ISSN:1015-9770    

DOI:10.1159/000109024

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Extracranial vertebral artery (VA) dissections usually present with unilateral occipital-nuchal pain or headache, often followed by lateral medullary or cerebellum ischemia. Posterior cerebral artery (PCA) ischemia may also occur. Women predominate, and the dissections are most often bilateral. The distal extracranial and proximal VA segments are most often affected. Recovery is common, and the lesions usually regress. Intracranial VA dissections are found more often in men. The dissections are usually unilateral and often extend into the basilar artery (BA). Subarachnoid hemorrhage (SAH) and brainstem ischemia are the commonest presentations. Ischemia is often severe, and fatal infarctions are common. Occasionally, patients present with mass effect. Some patients have chronic bilateral VA dissections that cause repeated ischemia or recurrent SAH. BA dissections are rarer but also show a male preponderance. Severe, often fatal, ischemia is the commonest presentation. SAH is rarer. The dissections often extend into the distal BA and cause rostral BA, superior cerebellar artery and PCA territory infarction.

ISSN:1015-9770    

DOI:10.1159/000109025

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A hospital-based series of 712 patients with either transient ischemic attacks (TIAs) or reversible ischemic neurologic deficits (RINDs) was followed prospectively for 4 years in order to determine the long-term prognosis for cerebral and cardiac events in this group. The annual recurrence rates for new TIAs were 15.9, 5.3, 4.7 and 3.5 % in the 1st, 2nd, 3rd and 4th year, respectively, and the corresponding ones for fatal and nonfatal strokes were 3.37, 2.36, 1.7 and 1.3%. Strokes tended to occur in the 1st follow-up year (51%). The ratio of cerebral to cardiac deaths was 2.4. The survival of patients with RIND was similar to that of patients with TIA. Both survival rates were lower than those of an age- and sex-matched cohort sampled from the general population. Male gender emerged as a reliable predictor for cardiac events (p < 0.01), multiple TIA or RIND on admission predicted subsequent TIA (p < 0.001) but not stroke. A history of hypertension predicted cerebral death (p < 0.01), and a history of cardiac disease predicted cerebral (p < 0.01) and cardiac death (p 60 years (p < 0.05), hypertension (p < 0.05) and cardiac disease (p < 0.001).

ISSN:1015-9770    

DOI:10.1159/000109026

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Clinical, CT, Doppler, and angiographic findings of 404 consecutive patients with brainstem/cerebellar strokes were registered in a data bank. One hundred and sixty-nine of the patients (41.8%) had a minor stroke, 160 patients (39.6%) a disabling event, and 75 patients (18.6%) died during stay at the hospital. Early recurrence rate was low with 1.7%. In a forward stepwise logistic regression analysis independent variables of a disabling or fatal outcome were age, diabetes mellitus, initial somnolence or coma, tetraparesis, certain pupil abnormalities, dysarthria, an infratentorial infarct in CT, and a bilateral vertebral artery stenosis or occlusion in angiography. Independent variables of a fatal outcome were an initial decreased consciousness, tetraparesis, and a basilar artery occlusion in angiography. Without prognostic relevance in either multivariate or univariate statistical analysis were previous stroke, evidence of concomitant carotid artery disease by Doppler or CT, and unilateral vertebral artery stenosis or occlusion.

ISSN:1015-9770    

DOI:10.1159/000109027

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The aim of this investigation was to study the circadian periodicity of ischemic stroke onset with regard to the day of the week. Six hundred and nine patients, aged from 16 to 59 years, admitted to the Helsinki University Central Hospital because of ischemic cerebral infarction were included in this study. We observed a significant heterogeneity in stroke onset between working days and holidays, including Saturdays and Sundays (p < 0.001). The onset of ischemic stroke peaked between 6 and 8 a.m. during working days and between 8 and 10 a.m. during holidays. Strokes occurred more often during the 2 h following awakening than during any other time of the day. We conclude that there is an early-morning increase in the onset of ischemic cerebral infarction among people of the working age, which varies according to the type of day probably because of differing waking times.

ISSN:1015-9770    

DOI:10.1159/000109028

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We prospectively analyzed 286 consecutive patients with lacunar syndromes. Using neuroimaging, 227 patients (80%) had findings compatible with occlusion of a single penetrating artery (presumed lacunar infarct), whereas other lesions were found in 59 patients (20%). The mean age of patients with lacunar syndromes not due to lacunar infarcts (nonlacunar patients) was 56 ± 14 years; 37 patients (63%) were males. The causes were: cerebral hemorrhage (30), large cerebral infarct (26), demyelinating disease (1), cerebral metastasis (1) and cerebral angioma (1). Between nonlacunar and lacunar patients, there were significant differences in the mean age (56 vs. 60 years, p = 0,02), mean diastolic arterial tension on admission (90 vs. 94 mm Hg, p = 0.03); occurrence of diabetes mellitus (13 vs. 28%, p = 0.03), hemoglobin value (15 vs. 16 g/100 ml, p = 0.05), occurrence of headache (22 vs. 12%, p = 0.05), nausea or vomiting (17 vs. 8 %, p = 0.04), sensorimotor deficit (36 vs. 15 %, p = 000.6) and medical complications in the acute stage (54 vs. 18%, p = 0.0001). In conclusion, 1 of 5 patients with a lacunar syndrome may not have a lacunar infarct. Similar symptoms can also be caused by small hemorrhages and large infarcts, mainly in the subcortical striatocapsular region. In patients with a lacunar syndrome, neuroimaging is essential to exclude lesions other than lacunar infarctions

ISSN:1015-9770    

DOI:10.1159/000109029

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Fifteen patients with a subclavian steal phenomenon were subjected to a neurological examination, ultrasonic duplex scanning, transcranial Doppler ultrasonography and a computerised eye-movement investigation before and after a postischaemic hyperaemia test. Four patients showed symptoms of vertebrobasilar ischaemia. They had very low mean blood flow velocities in the basilar artery before (1 patient) or after (3 patients) postischaemic hyperaemia. In 11 asymptomatic patients, transcranial Doppler revealed normal blood flow velocities in the basilar artery, and the hyperaemia test did not change the basilar-artery blood flow significantly. Transcranial Doppler ultrasonography was useful for the investigation of blood flow velocities in the basilar artery in the subclavian steal phenomenon, and in selecting patients with an insufficient blood flow in the basilar artery provoked by the hyperaemia test. Investigation of eye movements did not improve the diagnostic accuracy.

ISSN:1015-9770    

DOI:10.1159/000109030

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

To measure interobserver agreement for the diagnosis of lacunar transient ischemic attack (TIA with a lacunar syndrome), four neurologists in alternating pairs interviewed 36 patients referred for TIA. The initial diagnosis was confirmed by both observers in 33 cases, who were then classified as lacunar or nonlacunar TIAs on the basis of their clinical history alone: patients who reported symptoms compatible with a predefined lacunar syndrome were considered as lacunar TIAs, whereas the other patients were grouped as nonlacunar TIAs. Both observers agreed on the diagnosis of lacunar TIA in 13 cases and of nonlacunar TIA in 18 cases. Chance-corrected agreement rate was excellent for the diagnosis of lacunar TIA (kappa = 0.88). We conclude that the clinical history allows reliable identification of patients with lacunar TIA.

ISSN:1015-9770    

DOI:10.1159/000109031

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Using a solid-phase enzyme-immunosorbent assay in sera of 84 patients with recent transient ischemic attack, ischemic stroke, or deep intracerebral hemorrhage, anticardiolipin antibodies (ACLA) were found in 34 cases (40%; 95% confidence interval = 30–51 %). Thirteen patients had class IgM antibodies, 11 had class IgG antibodies, and 10 had antibodies belonging to both classes. Patients with ACLA more frequently had histories of previous cerebrovascular events (CVE) (44 vs. 16%) and clinical features of occlusive peripheral vascular disease (76 vs. 38%) than patients without antibodies. The distribution of other stroke risk factors was similar in both groups. Further clinical observations are needed to establish the significance of ACLA in the pathogenesis of CV

ISSN:1015-9770    

DOI:10.1159/000109032

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In a prospective hospital-based registry of all first-ever supratentorial brain infarcts, 149 patients of the first 169 had noninvasive tests. Twenty-three of 38 with at least unilateral carotid obstruction had standard ophthalmological assessment aimed at detecting venous stasis retinopathy (VSR), which was found in 2: 9%; 95% confidence interval (CI): 0–20. In a consecutive series of 22 patients with VSR, who all had noninvasive carotid tests, 15 had at least homolateral carotid obstruction (68%; 95% CI: 50–86). Our findings argue against a simple cause-and-effect relationship between significant homolateral carotid obstructive disease and VSR and dispute the rationale for surgical procedures aimed at ameliorating symptoms in this ocular afflict

ISSN:1015-9770    

DOI:10.1159/000109033

出版商:S. Karger AG    

年代:1992

数据来源: Karger