ISSN:1015-9770    

DOI:10.1159/000108205

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The predictive value of casual blood pressure (BP) levels following acute stroke on outcome is currently unclear. This may in part reflect the observer bias and variability of casual recordings, which are reduced with 24-hour recordings. We therefore proposed to assess the prognostic significance of 24-hour compared to casual BP in predicting 30-day mortality, dependency and neurological outcome. A total of 136 consecutive patients were assessed within 24 h of ictus by one observer, with casual and 24-hour BP recording, and National Institutes of Health Stroke Scale and Modified Rankin Scale scores. Repeat assessments were made at 7 and 30 days. Admission casual and 24-hour systolic BP (SBP) and diastolic BP levels were significantly higher in patients with poor outcome at 1 month following acute stroke, whether expressed in terms of mortality, dependency or neurological deterioration, on single-variable logistic regression analysis. However, of these variables, only admission 24-hour (not casual) SBP remained a significant outcome predictor in a multiple model containing factors with an established association with poor prognosis. The odds ratio for outcome of death or dependency associated with each 10-mm-Hg increase in 24-hour SBP at admission was 1.88 (95% confidence interval: 1.27-2.78). For an outcome of death or high dependency, the model had a specificity of 75% and sensitivity of 76% when tested by the jackknife technique. Therefore, increasing 24-hour BP levels following acute stroke predict poor outcome. Whether BP should be reduced pharmacologically in the acute stroke period now warrants a suitable prospective intervention trial.

ISSN:1015-9770    

DOI:10.1159/000108206

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108207

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

We report a sporadic case of type-IV Ehlers-Danlos Syndrome (EDS) in a woman presenting with a spontaneous carotid-cavernous fistula. This complication was treated successfully by endovascular treatment (EVT) with long-term relief. Analysis of collagens synthesized by the patient''s dermal fibroblasts in culture showed impaired secretion of abnormally slow, electrophoretically migrating type-III collagen, suggesting an underlying defect in the COL3A1 gene. The clinical features of type IV EDS and the outcome of EVT are reviewed.

ISSN:1015-9770    

DOI:10.1159/000108208

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

From an ongoing stroke registry, including all patients with a first cerebral infarct, we studied 41 borderzone small deep infarcts: (SDIs) in comparison with 123 remaining SDIs. We noted vascular risk factors, presence of a carotid occlusion or Stenosis > 50%, and the presence of asymptomatic lesions on CT. By univariate analysis and subsequent multivariate logistic regression analysis, we found that carotid stenosis/occlusion was more frequent among the borderzone group, but this difference was not statistically significant. The vascular risk factor profile was similar in both groups. Asymptomatic lesions, but especially asymptomatic borderzone small deep lesions were significantly more frequent among the symptomatic borderzone group. We conclude that carotid stenosis is not a numerically important contributor to the occurrence of borderzone SDI; generalised small-vessel disease may be more important in this respect. Therefore borderzone SDIs are most likely due to haemodynamic compromise in the distal supply areas of the perforating arteries.

ISSN:1015-9770    

DOI:10.1159/000108209

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Admission to an acute stroke unit is decided on the basis of clinical and computed tomographic data collected in emergency, leading to a risk of misdiagnosis. The aim of this study was to evaluate the rate of misdiagnoses in an acute stroke unit. This study was conducted over a 1-year period in consecutive patients, who were initially examined in the emergency department and underwent a non-contrast computed tomographic scan, an electrocardiogram (ECG) and routine biological tests. Then they were referred to the acute stroke unit, where they were re-examined by a board-certified in-house neurologist and underwent continuous ECG recording, ultrasonography and echocardiography within 24 h and other tests if necessary. Of 1,250 patients admitted to the acute stroke unit, 1,071 (85.7%) had a definite neurovascular disorder (ischemic stroke, transient ischemic attacks, intracerebral hemorrhage, cerebral venous thrombosis, subarachnoid hemorrhage and spinal stroke). 66 (5.3%) had a possible neurovascular disorder (migraine aura, post-stroke epileptic seizure, isolated acute vertigo and acute hypertensive encephalopathy), and 113 (9 %) had a non-vascular disorder, the final diagnosis was a neurological disorder in 96 of them. Therefore, misdiagnoses occur in one tenth of patients and usually consist of other neurological disorders. Therefore, neurologists should be involved in the management of stroke patients at the acute stage and should remain general neurologidts even if they are overspecialized ''strokologists.''

ISSN:1015-9770    

DOI:10.1159/000108210

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108211

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

An international consensus meeting to determine criteria for the characterization of extracranial carotid artery stenosis was held in Paris on December 13–14, 1996. Recommendations are the following if the degree of the stenosis and the precise location of the stenosis are well defined. Ultrasonic Doppler duplex methods 5 MHz capable of insonating up to 4 cm and retrievable documentation of relevant findings. Computed tomographic angiography 2 mm in size. Angiography may identify gross calcifications and large ulcers defined in two classes: 1 – large (2 mm depth by 2 mm width) and 2 – complex with multiple craters. Magnetic resonance imaging with or without angiography may play a role in the future. In vitro studies show that MR can demonstrate plaque components such as fibrosis, calcification, hemorrhage and necrotic core, but current technical limitations related to resolution and motion artifacts prevent this from being implemented in vivo. Pathological studies require en bloc surgery. Component areas should be calculated from their length and width, and ulcerations measured from their width. The risk of cerebrovascular ischemia is clearly related to the degree of stenosis. Factors of individual importance for higher risk include in descending importance: evidence of progression, surface ulceration and low echogenicity. Texture is still under investigation as a prognostic

ISSN:1015-9770    

DOI:10.1159/000108415

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108439

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108272

出版商:S. Karger AG    

年代:1997

数据来源: Karger