摘要:

Background and PurposeThe underlying reasons for the decline in stroke mortality in the United States are not well understood and have been the subject of ongoing debate. This study was undertaken to determine whether survival of hospitalized stroke patients has changed during the 1980s, thereby contributing to the decline in stroke mortality during that period.MethodsFor the years 1980, 1985, and 1990, we obtained listings of discharge diagnoses from hospitals in the Minneapolis-St Paul metropolitan area and identified all hospitalizations with a discharge diagnosis code of acute cerebrovascular disease according to the International Classification of Diseases, 9th Revision. A 50% random sample of men and women aged 30 to 74 years was selected in each survey for detailed medical record abstraction. Standardized sets of criteria for stroke were then used to validate acute stroke events throughout the 1980s. Each of the three period cohorts of hospitalized stroke patients (1980, 1985, and 1990) was followed for at least 2 years for all-cause mortality end point.ResultsA total of 1853 patients met minimal criteria for acute stroke: 564 patients in 1980, 598 patients in 1985, and 691 patients in 1990. Controlling for age, the odds of death within 2 years after stroke were approximately 40% lower in 1990 than in 1980. The relative odds of 2-year death in 1990 (versus 1980) were 0.65 (95% confidence interval, 0.47 to 0.89) and 0.60 (95% confidence interval, 0.42 to 0.85) for men and women, respectively. The improved survival was evident in the short term (28 days) as well as for stroke patients who survived that period. Analysis according to stroke subtype revealed that improved survival of ischemic stroke and specifically of stroke with no apparent cardioembolic source largely accounted for the overall trend. The prognosis of stroke patients who were admitted in a comatose state has not changed during that decade.ConclusionsDespite the absence of any clear major advances in acute stroke therapy, survival of stroke patients substantially improved during the 1980s. The underlying reasons for this unexpected yet remarkable trend remain uncertain but may include improved supportive and rehabilitative care of stroke victims as well as a change in the natural history of the disease.(Stroke. 1995;26:1-6.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThe purpose of this study was to clarify whether mitral valve prolapse increases the subsequent risk of stroke.MethodsA historical cohort study was conducted on 1079 residents of Olmsted County, Minnesota, who had an initial echocardiographic diagnosis of mitral valve prolapse between 1975 and 1989 without prior stroke or transient ischemic attack and who were followed up for first stroke occurrence.ResultsThere was an overall twofold increase in the incidence of stroke among individuals with mitral valve prolapse relative to the reference population (standardized morbidity ratio, 2.1; 95% confidence interval, 1.3 to 3.2). Sex, duration of follow-up from the diagnosis of mitral valve prolapse, or calendar year of initial diagnosis did not modify the association. Within the cohort of patients who were at least 35 years old at diagnosis of mitral valve prolapse, a time-dependent proportional-hazards multivariate model and a person-years analysis revealed that age, ischemic heart disease, congestive heart failure, and diabetes mellitus were important determinants for stroke when person-years of observation after mitral valve replacement were excluded. Among seven persons with mitral valve replacement, three strokes occurred in 24 person-years of follow-up. For those with an auscultatory diagnosis of mitral valve prolapse only as the indication for echocardiography (44%), the risk of stroke relative to the population was 1.0 (95% confidence interval, 0.2 to 2.9); for those with another cardiac diagnosis, the standardized morbidity ratio was 2.5 (95% confidence interval, 1.5 to 4.0).ConclusionsIndividuals with uncomplicated mitral valve prolapse did not have an increased risk of stroke, although a small increase in the risk may not have been detected. (Stroke. 1995;26:7-13.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThe aim of this investigation was to determine the importance of race as a determinant of intracranial atherosclerotic stroke in a community-based stroke sample.MethodsResidents from northern Manhattan over age 39 years hospitalized for acute ischemic stroke (n = 438, black 35%, Hispanic 46%, white 19%) were prospectively evaluated. Index ischemic strokes were classified as atherosclerotic (17%), lacunar (30%), cardioembolic (21%), cryptogenic (31%), and other (1%). Atherosclerotic infarcts were subdivided into extracranial (9%) and intracranial (8%) atherosclerosis.ResultsThe proportion of extracranial atherosclerotic stroke was similar among the three race-ethnic groups, while intracranial atherosclerosis was more frequent in blacks and Hispanics. The unadjusted odds ratio for nonwhites (blacks and Hispanics combined) was 0.8 (confidence interval [CI], 0.4 to 1.8) for extracranial and 7.8 (CI, 1.04 to 57.7) for intracranial atherosclerosis. Patients with intracranial disease were significantly younger and had an increased frequency of hypercholesterolemia and insulin-dependent diabetes compared with those with nonatherosclerotic disease. The odds ratio for the association of nonwhite race-ethnicity and intracranial atherosclerosis was reduced to 5.2 (CI, 0.7 to 40) after controlling for age and to 4.4 (CI, 0.6 to 35) after controlling for age, education, insulin-dependent diabetes, and hypercholesterolemia.ConclusionsThe greater prevalence of diabetes and hypercholesterolemia among blacks and Hispanics from northern Manhattan accounted for much of the increased frequency of intracranial atherosclerotic stroke. Further control of these risk factors could reduce the frequency of this stroke subtype and minimize the disparities among different race-ethnic groups.(Stroke. 1995;26:14-20.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeControversy continues to exist regarding optimal blood pressure control in acute hypertensive intracerebral hemorrhage. Persistent marked elevation of the blood pressure can promote further bleeding, increase cerebral blood flow, and raise intracranial pressure. Relative hypotension, on the other hand, may promote hypoperfusion with secondary ischemia. This study was designed to assess outcome in patient groups defined by the degree of elevation in their pretreatment and posttreatment blood pressures.Methods125 mm Hg (n = 40) or less than or equal to 125 mm Hg (n = 47).ResultsAn improved outcome in both mortality and severe morbidity was observed in the less than or equal to 145 (chi2= 7.0, P < .005) and the <125 mm Hg (chi2= 6.7, P < .005) groups.ConclusionsMarkedly elevated blood pressure on admission and persistent inadequate blood pressure control adversely affect the prognosis in hypertensive intracerebral hemorrhage.(Stroke. 1995;26:21-24.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThis article examines prevalence of isolated systolic hypertension (ISH) in a population of Japanese-American men living in Hawaii and compares rates of stroke among those with ISH, isolated diastolic hypertension (IDH), combined systolic/diastolic hypertension (SDH), and nonhypertension.MethodsEight thousand six men aged 45 to 68 years participated in a baseline examination as part of a prospective study of coronary heart disease and stroke and were followed up for 20 years for incident disease and total mortality. Men were divided into four groups according to baseline blood pressure: ISH (systolic blood pressure [SBP] greater than or equal to 160 mm Hg and diastolic blood pressure [DBP] less than 90 mm Hg); IDH (SBP < 160 mm Hg and DBP greater than or equal to 90 mm Hg); SDH (SBP greater than or equal to 160 mm Hg and DBP greater than or equal to 90 mm Hg); and nonhypertension (SBP < 160 mm Hg and DBP < 90 mm Hg).ResultsMen with ISH had the highest rates of stroke, followed by men with SDH. Men with IDH had rates only slightly higher than men in the nonhypertension group. Relative risk adjusted for other risk factors varied by age group. For men aged 45 to 54 years, relative risks of stroke associated with ISH, IDH, and SDH compared with nonhypertensive subjects were 4.8, 1.4, and 4.3, respectively. For men aged 55 to 68 years, the same relative risks were 1.2, 1.8, and 1.7. Excluding men on antihypertensive medication at baseline did not alter results.ConclusionsISH had a much greater impact on risk of stroke in younger than in older men. The results suggest that while ISH is more common in older men, in younger men it is associated with higher relative risk of stroke.(Stroke. 1995;26:25-29.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeWe investigated the relationship between hypertension, diabetes mellitus, and lacunes.MethodsFrom 1237 cases of ischemic stroke in the Stroke Data Bank of the National Institute of Neurological and Communicative Disorders and Stroke, data from 637 patients whose initial computed tomograms showed lacunar (n = 184) or nonlacunar infarcts (n = 453) were analyzed. The group with lacunar infarcts was further divided into subgroups according to whether the patients had multiple (n = 40) or single (n = 144) lacunar infarcts. The association of hypertension and diabetes mellitus with lacunar infarcts was investigated using logistic regression models that included age, sex, and cardiac disease. Similar models were used to analyze the effects of diastolic and systolic blood pressure.ResultsHypertension (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.1 to 6.0) and diabetes (OR, 2.3; 95% CI, 1.1 to 4.5) were significantly related to multiple but not to single lacunes. Cardiac disease was inversely associated with both single and multiple lacunes. Diastolic blood pressure significantly affected the probability of multiple lacunar infarcts (OR, 1.4; 95% CI, 1.04 to 1.9), whereas systolic pressure did not.ConclusionsThere may be etiologically distinct lacunar infarct subgroups, with multiple lacunes being strongly related to hypertension and diabetes mellitus. Other stroke risk factors may be more important in patients with single lacunes. Diastolic rather than systolic pressure seems to be a major determinant of multiple lacunes.(Stroke. 1995;26:30-33.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeIn this study, we investigated intima-media thickness and plaque occurrence in the carotid arteries of men with borderline hypertension compared with that in normotensive control subjects and investigated the relations of these variables to atherosclerotic risk factors.MethodsUsing B-mode ultrasonography, we compared carotid artery intima-media thickness and plaque occurrence in men with borderline hypertension (diastolic blood pressure of 85 to 94 mm Hg, n = 73) with that in age-matched normotensive control subjects (diastolic blood pressure of 80 mm Hg, n = 72). We evaluated the relationships of intima-media thickness and plaque occurrence to atherosclerotic risk factors such as age, smoking, lipoprotein levels, and fasting insulin levels.ResultsThe borderline hypertensive group exhibited a slight increase in overall intima-media thickness (0.73 versus 0.69 mm, P = .07), which was most evident in the right carotid artery (0.72 versus 0.67 mm, P < .05). There were more borderline hypertensive subjects with plaque (26% versus 16%, NS), again more evident on the right side (18% versus 6%, P < .05). Age and high-density lipoprotein cholesterol were consistently related to intima-media thickness (t = 1.94 to 3.24 and t = - 2.25 to - 2.69, respectively, P < .05), whereas age was the only significant determinant for plaque/nonplaque (F = 6.4, P less than .05). In addition, there was a significant difference in intima-media thickness between the right and left carotids, irrespective of group (F = 4.43, P less than .05).ConclusionsOur results indicate that vascular structural changes occur even in borderline hypertension, although this seems more related to general atherosclerotic risk factors than to blood pressure alone. Additionally, a possible difference in the development of atherosclerotic lesions of the left and right carotid arteries is suggested, emphasizing the importance of measuring and reporting values from both sides when studying carotid intima-media thickness and plaque occurrence.(Stroke. 1995;26:34-39.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThe role of recent heavy drinking of alcohol as a risk factor for ischemic brain infarction is unclear. We investigated this problem in young adults, in whom even a thorough workup often fails to reveal any predisposing factor.MethodsThis was a hospital-based case-control study comprising 75 consecutive subjects aged 16 to 40 years with first-ever ischemic brain infarction and 133 control subjects from the same hospital who were group-matched with the case patients for age, sex, day of the onset of symptoms, and acuteness of disease onset.ResultsMultiple logistic regression analysis showed that alcohol intake exceeding 40 g of ethanol within the 24 hours preceding disease onset was a significant independent risk factor for brain infarction among both men (odds ratio [OR], 6.0; 95% confidence interval [CI], 1.8 to 20.3) and women (OR, 7.8; 95% CI, 1.0 to 60.8). Cigarette smoking was not found to be an independent risk factor in the model, whereas among men arterial hypertension was (OR, 6.2; 95% CI, 1.5 to 24.7).ConclusionsWe conclude that very recent alcohol drinking, particularly drinking for intoxication, may trigger the onset of brain infarction in young adults and that there might be a variety of mechanisms behind this effect.(Stroke. 1995;26:40-45.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposePrecise identification of the cause of stroke is critical to research and clinical practice. Published series of ischemic stroke show considerable variation in the proportion of cases classified as atherosclerotic large-vessel disease, lacunar infarct, cardioembolic stroke, stroke of other known cause, and stroke of undetermined etiology. We describe the development and use of an etiology-specific classification of ischemic stroke. The interrater reliability of the classification is then evaluated.MethodsA total of 160 cases of ischemic strokes in young adults were reviewed by paired neurologists who assigned cases to prioritized categories. The results of paired ratings were evaluated for each of the potential causes. Interrater agreement was assessed by means of kappa, which is the chance-adjusted percent agreement.ResultsFor standard pairs, kappa was fair to good for all causes except lacunar stroke (kappa = 0.31); however, pair-to-pair variation was greatest for lacunar strokes. Strokes of undetermined cause and hematologic/other cause were of borderline fair reliability.ConclusionsThe utility of a stroke classification system is dependent on its intended use. An etiologic classification is useful in studies of the epidemiology and pathophysiological basis of stroke. Fair to good reliability for an etiologic classification of stroke can be obtained when criteria are explicit.(Stroke. 1995;26:46-51.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Background and PurposeThe sites of platelet activation in ischemic stroke are still unclear because previous reports have not identified them and various factors accompanied by stroke can activate platelets. We therefore examined the sites of platelet activation in patients with various types of ischemic stroke.MethodsThe ratio of the plasma concentration of beta-thromboglobulin (BTG) in the internal jugular vein to that in the antecubital vein (BTG-B) was calculated as an indicator of platelet activation in the cerebral circulation. Plasma BTG concentration was determined in 75 control subjects and in 186 patients with various subtypes of ischemic stroke including lacunar, atherothrombotic, and cardioembolic strokes, transient ischemic attacks, and Binswanger's disease. The BTG ratio was evaluated with regard to subtype of stroke, time of blood sampling, size of infarct, presence of vascular lesions, and the effect of ticlopidine administration.ResultsThe mean BTG ratio was increased even in the chronic phase of most subtypes of stroke with the exception of cardioembolic stroke, which exhibited a persistent elevation of BTG-B concentrations. Patients with Binswanger's disease showed a significant (P < .01) and frequent elevation of BTG ratio. High BTG ratios occurred in cases with vascular lesions observed on cerebral angiography. There was no correlation between the BTG ratio and infarct size. Use of ticlopidine was partially associated with a lower BTG ratio.ConclusionsPlatelets were activated in the cerebral circulation of patients with stroke even in the chronic phase, which suggests the development of underlying vascular lesions and of thrombogenesis with or without infarction. Platelets were activated mainly within the heart in cases of cardioembolic stroke. An enhanced release reaction secondary to platelet activation was often seen in patients with Binswanger's disease, which indicates that its pathophysiology differs from that of other subtypes of stroke.(Stroke. 1995;26:52-56.)

ISSN:0039-2499    

出版商:OVID    

年代:1995

数据来源: OVID