摘要:

Using death and functional status as end points, we prospectively analyzed the outcome 6 months after spontaneous intracerebral hemorrhage in 166 patients admitted to an acute-care stroke unit on the first day of their stroke. Seventy-one patients (43%) died, 69 (42%) had a satisfactory outcome, and 26 (16%) had a poor functional outcome. Early (30-day) survival was correlated with morphologic parameters on the initial computed tomogram (hemorrhage size, midline shift, and intraventricular spread of the hemorrhage), while later (6-month) survival was correlated with age. Using logistic regression, we found five independent predictors of satisfactory outcome at 6 months: age, hemorrhage size, intraventricular spread of the hemorrhage, limb paresis, and communication disorders. Of these, age was the most important predictor by far.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Finland has high rates of both cardiovascular disease and cardiovascular disease risk factors. We studied random samples of the population 30–59 years of age for risk factors in two provinces of eastern Finland in 1972 and 1977. We then followed both cohorts until 1985 through linkage with national hospital discharge and death certificate registers. The prevalence of hypertension and smoking in both provinces declined between 1972 and 1977, as did the stroke incidence in the 8-year period of follow-up of each cohort. We observed no differences in stroke incidence between the two provinces. The relative risk of stroke in the later period (1977–1985) was 0.71 and 0.58 for men and women, respectively, when compared with the earlier period (1972–1980). Overall, 28% of all stroke events could be attributed to hypertension, 17% to smoking, and 43% to these two factors jointly. The decrease in the prevalence of hypertension and smoking accounted for about 29% of the decline.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The hematologic disorders in patients with acute cardioembolic stroke are not fully understood, and no reliable measures are available to identify patients at high risk for recurrent embolism. We analyzed coagulation and fibrinolytic functions in 22 patients with cardiogenic cerebral embolism ≤24 hours after onset and in 25 age-matched controls. The levels of antithrombin III, protein C, and α2-plasmin inhibitor were significantly lower in the patients than in the controls (p< 0.001, 0.02, and 0.05, respectively). In contrast, the plasma concentrations of thrombinantithrombin III complex and crosslinked D-dimer were markedly higher in the patients than in the controls (p< 0.01 and 0.001, respectively). At the time of admission, the plasma concentrations of thrombin-antithrombin III complex and crosslinked D-dimer in the eight patients at high risk for recurrent embolization (one with prodromal embolism, three with intracardiac thrombi, and four with recurrent embolization) were 2.8 and 3.5 times, respectively, higher than those in the 14 patients without recurrence or thrombus formation. The lowest concentration of crosslinked D-dimer in the eight patients at high risk for recurrent embolization was 600 ng/ml on admission. Our results suggest that patients with acute cardioembolic stroke have various degrees of consumption coagulopathy and that the plasma concentrations of thrombin-antithrombin III complex and crosslinked D-dimer can be useful indicators of those who are prone to recurrent embolization during this stage.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We compared whole blood platelet aggregation, adenosine triphosphate release, platelet count, platelet crit (percentage volume of platelets), and mean platelet volume during the acute, subacute, and chronic periods of cerebral thrombosis in 22 patients with values in 29 controls. During the acute and subacute periods, platelet aggregation, platelet count, platelet crit, and mean platelet volume were significantly less in the patients than in the controls (p< 0.05-0.01) while the adenosine triphosphate release rate per volume of platelets was significantly greater (p< 0.05). During the acute period, infarct size showed a significant positive correlation with platelet aggregation (r= 0.59,p< 0.01) and adenosine triphosphate release rate (r= 0.70,P< 0.001) but a negative correlation with platelet count (r= − 0.44,p< 0.05). Our results suggest that platelet aggregation is reduced during the acute period due to the consumption of platelets during thrombogenesis but that the remaining individual platelets are hyperactive. Platelet consumption during the acute period increases with infarct size. During the chronic period, platelet crit and mean platelet volume were significantly less in the patients than in the controls (p< 0.01) while the adenosine triphosphate release rate was significantly greater (p< 0.01), suggesting sustained platelet consumption and chronically enhanced secretion of individual platelets.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We studied 119 patients with disturbance of consciousness following subarachnoid hemorrhage, due mostly to verified aneurysm rupture, admitted to five Italian neurosurgical departments over 18 months. Level of consciousness as assessed by score on the Glasgow Coma Scale ranged from 8 to 14 before the beginning of treatment; level of consciousness was assessed again 7, 14, and 21 days later. Patients were randomly allocated to treatment with monosialoganglioside or placebo according to a double-blind experimental design. The two treatment groups were homogeneous at entry with regard to the main clinical parameters. Both groups improved, but the rate and degree of improvement were greater in the monosialogangliosidetreated group. The difference was significant on days 14 (p= 0.04) and 21 (p= 0.02). Our results seem to confirm the hypothesis that monosialoganglioside reduces brain edema and provides nonspecific neuronal membrane protection.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To understand better the relationship between blood velocity measured by transcranial Doppler and cerebral blood flow measured by the133Xe inhalation method, we examined 23 patients undergoing evaluation in the Comprehensive Sickle Cell Center at Columbia University. Blood velocity in the middle cerebral artery was directly related to cerebral flow (r= 0.77;p< 0.05). A multivariate analysis in this sample made it possible to improve this correlation to account for more than 90% of the variability in cerebral blood flow by the use of transcranial Doppler measures of velocity and pulsatility along with the patient's age and hematocrit (r= 0.95;p< 0.001). It is likely that the combination of Doppler and clinical or demographic variables in other diseases will similarly improve the quantitative estimation of cerebral blood flow.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We assessed the potential of 2-MHz pulsed-wave transorfoital Doppler ultrasonography to delineate the role of the ophthalmic artery as a source of collateral cerebral blood supply by comparing oculopneumoplethysmography, transorbital Doppler ultrasonography, periorbital continuous-wave Doppler ultrasonography, and transcranial Doppler ultrasonography in 25 patients with unilateral internal carotid artery occlusion and five controls with 10 normal internal carotid arteries. Systolic ophthalmic artery blood velocity was reduced ipsilateral to an internal carotid artery occlusion (38.2 ±10.2 cm/sec) compared with the contralateral and control velocities (46.0 ±16.3 and 47.5 ±6.8 cm/sec, respectively;p< 0.05). Ophthalmic systolic pressure measured by oculopneumoplethysmography was 94.7 ±13.2 mm Hg ipsilateral to an internal carotid artery occlusion compared with 108.4 ± 153 mm Hg on the contralateral side (p< 0.01). Transorbital and periorbital Doppler ultrasonography detected reversed ophthalmic artery blood flow ipsilateral to an internal carotid artery occlusion in 44.0% and 40.0% of the patients, respectively. Systolic middle cerebral artery blood velocity was 55.2±22.3 cm/sec ipsilateral to an internal carotid artery occlusion compared with 79.4±23.5 cm/sec on the contralateral side (p< 0.05) and 101.2±18.9 cm/sec in the controls (p± 0.05). Reversed ophthalmic artery blood flow was associated with a low middle cerebral artery blood velocity and the lack of major intracerebral collaterals. Transorbital Doppler ultrasonography permits noninvasive evaluation of the ophthalmic artery. Transorbital Doppler measurements correlate with those from oculopneumoplethysmography and transcranial Doppler ultrasonography, reflect the hemodynamic consequences of internal carotid artery occlusion, and demonstrate the importance of the ophthalmic artery as a source of collateral blood supply to the brain.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We Investigated the effect of mild (34°C) postischemic hypothermia on hippocampal neuronal damage in 43 rats as a function of the duration of forebrain ischemia. Two temperatures and two durations were investigated. In two normothermic groups ischemia lasted 8 (n= 15) and 12 (n= 10) minutes, respectively. In two hypothermic groups ischemia lasted 8 (n= 9) and 12 (n= 9) minutes, respectively, and was followed immediately by the lowering and maintenance of rectal temperature to 34°C for 2 hours. Seven days after the ischemic insult, the rats were sacrificed and the brains were prepared for histologic analysis; the percentage of necrotic neurons among the total neuronal population in selected CA1/2 sectors of the hippocampus was determined. There was a significant decrease in the percentage of necrotic neurons in the central (115% versus 55.5%,p= 0.006) and lateral (62.5% versus 38.9%,p= 0.005) areas and in the overall CA1/2 sector of the hippocampus (71.8% versus 522%,p= 0.008) for the 8-minute hypothermic group compared with the 8-minute normothermic group. In contrast, no differences were detected in any area of the hippocampus between the 12 -minute normothermic and the 12-minute hypothermic groups (p= 0.29-0.49). Our data indicate that mild postischemic whole-body hypothermia ameliorates neuronal survival when ischemia lasts 8 minutes but not 12 minutes.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Cerebral ischemia is accompanied by many of the cardinal features of acute inflammation such as neutrophil and platelet activation and accumulation. We sought to determine whether circulating neutrophils or platelets contribute to brain injury in a rabbit model of thromboembolic stroke that includes a fixed duration of superimposed systemic hypotension. We randomized 18 rabbits to receive either antineutrophil antiscrum (n= 6), antiplatclct antiscrum (n= 5), or nonimmune serum (n= 7). We assessed brain ischemia by measuring cerebral blood flow, intracranial pressure, and infarct size. Following the intracarotid administration of an autologous clot, cerebral blood flow in all groups fell to <5 ml/100 g/min during induced hypotension. After restoration of baseline blood pressure, mean cerebral blood flow in neutropenic animals recovered to 20–30 ml/100 g/min while that in control and thrombocytopenic rabbits remained at <10 ml/100 g/min. Intracranial pressure in control animals rose steadily to a final value of 241% of baseline, while a much smaller increase (148% of baseline) was noted in the thrombocytopenic group; no change from baseline was evident in the neutropenic group. Infarct size was significantly (p<0.05) reduced in the neutropenic group but not in the thrombocytopenic group. These results suggest that neutrophils may be important contributors to ischemia-induced brain injury whereas the role of platelets is more subtle.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

We investigated the effects of nilvadipine, a calcium antagonist, on cerebral ischemia in rats. Under halothane anesthesia, 30 rats had a 3-0 nylon suture introduced through the extracranial internal carotid artery to occlude the left middle cerebral artery. Nilvadipine was dissolved in polyethylene glycol 400. Immediately following occlusion, group 1 rats (n= 10) were treated subcutaneously with vehicle and group 2 and 3 rats were treated with 1.0 (n= 10) add 3.2 (n= 10) mg/kg nilvadipine, respectively. Pcrfusion fixation was performed 24 hours later, and the histopathologlc outcomes were quantified. In group 1 infarct volume was 28.2 ±11.4% of the total cerebral volume; in groups 2 and 3 infarct volumes were 25.5±11.6% (NS) and 13.9±9.2% (p< 0.05 different from group 1), respectively. Nilvadipine decreased ischemic neuronal injury in a dose-dependent manner and may be of use in the treatment of cerebral ischemia.

ISSN:0039-2499    

出版商:OVID    

年代:1991

数据来源: OVID