ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeAlthough there are various methods of determining neurological prognosis after cardiopulmonary resuscitation, the final outcome of patients often remains unclear for quite a long time.MethodsWe investigated 30 consecutively admitted patients who had been successfully resuscitated by the team of the local mobile intensive care unit after cardiac arrest. Determinations of the period of anoxia and of the cardiopulmonary resuscitation time, clinical investigation, echocardiography, electroencephalography, evoked potentials, magnetic resonance imaging, and magnetic resonance spectroscopy were performed.ResultsDemonstration of brain lactate in proton magnetic resonance spectroscopy (P less than .01) and absent N20 waves in short-latency somatosensory evoked potentials (P less than .01) proved to be significant in terms of a poor prognosis. Correlations between both duration of anoxia and cardiopulmonary resuscitation time and neurological outcome could be shown as well (both P less than .05).ConclusionsProton magnetic resonance spectroscopy and short-latency evoked potentials are of great benefit in the prognostic evaluation after cardiopulmonary resuscitation.(Stroke. 1995;26:543-549.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeTranscranial magnetic stimulation of the motor cortex is well established as a valuable method for noninvasive examination of the central motor system. In addition to exciting corticospinal cells and evoking a direct motor response, the magnetic stimulus delivered during voluntary activity produces a prolonged postexcitatory inhibition (silent period) of activity. We investigated silent period changes in patients with ischemic stroke of different clinical degrees.MethodsStandardized transcranial magnetic stimulation during sustained muscle contraction was performed at the vertex. Electromyographic activity was recorded via surface electrodes placed over the abductor digiti minimi muscle on both sides. We examined 50 patients with stroke (divided into three subgroups according to the degree of impairment) and 50 healthy control subjects.ResultsIn the control group we found no statistically significant interside difference in the duration of the silent period, whereas a marked interindividual variation was found. In patients with prior minor stroke who showed no residual motor disturbance, we found a significant prolongation of the postexcitatory inhibition recorded from the affected side compared with the healthy side. This interside discrepancy was even more pronounced in patients with minor hemiparesis and patients with moderate hemiparesis.ConclusionsOur findings suggest that the measurement of the silent period elicited by transcranial magnetic stimulation is a useful and sensitive neurophysiological parameter in the management of stroke. Particularly in the subgroup of patients with no residual clinical signs of central motor impairment, it is capable of detecting subclinical motor function disturbances.(Stroke. 1995;26:550-553.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThis study examines the effects of lifetime net interstate migration on the geographic distribution of stroke mortality in the United States.MethodsNational Center for Health Statistics and Bureau of the Census data were used to map the geographic distribution of age-adjusted, race-, and race/sex-specific stroke mortality rates by interstate migration status for natives, outmigrants, nonmigrants, inmigrants, and residents in the United States for 1979 to 1981.ResultsHigh age-adjusted stroke mortality rates were significantly clustered in the southeastern United States for both whites and blacks; in addition, for whites, low-rate states were concentrated in some Mountain and northeastern states. Migrant status did not change this large-scale pattern, but individual states showed significant migration effects, which varied in magnitude and direction. Among whites, states that benefited from migration, with markedly lower stroke mortality rates among residents than natives, included Arizona, Colorado, District of Columbia, and Florida, whereas states that suffered from migration included California, Idaho, Montana, North Dakota, Nevada, and Oklahoma. Among blacks, only Colorado showed an apparent large benefit from migration, whereas 21 states suffered from migration.ConclusionsAlthough the overall large-scale spatial distribution of resident stroke mortality rates cannot be explained by migration effects, some individual states had rates that were strongly influenced by migration. Patterns of mortality among migrant groups in Sun Belt retirement destination states probably result from differential selection effects for retirement migration in older adults. Patterns of mortality for black migrants to the North are probably influenced by ``carryover'' effects from their origin states.(Stroke. 1995;26:554-561.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeWe carried out a door-to-door survey on stroke prevalence at high altitude in Cuzco City, a town in the Peruvian Andes located 3380 m above sea level.Methods and ResultsAmong the 3246 screened individuals over 15 years old, there were 21 cases of first-ever completed stroke, yielding a crude prevalence ratio of 6.47 per 1000 (95% confidence interval [CI], 3.71 to 8.93 per 1000). The age-adjusted to WHO population point prevalence ratio was 5.74 per 1000 (95% CI, 3.14 to 8.35 per 1000), and the age-adjusted to North American US population point prevalence ratio was 8.58 per 1000 (95% CI, 5.44 to 11.75 per 1000). Multivariate logistic regression analysis suggested that age, polycythemia, high consumption of alcohol, and area of residence were associated with stroke prevalence. Our results suggest that the stroke prevalence in the central areas of Cuzco with sedentary people having a relatively high standard of living was higher than that in the peripheral areas with people with a relatively lower standard of living and less sedentary activities (odds ratio, 5.8; 95% CI, 1.4 to 23).ConclusionsThe prevalence of stroke suggests that stroke may be a public health problem in developing countries. This study suggests the importance of environmental factors such as altitude and lifestyle in stroke occurrence. The role of these factors should be confirmed and taken into account in future stroke prevalence studies.(Stroke. 1995;26:562-568.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThe aim of this study was to clarify the association of weather and stroke occurrence in a subtropical area in Ilan, Taiwan.MethodsWe studied 517 patients with stroke (date of onset, January 1 to December 31, 1991) in Poh-Ai Hospital and St Mary's Hospital: 316 patients (61.1%) with cerebral infarction, 170 (32.9%) with intracerebral hemorrhage, and 31 (6.0%) with other types of stroke. The daily occurrence of cerebral infarction and intracerebral hemorrhage was analyzed and correlated with three major meteorologic factors: air temperature, air pressure, and relative humidity.ResultsThe occurrence of cerebral infarction was rather uniform in all kinds of weather. The occurrence of intracerebral hemorrhage was approximately twice as great on cold days (0.71 case per day) and high-pressure days (0.73) as on warm days (0.31) and low-pressure days (0.39) (P less than .005 by chi2test). When a linear regression model was used to test whether air temperature or air pressure had more influence on intracerebral hemorrhage, only air temperature showed a significant effect. Regarding intracerebral hemorrhage, the relative risks of cooler and median temperature days versus warmer days were 18.5 and 5.1, respectively.ConclusionsIntracerebral hemorrhage but not cerebral infarction occurs more frequently on cooler days, with a dose-response relationship, in Ilan, Taiwan.(Stroke. 1995;26:569-572.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeEarly predictors of functional outcome after stroke are necessary for better planning of treatment and care.MethodsWe evaluated prospectively early clinical predictors of short-term functional outcome in a group of patients with ischemic cerebral infarction and explored whether the intensity of the acute-phase response provided further information concerning the short-term functional outcome. We evaluated a group of 208 ischemic stroke patients using the Mathew scale at entry. All patients had neuroimaging studies and routine blood tests, including erythrocyte sedimentation rate (ESR), within 72 hours from clinical onset. At discharge, functional outcome was graded according to a Stroke Outcome Scale.ResultsLarger infarcts, more embolic infarcts, and fewer lacunar infarcts were observed in the poor-outcome group. Vascular risk factors, radiological findings not related to the index stroke, time to admission, and treatment were similar in the two outcome groups. Variables with statistically significant differences between outcome groups included the following: age more than 65 years, female sex, admission Mathew score less than 75, worsening at clinical presentation, infarct volume more than 6 cm3, complicating infections, fasting glucose more than 110 mg, nonfasting glucose more than 130 mg, and elevated ESR. With stepwise logistic regression analysis, Mathew score on admission, infarct volume, mode of clinical presentation, and ESR remained in the predictive model of stroke outcome, with a sensitivity and specificity of 89.91% and 85.71%, respectively. After removing the computed tomographic information from the model the same variables remained, with a sensitivity and specificity of 83.05% and 94.29%, respectively.ConclusionsInfarct size and clinical severity on admission are the stronger predictors of short-term functional outcome. Mode of clinical presentation, clinical evolution during the first day of stroke, and ESR are also independent predictors of short-term stroke outcome. These findings might be indicative of an inadequate collateral profile and/or a more pronounced prothrombotic state.(Stroke. 1995;26:573-576.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposePrevious studies suggest that the management of coronary artery disease differs for women compared with men. We examined this issue for ischemic cerebrovascular disease.MethodsWe reviewed the use of angiography and carotid endarterectomy among patients discharged from Connecticut hospitals during 6 years over the past decade. Crude and age-adjusted rates of angiography and endarterectomy were determined for each sex.ResultsAmong 22 582 female and 19 729 male patients discharged, the rate of cerebral angiography was 11.8% for men and 7.2% for women; the age-adjusted odds ratio was 0.77 (95% confidence interval [CI], 0.72 to 0.82). The rate of endarterectomy was 10.6% for men and 5.7% for women; the age-adjusted odds ratio was 0.67 (95% CI, 0.62 to 0.72). The distribution of cerebrovascular disease type differed by sex, however, with carotid artery disease representing a larger proportion of men (12.2% [2415/19 729]) than women (6.9% [1554/22 582]) (chi2equals 355.8, P less than .0001). When restricted to this diagnosis, no sex differences exist (odds ratio for angiography, 1.00 [95% CI, 0.87 to 1.14] and for endarterectomy, 0.93 [95% CI, 0.81 to 1.07]).ConclusionsOverall, women hospitalized for ischemic cerebrovascular disease undergo fewer angiograms and are less likely to have carotid endarterectomy than men. These differences are not found when analysis is restricted to subjects with carotid disease and suggest that part of the difference in management may be due to biological differences between men and women.(Stroke. 1995;26:577-580.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeWe sought to determine whether early (less than 8 hours) or delayed (8 to 24 hours) recanalization after stroke may be an independent variable in the improvement of clinical outcome in patients with occlusion of the middle cerebral artery.MethodsWe prospectively studied 77 patients by combined Scandinavian Stroke Scale score at admission, repeated computed tomography and angiography before and after thrombolytic treatment at less than 8 hours after stroke onset, and transcranial Doppler ultrasound 24 hours later. We tested an association between clinical and neuroradiological baseline characteristics, recanalization, and outcome as assessed by the modified Rankin Scale 4 weeks after stroke and determined the effect of recanalization on mortality and good outcome (Rankin Scale grades 0 to 3) by multiple logistic regression analyses.ResultsRecanalization rates at 8 and 24 hours after stroke correlated with sites of occlusion (middle cerebral artery branch, 73% and 73%; trunk, 27% and 38%, respectively; intracranial internal carotid artery bifurcation, 14% and 14%; P equals .002), collaterals (good, 43% and 51%, respectively; scarce, 17% and 19%, respectively; P equals .01), and Scandinavian Stroke Scale score at admission (P equals .002). Six of 7 patients with delayed recanalization had good outcomes. Recanalization at less than 8 hours after symptom onset had no independent predictive value for good outcome (P equals .69). Recanalization at 24 hours increased the proportion of good outcomes from 23% to 75% in a subgroup of patients. Recanalization did not independently affect mortality (P more than .15).ConclusionsEven if delayed, arterial recanalization may improve clinical outcome in a subgroup of patients with middle cerebral artery occlusion.(Stroke. 1995;26:581-587.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThis study was undertaken to determine factors of importance for the development of leukoaraiosis and to evaluate whether leukoaraiosis influences stroke outcome.MethodsThe study was prospective and consecutive and included 1084 unselected patients with acute stroke and transient ischemic attack admitted from the community of Bispebjerg (Copenhagen, Denmark) during a 25-month period from September 1, 1991, to September 30, 1993. All patients were treated in a stroke unit from the time of acute admission to completion of rehabilitation. Daily alcohol consumption and other putative risk factors were registered on admission, and patients were evaluated weekly to death or time of completed rehabilitation by means of neurological (Scandinavian Stroke Scale) and functional (Barthel Index) scores. Leukoaraiosis was diagnosed on computed tomographic scan. Multivariate analyses were applied to test relations independent of other influencing factors.ResultsLeukoaraiosis was present in 15% of the patients. Age was the only factor that significantly increased the risk of leukoaraiosis (odds ratio [OR] per 10-year increase, 2.4; 95% confidence interval [CI], 1.8 to 3.1), whereas the presence of atrial fibrillation was adversely related to leukoaraiosis (OR, 0.26; 95% CI, 0.13 to 0.52). Moderate daily alcohol consumption (1 to 5 drinks) reduced the risk of leukoaraiosis (OR, 0.50; 95% CI, 0.28 to 0.87), whereas heavy daily alcohol consumption (more than 5 drinks) tended to increase the risk (OR, 1.3; 95% CI, 0.5 to 3.3). Leukoaraiosis was not related to the presence of hypertension, diabetes, ischemic heart disease, atrial fibrillation, intermittent claudication, smoking, or sex. The presence of leukoaraiosis had no influence on neurological outcome (P equals .20), functional outcome (P equals .47), length of hospital stay (P equals .75), or mortality (P equals .31).ConclusionsModerate daily alcohol intake seems associated with a decreased risk of leukoaraiosis in stroke patients. The relation between alcohol intake and leukoaraiosis may even be U-shaped, like the relation between alcohol intake and coronary heart disease, alcohol intake and mortality, and alcohol intake and stroke. The presence of leukoaraiosis does not seem to influence the rehabilitation process or outcome of stroke.(Stroke. 1995;26:588-592.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID