bluuebunny/crossref_metadata_2025 huggingface dataset:
Inherited Thrombophilia in Ischemic Stroke and Its Pathogenic Subtypes
Authors: Hankey Graeme J. , Eikelboom John W. , van Bockxmeer Frank M. , Lofthouse Elizabeth , Staples Nicole , Baker Ross I.
Published: June 2011

Background and Purpose

—

One or more of the inherited thrombophilias may be causal risk factor for a proportion of ischemic strokes, but few studies have addressed this association or the association between thrombophilia and pathogenic subtypes of stroke.

Methods

—

We conducted a case-control study of 219 hospital cases with a first-ever ischemic stroke and 205 randomly selected community control subjects stratified by age, sex, and postal code. With the use of established criteria, cases of stroke were classified by pathogenic subtype in a blinded fashion. The prevalence of conventional vascular risk factors; fasting plasma levels of protein C, protein S, antithrombin III; and genetic tests for the factor V Leiden and the prothrombin 20210A mutation were determined in cases and control subjects.

Results

—

The prevalence of any thrombophilia was 14.7% (95% CI, 9.9% to 19.5%) among cases and 11.7% (95% CI, 7.4% to 17.0%) among control subjects (OR, 1.3; 95% CI, 0.7% to 2.3%). The prevalence of individual thrombophilias among cases ranged from 0.9% (95% CI, 0.1% to 3.4%) for protein S deficiency to 5.2% (95% CI, 0.3% to 9.1%) for antithrombin III deficiency; among control subjects, the prevalence ranged from 1.0% (95% CI, 0.1% to 3.6%) for protein S deficiency to 4.1% (95% CI, 0.2% to 7.8%) for antithrombin III deficiency. There were no significant differences in the prevalence of thrombophilia between cases and control subjects or between pathogenic subtypes of ischemic stroke.

Conclusions

—

One in 7 patients with first-ever acute ischemic stroke will test positive for one of the inherited thrombophilias, but the relation is likely to be coincidental rather than causal in almost all cases, irrespective of the pathogenic subtype of the ischemic stroke. These results suggest that routine testing for thrombophilia in most patients with acute ischemic stroke may be unnecessary. Whether the thrombophilias may still be important in younger patients with ischemic stroke or in predicting complications (eg, venous thrombosis) and stroke outcome remains uncertain.
Cerebrovascular Regulation in Preganglionic and Postganglionic Autonomic Insufficiency
Authors: CARONNA JOHN J. , PLUM FRED
Published: June 2011

Cerebral blood flow was measured in four subjects with chronic idiopathic autonomic insufficiency using
85
Kr inhalation, cerebral A-V samples for scintillation counting, and O
2
content determination. Blood pressure was varied by up or down tilting and L-norepinephrine infusion. In three patients with typical Shy-Drager syndrome and preganglionic denervation, CBF regulation to pressure and Pa

CO

CO
2

change was intact. In a fourth patient with postganglionic denervation, CBF autoregulation was absent to changes in blood pressure but was preserved normally to increases or decreases in Pa

CO

CO
2

CBF and CMRO
2
, at rest were normal (52.6 cc and 3.1 cc). Hyperventilation to Pa

CO

CO
2

34.3 mm failed to restore autoregulation to increased blood pressure. The results imply a functional role for postganglionic autonomic fibers in CBF autoregulation.
Sympathetic Cerebral Vasoconstriction Blocked by Adrenergic Alpha Receptor Antagonists
Authors: D'ALECY LOUIS G.
Published: June 2011

Alpha receptor adrenergic antagonists were used in chloralose-anesthetized dogs to block cerebral vasoconstriction elicited by stimulation of the sympathetic innervation of the cerebral vessels. A venous outflow technique was used to measure cerebral blood flow with an electromagnetic flow transducer. The brain's arterial supply was left undisturbed. The experiments were performed in both open and closed chest animals and in animals with open and closed craniums. The left sympathetic stellate ganglion was stimulated for 60 seconds at 15 Hz, 3 msec pulse duration, and 3 to 9 v intensity. Control stimulation produced a 65.8% decrease in cerebral blood flow. Dibozane, 1 or 2 mg/kg, or phentolamine, 2 mg/kg, was then administered, and stimulations were repeated with the same stimulus parameters. After alpha receptor blockade, cerebral blood flow decreased only 3.5% with sympathetic stimulation. The effective blockade by two different alpha receptor antagonists, of a different structure, indicated that an alpha receptor was responsible for the sympathetically mediated cerebral vasoconstriction. In conclusion, stimulation of the sympathetic innervation of the cerebral vessels results in a marked decrease in cerebral blood flow which is blocked by alpha receptor antagonists.
Transorbital Approach for Occluding the Middle Cerebral Artery Without Craniectomy
Authors: O'BRIEN MICHAEL D. , WALTZ ARTHUR G.
Published: June 2011

An experimental model of cerebral ischemia and infarction can be produced by occluding a middle cerebral artery in animals. Most surgical approaches to the artery require removal of some portion of the cranium, which may modify or prevent the changes of intracranial pressure and the development of pressure gradients that are caused by ischemic cerebral edema or brain swelling. A transorbital approach for the exposure of a middle cerebral artery requires only enlargement of the optic foramen, which can be sealed immediately after occlusion of the artery. The lack of disturbance and manipulation of the brain and the maintenance of the integrity of the cranium result in a superior experimental model.
Regional Cerebral Blood Flow During Stimulation of Seventh Cranial Nerve
Authors: SALANGA VIRGILIO D. , WALTZ ARTHUR G.
Published: June 2011

The right seventh cranial nerve (n. VII) was exposed intracranially via a suboccipital approach in each of eight cats. Measurements of cerebral blood flow (CBF) were made from superficial cortex, sulcal cortex, basal cortex, the basal ganglia, and the centrum semiovale of each cerebral hemisphere of each cat by autoradiography using
14
Cantipyrine. In six cats, measurements of CBF were made during electric stimulation of n. VII; in two of these, the nerve was sectioned before stimulation. In the remaining two cats, measurements were made after exposure but without stimulation of n. VII; in these cats, there were no side-to-side differences of CBF. In each of the four cats with n. VII intact, CBF values were lower on the stimulated side. In each of the two cats with n. VII sectioned, CBF values were higher on the stimulated side. Thus, stimulation of n. VII causes regional increases of CBF only when centripetal effects of stimulation are prevented. Cerebral vasodilatation has been observed by others during stimulation of a sectioned or an intact n. VII. When an intact nerve is stimulated, vasodilatation apparently is unable to compensate for decreases of CBF mediated centripetally through brain stem structures and extracranial or basal cerebral vessels; moreover, such vasodilatation may be due in part to regulatory responses of vessels to decreases of perfusion pressure.
Thrombosis During the Healing Phase
Authors: DYKEN MARK L. , CAMPBELL ROBERT L. , MULLER JANS , FEURE HENRY , HORNER TERRY , KING ROBERT , KOLAR OLDRICH , SOLOW ELIZABETH , JONES F. HAVEN
Published: June 2011

Twenty dogs were treated with either acetylsalicylic acid or a lactose placebo for 5.5 ± 2.3 days before surgical or chemical injury to the carotid and femoral arteries and for the following 34.5 days. Only the laboratory diener had knowledge of the random table used to select type of treatment until after all determinations had been completed. Following sacrifice the arteries were classified for the presence of intimal proliferation, defects in the internal elastica, presence of organized thrombi and the percentage of recanalization, and the presence of fresh thrombi and the percentage of occlusion. Thrombi were present in 8% of the arteries of dogs treated with acetylsalicylic acid and in 36% of those treated with placebo. This difference is significant (P<0.01). The degree of intimal proliferation and defects in the internal elastica were not significantly different between the two groups. We conclude that in dogs acetylsalicylic acid therapy during the healing phase following arterial injury protects against thrombosis and does not retard the healing process.
The Measurement of Cerebral Infarction Edema With Sodium 22
Authors: BRUNSON BRUCE , ROBERTSON JAMES T. , MORGAN HOWARD , FRIEDMAN BEN I.
Published: June 2011

Sodium 22 was used to determine quantitatively cerebral infarction edema in cats after occlusion of the middle cerebral artery. A comparison was made of the sodium 22 edema determination with the wet weight-dry weight method of edema determination. There was a high degree of correlation between the two methods. The sodium 22 method of measuring cerebral infarction edema was less time consuming and easier than the wet weight-dry weight method, and served as a reliable means of quantitatively comparing the edema content in the hemispheres of animals with stroke.
Differences in the Occurrence of Carotid Transient Ischemic Attacks Associated With Antiplatelet Aggregation Therapy
Authors: DYKEN MARK L. , KOLAR OLDRICH J. , JONES F. HAVEN
Published: June 2011

Twenty-six of 117 consecutive patients with a provisional diagnosis of transient ischemic attacks answered the following criteria: (1) transient hypofunction of an area supplied by a branch of an internal carotid artery, (2) no evidence of infarction, (3) carotid and vertebral arterial systems visualized angiographically, (4) cerebral blood flow and metabolism studies performed, (5) followed a minimum of three months, (6) other causes of transient dysfunction had been ruled out, and (7) no carotid arterial system surgery. Only six (23%) had occlusion greater than 50% and 21 (81%) had evidence of irregularity or ulceration of an atherosclerotic plaque in the appropriate internal carotid artery. It was noted in retrospect that 15 of the patients were treated with aspirin (300 mg b.i.d.) and 11 were not. No difference in ultimate infarction or death was noted, but only two (13%) of those treated with aspirin had an additional attack compared to nine (82%) of those who had no aspirin. These findings suggest that fibrin-platelet emboli may be a major contributor to transient ischemic attacks in the carotid circulation. The authors stress that this is a retrospective study and its importance is to further support the need for prospective studies before antiplatelet aggregating drugs are used indiscriminately.
Primary Subarachnoid Hemorrhage in Iceland
Authors: GUDMUNDSSON GUNNAR
Published: June 2011

This study was undertaken to estimate the incidence of primary subarachnoid hemorrhage among the population of Iceland during the 11-year period from 1958 through 1968. The incidence for the whole country was 8.0/100,000--males 9.1 and females 6.9. The incidence was significantly higher in Reykjavik (the capital) (10.5/100,000) than the area outside Reykjavik (rural and villages) (5.9/100,000).

In the rural area the incidence was significantly higher for males (7.47/100,000) than for females (4.32/100,000). This difference was not found in the city.

The incidence for Reykjavik is similar to the one found in comparable studies.
Fibrinogen Concentration and Immunoelectrophoresis in the Internal Jugular Vein and the Corresponding Arterial Blood in Ischemic Brain Afflictions
Authors: KOLAR OLDRICH J. , DYKEN MARK L.
Published: June 2011

In plasma specimens simultaneously obtained from the bulb of the internal jugular vein (UV) and the brachial artery, fibrinogen, alpha-
1
antitrypsin and alpha-
2
macroglobulin concentrations were determined using the radial immunodiffusion technique. In 16 (22%) from the total 71 patients with various ischemic central nervous system afflictions studied, significant arteriovenous differences in the fibrinogen concentration were observed.

In 32 patients from this series, simultaneous internal jugular vein and arterial plasma fibrinogen immunoelectrophoresis was performed. In 16 (50%) of these patients, immunoelectrophoretic abnormalities in the internal jugular vein plasma fibrinogen precipitate were established. In 12 (37%) instances, the internal jugular vein immunoelectropherograms revealed abnormal precipitates. From these 12 patients, ten (83%) showed immunoelectrophoretic abnormalities in the fibrinogen precipitation arc and in seven (58%) instances significant arteriovenous differences in the fibrinogen concentration were established.

In the patients with abnormal precipitates in the internal jugular vein plasma immunoelectropherograms, the average interval of 13 days from the onset of neurological symptoms of the ischemic central nervous system affliction to the cannulation of the internal jugular vein was significantly shorter (P < 0.001) as compared to the average of 34 days in the patients with normal internal jugular vein immunoelectropherograms.

The examination of UV plasma specimens by means of the techniques used appears to be prospectively important in two major areas: (1) as an auxiliary examination indicating localized thrombotic process in the vascular bed, primarily supplying the central nervous system; and on periodical examination, (2) as a laboratory indicator of resolution of the thrombosis.
Cerebral Atherosclerosis in European Populations: A Preliminary Report
Authors: BAKER A. B. , RESCH J. A. , LOEWENSON RUTH B.
Published: June 2011

Atherosclerosis in the arteries of the circle of Willis was studied in European populations using a coding technique developed by Baker and his associates. Results from six countries (Finland, Germany, Greece, Norway, Italy, and Poland) were compared with results from Minnesota. The material from the first four countries was coded by the Minnesota team, whereas the material from Italy and Poland was coded by their respective investigators. The
frequency
of cerebral atherosclerosis was highest in the German and Finnish populations and was lowest in the Polish population. The Norwegian, Greek and Italian populations showed
frequencies
of cerebral atherosclerosis quite similer to those in the Minnesota material.
The average amount
of cerebral atherosclerosis was established by determining the median vessel scores by ten-year age groups for the material coded by the Minnesota team. The Finnish population had the highest average involvement; the Finnish, German, and Greek populations all showed higher average vessel scores for cerebral atherosclerosis than the Minnesota population.
Barbiturate Protection in Acute Focal Cerebral Ischemia
Authors: SMITH ALLAN L. , HOFF JULIAN T. , NIELSEN SURL L. , LARSON C. PHILIP
Published: June 2011

We have found that anesthetic technique modifies the neurological and pathological sequelae of unilateral middle cerebral artery and internal carotid artery occlusion in dogs. Occlusion was performed in seven groups of six dogs during each of the following anesthetic regimens: light (0.8%) halothane, "awake," deep (1.9%) halothane, deep halothane with mean arterial pressure reduced to 55 torr, pentobarbital (56 mg per kilogram), light halothane plus 40 mg per kilogram thiopental begun just before cerebral artery occlusion, and light halothane plus 40 mg per kilogram thiopental begun 15 minutes after occlusion. Body temperature, arterial P

co

co
2

P

o

o
2

pH, and blood pressure (except as noted above) were maintained normal. Neurological examinations were performed daily. On the seventh day the dogs were killed and their brains removed for pathological study. Hemiparesis occurred in five of six dogs under light halothane and five of six awake dogs; a mean of 10.8% and 9.6%, respectively, of their right hemispheres were infarcted. In the deep halothane groups, all of the normotensive and five of the six hypotensive dogs became severely hemiplegic; mean infarction size was 28.2% and 34.1%, respectively. Only one of the 18 dogs who received a barbiturate sustained a neurological deficit -- a transient unilateral weakness. Means of 1.4%, 2.7%, and 0.1% of the right hemisphere were infarcted in the barbiturate animals. The protective action of barbiturates in canine acute focal cerebral ischemia suggests that they should be considered for anesthesia in surgery requiring cerebral vessel occlusion and perhaps even for treatment of acute stroke.
X. Community Health Services for Stroke
Authors: SHAPIRO MAYNARD I. , ATKINS RUTH , BONIFACE WILLIAM R. , HOLLEY LYDIA S. , MCNAMARA EVELYN M. , OLINGER CHARLES P. , PEEPLES WILLIAM J. , REGAN PATRICIA A. , VALLBONA CARLOS , WOOD COURTNEY B. , WYLIE CHARLES M.
Published: June 2011

The Section developed by the Community Health Services Study Group proved to be a difficult, yet important, segment of the "Guidelines." They have worked diligently to prepare a document which will give communities stimulation, information, and direction in achieving the goals of identifying persons at high risk, preventing stroke, improving care of stroke patients, and providing continuity of care, particularly after the life-threatening phase of illness. The awesome responsibilities facing various health workers and community agencies in after-care are detailed. It is i this area that concerted effort can make an important contribution, particularly in those instances where disability is severe and support from many sources is essential.

Although no blueprint can be outlined in a manner which will be universally applicable, this description of facilities and services, if applied imaginatively, should be useful to health planners, hospital trustees, civic leaders, health professionals, and educators in mounting community programs for prevention of stroke and comprehensive care of persons who suffer a stroke.
An Experimental Model of Brain Ischemia Combining Hypotension and Hypoxia
Authors: YATSU FRANK M. , LINDQUIST PETER , GRAZIANO CHARLES
Published: June 2011

A variety of experimental models for cerebral ischemia are currently available, but none are entirely satisfactory. We are reporting a model which combines hypotension, produced by intravenous Arfonad, with hypoxia, produced by respiring 4% oxygen. Rabbits used are awake but paralyzed with succinylcholine and ventilated mechanically. The electroencephalogram (EEG) is monitored with durally implanted electrodes. Onset of an isoelectric EEG ensues 4.5 ± 0.7 minutes in 17 rabbits studied and is used to measure the degree of ischemic insult. After three minutes of an isoelectric EEG, circulatory restoration is followed by complete functional recovery. After five minutes of an isoelectric EEG, rabbits do not recover or show neurological deficits such as limb weakness. The potential effects of systemic ischemia on these animals are minimized because of the rapid onset of ischemic brain damage. Examination of arterial blood gases, pH, platelets, various organs histologically, and the distribution of carbon-particles in the intracerebral circulation reveals that systemic factors are minimal. Moderately delayed onset of cortical EEG activity and the presence of motor impairment or an inability to respire satisfactorily after extubation indicates that the brunt of ischemic insult is upon brain. Our model has the advantages of simplicity and predictability and offers the opportunity to assess functional impairment after graded degrees of cerebral ischemia. We conclude that our model of cerebral ischemia produced by hypotension and hypoxia is a reasonable alternative to existing methods.
Fluorescein Angiography in Microvascular Surgery: A Study Using the Rodent Artery
Authors: FOX JOHN L. , YASARGIL M. GAZI
Published: June 2011

Fluorescein angiography was carried out on 45 Ostpon Mendelson rats with a view toward detecting injury areas following microvascular anastomoses. Decreased fluorescence was seen regardless if the injury occurred prior to or after the injection of fluorescein, and also if postin-jury angiography was filmed during direct arterial injection (mainly fluorescence from the blood stream) or one to five minutes later (mainly vessel wall fluorescence).

The effects of injury paralleled the effects of positive direct current applied to the fluorescent vessel. Focal absence of fluorescence also occurred at sites of clotting or intraluminal adventitia deposition at anastomotic sites in spite of good vessel wall pulsations.

The procedure may prove to be worthwhile and preferable to risky contrast x-ray angiography during intra-operative transcranial microvascular anastomoses for cerebrovascular insufficiency.
Regional Cerebral Blood Flow in Patients With Hypertensive Intracerebral Hemorrhage
Authors: KAWAKAMI HIROSHI , KUTSUZAWA TAKASHI , UEMURA KAZUO , SAKURAI YOSHIHARU , NAKAMURA TAKASHI
Published: June 2011

Regional cerebral blood flow was measured by
133
Xe clearance method in 44 patients with hypertensive intracerebral hemorrhage (HIH) within three weeks from attack. Mean CBF in cases with the more disturbed consciousness was the lower value. There was no definite relationship between mean CBF and the duration from last stroke to measurement. In 44 cases, 35 showed hematoma of so-called "lateral type" and nine showed a "mesial type." There was no difference of mean CBF between these two groups. In the group with lateral-type hematoma, 14 cases were thought to show large space-occupying signs, and their mean CBF was significantly lower than that of the other 21 cases.

In 16 cases, relative hyperemic regions were observed in both the focal and nonfocal areas. In seven cases, relative ischemic regions were frequently in nonfocus rather than focus.

Response of hyperemic region to carbon dioxide was good in seven and poor in three regions in focal area, and was good in eight and poor in one region in nonfocal area. Reactivity of ischemic region to 5% CO
2
inhalation was good in three and poor in zero regions in focus, and was good in three and poor in two regions in nonfocus.

Early venous filling (EVF) was observed in 13 cases and all of them were with lateral-type hematomas.

Only four out of 13 cases showed good correlation between angiographical findings and cerebral circulation.
Carotid Artery Occlusion Following Ingestion of LSD
Authors: LIEBERMAN ABRAHAM N. , BLOOM WILLIAM , KISHORE PULLA S. , LIN JOSEPH P.
Published: June 2011

A 20-year-old white woman developed a left hemiplegia following the ingestion of LSD. Initial angiography revealed marked constriction of the internal carotid artery at the level of the siphon which, in a few days, was converted to occlusion of the carotid artery at that level. It is suggested that LSD, an amine derivative of the ergot alkaloids, was responsible for the initial vasoconstriction and subsequent occlusion.
Pituitary Apoplexy: The Role of Atheromatous Emboli
Authors: SUSSMAN EDWARD B. , PORRO ROBERT S.
Published: June 2011

Patients with clinically unsuspected pituitary adenomas may present with sudden severe frontal headaches, stupor, ophthalmoplegia, meningeal irritation, compression of the optic nerves or chiasm, and abnormal cerebrospinal fluid. These findings are commonly misinterpreted as due to a ruptured cerebral aneurysm. The clinical features and controversial pathogenic mechanisms of pituitary apoplexy are reviewed. An unusual case of pituitary apoplexy with many atheromatous emboli in the tumor is presented. This previously undescribed possible cause of pituitary apoplexy should be considered in older patients with known predisposing factors for systemic atheromatous embolism.
The Distribution and Density of Reduced Cerebral Blood Flow Following Acute Middle Cerebral Artery Occlusion: An Experimental Study by the Technique of Hydrogen Clearance in Baboons
Authors: SYMON L. , PASZTOR E. , BRANSTON N. M.
Published: June 2011

The effect of middle cerebral arterial occlusion on blood flow over the parietal aspect of the cortex and in the putamen of baboons has been assessed by the technique of hydrogen clearance. Reduction of blood flow was present over the entire lateral aspect of the cerebral hemisphere, maximal in the regions of frontal, parietal and temporal opercula where the blood flow was reduced to some 25% of control levels, and in the deep nuclei where the average flow in three animals was 20%. Reactivity to carbon dioxide was correspondingly reduced and, indeed, paradoxical reactivity or intracerebral steal was found in the most densely ischemic opercular zone. There was no evidence in the present studies of any area with increased tissue blood flow following middle cerebral occlusion.

Under control conditions, some inhomogeneity of blood flow was evident in the cortical areas studied, the parietal association areas having a significantly lower blood flow than the more anterior regions of the hemisphere.
Ultrastructural Alterations in the Dog Brain After Profound Hypothermia Induced by Extracorporeal Circuit
Authors: HARRIS JAMES H. , ROBERTSON JAMES T.
Published: June 2011

This study has demonstrated that hypothermia with or without circulatory arrest produced ultrastructural alterations in the dog brain. Fluid accumulation in the perivascular area and in the neuropil persists for at least seven days. Neurons in all areas of the brain studied are quite resistant to fluid alterations. Minimal changes occurring in neurons appear to be reversible from these studies with no neuronal necrosis, even with cooling to 10°C. Endothelial cells and oligodendrocytes exhibit essentially normal morphology in all experimental groups. Astrocytes and their processes undergo the most severe alterations, with cellular changes greater in dogs subjected to 60 minutes than to 30 minutes of cardiac arrest, and progressive degrees of damage occurring with increases in postpumping time prior to sacrifice. Our studies indicate cytological damage increases for longer periods posthypothermia than earlier reports which noted a resolution at 72 hours of the edema observed at 24 hours. We have demonstrated with the electron microscope (EM) that edema persists for at least seven days.

The application of new developments in the pumping technique such as improved filtering of microemboli may reduce the pathological alterations described in this study and aid the clinical management of patients subjected to hypothermia.
Sturge-Weber Disease With Subarachnoid Hemorrhage
Authors: ANDERSON FRANK H. , DUNCAN GARY W.
Published: June 2011

A healthy adult with a nevus flammeus presented with a subarachnoid hemorrhage. Cerebral arteriography demonstrated vascular anomalies typical of encephalofacial angiomatosis (Sturge-Weber disease). A review of the literature failed to disclose a welldocumented case of subarachnoid hemorrhage in this condition.
Bilateral Reduction of Hemispheric Blood Flow in Patients With Unilateral Cerebral Infarction
Authors: FUJISHIMA MASATOSHI , TANAKA KENJIRO , TAKEYA YO , OMAE TERUO
Published: June 2011

Bilateral hemispheric blood flow was determined by the intravenous RISA technique in patients with unilateral cerebral infarction. Of all 29 patients, bilateral reduction of cerebral blood flow (CBF) was demonstrated in 13, of whom hemispheric vascular resistance was significantly increased and arm-to-brain circulation time prolonged.

In these cases with bilateral subnormal CBF, blood flow on the noninfarcted side tended to increase if the patients were conscious at the time of onset, whereas it remained unchanged even 77 days following stroke if their consciousness was impaired. The already lowered blood flow on the infarcted hemisphere, however, did not increase for a relatively long period of time after the onset.

It appears that bilateral reduction of CBF in patients with unilateral infarction is primarily caused by diffuse cerebral vascular changes and some additional systemic circulatory disorder. The possibility of other factors participating is also discussed.
A Method for Serial Measurement of Regional Cortical Metabolism and Blood Flow
Authors: SIMEONE FREDERICK A. , FRAZER GLENN , VINALL PHILLIP , BERNSTEIN RICHARD
Published: June 2011

There is a practical way to measure metabolism, flow, and function in a localized area of brain serially in the same animal. Our preliminary anatomical and angiographical studies have indicated that certain paired
cerebral veins
drain only blood from cortex supplied by easily identified cerebral arteries. These veins have been cannulated bilaterally without altering flow in their territory of distribution. When compared to the arterial concentrations of the substances and the regional blood flow, one can calculate the regional metabolic rate of the tissue in this inflow-outflow system (
vascular-metabolic unit
). This system can be subjected to
ischemia
, trauma, and pharmacological and neurophysiological alterations. In addition, it is accessible for measurement of electrical activity, surface fluorometry, and sampling for histological and cortical biochemical analysis.
Skin Blood Pressure in the Forehead in Patients With Internal Carotid Lesions
Authors: NIELSEN P. E. , HÜBBE P. , POULSEN H. LØNSMAN
Published: June 2011

The skin blood pressure was measured in the forehead using a photoelectric method in 12 subjects with occlusion and 16 subjects with arteriosclerotic stenosis of the internal carotid artery and compared to 18 normal subjects. The skin blood pressure was in average 37 mm Hg (SD 15) in the patients with occlusion, 44 mm Hg (SD 16) in the patients with stenosis, and 46 mm Hg (SD 10) in the normal subjects. During interruption of the blood supply from the external carotid artery (manual compression of the ipsilateral superficial temporal artery), the skin blood pressure was reduced in average 14 mm Hg in the patients with internal carotid occlusion, 8 mm Hg in the patients with stenosis, and not at all in the normal subjects. Skin blood pressure measured on the arm was in all groups 10 to 20 mm Hg higher than the diastolic arm blood pressure. It is emphasized that this method, as well as other methods using extracerebral registration in an attempt to evaluate the intracerebral arteries, is interesting from a hemodynamic point of view, but is of less diagnostic value in the single patient when compared to the arteriographical investigation.
Brain Phospholipid Metabolism During Ischemia
Authors: YATSU FRANK M.
Published: June 2011

Molecular mechanisms accounting for the vulnerability of brain to ischemic damage are incompletely understood. To assess the role of membrane integrity, phospholipid metabolism is investigated in subcellular organelles of brain following varying degrees of ischemia. Global brain ischemia is produced in rabbits by combining hypotension and hypoxia (4% oxygen). Restoration of blood pressure and oxygen after a three-minute isoelectric EEG results in full recovery, while a five-minute isoelectric EEG results in either a lack of recovery or neurological deficits. Quantitative analysis of seven phospholipids in subcellular organelles shows no consistent pattern of phospholipid changes following ischemia. Incorporation of radioactive phosphate, on the other hand, discloses moderate alterations following five-minute ischemia. These findings indicate that brain ischemia provokes phospholipid changes, but their role in impairing membrane integrity and in initiating irreversible ischemic brain damage is uncertain.
Reduced Nicotinamide Adenine Dinucleotide Fluorescence and Cortical Blood Flow in Ischemic and Nonischemic Squirrel Monkey Cortex. 2. Effects of Alterations in Arterial Carbon Dioxide Tension, Blood Pressure, and Blood Volume
Authors: SUNDT THORALF M. , ANDERSON ROBERT E.
Published: June 2011

The fluorescence of reduced nicotinamide adenine dinucleotide (NADH) from cerebral cortex was measured before, during, and after middle cerebral artery (MCA) occlusion and then at death of the animal. In normal cortex, NADH remained constant throughout a wide range of variations in blood pressure and Pa

co
co2

. In ischemic cortex, NADH levels were higher in hypovolemic hypotensive animals than in normotensive normovolemic animals. Neither hypercapnia nor hypocapnia was effective in decreasing NADH in regions of ischemia, but the latter was associated with a degree of hypotension that interfered with interpretation of data. NADH returned to normal with restoration of flow, supporting the reversibility of this degree of ischemia. The high levels of NADH at death, compared to those during ischemia, are consistent with incomplete ischemia in this model of cerebral infarction.
Todd's Paralysis: A Cerebrovascular Phenomenon?
Authors: YARNELL PHILIP R.
Published: June 2011

Postictal transient focal neurological deficits, i.e., Todd's paralysis, at times are correlated with early veins and/or vascular stain angiographically. Radionuclide gamma camera images show that they also may be accompanied by a relative flow hyperperfusion and a cortical rim static image uptake. Using these observations some portion of Todd's paralysis may be explained as the result of focal epileptic discharges that lead to local vasomotor and/or metabolic changes. The functional arterial venous shunting that results could contribute to cortical ischemia and the subsequent clinical deficits.
Atheromatous Emboli to the Lumbosacral Spinal Cord
Authors: SLAVIN RICHARD E. , GONZALEZ-VITALE JUAN C. , MARIN OSCAR S. M.
Published: June 2011

The lumbosacral spinal cords of 28 patients with atheromatous emboli to abdominal viscera and/or grafts to the abdominal aorta were examined by serial sections. In 12 patients, atheromatous emboli were found in spinal arteries, most commonly in the sacral cord, and most frequently in the anterior spinal artery. The general absence of spinal cord infarctions was attributed to the nature of the emboli, apparent good collateral circulation, and the absence of diffuse atherosclerosis. However, 38% of the patients had arteriosclerosis; this was generally focal and not associated with significant luminal narrowing. Only one patient had infarction, which was limited primarily to the gray matter. It would appear that hypoperfusion must exist in conjunction with atheromatous emboli in order for infarction to develop. Organized atheromatous emboli also caused focal ischemic atrophy of neurons. It is postulated that this change may be the morphological basis for some of the atypical lower motor neuron diseases found in the elderly.
Pial Microcirculation in Subarachnoid Hemorrhage
Authors: HERZ D. A. , BAEZ S. , SHULMAN K.
Published: June 2011

Microsurgical and microscopic methods were employed in guinea pigs to expose, observe, and measure response characteristics of cerebral cortical pial microvessels and microcirculation to traumatic and nontraumatic experimental subarachnoid hemorrhage. Bleeding produced by vascular micropuncture was associated with a 44.3% arteriolar constriction. Topical application of homologous blood alone produced a 33.2% vasoconstriction. Observed microcirculatory flow characteristics subsequent to such microvascular changes were consistent with those known to be associated with cerebral cortical infarction. These changes could be prevented or reversed by topical application of the alpha adrenergic blocker, phenoxybenzamine. Topical pretreatment with the beta adrenergic blocker, propranolol, prevented blood-induced spasm, but did not reverse such spasm once it had been established. A chemo-mechanical mechanism is suggested as underlying the vasoconstriction associated with rupture of pial microvessels. It is thought that consideration of such microvascular characteristics, in conjunction with those known to be associated with larger intracranial vessels, adds to current knowledge of the pathophysiology of subarachnoid hemorrhage and may be extrapolated to bear future clinical import.
The Contribution of Computerized Axial Tomography to the Diagnosis of Cerebellar and Pontine Hematomas
Authors: MÜLLER H. R. , WÜTHRICH R. , WIGGLI U. , HÜNIG R. , ELKE M.
Published: June 2011

Case histories are reported of seven patients in whom the diagnosis of cerebellar (four) or pontine hemorrhage (three) was made by computerized axial tomography (CT). In all of the patients except two the diagnosis, established on the basis of a space-occupying high absorption lesion, was proved by either operation or autopsy. In the two remaining cases, the evolution on CT was typical for an intracerebral hematoma, i.e., the high absorption zone was transformed into an area of reduced density. It is concluded that CT is a highly reliable method for the diagnosis and location of posterior fossa hematomas. A CT syndrome, observed in four of the seven cases, is described consisting of a hydrocephalus with the tips of the posterior horns being filled with blood. This seems to be specific for a posterior fossa hematoma having penetrated into the fourth ventricle.
Hypertension and Retinal Vascular Insufficiency Associated With Platelet Microthrombi
Authors: VYDEN JOHN K.
Published: June 2011

A 45-year-old woman is described who, during the two-year course of her illness, had abdominal pain, gastrointestinal damage, and hypertension. Platelet "white bodies’ also were seen to appear in her arterial circulation.
Transient Global Amnesia Associated With Cardiac Arrhythmia and Digitalis Intoxication
Authors: GREENLEE JOHN E. , CRAMPTON RICHARD S. , MILLER JAMES Q.
Published: June 2011

A 54-year-old woman with transient global amnesia (TGA) was found to have digitalisinduced bradyarrhythmia with atrioventricular dissociation. The amnesia cleared only upon resolution of the arrhythmia. Cardiac arrhythmia has been postulated as a cause, but TGA in the setting of cardiac arrhythmia has not been documented previously. Cardiac arrhythmia should be excluded in patients with TGA, and TGA, a syndrome diagnosed on clinical grounds alone, must be recognized as one possible manifestation of treatable, potentially serious cardiac or cerebrovascular disease.
The "Hot Stroke" and Transient Vascular Occlusions
Authors: YARNELL PHILIP R. , EARNEST MICHAEL P. , SANDERS BOB , BURDICK DUNCAN
Published: June 2011

Two patients with left middle cerebral artery (MCA) distribution infarctions fulfilled the "hot stroke" criteria on sequential 99m Tc pertechnetate flow and static gamma camera studies. The radioisotopic finding of a paradoxical relative increased flow to the affected hemisphere correlated with serial angiography showing multiple MCA branch occlusions becoming patent with a vascular blush and early venous drainage. The angiographical finding of transient vascular occlusions suggests embolism. Using the present cases together with prior observations, some transient vascular occlusions can be diagnosed by finding an increase in relative radioisotopic flow to the involved hemisphere within a few days to weeks of the infarction. This finding should launch a search for a possible embolic source.
Prognosis and Quality of Survival in a Hospitalized Stroke Population From the South
Authors: HAERER A. F. , WOOSLEY P. C.
Published: June 2011

Likelihood and quality of survival were assessed for patients (79% blacks) consecutively admitted to a southern teaching hospital stroke unit. The functional condition of 260 patients in eight categories of cerebrovascular disease was determined at discharge and three years later. Cumulative probability of five-year survival was calculated for 400 patients and compared to the population at large. Clinical variables were related to the prognosis in 155 patients with anterior circulation infarction.

Mortality during hospitalization varied from 8% to 52%. More than half of the patients in most diagnostic groups died within three years of their stroke. Only 22% of patients with anterior circulation infarcts were fully ambulatory three years later. Prognosis worsened markedly with age and known pre-existing hypertension, and survival was decreased in blacks and in men. Overall five-year survival probability for all stroke patients discharged alive was 49%. Survival was similar in patients discharged ambulatory with or without aid, but poor in patients not ambulatory at discharge. Less than half as many individuals in the anterior circulation infarct group survived five years than did in the general population. The prognosis for blacks was even somewhat worse when compared to the black population at large.
The Measurement of Cerebral Blood Flow in the Rat
Authors: MATSUMOTO AKIRA , NAMON RICHARD , UTSUNOMIYA YOHICHI , KOGURE KYUYA , SCHEINBERG PERITZ , REINMUTH OSCAR M.
Published: June 2011

Cerebral blood flow (CBF) was determined in the rat under 70% nitrous oxide anesthesia and pentobarbital anesthesia. The application of the Fick principle technique of Kety et al. was modified utilizing
123
Xe infused intravenously steadily for 30 seconds, at which time the animal was decapitated and the head frozen in liquid nitrogen. A prior femoral artery to femoral vein shunt was led through a polyethylene catheter of 0.13 ml volume. This catheter passed as a coil in a Nal crystal well-counter with the arterial
133
Xe concentration curve recorded by a ratemeter-recordcr system. The results of the hemispheric blood flow (HBF) were: under 70% nitrous oxide anesthesia in normocapnia (Paco, 38 mm Hg), 86 ± 15 ml/100 gm per minute; with hypocapnia (Paco, 20 mm Hg), 40 ± 5 ml/100 gm per minute; with hypercapnia (Paco, 63 mm Hg), 187 ± 10 ml/100 gm per minute; and with pentobarbital anesthesia (Paco, 38 mm Hg), 41 ± 8 ml/100 gm per minute.
The Value of Brain Scanning in the Management of Strokes
Authors: ANTUNES J. LOBO , SCHLESINGER EDWARD B. , MICHELSEN W. JOST , QUEST DONALD O.
Published: June 2011

The usefulness of brain scanning in the diagnosis and management of strokes was evaluated in 313 serial cases. Of 38 patients with transient ischemic attacks (TIAs), only one had a positive test. The optimal time for scanning completed strokes was between seven and 14 days after onset. The pattern of uptake was characteristic of a vascular lesion in 76.8%. When uptake was indistinguishable from tumor, follow-up scans were useful. Patients with negative scans in the second week have a significantly better prognosis than the ones with a positive study. Cerebral angiography and brain scan correlated well in 56 patients who had both tests performed. The postmortem findings in 12 cases again emphasize the importance of the correct timing of the study, and the fact that a brain scan does not usually demonstrate lesions smaller than 2 cm in diameter. It is concluded that the brain scan represents a useful tool in the diagnosis of strokes and helps in predicting the degree of recovery following a vascular insult.
Cerebrospinal Fluid and Arterial Lactate, Pyruvate and Acid-Base Balance in Patients With Intracranial Hemorrhages
Authors: FUJISHIMA MASATOSHI , SUGI TOMEI , CHOKI JUNICHIRO , YAMAGUCHI TAKENORI , OMAE TERUO
Published: June 2011

Lactate and pyruvate concentrations and acid-base balance in cerebrospinal fluid (CSF) and arterial blood were determined in patients with intracranial hemorrhages (28 subarachnoid hemorrhages and 15 intracerebral hemorrhages).

A greater increase in CSF lactate and lactate-pyruvate ratio (L/P ratio) was observed in patients with impairment of consciousness, focal neurological deficits, poor prognosis, or CSF pressures higher than 300 mm H
2
O. A combination of CSF lactate greater than 2.5 mM per liter, L/P ratio above 20, bicarbonate less than 20.4 mEq per liter, pH below 7.276, or arterial PCO
2
below 31.5 mm Hg seems to indicate a poor prognosis from intracranial hemorrhage.

The mechanism of hyperventilation in acute cerebrovascular diseases and of CSF pH regulation in acid-base disturbances was also discussed.
Effects of Ischemia on the Mg
+ +
Requiring Adenosine Triphosphatase Associated With Neuronal Synaptic Vesicles in Gerbil Brain
Authors: QUAYLE ELIZABETH S. , CHRISTIAN SAMUEL T. , HALSEY JAMES H.
Published: June 2011

The Mg
+ +
requiring adenosine triphosphatase (ATPase) associated with neuronal synaptic vesicles is extremely vulnerable to ischemia. After five minutes of ischemia both the maximum velocity and the substrate binding capacity of the enzyme were decreased. Results also indicate that these changes are related to the rapid intraneuronal lactic acidosis accompanying ischemia. Ischemia was simulated by 37°C incubation of gerbil brain after decapitation. According to a recent hypothesis this enzyme plays a key role in exocytotic neurotransmitter release. Therefore, any inhibition of the ability of this enzyme to function would result in a drastically reduced capacity for transsynaptic impulse propagation.
The role of the carotid body in mediating the cerebrovascular response to altered arterial carbon dioxide tension.
Authors: Eidelman B H , McCalden T A , Rosendorff C
Published: June 2011

The role of the carotid bifurcation chemoreceptors in mediating the cerebrovascular response to altered arterial PCO2 has been suggested to be large. In the present study the cerebrovascular response to raised PCO2 was measured in a group of baboons before and after bilateral inactivation of the carotid bodies. The results suggest that these chemoreceptors do play a part in the cerebral vasodilator response to raised PCO2. The role of the carotid body, however, appears to be relatively minor as it only accounted for +/- 40% of the total response and became significant only at arterial PCO2 levels of more than 50 mm Hg. It is postulated that the peripheral chemoreceptors in the carotid bifurcation mediate part of the cerebrovascular response to altered PaCO2 but the role is quantitatively small.
Comparison of computerized tomography and radionuclide imaging in "stroke".
Authors: Gado M H , Coleman R E , Merlis A L , Alderson P O , Lee K S
Published: June 2011

Forty patients were studied by computerized tomography and by radionuclide brain imaging. The final diagnosis was infarction in 29 patients, intracerebral hematoma in seven, acute SAH in one, and old cerebrovascular accidents in three. CT was far superior to RN in detecting intracerebral hematomas and distinguishing them from cerebral infarction. The results of CT and RN tests were comparable regarding the percentage of abnormalities. However, the results in the same patients were not identical in 55% of the cases, indicating a complementary role for the two tests. There was no relationship between the frequency of abnormalities on CT and the time lapse after the onset of cerebral infarction. RN uptake was not seen in patients with old cerebrovascular accidents.
Hypertension as an important factor for cerebrovascular atherogenesis in rats.
Authors: Yamori Y , Horie R , Sato M , Fukase M
Published: June 2011

A new model for studies on atherogenesis in the cerebrovascular system was obtained by using recently established stroke-prone spontaneously hypertensive rats (SHRSP). SHRSP on a hypercholesterolemic diet (20% suet, 5% cholesterol, and 2% cholic acid) had ring-like fat deposits in the circle of Willis, which were detected within a few weeks by new techniques for the macroscopical demonstration of fat deposits "as a whole" and were proved to be good quantitative indices for the initiation of atherogenesis. Experimental studies using more than 200 rats including SHRSP, experimental hypertensive rats (renal infarction hypertension) and WK rats, fed a hypercholesterolemic diet with 1% salt in the drinking water for 1 week, 2 weeks, 10 weeks and more than 10 weeks, revealed that the arterial fat deposition in the brain was affected by BP, serum cholesterol level, strain difference and age. High BP was confirmed to be more important than the other factors by the quantitative analysis of sudanophilic rings in relation to BP.