摘要:

Thirty-five years have demonstrated conclusively that stroke is a preventable disease. Clinical trials have determined that: anticoagulants prevent stroke when thrombi are in the left side of the heart and are of benefit in the presence of atrial fibrillation. Aspirin and ticlopidine reduce the risk of stroke in symptomatic patients. No other platelet-inhibiting drugs alone or in combination have a proven value. Primary stroke prevention trials remain to be done in the population most likely to benefit from aspirin. Bypass surgery has failed to prevent stroke; patients should not be subjected to this procedure except in an experimental setting. The appropriate indications and benefits from carotid endarterectomy in symptomatic and asymptomatic patients remain uncertain; present studies will give definitive answers to this 35-year-old question.

ISSN:1015-9770    

DOI:10.1159/000108819

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We prospectively reviewed the clinical and neuroimaging features of 10 men and 7 women (aged 25-81) with recent superior cerebellar artery territory infarctions. Six patients had superior cerebellar artery infarctions restricted to one cerebellar hemisphere. The remaining patients had infarctions in more than one vascular territory (6 had bilateral superior cerebellar artery infarctions; 4 associated brainstem infarctions; 3 associated supratentorial infarctions and 5 infarctions in other cerebellar vascular territories). Presumptive etiologies were: 7 atherothrombotic, 6 cardioembolic (3 had atrial fibrillation, 1 with a left atrial thrombus; 2 had myocardial infarctions, 1 with a left ventricular thrombus; 1 had a paradoxical embolus with Ebstein''s anomaly and atrial septal defect), 2 vertebral artery dissection and 2 undetermined cause. Two patients died. Two patients suffered major morbidity; 1 developed hydrocephalus requiring ventricular shunting and the other had brainstem compression requiring emergent posterior fossa decompression. Superior cerebellar artery infarctions result from a number of causes, but are usually of presumptive atherothrombotic or cardioembolic origin. Although other reports suggest a benign course with superior cerebellar artery infarctions, they can be associated with serious morbidity or death.

ISSN:1015-9770    

DOI:10.1159/000108820

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

In a retrospective study, we investigated the value of cerebral angiography in 64 patients with cerebral infarction aged 18–44 years. The patients were extensively investigated by computerized tomography, echocardiography, electrocardiogram, coagulation studies and other blood laboratory parameters. Forty-two patients were investigated by aortocervical angiography alone, 17 by both aortocervical and selective angiographies, and 5 by selective carotid or vertebral angiography alone. One patient who underwent selective carotid angiography developed transient neurological deficits, while none in the group who underwent aortocervical angiography developed any neurological complications. Thirty-seven (56%) of the patients had pathoiogical vascular lesions on angiography, located in arteries supplying the ischemic region. The most common findings were stenosis or occlusion of one carotid or vertebral artery. In 23 (36%) of the patients, angiography added clinically useful Information in determining the probable cause of the cerebral infarction. The corresponding figure for echocardiography was 11%. In 8 patients, the result of the angiography had a decisive influence on the treatment of the patient. Aortocervical angiography offered a satisfactory survey of lesions of the arteries from the aortic arch to the base of the skull. Selective angiography was necessary to identify 5 of the 8 patients in whom the pathological findings resulted in treatment. Thus, the adequate investigation of young patients with cerebral infarction should include both aortocervical and selective cerebral angiographies. Although cerebral angiography is associated with some risk of complication, it seems to be an acceptable risk in view of the diagnostic valu

ISSN:1015-9770    

DOI:10.1159/000108821

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Fifteen healthy subjects were tilted at 70° from the horizontal during a period of 4 min while recording the Doppler signal from the middle cerebral artery. Digital signal analysis carried out off-line provided the following data: mean spatial velocity (v), signal power (p) as an index of cross-sectional area, (v•p) as an index of volume flow. Flow as averaged over the entire period of tilted position was found to be 101 ± 25% of the supine steady state. There was evidence for autoregulatory vasodilation including the trunk of the middle cerebral artery. In a patient suffering from orthostatic dysregulation flow fell to 49% of its value as measured in supine position. From the evidence of this observation the clinical application of the method seems to warrant further st

ISSN:1015-9770    

DOI:10.1159/000108822

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Serum lipoprotein(a) [Lp(a)] was determined in 205 patients (71 ± 10 years; mean age ± SD) with acute stroke and in 204 nonhospitalized referent subjects in the 60- to 80-year age range. Lp(a) levels were significantly higher in the stroke patients (median 87 vs. 63 mg/l; p = 0.002). Within the group of stroke patients, Lp(a) levels were similar among men and women, correlated modestly with age (r = 0.15; p = 0.04) and increased only marginally through the first days after stroke. Patients with concomitant ischemic heart disease tended to have higher Lp(a) than those without coronary disease (median 103 vs. 71 mg/l; p = 0.07). Hypertensive patients had higher levels than normotensives (97 vs. 73 mg/l; p = 0.02) and this relation between hypertension and Lp(a) was particularly strong among patients below 65 years of age (p = 0.01). Median Lp(a) level was 75 mg/l in patients not on beta blocker treatment, 103 mg/l in patients on selective beta blockers and 150 mg/l in those on nonselective beta blockers. In a multiple regression model, the use of beta blockers was a predictor of high Lp(a) levels (p = 0.03) that was independent of other clinical variable

ISSN:1015-9770    

DOI:10.1159/000108823

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We report a series of 40 patients with anticoagulation-related intracerebral hemorrhage. Minor head trauma was most often noted as an additional factor causing the hemorrhage. Overall mortality was 50%. Only noncomatose patients survived. The fate of the surviving patients was quite favorable. Eighteen (90%) recovered completely and only 2 (10%) were left disabled. One third of the patients were anticoagulated without a medical indication. Therefore, the most efficient way to reduce anticoagulation-related cerebral hemorrhages would be to follow today''s medical guidelines for anticoagulation treatment more carefully than many physicians do. Treatment of anticoagulation-related cerebral hemorrhage consists in discontinuation of anticoagulation, administration of clotting factors and vitamin K, and surgical drainage of the hematoma in selected cases.

ISSN:1015-9770    

DOI:10.1159/000108824

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The Scandinavian hemodilution study in acute ischemic stroke used the neurological scale presented here in assessing prognosis and long-term outcome. The purpose of the present study was to test its interobserver reliability. The scale consists of two parts: one for assessing the acute prognosis and one for assessing the neurological deficit acutely and at follow-up. The items rated are: consciousness, gaze palsy, Iimb weakness, dysphasia, orientation, facial palsy and gait. Fifty acute stroke patients were rated by 2 doctors each. The agreement rates were corrected for chance (kappa statistics). Interobserver agreement was good to excellent with weighted kappa values ranging from 0.688 to 0.912. Patients who died within 6 weeks had a lower prognostic score than the survivors. The long-term scores of 2 observers were highly correlated (R = 0.954). The scale provides a reliable instrument for stratification of stroke patients and for evaluation of long-term outcome.

ISSN:1015-9770    

DOI:10.1159/000108825

出版商:S. Karger AG    

年代:1991

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108896

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Lateral tegmental pontine haemorrhages were diagnosed in 3 young, normotensive patients. All had stereotyped symptoms and signs. In 2, the onset was subacute, and the haemorrhage was recurrent, suggesting the presence of an underlying vascular malformation. The diagnoses were established by computerised tomography or magnetic resonance imaging, with angiographic abnormalities confirmed in all cases. Two patients had surgical management and 1 had stereotactic radiosurgery. The risks and potential benefits of these therapeutic options are discussed.

ISSN:1015-9770    

DOI:10.1159/000108826

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Previous studies have failed to document the occurrence of conduction aphasia in patients with acute putaminal hemorrhage. We present a patient with this aphasic condition in the period immediately following putaminal hemorrhage, which improved within several weeks after onset. This recovery is interpreted within the connectionist framework as a reflection of resolving hemorrhagic-mass effect on subcortical structures implicated in conduction aphasia.

ISSN:1015-9770    

DOI:10.1159/000108827

出版商:S. Karger AG    

年代:1991

数据来源: Karger