ISSN:1015-9770    

DOI:10.1159/000108228

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108229

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108230

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108231

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The aim of this study is to validate whether measuring the cerebral vasomotor response with the breath-holding method can be a useful technique in the differentiation of vascular and Alzheimer types of dementia. We adopted the clinical and neuropsychological diagnosis of dementia according to DSM-IV criteria as the standard diagnosis against which our method was compared. Resting middle cerebral artery velocity, its rate of increase on breath holding and its decrease on hyperventilation (full range of vasodilation, FRV) were measured using a transcranial Doppler (TCD) velocimeter on both sides in a prospective study on 32 age-matched controls, 36 patients diagnosed with Alzheimer type dementia, and 31 vascular dementia (VD) patients. A total of 186 vessels were studied in 99 patients. A high level of significance (p < 0.001) was noted in the FRV in the differentiation between the VD group and the other two groups, on both sides and in both sexes. By taking a statistically optimal cutoff point of 70%, the sensitivity and specificity of the FRV test for the diagnosis of VD are 84.5 and 93.0% respectively. Measurements of hemodynamic reserve using the cerebral perfusion reserve test assessed by TCD could provide a way to detect demented individuals with underlying vascular mechanism of dementia, but would not offer prognostic data or differentiate between varying degrees of dementia.

ISSN:1015-9770    

DOI:10.1159/000108157

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108232

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

This study aimed to establish the inter-rater reliability of a novel measure of stroke outcome which has been developed for use in large randomised trials and which could be used in any large follow-up study. One hundred and thirty-two stroke patients were asked the two ''simple questions'' during a face-to-face interview on two occasions approximately 6 months after their stroke. The inter-rater reliability of the ''dependency'' question (i.e. Do you require help from another person with everyday activities?) was moderate ((= 0.51) whilst that of the ''recovery'' question (i.e. Do you feel that you have made a complete recovery from your stroke?) was good ĸ= 0.61). Although this degree of reliability may be acceptable in very large studies, it will make it more difficult to demonstrate real differences between groups. We discuss the possible reasons for the moderate reliability and suggest modifications to the questions which we hope further testing will show improves their performance

ISSN:1015-9770    

DOI:10.1159/000108158

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:1015-9770    

DOI:10.1159/000108233

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

We evaluated the safety and clinical effect of the low-molecular-weight heparin dalteparin in 60 consecutive patients with acute ischemic cerebrovascular disease. The indication for dalteparin therapy was stable cardioembolic stroke in 24 patients, stroke in progression in 23 patients, and serious and frequent TIAs or TIAs despite aspirin in 13 patients. The mean age was 73.0 years (49–85). After exclusion of hemorrhage by cerebral CT scan, dalteparin therapy was started 39 h (2–168) after onset of symptoms. Dalteparin was administered as subcutaneous injections 100 IU/kg body weight every 12 h with a mean daily dose of 13,533.4 IU and a mean duration of 8.7 days (3–16). In patients with TIAs and cardioembolic stroke, there were no further cerebrovascular episodes or clinical deterioration. Clinical worsening occurred in a total of 6 patients (10%), all 6 included because of progressive stroke. Cerebral CT excluded hemorrhagic transformation as reason for deterioration. A second CT was done in all patients after a mean duration of 7.8 days (5–11) of dalteparin therapy and revealed asymptomatic hemorrhagic transformation in 3 patients (5.0%). All these 3 patients had taken aspirin prior to dalteparin therapy. There was no clinical significant decrease in hemoglobin values or platelet count during dalteparin therapy. We conclude that anticoagulant therapy with weight-adjusted doses of the low-molecular-weight heparin dalteparin in patients with acute ischemic cerebrovascular disease is safe in this setting and that the clinical effect should be studied in randomized

ISSN:1015-9770    

DOI:10.1159/000108160

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

We sought to determine whether there are any subgroups of patients who might benefit from endarterectomy of the asymptomatic carotid artery after successful operation for a symptomatic carotid stenosis. The incidence and outcome of stroke in the asymptomatic carotid artery distribution was prospectively studied in 966 patients who were entered into the European Carotid Surgery Trial and had a 30–99% asymptomatic carotid stenosis. The patients had been randomized to either carotid endarterectomy (61%) or no endarterectomy of their symptomatic carotid stenosis. We reviewed the literature on the risks and efficacy of carotid endarterectomy and used these data in a decision analysis. The 5-year risk of stroke lasting more than 7 days in the asymptomatic carotid distribution was 3.4%. Two independent prognostic factors were identified by means of Cox''s proportional hazards regression with stepwise forward selection: the degree of asymptomatic carotid stenosis (30–69 vs. 70–99%) and hypertension. The 5-year-restricted and quality-adjusted life expectancy for a patient with both a severe (70–99%) asymptomatic carotid stenosis and hypertension, and therefore with the highest risk of asymptomatic carotid distribution stroke, was 4.14 life years for both conservative management and for endarterectomy. Plausible changes in the estimated risk of asymptomatic carotid distribution stroke, and in the rate of complications from endarterectomy, increased the benefit of endarterectomy. But, the maximal benefit was only 0.1 quality-adjusted life years or 5 weeks, even when endarterectomy was without risk. A separate regression model, with the degree of asymptomatic carotid stenosis as a continuous variable, suggested a possible benefit of endarterectomy for the few patients (n = 27, 3%) with an 80–99% asymptomatic carotid stenosis and hypertension. Until our results are refuted in other studies, there seems to be no firm indication for operation on the asymptomatic carotid artery in patients who have been successfully operated for a symptomatic carotid stenosis, except within the context of a randomized control

ISSN:1015-9770    

DOI:10.1159/000108161

出版商:S. Karger AG    

年代:1997

数据来源: Karger