Showing papers on "Cerebral infarction published in 1977"

Controlled trial of aspirin in cerebral ischemia.

Abstract: Adouble-blind trial of aspirin for the treatment of cerebral ischemia was begun in 1972 and continued for 37 months. This was accomplished despite difficulties in controlling a long-term study of a drug which has widespread availability and consumption. The study design, criteria for selection of patients, follow-up surveillance, and methods of data analysis are presented. We report only subjects without carotid surgery before randomization. Patients (178) who had carotid transient ischemic attacks (TIAs) were randomly allocated to aspirin or placebo and followed to determine the incidence of subsequent TIAs,death, cerebral infarction or retinal infarction. Analysis of the first six months of follow-up revealed a statistically significant differential in favar of aspirin when death or cerebral or retinal infarction and the occurrence of TIAs were grouped and considered together as end points. Significance in favor of aspirin treatment was mainly revealed in patients with a history of multiple TIAs and was most evident in those individuals having carotid lesions appropriate to the TIA symptoms. It cannot be inferred from this study that aspirin prevents stroke because when end points were restriced to death or cerebral or retinal infarction, there was no statistically significant differential between the aspirin and placebo treatments.

Prognostic Value of the Stress Response Following Stroke

Abstract: The systemic metabolic response following intracranial vascular damage was measured in 65 consecutively seen patients (56 with cerebral infarction and nine with subarachnoid hemorrhage). Significantly ( P P ( JAMA 238:1374-1376, 1977)

Diaschisis with cerebral infarction.

Abstract: Fifteen patients admitted to Philadelphia General Hospital with acute strokes had repeated measurements of cerebral blood flow measured by the 133Xenon inhalation method. A progressive decline in cerebral blood flow in both hemispheres was observed during the first week after infarction in twelve of these patients. This decline could be partially explained by loss of autoregulation, but could not be correlated with level of consciousness, clinical status of PCO2. This progressive decline in flow in the non-ischemic hemisphere indicates a process more complex than a simple destruction of axonal afferants to neurons as implied by the term diaschisis. The flow changes in the non-ischemic hemisphere are likely caused by a combination of the immediate effects of decreased neuronal stimulation modified by loss of autoregulation, release of vasoactive substances, cerebral edema, and other factors.

Angiographic manifestations in postrecanalized cerebral infarction.

Abstract: In 14 stroke patients showing angiographic recanalization of the occluded internal carotid artery or middle cerebral arterial axis, the postrecanalized angiograms demonstrated several findings that have been considered to be generally rare in cerebral infarction. These findings principally consisted of narrowing of arterial caliber in six cases (43 percent), mass effect in eight cases (57 percent), and capillary blush in five cases (36 percent).

Kinking of the internal carotid artery. Clinical significance and surgical management.

Abstract: Observations of a series of fifteen surgically treated coiled and kinked internal carotid arteries are reported. The kinked internal carotid artery may be clinically significant and can cause cerebral infarction, even in the absence of atherosclerosis. Each patient must be thoroughly investigated and evaluated individually. One must distinguish simple tortuosity without blood flow obstruction from critical kinking of the internal carotid artery. If a patient with angiographic confirmation is symptomatic and other causes are eliminated, surgical correction should be carefully considered, especially if rotational cerebral ischemia is present. The surgical treatment of choice is resection of the redundant internal carotid artery with reimplantation and thromboendarterectomy of any associated plaque. Kinking of the internal carotid artery may lead to aneurysm formation requiring a difficult surgical resection. Although the evidence for a precise causal relationship between kinking of the internal carotid artery and cerebrovascular symptoms is sometimes difficult to establish, it is our belief that a more aggressive surgical approach may be warranted in this potentially disabling and even fatal condition.

“Release hallucinations” as the major symptom of posterior cerebral artery occlusion: A report of 2 cases

Abstract: Visual hallucinations were the presenting symptoms in 2 patients with probable infarcts in the territory of a posterior cerebral artery. They occurred in areas of paracentral scotomas, right in Patient 1 and left in Patient 2. In Patient 1 they were formed, prolonged, and not apparently related to past experience. In Patient 2 they were at first paroxysmal and unformed, with more prolonged metamorphopsia; later there appeared to be palinoptic formed images, possibly postictal in nature. Such hallucinations appear to be of a "release" type, and may be more common than is generally appreciated in patients with posterior cerebral artery occlusion.

Experimental regional cerebral ischemia in the middle cerebral artery territory in primates. Part 2: Effects on brain water and electrolytes in the early phase of MCA stroke.

Abstract: Experimental regional cerebral ischemia was produced in the middle cerebral artery (MCA) territory in primates (M. mulatta) by macrosphere embolization. Determinations of percentage tissue dry weight and tissue sodium and potassium concentrations were obtained in samples from the ischemic and non-ischemic hemispheres at various time from 12 to 48 hours after the onset of cerebral ischemia. Samples from the cortex normally supplied by the occluded MCA showed maximal accumulation of edema fluid with fluxes in sodium and potassium in reciprocal directions at 12 hours and similar edematous changes in putamen at 24 hours after embolization By 48 hours after MCA occlusion and despite the presence of infarction, partial reversal was observed in the redistribution of water and electrolytes in these gray matter structures. In contrast to cerebral cortex and putamen, the adjacent subcortical white matter showed progressive increases in water content from 12 to 48 hours and definite increases in tissue sodium with decreases in potassium were not observed until 48 hours after MCA occlusion. This late severe white matter edema associated with cerebral infarction appears to be a major factor responsible for the hemispheric swelling observed at this state.

Alpha-pattern coma: 24 cases with 9 survivors

Abstract: Alpha-pattern coma denotes the association of a comatose state with an electroencephalogram consisting predominately of alpha-frequency activity. Over the past three years we have studied 24 such cases: 14 following cardiopulmonary arrest, 6 following respiratory arrest, and 3 following brainstem infarction. Of the 9 patients who survived, only 1 had a significant neurological deficit. It was found that: (1) alpha-pattern coma can result from a variety of neurological insults; (2) a significant proportion of patients survive, often with little or no deficit; (3) clinical evidence of intact brainstem function implies a favorable outcome; (4) the electroencephalogram was similar in survivors and nonsurvivors and did not differentiate diffuse cerebral dysfunction from focal brainstem disease; and (5) neuropathological studies demonstrated diffuse cortical as well as brainstem changes.

Evaluation of Recent Cerebral Infarction by Computerized Tomography

Abstract: • Twenty patients with cerebral infarction were observed with serial computerized tomographic (CT) scans. Seventy percent of those infarctions showed a mass effect that had disappeared in all patients by the eighth week after the ictus. In 63%, there was enhancement after contrast infusion, with a definite temporal relationship to the day of onset of the neurological deficit. Twenty percent of the patients initially had normal CT scans that became abnormal weeks after the stroke. Radionuclide scans were positive in the patients who showed contrast enhancement, and the area of abnormal uptake correlated well with the area of enhancement. The timing of the performance of the CT scan in relation to the onset of neurological deficit is an important factor to consider when evaluating the stroke syndrome with CT.

Incidence of stroke in Frederiksberg, Denmark.

Abstract: Since 1971, stroke registers in several countries have been cooperating in a study of stroke epidemiology, initiated by WHO. One of the registers covers the population of Frederiksberg, Copenhagen. During the first two years of registration strokes were recorded in 556 Frederiksberg citizens. A certain diagnosis of cerebral hemorrhage--verified by angiography, spinal fluid examination, or autopsy--was made in 10% of the patients; subarachnoid hemorrhage was demonstrated in only 2%; most of the remaining patients probably had cerebral infarction. The overall annual incidence of stroke, when adjusted for age for the Danish population, was 1.9 per 1,000 for males, and 1.6 per 1,000 for females. For every type of stroke, except subarachnoid hemorrhage, the incidence increased markedly with age. The age-specific stroke incidence rates found in the present investigation are much lower than those demonstrated by Aho in a community-based study in Finland. In view of the strict comparability of the two studies, real differences in the risk of stroke may exist between the two communities.

Relative role of factors associated with cerebral infarction and cerebral hemorrhage. A matched pair case-control study.

Abstract: Comprehensive ascertainment of all possible new cases of stroke appearing between January 1, 1970 and June 30, 1971, and admitted to three major hospitals in Winnipeg, Manitoba, has been achieved by reviewing the Manitoba Health Services Commission claim reports. The medical records of these cases were reviewed, pertinent data were abstracted, and rigid criteria for diagnosis were followed. Also, data were obtained from death certificates, autopsy reports and long-term hospital records. A total of 606 ascertained cases (410 infarction, 137 hemorrhage, and 59 undetermined type) were matched for age, sex, residence and year of admission with 606 controls from admissions for other than cardiovascular and cerebrovascular disorders. The data were analyzed for elucidating the possible risk factors for infarction (INF) and hemorrhage (HGE). The findings suggested that hypertension was the main risk factor in hemorrhage, whereas in infarction, along with hypertension, other factors such as diabetes, heart enlargement in chest x-ray, ECG abnormalities, and smoking were suggested as risk factors. There was an association also between infarction, on one hand, and the history of receiving anticoagulants, diuretics, and medications for the heart, and the occurrence of myocardial infarction, on the other hand. These features indicate that infarction and ischemic heart disease have similar risk factors. Hemoglobin and hematocrit were higher in infarction cases than in their controls only when measured at stroke admission. No difference was revealed when they were measured prior to stroke. Their association with infraction therefore may be secondary to other factors and of no significance for its risk.

Myocardial infarction coincident with cerebrovascular accidents in the elderly

Abstract: In a three-year prospective study of acute cerebrovascular accident patients admitted to a geriatric unit within 72 hours of the onset, 12.7% had what was considered to be an associated acute myocardial infarction. In the majority of cases, 71%, there was no clinical indication of an acute myocardial infarction and, had it not been for electrocardiographic and enzyme studies, the concurrence of these two conditions might not have come to light. The possible explanations for the concurrence of these two conditions are explored. Patients were followed-up for five years. The mortality rate for the combined acute myocardial and cerebral infarction cases admitted to hospital was 53% in six weeks, and 64% in one year, compared with 26% and 42%, respectively, in those strokes uncomplicated by a cardiac infarction. Only one patient has survived for five years. The recognition of such cases is important in terms of management and prognosis and this may be achieved by ECG recordings followed by enzyme studies in all cases of acute stroke admitted to hospital.

Clinical Prognosis Correlated with Hemispheric Blood Flow in Cerebral

Abstract: Prognosis with Hemispheric Flow in Cerebral Infarction • In 44 patients with acute unilateral cerebral infarction, there was reduction of hemispheric blood flow (HBF) and metabolism in the healthy hemisphere (phenomenon of diaschisis) as well as in the diseased hemisphere in patients in all age groups (30 to 70 years of age). In patients with symptoms present for three weeks or longer, the decrease in HBF in the healthy hemisphere was less than during the acute stage of infarction. The HBF in the healthy hemisphere of the younger patients approached normal values months or years after the stroke but remained reduced in older patients, probably reflecting diffuse as well as focal cerebrovascular disease. When the severity and outcome of the neurological deficit was correlated with the blood flow and metabolism of the diseased hemisphere, it was apparent that HBF in patients with transient ischemic attacks and more prolonged but reversible neurological deficit was greater than in those who had sustained severe, permanent neurological deficit.

Computed tomography of intracerebral hematomas. II. Radionuclide and transmission CT studies of the perihematoma region

Abstract: Transmission CT studies of 40 patients with intracerebral hematomas were used for an analysis of the perihematoma region. Nineteen of these patients had radionuclide studies. In the brain adjacent to an intracerebral hematoma, the patterns of pertechnetate uptake on scintillation scans and contrast enhancement on transmission CT resemble those observed in cerebral infarctions. The healing of the perihematoma region proceeds similarly to that of infarcts. The brain about the hematoma is ischemic tissue which behaves much like cerebral infarction not related to hematomas.

The capacity for computed tomography diagnosis of cerebral infarction. An experimental study in the nonhuman primate.

Abstract: The characteristic serial CT scan appearance of cerebral infarction created by embolization of the middle cerebral artery in the nonhuman primate (10 baboons) is defined. The earliest CT changes are noted by 12 to 24 hours and include generalized ventricular enlargement and a focal region of decreased absorption in the opercula-basal ganglia region. The area of diminished brain absorption is better circumscribed and of lower attenuation coefficient with increasing chronicity. Distinct hydrocephalus, unilateral exophthalmos and ventricular displacement occurred with increased intracranial pressure. Little additional diagnostic information was obtained via intravenous enhancement and care should be taken as mild enhancement may obscure an area of abnormality.

Sanguineous cerebrospinal fluid in recanalized cerebral infarction.

Abstract: To clarify the causal relationship between spontaneous recanalization of the occluded cerebral artery and development of hemorrhagic infarction, 15 patients with internal carotid or middle cerebral arterial axis occlusion were submitted to consecutive lumbar punctures and follow-up cerebral angiography. Consequently, six of seven recanalized patients had sanguineous cerebrospinal fluid (CSF) on the second or third day after ictus, while only one of eight non-recanalized patients had bloody CSF. It was strongly suggested that recanalization might have an initimate relationship with the development of hemorrhagic infarction.

Transient ischemic attacks with normal arteriograms: serious or benign prognosis?

Abstract: Of 226 patients with cerebral transient ischemic attacks (TIAs) evaluated with panarteriography, 16 had no demonstrable abnormalities in the aorto-cervico-cranial arterial tree. During a follow-up period ranging from three to eight years, 8 of the 16 were asymptomatic; 4 developed strokes and 3 died, 2 of cerebral infarction and 1 of myocardial infarction. The surviving patient who had a cerebral infarct continues to have TIAs. There were 2 other deaths, 1 from myocardial infarction and the other accidental. Two other patients continue to have TIAs.

Cerebral infarction complicating subclavian vein catheterization .

Abstract: Cerebral infarction has not previously been reported as a complication of attempted subclavian vein catheterization for parenteral nutrition. Two patients developed clinical and pathological evidence of embolic infarction in the left carotid and left vertebral distributions, respectively, when an artery was inadvertently punctured during attempts to catheterize the left subclavian vein. These two complications occurred in more than 1,000 successful subclavian vein catheterizations.

Effect of encephalitogenic protein on migration in agarose of leukoytes from patients with multiple sclerosis. A longitudinal study of patients with relapsing multiple sclerosis or with cerebral infarction.

Abstract: Ten patients with MS were studied with leukocyte migration in agarose technique to detect changes in reactivity to encephalitogenic protein in connexion with a relapse. Six showed significant reactivity within a few days after the relapse. It decreased or disappeared during the 2 weeks after the relapse, but sometimes reappeared and was found in tests performed 2-3 months later. Five patients with cerebral infarction were studied in a similar way--in three, marked reactivity was noted within a few days after the stroke; in these, reactivity decreased or disappeared in later tests. In the two other patients, reactivity appeared in the second and/or third test. The possibility of a reactivity as in epiphenomenon due to CNS tissue destruction is discussed, and the need for antigens with a more restricted specificity for such an analysis is stressed.

Frequency and course of pure motor hemiparesis: a clinical study.

Abstract: A review of 850 acute unselected stroke cases at Harlem Hospital found only 25 (3%) who met a clinical definition of pure motor hemiparesis. Compared to other cerebral infarction survivors, the 23 pure motor syndrome survivors were slightly younger, not much more often hypertensive and did not make a faster recovery. The degree of motor deficit a year later was nearly the same in both groups. Brain scans were positive in one-third of the pure motor patients, which suggests that this clinical picture may be associated with larger brain lesions than had been suspected before, as well as with lacunar infarction.

Wasp sting anaphylaxis with cerebral infarction.

Abstract: A cerebral infarction occurred in a 37-year-old man following wasp stings. Computerized axial tomography documented the neurologic lesion. Language: en

An ultrastructural study of developing cerebral infarction following bilateral carotid artery occlusion in spontaneously hypertensive rats.

Abstract: An ultrastructural study of cerebral infarcts in spontaneously hypertensive rats 1–5 h after bilateral carotid artery occlusion was performed. The alterations of the neocortex consisted of shrinkage of the neurons surrounded by swollen astrocytic processes. Distension of the rough endoplasmic reticulum of the neuronal cytoplasm appeared early, while changes of the mitochondria were slight. Though there appeared slight to moderate perivascular astrocytic swelling, endothelial swelling was rare and there was no severe narrowing of the capillary lumen. There were no filling defects of colloidal carbon injected to the blood vessels of the ischemic brains. Ischemic neuronal alterations were proved to develop in the absence of severe morphological changes of the microvasculature in the developing cerebral infarcts in the present experimental model.

False-negative computerized tomography in brain tumor.

Abstract: COMPUTERIZED axial tomography (CT) has been used in clinical neuroradiology for slightly less than four years and is considered to be the most effective means for diagnosing brain tumors. Diagnosis by CT of cerebral infarction, 1 cerebral and intraventricular hemorrhage, 2 and brain tumors 3 has been reported. Refinements of technique, especially the intravenous injection of iodinated contrast material, 4 have led to increased yields in tumor diagnosis. Tumors are being discovered at a rate not achieved with isotope scanning 5 and at a rate equal to arteriography without its concomitant risk. Such successes, however, may lead to an unwarranted assumption that a tumor does not exist if it does not visualize on CT scan. We report a case of false-negative CT scan in a patient who had a brain tumor. Report of a Case A 52-year-old, right-handed woman was seen for the first time on Sept 3, 1976. On

Reduction of coagulation factor XIII concentration in patients with myocardial infarction, cerebral infarction, and other thromboembolic disorders.

Abstract: Coagulation factor XIII and plasma fibrinogen chromatographic assays have been performed serially in patients suffering from acute myocardial and cerebral infarction, and in others with disseminated intravascular coagulation. The findings were compared with 2 groups of "controls"; normal clinically-well subjects and hospitalized patients with cerebral infarction who exhibited minimal, stable, or improving neurological deficits. Substantial depression of factor XIII concentrations developed in the 3 patient groups, together with concomitant significant increases in the proportion and concentration of plasma high molecular weight fibrin(ogen) complexes (HMWFC). An inverse correlation (p less than 0.05) between coagulation factor XIII concentration and percentage of HMWFC was demonstrated in the early stages of the illness. These findings suggest that depression of coagulation factor XIII concentration in these states, is secondary to extravascular or intravascular coagulation and may reflect its degree.

Occlusive Cerebrovascular Disease in Young Adults

Abstract: 13 patients under 40 years of age had cerebral infarction and angiographic evidence of arterial stenosis or occlusion. None of them had cardiac disorders prone to cerebral embolism. Five patients had occlusion at the origin of the internal carotid artery, one had occlusion of the common carotid artery and one each had stenosis at the origin of the internal carotid and common carotid arteries, respectively. Two patients had unilateral occlusion of the supraclinoid portion of the carotid artery with basal collaterals that had some resemblance to the Moyamoya disease. Three patients demonstrated stenosis or occlusion of the middle and/or anterior cerebral arteries. Three patients had hyperchlolesterolemia, one of whom was hypertensive. None had confirmed diabetes mellitus. One female, who died, had taken oral contraceptives for 3 years. A male, with internal carotid artery occlusion, had serological evidence for syphilis.