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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 289 carotid endarterectomies were performed in 204 patients. A decision to place a temporary shunt during carotid endarterectomy in this series was made entirely on the basis of intraoperative EEG monitoring. Retrospectively, the correlation between stump pressures and the results of intraoperative EEG monitoring in each case was determined. Evidence of ischemia developed in 6% of the total series on intraoperative EEG monitoring despite a stump pressure of greater than 50 mm Hg. The degree of disagreement between stump pressure and EEG varied according to clinical category in this series. In those endarterectomies performed for completed stroke, all cases requiring shunting had stump pressures less than 50 mm Hg. In those cases performed for symptoms of vertebral basilar insufficiency, however, 77% of the cases requiring an intraoperative shunt had stump pressures greater than 50 mm Hg. A review of the complication rate in the various study groups indicates that the use of intraoperative EEG is a safe indicator of cerebral ischemia during carotid endarterectomy regardless of stump pressure.
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PMID:Failure of carotid stump pressures. Its incidence as a predictor for a temporary shunt during carotid endarterectomy. 53 56

Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.
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PMID:[Long term survival after basilar artery occlusion. 4 cases]. 259 68

We initiated a prospective study of the dizzy patient to identify key factors on which a directed evaluation could be based. This study used a standardized history, physical examination, and basic laboratory evaluation totalling 66 items to assist collection of relevant clinical information on 125 patients. Diagnosis was based on the emergency physicians' diagnosis. This was modified when necessary based on one month of follow-up using diagnostic criteria adapted from previous studies. The most common disorder was some form of peripheral vestibular disorder, found in 54 patients (43%). These patients were typically vertiginous and were managed successfully as outpatients. Despite correlations with multiple factors, this diagnosis was best predicted by positive Nylen-Barany test with either vertigo, vomiting, or both with 94% specificity and 43% sensitivity. Potentially serious causes were identified, including medication-related, seizure, stroke, transient ischemic attacks, vertebral-basilar insufficiency, hypertension, pericarditis, arrhythmias, and all those requiring hospitalization. The best predictors, either older age, lack of vertigo, or neurologic deficit, could identify 86% of "serious" dizziness with 42% specificity. The following tests were of low yield and may be done in a directed manner based on a brief history: Valsalva, carotid stimulation, Romberg and Quix tests, mental status examination, complete blood count, serum electrolytes, and BUN. Our results do support routine testing of glucose in all patients and monitoring rhythm in patients age 45 and older. Such a directed approach could rapidly classify a significant number of dizzy patients and forego many time- and cost-intensive elements of provocative examination and laboratory testing.
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PMID:A directed approach to the dizzy patient. 272 92

Various surgical techniques have been reported for vascular reconstruction in cases of vertebro-basilar occlusive disease, but sufficient study has not been made on the question of which technique should be applied in various pathological conditions. Based on our experience, we have examined the advantages and disadvantages of these techniques. In 34 patients with clinically and angiographically diagnosed vertebro-basilar insufficiency, the reconstructive vascular surgery to the posterior circulation was performed. Preoperatively, 24 had vertebro-basilar TIAs, 2 had RIND, 3 had progressing symptoms and 5 had brain stem infarctions verified by persistent deficits. In the 18 patients with intracranial vertebro-basilar occlusive lesions, the bypass were done to the proximal posterior inferior cerebellar artery in 7 cases, proximal superior cerebellar artery in 9 cases, posterior cerebral artery in one and anterior inferior cerebellar artery in one. In the 16 patients with extracranial occlusive lesions of vertebral artery, endarterectomy or subclavian-vertebral transposition was performed. With the exception of one of the progressing stroke cases, in which the surgery was ultimately too late, there were no cases in which neurological symptoms become aggravated following operation. Patency was 94% (32/34). In light of these findings, the following conclusions concerning the operative indication and the selection of the technique have been drawn. In cases with occlusive lesions of basilar artery, the first choice should be bypass to the proximal superior cerebellar artery. In cases with occlusive lesions of vertebral artery, bypass to the posterior inferior cerebellar or superior cerebellar or anterior inferior cerebellar artery should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Revascularization of vertebro-basilar occlusive disease]. 336 33

A 5-year experience with 562 carotid endarterectomies, using electroencephalogram (EEG) monitoring and selective shunting, was reviewed. EEG changes occurred in 102 patients (18%). The frequency of EEG changes, as related to cerebral vascular symptoms, was as follows: transient ischemic attacks, seven per cent (19/259); completed strokes, 37% (36/98); vertebral basilar insufficiency, 24% (32/135); asymptomatic, 21% (15/71). Patients with contralateral carotid occlusion exhibited EEG changes in 37% (28/76) of operations. Fifteen patients suffered perioperative strokes (2.6%). Nine of the 15 were associated with a technical problem of either thrombosis of the internal carotid artery (five) or emboli (four). Technical problems were more common when shunts were used (five per cent) than when they were not (0.9%). Patients who suffered strokes prior to surgery were more at risk to develop a perioperative stroke (three per cent) than those not suffering prior strokes (0.3%). The EEG did not change in three patients who had lacunar infarcts prior to surgery and who awoke with a worsened deficit. Our series does not clearly establish the advantages of EEG monitoring, which is expensive (+375/patient) and may not detect ischemia in all areas of the brain. However, the use of shunts may introduce a risk of stroke due to technical error that is equal or greater than the risk of stroke due to hemodynamic ischemia. Since the need for protection is unpredictable by angiographic or clinical criteria, the benefit of EEG monitoring may be in reducing the incidence of shunting in those patients whose tracing remains normal after clamping. The decision to shunt, however, when there is electrical dysfunction after carotid clamping should be based not only on the EEG but also on the clinical signs and computed tomography (CT) scan. Our data does not show a net benefit in selective shunting unless the patient has sustained a stroke prior to surgery.
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PMID:Benefits, shortcomings, and costs of EEG monitoring. 392 54

Transient visual loss due to cerebro-ocular vascular disease is a common symptom. The purpose of this paper is to present a unified terminology of the monocular vs. binocular or homonymous types. Lack of proper identification may lead to mis-diagnosis and improper management of these entities. Monocular blurred vision must be investigated since its origin is so commonly due to atherosclerosis of the carotid system. Binocular blurred vision due to vertebro-basilar insufficiency is managed conservatively in almost all instances.
Stroke
PMID:The terminology of transient visual loss due to vascular insufficiency. 647 46

Regional cerebral blood flow (rCBF) was measured in three groups; (1) 20 healthy subjects, (2) 14 patients with diffuse alpha wave pattern of EEG, (3) 14 patients without diffuse alpha wave pattern matching with ages of group 2. In the group 2, one patient with transient ischemic attack, 7 with reversible ischemic neurological deficit, 3 with vertebro-basilar insufficiency, 2 with minor stroke and one with posttraumatic sequelae were selected for rCBF measurements. In the group 3, 3 patients with transient ischemic attack, 7 with reversible ischemic neurological deficit, 2 with vertebro-basilar insufficiency and 2 with minor stroke were selected for rCBF measurements. Electroencephalographic analyses were performed by using a BERG-Fourier Analyzer, simultaneously with rCBF measurements. All patients in the group 2 had diffuse alpha wave (generalized continuous simple rhythmic alpha wave--Hori et al) pattern of EEG. Regional cerebral blood flow measurement was performed with intracarotid injection method of 133Xe (10 mCi) by using the scintillation camera and on-line computer system. 133Xe clearance curve from the whole hemisphere were computed by height over area method. Regional value were obtained from brain areas of 6 mm X 6 mm. Mean hemispheric values were 59.2 +/- 7.9 ml/100 g/min in the group 1, 47.8 +/- 4.9 ml/100 g/min in the group 2 and 49.0 +/- 3.7 ml/100 g/min in the group 3. Although difference between group 2 and 3 was not significant, difference between group 1 and 2 was significant (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Correlation between diffuse alpha wave pattern of EEG and hyperfrontal pattern of regional cerebral blood flow]. 652 21

The natural history of extracranial cerebrovascular disease and available alternatives in its treatment are reviewed. An evaluation of the evidence suggests that carotid endarterectomy is the treatment of choice in patients with transient ischemic deficits, provided that an anatomically appropriate lesion can be identified. These patients have a 25-38% chance of stroke if untreated, which can be reduced to 5-10% by carotid endarterectomy. Patients with asymptomatic carotid stenosis who are good operative risks are also candidates for surgery, although this issue remains controversial. Patients with small asymptomatic ulcerated carotid plaques have a relatively benign prognosis and should not undergo preventive carotid surgery. Carotid surgery is occasionally indicated in patients with vertebral basilar insufficiency and carotid stenoses, fibromuscular dysplasia, or carotid kinks associated with symptoms of ischemia. Carotid endarterectomy may be performed with an overall mortality of 1-2% and morbidity of 2-5% if the patients are carefully selected and the surgical team is expert.
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PMID:The current status of carotid artery surgery. 709 1

CT examination in 100 patients affected by chronic cerebrovascular insufficiency showed a normal picture in 16 cases, while 84 subjects showed different degrees of atrophy, generalised and focal, controlateral or sometime omolateral to the infarct, with differing patterns. The mean age of subjects with normal CT was significantly lower in comparison with patients with definite atrophy. Besides the neurological picture and the time course, the patients' psychiatric status was also assessed: no definite relationship seems to exist between psychiatric disturbances and brain atrophy. Pseudobulbar syndrome was found in 46 cases and many of them showed cortical and mainly ventricular atrophy. This picture was very seldom found in patients with vertebro-basilar insufficiency. Localised cortical atrophy, on the contrary, was often associated with ischaemic stroke. The incidence of predisposing risk factors (hypertension, diabetes mellitus or high lipid levels) was greater in subjects with brain atrophy and older age than in patients with normal CT scan.
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PMID:[CT findings in chronic cerebrovascular insufficiency (author's transl)]. 729 86

Six patients for whom computed tomography revealed a curvilinear calcific mass anterior to their brainstem were evaluated and magnetic resonance imaging and magnetic resonance angiography were performed on each. Magnetic resonance studies confirmed the suspicion of basilar artery dolichoectasia, and demonstrated a partial thrombus in the basilar artery in 1 patient. The patients' clinical features were combined with those of basilar artery dolichoectasia patients reported in the literature (n = 122) who had case histories sufficiently detailed enough to determine each person's mode of clinical presentation. Basilar artery dolichoectasia patients were more often men (95/128, 74%) and had a mean age of 59 +/- 11 years. Of the 128 patients studied, there were cranial nerve compressive signs in 74 (58%), especially facial spasm (29/74, 39%) and trigeminal neuralgia (20/74, 27%); vertebral basilar insufficiency or vertebral basilar stroke or both in 61 (48%); hydrocephalus in 40 (31%); compressive brainstem symptoms and signs that progressed clinically in 31 (24%); and arterial hypertension in 31 (24%). Magnetic resonance imaging and magnetic resonance angiography safely diagnose this interesting arterial abnormality. The modes of clinical presentation of this disorder are reviewed.
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PMID:Basilar artery dolichoectasia. Review of the literature and six patients studied with magnetic resonance angiography. 762 24


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