摘要:

Sixty-six patients with primary intracerebral haemorrhage were identified in a prospective, community-based register of 675 consecutive patients with first-ever in a lifetime stroke. No patient was lost to follow-up (up to 6 years). The 30-day case fatality rate was 52%. For patients surviving 30 days the average annual mortality rate was 8% per year for the next 5 years. The main cause of early death (≤30 days) was the neurological sequelae of the original stroke (73%, whilst late deaths (> 30 days) were due to either complications of immobility (45%) or vascular disease (55%). Twenty one percent of all patients were independent at 6 months (52% of survivors). The main predictors for death within 30 days were age, reduced conscious level, abnormal proprioception and rupture of blood into the ventricles or subarachnoid space. In addition, the size of the initial haemorrhage was predictive for death at any stage of follow-up, and the degree of limb weakness was predictive of death or dependency at 6 months. Nine patients had 14 recurrent strokes (including 4 definite haemorrhages and 4 definite cerebral infarctions). Five of the recurrences were fatal. The actuarial risk of recurrence in 30-day survivors was 7% per year (14 per 100 patient-years) and the actuarial risk of death or recurrence in 30-day survivors was 11% per year. Seven patients (11%) had at least one seizure during follow-up, the risk of first seizure being 8 per 100 patient-years overall. Patients with primary intracerebral haemorrhage have a high early case fatality but survivors have a similar outcome to patients with cerebral infarctio

ISSN:1015-9770    

DOI:10.1159/000107814

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Multi-modality therapy for acute ischaemic stroke is an emerging concept stimulated by the existing vacuum in stroke treatment and an increasing understanding of the ischaemic cascade. Experimental studies have shown that infarct size can be reduced more by combinations of reperfusion and neuroprotective strategies than by either one alone. An optimal combination regimen remains to be determined, but will probably target several sequential events occurring after ischaemia. Many logistic hurdles must be overcome before multimodality therapy can be properly tested in clinical trials. This will require a combination of pragmatism, adherence to scientific principles, and international cooperation among clinic investigators.

ISSN:1015-9770    

DOI:10.1159/000107904

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000107905

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000107908

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We retrospectively studied the incidence of recurrent embolization and hemorrhagic complications during a 2-week period after the onset of cardioembolic stroke according to the form of anticoagulation given immediately after the event. Twenty-six patients had full-dose heparin (F/H group), 37 had low-dose heparin (L/H group), 81 were treated with warfarin potassium (W group), and 20 were treated with antithrombin III (AT group), while 227 patients (non-A/C group) received no anticoagulation. The incidence of early recurrence was significantly lower in all anticoagulated groups (3.8% in the F/H group, 5.4% in the L/H group, 3.7% in the W group and 0% in the AT group), than that in the non-A/C group (20.3%). There were no significant differences in the incidence of hemorrhagic complications among the groups. Not only full-dose anticoagulation but also antithrombin III or low-dose heparin therapy may prevent the recurrence of embolization in acute cardioembolic stroke.

ISSN:1015-9770    

DOI:10.1159/000107816

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The rate of recurrent stroke after cervical artery dissection (CAD) remains unknown. The aim of this study was to evaluate the rate of recurrent stroke in the same territory in patients who were discharged alive after CAD. The secondary aims were to evaluate the rate of death, any stroke or transient ischemic attacks (TIA), recurrent CAD, reopening and residual headache or cervical pain. We contacted 110 consecutive patients with angiographically proven CAD who were discharged alive after CAD. Five of the 110 patients (4.5%) were lost to follow-up. The 105 remaining patients shared a total of 110 CAD (67 carotid, 43 vertebral). The median duration of follow-up was 36 months. Ninety-two patients had no event and 5 died 1–7 years after CAD. Two patients had a recurrent stroke and 3 had TIA in the territory of the previously dissected vessel; 3 had a recurrent dissection of the same vessel, revealed by TIA in 1 and isolated cervical pain in 2. Twenty-one patients had residual headache or cervical pain. In 90 patients who underwent a second angiography, reopening occurred in 52 (partial in 2) and an aneurysm in 5. The risk of recurrent stroke remains low in patients discharged alive after CAD. One of the most frequent sequelae is residual headach

ISSN:1015-9770    

DOI:10.1159/000107817

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000107818

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Proteolytic enzymes by polymorphonuclear leukocytes such as elastase may contribute to the pathogenesis of acute cerebral ischemia. We measured elastase α1-protease inhibitor complexes (EIC) in acute ischemic stroke and in controls with and without vascular risk factors. Levels of EIC were higher in patients (n = 24, 51.4 ± 18.5 ng/ml) than in healthy controls (n = 26, 36.2 ± 11.5 ng/ml, p < 0.001) but not higher than in controls with risk factors (n = 22, 53.4 ± 29.6 ng/ml). Stroke patients with recent or concomitant infections had higher EIC levels than all other groups (n = 14, 71.0 ± 24.6 ng/ml). This result suggests leukocyte activation in acute stroke and in subjects with increased risk for st

ISSN:1015-9770    

DOI:10.1159/000107819

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We report a patient with a small infarct in the posterior thalamic nuclei involving the pulvinar, probably in the territory of the lateral branches of the left posterior choroidal artery, who first presented with acute right sensorimotor stroke, followed 5 months later by a kinesigenic pain on the same side, which evolved in a few weeks toward a painless urge to move (hemiakathisia). There was a good response to a short trial of clonazepam. Posterior thalamic nuclei are at a crossroad between sensory inputs to the ventroposterolateral nuclei and motor efferent ones from the cerebellum and internal pallidum in their way back to the secondary motor areas, and lesions in this region could possibly induce plastic changes evolving to misdirection or cross-talk of sensory and motor information responsible for involuntary hyperkinetic movement disorders. This unique case report lends strong support to a causal role of sensory deficits in the occurrence of some movement disorders.

ISSN:1015-9770    

DOI:10.1159/000107820

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The main features of the alien hand syndrome are denial of hand ownership and involuntary arm movements. The underlying lesions are usually medial frontal infarction or degeneration contralateral to the affected arm. We describe a patient who developed an alien hand syndrome of the right arm after mesencephalic haemorrhage together with bilateral internuclear ophthalmoplegia and hemisensory loss. Three previous intracranial bleedings had been asymptomatic. We discuss whether hemisensory disturbance in addition to mild optical ataxia may produce the picture of an alien hand syndrome.

ISSN:1015-9770    

DOI:10.1159/000107821

出版商:S. Karger AG    

年代:1995

数据来源: Karger