Showing papers in "Cerebrovascular Diseases in 1993"
TL;DR: In a community-based stroke register, 675 patients with first-ever stroke were identified, with sixty-six due to primary intracerebral haemorrhage giving a crude incidence of 0.16/1,000/year (age adjust).
Abstract: In a community-based stroke register we identified 675 patients with first-ever stroke. Sixty-six (10%) due to primary intracerebral haemorrhage giving a crude incidence of 0.16/1,000/year (age adjusted to England and Wales population = 0.23/1,000/year). The site of the haemorrhage was lobar in 36%, basal ganglionic in 27%, cerebellar in 11 %, massive supratentorial in 9%, brain stem in 3% and unknown in 14%. Intraventricular haemorrhage was least common in the lobar group (13%) but occurred in 29% overall. The clinical presentation and features depended upon the site and size of the haematoma. Hypertension preceded the stroke in 58%, other aetiologies were uncommon.
168 citations
TL;DR: The results of a double-blind, placebo-controlled, multicenter trial on the efficacy of intravenous recombinant tissue plasminogen activator (rt-PA, duteplase) in 98 patients with hyperacute Huntington's disease are reported.
Abstract: We report the results of a double-blind, placebo-controlled, multicenter trial on the efficacy of intravenous recombinant tissue plasminogen activator (rt-PA, duteplase) in 98 patients with hyperacute
149 citations
TL;DR: Vascular dementia may be regarded as a syndrome of cognitive impairment resulting from vascular diseases, especially isc cerebral palsy.
Abstract: Vascular dementia is growing in importance, so is the confusion surrounding it. Vascular dementia may be regarded as a syndrome of cognitive impairment resulting from vascular diseases, especially isc
119 citations
TL;DR: A proposed classification of subcortical infarcts is presented, a clinicoradiological one with the distribution of infarCTs based on known vascular territories and the borderzone.
Abstract: A proposed classification of subcortical infarcts is presented. The classification is a clinicoradiological one with the distribution of infarcts based on known vascular territories and the borderzone
77 citations
TL;DR: The analysis of the preliminary data suggests surgical decompression of the posterior fossa as the optimum therapeutic regimen in obtunded patients presenting with occlusive hydrocephalus and signs of brainstem compression.
Abstract: This study presents 42 patients with cerebellar infarctions; 27 patients were studied retrospectively, 15 patients were studied prospectively according to a fixed protocol. Rating of the clinical status using an adapted classification schema according to Heros with additional neuroimaging and neurophysiological data was found to be a reliable tool to estimate the severity of the disease. Evoked potential studies are useful and reliable to monitor the clinical course and to estimate the severity of the disease (i.e. BAEP) or predict outcome (i.e. SSEP). Treatment should be determined by the severity of the disease, i.e. awake and drowsy patients can be treated either medically or with ventriculostomy, if hydrocephalus occurs. In comatose patients decompressive surgery is significantly superior to ventriculostomy (p < 0.05). The analysis of the preliminary data suggests surgical decompression of the posterior fossa as the optimum therapeutic regimen in obtunded patients presenting with occlusive hydrocephalus and signs of brainstem compression. An open multicenter trial in Austria and Germany is in progress to confirm the results of this pilot study.
74 citations
TL;DR: Acute confusional state (ACS), or delirium according to DSM-III-R, and the function of the hypothalamic-pituitary-adrenal-axis were studied in 83 patients soon after an ischemic supratentorial stroke.
Abstract: Acute confusional state (ACS), or delirium according to DSM-III-R, and the function of the hypothalamic-pituitary-adrenal-axis were studied in 83 patients soon after an ischemic supratentorial stroke. ACS was common (35/83 = 42%). Patients with stroke had higher cortisol levels after dexamethasone than an elderly healthy control population (median = 75 and 31 nmol/l, respectively; p < 0.001). The stroke patients with ACS had higher post-dexamethasone cortisol levels than stroke patients without ACS (median = 98 vs. 59 nmol/l; p < 0.001). A logistic regression analysis revealed that ACS in stroke patients was independently associated with high cortisol levels after dexamethasone, extensive motor impairment and left-sided brain lesion. There is a close association between ACS and hypercortisolism in stroke patients, not explained by other known determinants of ACS. The possibility that hypercortisolism is involved in the pathophysiology of confusion caused by an acute stroke should be considered.
71 citations
TL;DR: The economic benefits of three types of preventive strategy have been calculated using the results of recent randomized trials applied to the Swedish medical setting, showing that antihypertensive therapy effectively reduces the risk of stroke and also of myocardial infarction in people above 70 years of age.
Abstract: In view of the lack of reliable economic information from most European countries, Sweden (population 8.5 million) is used here as an example of the cost-effectiveness of stroke care in Europe. In 1988, stroke patients in Sweden accounted for 3.25 million bed days in hospitals and nursing homes (382,000/million inhabitants). The total direct and indirect costs associated with stroke have been calculated for these patients, using 1991 prices. The total direct costs (made up mainly of medical care and social services costs) are calculated to be US$ 1,579 million (US$ 185.8 million/million inhabitants) and the total indirect costs (made up of sickness benefits, stroke-related early retirement and death before the age of 65 years) are calculated to be US$ 396 million (US$ 46.6 million/million inhabitants). The total calculated costs are therefore US$ 1,975 million (US$ 232.4 million/million inhabitants). Stroke patients are major consumers of medical care and social services even before the occurrence of stroke. Adjusting for this, the national incremental cost attributed to stroke is calculated to be US$ 1,017 million (US$ 120 million/million inhabitants). The average cost from first stroke to death is US$ 79,000 per patient (US$ 41,000 if adjusted for the high consumption of medical care and social services before stroke). The economic benefits of three types of preventive strategy have been calculated using the results of recent randomized trials applied to the Swedish medical setting. Anticoagulants given to eligible patients with atrial fibrillation might prevent 420 strokes/year, and give a net economic saving of US$ 1.5 million/year (US$ 0.2 million/million inhabitants), provided that the risk of intracranial bleeding is low (1.3%/year), as in well-controlled routine care in Sweden. Carotid surgery in patients with transient ischemic attack or minor stroke might prevent 255 strokes/year and save US$ 8 million/year (US$ 0.9 million/million inhabitants). Antiplatelet agents in patients with transient ischemic attack or minor stroke have the potential to prevent 180 strokes/year and save US$ 7.2 million/year (US$ 0.8 million/million inhabitants); these drugs now being used routinely, the US$ 7.2 million saving has already been made. Intensified efforts to identify and treat hypertension have a high potential for reducing the number of strokes (at least 1,000 prevented per year in Sweden), but the costs are considerable. Recent randomized trials have shown that antihypertensive therapy effectively reduces the risk of stroke and also of myocardial infarction in people above 70 years of age. In the 70- to 80-year age range, the net cost is approximately US$ 250/year gained. At 50 years, the corresponding economic saving approaches US$ 250/year gained. At 50 years, the corresponding economic saving approaches US$ 60,000/year. Nonpharmacological strategies to reduce blood pressure levels in the population and campaigns against smoking are probably cost-effective, but no data are yet available to support this proposition. Admitting stroke patients to specialized stroke units during the acute phase has no major influence on mortality. However, early intensive rehabilitation in such units reduces the need for long-term institutional care, as shown by two Scandinavian randomized trials. Ongoing analyses indicate that stroke units are also extremely beneficial from an economic perspective.
48 citations
TL;DR: Forty-seven patients presenting with symptoms of large middle cerebral artery territory infarcts were studied prospectively using serial CT brain scanning to assess infarCT extent and swelling, and the results confirmed the need for further study.
Abstract: Forty-seven patients presenting with symptoms of large middle cerebral artery territory infarcts were studied prospectively using serial CT brain scanning to assess infarct extent and swelling, and tr
39 citations
TL;DR: Dolichoectasia of intracranial arteries may cause a variety of neurological problems including cranial nerve and brain tissue compression, hydrocephalus, and cerebral ischemia.
Abstract: Dolichoectasia of intracranial arteries may cause a variety of neurological problems including cranial nerve and brain tissue compression, hydrocephalus, and cerebral ischemia. Different mechanisms ma
37 citations
TL;DR: Patients with lacunar infarct had better survival, and less disability than patients with superficial infarction, and the difference in risk of recurrent infarctions was not statistically significant, supporting the hypothesis that Lacunar Infarcts are usually caused by a local small-vessel obstruction.
Abstract: In a prospective study, we compared the prognosis for survival, handicap, and recurrence of stroke in 103 patients with a first-ever lacunar infarct, presumably due to small-vessel obstruction, with that in 94 patients who had a first-ever superficial infarct associated with large-vessel disease. Patients with lacunar infarction had better survival, as shown by Kaplan-Meier analysis, and less disability than patients with superficial infarction, whereas the difference in risk of recurrent infarction was not statistically significant. Six of the 7 (86%) recipient infarcts in the lacunar infarction group were lacunar again, supporting the hypothesis that lacunar infarcts are usually caused by a local small-vessel obstruction.
33 citations
TL;DR: In the normal media, quiescent smooth muscle cells (SMCs) express predominantly the α-smooth muscle (SM) actin isoform, whereas in vitro SMCs may represent a useful experimental model to study phenotypic modifications of SMCs during pathological process as discussed by the authors.
Abstract: Smooth muscle cells (SMCs) implicated in the human atheromatous process show dedifferentiated features characterized by typical changes in cytoskeletal elements. In the normal media, quiescent SMCs express predominantly the α-smooth muscle (SM) actin isoform. In the human atheromatous plaque and in rat experimental intimal thickening 15 days after balloon-induced endothelial injury, a decrease in the α-SM actin isoform and a predominance of the β-cytoplasmic actin isoform develop. Thus, the study of cytoskeletal changes enables a better definition of SMC phenotype. Furthermore, in vitro SMCs may represent a useful experimental model to study phenotypic modifications of SMCs during pathological process. Cytokines and growth factors, released by cells present in the atheromatous plaque, and extracellular components of the arterial wall, such as heparin, modulate the expression of α-SM actin in cultured SMCs and represent good candidates to exert important regulatory actions in vivo. Clones of aortic SMC derived from rats of different ages show different phenotypic features. A better understanding of the mechanisms leading to cytoskeletal modifications may help in the clarification of the mechanisms playing a role in the development of arterial pathological events.
TL;DR: A series of 53 patients with angiographically proven middle cerebral artery (MCA) trunk occlusions treated with intravenous or intra-arterial recombinant tissue plasminogen activator for MCA trunk Occlusions are described.
Abstract: A series of 53 patients with angiographically proven middle cerebral artery (MCA) trunk occlusions treated with intravenous (in 46) or intra-arterial (in 7) recombinant tissue plasminogen activator (r
TL;DR: The emphasis needs to be shifted to identifying and understanding the interactive vascular factors that contribute to cognitive impairment, which may open avenues in the search for modifiable and treatable vascular components.
Abstract: Vascular dementia is growing in importance, so is the confusion surrounding it. Vascular dementia may be regarded as a syndrome of cognitive impairment resulting from vascular diseases, especially ischemic brain changes. It may be related to many different vascular mechanisms, types of brain changes and risk factors. However, currently no precise knowledge exists regarding the extent to which these factors cause, contribute or only coincide with the cognitive loss. The resulting imprecision in definition and diagnosis breeds confusion regarding prevention, treatment and incidence of the syndrome. In addition, the changing patterns of age of the population, risk factors and types of stroke complicate the clinical picture. Instead of comfortable categorization, the emphasis needs to be shifted to identifying and understanding the interactive vascular factors that contribute to cognitive impairment. This may open avenues in the search for modifiable and treatable vascular components.
TL;DR: The predominant problem resulting in brain injury and death in patients with cerebral venous (veins and sinuses) thrombosis is hemorrhagic infarction.
Abstract: The predominant problem resulting in brain injury and death in patients with cerebral venous (veins and sinuses) thrombosis is hemorrhagic infarction. The predominant issue in treatment is whether to
TL;DR: Although MK-801 caused a significant drop in blood pressure, it significantly improved the neurological status 24 h after MCA occlusion and led to a significant improvement in infarct volumes.
Abstract: We examined neurological deficits and infarct volumes, as determined by 2,3,5-triphenyltetrazolium chloride staining, 24 h after intraluminal suture occlusion of the middle cerebral artery (MCA) in 2 groups of 10 male Sprague-Dawley rats treated after the onset of ischemia with the noncompetitive N-methyl-D-aspartate antagonist, dizocilpine maleate (MK-801) or saline. Although MK-801 caused a significant drop in blood pressure, it significantly improved the neurological status 24 h after MCA occlusion (p 3 in the control and 157 ± 46 in the MK-801-treated group (mean ± SEM, p
TL;DR: Cerebrovascular reserve capacity (CVRC) was investigated in 13 insulin-dependent diabetic patients with clinical microangiopathy and in 12 healthy subjects.
Abstract: Cerebrovascular reserve capacity (CVRC) was investigated in 13 insulin-dependent diabetic (IDDM) patients with clinical microangiopathy and in 12 healthy subjects. CVRC was assessed by transcranial Do
TL;DR: The management of unruptured aneurysms is a complicated one and few definitive data exist to guide us and sensible people often disagree about the best recommendations for a given patient.
Abstract: The management of unruptured aneurysms is a complicated one. Few definitive data exist to guide us and sensible people often disagree about the best recommendations for a given patient. There are some
TL;DR: A group of 30 patients with symptomatic internal carotid artery (ICA) occlusion and different computed tomography (CT) patterns of cerebral ischemia (14 borderzone and/or terminal, 16 territorial) wer diagnosed.
Abstract: A group of 30 patients with symptomatic internal carotid artery (ICA) occlusion and different computed tomography (CT) patterns of cerebral ischemia (14 borderzone and/or terminal, 16 territorial) wer
TL;DR: This case illustrates the association of significant carotid stenosis, focal seizure activity over the ipsilateral motor strip an with inhibitory seizures presenting as transient ischemic attacks.
Abstract: Inhibitory seizures presenting as transient ischemic attacks are rare. This case illustrates the association of significant carotid stenosis, focal seizure activity over the ipsilateral motor strip an
TL;DR: Infarction in the anterior inferior cerebellar artery (AICA) territory is rare, and most reports on such infarction have been restricted to autopsy studies.
Abstract: Infarction in the anterior inferior cerebellar artery (AICA) territory is rare, and most reports on such infarction have been restricted to autopsy studies. We analyzed the clinical figures of 5 patie
TL;DR: A favorable outcome is the most remarkable finding, contrasting with the usually poor prognosis of dissections in the intracranial posterior circulation.
Abstract: Dissecting aneurysms localized to intracranial part of the vertebrobasilar circulation are a rare condition with, generally, a severe outcome. Much more rare are dissections confined to the posterior cerebral artery. We describe one such case, and review prior reports to clarify clinical, angiographic, and therapeutic aspects. Classical clinical presentation is represented by subarachnoid hemorrhage with or without mild focal deficit. Conservative management seems to be the treatment of choice. A favorable outcome is the most remarkable finding, contrasting with the usually poor prognosis of dissections in the intracranial posterior circulation.
TL;DR: The authors performed magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in 16 patients with vertebrobasilar dolichoectasia (VBD) and five patients had compressive cranial nerve deficits.
Abstract: We performed magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in 16 patients with vertebrobasilar dolichoectasia (VBD). Five patients had compressive cranial nerve deficits an
TL;DR: The validity of clinical diagnosis of topography (CDT) and etiology (CDE) in 100 consecutive patients who were examined within 12 h of stroke onset by a stroke team is assessed.
Abstract: We assessed the validity of clinical diagnosis of topography (CDT) and etiology (CDE) in 100 consecutive patients who were examined within 12 h of stroke onset by a stroke team (1 neurologist with int
TL;DR: 167 of 1,802 patients with first strokes, admitted to a stroke primary care center and included prospectively into the Lausanne Stroke Registry had sensorimotor stroke (SMS) involving face/upper limb/
Abstract: 167 of 1,802 patients with first strokes, admitted to a stroke primary care center and included prospectively into the Lausanne Stroke Registry had sensorimotor stroke (SMS) involving face/upper limb/
TL;DR: To determine the precipitating factors of aneurysmal rupture, the medical records of 425 consecutive patients with aneurYSmal subarachnoid hemorrhage were reviewed and the time of onset was determined to be within three days of rupture.
Abstract: To determine the precipitating factors of aneurysmal rupture, the medical records of 425 consecutive patients with aneurysmal subarachnoid hemorrhage were reviewed. As for the time of onset, a signifi
TL;DR: Smoking has only more recently been established as one of the major risk factors for stroke, and numerous epidemiological studies have now established a close relationship between smoking and stroke as a closely related condition.
Abstract: Smoking has only more recently been established as one of the major risk factors for stroke. Numerous epidemiological studies have now established a close relationship between smoking and stroke as a
TL;DR: FOS and JUN proteins are encoded by cellular early response or immediate early genes (IEGs) and act as transcription factors and are thought to represent third or fourth messengers in an intracellul
Abstract: FOS and JUN proteins are encoded by cellular early response or immediate early genes (IEGs). They act as transcription factors and are thought to represent third or fourth messengers in an intracellul
TL;DR: The modern concepts of recanalization strategies by using fibrinolytic agents are discussed and the use of streptokinase, urokinase, and recombi are discussed.
Abstract: The modern concepts of recanalization strategies by using fibrinolytic agents are discussed. Therapeutic thrombolysis in cerebral ischemia has entailed the use of streptokinase, urokinase, and recombi
TL;DR: This study studied the occurrence and severity of CCD in two groups of hemiparetic stroke patien to evaluate whether hypotonia could be the clinical expression of crossed cerebellar diaschisis.
Abstract: In order to evaluate whether hypotonia could be the clinical expression of crossed cerebellar diaschisis (CCD), we studied the occurrence and severity of CCD in two groups of hemiparetic stroke patien
TL;DR: A case of spontaneous atherosclerotic extracranial vertebral aneurysm characterized by vertebrobasilar transient ischemic attacks and stroke is reported.
Abstract: Spontaneous extracranial vertebral aneurysms are very rare, presenting with varying clinical features such as laterocervical mass, cervicobrachial neuralgia, spinal cord compression or vertebrobasilar ischemic events. These aneurysms may be due to arteritis, parietal dissecting hematoma or atherosclerosis. We report a case of spontaneous atherosclerotic extracranial vertebral aneurysm characterized by vertebrobasilar transient ischemic attacks and stroke.