bluuebunny/crossref_metadata_2025 huggingface dataset:
Compliance With Secondary Prevention of Ischemic Stroke
Authors: Sappok Tanja , Faulstich Andreas , Stuckert Erika , Kruck Holger , Marx Peter , Koennecke Hans-Christian
Published: June 2011

Background and Purpose
—

Compliance with pharmacological therapy is essential for the efficiency of secondary prevention of ischemic stroke. Few data exist regarding patient compliance with antithrombotic and risk factor treatment outside of controlled clinical trials. The aim of the present study was to assess the rate of and predictors for compliance with secondary stroke prevention 1 year after cerebral ischemia and to identify reasons for noncompliance.

Methods
—

Patients with a diagnosis of ischemic stroke or TIA and antithrombotic discharge medication were prospectively recruited. At 1 year, the proportion of patients compliant with antithrombotic treatment and with medication for risk factors (eg, hypertension, diabetes, hyperlipidemia) was evaluated through structured telephone interviews. In addition, the reasons for nontreatment with antithrombotic and risk factor medication were determined. Independent predictors for compliance were analyzed by logistic regression analyses.

Results
—

Of 588 consecutive patients admitted to our stroke unit, 470 had a discharge diagnosis of cerebral ischemia (TIA 26.2%, cerebral infarct 73.8%) and recommendations for antithrombotic therapy. At 1 year, 63 patients (13.4%) had died and 21 (4.5%) were lost to follow-up, thus, 386 could finally be evaluated. Of the patients, 87.6% were still on antithrombotic medication, and 70.2% were treated with the same agent prescribed on discharge. Of the patients with hypertension, diabetes, and hyperlipidemia, 90.8%, 84.9%, and 70.2% were still treated for their respective risk factors. Logistic regression analyses revealed age (OR 1.03, 95% CI 1.00 to 1.06), stroke severity on admission (OR 1.09, 95% CI 1.00 to 1.20), and cardioembolic cause (OR 4.13, 95% CI 1.23 to 13.83) as independent predictors of compliance.

Conclusions
—

Compliance with secondary prevention in patients with ischemic stroke is rather good in the setting of our study. Higher age, a more severe neurological deficit on admission, and cardioembolic stroke cause are associated with better long-term compliance. Knowledge of these determinants may help to further improve the quality of stroke prevention.
Regional Variations in the Apparent Diffusion Coefficient and the Intracellular Distribution of Water in Rat Brain During Acute Focal Ischemia
Authors: Liu Kai-Feng , Li Fuhai , Tatlisumak Turgut , Garcia Julio H. , Sotak Christopher H. , Fisher Marc , Fenstermacher Joseph D.
Published: June 2011

Background and Purpose—

The apparent diffusion coefficient of water (ADC) rapidly drops in ischemic tissue after cerebral artery occlusion. This acute drop is thought to be caused by the loss of extracellular fluid and the gain of intracellular fluid. To test the latter possibility, changes in ADC and the size of several cellular compartments were assessed in 3 regions of rat brain at the end of 90 minutes of focal cerebral ischemia.

Methods—

One middle cerebral artery was permanently occluded in 8 Sprague-Dawley rats; sham occlusions were performed in 2 other rats. ADC maps were generated 90 minutes later, and the brains were immediately perfusion fixed. Three regions of interest (ROIs) were defined on the basis of ADC range. Various neuronal, astrocytic, and capillary compartments in each ROI were quantified with light and electron microscopy.

Results—

At the end of 90 minutes of ischemia, mean ADC was normal in the cortex of sham-operated rats and the contralateral cortex of ischemic rats (ROI-a), 25% lower in the ipsilateral frontoparietal cortex (ROI-b), and 45% lower in the ischemic lateral caudoputamen (ROI-c). At this time, the frequency of swollen astrocytic cell bodies and volume of swollen dendrites and astrocytic processes in neuropil were ROI-a<ROI-b<ROI-c. In ROI-b and ROI-c, 40% and 60% of the neurons, respectively, were shrunken; the shrunken neurons were ≈25% smaller in ROI-c than in ROI-b. In these areas, many capillary endothelial cells, pericytes, and perivascular foot processes were swollen.

Conclusions—

The initial lowering of ADC during focal ischemia probably is the result of not only the acute loss of extracellular fluid and concomitant swelling of various cellular compartments but also concurrent neuronal shrinkage.
Impaired Neurogenic Cerebrovascular Control and Dysautoregulation After Stroke
Authors: MEYER JOHN STIRLING , SHIMAZU KUNIO , FUKUUCHI YASUO , OHUCHI TADAO , OKAMOTO SHIGEMICHI , KOTO ATSUO , ERICSSON ARTHUR DALE
Published: June 2011

Cerebral autoregulation was tested in 32 patients with various anatomical locations and stages of ischemic cerebrovascular disease. Cerebral perfusion pressure (CPP) was raised or lowered in a standard manner by the use of head-up tilting (induced hypotension) and head-down tilting (induced hypertension). Any impairment of cerebral autoregulation was analyzed quantitatively by the ratio of the change in cerebral blood flow (CBF) over the change in CPP. There was significant correlation between the degree of dysautoregulation whether CPP was increased or decreased. An inverse correlation was shown between the degree of dysautoregulation and the duration after the ischemic episode during both induced hypotension and hypertension. Patients with brainstem lesions including those with transient ischemic attacks (TIAs) showed a greater impairment of autoregulation which persisted longer than those with hemispheric lesions. Patients with severe cerebral hemispheric infarction showed greater impairment of autoregulation than those with minor hemispheric lesions. Dysautoregulation also was greater in patients with subcortical lesions compared to those with cortical lesions.

Hypertensive patients showed significantly greater decreases in CBF and effective MABP during induced hypotension than normotensive patients although autoregulation index was the same. Thus, symptoms are more frequent in hypertensives because of greater changes in CPP.

Paradoxical responses in CBF to changes in CPP occurred in six patients. These were noted in moderately severe lesions in relatively young patients with hypertension and deeply located cerebral or brainstem lesions in the subacute stage. The mechanisms which control cerebral autoregulation were discussed and the nervous structures situated in the deep cerebral regions and brainstem, possibly the central structures of the autonomic nervous system, were proposed to control autoregulation of CBF.
Effects of Alpha Adrenergic Blockade on Autoregulation and Chemical Vasomotor Control of CBF in Stroke
Authors: MEYER JOHN STIRLING , SHIMAZU KUNIO , OKAMOTO SHIGEMICHI , KOTO ATSUO , OHUCHI TADAO , SARI ATSUO , ERICSSON ARTHUR DALE
Published: June 2011

Autoregulation and chemical vasomotor control of cerebral blood flow (CBF) were quantitatively tested in 19 patients with various types and sites of cerebral ischemia and infarction. The effect of alpha adrenergic blockade of cerebral vessels by phenoxybenzamine (PBZ) also was evaluated in more than half of the patients. No correlation was found between the degree of cerebral dysautoregulation and impairment of chemical vasomotor control of CBF. Patients with brainstem ischemia and infarction showed normal vasomotor reactivity of CBF to changes in Pa
CO
2
, despite the impairment of cerebral autoregulation during both induced hypotension and hyper ension.

Following intracarotid injection of 10 mg PBZ, the degree of cerebral dysautoregulation lessened during induced hypotension but increased during induced hypertension. Chemical vasomotor control of CBF in response to changes in P
CO
2
, was not significantly altered by the PBZ injection. Changes in autoregulation index (a quantitative measure of cerebral autoregulation) after the infusion were compared with changes in chemical regulation index (a quantitative measure of cerebral vasomotor reactivity). Induced hypotension and hypercapnia yielded a proportional correlation between these two indexes, while induced hypotension and hypocapnia revealed a significant inverse correlation.

This study demonstrates that cerebral autoregulation is influenced by the autonomic innervation of cerebral vessels. Alpha adrenergic blockade improves impaired autoregulation when cerebral perfusion pressure (CPP) is lowered but worsens it when CPP is raised, indicating that PBZ impairs the ability of cerebral vessels to constrict during induced hypertension and improves their ability to dilate during induced hypotension. This study also supports the view that chemical vasomotor control is regulated not directly by autonomic innervations of cerebral vessels but by a local controlling mechanism.
Middle Cerebral Artery Embolectomy and Prolonged Widespread Vasospasm
Authors: KHODADAD G.
Published: June 2011

Cerebral vasospasm following subarachnoid hemorrhage due to ruptured aneurysms has been discussed extensively during the past decade. Spasm involving the cerebral arteries also has been described in severe head injuries, infections, hypertensive encephalopathy and migraine. However, it has not been reported in cerebral embolism or following reconstructive cerebrovascular operations.

Widespread and prolonged cerebral vasospasm was recently observed angiographically in a 40-year-old patient two weeks after a middle cerebral artery embolectomy. Although the repaired artery was patent, the patient's neurological recovery was slow and incomplete.

With the increasing interest in cerebral microvascular procedures, more examples of vasospasm may be seen in the future. Its frequency and possible ill effects on neurological recovery and patency of the repaired artery, nevertheless, cannot be evaluated with certainty unless early postoperative angiograms are carried out.
Acute Stroke Management and Patient Outcome: The Value of Neurovascular Care Units (NCU)
Authors: DRAKE WILLIAMS E. , HAMILTON MARSHA J. , CARLSSON MONICA , BLUMENKRANTZ JACK
Published: June 2011

Medical records of 455 acute stroke patients admitted to six community hospitals between October and April, 1969 through 1970 and 1971 through 1972, were surveyed. Data were obtained for: demography, diagnosis and management, complications, patient status and outcome variables (discharge status, disposition, length of stay, mortality and survival time), for one year before and after establishment of acute neurovascular care units (NCUs) in three of the hospitals. Patient status on admission based on a self-care scale was the most accurate measure used in predicting outcome (except when secondary complications occurred). There was a significant decline in mortality for nonhemorrhagic strokes for all patients, due to reduction in complication-related deaths among younger and less impaired persons. Forty-one percent of complication-related deaths for both surveys occurred during the first nine hospital days. Complications significantly lengthened hospitalization, increased the risk of late complication-related deaths, and decreased home discharges. Complication-related deaths were reduced in the second survey. Hospitals with NCUs showed a 50% reduction in secondary complications; hospitals without NCUs showed no reduction. Frequency of complications is an excellent measure of the quality of care. The acute NCU appears to be a practical method for achieving such quality.
Lactate Uptake and Metabolism by Brain During Hyperlactatemia and Hypoglycemia
Authors: NEMOTO EDWIN M. , HOFF JULIAN T. , SEVERINGHAUS JOHN W.
Published: June 2011

Entry into CSF and consumption by brain of blood-borne lactate (La) was quantified in pentobarbital-anesthetized, normocapnic dogs loaded and infused with NaLa and HLa to hold constant, in arterial blood, both the La concentration at about 8 mM (normal = 1 mM) and the pH at 7.4. In four dogs studied hourly over six hours, the arteriosagittal sinus blood concentration difference (δA-V La) was 0.41 ± 0.14 (SE) mM (P <0.05) and was time independent. CSF La rose slowly over four hours to about 0.6 of blood La while cisternal CSF pH remained nearly constant. Four acetate loaded controls showed no changes of δA-V La, CSF La, CSF, or arterial pH. Brain uptake of La was quantitated in eight dogs during insulin-induced hypoglycemia, to minimize possible competition by glucose. Cerebral blood flow (CBF) and δA-V for La, glucose, and O
2
were determined at 30-minute intervals. CBF and cerebral metabolic rate of O
2
(CMRO
2
) both fell about 17% during two hours of hypoglycemia and returned to control with La loading although blood glucose continued to fall to 1.5 mM. In the two hour La loaded period δA-V La was 0.27 ± 0.10 mM (n = 32) and CSF La rose to 0.7 of arterial La without altering CSF pH. CMRO
2
averaged 1.61 ± 0.14 µ mol/(min.gm brain), of which CMR glucose (x6 to give O
2
, equivalents) provided 75% or 1.18 ± 0.13 µ O
2
eq/(min.gm). CMR La x 3 was 28% of CMRO
2
or 0.45 ± 0.15 µ eq/(min.gm). The results suggest that blood-borne La can stoichiometrically replace about one-fourth of the glucose used as brain substrate during hypoglycemia, and probably during normoglycemia. Uptake may be limited by saturation of carriers facilitating passage of La across the blood-brain barrier and into brain cells.
Stereospecific Permeability of Rat Blood-Brain Barrier to Lactic Acid
Authors: NEMATO EDWIN M. , SEVERINGHAUS JOHN W.
Published: June 2011

Blood and whole brain
14
C and
32
P activities were determined in hepatectomized rats one, two, five and ten minutes after intravenous (I.V.) injection of
14
C-labeled L-lactate or D-lactate and
32
P-labeled rat red blood cells. Whole brain homogenate
14
C was corrected for blood
14
C and chemically partitioned into
14
C-lactate,
14
CO
2
and other
14
C compounds. In controls, lactate was replaced with
14
C-D-glucose and
125
l-antipyrine. At one minute postinjection, whole brain
14
C expressed as percent of total injected
14
C activity and as percent of the antipyrine value were: antipyrine 1.78% (100%); D-glucose 1.45% (81%); L-lactate 0.36% (20%); and D-lactate 0.13% (7%). One minute after L-lactate injection, brain
14
C was 74% lactate, 5% CO
2
and 21% other compounds. Preloading rats with cold racemic Na-lactate reduced L-lactate uptake to 0.14% of the injectate (8% of antipyrine), and reduced D-Iactate uptake to 0.09% (= 5% of antipyrine). At two, five and ten minutes, brain contained more
14
C with larger fractions metabolized to CO
2
and other compounds from both L-lactate and D-lactate. The blood-brain barrier appears to contain a saturable lactate carrier exhibiting threefold L-stereospecificity to D-stereospecificity, but resulting in far less net transport than the comparable glucose carrier. Lactate transport may be limited by the scarcity of neutral lactic acid at normal blood pH.
Fibromuscular Dysplasia of the Posterior Cerebral Artery: Report of a Case and Review of the Literature
Authors: FRENS DAVID B. , PETAJAN JACK H. , ANDERSON ROBERT , DEBLANC HAROLD J.
Published: June 2011

A case of fibromuscular dysplasia (FMD) of the posterior cerebral artery with classic presumptive angiographical findings is presented, and the literature pertaining to FMD of the cervical arteries is reviewed. The focal neurological findings and characteristic changing pattern seen on sequential brain scans clearly associate the presence of this lesion to cerebral infarction. Various proposed etiologies and the characteristic pathological and radiological appearance of FMD are discussed. Emphasis is placed on the potential for this lesion to produce significant clinical sequelae, and on the relationship between FMD and the presence of intracranial aneurysms. The natural history and proper treatment remain uncertain; however, the general impression is for slow progression of existing lesions associated with development of new lesions in other locations.
Neurogenic Control of Cerebral Blood Flow in the Baboon. Effects of Alpha Adrenergic Blockade With Phenoxybenzamine on Cerebral Autoregulation and Vasomotor Reactivity to Changes in Pa
CO
2
Authors: KAWAMURA YASUO , MEYER JOHN STIRLING , HIROMOTO HIDEHARU , AOYAGI MINORU , HASHI KAZUO
Published: June 2011

Cerebral autoregulation was studied in the baboon by increasing and decreasing cerebral perfusion pressure (CPP) before and after intravenous administration (1.5 mg per kilogram) of a long-acting alpha adrenergic blocker, phenoxybenzamine (PBZ). Likewise, cerebral vasomotor reactivity to changes of arterial carbon dioxide tension (Pa
CO
2
) was examined before and after PBZ.

In order to permit quantitative analysis, cerebral autoregulation (A.I.) and chemical vasomotor reactivity (C.I.) were expressed as indices where

A.I.=δCBF/δCPP and C.I.=δCBF/δPa
CO
2
.

Following the intravenous injection of PBZ, cerebral autoregulatory vasoconstriction was impaired as CPP was increased. Cerebral vasomotor reactivity to changes in Pa
CO
2
was altered both during hyperventilation hypocapnia (HV) and hypercarbia induced by inhalation of 5% carbon dioxide if alterations of CPP brought about by these procedures were taken into consideration. During hypocapnia C.I. was reduced 30% and during hypercarbia C.I. was increased 10%.

It is concluded that PBZ reduces the vasoconstrictor tonus of cerebral vessels during hypocapnia and raised CPP. It also enhances the vasodilator response to CO
2
inhalation.
Measurement of Outcomes of Care for Stroke Patients
Authors: GRANGER CARL V. , GREER DAVID S. , LISET ELIZABETH , COULOMBE JOAN , O'BRIEN ELIZABETH
Published: June 2011

A coordinated system of care for stroke patients is established in the community of Fall River, Massachusetts, involving the Stroke Unit of Union Hospital, the Rehabilitation Unit of Earle E. Hussey Hospital, and the Fall River District Nurse Association. Long-Range Evaluation Summary (LRES) data collection forms developed at the Tufts University Medical Rehabilitation Research and Training Center (RT-7) are being used to reflect the functional status of the patient at any given point in time. Of 164 patients the Stroke Unit returned 49% home and the Rehabilitation Unit returned another 9% home. This systematic approach to functional assessment relates the disease-state and disability to outcomes of care. By taking into account the several-fold nature of outcome determination it is possible to analyze program effectiveness because such uniform descriptions, over time, permit us better to relate the population under care, its key characteristics for these purposes, and the comprehensiveness of problem identification and planning all at the same time.
Immediate Effects of Cerebral Ischemia: Evolution and Resolution of Neurological Deficits After Experimental Occlusion of One Middle Cerebral Artery in Conscious Cats
Authors: HAYAKAWA TORU , WALTZ ARTHUR G.
Published: June 2011

Acute occlusion of the left middle cerebral artery (MCA) was accomplished without anesthesia and inside an intact cranium containing cerebrospinal fluid (CSF) in ten cats five to nine days after implantation of an occlusive device through the orbit. Immediate neurological deficits included forced ambulation, circling, and tonic deviation of the head and neck toward the side of the occluded artery; weakness of the opposite limbs; and an apathetic or akinetic state. Two cats died within 24 hours. The other eight cats improved, but secondary deficits developed in two, causing death. In two of the remaining six cats no deficits were apparent seven days later. The cerebral infarcts regularly involved the basal ganglia, internal capsule, and cortical regions, and were larger and less variable than those produced by MCA occlusion through an open optic foramen or craniectomy with cranial decompression by drainage of CSF. This model of acute focal cerebral ischemia may be of value for studies of physiological and biochemical factors uninfluenced by sedatives, anesthesia, or recent surgical procedures.
Chronic Diabetes Followed by Chronic Cerebral Ischemia Induced by Bilateral Carotid Artery Ligation in Arteriosclerotic Versus Nonarteriosclerotic Rats
Authors: WEXLER BERNARD C.
Published: June 2011

Male and female, arteriosclerotic (breeder) and nonarteriosclerotic (virgin), Sprague-Dawley rats were made severely diabetic with alloxan. Two weeks later experimental animals had both carotid arteries ligated to induce a state of acute cerebral ischemia. After six weeks of cerebral ischemia either with or without severe diabetes the animals were killed. Animals which survived either the acute induction of diabetes or cerebral ischemia did not manifest any new episodes of cerebral ischemia. Subjects with combined diabetes and cerebral ischemia manifested the greatest loss in body weight, adrenal hypertrophy and thymus gland involution, increased levels of serum CPK and SGOT, but decreased SGPT and LDH, hyperglycemia and hypertriglyceridemia, and the most extensive cerebral edema. It is suggested that diabetic rats may have a greater predilection toward cerebrovascular accidents because the diabetic state contributes not only to an exacerbation of atherosclerosis, but also complicates any condition of cerebrovascular ischemia by creating extracerebral edema.
Amaurosis Fugax: A Clinical Comparison
Authors: SLEPYAN DAVID H. , RANKIN ROBERT M. , STAHLER CHRISTOPHER , GIBBONS GERALD E.
Published: June 2011

Amaurosis fugax (transient monocular blindness) is a symptom of retinal ischemia just as contralateral hemiparesis and sensory loss are symptoms of cerebral ischemia. These symptoms are produced by atherosclerotic stenosis of the carotid vessels at the ipsilateral carotid bifurcation and emboli from these areas causing focal, repetitive, retinal ischemia.

A study of 31 endarterectomy patients was undertaken to see if eight patients with amaurosis fugax (25%) could be differentiated from 22 patients with transient cerebral ischemia. The patients with amaurosis fugax were found to be younger. They all had 75% or greater stenosis of the internal carotid artery at the bifurcation on the symptomatic side. They all had unilateral visual symptoms and these symptoms were relieved by surgery. The patients with amaurosis fugax were devoid of cardiac disease, while 45% of the cerebral ischemic patients had documented myocardial disease.

Amaurosis fugax (transient monocular blindness) in the setting of clinically significant atheroslerosis of the carotid vessels is an indication for carotid endarterectomy.
Microcirculatory Obstruction in Focal Cerebral Ischemia: An Electron Microscopic Investigation in Monkeys
Authors: LITTLE JOHN R. , KERR FREDERICK W. L. , SUNDT THORALF M.
Published: June 2011

The fine structure of the microvasculature in areas of focal cerebral ischemia was studied in squirrel monkeys and the changes in areas of impaired and unimpaired microvascular filling, as defined by carbon perfusion, were compared. Microcirculatory obstruction became evident three hours following middle cerebral artery (MCA) occlusion and appeared to be partly the result of compression of capillaries by perivascular glial swelling and developing cerebral edema. Slight endothelial swelling was a common finding. Intraluminal membrane-bound bodies were occasionally identified but they did not appear to be producing significant obstruction. The tight endothelial junctions remained intact and there was no evidence of accelerated micropinocytosis. Severe neuronal injury frequently preceded the development of the microvascular obstruction and was more widespread than the zones of impaired perfusion.
Influence of adrenergic receptor blockade on circulatory and metabolic effects of disordered neurotransmitter function in stroke patients.
Authors: Meyer J S , Miyakawa Y , Welch K M , Itoh Y , Ishihara N , Chabi E , Nell J , Bartosh K , Ericsson A D
Published: June 2011

Cerebral hemispheric blood flow and metabolism were measured before and after therapy with intracarotid infusion of combined PBZ and PPL in 15 patients with recent cerebral infarction. HBF was unaltered despite decrease in cerebral perfusion pressure. Cerebral hemispheric oxygen comsumption and carbon dioxide production decreased while cerebral hemispheric lactate production increased. Biphasic cerebral uptake of tyrosine was observed during and immediately after PBZ and PPL infusion. CSF HVA increased, indicating altered DA turnover. CSF 5HIAA levels also increased, suggesting altered 5HT turnover after PBZ and PPL. Release of cyclic AMP from ischemic brain into cerebral venous blood seen in the steady state was abolished after therapy. Cerebral hemodynamic studies suggest a functional balance between monaminergic neurogenic influences in the control of cerebral circulation. Imbalance of such controlling factors in ischemic brain may lead to paradoxical vascular responses to induced hypertension and hypotension. PBZ and PPL enhance such responses perhaps by increasing central neurotransmitter turnover and release. Further shift toward cerebral anaerobic metabolism may occur in ischemic brain following the use of phenoxybenzamine and propranolol. Worsening of neurological deficit occurred in four cases. Combined therapy with PBZ and PPL does not appear beneficial in the therapy of patients with recent stroke.
Aphasia in acute stroke.
Authors: Brust J C , Shafer S Q , Richter R W , Bruun B
Published: June 2011

Previous surveys of stroke populations have offered only cursory information on language disturbance, and, conversely, few surveys of aphasic populations have dealth exclusively with stroke or with acute phenomena. This paper describes aphasia in 850 acute stroke patients consecutively registered by the Harlem Regional Stroke Program, of whom 177 (21%) were aphasic; of these, nine were of Broca's type, 24 were of Wernicke's type, 14 were of anomic, ten were conduction, seven were of "isolation" type, and 107 were "mixed." An unexpected finding was a significant over-representation of men among the nonfluent aphasics. During the following four to 12 weeks, 12% of fluent aphasics died, and 12% remained moderately or severely impaired; among survivors, aphasia improved in 74%, and in 44% it cleared completely. During the same period, 32% of nonfluent aphasics died, and 34% remained moderately or severely impaired; among survivors, aphasia improved in 52%, and in only 13% did it clear completely. In both fluent and nonfluent groups, hemiparesis and/or visual field cut were associated with poor prognosis.
Neurogenic cerebral vasodilation from electrical stimulation of the cerebellum in the monkey.
Authors: McKee J C , Denn M J , Stone H L
Published: June 2011

The effect of stimulation of fastigial nucleus (FN) on cerebral blood flow (CBF) was examined in anesthetized, paralyzed monkeys. CBF was measured with a flow transducer chemically implanted on the left common carotid artery. The left external carotid artery and its branches were ligated. Electrical stimulation of the fastigal nucleus produced rapid (within two seconds) increases in arterial pressure (AP) and heart rate. Mean carotid blood flow (MCBF) rose 77% (+/- 40% SEM) above control and followed the increases in mean arterial pressure (MAP). Calculated cerebrovascular resistance decreased immediately by 27% (+/- 14% SEM) below control. The increases in MCBF were not caused by a passively responding cerebrovascular bed (CVB) resulting from the stimulation or trauma to the vessels. Cerebral metabolism was not altered during stimulation as determined from the arteriovenous oxygen content difference. CBF autoregulation was still present with stimulation of the fastigial nucleus. The autoregulatory curve was shifted to a higher flow level. During the initial MAP changes in sympathectomized animals, MCBF increased to a greater extent than in the innervated animals, suggesting the presence of two neurogenic vasodilatory systems. It appears that electrical stimulation of the fastigial nucleus inhibits sympathetic tone and increases parasympathetic activity to the CVB, resulting in vasodilation and an increase in MCBF.
Cerebral Uptake of Glucose and Oxygen in the Cat Brain After Prolonged Ischemia
Authors: HOSSMANN KONSTANTIN-ALEXANDER , SAKAKI SABURO , KIMOTO KATSUHARU
Published: June 2011

In cats, total cerebral ischemia of one hour's duration was produced by arterial clamping and lowering of the blood pressure. Following ischemia the brains were recirculated with blood for various periods between 30 minutes and six hours. CBF and uptake of O
2
and glucose were determined and correlated with the electrophysiological recovery of the brain.

In four of 20 cats recovery was absent because of respiratory or circulatory insufficiency. In 16 cats signs of progressive electrophysiological function returned. These animals exhibited postischemic hyperemia; electrical excitability of the brains recovered within 15 minutes, and the adenylate energy charge returned to more than 95% of the preischemic value within 30 minutes. O
2
uptake was significantly reduced for about one hour, but returned to or above normal as soon as spontaneous ECoG activity began to reappear. Glucose uptake was initially in the normal range until the cerebral glucose stores were replenished, but then followed a time course similar to that of O
2
.

It is concluded that aerobic glycolysis may return after one hour's ischemia if the brain is adequately resupplied with glucose and O
2
.
Respiratory rate and pattern disturbances in acute brain stem infarction.
Authors: Lee M C , Klassen A C , Heaney L M , Resch J A
Published: June 2011

Respiratory rates and patterns were studied in 23 patients with acute brain stem infarction using impedance pneumography. Autopsy was obtained in six of eight fatal cases. Pontine lesions were present in all patients, with coexistent infarction of midbrain in four and of medulla in nine. Respiratory rate and pattern abnormalities observed included Cheyne-Stokes respiration, Cheynb-Stokes variant pattern and tachypnea. Abnormalities of respiratory rate and pattern of varying duration were observed at some time in all patients. All patients in whom prominent Cheyne-Stokes respiration or tachypnea were observed had extensive bilateral pontine lesions involving both basal and tegmental portions. However, not all patients with large pontine infarcts had Cheyne-Stokes respiration or tachypnea. Cheyne-Stokes respiration was prominent in four patients (two fatal, two nonfatal). Cheyne-Stokes variant pattern was present frequently in four patients (one fatal, three nonfatal). Sustained tachypnea developed in five patients, four of whom died. In ten patients (one fatal, nine nonfatal), normal respiratory rate and pattern predominated with only rare or occasional apperance of Cheyne-Stokes respiration or Cheyne-Stokes variant pattern, especially during sleep. The types of respiratory rate and pattern abnormalities in acute brain stem infarction were not specifically related to the level of lesions, but rather to the size and bilaterality of the lesions. Respiratory alkalosis was present in varying degrees in most patients with either tachypnea or prominent CSR.
Acute gastric changes in patients with acute stroke. Part 1: with reference to gastroendoscopic findings.
Authors: Kitamura T , Ito K
Published: June 2011

A gastroendoscopic study was performed on 177 patients with acute stroke. Gastric changes were found in 92 among them (52%), including ten with acute ulcer. A high frequency of gastric changes was found in patients with serious stroke and/or in patients whose cerebral lesions were located close to the hypothalamus or its centrifugal tract. The mortality in patients with gastric changes was high, especially in patients with acute ulcers, multiple erosions and petechiae. The frequency of brown gastric juice and coffee grounds at gastroendoscopic examination (gastric hemorrhage) was three times as high as that of melena and/or hematoemesis. On the other hand, the mortality of patients with gastric hemorrhage differed little from that of patients with melena and/or hematoemesis.
Vascular clips for the microsurgical treatment of stroke.
Authors: Fox J L
Published: June 2011

A synopsis of the types of vascular clips (malleable clips, screw clips, and spring clips) used by neurosurgeons during this century is presented. A review of the pertinent literature is included.
Central dual innervation of arterioles and capillaries in the brain.
Authors: Itakura T , Yamamoto K , Tohyama M , Shimizu N
Published: June 2011

Fluorescence-and electron-microscopic studies were performed on nerve terminals close to intracerebral blood vessels in the rat. For the electron microscope subdural perfusion fixation with potassium permanganate was used. In the rat cerebral cortex deprived of the bilateral superior cervical ganglion some aminergic terminal boutons containing large and small core vesicles were observed contiguous to blood vessels. These terminals abutted on the capillary basement membrane. Since these terminals are found in the rat after bilateral superior cervical ganglion exision, they probably originate from central catecholaminergic neurons in the brain stem. These findings suggest that central aminergic neurons might play some role in cerebral blood flow regulation. In addition to aminergic terminal boutons, non-aminergic nerve terminals containing non-core vesicles also ended in the capillaries. Cerebral capillaries also have central dual innervation, aminergic and cholinergic, and dual peripheral innervation by sympathetic and parasympathetic fibers.
Levels and disappearance of prostaglandin F2alpha in cerebral spinal fluid: a clinical and experimental study.
Authors: Hagen A A , Gerber J N , Sweeley C C , White R P , Robertson J T
Published: June 2011

The concentration of prostaglandin F2alpha (PGF2alpha) was measured in cerebrospinal fluid (CSF) obtained by lumbar puncture in patients with subarachnoid hemorrhage and compared to control values. The level of this prostaglandin was elevated at some time in most patients during the course of their illness. However, this could not be correlated with the severity of neurological deficits observed. The possibility that the concentration of PGF2alpha in lumbar fluid may not reflect that present intracranially was tested experimentally in anesthetized dogs. In these experiments only a small fraction of the radioactive PGF2alpha injected into the cisterna magna appeared in lumbar CSF. Prostaglandin F2alpha rapidly disappeared from the cisterna magna, half time 8 minutes, and radioactivity was present in blood from the jugular vein indicating that normally this prostaglandin rapidly egresses from the CSF into blood. These findings suggest that PGF2alpha can be rapidly transported away from the brain. This could explain the low concentrations of PGF2alpha in CSF of normal individuals and in some patients who have severe cerebral vasospasm. Conversely, the elevation of PGF2alpha in lumbar CSF noted in some patients might be due, in part, to an impairment of transport caused by the size and location of the hemorrhage.
Diaschisis with cerebral infarction.
Authors: Slater R , Reivich M , Goldberg H , Banka R , Greenberg J
Published: June 2011

Fifteen patients admitted to Philadelphia General Hospital with acute strokes had repeated measurements of cerebral blood flow measured by the 133Xenon inhalation method. A progressive decline in cerebral blood flow in both hemispheres was observed during the first week after infarction in twelve of these patients. This decline could be partially explained by loss of autoregulation, but could not be correlated with level of consciousness, clinical status of PCO2. This progressive decline in flow in the non-ischemic hemisphere indicates a process more complex than a simple destruction of axonal afferants to neurons as implied by the term diaschisis. The flow changes in the non-ischemic hemisphere are likely caused by a combination of the immediate effects of decreased neuronal stimulation modified by loss of autoregulation, release of vasoactive substances, cerebral edema, and other factors.
Dose dependent reduction of glucose utilization by pentobarbital in rat brain.
Authors: Crane P D , Braun L D , Cornford E M , Cremer J E , Glass J M , Oldendorf W H
Published: June 2011

A new method of determining the rate of glucose utilization in brain regions of individual rats has been used to measure the dose dependency of the reduction of the metabolic activity of the cerebral cortex by pentobarbital. Cerebral cortical glucose utilization is depressed to a basal level of 44% of the control rate when cerebral pentobarbital levels exceed 50 microgram per g of tissue. The major portion of this effect occurs between the cerebral pentobarbital range of 10--20 microgram per g, which can be achieved by 1/5 to 1/10 the normal anesthetic intraperitoneal dosage. If a depression of brain metabolism is responsible for the previously reported protection of the brain from ischemic damage, these data suggest a substantial reduction of brain metabolic rate is achieved in the rat at a barbiturate dosage which may be therapeutically relevant in the human after acute brain ischemia.
Isoproterenol and propranolol: ability to cross the blood-brain barrier and effects on cerebral circulation in man.
Authors: Olesen J , Hougård K , Hertz M
Published: June 2011

Using the "double indicator" technique the ability of 3H-isoproterenol and 14C-propranolol to cross the blood-brain barrier was studied in man. In 3 subjects extraction of isoproterenol was 3.8% in a single passage and the PS product was 2.0 ml/100g/min. In 4 patients extraction of propranolol was 63% and PS was 46.7 ml/100/min. Regional cerebral blood flow (rCBF) was studied in man with the 133Xe-intraarterial injection method. Intracarotid isoproterenol (3 migrogram/min., 6 patients) caused a significant reduction in rCBF, but after correction for a concomitant decrease in arterial PCO2 the alteration was no longer significant (59.8 -51.7/57.4 ml/100g/min.). Intracarotid propranolol (0.15 mg/kg, 11 patients) caused no significant change in rCBF, but after correction for arterial PCO2 change the lateration although on 4% was just significant, p less than 0.05. (56.3 -55.8/54.1 ml/100g/min). After propranolol the rCBF changes caused by alterations in the arterial PCO2 were normal and the focal flow increase during hand work could not be changed by simultaneous intracarotid propranolol.
Effects of acute hypertension on brain metabolism in normotensive, renovascular hypertensive and spontaneously hypertensive rats.
Authors: Fujishima M , Onoyama K , Oniki H , Ogata J , Omae T
Published: June 2011

Effects of angiotensin-induced acute hypertension on cerebral metabolism were studied in normotensive (NTR), spontaneously hypertensive (SHR) and experimental renovascular hypertensive rats (RHR). Lactate, pyruvate and adenosine triphosphate (ATP) concentrations in the brain frozen in situ at 18--20 min after angiotensin infusion, which raised mean arterial pressure (MAP) by 28--62% of control, were determined by enzymatic methods. Supratentorial lactate was significantly increased to 135% of control in RHR, its increase being correlated with the degree of hypertension, wherease it remained unchanged in NTR or SHR. Furthermore, RHR showed a tendency toward increase in lactate/pyruvate ratio with a decrease in ATP despite no change of arterial acid-base balance measured simultaneously before and after acute induced hypertension. From the present study, it is postulated that some renal factor seems to contribute ischemic metabolic changes in RHR following acute hypertension. The possible effect of renin on the vascular permeability is discussed as the pathogenesis of hypertensive encephalopathy.
Cerebral blood flow in the monkey after focal cryogenic injury.
Authors: Martins A N , Doyle T F
Published: June 2011

A focal cryogenic lesion was made in the left superior frontal gyrus of the anesthetized macaque brain. Cerebral blood flow (CBF) was determined by the hydrogen clearance technique before and during the 4 hours following trauma. Local CBF in tissue adjacent to the lesion increased in the first half hour after the lesion was made and then decreased during the ensuing 3 1/2 hours. Local CBF in the contralateral superior frontal gyrus, as well as total CBF and oxygen consumption, were unchanged by cryogenic trauma. The spread of vasogenic edema into uninjured tissue probably accounts for the observed decrease in local CBF. This experimental model may assist in discovering therapy to alter favorably the spatial and temporal profile of pathologic CBF changes in tissue surrounding an acute lesion of the brain.
Effect of an acute increase of the intravascular pressure on the blood-brain barrier: a comparison between conscious and anesthetized rats.
Authors: Johansson B B
Published: June 2011

Conscious rats and rats under nitrous oxide anesthesia were subjected to blood pressure elevations by injection of epinephrine, bicuculline and amphetamine. Mean arterial pressure was measured from a chronic indwelling cannula in the aorta in awake rats. The protein leakage in the brains was studied using Evans blue and 125IHSA. Conscious animals developed less blood-brain barrier dysfunction than anesthetized ones. The largest difference was obtained with amphetamine and the smallest with epinephrine. Possible explanations to the results are discussed.
Age-Related Macular Degeneration and the Risk of Stroke
Authors: Wieberdink Renske G. , Ho Lintje , Ikram M. Kamran , Koudstaal Peter J. , Hofman Albert , de Jong Paulus T.V.M. , Vingerling Johannes R. , Breteler Monique M.B.
Published: June 2011

Background and Purpose—

Age-related macular degeneration (AMD) and stroke are both frequent diseases in the elderly. A link between AMD and stroke has been suggested, because both disorders have many risk factors in common. The aim of this study was to investigate the association between AMD and stroke and the subtypes cerebral infarction and intracerebral hemorrhage in the general elderly population.

Methods—

This study was part of the population-based Rotterdam Study and included 6207 participants aged ≥55 years who were stroke-free at baseline (1990 to 1993). Signs of AMD were assessed on fundus photographs at baseline and at regular follow-up examinations and were categorized in 5 stages (0 to 4) representing an increasing severity. Late AMD (Stage 4) was subdivided into dry and wet AMD. Follow-up for incident stroke was complete up to January 1, 2007. Data were analyzed using time-dependent Cox regression models adjusted for age, sex, and potential confounders.

Results—

During a median follow-up of 13.6 years, 726 participants developed a stroke (397 cerebral infarction, 59 intracerebral hemorrhage, 270 unspecified). Late AMD was associated with an increased risk of any stroke (hazard ratio, 1.56; 95% CI, 1.08 to 2.26) due to a strong association with intracerebral hemorrhage (hazard ratio, 6.11; 95% CI, 2.34 to 15.98). In contrast, late AMD was not associated with cerebral infarction. Earlier AMD stages were not associated with risk of stroke or any of its subtypes.

Conclusions—

We found that late AMD is strongly associated with intracerebral hemorrhage, but not with cerebral infarction, in the general elderly population.
The Trouble with the Inclusive Jesus
Authors: Bockmuehl Markus
Published: June 2011

In the long-standing debate between universalist and particularist interpretations of Jesus, recent years have witnessed the relentless rise of the idea that his was a socially radical and subversive gospel ahead of its time, fully in keeping with contemporary cultural agendas of “inclusion” or “inclusiveness”. The present study attempts to contextualize this “inclusive Jesus” within New Testament studies by means of three angles of approach: (1) recent work on the “inclusive”ethics of Jesus, (2) Jacob Neusner’s critique of New Testament scholarship on Jewish particularism and Christian universalism, and (3) the reception in current debate of Joachim Jeremias’ interpretation of Jesus’ view of Gentiles. In view of the overwhelming evidence that Jesus was “inclusive” as well as “exclusive” in both theology and praxis, Concluding Observations stress the location of this problem within a wider understanding of the biblical view of Election, and identify the Israelite particularity of Jesus as essential to his mission on behalf of Israel as well as the nations.
Baptism “Into Christ Jesus” and the Question of Universalism in Paul
Authors: Wagner J. Ross
Published: June 2011

This essay adopts Paul’s occasional theological reflections on the concrete social practice of baptism as a vantage point from which to investigate the question of universalism in the apostle’s thought, examining passages from 1 Corinthians, Galatians, Romans, and Colossians. In these texts, Paul variously conceptualizes salvation as incorporation into “the one body of Christ”; “the seed of Abraham”; “the children of God”; or “the new humanity,” whose representative is Christ, the last Adam. Despite the different metaphors, it is clear in each case that it is the singular identity of the man Jesus Christ that is determinative for the collective identity of redeemed humanity; it is precisely—and only—with respect to union with him that diverse human beings become “one.” The essay concludes by considering briefly the implications of Paul’s christologically determined anthropology for the question of universal salvation and for the idea of the enduring election of Israel as God’s peculiar possession.
Word Order in the War Scroll (1QM) and Its Implications for Interpretation
Authors: Screnock John
Published: June 2011

In studies of Qumran Hebrew, syntax has been somewhat neglected. The present study attempts to help fill in our understanding of QH syntax, and word order specifically. The data of 1QM can best be explained using a Subject-Verb model. However, the model is not perfect. Consideration of the strange word order patterns of and leads to a revision of the SV model, which is better able to account for all the word order phenomena in 1QM. The basic word order of 1QM is best described as Subject-Verb, with inversion triggered by the fronting of a non-subject element or by the use of an intransitive main verb. A robust understanding of word order carries important ramifications for interpretation. In 1QM 1:1‐3, for example, word order supports an identification of the sons of Levi, Judah, and Benjamin as “violators of the covenant.”
Female Imagery in Proverbs 1-9 in the Light of Egyptian Sources
Authors: Shupak Nili
Published: June 2011

The enigmatic figure of the personified Wisdom described in Proverbs 1 and 8, appears in contrast with the image of Folly in chapter 9. Both figures, the Wisdom and the Folly have common features with the Strange Woman mentioned in Proverbs 2, 5, 6 and 7. The purpose of the present paper is to clarify the identity of the Strange Woman in the light of recently published Egyptian sources and thus to throw light on the rest of the female imagery in the book of Proverbs.