摘要:

Neurosyphilis is increasing due to a rise in the number of cases of syphilis in cocaine/crack addicts and in patients with HIV infection. Neurosyphilis is an example of a unique group of chronic CNS diseases that may cause either a degenerative or a vasculitic process, where the main pathogenic event is ''endarteritis obliterans'' of terminal arterioles. In meningovascular neurosyphilis, the most commonly involved artery is the middle cerebral artery. It generally presents with a prodromic phase, weeks or months before the onset of identifiable vascular syndromes. When there is focal inflammation the clinical picture is characterized by hemiplegia, whereas in the case of multifocal involvement of small intracranial arteries, it presents with a slowly progressive loss of cognitive functioning and personality changes. Since neurological deficits once established may only slightly improve with treatment, the goal of therapy is to halt the progression of the disease. Intravenous aqueous crystallin penicillin G is the most accepted treatment. HIV-infected patients have shown accelerated development of neurosyphilis, and it is suggested that coinfection with HIV alters the course of Treponema pallidum infection. Atypical manifestations of neurosyphilis have been reported among HIV patients, including fulminant presentation, rapid progression, atypical serological findings, and failure of conventional doses of penicillin to eradicate infection.

ISSN:1015-9770    

DOI:10.1159/000108021

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The capsular warning syndrome (CWS) is a specific form of crescendo transient ischaemic attack (TIA) where the ischaemia is thought to be restricted to the region of the internal capsule due to in situ disease of a single penetrating artery. The stroke risk associated with CWS may be extremely high, although this has never been quantified against an appropriate control group. Forty-one consecutive cases of CWS who had not developed a fixed deficit before admission to a stroke unit were compared to 85 randomly selected patients with other forms of TIA admitted during the same period. The follow-up was from 1 to 14 years (mean 5.3 years). The stroke risk was significantly higher among CWS patients (11.1% per year) compared to other forms of TIA (2.7% per year) with an odds ratio of 3.5 (95% CI 1.7–7.2). The difference in stroke risk was most marked during the first 30 days when 32% of CWS patients reached this endpoint compared to only 1 % of controls. There was no difference in mortality during the follow-up period. All forms of therapy appeared to have little impact on outcome except for a reduced stroke rate for those controls still on aspirin therapy at the time of follow-up. The identification of patients with CWS as a pathophysiologically and prognostically distinct form of TIA has important implications for management and potential therapeutic interventio

ISSN:1015-9770    

DOI:10.1159/000108022

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The association of post-stroke depression (PSD) and site of cerebral lesion was investigated in 117 patients with first-ever stroke in the Perth Community Stroke Study, who were depressed 4 months post-stroke. The site of lesion was previously localised by studying the CT scan in conjunction with the atlas of neuroanatomy and cranial computed tomography of Kretschmann and Wainrich, rather than the topographical approach used in most previous studies. Patients who were depressed immediately prior to the stroke were excluded. No support was found for the assertion that lesion location is a prime factor in the aetiology of PSD. Future investigations of this topic should encompass a much broader range of variables than lesion location, as the aetiology of PSD is likely to be multi-factorial.

ISSN:1015-9770    

DOI:10.1159/000108023

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The trends in 28-day mortality of cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage during the period 1986–1993 were assessed in the population aged 35–64 years in Kaunas, Lithuania. The Kaunas community-based stroke register was the source of data. During the study period, increasing trends in mortality from cerebral infarction and intracerebral hemorrhage were observed among both men and women. Mortality from subarachnoid hemorrhage decreased among women and did not change among men. These findings demand future detailed analysis of the specific risk factors for stroke in the Kaunas population as well as urgent response measures from public health officials in Lithua

ISSN:1015-9770    

DOI:10.1159/000108024

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The purpose of this study was to evaluate the safety and efficacy of local intra-arterial fibrinolysis (LIF) in the treatment of thromboembolic MCA occlusions that occurred during angiography and/or endovascular procedures. A retrospective analysis included 14 consecutive cases of iatrogenic thromboembolic MCA occlusions, encountered between January, 1983 and December, 1994 in a single neuroradiological department. During that period, a total of approximately 12,000 cerebral angiographies and of 4,000 neuroendovascular procedures were performed. Only patients in whom vessel occlusion by an embolic agent (e.g., glue, particles) could be positively excluded were accepted. LIF was performed using standard microcatheters. The fibrinolytic agents were streptokinase or urokinase, in varying dosages. Immediate LIF resulted in a complete recanalization of the previously occluded vessel within 2 h or less in 8/14 patients, all of whom were asymptomatic at discharge. Partial recanalization was achieved in 5/14 patients. Four of these patients showed mild to moderate neurological deficits on discharge. In 1 patient, LIF was initiated 3 h after embolic occlusion of the MCA due to cerebral angiography. No recanalization was observed in this case. The patient improved from her initial status but continued to show moderate hemiparesis and aphasia. None of the patients sustained an intracranial hemorrhage due to LIF. Acute thromboembolic occlusion of the MCA is a rare consequence of angiography and endovascular therapy. LIF is a safe and effective tool in the treatment of this complication. Thus, LIF is an indispensable part of neuroendovascular procedures. The well-defined onset time and site of vessel occlusion, the angiographically charted effect of fibrinolytic therapy, and the possibility of following up these patients with angiography, MRI and clinical investigation are all factors which render this complication and its correction a unique clinical model for evaluating the benefits and limitations of LIF in the treatment of acute MCA occlusion.

ISSN:1015-9770    

DOI:10.1159/000108100

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The accuracy of two-dimensional time-of-flight magnetic resonance angiography (MRA) in judging diameter narrowing of the extracranial carotid artery was studied using digital subtraction angiography (DSA) as the gold standard. Particular attention was paid to the specificity of the technique for 70–90% diameter stenoses. MRA and DSA examinations of 90 cervical carotid arteries were graded independently by 2 blinded readers. The examinations were compared in the categories 0–29, 30–69, 70–99 and 100% diameter narrowing (NASCET measurements). Overestimation of the degree of stenosis measured angiographically resulted in MRA sensitivity estimates of 77.8% for 0–29% angiographic stenosis and 31% for 30–69% angiographic stenosis. In the 70–99% stenosis group a false-positive rate of 21.9% resulted in 22 of 42 arteries being inappropriately placed in the high-grade stenosis group. In cases of 100% occlusion there was a false-negative rate of 35.7% (5 of 14 cases). MRA is reliable as a screening test for extracranial carotid occlusive disease. Limited ability of the technique to distinguish between ''surgical'' and ''non-surgical'' disease with inappropriate inclusion of some patients as potential surgical candidates limits its application as a single definitive pre-o

ISSN:1015-9770    

DOI:10.1159/000108026

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A 49-year-old man was referred for an episode of regressive hemiparesis, caused by proven brainstem infarction. Five weeks later, he started a series of posterior circulation transient ischemic attacks (TIAs) and angiography revealed left intracranial vertebral artery occlusion with contralateral severe vertebral artery stenosis and a significant collateral flow from the anterior spinal artery to the basilar artery. The TIAs stopped immediately after beginning of treatment with aspirin and heparin, and with this the patient has been asymptomatic for 4 years. This rare collateral pathway seems to be efficient in preventing hemodynamically induced ischemia in the posterior circulation, while antiaggregation and anticoagulation prevent further artery-to-artery embolism and may help to keep the collateral open.

ISSN:1015-9770    

DOI:10.1159/000108027

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Background and Purpose: Little is known about different varieties of transient monocular blindness (TMB) in relation to the subsequent occurrence of vascular outcome events. Very few studies have addressed the prognostic value of the form of the attack in patients with TMB. To try and distinguish benign and hazardous symptoms of TMB, we studied the prognosis of different subtypes of TMB in terms of subsequent vascular complications. Methods: We analysed the characteristics of transient monocular loss of vision, vascular risk factors, and vascular events during follow-up in patients with TMB, who were recorded in the Royal Victoria Infirmary, Newcastle, United Kingdom (n = 137) or were entered into the Dutch TIA Trial (n = 185). The mean follow-up period was 5.0 years. The attacks were categorized in different ''patterns''. These patterns were related to the occurrence of (1) the combined event of vascular death, stroke or myocardial infarction and (2) cerebral infarction (fatal or non-fatal). Results: Patients with attacks of blurred vision had a more than twofold risk of vascular outcome events than patients with blackened vision, complete or in part [hazard ratio (HR) 2.3; 95% confidence limits (CL) 1.2–4.5]. Involvement of only a part of the visual field of one eye during the attack (instead of complete loss of vision) carried a lower risk (HR 0.4; 95% CL 0.2–0.9). Conclusion: Our findings suggest a relation between different types of TMB and outcome, but this needs to be validated in a subsequent coh

ISSN:1015-9770    

DOI:10.1159/000108028

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108142

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108143

出版商:S. Karger AG    

年代:1996

数据来源: Karger