摘要:

Background and PurposeThe goal of the present study was to prospectively determine how frequently early growth of intracerebral hemorrhage occurs and whether this early growth is related to early neurological deterioration.MethodsWe performed a prospective observational study of patients with intracerebral hemorrhage within 3 hours of onset. Patients had a neurological evaluation and CT scan performed at baseline, 1 hour after baseline, and 20 hours after baseline.ResultsSubstantial growth in the volume of parenchymal hemorrhage occurred in 26% of the 103 study patients between the baseline and 1-hour CT scans. An additional 12% of patients had substantial growth between the 1- and 20-hour CT scans. Hemorrhage growth between the baseline and 1-hour CT scans was significantly associated with clinical deterioration, as measured by the change between the baseline and 1-hour Glasgow Coma Scale and National Institutes of Health Stroke Scale scores. No baseline clinical or CT prediction of hemorrhage growth was identified.ConclusionsSubstantial early hemorrhage growth in patients with intracerebral hemorrhage is common and is associated with neurological deterioration. Randomized treatment trials are needed to determine whether this early natural history of ongoing bleeding and frequent neurological deterioration can be improved. (Stroke. 1997;28:1-5.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeIntracranial hemorrhage is an important complication of treatment with anticoagulants. We studied outcome of aneurysmal subarachnoid hemorrhage (SAH) occurring in patients on anticoagulant drugs because this may influence management of patients needing anticoagulant treatment but with increased risk of aneurysmal hemorrhage.MethodsFrom the prospective database of patients admitted with SAH to the Utrecht University Hospital, we compared 3-month outcome in patients with or without anticoagulant drugs by means of stratified analyses to adjust relative risks for biological and clinical differences between the two groups.ResultsDeath or dependency after SAH occurred in 14 of 15 patients on anticoagulant treatment and in 62 of 126 patients not being treated with anticoagulants (relative risk, 1.9; 95% confidence interval, 1.5 to 2.4). The patients on treatment with anticoagulants were more often comatose on admission; the frequencies of rebleeding, secondary ischemia, and hydrocephalus were not higher in patients on anticoagulants. In the stratified analysis, the worse outcome in the group on anticoagulant drugs was not essentially influenced by differences in sex, age, cardiovascular history, site of aneurysm, amount of cisternal blood, or extension of hemorrhage into the ventricles.ConclusionsThe outcome of aneurysmal SAH in patients on anticoagulant drugs is extremely poor. The explanation for the worse prognosis in patients on anticoagulants lies in a worse clinical condition from the outset. The poor outcome urges a reconsideration of the balance of risks for anticoagulant treatment in patients with an unoperated intracranial aneurysm or with a family history of SAH and may lead to withholding treatment with anticoagulant drugs or to a preventive operation. (Stroke. 1997;28:6-9.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeOur aims were to identify predictors of early neurological improvement in acute ischemic stroke patients, to evaluate its impact on clinical outcome, and to investigate possible mechanisms.MethodsA consecutive series of 152 first-ever ischemic hemispheric stroke patients hospitalized within 5 hours of onset underwent a first CT scan within 1 hour of hospitalization, and the initial subset of 80 patients also underwent angiography. During the first 48 hours of hospital stay, an increase or a decrease of 1 or more points in the admission Canadian Neurological Scale (CNS) score was defined as early improvement or early deterioration, respectively. Repeated CT scan or autopsy was performed 5 to 9 days after stroke.ResultsThirty-four patients (22%) improved, 84 (56%) remained stable, and 34 (22%) deteriorated. Logistic regression, which took into account vascular risk factors, baseline clinical and CT data, and therapies administered, selected younger age, lower admission CNS score, and absence of early hypodensity at first CT as independent predictors of early improvement. Among the patients who underwent angiography, logistic regression selected arterial patency and presence of collateral blood supply as independent predictors of early improvement. At the repeated CT scan or autopsy, improving patients presented the highest frequency of small infarcts. Thirty-day case-fatality rate and disability were lower in improving patients. Variables independently associated with outcome at logistic regression were admission CNS score, early deterioration, and early improvement.ConclusionsEarly improvement can be predicted by the absence of early CT hypodensity and is highly predictive of good outcome. Presence of collateral blood supply and presumably early spontaneous recanalization are likely to be the mechanisms underlying early improvement. (Stroke. 1997;22:10-14.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeHispanic American (HA), African American (AA), and non-Hispanic white (NHW) populations are well represented in Texas. The Texas HA population is 95% Mexican American, affording comparison with other Hispanic populations. From risk factor profiles we expected stroke mortality to be highest in AAs and HAs. We also expected stroke mortality to be considerably higher for men than for women based on previous data.MethodsWe used International Classification of Diseases, 9th Revision, codes 430 to 438 to search Texas vital statistics data for the 5-year period from 1988 through 1992. Race/ethnic differences are presented in age- and sex-specific format to avoid masking the important interaction of age and sex with stroke mortality.ResultsWomen constituted 61% of the 40 346 stroke deaths in Texas during this period. The ratio of stroke deaths for women versus men approximates the ratio of women to men in the population. AAs had a threefold to fourfold increased stroke mortality relative to NHWs at young ages. At older ages, when stroke mortality is the highest, the stroke mortality rate in NHWs approached the stroke mortality rate of AAs. HAs had a significantly higher rate of stroke mortality at younger ages relative to NHWs but a significantly lower rate at older ages.ConclusionsMeasures to prevent stroke mortality should emphasize its predilection for young AAs and women. A rigorous surveillance project is needed to determine whether stroke mortality is underestimated in the HA population. (Stroke. 1997;28:15-18.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeWe undertook this study to ascertain whether elderly black and white patients who are hospitalized for stroke utilize inpatient physical and occupational therapy (PT/OT) services differently, adjusting for characteristics associated with use of these services.MethodsWe retrospectively reviewed medical records regarding the care received by a nationally representative sample of 2497 black and white Medicare patients, aged 65 years or older, who were hospitalized at any of 297 acute-care hospitals located in 30 communities within five states.ResultsCompared with whites, black stroke patients were younger and more likely to have Medicaid coverage, have an ischemic stroke, and have a motor deficit noted at the time of admission. There was no difference in either sex or level of consciousness on admission. Overall, a larger proportion of black stroke patients used inpatient PT/OT at some point during the hospitalization (66.3% versus 55.8%; P<.01). However, after adjustment for characteristics associated with use of PT/OT, there was no racial difference in either the likelihood of inpatient PT/OT use (adjusted relative risk, 1.06; 95% confidence limits, 0.89 to 1.27; P=.42) or time to initial contact (median: blacks, 6.6 days; whites, 7.4 days; P=.42). Adjusted analyses also indicated a similarity between the racial groups in the number of inpatient PT/OT days overall or as a proportion of the hospital stay.ConclusionsElderly black and white stroke patients who have Medicare coverage have similar patterns of use of inpatient PT/OT services. (Stroke. 1997;28:19-25.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeThis study was designed to identify whether cigarette smoking, alcohol drinking, obesity, and use of oral contraceptives are independent risk factors for brain infarction among persons of working age.MethodsHealth habits and previous diseases of 506 patients (366 men and 140 women aged 16 to 60 years) with acute first-ever symptomatic brain infarction were compared with those of 345 hospitalized control patients (219 men and 126 women) who did not differ from case subjects in respect to day of onset of symptoms or acuteness of disease onset. With the use of stepwise logistic regression, the variables for which the simultaneous risks of acute brain infarction were tested by sex were age, amount of alcohol consumed within 24 hours and 1 week before the illness, heavy drinking, smoking status, current smoking, cardiac disease, hypertension, diabetes, hyperlipemia, migraine, body mass index, and, in women, current use of oral contraceptives.Results40 g ethanol within the 24 hours preceding the onset of illness increased the risk for acute brain infarction both among men (P<.001) and women (P<.01) independently from other risk factors. Other significant independent risk factors for brain infarction among men were hypertension (P<.001), cardiac disease (P<.01), current smoking (P<.01), diabetes (P<.05), and history of migraine (P<.05) and among women, current use of oral contraceptives (P<.01) and current smoking (P<.05).ConclusionsRecent heavy drinking of alcohol, hypertension, cardiac disease, current smoking, diabetes, and history of migraine among men, and recent heavy drinking of alcohol, current use of oral contraceptives, and current smoking among women, seem to be independent risk factors for acute brain infarction. (Stroke. 1997;28:26-30.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeAmbulatory blood pressure monitoring (ABPM) devices are increasingly used in the assessment of hypertension, but their value in patients after a stroke is unknown, despite the fact that hypertension is an important cause of stroke and many patients have relatively high blood pressure (BP) levels at presentation. We therefore investigated the clinical use of a 24-hour oscillometric ABPM device in patients after acute stroke. We also investigated ABPM in different types of stroke (thrombosis, hemorrhage, and transient ischemic attack) and ethnic and sex differences.MethodsBP was measured manually with a standard mercury sphygmomanometer, and ABPM measurements were made with an oscillometric device. The first reading obtained with the ABPM device was compared with simultaneous manual BP measurements. Mean daytime and nighttime pressures were also analyzed to determine the frequency of nocturnal BP falls ("dipping").ResultsWe studied 86 patients (48 men; mean +/- SD age, 64.2 +/- 9.2 years) admitted with acute-onset stroke (ictus within 12 hours) in a district general hospital. Thirty-one patients (36.0%) had a previous history of hypertension. The median percentage of successful BP readings by ABPM was 92% (interquartile range, 72 to 98). There was no significant difference in manual BP levels compared with the first simultaneous systolic or diastolic ABPM measurements. Systolic BPs recorded by ABPM were significantly higher in black patients with acute stroke and in patients with intracerebral hemorrhage, who also showed a trend toward higher nocturnal BPs. There was no difference in BPs between men and women and those who were alive or dead 6 months later (P=NS). There was also no difference between mean day and night systolic BP (mean difference, 1.9 mm Hg; P=.08), although mean daytime diastolic BP was higher than mean nighttime diastolic BP (mean difference, 2.4 mm Hg; P=.01). Patients with stroke therefore demonstrated a loss of diurnal BP rhythm and may be considered "nondippers"; there was also a trend toward "reverse dipping" in patients with intracranial hemorrhage.ConclusionsThis study demonstrates higher systolic BPs as recorded by ABPM (but not manually) in patients with intracerebral hemorrhage than in those with cerebral infarcts; higher levels were also found in blacks. ABPM recordings are useful in the assessment of BP in patients with stroke, who may be considered nondippers. (Stroke. 1997;28:31-35.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeAn association between aortic arch atherosclerosis and vascular events has been demonstrated. However, few data exist regarding follow-up evaluation of this disease.Methodsor=to5 mm or plaques with mobile components had been demonstrated on the initial transesophageal echocardiography.ResultsDuring a mean follow-up period of 16 +/- 7 months, vascular events with a presumed embolic origin occurred in 15 patients. The incidence was 4.1 per 100 person-years in patients with raised plaques compared with 13.7 per 100 person-years in the group with complex plaques. The Kaplan-Meier survival analysis revealed a significantly higher rate of vascular events in patients who were found to have complex plaques (P<.01). In the Cox proportional hazards analysis, the finding of complex plaques (relative risk [RR], 4.3; 95% confidence interval [CI], 1.5 to 12.0; P=.006), coronary artery disease (RR, 4.0; 95% CI, 1.2 to 13.1; P=.02), and a history of previous embolism (RR, 4.0; 95% CI, 1.1 to 14.4; P=.03) were independent predictors of vascular events.ConclusionsPatients with the finding of protruding plaques or plaques with mobile components have a high risk of subsequent vascular events. (Stroke. 1997;28:36-39.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeThe continued decrease in cerebrovascular disease in Spain remains unexplained. Age-period-cohort analysis enables description of birth cohort and period-of-death components. This study sought to describe these effects on the decline of stroke mortality in Spain.MethodsDeaths due to cerebrovascular diseases in the period from 1952 through 1991 and the corresponding population figures were grouped into 11 age groups and 8 5-year periods, from which age-specific mortality rates for 18 birth cohorts were then computed. These were plotted for graphical presentation purposes and fitted to Poisson regression models to assess age, period, and cohort effects.ResultsAn exponential age effect was present for both sexes regardless of cohort or period. A definite downward period effect was observable from 1962 to 1991, except for a sharp fall and peak in the periods 1967 to 1971 and 1972 to 1976, respectively, which was possibly ascribable to changes in diagnostic and coding practices. Age- and period-adjusted stroke mortality increased for earlier cohorts and decreased for generations born between 1892 and 1940. For post-1940 generations, there was an increasing risk of stroke mortality.ConclusionsThe results suggest that a decrease in incidence coupled with an increase in survival may account for the observed decline in stroke mortality, but further studies on the Spanish population are needed to assess these findings. Although not yet definitive, there are signs of an increase in incidence among the more recent generations. If the decreasing period effect fails to offset this increase, future years may see a deceleration in the current decline in stroke mortality. (Stroke. 1997;28:40-44.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background and PurposeChange toward Western lifestyles, particularly during the high economic growth period (approximately 1960 to 1975), dynamically altered stroke frequency and the distribution of risk factors in the Japanese. We reexamined their association after this environmental change by a cohort study.MethodsThe cohort (2302 subjects) comprised residents aged 40 years or older of the Akadani-Ijimino district in Shibata City, Niigata Prefecture, Japan, who were followed up from 1977 for 15.5 years.ResultsCrude incidence rates per 1000 person-years for all strokes were 5.22 for men and 4.36 for women (3.02 and 2.18 for cerebral infarction, 0.65 and 1.06 for intracerebral hemorrhage, and 0.41 and 0.34 for subarachnoid hemorrhage, respectively). Multivariate analyses performed with the Cox proportional hazard model revealed these risk factors to be independently significant: for cerebral infarction in men, age, blood pressure, atrial fibrillation, albuminuria, funduscopic abnormality, and current smoking; for cerebral infarction in women, age, atrial fibrillation, and history of ischemic heart disease; for intracerebral hemorrhage in men, age and funduscopic abnormality; for intracerebral hemorrhage in women, age, blood pressure, and light physical activity; for all strokes in men, age, blood pressure, atrial fibrillation, albuminuria, funduscopic abnormality, current smoking, and heavy physical activity; and for all strokes in women, age, atrial fibrillation, and light physical activity.ConclusionsMost traditional risk factors, including blood pressure and its related organ diseases, were confirmed, but serum total cholesterol had almost no effect. Physical activity had both negative and positive effects on stroke risk. In these findings, however, some differences related to sex were also observed. (Stroke. 1997;28:45-52.)

ISSN:0039-2499    

出版商:OVID    

年代:1997

数据来源: OVID