摘要:

Background and PurposeWe sought to identify MRI measures that have high probability in a short acquisition time to predict, at early time points after onset of ischemia, the eventual development of cerebral infarction in clinical patients who suffer occlusion of a cerebral artery.MethodsWe developed an MR tissue signature model based on experimentally derived relationships of the apparent diffusion coefficient of water (ADCw) and T2to ischemic brain tissue histopathology. In eight stroke patients we measured ADCwand T2intensity using diffusion-weighted echo-planar imaging (DW-EPI). Tissue signature regions were defined, and theme maps of the ischemic focus at subacute time points after stroke onset were generated.ResultsFive MR signatures were identified in human stroke foci: two that may predict either cell recovery or progression to necrosis, one that may mark the transition to cell necrosis, and two that may be markers of established cell necrosis.ConclusionsAn MR tissue signature model of ischemic histopathology using ADCwand T2can now be tested for its potential to predict reversible and identify irreversible cellular damage in human ischemic brain regions.(Stroke. 1995;26:1983-1989.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeIncidence of stroke varies markedly in different world populations. In seven Chinese cities, the effect of a program of risk factor modification on the incidence and mortality of stroke was studied and compared with a control population. This article describes the incidence of stroke in the control populations for the years 1986 through 1990.MethodsIncidence (first-ever strokes only) for 1986 was obtained by door-to-door interview with heads of households with subsequent verification on examination by a neurologist and review of medical and or hospital records. In subsequent years, cases were ascertained with a three-tier monitoring system: by community health workers, local medical centers, and the Beijing Neurosurgical Institute.ResultsAverage annual age-adjusted incidence per 100 000 was 215.6 (261.5 for males, 174.5 for females; P less than .001). There was a significant drop in the total number of cases from 137 in 1986 to 106 in 1990, but the age-adjusted rate showed a significant drop for males only (322.3 to 182.5, P less than .001). Marked differences in average annual age-adjusted rates existed among the seven cities, from 486.4 for Harbin to 80.9 for Shanghai. This difference in rate among cities was found for both sexes but was more pronounced in males.ConclusionsThe stroke incidence rates in China, like those in Japan, are among the higher ones in the world. In recent years, there has been an apparent decline in stroke incidence. Marked differences in rates were found between males and females with decline in incidence occurring almost exclusively in males. There were also marked differences in stroke incidence among the cities studied. These differences may result in part from differences in diet, alcohol and cigarette consumption, or prevalence of hypertension.(Stroke. 1995;26:1990-1994.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeStroke subtypes and prognosis differ among older black patients compared with whites; however, few data are available regarding stroke among young black patients.MethodsTo determine the risk factors for stroke, stroke subtype, and prognosis among young black patients, we retrospectively reviewed the medical records of all 15- to 44-year-old patients admitted with stroke to a university-affiliated public hospital from January 1990 through June 1994.ResultsOf the 248 eligible patients admitted with stroke, 219 were blacks. Hypertension was more frequently associated with stroke in young black than in non-black patients (55% versus 24%, P equals .003). Cocaine abuse was frequent among both black and non-black patients (27% versus 38%, P equals NS). Hypertensive intracerebral hemorrhage (64%) was the most common subtype of intracerebral hemorrhage (n equals 67), and lacunar infarction (21%) was the most common subtype of cerebral infarction (n equals 112) in young black patients. Outcome in black patients with stroke at discharge was 69% independent, 8% dependent, and 23% dead.ConclusionsThe high frequency of hypertension, hypertensive intracerebral hemorrhage, and lacunar infarction among young black patients with stroke suggests accelerated hypertensive arteriolar damage, possibly due to poor control of hypertension.(Stroke. 1995;26:1995-1998.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThis study examines the geographic variation in the reporting of deaths with stroke as the underlying or contributing cause in the United States.MethodsData from the National Center for Health Statistics and Bureau of the Census were used to map the geographic distribution of race- and race/sex-specific, underlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates in the United States by state for 1979 through 1981.ResultsUnderlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates were significantly clustered for both whites and blacks. However, the spatial distributions of underlying- and contributing-cause rates differed; there was no association between underlying- and contributing-cause rates for either racial group or for the various race/sex groups. There was no association between nonstroke mortality and stroke mortality rates. There was also very little spatial variation and no spatial clustering of the median number of contributing causes reported.ConclusionsThe overall large-scale spatial distribution of resident underlying-cause stroke mortality rates cannot be explained by geographic variation in the selection of the underlying cause of death from among all causes reported on the death certificate, by different area-dependent tendencies for mortality generally, or by different tendencies to consider stroke as the cause of death when death occurs. Geographic variation in contributing-cause rates is not explained by variation in tendency to report contributing causes of death.(Stroke. 1995;26:1999-2003.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThis report examines the relationship between lung function and risk of major stroke events (fatal and nonfatal).MethodsWe completed a prospective study of 7735 men aged 40 to 59 years at screening selected at random from one general practice in each of 24 British towns.ResultsDuring the mean follow-up period of 14.8 years, there were 277 major stroke events in the 7650 men with data on forced expiratory volume in 1 second (FEV sub 1). After exclusion of 499 men with definite myocardial infarction, stroke, or atrial fibrillation at screening, 7151 men experienced 239 major stroke events. Lower levels of FEV1were associated with a significant increase in risk of stroke even after adjustment for age, smoking, social class, physical activity, alcohol intake, systolic blood pressure, antihypertensive treatment, diabetes, and preexisting ischemic heart disease. Relative risk in the low third (less than 3.10 L) versus high third (more than 3.65 L) was 1.4 (95% confidence interval, 1 .0 to 2 .0). The inverse association between FEV1and stroke was only apparent in older men, current nonsmokers, hypertensive men, and men with preexisting ischemic heart disease. Lower FEV1was associated with higher rates of stroke in hypertensive men irrespective of smoking status. Inclusion of FEV1in a risk score for stroke provided only a small increase in the absolute risk or the yield of cases in the top fifth of the score distribution during the follow-up period.ConclusionsLower levels of FEV1are associated with an increased risk of stroke in those already at high risk, eg, those with ischemic heart disease or hypertension. However, the association is not strong enough to warrant the use of FEV1in making clinical decisions regarding the treatment of hypertension as it relates to the prevention of stroke.(Stroke. 1995;26:2004-2010.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeWe studied prognosis for survival after an initial stroke in 662 patients who survived at least 30 days after onset while taking into account age, sex, the number of neurological deficits from the initial stroke, stroke type, and five selected medical conditions: hypertension, myocardial infarction, cardiac arrhythmia, diabetes mellitus, and history of transient ischemic attacks.MethodsAll patients were enrolled between July 1, 1987, and August 1, 1989, and were followed regularly at about 6-month intervals until death or the end of the study (mean of 24 months).ResultsAt 6 months, 90.8% of the 30-day stroke survivors were still alive. At 1, 2, 3, and 4 years, the cumulative survival rates were 86.9%, 78.7%, 73.2%, and 72 .0%, respectively. Older age and the number of neurological deficits at onset of initial stroke increased risk of death. Compared with patients of the same age, sex, number of neurological deficits, and comorbidities, increased risk of death is present among those with myocardial infarction, cardiac arrhythmia, and diabetes mellitus. Hazard ratios were 1.7 (P equals .006), 1.5 (P equals .023), and 1.4 (P equals .059), respectively. Hypertension and transient ischemic attacks were not significantly associated with increased mortality.ConclusionsThis study clarifies prognosis for survival after an initial stroke by taking into account other confounding variables that could also contribute to risk of death.(Stroke. 1995;26:2011-2015.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeInvestigations regarding arteriosclerosis of carotid arteries showed an association between increased intima-media thickness and vascular risk factors. A newly developed three-dimensional ultrasound method increases the reproducibility of plaque volume measurements because more exact volume measurements can be performed with a reduction of the disadvantages of two-dimensional measurements. In a pilot study the influence of vascular risk factors on carotid artery plaque progression was examined.MethodsVolumes of atherosclerotic plaques in carotid arteries in 54 patients were measured with a three-dimensional ultrasound system during a 12-month period to determine the relationship between progression or regression of plaque volume, vascular risk factors, dose of aspirin, and flow turbulence in the plaque region.ResultsA progression of plaque volume occurred in 67% (36/54) of all plaques. In no plaque was a regression of plaque volume seen. The optimal adjustment of all risk factors showed a significant influence on plaque progression (r equals .31). Diastolic blood pressure was the strongest predictor of plaque progression (P less than .01), followed by diabetes (P less than .03). Turbulence in the plaque region was found in 78% of the patients in the progression group (n equals 36) versus 61% in the nonprogression group (n equals 18) but was not significant. Dose of aspirin (100 mg versus 250/300 mg) had no influence on plaque volume after 1 year.ConclusionsTreatment of vascular risk factors reduces the progression of carotid artery plaque volume in three-dimensional ultrasound. The most important factor for plaque progression is a high diastolic blood pressure. Turbulence in the flow pattern and the examined doses of aspirin showed no significant influence.(Stroke. 1995;26:2016-2022.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposePatients with hemiparesis, hemisensory loss, and hemianopsia (``HHH'' deficits) due to stroke may have large cortical lesions caused by middle cerebral trunk vessel occlusion or smaller subcortical lesions due to lenticulostriate involvement. We studied the usefulness of lesion location in predicting functional recovery within this syndrome.MethodsWe reviewed our records and found 41 patients who had a single ischemic hemispheric stroke, HHH deficits, and an available CT scan performed more than 24 hours after the onset of symptoms. CT scans were read independently and blindly by the authors. Lesions were initially categorized by arterial distribution on the basis of CT templates published by Kinkel. The numerous combinations of arterial branch vessel occlusions observed did not allow for statistical analyses because of the small number of subjects within each subgroup. Lesions were therefore classified as cortical (C), subcortical (S), or mixed (M).ResultsThere were no significant differences among the three anatomic groups for age, sex, interval after stroke, Mini-Mental Status Examination score, or admission Barthel Index score. Functional outcome measures did not differ significantly for the three groups: mean plus minus SD discharge Barthel score (C, 64 plus minus 31; S, 47 plus minus 20; M, 57 plus minus 21), length of stay ([days] C, 64 plus minus 25; S, 77 plus minus 24; M. 73 plus minus 28), and frequency of nursing home placement (C, 4/8; S. 3/6; M, 2/16).ConclusionsFor patients with HHH deficits, the anatomic location of the lesion (C versus S versus M) does not affect functional outcome.(Stroke. 1995;26:2023-2026.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThe Rankin Scale is a frequently used handicap index in stroke outcome research. However, relatively little is known about its validity. The purpose of this study was to investigate the clinical meaning of Rankin grades by identifying the functional health aspects that contribute to Rankin scores.MethodsWe studied 438 patients 6 months after stroke. Data were collected on the following functional health indicators: alertness, communication, independence, disability in activities of daily living, mobility, instrumental disability, social interaction, and recreation. Disability in activities of daily living was assessed with the Barthel Index, whereas the other indicators were measured with subscales of the Sickness Impact Profile. The association between functional health and Rankin Scale was expressed in terms of relative frequencies and Somers' D statistic. Linear regression analysis (after ordinal transformation) was used to identify the significant health factors that explain Rankin scores.ResultsMobility, disability in daily and instrumental activities, and living arrangements showed a stronger association with Rankin scores (Somers' D range, 0.60 to 0.74) than cognitive and social functioning (Somers' D range, 0.34 to 0.47). Disability in activities of daily living turned out to be the most important explanatory factor of Rankin scores (R2equals 67%).ConclusionsThe Rankin Scale is not a pure handicap measure but should be viewed as a global functional health index with a strong accent on physical disability. The index is useful as a simple and time-efficient outcome measure in large-scale multicenter trials. It is argued that at present there is no clear need to assess handicap as the primary outcome in medically oriented stroke intervention studies.(Stroke. 1995;26:2027-2030.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeStroke unit rehabilitation tends to be directed toward stroke patients with moderately severe disabilities (``the middle group''). Data collected on a stroke rehabilitation unit, however, showed improving outcome over 3 years in patients with a poor prognosis (discharge home: 48% versus 16%, P less than .02; discharge Barthel Index score: 9 versus 6, P less than .05). The hypothesis that stroke rehabilitation units may improve outcome in severely disabled stroke patients was tested in this study.MethodsA randomized controlled study was undertaken in 71 patients with a poor prognosis who were treated either on a stroke rehabilitation unit (n equals 34) or on general wards (n equals 37) to compare outcome between the two groups. Data collected were also compared with those from a methodologically similar study undertaken 3 years ago.ResultsSevere stroke patients treated on the stroke rehabilitation unit had a significantly better outcome compared with general wards (mortality: 21% versus 46%, P less than .05; discharge home 47% versus 19%, P less than .01; median length of hospital stay: 43 versus 59 days, P less than .02). The number of stroke unit patients being discharged home had increased significantly from the previous study, with a trend toward improvement in median discharge Barthel Index score.ConclusionsStroke rehabilitation units may improve outcome in severe stroke patients. This improvement appears to be due to the development of innovative management strategies that reduce mortality and institutionalization and enable caregivers to support more disabled stroke patients at home.(Stroke. 1995;26:2031-2034.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID