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

A prognostic score was derived from a prospective study of 148 consecutively admitted patients, aged less than 76 years, who survived the first 24 hours after an acute stroke. Multivariate analysis was used to compare the presenting clinical features of 137 (93%) of these patients with their outcome after two months. Little change in the level of residual disability was detected in 128 of these patients after a further four months. The features which were found to predict functional dependence or death included older age, complete limb paralysis, depression of conscious level and the combination of hemiplegia and hemianopia with higher cerebral dysfunction. Hemiparesis uncomplicated by hemianopia or higher cerebral dysfunction predicted a return to functional independence. A discriminant function derived from this analysis can be used to calculate the likelihood of recovery to independent function for an individual patient following an acute stroke.
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PMID:Predicting the outcome of acute stroke: a prognostic score. 673 78

By means of emission computed tomography (ECT), we used 18F-fluorodeoxyglucose (18FDG) and 13N-ammonia (13NH3) as indicators of abnormalities in local cerebral glucose utilization (LCMRglc) and relative perfusion, respectively. The ECAT positron tomograph was used to scan normal control subject and 10 stroke patients at various times during recovery. In normal subjects, mean CMRglc was 5.28 +/- 0.76 mg per 100 gm tissue per minute (mean +/- SD; N = 8). In patients with stroke, mean CMRglc in the contralateral hemisphere was moderately decreased during the first week, profoundly depressed in irreversible coma, and normal after clinical recovery. Quantification was restricted by incomplete understanding of tracer behavior in diseased brain, but relative local distributions of 18FDG and 13NH3 trapping qualitatively reflected the increases and decreases as well as coupling and uncoupling expected for local alterations in glucose utilization and perfusion in stroke. Early after cerebrovascular occlusion there was a greater decrease in local trapping of 13NH3, than 18FDG within the infarct, probably because of increased anaerobic glycolysis. Otherwise, 18FDG was a more sensitive indicator of cerebral dysfunction than was 13NH3. Hypometabolism, due to deactivation or minimal damage, was demonstrated with the 18FDG scan in deep structures and broad zones of cerebral cortex that appeared normal on x-ray computed tomography and technetium 99m pertechnetate scans. In its present state of development, the 18FDG ECT method should aid in defining the location and extent of altered brain in studies of disordered function after stroke. With improved knowledge of tracer behaviour in diseased brain, the method has promise for mapping the response to therapeutic intervention and increasing our understanding of how the human brain responds to stroke.
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PMID:Effects of stroke on local cerebral metabolism and perfusion: mapping by emission computed tomography of 18FDG and 13NH3. 696 12

Disruption of the blood-brain barrier may play a major role in the pathogenesis of hypertensive encephalopathy. In this study we determined whether sympathetic nerves to cerebral vessels protect the blood-brain barrier during chronic hypertension. We removed the cervical sympathetic ganglion on one side in 24 stroke-prone hypertensive rats when they were 1 month old. After signs of cerebral dysfunction developed at the mean age of 160 +/- 5 days (SE), we injected 125I-albumin and Evans blue dye intravenously to evaluate the permeability of the 125I-albumin was 3.53 +/- 0.83 (brain albumin x 100/blood albumin) in areas of the cerebrum stained with blue dye and 0.24 +/- 0.02 in unstained areas (p less than 0.05). We conclude that sympathetic nerves protect the blood-brain barrier against disruption during chronic hypertension and thereby may protect against hypertensive encephalopathy.
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PMID:Sympathetic nerves protect the blood-brain barrier in stroke-prone spontaneously hypertensive rats. 714 13

The effectiveness of preventive and therapeutic measures depends upon their adequacy in the individual diagnostic situation. This is also true for stroke which is a superimposed concept for different mechanisms leading to acute localized brain ischemia. For the choice of treatment we have to consider in each case the actual clinical situation, i.e. the natural stage of disease, the localization of cerebral dysfunction and its etiology and pathogenesis. Thus transient ischemic attacks (TIA), completed stroke with prolonged complete, partial or no recovery and progressive stroke (stroke in evolution) demand different treatment. Concerning pathogenesis it is important to differentiate between intracerebral hemorrhage, ischemia due to extracranial carotid stenosis or occlusion, intracranial arterial thrombosis, predominantly hemodynamic pathogenesis and embolism of cardiac origin. Prevention of stroke may be of general kind like treatment of hypertension or other risk factors for apoplexy, and there are more specific measures like surgery of vascular obliteration and treatment with agents inhibiting platelet aggregation (Aspirin) or anticoagulants. The indications for the various surgical and medical procedures are discussed. Because of the risk of hemorrhagic complications the indication for anticoagulants is limited considerably. The treatment of completed stroke has to consider the normalization of basic functions (cardiocirculatory, respiration, water-electrolyte balance a.o.). Vasoactive and especially vasodilatatory drugs are not recommended in the acute stage of stroke, as their effectiveness is not secure and may even be disadvantageous. Ischemic brain edema is treated with mannitol or sorbit and with dexamethasone although its effectiveness has not yet been proven. Low molecular dextran solution is supposed to improve microcirculation in the ischemic tissue by means of hemodilution i.e. improvement of rheological properties.
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PMID:[Prevention and therapy of stroke]. 740 3

The clinical and laboratory features of 24 patients with proven mitral valve prolapse (MVP) and brain dysfunction are reported. The age range of affected patients was between 20 and 63 years (average of 43) and 70 percent were women. MVP was documented prior to the brain illness in only 4 patients. The majority of patients experienced bland cerebral infarction. Disorders also included transient ischemic attacks, cerebellar infarctions, parencymatous and subarachnoid hemorrhage, seizures and retinal artery occlusion. Significant risk factors for stroke other than MVP were lacking in the patient group. Cerebral angiograms occasionally showed distal occlusions of small arteries suggesting embolic brain lesions. Our study suggests that MVP is a risk factor for stroke. We recommend echocardiography in patients with cerebral ischemia who lack clear, recognized risk factors for stroke. We believe the basis for this brain disorder to be emboli from damaged mitral valve leaflets.
Stroke
PMID:Brain events associated with mitral valve prolapse. 742 82

Cardiac surgical patients face the threat of neurologic complications in all phases of their disease and its treatment. The incidence of preoperative transient ischemic attacks and stroke ranges from 5% to 14% and from 2% to 11%, respectively. The risk of preoperative cerebrovascular accidents is higher in patients with valvular disease than in those with coronary artery disease. The prevalence of postoperative neurologic disorders varies widely because of differences in defining the clinical criteria, heterogeneity of patient populations, timing of evaluation, follow-up times, study designs, and surgical and anesthesia-related procedures. Fatal cerebral damage is very rare (< 0.1%). Focal cerebral deficits, or definite stroke, are encountered in 1% to 3% of patients and minor clinical abnormalities, in 5% to 10%. Recent studies have shown that contrary to previous concepts, valve replacement does not carry essentially higher neurologic risks than coronary bypass grafting. The most common causes of operation-related neurologic disorders are microembolization or macroembolization and hypoperfusion. Although most disorders resolve early postoperatively, some deficits persist. From the neurologic standpoint, a main objective of a cardiac surgical intervention is to prevent stroke. Today, the incidence of cardiogenic cerebrovascular accidents is very low after reparative cardiac procedures. Despite surgical and anesthesia-related improvements, neurologic complications do occur. Multidimensional investigatory procedures have shown that cardiopulmonary bypass often causes cerebral dysfunction. Whether the harmful consequences are detected depends on the evaluation criteria and the investigatory methods and timing used. Further methods are needed to prevent or treat preoperative cerebrovascular accidents and particularly to improve cerebral protection during operative procedures.
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PMID:Long-term neurologic outcome after cardiac operation. 773 64

Pituitary adenoma apoplexy was considered an acute life-threatening condition until more benign and even asymptomatic courses were found by advanced neuroimaging procedures. Necrosis and hemorrhage in the pituitary adenoma can cause acute enlargement of the tumor. sometimes with rupture of the tumor capsule and bleeding into the subarachnoid space and surrounding parts of the brain. Clinical symptoms include acute or subacute headache in combination with signs of meningeal irritation and neuroophthalmological and cerebral dysfunction. Severe panhypopituitarism may be an additional complication. Acute blindness due to compression of the optic chiasm and symptomatic compression of basal cerebral arteries require immediate transsphenoid tumor resection. If panhypopituitarism is suspected, immediate hormone substitution is necessary.
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PMID:[Adenomatous hypophyseal apoplexy. Clinical, diagnostic and therapeutic aspects of a frequently misdiagnosed emergency state]. 778 16

Cerebral dysfunction after coronary artery bypass operations represents some of the most serious and costly complications of cardiac surgery. We used transcranial Doppler ultrasonography to detect and quantify the number of microemboli in the right middle cerebral artery of patients undergoing elective first coronary bypass operations (n = 117) and second coronary bypass operations (n = 10). We hypothesized that total microemboli were related to clinical outcome. A 2 MHz transducer was positioned in front of the ear above the zygomatic arch and depth gated to 50 mm. Microemboli were recorded as perturbations of the blood flow velocity in the middle cerebral artery and aurally monitored. Each episode of microembolism was specified both by clock time and as a perfusion or surgical event. Forty-one patients (32%) completed neuropsychologic evaluation with a battery of tests for cognitive function. Anxiety states and traits were also assessed. The distribution of microembolism showed that there were three groups of patients: < 30 microemboli (n = 83); 30 to 59 (n = 24); and > 60 (n = 20). Seven of 10 patients with cerebral complications (stroke, coma, delirium, aberrant behavior) were in the > 60 microemboli group. Those with cerebral complications had 20.7 +/- 4.5 microemboli from perfusion and 57.4 +/- 15.6 from surgical events. The 13 patients in the > 60 microemboli group without central nervous system symptoms had 95.5 +/- 19.5 microemboli from perfusion and 36.0 +/- 6.9 from surgical events. Neuropsychologic scores were most often depressed for memory (73%), comprehension (49%), attention (46%), and constructional ability (44%). The greatest change was in total score in the > 60 microemboli group (-3.3 +/- 0.6) compared with -1.1 +/- 0.2 and -1.9 +/- 0.2 for the 30 to 59 and < 30 groups, respectively. The incidences of cardiac and pulmonary complications and mortality were different between those patients with < 60 microemboli versus those with > 60 microemboli. Cardiac and pulmonary complications and mortality percentages were 4.7%, 3.7%, and 0.9%, respectively, for the < 60 microemboli group and 20%, 20%, and 15%, respectively, for the > 60 microemboli group. We concluded that transcranial Doppler ultrasonography is a useful technique to quantify and detect the source of microemboli during coronary artery bypass operations and may be useful in assessing new operative strategies, the quality of the perfusion, and potentially as an indicator for pharmacologic therapy in the operating room in patients with high microemboli counts.
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PMID:Microemboli during coronary artery bypass grafting. Genesis and effect on outcome. 747 50

Caregivers of brain-impaired persons report that the caregiving experience often is stressful to them. The caregiving stress model has been based primarily on stress associated with caring for persons with Alzheimer's disease. Relatively little information is available on stressors for caregivers of stroke victims, however, who could be expected to have different stressors based on the different underlying pathology. Caregivers of persons with stroke therefore were asked to respond to the Brain Impairment Behavior Inventory (BIBI) and the companion Brain Impairment Behavior Bother Scale (BIBBS) and to list the three most important stressors for them. The behaviors of the persons with stroke which were most stressful for this sample of caregivers were irritability, dependence with resulting caregiver confinement and immature behavior. Nursing interventions targeted toward alleviating the stress caused by these behaviors could include investigation of treatable causes of brain dysfunction, a search for triggers for irritability and bad temper, and use of community-based support systems such as stroke clubs.
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PMID:What bothers caregivers of stroke victims? 796 20

The functional independence measure (FIM) is used to determine the degree of disability that patients experience and the progress that they make through programs of medical rehabilitation. Rasch analysis is a statistical technique for constructing interval measures from ordinal data that was applied to derive FIM measures. The major factors that are taken into account to produce FIM measures are the relative difficulty in performance of FIM items and the ability of the persons tested. Our analyses showed the relative difficulties that patients experienced in performing items in the FIM. There were two dominant patterns of difficulty, one for motor FIM items and the other for cognitive FIM items. The patterns were consistent across impairment groups, although not identical. Of the motor items, eating and grooming were easiest whereas stair climbing, tub/shower transfers and locomotion were most difficult. Of the cognitive items, expression and comprehension were easiest and problem solving was the most difficult. The patterns of difficulty in performing FIM items are illustrated by analysis of the following impairment groups: for motor items, orthopedic conditions, stroke with left hemiparesis and spinal cord dysfunction; for cognitive items, orthopedic conditions, brain dysfunction, stroke with right hemiparesis and spinal cord dysfunction. By understanding patterns of difficulty in performing FIM items according to types of impairment and levels of function, clinicians may more precisely design treatment programs, use services and predict outcomes of medical rehabilitation.
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PMID:Performance profiles of the functional independence measure. 847 48


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