ISSN:1015-9770    

DOI:10.1159/000108035

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108036

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Background: Several studies have shown that stroke units improve patient outcome under test conditions. The reproducibility of these findings in mainstream practice remains unknown. Patients and Methods: An observational study over 3 years was undertaken on a stroke rehabilitation unit to determine variances in patient composition and outcome from data collected during a randomised controlled study. Results: Three hundred and sixty patients were managed on the stroke rehabilitation unit over the 3-year period of the study. Of these, 124 participated in a randomised study (Year 1) and 236 were managed on the stroke rehabilitation unit in the 2 years after the study (Years 2 and 3). The proportion of patients with very severe strokes managed on the unit increased from 18 (15%) in Year 1 to 33 (27%) in Year 3 (p < 0.01). The outcome in stroke patients with intermediate prognosis managed on the unit after its transition to mainstream practice was similar to the outcome observed under trial conditions. Despite comparable stroke characteristics the number of severe stroke patients being discharged home and median discharge Barthel Index rose significantly over the 3-year period (discharge home: 48 vs. 16%, p < 0.02; discharge Barthel Index: 9 vs. 6, p < 0.05). Conclusions: Mainstream stroke rehabilitation units have a higher proportion of severely disabled stroke patients compared with trial units. Outcome observed in stroke patients within each prognostic group managed on the stroke rehabilitation unit during trial conditions is maintained after transition to mainstream practice.

ISSN:1015-9770    

DOI:10.1159/000108037

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

To evaluate the frequency of subclinical cerebral complications of carotid endarterectomy, 19 patients were studied before and 1 month after surgery. Significant neurological complications were detected only in 1 patient (5%), while neuropsychological deterioration was found in 12 patients (63%) as compared to 5 (29%) of 17 control subjects undergoing other vascular surgery procedures (p < 0.05). MRI detected new cerebral lesions in 3 (16%) patients, who also showed a decline in cerebral perfusion reserve in the peri-infarct area as assessed by acetazolamide-enhanced SPET. Global cerebral perfusion reserve declined in three patients. Quantitative EEG did not reveal deterioration in any patients. The possible prognostic significance of these sublinical complications should be defined.

ISSN:1015-9770    

DOI:10.1159/000108038

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

To evaluate the frequency of subclinical cerebral complications of carotid endarterectomy, 19 patients were studied before and 1 month after surgery. Significant neurological complications were detected only in 1 patient (5%), while neuropsychological deterioration was found in 12 patients (63%) as compared to 5 (29%) of 17 control subjects undergoing other vascular surgery procedures (p < 0.05). MRI detected new cerebral lesions in 3 (16%) patients, who also showed a decline in cerebral perfusion reserve in the peri-infarct area as assessed by acetazolamide-enhanced SPET. Global cerebral perfusion reserve declined in three patients. Quantitative EEG did not reveal deterioration in any patients. The possible prognostic significance of these sublinical complications should be defined.

ISSN:1015-9770    

DOI:10.1159/000315480

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

We compared the degree of carotid stenosis, risk factor profile, and effect of carotid surgery on incidence and type of recurrent stroke in lacunar infarct and non-lacunar infarct patients from the European Carotid Surgery Trial. The two patient groups were defined by the site and size of any symptomatic infarct on the pre-randomisation CT scan. The follow-up ischaemic carotid strokes were classified into lacunar, non-lacunar or uncertain. The risk factor profile was similar for the 222 lacunar and the 404 non-lacunar infarct patients. However, lacunar infarct patients had less severe carotid stenosis (p< 0.001). Small numbers did not allow conclusions about the efficacy of carotid surgery in those few lacunar infarct patients who had severe carotid stenosis. These findings are consistent with the hypothesis that severe carotid stenosis in lacunar infarct patients is usually incidental, and so 'asymptomatic', and that lacunar infarcts are most likely to be due to intracranial small-vessel disease.

ISSN:1015-9770    

DOI:10.1159/000108039

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The aim of this case-control study was to test the hypothesis that women with ischemic stroke exhibit changes in their sex hormone concentrations. Cases were 149 consecutive female patients with acute ischemic stroke. Fifty-one of these were examined after 6 months. Controls were 80 healthy women at the same age. Stroke severity was assessed on the Scandinavian Stroke Scale and infarct size by computed tomographic scan. Mean serum 17β-estradiol was 76 ± 5 pmol/l (SEM) in stroke patients and 52 ± 5 pmol/l in controls (p < 0.0001); the respective values of serum testosterone were 1.58 ± 0.11 and 0.90 ± 0.07 nmol/l (p < 0.0001). In stroke patients, high levels of 17β-estradiol and testosterone were significantly associated with stroke severity and infarct size, as well as with 6-month mortality. In a subgroup of patients, serum 17β-estradiol was not significantly changed after 6 months, whereas serum testosterone significantly decreased and was similar to the level in the controls. We conclude that serum concentrations of 17β-estradiol and testosterone are associated with stroke severity and 6-month mortality. The present data do not address the question of causality.

ISSN:1015-9770    

DOI:10.1159/000108040

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Although borderzone brain infarcts lack a uniform definition and are difficult to define because of significant variability in cerebral vascular supply, they are presumed to be related to haemodynamic factors such as carotid obstruction. In this study on 813 first-ever stroke patients, borderzone infarcts were defined not only according to the currently used 'classic' definition, but also taking into account the variability in cerebral vascular supply areas. Borderzone infarcts, defined in either way, were compared with remaining superficial infarcts with respect to vascular risk factors. We identified 5 patients with 'classic' borderzone infarcts (slit-like infarcts along the borders of the different vascular territories). Four of these had a carotid occlusion, which was significantly more frequent than in remaining superficial infarcts (odds ratio, OR: 15.52; 95% confidence interval, CI: 2.01–119.68; p = 0.008). Borderzone infarcts defined accounting for variability in vascular supply did not show any difference with regard to specific risk factors when compared with remaining superficial infarcts. Chronic obstructive pulmonary disease (COPD) and especially COPD combined with diabetes mellitus was more frequent among borderzone infarcts defined in either way (adjusted OR 21.3, 95% CI, 3.80–120, p = 0.0004, and adjusted OR 12.0, 95% CI 2.26–63.6, p = 0.003, respectively); this factor may increase the risk of infarction in case of reduced flow or thrombo-embolism. In conclusion: 'classic' borderzone infarcts are associated with ipsilateral carotid occlusive disease; this association is lost when expanding the definition, although COPD combined with diabetes mellitus then appears as a new risk factor associated with borderzone infarcts.

ISSN:1015-9770    

DOI:10.1159/000108041

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The present study was performed to elucidate the time course of the cerebral and cerebellar blood flows and the significance of SPECT for predicting the outcome in cerebral embolism. 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) SPECT was repeatedly performed in 60 patients with unilateral cerebral embolism. The distribution of 99mTc-HMPAO in the infarct area decreased in the acute phase, increased from 3 h to 22 days after the stroke and then gradually and eventually decreased in the chronic stage. This tendency was observed irrespective of the thrombolytic therapy. The asymmetry index (AI) in the cerebral hemisphere in the first 6 h and later than 30 days correlated significantly with activities of daily living in the chronic stage (p < 0.05). The cerebellar AI after, but not up to 14 days also correlated with the long-term outcome (p < 0.05). In conclusion, a high distribution of 99mTc-HMPAO frequently and transiently occurs in the subacute stage of cerebral embolism. The cerebral and cerebellar asymmetry of the 99mTc-HMPAO distribution is an important predictive value for the outcome; however, the timing of SPECT is critically important.

ISSN:1015-9770    

DOI:10.1159/000108042

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

We present a patient with bilateral medial medullary infarction demonstrated by magnetic resonance imaging (MRI). A 70-year-old male suffered complete quadriplegia and bulbar palsy without impairment of deep sensation. The MRI on the 10th day revealed an infarcted lesion in the bilateral ventral half in the middle of the medulla oblongata. Three months later, atrophy in both lateral sides of the tongue was observed, which may suggest the involvement of a part of the Xllth nerve intranuclear fibers, excluding Xllth nerve nuclei. A review of the literature has disclosed that the combination of clinical signs described as typical in textbooks is not common among reported patients.

ISSN:1015-9770    

DOI:10.1159/000108043

出版商:S. Karger AG    

年代:1996

数据来源: Karger