM-1, VCAM-1, and E-selectin-were expressed.ConclusionsWe were able to demonstrate a focal expression of ICAM-1 in the outer lateral wall of the internal carotid artery, which is a high-risk region for the development of atherosclerotic lesions. (Stroke. 1997;28:77-82.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeWhile there is overwhelming evidence relating low levels of HDL cholesterol (HDL-C) with coronary heart disease, the association with cerebrovascular disease is not clear. The aim of the present report was to assess the association between HDL-C levels and ischemic stroke mortality obtained from a long-term follow-up in the Israeli Ischemic Heart Disease Study.MethodsThe subjects of this report are 8586 men, tenured civil servants and municipal employees, aged 42 years or older at the time of HDL-C measurements in 1965. They were followed up for mortality for 21 years. Death due to cerebrovascular disease included the International Classification of Disease, 9th Revision, codes 430 to 438, of which presumed ischemic stroke included codes 433 to 438.ResultsDuring the 21-year follow-up, 295 men died from cerebrovascular events, of which 241 deaths were due to presumed ischemic stroke. Individuals subsequently experiencing a fatal ischemic stroke had a marginally lower age-adjusted mean HDL-C (1.05 mmol/L) and a significantly lower (P<.001) age-adjusted mean percentage of serum cholesterol contained in the HDL fraction (%HDL) (19.3%) than counterparts surviving the follow-up period (1.06 mmol/L and 20.6%, respectively). Decreasing age-adjusted rates of ischemic stroke mortality were observed with increasing %HDL: 14.6, 14.0, and 11.8 per 10 000 person-years in the low, middle, and upper tertiles of %HDL, respectively. In multivariate analysis, a low concentration of HDL-C appeared to be significantly predictive of ischemic stroke mortality. The relative risk associated with a 5% decrease of %HDL was 1.18 (95% confidence interval, 1.03 to 1.34). Men at the lower tertile of HDL-C levels experienced a 1.32-fold increase of covariate-adjusted ischemic stroke mortality risk compared with counterparts at the upper tertile.ConclusionsIn this prospective study of middle-aged and elderly men from a healthy, working population, we have demonstrated an independent negative association between HDL-C and ischemic stroke mortality during a long-term (21-year) follow-up. (Stroke. 1997;28:83-87.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeA subsample of 147 Chinese subjects from a population-based study of cardiovascular diseases (Cardiovascular Disease Risk Factor Two-Township Study) participated in an ancillary study on extracranial carotid color duplex ultrasonography that aimed to assess the relations of coagulation factors to stroke and carotid atherosclerosis.MethodsLogistic models were used to study the associations between cardiovascular disease risk factors and stroke/carotid atherosclerosis, controlling for the effects of age and sex.Results1.53) was associated with an odds ratio of 3.35 for carotid atherosclerosis when compared with the lowest tertile (<1.20). A multiple logistic regression including all significant risk factors showed that the degree of association between factor VIIIc and atherosclerosis was attenuated to an odds ratio of 2.65 (P=.061).ConclusionsIn the present study, the roles of hypertension, hypercholesterolemia, and hypertriglyceridemia have been implicated in the pathogenesis of carotid atherosclerosis, and roles for hypertension and hyperglycemia in stroke were indicated. A positive association between factor VIIIc and carotid atherosclerosis in this Chinese population was found. Whether this association is independent of the effect of other cardiovascular risk factors awaits further study. (Stroke. 1997;28:88-94.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeStudies have suggested that B-mode ultrasonography can be used to determine carotid plaque composition and that specific plaque characteristics are associated with a worse clinical outcome. However, histological studies examining the relationship between carotid plaque morphology and clinical outcome have reported conflicting findings. Furthermore, few investigators have described plaque morphology in quantifiable terms. This study examines the association between the volume of carotid plaque constituents and preoperative ischemic neurological symptoms. Constituents examined were chosen based on their potential for identification by current diagnostic imaging modalities such as ultrasound or MRI.MethodsAtherosclerotic plaques from 43 patients undergoing carotid endarterectomy were examined histologically, with sections obtained every 0.5 to 1 mm. The lesions were examined for the presence and quantity of fibrous intimal tissue, intraplaque hemorrhage, lipid core, necrotic plaque core, and calcification. The quantity of each constituent was compared in plaques removed from symptomatic patients with those excised from asymptomatic individuals. Differences were analyzed with a Kolmogorov-Smirnov statistic.ResultsThere was no difference between plaques removed from asymptomatic and symptomatic patients with regard to the presence and volume of fibrous intimal tissue, intraplaque hemorrhage, the lipid core, the necrotic core, or calcification.ConclusionsIn patients with highly stenotic carotid lesions who are undergoing carotid endarterectomy, gross plaque composition is similar regardless of preoperative symptom status. Given this similarity, it is unlikely that differences in the volume of intraplaque hemorrhage, lipid core, necrotic core, or calcification in atherosclerotic carotid plaques explain their embolic history. (Stroke. 1997;28:95-100.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeDetermining how cerebral cortex adapts to sudden focal damage is important for gaining a better understanding of stroke. In this study we used a computational model to examine the hypothesis that cortical map reorganization after a simulated infarct is critically dependent on perilesion excitability and to identify factors that influence the extent of post-stroke reorganization.MethodsA previously reported artificial neural network model of primary sensorimotor cortex, controlling a simulated arm, was subjected to acute focal damage. The perilesion excitability and cortical map reorganization were measured over time and compared.ResultsSimulated lesions to cortical regions with increased perilesion excitability were associated with a remapping of the lesioned area into the immediate perilesion cortex, where responsiveness increased with time. In contrast, when lesions caused a perilesion zone of decreased activity to appear, this zone enlarged and intensified with time, with loss of the perilesion map. Increasing the assumed extent of intracortical connections produced a wider perilesion zone of inactivity. These effects were independent of lesion size.ConclusionsThese simulation results suggest that functional cortical reorganization after an ischemic stroke is a two-phase process in which perilesion excitability plays a critical role. (Stroke. 1997;28:101-109.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID