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

Cerebral hemispheric asymmetries were assessed in relation to motor and functional recovery in nine patients with stroke. All were globally aphasic, assuring similar location and extent of lesion. Initial motor and functional ability were appraised from medical records and compared with neurologic and functional outcome. Frontal and occipital hemispheric widths and lengths were determined from CT. Patients were classified into three groups on the basis of mean combined asymmetry for width (typical asymmetry, atypical asymmetry, and equal symmetry). Patients with the most atypical cerebral asymmetries showed greater recovery than patients in other groups. Two patients with atypical mean occipital asymmetry (width) fared best functionally, whereas the patient who showed the greatest motor recovery had the most atypical mean occipital asymmetry (width). Cerebral asymmetries may contribute to recovery after stroke.
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PMID:Cerebral hemisphere asymmetry in CT and functional recovery from hemiplegia. 668 94

Prognostic factors for survival and neurological recovery were assessed in 42 patients with nontraumatic intracerebral hematoma (ICH) diagnosed by CT scan. None underwent surgical evacuation of hematoma. CT scans were used to determine location and volume of ICH and presence or absence of intraventricular hemorrhage (IVH). Only 11 patients (26%) died and 17 patients (40.5%) recovered fully. Mortality was associated with: 1) loss of consciousness as a presenting symptom (63.5% mortality rate versus 13% when there was no loss of consciousness at the onset; p less than 0.01). 2) extension of the bleeding into the ventricular system (45% mortality rate versus 9% when hemorrhages were confined to brain parenchyma; p less than 0.01). 3) location of hematoma in the posterior fossa (mortality rate of 43% versus 23% for intrahemispheric hematomas). Mortality was unaffected by age of patients and size of ICH. Full neurological and functional recovery occurred mainly when estimated volume of hematomas was less than 15 cc and with lobar hematomas regardless of size. In survivors there is CT evidence of complete resolution of ICH. Our data indicates a favourable outcome in a relatively large percentage of patients with ICH treated conservatively and therefore questions the need for surgical evacuation of hematoma.
Stroke
PMID:The prognostic value of the CT scan in conservatively treated patients with intracerebral hematoma. 670 36

Of 135 patients who survived the first 2 weeks following a stroke 25% were under the age of 65 years, 40% between 65 and 74 years and 35% were 75 years of age or older. Those under 65 years had a lower incidence of a previous history of lower limb arthritis, balance problems, and limited mobility but a greater incidence of ischaemic heart disease than those 65 years and over. This younger age group had a lower mortality and were more likely to progress beyond severe degrees of disability. However, if only those who survived the first year are included, then there was no difference in outcome between the age groups. In none of the parameters studied was there any difference between those 65 to 74 years of age and those 75 years and over. It was, however, those over the age of 74 years who were more likely to require long-term institutional care. These findings suggest that, although elderly 1-year survivors had a similar level of functional recovery to younger patients, other factors, probably social, affected the eventual placement of stroke patients.
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PMID:The influence of age on the clinical presentation and outcome of stroke. 674 1

The protection afforded by cardioplegia during elective ischemic arrest can be partly compromised by a reperfusion injury, which may impede the recovery of cardiac function. We previously showed experimentally that this postischemic damage could be largely avoided by an appropriate crystalloid reperfusate. The present study was thus undertaken to assess the effects of this "reperfusion solution" clinically. One hundred twelve patients undergoing valve replacement with the aid of hypothermic cardioplegia (K+ 12 mEq, Mg2+ 26 mEq) were prospectively divided in two groups: Group I (n = 49) received an unmodified blood reperfusate. In Group II (n = 63), 1 L of the reperfusion solution was delivered just prior to removal of the aortic clamp. The formulation of the reperfusion solution adhered to the following principles: (1) maintenance of cardioplegia (K+ = 15 mEq), (2) replenishment of Ca2+ stores (Ca2+ = 2.5 mEq), (3) substrate provision (glutamate = 2,942 gm), (4) buffering (pH = 7.70 at 28 degrees C), and (5) hyperosmolarity (370 mOsm). The two groups were matched for preoperative data except for a higher incidence of isolated aortic valve replacement (p = 0.01) in Group II. Also, the cross-clamp time (mean +/- standard error of the mean) was longer in Group II (94 +/- 4 minutes versus 63 +/- 4 minutes, p less than 10(-6]. The reperfusion solution was found to increase both the rate and extent of postischemic functional recovery, as evidenced by (1) a lower proportion of catecholamine-supported patients 48 hours after operation (9/63 [14.28%] versus 16/49 [32.6%] in the control group [p less than 0.03]) and (2) a lower amount (gamma/kg/min) of dobutamine required to achieve stable hemodynamics (11 +/- 1 versus 26 +/- 6 in the control group [p less than 0.03]). A similar recovery pattern was noted in the high-risk subgroup of patients with mitral valve disease. Further, serial postoperative hemodynamic measurements were performed in 31 randomly selected patients (10 control and 21 reperfused). Although the reperfused patients were found to be at higher risk because of lower preoperative cardiac indices and longer cross-clamp times, they consistently achieved better postoperative hemodynamics with a lower incidence of catecholamine support. This hemodynamic improvement was particularly reflected by a higher left ventricular stroke work index throughout the postoperative course, the difference being significant 6 hours and 12 hours postoperatively.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:An asanguineous reperfusion solution. An effective adjunct to cardioplegic protection in high-risk valve operations. 674 22

Proprioception and neglect were studied in 287 patients surviving up to one week after the onset of their stroke. The presence of proprioceptive loss indicated a more extensive lesion and a larger proportion of these patients had impairment of intellectual function, motor power in the upper and lower limb, and postural function. Proprioceptive loss also had an adverse effect on the level of independence achieved by discharge, final placement, mortality and length of stay in hospital. In 87% of the survivors recovery of proprioception had occurred by eight weeks. Significant neglect was associated with high mortality and poor outcome for functional recovery.
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PMID:Proprioception and spatial neglect after stroke. 684 94

The hypothesis tested was that the composition of the prime and the perfusate at the time of reperfusion had an influence on postischemic cardiac performance. Twelve dogs in two equal groups had long (210 +/- 10 minutes) hypothermic (25 degrees +/- 1 degree C) perfusions. Each had 180 minutes of global ischemia and were given 500 ml of the same cold (4 degrees C) cardioplegic solution (CPS) every 45 minutes and topical hypothermia with a resultant average myocardial temperature of 10 degrees +/- 2 degrees C. Group A had a prime (1,958 ml) consisting of a 50/50 mixture of 5% dextrose in water and 5% dextrose in Ringer's injection to which mannitol (12.5 gm), furosemide (20 mg), and heparin (6,000 units) were added. Group B received a prime (1,868 ml) of 5% dextrose in Ringer's injection (1 L) and 750 ml of 6% helastarch in normal saline to which NaHCO3 (10 mEq), furosemide (20 mg), mannitol (25 gm), and heparin (6,000 units) were added. During perfusion, Group A received lactated Ringer's solution and Group B received a 1 : 2 portions of Ringer's injection and 6% helastarch. Additionally, Group B received additional furosemide and mannitol 5 minutes prior to the reperfusion interval. The results showed a marked difference between groups in postischemic cardiac recovery 120 minutes after cessation of cardiopulmonary bypass. The Group B dogs had statistically (less than 0.02) greater cardiac output, stroke volumes, and stroke work index at equal preloads and lower total peripheral resistances. Arterial systolic, diastolic, and mean pressures and right atrial pressures were not different. The Group A dogs required nearly threefold the volume of fluid additions required during bypass and twice the amount of NaHCO3 as Group B dogs. It is concluded that the composition of the prime and fluids used during bypass and use of agents to counteract tissue water accumulation during the ischemic and reperfusion intervals strongly influences postischemic cardiac performance. Further, these data suggest that the composition of the perfusate may have a greater influence on the functional recovery of the heart than the composition of various CPSs.
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PMID:Adequacy of the perfusate: its influence on successful myocardial protection. 713 9

Acute functional recovery after a stroke was evaluated in 31 subjects over a three-month period. Assessments were made at four, eight and 12 weeks after insult in the areas of activities of daily living, mobility, functional movement and cognitive abilities. Maximum recovery was achieved by eight weeks, although a trend towards recovery was continued to 12 weeks. Significant recovery was noted in activities of daily living, gait and functional movement, but not in cognitive abilities. A hemispheric difference in recovery rate was looked for, but not found, although unilateral spatial neglect, which, in this study, was exclusively found in right hemisphere lesions, emerged as a factor associated with poor outcome. The present results need to be confirmed by long term follow-up studies.
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PMID:Acute recovery from patterns in stroke patients: neuropsychological factors. 721 1

This study analyzes 234 patients who recovered from an initial ischemic episode. The object was to see if the duration of the first episode influenced the chance of finding a treatable lesion or the chance of a further episode. The initial episodes varied from less than 5 minutes to longer than 3 weeks. There seemed to be no fundamental difference between transient ischemic attacks (TIAs) (less than 24 hours) and strokes which recover. However, 51% of those whose initial episode lasted less than 5 minutes had a subsequent stroke compared to 28% of those with an initial episode of more than 24 hours duration. Thirty percent of the former group who had angiograms had an operable lesion against 10% in the latter group. It seems that angiography has sufficiently high yield to be warranted in all patients where the initial attack lasted less than 30 minutes. In those with longer attacks the yield from angiography was much lower and noninvasive techniques should be considered in these patients, where available, prior to consideration for angiography. Investigation should be based on the degree of functional recovery and not on the arbitrary time division which normally divides TIAs and strokes. Bruits were the most reliable clinical indicators of stenosis. However the presence of intermittent claudication, hypertension and age over 50 were all more common in those with carotid stenosis.
Stroke
PMID:Transient ischemic attacks and strokes with recovery prognosis and investigation. 730 66

Thirty-one age-matched, conscious, virgin, male Sprague-Dawley rats and spontaneously hypertensive rats (SHRs) were individually injected with a single subcutaneous dose of 85 mg/kg dl-isoproterenol to determine the degree and time course of drug-induced cardiac failure and functional recovery. At 24 hr and 1 week postisoproterenol, rats were anesthetized and prepared for the recording of cardiac output and arterial pressure. Calculated cardiac index was used to determine normal cardiac function. Following that measurement, a 2-min, 15.3 ml/min infusion of Tyrode's solution was performed via a right jugular vein cannula. Volume-loaded peak-cardiac outputs and peak stroke volumes were also used as indices of cardiac function. Twenty-four hours after the injection of isoproterenol to he normotensive Sprague-Dawley rats, cardic failure was evident only during the stress of volume loading. Normal cardiac index was unaffected, but peak cardiac output and peak stroke volume were depressed. By 1 week after isoproterenol, the volume loaded measures of cardiac function had returned to normal. Interestingly, by 1 week postisoproterenol, total peripheral resistance was reduced. This reduced vascular resistance may have aided myocardial repair. At 24 hr postisoproterenol, the volume loaded peak cardiac outputs and peak stroke volumes in the SHRs were reduced to the same degree as in the Sprague-Dawley rats. Here, also, no change in normal cardiac index occurred. In the SHRs, however, total peripheral resistances were elevated at both 24 hr and 1 week. These increases in resistance appeared to impair the myocardial healing process, as both normal cardiac index and volume-loaded peak cardiac output and peak stroke volume were depressed at 1 week postisoproterenol. In normotensive and hypertensive rats, different vascular responses to isoproterenol or its initial cardiac effects may determine the duration and eventual degree of cardiac failure.
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PMID:Isoproterenol-induced cardiac failure in the spontaneously hypertensive rat. 732 63

Activation of areas of the health hemisphere seems to play a role in functional recovery from stroke. We studied cerebral blood flow changes during motor and mental activity in patients with cortical ischemic lesions. We simultaneously measured blood flow velocity in the two middle cerebral arteries of 45 patients with single cortical ischemic lesions and good functional recovery and of 16 healthy controls by means of bilateral transcranial Doppler ultrasonography during a 2-minute sequential thumb-to-finger opposition task, alternately performed with the right and left hands, and during a 1-minute word-fluency task. Twenty-five patients had left cortical lesions, 12 with previous motor deficit alone and 13 with associated motor deficit and Broca's aphasia. Twenty patients had right cortical lesions with previous motor deficit. With respect to baseline values, the increase of flow velocity in the middle cerebral artery contralateral to the hand performing the motor task was comparable in controls and patients, regardless of the side of the lesion and the hand (normal or recovered) involved in the task. During movement of the recovered hand, the increase of flow velocity in the ipsilateral middle cerebral artery was significantly greater (p < 0.001, two-way ANOVA) than the increase during movement of the normal hand in both controls and patients. During performance of the word-fluency task, the increase of flow velocity in the left middle cerebral artery was comparable in controls and patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Involvement of the healthy hemisphere in recovery from aphasia and motor deficit in patients with cortical ischemic infarction: a transcranial Doppler study. 747 74


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