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

The systemic hemodynamic effects of deep hypotension (MAP: 38 +/- 6 mm Hg) induced by sodium nitroprusside (S.N.) were studied in 20 patients who underwent surgery for cerebral aneurysm. The hemodynamic measurements were performed four times.: (1) during the preoperative period, (2) during stable anesthesia just before hypotension, (3) during stable hypotension, (4) 20 minutes after stopping nitroprusside. All patients were mechanically ventilated with a constant tidal volume and rate. Parameters for acid-base balance and Pa O2 were also recorded. Nitroprusside produces arterial and venous dilatation which results in a decrease of afterload and preload. The mean dosage of S. N. was 18 mcg/kg/mn. Systemic vascular resistances decreased by 62 p. cent. Mean arterial pressure decreased by 53 p. cent; it reached 40 mm Hg. Fall in preload resulted in a decrease in pulmonary wedge pressure by 28 p. cent. This fall in preload produced a decrease in stroke index according to Frank-Starling's mechanisms. However tachycardia allowed a rise in cardiac index by 20 p. cent. Increase of pulmonary wedge pressure at 8-10 mm Hg by blood volume expansion maintains stroke index at control level. Under these conditions the elevation of cardiac index is due to tachycardia. Cardiac rhythm disorders (wandering pace-maker, nodal rhythm) are observed in 5 patients after having stopped nitroprusside.
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PMID:[Deep hypotension induced by sodium nitroprusside in neurosurgery. I.--Systemic hemodynamic effects (author's transl)]. 48 87

Case 1. A 65 year old male had left hemiparesis with sudden onset since 8 years ago, which gradually aggravated for these 2 years. On Sept. 27, 1973, he was admitted to the Department of Neurosurgery, Kitano Hospital. There was left spastic hemiparesis with hemisensory disturbance and he could not walk without help for the maked spasticity. Left carotid angiogram revealed the complete occlusion of the internal carotid artery and marked stenosis of the external carotid artery at the common carotid bifurcation. External carotid endarterectomy was performed on Nov. 19, 1973, which was followed by STA-MCA anastomosis 2 months later. The spasticity of extremities and left hemisparesis were gradually improved and he was able to walk without help. Case 2. On Apr. 14, 1974, a 63 year old female developed complete stroke with right hemiparesis and speech disturbance after transient ischemic attacks of 5 days duration. On Aug. 9, he was admitted and had emotional incontinence, right hemiparesis, Gerstmann's syndrome and motor aphasia. Left carotid angiogram revealed a saccular aneurysm of the middle cerebral artery and the occlusion of the distal middle cerebral arterys. These findings suggested that the occlusion was caused by embolus from the middle cerebral aneurysm, and the combined surgery with STA-MCA anastomosis and operation for the aneurysm was planned. On Aug. 30, 1974, under left frontotemporal craniotomy, aneurysmal neck clipping and aneurysmectomy were performed and thereafter, STA-MCA double anastomosis was done. One week after operation, the gradual improvement of pre-operative symptomes was noted. Recently, STA-MCA anatomosis is well known to be one of the effective operative methods for the occlusive methods for the occlusive cerebrovascular diseases and in addition, we found that the combination of STA-MCA anastomosis with other operations was effective for unusual cases presenting in this report. Furthermore, except for the occlusive cerebrovascular diseases, we usually plan STA-MCA anastomosis for the cases of 1) carotid ligation or trapping for carotid-cavernous sinus fistula and some internal carotid aneurysms, 2) some intracranial tumors with the danger involving the main cerebral arteries by operation to protect the cerebrovascular insufficiency.
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PMID:[The combination of STA-MCA anastomosis with another operation for the occlusive cerebrovascular disease (author's transl)]. 55 37

In this cooperative study among 13 institutions, 502 patients were treated with antifibrinolytic medication (epsilon-aminocaproic acid or tranexamic acid) within a 14-day period following rupture of an intracranial aneurysm. Mortality at the end of 14 days was 11.6%; proved rebleed rate was 12.7%. Patients with an internal carotid or anterior cerebral aneurysm had the highest mortality and rebleed rate. Most rebleeds occurred between the sixth and eleventh days following the initial bleed. Significantly higher mortality was reported among patients with cerebral vasospasm, yet rebleed rate was no different among those patients with or without vasospasm. The same pattern was observed among patients with a mean blood pressure value above and below 110 mm Hg. We conclude that antifibrinolytic therapy provides beneficial treatment to patients with recent onset subarachnoid hemorrhage (SAH) following rupture of an intracranial aneurysm.
Stroke
PMID:Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Antifibrinolytic therapy in recent onset subarachnoid hemorrhage. 119 27

A 55-year-old man with a mild fever and sweating developed severe headache for the days before admission. Cerebral computed tomography and selected cerebral angiography on the day of admission revealed subarachnoid hemorrhage due to rupture of an aneurysm of a distal branch of the left middle cerebral artery. Detection of vegetation on the aortic valve by two dimensional echocardiography confirmed the diagnosis of infective endocarditis with a ruptured mycotic cerebral aneurysm. Because of rapid growth of the vegetation on the aortic valve and progression of heart failure despite antibiotic therapy, emergency cardiac surgery was performed. To prevent re-rupture of the aneurysm, the aortic valve was replaced with a bioprosthetic valve, and no anticoagulant was administered postoperatively. Repeated cerebral angiography revealed that the aneurysm was becoming progressively smaller during the next 9 months. No cerebrovascular accident occurred postoperatively. We believe that it is safe to treat a ruptured mycotic cerebral aneurysm without involvement of a hematoma mass in the brain conservatively, and that use of a bioprosthetic valve, if valve replacement is mandatory, and avoidance of anticoagulant therapy during the postoperative period are advisable in the treatment of a patient with infective endocarditis and a ruptured cerebral mycotic aneurysm.
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PMID:[Valve replacement in a patient with infective endocarditis and ruptured mycotic cerebral aneurysm]. 156 43

Cocaine, especially in its alkaloidal or "crack" form, has been increasingly associated with cerebrovascular disease. Before the crack epidemic, cocaine hydrochloride (HCl) was also implicated as a cause of stroke. However, less is known about the differences in stroke subtypes, age at stroke onset, or presence of underlying structural cerebrovascular disease with different forms of cocaine use. We compared 26 patients (previously reported) from our four institutions plus 16 cases reported in the literature of stroke associated with alkaloidal cocaine to 63 (57 reported in the literature and six not previously reported from our four institutions) cases of stroke associated with cocaine HCl. Ischemic and hemorrhagic strokes are equally likely after alkaloidal cocaine use, whereas cocaine HCl is more likely (approximately 80% of the time) to cause hemorrhagic stroke, with approximately half the intracranial hemorrhages occurring from ruptured cerebral saccular aneurysms or vascular malformations. The presence of an underlying cerebral aneurysm was more common among patients with cocaine HCl-associated strokes than alkaloidal cocaine-associated strokes. Cerebral infarction was significantly more common among the alkaloidal cocaine users than in all the cocaine HCl users, and this was also true when alkaloidal cocaine users were compared with parenteral cocaine HCl (intravenous and intramuscular) users. Only hemorrhagic stroke has been reported with intravenous cocaine HCl use. We conclude that the pathogenesis of cocaine-related stroke is heterogeneous, and depends, in part, on the form of cocaine used.
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PMID:A comparative study of the cerebrovascular complications of cocaine: alkaloidal versus hydrochloride--a review. 186

Five male patients sought medical attention for diplopia and were found to have third nerve palsies secondary to pituitary adenomas. In four cases this was the only neurologic abnormality. In the fifth there was an additional, asymptomatic, temporal visual field defect in one eye. Partial third nerve involvement was seen in all but one patient. Four patients underwent successful surgery and were found to have chromophobe adenomas. One patient had clinical and laboratory evidence of Cushing's syndrome. An initial diagnosis of cerebral aneurysm was made in three cases when the third nerve palsy followed a severe, acute headache. Later it became evident that pituitary apoplexy was the correct diagnosis. The mechanisms by which a pituitary adenoma causes a third nerve palsy are discussed. The importance of recognizing a pituitary tumor as the etiology of an isolated third nerve palsy is emphasized.
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PMID:Third nerve palsy: the presenting sign of a pituitary adenoma in five patients and the only neurological sign in four patients. 293 21

A case is presented in which the sudden onset of bitemporal hemianopsia was caused by partial thrombosis associated with enlargement of an unruptured anterior communicating artery aneurysm. The features of the sequential computed tomographic scans resembled those of pituitary apoplexy, reemphasizing the necessity for cerebral angiography in preoperative evaluation. The clinical significance of the warning signs of cerebral aneurysm during the era of computed tomography is discussed.
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PMID:Partially thrombosed aneurysm presenting as the sudden onset of bitemporal hemianopsia. 336 25

To elucidate the role of the internal elastic lamina in the development of cerebral aneurysm, the bifurcation of the anterior cerebral artery and olfactory artery was histologically studied in control and experimental rats treated with unilateral carotid ligation and renal hypertension. Various stages of aneurysm formation were compared, and it was found that early aneurysmal changes were always present just distal to the apical intimal pad on the anterior cerebral artery side. The internal elastic lamina was thinned and fragmented just distal to the pad even in the very early stage of aneurysm formation when the medial layer was still present. In control rats, the internal elastic lamina had a tendency to thin and fragment at the site where aneurysms would develop in experimental rats. Our study shows that changes of the internal elastic lamina were present just distal to the pad even in control rats, which never develop cerebral aneurysms. Under hemodynamic stress augmented by experimental treatments, further degenerative changes of the internal elastic lamina and involvement of the medial layer are considered to occur and result in aneurysm formation there.
Stroke 1988 Apr
PMID:Involvement of internal elastic lamina in development of induced cerebral aneurysms in rats. 336 80

Infarction of the central nervous system secondary to embolism from left atrial myxoma is a recognized phenomenon. However, myxoma as the source of an embolus may be overlooked if an index of suspicion is not present during the evaluation of the patient with a stroke without a known cause. We present a case report that illustrates some of the pitfalls and characteristic findings present in the evaluation of these patients. The magnetic resonance image of multiple cerebral aneurysms and infarction associated with this condition is presented along with a unique, arteriographically proven resolution of a fusiform cerebral aneurysm after the removal of the cardiac tumor. A review of published case reports suggests that, if the cardiac tumor is recognized and treated quickly, the ultimate prognosis, while uncertain, is usually good. However, because the potential exists for recurrence of the cardiac tumor, for enlargement of the cerebral lesions, or for late development of cerebral lesions, long term follow-up is mandatory and a vigorous work-up must be pursued if the patient again becomes symptomatic or develops central nervous system manifestations for the first time.
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PMID:Left atrial myxoma with cerebral emboli. 400 Apr 42

The association of pituitary adenoma and adjacent cerebral aneurysm is not uncommon and acute hemorrhage into a pituitary adenoma is also a well recognized condition. However, the simultaneous occurrence of pituitary apoplexy with intracranial aneurysm is very rare. Such a case demonstrates the diagnostic difficulty in distinguishing between pituitary apoplexy and rupture of an aneurysm. We reported a patient with subarachnoid hemorrhage in whom a hemorrhage into the pituitary adenoma and a carotid-ophthalmic aneurysm was proven, and discussed the differential diagnosis and treatment. A 41-year-old man, who developed sudden severe headache with nausea and vomiting, was admitted to our hospital. Examination disclosed a mildly stuporous man with bilateral defects of upper lateral visual fields and lumbar puncture revealed subarachnoid hemorrhage. Plain radiographs of the skull showed an enlarged and eroded sella turcica. Carotid angiography revealed a left carotid-ophthalmic aneurysm. A plain CT scan demonstrated an acute suprasellar hematoma. A transsphenoidal operation was performed and postoperative course was uneventful.
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PMID:[Pituitary apoplexy with an unruptured carotid-ophthalmic aneurysm]. 401 Aug 80


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