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

Body fluid gas pressure and electrolytes of patients with ruptured aneurysm were continuously analyzed. Intracranial pressure (ICP) was regulated at the level of 120-100 mm H2O by cerebral ventricular drainage. There was no significant change in the pH, PCO2, HCO3-, Na+, K+, Ca++ in the cerebrospinal fluid (CSF) of patients with slight or moderate disturbance of consciousness (lethargic-drowsy state). The PcsfO2 of the patients with marked disturbances of consciousness (semicoma-coma) was significantly low. PcsfO2 of the patients with cerebral vasospasm was significantly lower than for those without vasospasms. PcsfO2/PaO2 was 0.27 +/- 0.01 in the patients with vasospasm and 0.50 +/- 0.01 in those with vasospasm. PcsfO2 tended to decrease in patients with markedly bloody CSF. When the bloody CSF was cleared by ventricular drainage, PcsfO2 increased. PcsfO2 did not return to a normal value in the patients with marked disturbances of consciousness despite sufficient arterial oxygen tension. This suggests that PcsfO2 and PcsfO2/PaO2 should provide a convenient index for the prognosis of patients with ruptured aneurysm.
Stroke
PMID:Body fluid oxygen tension and prognosis in patients with ruptured aneurysm. 4 45

Three weeks of regulated bed rest was one of four treatments evaluated in the Cooperative Aneurysm Study. A total of 187 patients with a recently ruptured intracranial aneurysm had subarachnoid hemorrhage confirmed by lumbar puncture. A group of 124 patients were assigned to treatment within 7 days after the bleed, 49 between 8 and 21 days, and 14 between 22 days and 92 days. During the mean follow-up interval of 6.5 years, mortality was 55.1%. A proved rebleed was the cause of death in 34.2%, progressive deterioration from aneurysm rupture in 8.0%, and a suspected rebleed in 4.8%. A total of 47.1% died of causes related directly to the cerebral effects of the ruptured aneurysm.
Stroke
PMID:Intracranial aneurysms and subarachnoid hemorrhage - report on a randomized treatment study. IV-A. regulated bed rest. 84 85

Abdominal aortic aneurysm resections were performed on 298 patients between January, 1966 and December, 1973. The results were compared with 186 resections previously reported between 1955-1965. Hospital mortality rates for elective resections were 13% in 1955-1965, 8.4% in 1966-1973, and 4.2% in the 113 patients treated during the last 3 years. Urgent resections for intact aneurysms, previously associated with a 36% mortality, resulted in a 6% mortality rate in 1966-1973. The emergency resection mortality rate for ruptured aneurysm, originally 69%, was reduced to a present day over-all mortality of 55%, and 42% for the last 3 years. Calculated actuarial survival at 5 years was 65% for urgent (intact), 60% for elective and 40% for emergency (ruptured) groups. Atherosclerosis remains the major deterrent to long-term survival with myocardial infarction and stroke causing 43% of deaths occurring within 5 years. Improved survival appeared secondary to better operative technique, postoperative patient monitoring, increased surgical experience, and more elective resections of smaller, asymptomatic aneurysms than in 1955-1965. With present day low mortality rates, elective resection should be recommended in all patients without significant medical contraindications.
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PMID:Survival improvement following aortic aneurysm resection. 113 37

A case of systemic lupus erythematosus (SLE) with subarachnoid hemorrhage due to a ruptured intracranial aneurysm is reported. A 31-year-old woman who had been treated with steroid for SLE was admitted to our department with severe headache, and nausea. CT scan showed subarachnoid hemorrhage and the left carotid angiogram revealed a small aneurysm at the supraclinoid portion of the left internal carotid artery. She had no neurological deficit. Hematological examination on admission showed disseminated intravascular coagulation (DIC), therefore, we decided to perform an intentionally delayed operation. In the meantime we treated the patient for DIC with FOY and methylprednisolone. The operation was performed after two weeks, when DIC had been eliminated completely. Postoperative hematological examination showed severe thrombocytopenia. We considered that SLE had come to the fore again, so we used Danazol in company with FOY and steroid. It seemed that Danazol was very effective for her. She was discharged about two months after admission with no problem. Cerebral apoplexy, such as cerebral infarction and cerebral hemorrhage, has often been seen in SLE, but subarachnoid hemorrhage due to a ruptured aneurysm is very rare. We could find only five reports of this phenomenon. Their prognoses were all, unfortunately, poor. It should be born in mind for therapy that a patient in SLE has a tendency to bleed. It seems that repeated hematological examinations and quick and proper management are important. We think that the aneurysmal formation in SLE is due to lupus vasculitis or the fragility of blood vessels due to a long use of Steroid.
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PMID:[A case of systemic lupus erythematosus with subarachnoid hemorrhage due to ruptured aneurysm]. 220 86

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequently observed in the thalamus, midbrain, temporal lobe, and lateral geniculate body (LGB) territories of the AChA. The most common clinical finding is hemiparesis. Hemianesthesia may be severe at onset but is usually transient. Homonymous hemianopia, upper-quadrant anopia, or upper- and lower-quadrant sector anopia can be present. Occasionally these patients are reported to have transient abnormalities of higher cortical function. The most common stroke mechanism is known to be small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients. Vasospasm due to ruptured aneurysm or intraoperative mechanical manipulation, and cardiac origin the AChA territory. The infarct lesion is usually recognized and diagnosed by computed tomography. The best treatment is still unknown.
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PMID:Two cases of anterior choroidal artery territory infarction. 258 69

Operative treatment of nonspecific aortoarteritis remains controversial and little information is available on the results of reconstruction of extracranial cerebral vasculature in this disease. Our experience with 25 patients with histologically proven symptomatic disease treated during a 4-year period is presented. The aortic arch and its branches were involved in 12 patients and 13 had disease affecting the descending aorta and its tributaries. Patients with cerebrovascular disease had aneurysms, minor stroke, or intermittent neurologic dysfunction. Descending aortic involvement resulted either in symptomatic or ruptured aneurysm and renovascular hypertension. Operative treatment of cerebrovascular disease comprised aortic arch (three patients), carotid (three patients), or subclavian artery reconstruction (six patients). Descending aortic reconstruction comprised thoracoabdominal (four patients) or infrarenal (five patients) aneurysmorrhaphy, abdominal aortic replacement with bilateral renal artery reconstruction (two patients), and nephrectomy (two patients). One early postoperative death occurred because of stroke. Twenty-four survivors have been observed between 3 and 42 months. No deaths or further neurologic episodes have occurred during this period and three of five hypertensive patients were cured. We conclude that symptomatic aortoarteritis, including cerebrovascular disease, may be treated by standard operative techniques with rewarding results.
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PMID:Operative treatment of nonspecific aortoarteritis (Takayasu's arteritis). 287 Feb 2

True, three-dimensional proton nuclear magnetic resonance imaging at 0.147 tesla was performed postmortem on 2 patients embodying various stroke syndromes, including chronic (4 and 15 years) infarction, subacute (within 1 week) bland infarction, acute (2 days) hemorrhagic infarction, and hematoma secondary to ruptured aneurysm. A third patient, with subcortical arteriosclerotic encephalopathy, so-called Binswanger's disease, was examined antemortem using a 0.6 tesla scanner. Nuclear magnetic resonance images were reconstructed at levels matching the pathologic specimens. Qualitative and, when available, quantitative comparisons between the results of nuclear magnetic resonance imaging and pathology were carried out. Areas of qualitatively prolonged T1 and T2 relaxation times on nuclear magnetic resonance imaging were more extensive than the corresponding areas of chronic infarction noted pathologically and were determined to be infarcts plus the adjacent areas of Wallerian degeneration. Hemorrhagic infarction, without evidence of blood on computed tomography, was found to have mildly prolonged T1 and T2 relaxation times, between those of normal brain and chronic infarction; a 10-day-old hematoma had a very short T1, slightly shorter than that of white matter, and a mildly prolonged T2, with values between those of white and gray matter. Subcortical arteriosclerotic encephalopathy was found to have areas of prolonged T1 and T2 relaxation times involving almost the entire white matter of the corona radiata.
Stroke
PMID:NMR-neuropathologic correlation in stroke. 356 90

A cooperative study was made of 4750 intracranial aneurysm cases collected from 133 neurosurgical clinics in Japan by letter inquiry for the period of 2 years from January 1974 to December 1975. Among them, 4124 cases (87%) had a single aneurysm, and 626 cases (13%) had multiple ones. Direct radical surgery was done in 78% of all cases, carotid ligation in 2% and non-surgical treatment in 17%. Direct surgery in a mortality rate of 15% for ruptured aneurysm cases and 7% for nonruptured cases. Radical surgery within 24 hours after rupture had a mortality of 51%, while those within 1 week and 2 weeks were 39% and 30% respectively; grade I or II patients, however, showed much better surgical results even in early operations. The neurosurgical clinics included in this study were spread throughout most of Japan. Micro-surgical technic was already in use of aneurysm surgery at the time of this study in Japan.
Stroke
PMID:Nationwide co-operative study of intracranial aneurysm surgery in Japan. 396 65

To evaluate long-term survival in relation to preoperative risk factors, we reviewed 1112 patients undergoing abdominal aortic aneurysm (AAA) repair from 1970 to 1975. A 6-to 12-year follow-up was obtained on 1087 patients (97.7%) by chart review, death certificates, autopsy reports, and questionnaires returned by patients and referring physicians. Preoperatively 24% of patients had a history of prior myocardial infarction, 19.9% had a history of angina, and 40.4% were hypertensive. Emergency operation for ruptured aneurysm was performed in 6.5% and for expanding aneurysm in 3.4% of patients. The survival rate at 5 years was 67.5% and at 10 years was 40.7%. Cardiac-related problems were the most frequent cause of death (38%); 23% died of myocardial infarction and 15% from other heart disease or sudden death. Other causes included neoplasm (14.6%), other ruptured aneurysm (8.2%), and stroke (6.8%). Cause of death was unknown in 19.6%. A significant correlation of reduced survival time was noted in patients with advanced age and those with evidence of heart disease or hypertension. For patients without preoperative evidence of heart disease or hypertension, the 5-year mortality rate from myocardial infarction was 3.7%, compared with 11.7% for those with a positive history of hypertension and heart disease (p = 0.0001). For patients with no preoperative evidence of hypertension or heart disease, the length of survival after AAA repair was the same as that expected for the general population with the same age and sex composition. This study supports the contention that coronary angiography and prophylactic coronary bypass grafting should be performed selectively. Decisions regarding the need for coronary revascularization should be based on symptoms, noninvasive testing, and selective coronary angiography because aneurysmal disease alone is not shown in this study to increase the risk of death from myocardial disease. For patients with clinical findings of coronary artery disease, an aggressive diagnostic approach appears to be justified.
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PMID:Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease. 648 77

The occurrence of secondary brain stem hemorrhage was studied in 435 autopsies from patients with recent cerebral hemorrhage, infarction or ruptured cerebral aneurysms. The frequency of secondary brain stem hemorrhage was found to be 45% in cerebral hemorrhage, 15% in cerebral infarction, and 36% in ruptured aneurysms. In the majority of cases the secondary brain stem hemorrhage occurred a few days after the onset of cerebral hemorrhage or infarction. Ruptured aneurysms showed a more widespread temporal distribution of secondary brain stem hemorrhage. The median survival time was 2 days in cases of cerebral hemorrhage, 4 days in ruptured aneurysm and 4 days in cerebral infarction. The frequency of secondary brain stem hemorrhage was significantly lower in patients younger than 20 years. No significant difference was found in its distribution between the sexes. Secondary occipital lobe infarction was present in 3.5% of the patients. It is concluded that secondary brain stem hemorrhage is a common major contribution to the cause of death in stroke.
Stroke
PMID:Secondary brain stem hemorrhage in stroke. 665 22


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