摘要:

Background and Purpose: In the stroke component of the WHO MONICA Project, community-based registers of acute stroke have been undertaken in 20 populations in Finland, Sweden, Denmark, Germany, Italy, Yugoslavia, Hungary, Poland, Lithuania, Russia and China. This paper reports on diagnostic procedures and management of acute stroke in these populations. Methods: The MONICA stroke registers apply uniform registration procedures and diagnostic criteria. Data for 3 years were pooled and used for cross-sectional comparisons. Longitudinal analyses of the use of computerized tomography (CT) scans and autopsy rates were based on all years up to 1990 for which information was available. The total population in the age range investigated (35–64 years) was 3,250,000. Strokes were also recorded for the 65- to 74-year age range in seven of the 20 populations. Results: In all populations, more than three quarters of all 35- to 64-year-old stroke patients were managed in hospital; in nine populations more than 90% were managed in hospital. The use of CT scans ranged from 0% in Russia to 70–76% in West Germany, Italy, Sweden and two of the 3 Finnish populations. During the mid 1980s, use of CT scan increased rapidly in China (Beijing), Denmark, Finland and Yugoslavia but spread only slowly in Poland, Lithuania and Russia. Autopsy rates varied from 0% in China to 76% in the Hungarian and one of the Russian populations. During the 1980s, autopsy rates were stable in most populations, but declined considerably in Lithuania, Poland and Sweden. Elderly patients (65–74 years) were less often hospitalized in China but this was not the case in European populations. In all populations, CT scan and autopsy were less often performed in older subjects. Conclusions: Large variations exist between countries in the use of diagnostic procedures and the management of acute stroke. Data obtained before the late 1980s permit only very limited multinational epidemiological comparisons of stroke subtypes, but the possibility of making such comparisons is rapidly impr

ISSN:1015-9770    

DOI:10.1159/000108000

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108075

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000315501

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Cerebral infarction in young people is considered a rare event. There are many potential etiologies capable of causing a cerebral infarction in this age group. Three hundred consecutive patients younger than 40 years with cerebral infarction were extensively evaluated. One hundred and sixty-two women were included in this study, most under 30 years. The most frequently encountered risk factors were tobacco and alcohol use, and rheumatic valvular heart disease. Etiologies for cerebral infarction in the order of frequency were: cryptogenic 32%, nonatherosclerotic vasculopathy 27%, cardioembolism 24%, hematological disturbance 10% (including 11 patients with deficiency of natural anticoagulant proteins), premature atherosclerosis 3% and migraine 3%. Our paper demonstrates that atherosclerosis is an uncommon cause of cerebral infarction in patients under 40 years. The principal etiologies were rheumatic valve disease, arterial dissections and prothrombotic states.

ISSN:1015-9770    

DOI:10.1159/000108001

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Within the WHO MONICA Project, stroke has been recorded in 7 populations in 4 countries around the Baltic Sea (Denmark: Glostrup; Finland: North Karelia, Turku/Loimaa and Kuopio; Sweden: Gothenburg and northern Sweden; Lithuania: Kaunas). In population surveys, risk factors for cardiovascular diseases have been examined in 10,364 persons in the age group 35–64 years. During 1987–1989, acute strokes were registered within the same age range in 2,847 men and 1,610 women. The yearly incidence (first ever stroke) per 100,000 was more than twice as high in Kuopio (men 284 and women 142) compared to Gothenburg (men 123 and women 64). Population mean systolic blood pressure was highest in 2 of the Finnish populations and lowest in the Danish population. The blood pressure levels in the populations correlated with stroke incidence in men (r = 0.87; p = 0.01) and in women (r = 0.70; p = 0.08). The large differences in community levels of blood pressure seem to explain much of the large variations in stroke incidence between populations around the Baltic

ISSN:1015-9770    

DOI:10.1159/000108002

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108539

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Stroke is responsible for a significant proportion of acute admissions to hospital and for long-term disability. Large amounts of money are spent on prevention and treatment, but many of the components of management are of unproven value. Effective organisation of care, as with other chronic diseases, may significantly improve outcome. This paper describes the components necessary for a stroke service, based on published evidence and practical experience in developing such a service in an inner-city district.

ISSN:1015-9770    

DOI:10.1159/000108003

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108076

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A total of 61 percutaneous transluminal angioplasties (PTAs) have been performed in 58 patients with symptomatic severe stenosis of the internal carotid artery in our department since 1990. Forty-nine PTAs were successful (residual stenosis 0–49%). In 5 cases, residual stenosis ranged between 50 and 70%. Seven PTAs failed due to technical reasons. Transient ischemic neurological symptoms occurred in 8 patients. Minor stroke occurred in 2 patients with small hemodynamic infarcts, as revealed by control CT scans. Disabling stroke occurred in 1 patient. The overall neurological complication rate was 18%; the severe complication rate was 1.6%; mortality was 0%. Out of the 53 patients surveyed during the follow-up period (range, 3–48 months; mean, 16 months), there was 1 ipsilateral clinical relapse in a patient with restenosis. Three patients died, 2 of cardiac causes. One patient who refused surgery died of fulminant stroke 3 months after failed PTA. Ultrasonic follow-up in 47 patients (3–48 months; mean, 14 months) revealed asymptomatic restenosis in 2 patients, resulting in a total of 3 cases of restenosis. Carotid PTA seems to be a reasonable alternative to carotid endarterectomy; however, in comparison to carotid surgery, clinical efficacy has yet to be verified by means of randomized clinical t

ISSN:1015-9770    

DOI:10.1159/000108004

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000323257

出版商:S. Karger AG    

年代:1996

数据来源: Karger