摘要:

In an attempt to answer unresolved questions and to suggest directions for future research concerning stroke in black populations, data from the National Center for Health Statistics were examined and published studies were reviewed. Stroke was the third leading cause of death among U.S. blacks in 1982, accounting for 18,698 deaths, 8.25% of the total. Black men aged 35–74 years were 2.5 times and black women 2.4 times as likely as whites to die of stroke. A long‐term decline in stroke mortality rates continued through 1982, with the declines since 1968 probably due to improved hypertension control. Data on morbidity trends are lacking. About 7% of black men and 11% of black women in the U.S. noninstitutionalized population aged 65 and over reported having had a stroke in 1977, black women having the highest prevalence of any group. In several studies, black women had higher incidence rates of stroke than white women in each age group. Black men had higher incidence rates than whites up to age 75 years. Survivorship and outcome following stroke may have been poorer in blacks than in whites. Advanced age and elevated blood pressure were the only putative risk factors for stroke for which published data were adequate to firmly establish the association in blacks. Thus, data are needed to examine trends in stroke incidence and survivorship in blacks and to assess the relation of many variables to the risk of stroke. (Stroke1988;19:l–9)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Anticoagulation with heparin is frequently recommended for patients with progressing ischemic cerebral infarction, yet little data is available detailing the acute results of treatment with this agent. We report the results of continuous intravenous heparin treatment in 36 consecutive patients admitted with progressing ischemic infarction, all of whom had computed tomography scans to exclude the diagnosis of hemorrhage prior to treatment. Overall, 18 of 36 (50%) had continued neurologic worsening despite treatment. The incidence of further worsening was greater in carotid territory infarctions (14 of 19, 74%) than in either vertebrobasilar (2 of 8, 25%) or lacunar (2 of 9, 22%) infarctions (p< 0.05, Fisher's exact test). These observations suggest that additional controlled studies of the efficacy of heparin in progressing ischemic infarction are warranted. (Stroke1988; 19:10–14)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Chronic atrial fibrillation is associated with an increased risk of stroke. In elderly patients with thyrotoxicosis, atrial fibrillation is frequently encountered, and the true risk of cerebrovascular events in these patients is controversial. We retrospectively studied 610 patients with initially untreated thyrotoxicosis, 91 (14.9%) of whom had atrial fibrillation, with the highest frequency in the elderly patients. The risk of cerebro vascular events, with special attention to the first year after the diagnosis of thyrotoxicosis, was calculated using logistic regression methods with age, sex, and atrial fibrillation as independent variables. Only age was an important risk factor (p< 0.005), whereas sex and atrial fibrillation were not significant (p= 0.09 andp= 0.17, respectively) as independent risk factors. This is contrary to other studies of patients with thyrotoxic atrial fibrillation, and the need for further clarification of this issue is clear. From our study the indication for prophylactic treatment with anticoagulants for prevention of stroke in thyrotoxic atrial fibrillation seems doubtful, especially as no controlled studies of such treatment in patients with atrial fibrillation are currently available. (Stroke1988;19:15–18)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

An index of cerebral perfusion reserve (RES%), defined as the percent change of regional cerebral blood flow over baseline per mm Hg of end‐tidal CO2tension, was determined for each middle cerebral artery (MCA) territory in patients with unilateral carotid distribution transient ischemic attacks or minor cerebrovascular accidents and was compared with that of age‐matched, neurological ly normal volunteers. Vasodilator responses to induced hypercapnia were tested during inhalation of 5 % CO2in 95 % O2while regional cerebral blood flow was measured by fluoromethane inhalation positron emission tomography. Mean RES% for 24 normal MCA territories was 5.2±0.8%. Mean RES % for 15 patient nonischemic MCA territories was 3.8±1.3 % and for 15 ischemic MCA territories was 2.8±1.9% (bothp< 0.001). Individual RES% values and symmetry ratios between ischemic and nonischemic regions were also determined and compared with angiographic data. Areas of diminished, asymmetric, or paradoxical (two patients) CO2reactivity appear to correspond to areas of compensatory vasodilation. We found this technique to be a safe and reproducible method for defining and recording localized areas of cerebral tissue at apparent risk for hemodynamically related damage. (Stroke1988;19:19–27)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The spatial correlation of nuclear magnetic resonance imaging (NMRI) and cerebral blood flow (CBF) may improve our ability to identify ischemic brain lesions and may provide further insight into the pathophysiology of early cerebral ischemia. Eleven pentobarbital‐anesthetized adult cats underwent exposure of the common carotid arteries bilaterally and the right middle cerebral artery through a transorbital approach. Baseline NMRI images were obtained with a single spin‐echo, multislice technique using a 0.6‐T field, 0.4‐cm slice thickness, and a surface coil. Focal ischemia was produced with right middle cerebral artery occlusion and potentiated with bilateral common carotid artery ligation. Sequential NMRI studies were then performed at 1, 2, 4, 6, and 12 hours or until CBF was determined in the same cats using [14C]iodoantipyrine at either 2 (n= 2), 4 (n= 2), 6 (n= 2), or 12 (n= 1) hours after the time of occlusion. This protocol allowed temporal and spatial correlation of NMRI and CBF. Alternate 5‐mm brain slices were incubated with 1 % 2,3,5‐triphenyltetrazolium chloride (TTC) for 45 minutes at 37–41°C and frozen in liquid Freon for later autoradiographic CBF determination. Four cats were studied only with NMRI and TTC (not CBF). The correlation between areas of increased NMRI signal intensity observed in T2‐weighted images (repetition time 2,000 msec, echo time 120 msec), vital staining with TTC, low CBF, and routine histology was evaluated. During the early phase (< 6 hours), T2‐weighted NMRI changes were localized to the central ischemic gray matter areas, as defined in the later CBF images, with no involvement of the white matter. By the twelfth hour the NMRI changes involved the entire ischemic area including gray and white matter. The initial visible changes seen on T2‐weighted NMRI are suggestive of cellular edema, and the later changes are characteristic of vasogenic edema. The spread of NMRI changes compared with the ischemic area determined from autoradiographic CBF is consistent with the previously described biphasic evolution of ischemic injury. These data suggest that T2‐weighted NMRI could be used clinically to delineate areas of acute ischemic stroke. (Stroke1988; 19:28–37)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Cerebral ischemia induced by unilateral carotid occlusion in rats decreases in an asymmetric manner the number of β‐adrenergic receptors in microvessels prepared from cerebral cortexes ipsilateral and contralateral to the side of the ligature. In particular, the reduction is more pronounced in the left hemisphere in case of both right and left carotid ligature. The greater receptor decrease in the left side of the brain was shown to depend on the integrity of interhemispheric connections. We show that the changes in capillary β‐adrenergic receptors in response to unilateral carotid occlusion are qualitatively modified during aging. In particular, the asymmetry in the response pattern observed in young rats is lost. The mechanisms underlying this phenomenon may be based on an age‐related impairment in the transfer of neuronal information between the two sides of the brain. (Stroke1988; 19:38–41)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The frequency of clinically significant coronary artery disease (CAD) among stroke patients and the impact of CAD on stroke rehabilitation were studied in 132 patients with first thrombotic or embolic stroke who participated in comprehensive rehabilitation. Sixty‐one patients (46%) had a history of CAD, and 16 of the 61 also had congestive heart failure (CAD‐CHF). Patients with CAD, and especially those with CAD‐CHF, had significantly longer intervals from stroke onset to rehabilitation admission (p< .001), and once in rehabilitation they experienced three times as many cardiac complications (p< 0.001). While all patient groups improved function during rehabilitation, those with CAD and CAD‐CHF unproved significantly less than did those without CAD (p< 0.01). Patients with CAD did least well with rolling, moving in bed, transferring from a wheelchair to bed, and walking. CHF not only adversely influenced overall function and mobility task performance but also affected the potential for achieving functional gains. These data suggest that specific measures of function and rehabilitation are affected by CAD and that the levels of achievement for patients with CAD‐CHF are limited. (Stroke1988;19:42–47)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The incidence of intracerebral hemorrhage over 13 years is compared between two Hisayama cohorts. Among men aged 40 years or older, the annual incidence declined significantly from 3.1/1,000 in the early cohort (1961–1970) to 1.2/1,000 in the recent cohort (1974–1983). Massive ganglionic hemorrhage decreased, while small or medium‐sized intracerebral hemorrhage increased in the recent cohort on pathologic or computed tomographic examination. These trends could be due to the reduced prevalence of hypertension in the Hisayama population. The association of serum total cholesterol with intracerebral hemorrhage is discussed based on the results during a 22‐year follow‐up period. (Stroke1988;19:48–52)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Moyamoya disease occurring in Chinese has been inadequately described. Here we report 13 cases of this disease identified by review of 3,200 cerebral angiograms performed between August 1979 and March 1986. Nine were males and four were females; there were 12 adults (aged 34–51 years) and one child (aged 11 years). All had hemorrhagic strokes with one exception, a patient with an occipital infarction. Intraventricular hemorrhage was noted by computed tomographyin10; five of these emanated from the caudate nucleus. A localized hematoma without intraventricular hemorrhage was found in two. All 13 angiograms had smokelike basal anastomoses with various degrees of stenosis or occlusion of the anterior portion of the circle of Willis; the involvement was bilateral in 12 and unilateral in one. Aneurysms were found in two patients, one in the anterior communicating artery and the other in the left anterior choroidal artery. Eleven patients recovered from the initial stroke, but two died with recurrent hemorrhage. This series differs from the series reported in Japan by the predominance of adult males. The high incidence of intraventricular hemorrhage and intracerebral hematoma is not in keeping with the previous Chinese series, in which subarachnoid hemorrhage was suspected to be the major clinical manifestation. (Stroke1988; 19:53–59)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A door‐to‐door survey of 14,010 Parsis living in colonies in Bombay, India, screened people for possible neurologic diseases. High school graduates, social workers, and a medical student administered a questionnaire that had been shown in a pilot study to have a sensitivity of 100% for identifying persons with stroke. Neurologists used defined diagnostic criteria to evaluate those who were positive on the screening survey. One hundred eighteen persons (57 men, 61 women) suffered from stroke (842.3 cases/100,000 population). The age‐specific prevalence ratios increased with age for both sexes and for each age group. Age‐adjusted prevalence ratios were slightly higher for men than for women. The most common type of stroke was ischemic (114 cases). (Stroke1988;19:60–62)

ISSN:0039-2499    

出版商:OVID    

年代:1988

数据来源: OVID