ISSN:1015-9770    

DOI:10.1159/000108978

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108979

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Episodic vertigo frequently occurs in patients suffering from ischemia in the distribution of the vertebrobasilar circulation. It may occur in isolation, with other symptoms of vertebrobasilar insufficiency or with persisting symptoms and signs of infarction of the brain stem and cerebellum. When other symptoms and signs are present, the diagnosis is usually obvious, whereas, when vertigo occurs in isolation it can be difficult to differentiate from more benign disorders involving the inner ear. Typical attacks of ischemic vertigo are abrupt in onset and last minutes. Since the inner ear is supplied by the vertebrobasilar circulation, inner ear symptoms are common with ischemia in this distribution. The labyrinth may be selectively vulnerable because it is an end circulation with minimal collaterals.

ISSN:1015-9770    

DOI:10.1159/000108980

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Aspirin is effective in reducing vascular outcomes in patients with atherosclerosis: a relative risk reduction of about 30% for stroke, 22% for stroke and death and 15% for vascular mortality. It is probable that moderate and high-dose aspirin are similar in efficacy, but this has not been proven in stroke prevention. Low-dose aspirin, such as 30 or 75 mg a day, may be equally as effective. Complications of high-dose aspirin are more frequent than with low doses. Four cerebrovascular randomized trials evaluating sulfinpyrazone versus placebo, and three trials evaluating sulfinpyrazone versus aspirin, showed more events in the sulfinpyrazone than in the aspirin and placebo groups. One small trial compared dipyridamole to placebo in patients with cerebrovascular disease and there were no differences in outcomes in the two groups. No other studies have compared dipyridamole alone to placebo or aspirin. The European Stroke Prevention Study II is in progress and is comparing (1) aspirin 25 mg twice daily, (2) dipyridamole 200 mg twice daily, (3) aspirin 25 mg + dipyridamole 200 mg twice daily and (4) placebo. The Ticlopidine Aspirin Stroke Study showed, in the 1st year, a 42% risk reduction for stroke and death by the efficacy analysis and a 47% risk reduction for stroke and stroke death. The superiority of ticlopidine in the reduction of strokes was seen in both males and females. Save for a reversible severe neutropenia in 0.86% of patients on ticlopidine, ticlopidine related side effects were relatively benign and reversible. The Canadian American Ticlopidine Study compared ticlopidine to placebo in patients with completed major strokes. The cumulative event rates for the primary outcome of stroke, myocardial infarction and vascular death, using the efficacy approach, show clear evidence of separation almost immediately following randomization consistent with a constant risk reduction of about 30% in the ticlopidine group. The data of the Canadian American Ticlopidine Study provide strong evidence that ticlopidine conveys a clinically important reduction in the risk of thromboembolic events in patients with a history of completed thromboembolic stroke. Ticlopidine reduced the risk of vascular events by 30%. In conclusion, sulfinpyrazone and dipyridamole appear to add nothing important over aspirin alone to stroke prevention. Ticlopidine is more effective than aspirin in preventing stroke. The modest, reversible risk of neutropenia, affecting less than 1% of patients, makes the benefit-risk ratio a reasonable one.

ISSN:1015-9770    

DOI:10.1159/000109056

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

A major cause of death in acute stroke is postinfarction edema. Glycerol is a hyperosmolar agent that is claimed to reduce edema and improve cerebral blood flow and metabolism. Intravenous glycerol therapy has been tested in 8 controlled, randomized trials including 603 patients but with conflicting results. Of 7 studies, the results of the effect of glycerol therapy on death within the first 3 weeks after infarction were combined in a statistical review. Statistical analysis indicated a significant positive effect with a relative odds reduction in death by 38 % (confident limits: 9 % to 59 %) within the first 3 weeks but with wide confidence limits. The long-term results and influence on morbidity are uncertain.

ISSN:1015-9770    

DOI:10.1159/000108981

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

We prospectively evaluated 125 patients with cerebral ischemia aged less than 45 years with cerebral angiography, CT and cardiac tests including two-dimensional echocardiography. Cardiac abnormalities were disclosed in 36 patients (33.6%). Potential sources of embolism were detected in 17 patients (15.8%); in 13 of them the cardiac lesion had previously been unrecognized. Mitral valve prolapse was the commonest cardiac lesion (6.5%). In 5 of these patients carotid atherosclerotic lesions were absent, and associated prothrom-botic factors were always present. In the remaining 2 cases dysplasia and/or dissection of carotid arteries were disclosed. Six patients showed an ''idiopathic'' aortic dilation; in 4 of them dysplasia or dissection of carotid arteries was observed. The ''idiopathic'' pattern of aortic root dilation (dilation limited to the first tract of the aortic root, normal echogenicity and aortic profile) was different from the ''atherosclerotic'' pattern (extensive dilation, increased echogenicity, irregular profile of aortic wall). Only few patients had cardiac lesions with high embolic risk, most patients having asymptomatic, previously unrecognized cardiac diseases. Therefore two-dimensional echocardiography is warranted for the etiological screening of cerebral ischemia in young adults. The detection of a cardiac lesion with low or unknown embolic risk should not preclude a search for other coexisting or prothrombotic factors. Finally, mitral valve prolapse and idiopathic aortic root dilation may be an expression of a minor connective tissue disorder accountable for dysplasia or dissection of carotid arteries.

ISSN:1015-9770    

DOI:10.1159/000108982

出版商:S. Karger AG    

年代:1992

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000109058

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

In a prospective study of 24 consecutive patients satisfying all clinical, cerebrospinal fluid and CT scan criteria for benign intracranial hypertension (BIH), angiography showed cerebral venous thrombosis affecting dural sinuses (CSVT) in 6 (25 ± 17%, 95%, confidence limits). When comparing patients with (n = 6) and without CSVT (n = 18), the only statistically significant difference concerned the prevalence of obesity (CSVT = 1/6; BIH = 14/18, p < 0.03). Another trend emerged but did not quite reach statistical significance (sex ratio female/male: CSVT = 3/3; BIH = 17/1, p < 0.07). The present study shows that CSVT can present with all the clinical and radiological criteria of BIH and illustrates the need for angiography or MRI to rule out this possibility, particularly in males and in nonobese females

ISSN:1015-9770    

DOI:10.1159/000108983

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

An incorrect measure of outcome in a clinical trial may invalidate the entire study, no matter how well-designed the trial is in other respects. In general, outcome can be measured at four different levels. Level 1: the biological activity of the disease (e.g. lactate level, ipsilateral stroke after carotid endarterectomy, aneurysmal rebleeding after antifibrinolytic agents); level 2: clinical manifestations (e.g. degree of weakness or aphasia, which are included in the so-called ''stroke scales''); level 3: activities of daily living (disability scales, e.g. the Barthel Scale), and level 4: the restriction of the life-style (handicap scales, e.g. the Glasgow Outcome Scale or Rankin Scale) or even the quality of life. Level 1 is easy to measure, but is not clinically relevant, whereas level 4 is highly relevant, but difficult to measure. Levels 1 and 2 are suitable only for preliminary studies which aim to identify a biological effect; they are unsuitable for studies where the result will be applied in clinical practice. In such cases, the measurement must be based on the outcome from the patient''s own perspective, which implies the use of disability scales, or preferably handicap scales. In addition, death (or at least vascular death) should always be included in the analysis. Finally, the statistical methods used should be nonparametric, as the scales represent classes and not true numbers.

ISSN:1015-9770    

DOI:10.1159/000109059

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Living conditions and life satisfaction before and after stroke were assessed in 80 patients with acute stroke (mean age 73 years). The results were compared with a general elderly population. Already prior to their stroke the patients had more health problems, lower functional ability, more passive leisure time and lower global life satisfaction. Low life satisfaction was associated with dependence in the activities of daily living (ADL). Economic resources, social network and psychiatric morbidity before stroke did not differ from the general elderly population. At 3 months of follow-up, almost half of the patients reported low life satisfaction, compared to only 2% in the national sample. Major depression and ADL dependence were associated with low life satisfaction after stroke. We conclude that much of the disability and handicap seen in stroke patients is present already before the stroke. Stroke-related deterioration of ADL performance, major depression and social disintegration after stroke interact to further reduce life satisfaction for the stroke victims and their families.

ISSN:1015-9770    

DOI:10.1159/000108984

出版商:S. Karger AG    

年代:1992

数据来源: Karger