ISSN:1015-9770    

DOI:10.1159/000108046

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108047

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Stroke-associated seizures and epilepsy provide an excellent clinical model to study both acute hyperexcitability after stroke and long-term tissue changes responsible for epileptogenic scar formation. The authors critically review the literature regarding stroke and seizures, to define the clinical spectrum of the association between stroke and seizures. Unfortunately, most of the studies performed in the past were either retrospective and heterogeneous or not designed to address this important issue. Constant improvements and advances in technology, including computerized tomography, magnetic resonance imaging, cerebral angiography and ultrasound, have made possible increasing sophistication in our investigation of patients with stroke and stroke-related seizures and emphasize the need for reassessment of this relationship. Part I gives an overview of the incidence of stroke-associated seizures, their phenomenology and dynamics, and attempts to identify specific risk factors for this association such as stroke subtypes starting with hemorrhagic conditions.

ISSN:1015-9770    

DOI:10.1159/000108048

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

In order to determine the significance of microemboli in atrial fibrillation (AF), we used transcranial Doppler ultrasonography to study 27 AF patients with recent stroke, 27 AF patients without stroke and 19 sinus rhythm (SR) controls. Where possible, both middle cerebral arteries were monitored for 30 min. Microembolic signals were associated with clinical stroke (p = 0.05) but were no more prevalent in the AF group than in SR controls. In stroke patients, microembolic signals were independently related to recency of stroke onset (p = 0.01) and absence of anticoagulation (p = 0.05). There was no association between the hemisphere in which microembolic signals were detected and either stroke territory or carotid stenosis. Of the 27 asymptomatic AF patients, 20 were taking anticoagulants. There was no relation, however, between microembolic signals and anticoagulation status in this group, possibly due to small numbers. Embolus detection may be useful in confirming cardioembolic pathogenesis in acute stroke and therefore may influence choice of therapy.

ISSN:1015-9770    

DOI:10.1159/000108049

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Background and Purpose: Stroke rehabilitation units have been shown to improve mortality and reduce morbidity and hospital length of stay as compared with conventional medical ward care. In contrast, the effectiveness of acute stroke units (ASUs), which only provide early in-patient care, is unknown. We have compared ASU care with that administered on a general medical or geriatric ward. Methods: Historical comparison of 116 consecutive patients admitted to a new ASU during the 6-month period from February to July 1994 with 128 consecutive patients admitted to general medical or geriatric wards during the previous 6-month period (August 1993 to January 1994). Results: Admission baseline characteristics were similar between the two groups. As compared with conventional general ward care, patients admitted to the ASU had a shorter stay in casualty, 6 h (4–6) versus 7 h (4–11; 2p = 0.03); reduced length of stay in hospital, 20 days (10–55) versus 31 days (13–80; 2p = 0.09); increased carotid Doppler investigation, 40/94 versus 25/101 (2p = 0.013); increased prescription of secondary prevention measures, aspirin 49/94 versus 33/101 (2p = 0.009) or treatment of hypertension 19/50 versus 5/47 (2p = 0.004); improved outcome, home: institution: death, 69:11:18 versus 63:13:32 (2p = 0.049). Conclusion: ASUs appear to contribute to improved care (investigations, secondary prevention) and outcome following stroke whilst patients spend less time in h

ISSN:1015-9770    

DOI:10.1159/000108050

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

To clarify the role of coagulopathy in cerebral infarction (CI) in adults with onset before age 45, we performed comprehensive and repeated hemostatic analyses in 77 consecutive young adult patients with CI. Coagulopathy was found in 24% (9% in older adults, n = 241); inherited coagulopathy was observed in 14 patients, including protein-S deficiency in 6, abnormal plasminogen (genetically confirmed) in 5, and protein-C deficiency in 2. Acquired coagulopathy confined to the acute stage was observed in 6 patients, including siently present anticardiolipin antibody in 3, and transiently present lupus anticoagulant in 2. Of 20 patients who did not have any risk factor for atherosclerosis, acquired coagulopathy was observed in 6. We conclude that protein-S deficiency and abnormal plasminogen are frequent and might be critical causes of CI in younger adults; transient coagulopathy is also a possible cause.

ISSN:1015-9770    

DOI:10.1159/000108051

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Activated protein-C (APC) resistance, a poor anticoagulant response to APC due to a mutation of the factor V gene (factor V Leiden, FVL), has recently been reported to be the most common hereditary coagulation disorder associated with familial deep venous thrombosis. However, all data have been derived from investigation of Western populations. Therefore we investigated the prevalence of low APC ratios (APC resistance) and FVL in Japanese patients suffering from ischemic stroke (n = 106) and neurological diseases without vascular involvement (n = 37). We conclude that the prevalence of low APC ratios (APC resistance) and FVL is very low in Japanese ischemic stroke patients, and the low APC ratio found in 2 of 143 subjects might be attributable to coexistent antiphospholipid antibodies and/or protein-S deficiency rather than to FVL. Our results suggest the existence of racial differences in the frequency and cause of APC resistance.

ISSN:1015-9770    

DOI:10.1159/000108052

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A common point mutation in the factor-V gene at the exact site (Arg 506) where activated protein C (APC) normally cleaves and inactivates the Va pro-coagulant accounts for APC resistance and is the most important genetic risk factor for venous thrombosis. It has also been suggested as a possible risk factor for stroke. We determined the prevalence of the Arg 506 Gln mutation in 180 patients (mean age 65.3 years) with cerebrovascular disease (138 stroke and 42 TIA) and compared it with that in 70 age-matched controls (mean age 64.9 years). The mutation was no more common in patients than controls [15/180 (8.3%) vs. 5/70 (7.1 %), p = 0,6]. Within the patient group there was no relationship between the presence of the mutation and age of stroke or the occurrence of TIA or stroke. There was no association between the mutation and any particular stroke subtype (large-vessel, lacunar, cardioembolic or unknown). The factor-V Arg 506 Gln mutation is not an important risk factor for stroke and TIA in an unselected group of patients, and routine screening is not justified.

ISSN:1015-9770    

DOI:10.1159/000108053

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

General intellectual impairment during the first year following stroke in 188 unselected, previously not demented patients aged 60–80 years was assessed with a comprehensive screening test, the Mattis Dementia Rating Scale, and compared to an age-matched population sample. Significant impairment occurred in 32, 26 and 26% of the stroke patients at 1, 6 and 12 months, which correlated to subjective complaints and a dependent life after discharge. Most patients scored stable or improved (84%), while 16% deteriorated significantly. Intellectual impairment correlated to CT lesion size and central atrophy, age and pre-stroke lower functional and social activity, as well as to stroke-induced handicap including aphasia, neglect, and increased mood symptoms. Thus, stroke-induced brain damage influences general intellectual function but may not be the sole reason for intellectual impairmen

ISSN:1015-9770    

DOI:10.1159/000108054

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108055

出版商:S. Karger AG    

年代:1996

数据来源: Karger