摘要:

Background and Purpose—Proportions of patients with single and multiple aneurysms among patients suffering from subarachnoid hemorrhage (SAH) are not well established. We evaluated these proportions and the differences in outcome between SAH patients with a single aneurysm and those with multiple aneurysms in a defined population.Methods—Between 1989 and 1998, 2037 patients (age, 20 to 89 years) with ruptured intracranial aneurysm were treated in 11 hospitals in Nagasaki Prefecture. Multiple aneurysms were found in 361 of these patients. Age- and sex-specific incidences of ruptured aneurysm per 100 000 people were calculated.Results—For both single and multiple aneurysms, the incidences were significantly higher in women than in men 60 to 69 and 70 to 79 years of age. In every age category except 80 to 89 years, the frequency of multiple aneurysms was higher in women than in men. The overall frequency of multiple aneurysms was 20.2% in women, which was significantly higher than the 12.4% in men (P<0.0001). In patients 70 to 89 years of age, outcome was significantly worse (in terms of surgical complications) in patients with multiple aneurysms (12.1%) than in patients with a single aneurysm (6.0%).Conclusions—Among all patients with SAH, women ≥50 years of age outnumber other age and sex categories. Female sex itself is also associated with an increased rate of multiple aneurysms among SAH patients. Among the elderly ≥70 years of age, prognosis is less favorable for SAH patients with multiple aneurysms than for those with a single aneurysm.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Although it is recognized that in heterozygous familial hypercholesterolemia, large extracranial carotid vessels are affected by atherosclerosis, the risk of fatal stroke after treatment with cholesterol-lowering therapy remains uncertain. The goal of this study was to determine the risk of fatal stroke in patients with treated familial hypercholesterolemia.Methods—A cohort of 1405 men and 1466 women with definite or possible heterozygous familial hypercholesterolemia was recruited from 21 outpatient lipid clinics in the United Kingdom. Patients were followed up prospectively from 1980 to 1998 for 22 992 person-years for a median duration of 7.9 years (interquartile range, 4.9 to 12.0 years). The mortality rate was calculated, and the standardized mortality ratio for men and women 20 to 79 years of age was derived from the ratio of the observed deaths to the number expected in the general population of England and Wales (standardized mortality ratio=100 for the standard population).Results—A total of 169 deaths occurred; 9 (5.3%) were a result of stroke. The mortality rate from stroke was 0.39 per 1000 person-years (95% confidence interval, 0.18 to 0.74), and the standardized mortality ratio for fatal stroke was nonsignificantly lower than in the general population (79; 95% CI, 36 to 150).Conclusions—The results suggest that patients with treated familial hypercholesterolemia are not at increased risk of fatal stroke. However, the possibility cannot be excluded that untreated individuals are at increased risk, which would be consistent with the evidence that familial hypercholesterolemia is a panvascular disease.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—The pathogenic link between patent foramen ovale (PFO) and stroke remains unknown in most cases. We investigated the association between inherited thrombophilic disorders and PFO-related strokes in a series of young adults in the setting of a case-control study.Methods—We investigated 125 consecutive subjects (age, 34.7±7.3 years) with ischemic stroke and 149 age- and sex-matched control subjects. PFO was assessed in all patients with transcranial Doppler sonography with intravenous injection of agitated saline according to a standardized protocol. Genetic analyses for the factor V (FV)G1691Amutation, the prothrombin (PT)G20210Avariant, and theTT677 genotype of methylenetetrahydrofolate reductase (MTHFR) were performed in all subjects.Results—A pathogenic role of PFO was presumed in 36 patients (PFO+). Interatrial right-to-left shunt either was not detected or was considered unrelated to stroke occurrence in the remaining 89 patients (PFO−). The PTG20210Avariant was more frequent in the PFO+ group compared with control subjects and the PFO− group (PFO+ versus control subjects, 11% versus 2%; 95% CI, 0.04 to 0.94; PFO+ versus PFO−, 11% versus 1.1%; 95% CI, 1.09 to 109;P=0.047). A similar distribution was observed for subjects carrying either the PTG20210Avariant or the FVG1691Amutation (PFO+ versus control subjects, 19.4% versus 5.3%; 95% CI, 0.08 to 0.75; PFO+ versus PFO−, 19.4% versus 3.3%; 95% CI, 1.45 to 26.1;P=0.021). Combined thrombophilic defects were observed in 3 subjects of the PFO+ group, in 2 control subjects (8.3% versus 1.3%; 95% CI, 0.01 to 0.66;P=0.015), and in 0 subjects in the PFO− group. A trend toward a difference in the frequency of the FVG1691Amutation between PFO+ and control subjects was found after bivariate analysis (11% versus 3.3%;P=0.068) but not after multinomial logistic regression analysis. No significant association was found in the distribution of theTT MTHFRgenotype in the 3 groups.Conclusions—In young adults, the PTG20210Avariant and, to a lesser extent, the FVG1691Amutation may represent risk factors for PFO-related cerebral infarcts. A role of systemic thrombophilic disorders in the pathogenesis of this specific subtype of stroke may be hypothesized.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Transcranial Doppler has been extensively used to measure cerebrovascular control mechanisms, including autoregulation in humans and in patients with cerebrovascular diseases. There have been sufficient reports on the measurement of normal autoregulatory response (AR) and CO2reactivity (CR) of the middle cerebral artery (MCA) but few reports of these indices for the basilar artery (BA). We measured AR and CR in the BA in healthy volunteers to determine normal values and compared them with simultaneous measurements made in the MCA.Methods—Sixteen normal subjects were enrolled. Time-averaged mean velocities of maximum blood flow in the BA and MCA were continuously and simultaneously monitored by using transcranial Doppler along with continuous measurement of mean arterial blood pressure (MABP). Values were obtained during rest, alterations of end-tidal Paco2(ETCO2), and acute decrease and recovery of MABP. AR was evaluated by using the thigh cuff method and graded by the standard dynamic autoregulatory index (ARI), with values between 0 and 9. CR was measured as percentage change in time-averaged mean velocity per mm Hg ETCO2.Results—The mean age of 16 subjects was 27.38±8.50 years. Average baseline values for MABP and ETCO2were 82.29±7.10 and 42.75±3.77 mm Hg, respectively. Mean ARI was 4.62±1.26 for the BA and was 4.77±1.23 for the MCA (n=15) (P=0.598). Average CR was 2.54±0.39%/mm Hg ETCO2for the BA and 2.51±0.29%/mm Hg ETCO2for the MCA (n=16) (P=0.686).Conclusions—Our study demonstrates that ARI and CR values for the BA are similar to those for the MCA.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Matrix metalloproteinase-9 (MMP-9) activity has been associated with hemorrhagic transformation (HT) in experimental models of cerebral ischemia. Our aim was to investigate the relationship between MMP-9 concentrations in blood within 24 hours of stroke onset and subsequent HT of cerebral infarction.Methods—We studied 250 patients with a hemispheric ischemic stroke of 7.8±4.5 hours’ duration. Early CT signs of cerebral infarction were evaluated on admission. The HT and infarct volume were analyzed from the CT performed on days 4 through 7. MMP-9 levels were determined by enzyme-linked immunosorbent assay in blood samples obtained on admission.Results—HT was observed in 38 patients (15.2%): 24 (63.2%) had a hemorrhagic infarction, and 14 (36.8%) had a parenchymal hematoma. A total of 108 patients (43%) received anticoagulants before the second CT scan. Systolic and diastolic blood pressures, body temperature, frequency of early CT signs of ischemia (92% versus 22%), and treatment with anticoagulants (79% versus 37%) were significantly higher in the group with HT (P<0.001). Mean infarct volume was 126±60 cm3in the HT group and 90±68 cm3in the group without HT (P=0.003). Median (quartiles) plasma MMP-9 concentrations were higher in the HT group (193 [163, 213] versus 62 [40, 93] ng/mL,P<0.001), even in the 24 patients seen within 3 hours of symptom onset (P=0.014). MMP-9 levels ≥140 ng/mL had a positive and negative predictive value of HT of 61% and 97%, respectively. MMP-9 ≥140 ng/mL was associated with HT (odds ratio, 12; 95% confidence interval, 3 to 51;P<0.001) after adjustment for potential confounders and final infarct volume.Conclusions—High plasma MMP-9 concentration in the acute phase of a cerebral infarct is an independent biochemical predictor of HT in all stroke subtypes.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Periodontal and other infections have been suggested as potential risk factors for stroke. This study evaluates periodontal disease and tooth loss as risk factors for ischemic stroke.Methods—The study population consisted of 41 380 men who were free of cardiovascular disease and diabetes at baseline. Periodontal disease history was assessed by mailed validated questionnaires. During 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. Sex and socioeconomic status were inherently controlled for by restriction. Confounding variables were updated in the analyses for each 2-year follow-up interval.Results—We documented 349 ischemic stroke cases during the follow-up period. Men who had ≤24 teeth at baseline were at a higher risk of stroke compared to men with ≥25 teeth (HR=1.57; 95% CI, 1.24 to 1.98). There was little evidence of an increased risk with recent tooth loss during follow-up. A modest association was seen between baseline periodontal disease history and ischemic stroke (HR=1.33; 95% CI, 1.03 to 1.70). Addition of dietary factors to the model changed the HR only slightly.Conclusions—Our results suggest that periodontal disease and fewer teeth may be associated with increased risk of ischemic stroke.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Lower concentrations of albumin have been positively related to coronary disease. The aim of this project was to assess the association between serum albumin and carotid atherosclerosis.Methods—B-mode ultrasound was used to assess carotid plaques and intima-media thickness (IMT) among white subjects from 592 randomly ascertained families in the National Heart, Lung, and Blood Institute Family Heart Study. Logistic regression was used to estimate prevalence odds ratios of any carotid plaques.Results—Of the 2072 persons studied, 47% were men. Higher serum albumin was associated with younger age, lower body mass index, and lower prevalence of hypertension and coronary disease. Lower serum albumin levels were not associated with an increased odds of carotid plaques. From the lowest to the highest quartile of albumin, multivariate adjusted odds ratios for the prevalence of any carotid plaques were 1.05 (95% CI, 0.59 to 1.86), 1.34 (95% CI, 0.78 to 2.32), 1.03 (95% CI, 0.52 to 1.86), and 1.0 (reference), respectively, in men and 0.71 (95% CI, 0.40 to 1.26), 0.76 (95% CI, 0.42 to 1.36), 0.79 (95% CI, 0.46 to 1.36), and 1.0, respectively, in women. Similarly, in a linear regression model adjusted for demographic, lifestyle, and metabolic factors, serum albumin was not associated with carotid IMT. When the first 3 were compared with the highest quartile of serum albumin, regression coefficients for internal carotid IMT were 0.06458 (SE, 0.06408), 0.07205 (SE, 0.05469), and 0.000773 (SE, 0.05687), respectively, for men and −0.01795 (SE, 0.05085), −0.08501 (SE, 0.04800), and 0.009528 (SE, 0.04622), respectively, for women.Conclusions—Our data suggest that lower serum albumin levels are not associated with an increased odds of prevalent carotid atherosclerosis in either men or women.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Several factors have been held responsible for the development of atherosclerosis. To avoid the masking effect of age, we evaluated correlates of carotid atherosclerosis in patients <55 years of age.Methods—Plasma lipids, oxidative resistance of low-density lipoprotein, homocysteine, inflammatory markers, plasma viscosity, and red cell deformability were measured in fasting blood samples of 100 subjects: 45 patients with >30% stenosis of the internal carotid artery, 20 patients with carotid occlusion, and 35 control subjects. Stenosis and intima-media thickness (IMT) of the carotid artery were evaluated by duplex ultrasound.Results—White blood cell (WBC) count, plasma fibrinogen, C-reactive protein (CRP), and lipoprotein(a) levels were significantly higher in patients than in control subjects, and patients had increased IMT (P<0.01 for all comparisons). There was a tendency for higher homocysteine levels in patients. Smokers had higher WBC, fibrinogen, and CRP levels. After the effect of smoking was controlled for, WBC count, natural logarithmic transform of homocysteine, and online-measured IMT remained significantly higher in patients than in control subjects. WBC, fibrinogen, and CRP levels were highest in the highest IMT quartile (P=0.012,P=0.007, andP=0.036, respectively).Conclusions—Inflammatory markers and homocysteine have a more important role than lipid factors in early-onset carotid atherosclerosis. We cannot recommend the measurement of low-density lipoprotein peroxidation as a routine screening test to identify high-risk patients for early-onset carotid atherosclerosis. The confounding effect of smoking on inflammatory markers should be considered in studies on atherosclerosis.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Diffusion-weighted imaging (DWI) has been established as a marker of acute ischemic brain injury. We sought to determine the relationship between cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) and to explore whether the elapsed time between MRI acquisition and symptom onset alters this relation in acute stroke patients.Methods—Sixteen acute stroke patients were studied with DWI and perfusion-weighted imaging, from which ADC and CBF were calculated. ADC values were normalized (nADC) to the contralateral, nonischemic hemisphere and then correlated pixel by pixel with CBF within a region of interest defined by abnormal transit time. To explore potential temporal effects on the relationship between CBF and nADC, patients were divided into 2 groups based on the duration between symptom onset and MR imaging for data analysis: group A, 2 to 4 hours (n=8), and group B, 4.5 to 6.5 hours (n=8).Results—nADC was plotted against CBF for each pixel in all 16 subjects, and a composite relationship was derived. After a gradual decline, an abrupt drop in nADC occurred below a CBF threshold value of 21 mL · min−1· 100 g−1. When subjects were divided into early and late imaging groups, the group of patients imaged earlier (group A) had a lower threshold (15 mL · min−1· 100 g−1) than the group imaged later (group B, 24 mL · min−1· 100 g−1).Conclusions—Our results demonstrate that a relationship between nADC and CBF exists in the ischemic brain and that ADC values alone may provide useful information in predicting perfusion status. However, this relationship may change with elapsing time between stroke onset and imaging.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background and Purpose—Timely referral of appropriate patients to acute stroke units is necessary for effective provision of skilled care. We compared the characteristics of referrals with suspected stroke to an academic acute stroke unit via 3 primary referral routes: ambulance paramedics using a rapid ambulance protocol and stroke recognition instrument, the Face Arm Speech Test; primary care doctors (PCDs); and emergency room (ER) referrals.Methods—Patient characteristics, final diagnosis, and admission delay were recorded in all suspected acute stroke referrals in a 6-month period.Results—Four hundred eighty-seven patients (356 strokes/transient ischemic attacks) were admitted by the 3 routes: 178 by ambulance, 216 by PCDs, and 93 through the ER. The proportion of nonstrokes admitted by each route was similar (23%, 29%, and 29%, respectively). Ambulance paramedics’ stroke diagnosis was correct in 144 of 183 (79%) stroke patients who initially presented to them. Thirty-nine of 66 strokes/transient ischemic attacks referred via ER were taken there following initial ambulance assessment. Compared with PCDs, paramedics referred more total anterior circulation (39% versus 14%,P<0.0001) and fewer lacunar strokes (14% versus 31%,P<0.001) and admitted more patients (46% versus 12%,P<0.01) within 3 hours of symptom onset. The most common nonstroke conditions were seizures, infections and confusion, cardiovascular collapse, and cerebral tumors. Paramedics admitted more patients with seizures.Conclusions—Misdiagnosis of stroke is common in the ER and by PCDs. Paramedics using the Face Arm Speech Test achieved high levels of detection and diagnostic accuracy of stroke.

ISSN:0039-2499    

出版商:OVID    

年代:2003

数据来源: OVID