bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alcohol and stroke. A case-control study of drinking habits past and present.
Authors: Rodgers H , Aitken P D , French J M , Curless R H , Bates D , James O F 
Published: June 2011

Previous studies have reported a U-shaped relation between alcohol consumption and stroke. Those studies have been criticized for failing to distinguish between lifelong abstainers from alcohol and those who have given up drinking.
We examined current and previous drinking habits of 364 cases of acute stroke and 364 community-based control subjects matched for age, sex, and family practitioner.
Stroke patients were more likely to have been lifelong abstainers from alcohol than were the control subjects. The odds ratio (OR) or lifelong abstainers versus those who had ever drunk regularly was 2.36 (95% confidence interval [CI], 1.67 to 3.37). No relation was found between stroke and current nondrinkers. Current male heavy drinkers also had an increased risk of stroke (OR, 2.88; 95% CI, 1.08 to 2.31).
Lifelong abstention from alcohol is associated with an increased risk of stroke. Moderate alcohol consumption may protect against cerebrovascular disease.
The influence of depression, social activity, and family stress on functional outcome after stroke.
Authors: Angeleri F , Angeleri V A , Foschi N , Giaquinto S , Nolfe G 
Published: June 2011

This study was designed to assess the quality of life after an active poststroke period of rehabilitation and to investigate the possibility of a return to a working environment for those still of working age.
The study was conducted on 180 consecutive patients affected by stroke who were hospitalized for the first time and discharged at least 1 year before the study. The group consisted of 65% men and 35% women with a mean age 65.29 years (SD, 11.22). The period between the stroke and the interview ranged from 12 to 196 months, with a mean of 37.5 months. The average Rankin score on discharge from the rehabilitation center was 2.718 (moderate handicap). The interview took place at home after consent obtained by telephone. The questionnaire included general and personal information regarding the individuals, their socioeconomic position, and scales for daily activity, depression, social activity, and stress produced in the family. The control group consisted of 167 age-matched subjects.
A close correlation was observed in all patients between depression, social activity, and stress caused to relatives. The scores on the individual scales were clearly worse than those for control subjects. The patients received approximately 5 months of rehabilitation after the stroke. Differences emerged between men and women for depression and social activities, with the women scoring worse. In reference to daily life, 70% of prestroke ability was required on average after rehabilitation. The daily activity score at the time of the interview was also strongly influenced by the discharge score. The majority of patients were retired. Of the total, 20.64% returned to work, but not always to the same job and often after readapting to new conditions. Of this population, only 31.5% were women. With regard to the population aged younger than 65 years, 21.42% returned to work. Lesions in the dominant hemisphere do not necessarily seem to rule out return to work, even if associated with aphasia. The main discriminating element was the ability to understand language. The patients were often criticized by their cohabitants; the criticisms most often raised concerned apathy, irritability, and self-centeredness. Sexual activity was depressed in almost all cases.
Despite the progress made in studying cerebral vasculopathies, patients in the aftermath of a stroke still seem to live unsatisfactorily, as they did many years ago. Useful measures include valid treatment against spasticity, psychological assistance, and greater social support.
Early prognostic factors in ischemic stroke. The role of protein C and protein S.
Authors: Anzola G P , Magoni M , Ascari E , Maffi V 
Published: June 2011

Protein C and protein S have been found reduced in some patients with ischemic cerebrovascular diseases, but the relevance of this finding for prognosis is unsettled.
In 43 consecutive patients admitted over 6 months for acute ischemic stroke, protein C and free protein S were evaluated on admission, and at 2 and 6 months after stroke. Excluded were all patients with known causes liable to reduce the levels of protein C, free protein S, or both.
In 14% of patients, abnormally low levels of protein C were found at entry. In comparison to the remaining sample, this group had a significantly lower initial score on the Barthel and Canadian neurological scales, a higher prevalence of emboligenic cardiac diseases, and had a higher mortality at 6 months. No statistical difference was found for the other vascular risk factors. Eight patients (18.4%) had abnormally low levels of free protein S at entry. In comparison to the remaining sample, there was no statistical difference in the severity scores, prevalence of emboligenic cardiac diseases, mortality, or vascular risk factors.
These findings suggest that low levels of protein C in the acute stroke reflect the massive activation of coagulation factors and are predictive of adverse outcome, whereas the significance of low levels of free protein S remains to be clarified.
In vivo radiofrequency-based ultrasonic tissue characterization of the atherosclerotic plaque.
Authors: Urbani M P , Picano E , Parenti G , Mazzarisi A , Fiori L , Paterni M , Pelosi G , Landini L 
Published: June 2011

The ultrasonic image can offer unique information on the composition of atherosclerotic plaque, ie, the relative content of lipids, fibrous tissue, and calcific deposits. To date, however, the echographic assessment of plaque structure is based on a subjective, qualitative evaluation of the bidimensional images. We evaluated the feasibility and accuracy of assessing, in vivo, the acoustic properties of arterial carotid plaques by means of a suitably modified echographic apparatus allowing direct access to the radiofrequency signal.
In 15 patients undergoing carotid thromboendarterectomy, the ultrasonic findings in 70 discrete sites (within the plaque, n = 54; normal sites, n = 11; or intraluminal thrombi, n = 5) were correlated with the histological analysis (hematoxylin-eosin and Mallory trichrome stains) independently performed on the arterial samples. The pathological examination was carried out at a similar level of the insonation; the sites analyzed within the plaque were chosen because of their uniform echoic characteristics. In each ultrasonic region of interest selected from the echographic image, the integrated amplitude of the rectified radiofrequency signal was measured as the integrated backscatter index.
The intimal-medial layer of normal carotid wall (n = 11) exhibited values of -32.5 +/- 9.4 dB. The integrated backscatter index in fatty sites (n = 11, -40.3 +/- 5.4 dB) differed from that of fibrous (n = 12, -23.8 +/- 5.0 dB) and calcified (n = 26, -11.5 +/- 5.2 dB, P < .01 for all intergroup differences) sites. Intraluminal thrombotic sites (n = 5, -42 +/- 5.1 dB, P < .01) differed from fibrous and calcified subsets (P < .01) but overlapped (P = NS) with fatty sites. Histological sampling also showed two sites of intraplaque hemorrhage that exhibited very low backscatter values (-53 and -58 dB) and three fibrofatty sites showing backscatter values (-28, -28, and -32 dB) intermediate between the fibrous and the fatty subsets.
Quantitative analysis of integrated backscatter of the arterial wall is feasible in humans and provides an operator-independent assessment of plaque echoic structure. In particular, integrated backscatter is effective in distinguishing lipidic, fibrotic, and calcific components in human atherosclerotic plaques.
Transcranial color-coded duplex sonography of intracerebral hematomas in adults.
Authors: Seidel G , Kaps M , Dorndorf W 
Published: June 2011

It is well established from pediatric experience and animal experiments that intracerebral blood can be demonstrated by B-mode real-time duplex scanning. This has recently become feasible in adults as well. The present study investigated the changes in the sonographic appearance of intracerebral hematomas over the course of time.
Starting in May 1991, 23 consecutive patients with intracerebral hematoma confirmed by computed tomography (21 spontaneous and 2 traumatic hematomas) were investigated within 1 year. They were monitored by repeated ultrasound scanning via the transtemporal approach. The sonographic appearance of the hematomas on B-mode scans and the angle-corrected blood flow velocity in the basal cerebral arteries were assessed.
There was unequivocal localization of the hematoma in 18 patients (78%). In 3 cases (13%), an adequate acoustic window could not be found. One small intracerebral hemorrhage was overlooked, and one extensive hemorrhage in the basal ganglia was misdiagnosed as a lobar hematoma. There was an alteration of the appearance of the hematoma with time. This was divided into three sonographic stages (initial stage, days 1 to 5; intermediate stage, days 6 to 10; and capsular stage, from day 10). In 14 of the 20 patients with an appropriate acoustic bony echo window, the blood flow velocity in the middle cerebral artery could be measured; in 1 of these patients, the signs of increasing intracranial pressure were apparent from Doppler frequency spectrum. In 5 patients, the intracerebral hematoma could be imaged but not the ipsilateral middle cerebral artery. One female patient showed cerebral circulatory arrest at the time of examination, which took place within 24 hours after the onset of clinical symptoms.
Most intracerebral hematomas in adults can be imaged in B-mode. Their sonographic appearance changes over the course of the disease. The advantages of this noninvasive method are its easy bedside operation and its suitability for follow-up; it is also less stressful than other imaging procedures. It yields a combination of structural and functional diagnostic information. In approximately 13% of the cases, the investigation was not feasible because of inadequate ultrasonic penetration of the intact skull.
Transient platelet accumulation in the rat brain after common carotid artery thrombosis. An 111In-labeled platelet study.
Authors: Dietrich W D , Dewanjee S , Prado R , Watson B D , Dewanjee M K 
Published: June 2011

Thromboembolic events are a major cause of ischemic stroke. To obtain evidence for platelet embolization after cerebrovascular injury, the accumulation of indium-labeled platelets was documented after photothrombosis of the rat common carotid artery.
Heterologous blood was collected from donor rats, and the isolated platelets were labeled with 111In-tropolone. Labeled platelets were then infused into Wistar rats 30 minutes before right carotid artery thrombosis. Nonocclusive common carotid artery thrombosis was induced by a laser-driven rose bengal-mediated photochemical insult to the vascular endothelium, and the rats were killed 15 minutes or 3 hours later. Carotid arteries and brains were immediately removed and dissected for regional radioactivity assessment or sectioned for the autoradiographic visualization of platelet emboli.
At 15 minutes after thrombosis, the ratio of right-to-left common carotid artery radioactivity was significantly elevated compared with control (33 +/- 12 [mean +/- SEM] versus 0.97 +/- 0.2). Within individual brain regions, including the frontal and frontoparietal cortices and hippocampus, significant elevations in right-to-left radioactivity ratios were also documented. Autoradiographic images revealed multiple foci of 111In-labeled platelets throughout the thrombosed hemisphere. At the level of the frontal cortex, bilateral platelet accumulation was seen. Regional counts demonstrated significantly increased platelet density within selective cortical and subcortical regions. In contrast to the 15-minute findings, right-to-left ratios of carotid arteries or brain regional radioactivities were not significantly elevated at 3 hours after injury. In addition, the areal densities of autoradiographically visualized platelets in the 3-hour group were not different from control except in the right frontal cortex.
These data demonstrate (1) the acute accumulation of labeled platelets in downstream vessels after nonocclusive common carotid artery thrombosis, (2) that platelet accumulation is widespread and also involves contralateral areas, and (3) that platelet accumulation within the thrombosed carotid artery and brain is largely transient.
Trends in survival of hospitalized stroke patients between 1970 and 1985. The Minnesota Heart Survey.
Authors: McGovern P G , Pankow J S , Burke G L , Shahar E , Sprafka J M , Folsom A R , Blackburn H 
Published: June 2011

Age-adjusted stroke mortality rates declined approximately 50% between 1970 and 1990 in both the United States and Minnesota, but the reasons for this decline are not clear. This report examines possible improvements in short- and long-term survival of hospitalized definite stroke patients in the Minneapolis-St Paul (the Twin Cities) metropolitan area during this period.
Fifty percent random samples of patients discharged with an acute stroke diagnosis from area hospitals were selected in 1970 (n = 1200), 1980 (n = 1040), and 1985 (n = 896). Trained nurses abstracted pertinent clinical data from the hospital charts. By standardized clinical criteria similar to World Health Organization criteria (without computed tomography data), 376, 442, and 453 definite strokes were established for 1970, 1980, and 1985, respectively.
Age- and sex-adjusted 28-day case fatality of definite stroke improved significantly from 1970 to 1985; the odds ratio (OR) of death within 28 days in 1985 (versus 1970) patients was 0.55 (95% confidence interval [CI], [0.39, 0.77]). Substantial improvements in 28-day mortality were observed both from 1970 to 1980 and from 1980 to 1985, although the latter change was not statistically significant. Further adjustment for predictors of early stroke mortality (such as level of consciousness) somewhat attenuated these results. Age- and sex-adjusted 5-year survival of definite stroke also improved significantly from 1970 to 1985 (OR, 0.72; 95% CI, [0.54, 0.96]), although the improvement was restricted to the 1970 to 1980 time period (OR, 0.76; 95% CI, [0.57, 1.01]). None of the survival trends differed significantly between men and women.
There were marked improvements in survival from 1970 to 1985 among hospitalized stroke patients in the Twin Cities. These improvements occurred almost exclusively in the acute hospitalization phase. Although the advent of computed tomography and improvements in hospital record-keeping during this period prevent an unequivocal conclusion, improved medical care and decreased severity of stroke probably contributed to gains in survival.
Transhemispheric passage of microemboli in patients with unilateral internal carotid artery occlusion.
Authors: Georgiadis D , Grosset D G , Lees K R 
Published: June 2011

Ischemic episodes distal to an internal carotid artery occlusion are common. We undertook this study to look for evidence of transhemispheric passage of embolic material in this patient category as a mechanism for embolic events.
Seven symptomatic patients with unilateral internal carotid artery occlusion and contralateral stenosis were examined by transcranial Doppler ultrasonography with 2-MHz probe (average monitoring time, 2.5 hours per patient). Both middle cerebral arteries and (if present) the reverse-flow anterior cerebral artery ipsilateral to the occluded internal carotid were monitored. Three patients were reexamined 1 month after carotid endarterectomy.
Embolic signals were detected in the middle cerebral artery ipsilateral to the stenosed internal carotid artery in all seven patients and in the opposite middle cerebral artery in four patients. In these four patients, a reverse-flow anterior cerebral artery was observed in which embolic signals were detected. No embolic signals were detected after surgery in any of the three patients who underwent carotid endarterectomy.
Transhemispheric passage of embolic material occurs in patients with unilateral internal carotid artery occlusion and contralateral stenosis. Endarterectomy of the stenosed internal carotid artery may eliminate the detected embolic signals in both hemispheres. Transcranial Doppler ultrasonography could be used as a diagnostic tool to identify the embolic source in patients with unilateral carotid occlusion.
Computerized detection of cerebral emboli and discrimination from artifact using Doppler ultrasound.
Authors: Markus H , Loh A , Brown M M 
Published: June 2011

Transcranial Doppler ultrasound can detect circulating cerebral emboli. Monitoring of patients with potential embolic sources may allow identification of high-risk patients who can then be selected for prophylactic treatment. However, practical patient monitoring will require automated programs that can detect emboli and differentiate them from artifact.
A new off-line algorithm for the detection of emboli, which detects the characteristic relative power increase occurring with an embolus, was evaluated in both an animal model and in patients. (1) In a sheep model, solid embolic materials (thrombus, platelet aggregates, and atheroma) were introduced into the proximal carotid artery while the distal carotid artery or a major branch was insonated. The signals resulting from 77 emboli (mean size, 1.77 mm) were studied and compared with the Doppler signals resulting from artifact. (2) In patients, 100 embolic signals occurring in three patients were analyzed and compared with signals associated with artifact in the same patients.
(1) In the sheep model, emboli resulted in a short-duration, high-intensity signal, but intensity increase alone did not distinguish between emboli and artifact. In contrast, the algorithm discriminated embolus from artifact with a sensitivity of 98.7% and a specificity of 98.0%. (2) In patient studies, embolic signals were differentiated from artifact with a sensitivity of 97.2% and a specificity of 97.0% by the algorithm.
Using such an algorithm, detection of cerebral emboli and discrimination from artifact are possible with a high sensitivity and specificity. Incorporation of such an algorithm into an on-line system should make prolonged patient monitoring practical.
Internal carotid artery dissection in a community. Rochester, Minnesota, 1987-1992.
Authors: Schievink W I , Mokri B , Whisnant J P 
Published: June 2011

Cervical internal carotid artery dissections are diagnosed with an increasing frequency, but reliable epidemiologic data are not available. The aim of this study was to determine the incidence rate of spontaneous cervical internal carotid artery dissection in a defined population.
Using the medical record linkage system used for epidemiologic studies in Rochester, Minn, all patients diagnosed with spontaneous cervical ICA dissection for 1987 through 1992 were identified.
A total of 10 patients with spontaneous cervical internal carotid artery dissection (6 women and 4 men; mean age, 44 years) were identified. For the period 1987 through 1992, the average annual incidence rate for all ages was 2.6 per 100,000 (95% confidence intervals, 0.9 to 4.2).
This study, for the first time, provides incidence rates for spontaneous cervical internal carotid artery dissections. No diagnoses were made before 1987, probably reflecting an increased awareness of the disorder among physicians.
Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. The Tohoku Cerebellar Infarction Study Group.
Authors: Tohgi H , Takahashi S , Chiba K , Hirata Y 
Published: June 2011

We performed this multicenter study to explore the full spectrum of the clinical characteristics and neuroimaging findings of cerebellar infarction, including patients with mild to severe illnesses.
We studied 293 consecutive patients with cerebellar infarction diagnosed by computed tomography and/or magnetic resonance imaging who were admitted to 36 hospitals during 5 years.
Cerebellar infarcts constituted 2.3% of the total patients with acute brain infarction. The backgrounds and risk factors were similar to those in patients with infarctions of the cerebral hemispheres. At least 24% were embolic, and the diagnosis of embolism could not be ruled out in 27%. Infarcts involving the superior cerebellar artery (SCA) region (52%) and the posterior inferior cerebellar artery (PICA) region (49%) were far more frequent than those involving the anterior inferior cerebellar artery (AICA) region (20%). Patients with SCA infarcts exhibited obtunded consciousness and ataxia more frequently than those with PICA infarcts (P < .05). Infarcts in the PICA regions were associated with abnormalities of the PICA (64%) or the vertebral arteries (57%), whereas infarcts in the SCA and AICA regions were associated with abnormalities in the SCA or AICA, respectively, in approximately 30% of patients, in the basilar artery in approximately 16%, and in the vertebral artery in more than 60% of patients. Outcomes were poorer with SCA infarcts than with AICA and PICA infarcts.
These data indicate similar frequencies of SCA and PICA infarcts and illustrate the difference in clinical presentation and outcomes between SCA and PICA infarcts. They also indicate that not only in situ thrombosis but also cardiogenic or artery-to-artery embolism and the insufficiency of collateral circulation play important roles in the pathogenesis of cerebellar infarction.
Retention of cerebrovascular dilation after cortical spreading depression in anesthetized rabbits.
Authors: Busija D W , Meng W 
Published: June 2011

We examined responses of rabbit pial arterioles to three different stimuli before and after induction of cortical spreading depression.
In urethane-anesthetized rabbits equipped with a closed cranial window, we measured pial arteriolar diameter during baseline conditions, topical application of calcitonin gene-related peptide (CGRP), topical application of acetylcholine, and inhalation of 10% CO2 in air (arterial hypercapnia) before cortical spreading depression and 30, 60, and 120 minutes after cortical spreading depression. Cortical spreading depression was induced by localized application of a 5% KCl solution anterior to the arteriole being measured.
Average baseline diameter was approximately 90 microns. During cortical spreading depression, arteriolar diameter increased to a peak value that was 50 +/- 4% above baseline (n = 32). Before cortical spreading depression, arteriolar diameter changed 47 +/- 7% (n = 9) during hypercapnia, 17 +/- 3% (n = 4) during 10(-9) mol/L CGRP, 42 +/- 10% (n = 7) during 10(-7) mol/L CGRP, 29 +/- 6% (n = 4) during 10(-6) mol/L acetylcholine, and 61 +/- 13% (n = 6) during 10(-4) mol/L acetylcholine. Arteriolar responsiveness to any of these stimuli was not changed significantly by prior cortical spreading depression.
Dilator capacity of pial arterioles is still intact in urethane-anesthetized rabbits after cortical spreading depression.