摘要:

We have reviewed the twelve prospective follow-up studies of angiographically documented symptomatic carotid artery occlusion in a total of 1,261 patients who were followed up over a mean period of 45.5 months. The average risk of death was 9.5% per year (95% confidence interval (CI): 8.4–10.7%), the risk of stroke was at least 7.0% per year (95% CI: 6.2–7.7%) and the risk of stroke ipsilaleral to the carotid occlusion was 5.9% per year (95% CI: 4.3–7.5%). The true risk of death and stroke has probably been underestimated in this review because of probable underreporting of non-stroke deaths, symptomatically mild strokes and stroke in vascular territories outside that of the occluded carotid artery. However, the proportion of strokes occurring ipsilateral to the occluded carotid artery may have been overestimated because some studies only reported the rate of ipsilateral stroke and not the rate of stroke in vascular territories outside that of the occluded carotid artery. The nature and severity of the presenting ischaemic symptoms did not appear to have a significant impact on prognosis. The mechanisms of stroke ipsilateral to the occluded carotid artery probably include embolism from the proximal ''stump'' through the collateral circulation, thrombo-embolism from propagated distal thrombosis and haemodynamic insufficiency. These results have been derived from methodologically heterogeneous studies and can only be used as an approximate guide to prognosis. Nevertheless, it is clear that carotid occlusion is not a stable condition, and patients should benefit from measures aimed at the prevention of subsequent major cardiovascular as well as cerebrovascular e

ISSN:1015-9770    

DOI:10.1159/000108851

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Acute confusional states (ACS) were studied in 155 consecutive representative patients (mean age 73 years) with acute cerebrovascular disorders. Testing for ACS could be done in 94% of the patients. Sixty-nine of the 145 testable patients (48%) were acutely confused on admission or developed ACS within 7 days of admission. The mean age for the patients who developed ACS was 76 years compared with 69 years for patients without ACS (p < 0.001). Fifty-six of 113 patients (50%) with cerebral infarction, 6 of 21 patients (29%) with transitory ischemic attack and 7 out of 8 patients (88%) with intracerebral hemorrhage developed ACS. ACS were more common in patients with left-sided brain lesions (38/65; 58%) than in patients with right-sided brain lesions (18/47; 38%, p < 0.05). Multivariate analysis showed that extensive extremity paresis, previous ACS, left-sided brain lesions, old age and treatment with drugs with anticholinergic effects were independent predictors for ACS. ACS were associated with poststroke complications such as myocardial infarction, pulmonary embolism, pneumonia, deep vein thrombosis, urinary retention or urinary tract infection. Extensive paresis and ACS were the main independent predictors for discharge to geriatric rehabilitation.

ISSN:1015-9770    

DOI:10.1159/000108852

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Preliminary reports on percutaneous transluminal angioplasty (PTA) of the internal carotid artery are promising. Our experience on 32 patients with symptomatic carotid stenoses is reviewed here. Successful dilation was obtained in 33 of 35 procedures, with an estimated patency rate of 85% at 1 year. In 3 cases, transient neurologic symptoms occurred within 2 days of angioplasty. Transient neck pain and bradycardia were the most commonly observed complications during carotid dilation. Carotid PTA may be considered as a valid alternative to endarterectomy, at least in selected cases.

ISSN:1015-9770    

DOI:10.1159/000108853

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

In 8 patients with delayed neurological deterioration, following acute CO poisoning, the clinical outcome, the neuroimaging and the positron emission tomography (PET) findings were compared. The severity of the neuropsychiatric sequelae correlated well with the changes of blood flow and oxygen metabolism and the CT scan findings in the brain. Nuclear magnetic resonance (NMR) appeared to have less predictive value on the clinical outcome. In the severe cases of post-CO encephalopathy, the ischemic nature of the metabolic changes could be demonstrated in the cortical regions by PET. However, it could not be determined whether the disturbances in the basal ganglia and cerebral white matter were only due to ischemia or to an additional cytotoxic effect of CO.

ISSN:1015-9770    

DOI:10.1159/000108854

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

In 755 patients with acute stroke, blood pressure was followed throughout the hospital stay. The blood pressure showed a fast decline after admission. Patients with intracerebral hemorrhage had higher blood pressure levels and a slower blood decline than patients with other stroke diagnoses. Patients with a history of hypertension consistently had higher blood pressures than nonhypertensives throughout the acute phase. The blood pressure showed grossly the same course irrespective of the latency between the onset of stroke Symptoms and admission. Patients with severer neurological deficits or impaired consciousness had no higher blood pressures than the other patients. It is hypothesized that mental stress may play an important role for the high blood pressure levels often seen on hospital admission in stroke patients.

ISSN:1015-9770    

DOI:10.1159/000108855

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Most of the information on the role of the endothelium for the vascular reactivity comes from in vitro experiments on noncerebral vessels. Few studies address the contribution of the endothelium to the cerebrovascular reactions in vivo. In the present study, arterial cerebral air embolism was employed to induce endothelial damage in anesthetized cats. The endothelial injury was verified by scanning electron microscopy: air embolism induced obvious damage to the endothelial layer, consisting of flattening, superficial peeling and/or fissures within and between endothelial cells. Cell debris and small platelet and erythrocyte aggregations were also observed. The present study concerns the effect of endothelial damage on the reactivity to the vasoconstrictor substances serotonin (10–10–10-4M) and norepinephrine (10–9–10–3M) in vivo. The reactions of the same pial arteries to these substances were tested using the microapplication method before and after air embolism. In contrast to the abolition of the vasodilatation to carbachol found in a previous study, the constriction of pial arteries to serotonin and norepinephrine was preserved after air embolism, although it was diminished in the case of norepinephrine. These results are consistent with the hypothesis that the endothelium may be less important for vasoconstriction than for vasodilatation in cerebra

ISSN:1015-9770    

DOI:10.1159/000108856

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

In a series of 187 consecutive patients sustaining aortic dissection during a 15-year period, 144 had an acute dissection of type A, whereas 43 patients suffered from other types of aortic dissection (type B). 13 patients with acute aortic A dissection and 3 patients with acute aortic B dissection developed neurological symptoms preoperatively. 11 patients presented diminished or absent carotid pulse and various cerebral symptomatology, 1 had transient ischemic attack and normal carotid pulse. 4 patients had paresis or paralysis of the lower extremity. Three patients died without operation and one other patient died in the immediate post-operative period due to the brain pathology. Four patients presented with persistent or improved hemiplegia or paraplegia after operative repair, one patient showed increase of the neurological symptomatology and 7 patients showed rapid improvement of the symptomatology after repair of the thoracic aorta and had resolution of their neurological deficit; they were evaluated between 2 and 8 years postoperatively and were in a very satisfactory general condition. Preoperative stroke is known to be a predictor of late mortality after ascending aortic dissection. However, its presence should constitute only a relative contraindication to operation because full neurological recovery after thoracic aortic repair and satisfactory long term outcome are possible.

ISSN:1015-9770    

DOI:10.1159/000108857

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

A 46-year-old Korean man is reported who developed a right-sided pure sensory stroke. Magnetic resonance images identified a small, left-sided lentiform lacune which abutted on the lateral portion of the posterior limb of the internal capsule.

ISSN:1015-9770    

DOI:10.1159/000108858

出版商:S. Karger AG    

年代:1991

数据来源: Karger