ISSN:1015-9770    

DOI:10.1159/000108193

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Cerebrovascular dysautoregulation is well recognised following acute stroke, and thus blood pressure (BP) changes may have important effects on cerebral blood flow. Whilst absolute BP levels have been shown to influence outcome in some studies, the importance of short-term BP variability has not been addressed. We assessed beat-to-beat BP and pulse interval variability non-invasively using the Finapres device in 32 patients with CT-diagnosed acute cerebral infarction compared to a control group matched with respect to age and sex. Systolic BP variability was assessed as the standard deviation (SD) of all measurements and as the root mean squared of successive differences (RMS; which removes the portion of variability related to the underlying BP level). Systolic BP variability (taken as either the SD or the RMS) was significantly greater in acute stroke patients than controls. This difference is unlikely to reflect impaired cardiac baroreceptor sensitivity in acute stroke patients as no differences were observed in pulse interval variability compared to controls, but may be related to alterations in peripheral vascular resistance mediated by centrally induced changes in sympathetic nervous system activity. The prognostic significance of increased BP variability and the implications for BP management in acute stroke require further evaluation.

ISSN:1015-9770    

DOI:10.1159/000108194

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

From April 1993 to March 1994, 187 ischemic stroke patients were prospectively registered in the Hospital de Santa Maria Stroke Data Base. Demographic features, vascular risk factors, clinical symptoms and signs, computerized tomography results, the most plausible stroke mechanism, and the vascular territories affected were compared between patients with and without nausea or vomiting by univariate and multivariate statistical techniques. The same comparisons were performed in the subgroups of patients with stroke in the vertebrobasilar or carotid territory. This regression model was validated in a second sample of 102 ischemic stroke patients registered in the data base from August 1995 to April 1996. Twenty-two percent of 187 patients with ischemic stroke complained of nausea or vomiting within a 12-hour interval of stroke onset. Nausea or vomiting was more frequent in vertebrobasilar territory strokes (45%) than in carotid territory strokes (10%). In multiple regression analysis, vertebrobasilar stroke (odds ratio, OR, 3.6), headache (OR 3.1) and vertigo (OR 3.4) were significant independent predictors, while in the subgroup of patients with vertebrobasilar stroke, headache (OR 3.0) and vertigo (OR 2.5) were significant independent predictors. The identification of independent variables associated with nausea or vomiting in ischemic stroke allows the detection of patients at high risk of vomiting during the acute stroke phase and to postulate its possible pathophysiological mechanism, namely, stimulation of the vomiting center by vestibular or trigeminovascular afferents.

ISSN:1015-9770    

DOI:10.1159/000108195

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

This report details the successful microsurgical removal of a migrated coil and an embolectomy of the middle cerebral artery (MCA). During endovascular occlusion of a giant carotid artery aneurysm, a detached coil at the neck of the aneurysm migrated up into the MCA and could not be removed with a retriever. Acute occlusion of the anterior cerebral artery and MCA caused progressive neurological deterioration, and an emergency microsurgical embolectomy was performed, which led to a good postoperative neurological outcome. However, angiographical follow-up after 1 year demonstrated marked compaction of the coils and recanalization of the giant aneurysm, which requires additional treatment.

ISSN:1015-9770    

DOI:10.1159/000108196

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Cerebral ischemia resulting from carotid artery atherosclerosis is related most frequently to atherosclerosis of the proximal internal carotid artery (ICA). Cerebral ischemic symptoms associated with atherosclerosis of the external carotid artery (ECA) occur uncommonly and usually only when the ipsilateral ICA is occluded. This report documents a case of thrombosis related to ECA atherosclerosis causing a stroke due to embolism via a patent ICA. The case also illustrates the value of performing cerebral angiography in a patient without a clearly identified cause of stroke.

ISSN:1015-9770    

DOI:10.1159/000108197

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

In patients with cerebrovascular disease the acetazolamide (ACZ) test is performed to evaluate the decrease in cerebral perfusion pressure through the investigation of the vasomotor reactivity (VMR). The latter is currently assessed with ACZ using several methods. Dynamic susceptibility contrast-enhanced gradient echo MRI techniques (DSC-MRI) might be an attractive tool to assess VMR. We described the course of VMR in a patient with high-grade internal carotid artery stenosis before and after surgery using DSC-MRI.

ISSN:1015-9770    

DOI:10.1159/000108198

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Cardiac myxomas are fragile endothelial tumors with a high incidence of cerebral embolism. After diagnosis they have to be excised as rapidly as possible. We report a patient with a myxoma of the left atrium who developed an intracranial hematoma. MRI showed multiple infarcts from repeated cerebral embolization and facilitated the decision for rapid surgery under severe heparinization. No increase of the hematoma size or further intracranial bleeding occurred. Bleeding into embolic infarction need not contraindicate relatively early maximal heparinization. The sensitivity of MRI for both ischemic and hemorrhagic changes may contribute to risk-benefit considerations affecting the management of such patients.

ISSN:1015-9770    

DOI:10.1159/000108199

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108200

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108427

出版商:S. Karger AG    

年代:1997

数据来源: Karger