Showing papers in "Cerebrovascular Diseases in 1996"

European Strategies for Early Intervention in Stroke (Part 1 of 2)

Abstract: Stroke is a major cause of death and disability in industrialized countries, but stroke awareness is still generally poor and treatment often ill-defined. At a meeting of a European Ad Hoc Consensus G

The Effect of a Stroke Rehabilitation Unit on Functional and Psychological Outcome: A Randomised Controlled Trial

Abstract: The outcome of patients receiving rehabilitation on a stroke unit (SU) was compared with that of patients on general medical and health care of the elderly wards (conventional wards; CWs) in a randomi

Stroke and Epilepsy: Critical Review of the Literature

Abstract: Stroke-associated seizures and epilepsy provide an excellent clinical model to study both acute hyperexcitability after stroke and long-term tissue changes responsible for epileptogenic scar formation. The authors critically review the literature regarding stroke and seizures, to define the clinical spectrum of the association between stroke and seizures. Unfortunately, most of the studies performed in the past were either retrospective and heterogeneous or not designed to address this important issue. Constant improvements and advances in technology, including computerized tomography, magnetic resonance imaging, cerebral angiography and ultrasound, have made possible increasing sophistication in our investigation of patients with stroke and stroke-related seizures and emphasize the need for reassessment of this relationship. Part I gives an overview of the incidence of stroke-associated seizures, their phenomenology and dynamics, and attempts to identify specific risk factors for this association such as stroke subtypes starting with hemorrhagic conditions.

The Effects of Lifarizine in Acute Cerebral Infarction: A Pilot Safety Study

Abstract: Background and Purpose: Lifarizine is a novel ion channel modulator which is neuroprotective in experimental global and focal ischemia, at doses that have minimal systemic vascular

Angioplasty of the Internal Carotid Artery: Results, Complications and FoIlow-Up in 61 Cases

Abstract: A total of 61 percutaneous transluminal angioplasties (PTAs) have been performed in 58 patients with symptomatic severe stenosis of the internal carotid artery in our department since 1990. Forty-nine

Intellectual Impairment in the First Year following Stroke, Compared to an Age-Matched Population Sample

Abstract: General intellectual impairment during the first year following stroke in 188 unselected, previously not demented patients aged 60–80 years was assessed with a comprehensive screening test, the Mattis Dementia Rating Scale, and compared to an age-matched population sample. Significant impairment occurred in 32, 26 and 26% of the stroke patients at 1, 6 and 12 months, which correlated to subjective complaints and a dependent life after discharge. Most patients scored stable or improved (84%), while 16% deteriorated significantly. Intellectual impairment correlated to CT lesion size and central atrophy, age and pre-stroke lower functional and social activity, as well as to stroke-induced handicap including aphasia, neglect, and increased mood symptoms. Thus, stroke-induced brain damage influences general intellectual function but may not be the sole reason for intellectual impairment.

Cerebral Infarction in PeopleUnder 40 YearsI

Abstract: Cerebral infarction in young people is considered a rare event. There are many potential etiologies capable of causing a cerebral infarction in this age group. Three hundred consecutive patients young

Stroke around the Baltic sea: Incidence, case fatality and population risk factors in Denmark, Finland, Sweden and Lithuania

Abstract: Within the WHO MONICA Project, stroke has been recorded in 7 populations in 4 countries around the Baltic Sea (Denmark: Glostrup; Finland: North Karelia, Turku/Loimaa and Kuopio; Sweden: Gothenburg and northern Sweden; Lithuania: Kaunas). In population surveys, risk factors for cardiovascular diseases have been examined in 10,364 persons in the age group 35–64 years. During 1987–1989, acute strokes were registered within the same age range in 2,847 men and 1,610 women. The yearly incidence (first ever stroke) per 100,000 was more than twice as high in Kuopio (men 284 and women 142) compared to Gothenburg (men 123 and women 64). Population mean systolic blood pressure was highest in 2 of the Finnish populations and lowest in the Danish population. The blood pressure levels in the populations correlated with stroke incidence in men (r = 0.87; p = 0.01) and in women (r = 0.70; p = 0.08). The large differences in community levels of blood pressure seem to explain much of the large variations in stroke incidence between populations around the Baltic Sea.

Presumed Pathogenetic Mechanisms of Recurrent Stroke after Lacunar Infarction

Abstract: We report presumed mechanisms of recurrent stroke in a prospective study on patients with lacunar infarction. Eighty-one patients with clinical and magnetic resonance imaging (MRI) findings compatible with lacunar infarction were followed for a median time of 48 months. Patients with recurrent stroke were assessed clinically by computed tomography, contrast-enhanced MRI and with respect to large-artery disease and cardioembolic sources of embolism. During follow-up, 9 patients (11.1%) died and 20 patients (24.7%) had 27 recurrent strokes (3 hemorrhagic, 24 ischemic). The annual risk of recurrent stroke was 6.8% and approximately even with time. Univariate analysis revealed age as the only risk factor significantly associated with recurrent stroke. Out of 24 episodes of recurrent ischemic stroke, 16 had clinical and neuroimaging features compatible with small penetrating artery occlusion, 6 were due to cortical infarcts, 1 episode was caused by presumed cerebral amyloid angiopathy, and 1 by a retinal infarct. Relevant large-artery disease was diagnosed in 2 patients with recurrent, small brainstem infarcts and in 2 patients with recurrent cortical and retinal infarcts. Although presumed lacunar infarcts predominated, our series highlights the heterogeneity of recurrent strokes after lacunar infarcts.

Ischaemic lacunar stroke in the European Carotid Surgery Trial. Risk factors, distribution of carotid stenosis, effect of surgery and type of recurrent stroke

Abstract: We compared the degree of carotid stenosis, risk factor profile, and effect of carotid surgery on incidence and type of recurrent stroke in lacunar infarct and non-lacunar infarct patients from the European Carotid Surgery Trial. The two patient groups were defined by the site and size of any symptomatic infarct on the pre-randomisation CT scan. The follow-up ischaemic carotid strokes were classified into lacunar, non-lacunar or uncertain. The risk factor profile was similar for the 222 lacunar and the 404 non-lacunar infarct patients. However, lacunar infarct patients had less severe carotid stenosis (p< 0.001). Small numbers did not allow conclusions about the efficacy of carotid surgery in those few lacunar infarct patients who had severe carotid stenosis. These findings are consistent with the hypothesis that severe carotid stenosis in lacunar infarct patients is usually incidental, and so 'asymptomatic', and that lacunar infarcts are most likely to be due to intracranial small-vessel disease.

The Place of Site of Lesion in the Aetiology of Post-Stroke Depression

Abstract: The association of post-stroke depression (PSD) and site of cerebral lesion was investigated in 117 patients with first-ever stroke in the Perth Community Stroke Study, who were depressed 4 months pos

Effect of early treatment with tirilazad (U74006F) combined with delayed thrombolytic therapy in rat embolic stroke

Abstract: Sixty-eight rats were embolized in the right carotid territory with a 200-µl suspension of white clots made from autologous blood. The purpose was to investigate the effect of early treatment wit

Frequency of Carotid Endarterectomy-Related Subclinical Cerebral Complications (Part 2 of 2)

Abstract: To evaluate the frequency of subclinical cerebral complications of carotid endarterectomy, 19 patients were studied before and 1 month after surgery. Significant neurological complications were detected only in 1 patient (5%), while neuropsychological deterioration was found in 12 patients (63%) as compared to 5 (29%) of 17 control subjects undergoing other vascular surgery procedures (p < 0.05). MRI detected new cerebral lesions in 3 (16%) patients, who also showed a decline in cerebral perfusion reserve in the peri-infarct area as assessed by acetazolamide-enhanced SPET. Global cerebral perfusion reserve declined in three patients. Quantitative EEG did not reveal deterioration in any patients. The possible prognostic significance of these sublinical complications should be defined.

Borderzone Brain Infarcts on CT Taking into Account the Variability in Vascular Supply Areas

Abstract: Although borderzone brain infarcts lack a uniform definition and are difficult to define because of significant variability in cerebral vascular supply, they are presumed to be related to haemodynamic

Predictive Factors of In-Hospital Mortality in 986 Consecutive Patients with First-Ever Stroke

Abstract: The aim of this study was to determine predictors of in-hospital mortality in 986 consecutive first-ever stroke patients by means of a multivariate analysis. In a first predictive model based on 13 de

Multinational Comparison of Diagnostic Procedures and Management of Acute Stroke: The WHO MONICA Study

Abstract: Background and Purpose: In the stroke component of the WHO MONICA Project, community-based registers of acute stroke have been undertaken in 20 populations in Finland, Sweden, Denmark, Germany, Italy, Yugoslavia, Hungary, Poland, Lithuania, Russia and China. This paper reports on diagnostic procedures and management of acute stroke in these populations. Methods: The MONICA stroke registers apply uniform registration procedures and diagnostic criteria. Data for 3 years were pooled and used for cross-sectional comparisons. Longitudinal analyses of the use of computerized tomography (CT) scans and autopsy rates were based on all years up to 1990 for which information was available. The total population in the age range investigated (35–64 years) was 3,250,000. Strokes were also recorded for the 65- to 74-year age range in seven of the 20 populations. Results: In all populations, more than three quarters of all 35- to 64-year-old stroke patients were managed in hospital; in nine populations more than 90% were managed in hospital. The use of CT scans ranged from 0% in Russia to 70–76% in West Germany, Italy, Sweden and two of the 3 Finnish populations. During the mid 1980s, use of CT scan increased rapidly in China (Beijing), Denmark, Finland and Yugoslavia but spread only slowly in Poland, Lithuania and Russia. Autopsy rates varied from 0% in China to 76% in the Hungarian and one of the Russian populations. During the 1980s, autopsy rates were stable in most populations, but declined considerably in Lithuania, Poland and Sweden. Elderly patients (65–74 years) were less often hospitalized in China but this was not the case in European populations. In all populations, CT scan and autopsy were less often performed in older subjects. Conclusions: Large variations exist between countries in the use of diagnostic procedures and the management of acute stroke. Data obtained before the late 1980s permit only very limited multinational epidemiological comparisons of stroke subtypes, but the possibility of making such comparisons is rapidly improving.

Screening for the Factor-V Arg 506 GIn Mutation in Patients with TlA and Stroke

Abstract: A common point mutation in the factor-V gene at the exact site (Arg 506) where activated protein C (APC) normally cleaves and inactivates the Va pro-coagulant accounts for APC resistance and is the most important genetic risk factor for venous thrombosis. It has also been suggested as a possible risk factor for stroke. We determined the prevalence of the Arg 506 Gln mutation in 180 patients (mean age 65.3 years) with cerebrovascular disease (138 stroke and 42 TIA) and compared it with that in 70 age-matched controls (mean age 64.9 years). The mutation was no more common in patients than controls [15/180 (8.3%) vs. 5/70 (7.1 %), p = 0,6]. Within the patient group there was no relationship between the presence of the mutation and age of stroke or the occurrence of TIA or stroke. There was no association between the mutation and any particular stroke subtype (large-vessel, lacunar, cardioembolic or unknown). The factor-V Arg 506 Gln mutation is not an important risk factor for stroke and TIA in an unselected group of patients, and routine screening is not justified.

Frequency of Carotid Endarterectomy-Related Subclinical Cerebral Complications (Part 1 of 2)

Abstract: To evaluate the frequency of subclinical cerebral complications of carotid endarterectomy, 19 patients were studied before and 1 month after surgery. Significant neurological complications were detected only in 1 patient (5%), while neuropsychological deterioration was found in 12 patients (63%) as compared to 5 (29%) of 17 control subjects undergoing other vascular surgery procedures (p < 0.05). MRI detected new cerebral lesions in 3 (16%) patients, who also showed a decline in cerebral perfusion reserve in the peri-infarct area as assessed by acetazolamide-enhanced SPET. Global cerebral perfusion reserve declined in three patients. Quantitative EEG did not reveal deterioration in any patients. The possible prognostic significance of these sublinical complications should be defined.

Cerebral Microemboli in Atrial Fibrillation Detected by Transcranial Doppler Ultrasonography

Abstract: In order to determine the significance of microemboli in atrial fibrillation (AF), we used transcranial Doppler ultrasonography to study 27 AF patients with recent stroke, 27 AF patients without strok

Amphetamine-Associated Stroke

Abstract: Seven patients with presumed amphetamine-associated stroke are reported. Ischaemic stroke occurred in four patients, a transient ischaemic attack in one patient and a haemorrhagic stroke in two patien

Trends in the Incidence and Mortality of Stroke in Kaunas, Lithuania, 1986-1993

Abstract: The trends in incidence, 28-day mortality and 28-day case fatality of stroke during the period 1986–1993 were assessed in the population aged 35–64 years in Kaunas, Lithuania. The Kaunas community-bas

The Capsular Warning Syndrome The High Risk of Early Stroke

Abstract: The capsular warning syndrome (CWS) is a specific form of crescendo transient ischaemic attack (TIA) where the ischaemia is thought to be restricted to the region of the internal capsule due to in sit

Do Acute Stroke Units Improve Care

Abstract: Background and Purpose: Stroke rehabilitation units have been shown to improve mortality and reduce morbidity and hospital length of stay as compared with conventional medical ward care. In contrast, the effectiveness of acute stroke units (ASUs), which only provide early in-patient care, is unknown. We have compared ASU care with that administered on a general medical or geriatric ward. Methods: Historical comparison of 116 consecutive patients admitted to a new ASU during the 6-month period from February to July 1994 with 128 consecutive patients admitted to general medical or geriatric wards during the previous 6-month period (August 1993 to January 1994). Results: Admission baseline characteristics were similar between the two groups. As compared with conventional general ward care, patients admitted to the ASU had a shorter stay in casualty, 6 h (4–6) versus 7 h (4–11; 2p = 0.03); reduced length of stay in hospital, 20 days (10–55) versus 31 days (13–80; 2p = 0.09); increased carotid Doppler investigation, 40/94 versus 25/101 (2p = 0.013); increased prescription of secondary prevention measures, aspirin 49/94 versus 33/101 (2p = 0.009) or treatment of hypertension 19/50 versus 5/47 (2p = 0.004); improved outcome, home: institution: death, 69:11:18 versus 63:13:32 (2p = 0.049). Conclusion: ASUs appear to contribute to improved care (investigations, secondary prevention) and outcome following stroke whilst patients spend less time in hospital.

European Strategies for Early Intervention in Stroke (Part 2 of 2)

Abstract: Stroke is a major cause of death and disability in industrialized countries, but stroke awareness is still generally poor and treatment often ill-defined. At a meeting of a European Ad Hoc Consensus G