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

The occurrence of epileptic seizures was investigated in 141 patients with angiographically proven carotid or MCA occlusive disease. Epileptic seizures occurred some time during the clinical course of the disease in 17.3% of carotid patients and in 10.8% of MCA patients, being mainly represented by partial motor seizures. The pattern of occurrence of seizures in the natural history of cerebral arterial disease was different in the two groups. In the carotid group, epilepsy was the presenting symptom in 6.7% of patients, whereas no MCA patient had seizures prior to the appearance of a neurological deficit. Since epileptic seizures may complicate an otherwise asymptomatic carotid obstruction, angiography should be performed whenever the other standard investigations, including CT-scan, fail to reveal the cause of late-onset epilepsy.
Stroke
PMID:Epileptic seizures in cerebral arterial occlusive disease. 706 90

Regional cerebral blood flow and vasomotor reactivity were measured in 33 patients with surgically remediable hemispheric ischemia by the 133Xe inhalation method prior to superficial temporal to middle cerebral artery (STA-MCA) by-pass. Thirteen patients also underwent LCBF and L lambda measurements by the stable xenon CT method for comparison. Twenty-four had proximal occlusion of one or both internal carotid arteries, 9 had intracranial occlusive disease (4 internal carotid, 5 middle cerebral). Measurements were repeated at intervals up to 30 months following surgery and compared to measurements in a similar group (N = 13) treated medically. In the surgically treated group 22 patients had recurrent TIAs, of whom 12 also had minor residual neurological deficits from recent small cerebral infarctions with potential for recovery (RINDs) while the remaining 11 had RINDs without TIAs. After surgery 28 improved with cessation of TIAs and/or neurological recovery, 3 remained unchanged, 2 cases worsened. Compared to age-matched normal hemispheric F1 (gray matter) values, pre-operative F1 values in the STA-MCA group were reduced in both ischemic and opposite hemispheres. Ischemic regions showed imparied vasomotor reactivity to 5% CO2 or 100% O2 inhalation. After surgery, mean hemispheric F1 values increased + 12.8% on the by-pass side and + 10.5% on the contralateral side. Mean F1 increases reached a maximum 3 months after by-pass, most evident in ipsilateral frontal regions (+ 24.2%). Vasomotor reactivity did not significantly improve. Medically treated cases did not show similar F1 increases. Thirteen with carotid occlusive disease (8 with TIAs, 5 with small recent infarcts) underwent CT LCBF and L lambda measurements before and after STA-MCA by-pass. Cases with recent infarcts showed reduced LCBF and L lambda values which increased significantly after STA-MCA by-pass, however the total group operated upon showed only trends for CBF increases, probably due to large standard deviations encountered in serial measurements.
Stroke
PMID:Redistribution of cerebral blood flow following STA-MCA by-pass in patients with hemispheric ischemia. 714 91

Thirty-one cats were divided by age into 3 groups, young (Y), middle (M) and old (O). Continuous recordings of local cerebral blood volume (CBV) and frequent measurements of mean transit time of blood (t) were made from the Sylvian opercula after ischemia was produced by transorbital clipping of the middle cerebral artery at its origin (MCA occlusion). Control recordings were made simultaneously from the corresponding area of the contralateral cerebral hemisphere. MCA occlusion temporarily stopped cerebral blood flow (CBF) in the area supplied by the ipsilateral MCA, as indicated by a rapidly decreasing CBV and complete disappearance of hemodilution curves. Within 30 sec, CBF resumed with a dilatation of the vascular bed and reappearance of hemodilution curves through newly developed collateral channels. Despite a low CBF, below half the control, CBV recovered, overshooting the control level. The appearance of hyperemia in the ischemic area was statistically significant. Such "low perfusion hyperemia" was slower in appearance and of more diverse magnitude in group O than in group Y. This suggested that aging may lead to a decrease in rapidity of the vascular response to ischemia and impair the integrity of collateral vessels.
Stroke
PMID:"Low perfusion hyperemia" following middle cerebral arterial occlusion in cats of different age groups. 721 69

Eight dogs had a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis, followed immediately by ligation of the ipsilateral middle cerebral artery. Subsequently, utilizing the radioactive microsphere technique, regional cerebral blood flow determinations were made both before and after ligation of the superficial temporal artery. A significant reduction in blood flow of 20-35% was noted in both cerebral hemispheres, caudate and thalamic nuclei, brain stem and cerebellum following occlusion of the bypass. It is our impression that this generalized reduction in flow is due to a redistribution of blood from normal areas previously supplied by the bypass. This implies that the newly created extracranial to intracranial arterial anastomosis reduces the shunting of blood from zones of higher to zones of lower flow through the circle of Willis and leptomeningeal collaterals. It also suggests a mechanism for the development in neurological function referable to areas of the brain remote from the bypass which is detected in some patients after STA-MCA anastomosis.
Stroke
PMID:Influence of superficial temporal artery to middle cerebral artery bypass on cerebral blood flow in dogs with middle cerebral artery occlusion. 723 68

2,3,5-triphenyltetrazolium chloride (TTC) is commonly applied in rodents and cats as a marker of infarcted tissue as early as 20 min after the onset of focal ischaemia. At this stage it is suggested that it reflects hypoperfusion rather than failure of respiratory chain. Immersion of brain slices in TTC solution is preferable in comparison to perfusion with TTC in order to ensure, that enough TTC enters the post-occlusion tissue. We compared immersion technique versus perfusion technique 6 h after permanent occlusion of the left middle cerebral artery in 18 baboons. In addition, we assessed the function of the respiratory chain enzymes of stained and unstained tissue in three baboons. The immersion technique revealed an absence of TTC staining limited to subcortical structures in two animals. In seven experiments TTC indicated involvement of almost the entire MCA territory. The extent of the ischaemic lesion indicated by the perfusion technique was very similar. Tissue samples from the presumed infarcted areas revealed normal mitochondrial function. We conclude that perfusion and immersion technique do not cause significant different ischaemic delineation 6 h after middle cerebral artery occlusion. TTC staining appears to be a reliable method of evaluating volume of infarction in primates. Furthermore, absence of TTC staining 6 h after stroke onset is caused by energy or oxygen depletion rather than by mitochondrial injury.
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PMID:Immersion and perfusion staining with 2,3,5-triphenyltetrazolium chloride (TTC) compared to mitochondrial enzymes 6 hours after MCA-occlusion in primates. 752 75

We report a patient with spontaneous cervical internal carotid artery (ICA) dissection. A 46-year-old woman had experienced left neck pain for 10 days. One month later, she was admitted because of the sudden onset of right hemiparesis and left amaurosis, which lasted for 30 minutes. On hospital day 3, the patient experienced the sudden onset of right hemiparesis and total aphasia, which lasted for two weeks. A CT scan failed to reveal any abnormal findings. Cerebral angiograms showed irregular narrowing of the left internal carotid artery distal to the carotid sinus and extending to the base of the skull ("string sign"). Magnetic resonance imaging (MRI) revealed a high signal intensity crescent-shaped mass expanding the wall of the left ICA and narrowing its lumen. SPECT scans showed decreased cerebral blood flow in the left hemisphere. When the symptoms progressed despite-conservative therapy, surgery was performed (STA-MCA anastomosis). Many patients who develop spontaneous ICA dissection show recovery to normal arterial caliber angiographically 1 to 3 months after the onset. Thus, careful monitoring of the clinical course is important and in cases of impending stroke, surgery should be performed immediately.
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PMID:[A case of spontaneous cervical carotid artery dissection]. 766 30

To develop an easy, reproducible experimental model of cerebral infarction (CI) without craniotomy in New Zealand white rabbits, a silicone rubber cylinder embedded in a nylon suture was delivered to the middle cerebral arteries through the internal carotid artery in anesthetized animals. Rabbits were sacrificed 0.5-5 h after embolization. CI size and location were ascertained by the triphenyl-2H-tetrazolium chloride (TTC) staining method; cerebral blood flow (CBF) was measured prior to and after embolization. PCO2, temperature and blood pressure were monitored and kept constant. CI occurred in all rabbits after 4 h of ischemia, in 50% after 3 h and only in 33% after 2.5 h. CI did not occur within less than 2.5 h of ischemia. No correlation was found between size and location of CI and occlusion time. CBF was maximally reduced in the right MCA territory but was also reduced in both anterior cerebral arteries and left MCA territories. This model is technically easy and the retrievable embolus allows the study of reperfusion by pulling on the nylon suture. It is suitable for studying chemical and molecular changes of the ischemic cells and/or for studying neuroimage changes after ischemic stroke.
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PMID:A new model of experimental cerebral infarction in New Zealand white rabbits. 778 65

Intra-carotid urokinase (UK) infusion in 20 patients with acute internal carotid artery (ICA) territorial ischemic stroke achieved immediate recanalization in 45% and the clinical outcome in patients with recanalization was superior to that of patients without recanalization. The procedure was most effective in patients with smaller arterial occlusions: 7 of 10 patients with MCA branch occlusions (M2 to M4) achieved recanalization compared to only 2 of 10 with distal ICA or M1 occlusions, which should be an important issue for the critical evaluation of the efficacy of thrombolytic therapy (TT). Hemorrhagic transformation was observed in 9 patients on CT scan; petechial hemorrhage in 5 and intraparenchymal hematoma formation in 4. Among 4 patients with hematoma formation, clinical deterioration was seen in 3 cases and the angiography at the immediate end of the UK infusion showed recanalization in only one patient. The average dose of UK in patients with parenchymal hematoma formation was higher than that of patients without hemorrhagic transformation (123.3 x 10(4) units vs 101 x 10(4) units). The administration of a large dose of UK, probably more than 100 x 10(4) units, and the absence of immediate recanalization seemed to increase the risk of parenchymal hematoma formation. Despite the effort of investigators, the in-hospital time delay for the TT was significant which was mainly related to the time consuming preparation for angiography especially during night. A more effective system for the earlier intervention of acute ischemic stroke needs to be developed.
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PMID:Intra-carotid thrombolytic therapy in acute ischemic stroke of carotid arterial territory. 800 97

PMNs are believed to play an important role in ischemia and C5a uptake is an important functional indicator for G protein-coupled receptor trafficking. The ability of PMNs to internalize 125I-labeled C5a in vitro is an index of the functional state of these cells. We evaluated the effects of model preparation and focal cerebral ischemia by middle cerebral artery occlusion and reperfusion (MCA:O/R) on internalization of C5a by PMNs isolated from baboons (Papio anubis/cynocephalus). Similar assays were performed on PMNs isolated before and after exposing the animals undergoing MCA:O/R to an anti-inflammatory 21-aminosteroid, tirilazad mesylate (U74006F). Surgical implantation of the MCA occlusion device had no measureable effect on uptake of C5a to the cytosol by the PMN. In contrast, MCA:O/R appeared to decrease uptake of C5a. Both in vivo and in vitro administration of tirilazad, to otherwise untreated animals and to isolated cells, respectively, reduced baseline values of C5a uptake in the PMNs. Cytosolic uptake of C5a was also reduced in PMNs isolated from subjects that had undergone MCA:O/R and tirilazad treatment. These results suggest that focal cerebral ischemia, with or without exposure to tirilazad mesylate, may inhibit internalization of C5a by the PMN receptors. The effects of stroke on the ability of C5a to gain entry into the PMN may result from receptor down-regulation or "desensitization" of the cell, possibly due to activation of complement and generation of C5a which occupied the receptors. Alternatively, the effect of tirilazad presumably results from the ability of this drug to enter the membrane lipid layer and reduce fluidity.
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PMID:Uptake of C5a by polymorphonuclear leukocytes (PMNs) after focal cerebral ischemia. I. Effect of tirilazad mesylate intervention on C5a uptake by PMNs. 807 Oct 59

Correlates of the size of infarcts, the time from stroke to death, and the mechanisms of death were studied in 77 consecutive patients who died from infarction in the middle cerebral artery territory. The area of infarcts was assessed by planimetry on schemas of representative brain levels and the results were expressed as a ratio of infarcted area on the whole MCA territory. No clear relationship was found between the size of infarcts in the MCA territory, and any of the characteristics of the patients, but extensive infarcts were more frequent when the internal carotid artery was occluded. No evidence was found of an adverse effect of age, diabetes or initial hyperglycemia on the size of infarcts. The mechanisms of death were not linked to sex, age, high blood pressure, diabetes, blood glucose level at admission, presence and location of an arterial occlusion, or etiology of the infarct. On the contrary, they varied as a function of interval from stroke to death. Transtentorial herniation, the main cerebral cause of death, occurred mainly in the first week and was related to the large size of infarcts. Rare recurrences of stroke and frequent extracerebral mechanisms of death (mainly pneumonia, pulmonary embolism and cardiopathy) occurred later on.
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PMID:Infarcts in the middle cerebral artery territory. Pathological study of the mechanisms of death. 833 39


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