bluuebunny/crossref_metadata_2025_split huggingface dataset:
Doppler CO2 test as an indicator of cerebral vasoreactivity and prognosis in severe intracranial hemorrhages.
Authors: Klingelhöfer J , Sander D 
Published: June 2011

Transcranial Doppler ultrasonography is a noninvasive, reproducible technique that allows the assessment of CO2-induced cerebral vasomotor reactivity. We investigated the effect of CO2 changes on cerebral blood flow velocity in patients with severe intracranial hemorrhage and evaluated the relation between CO2 reactivity, intracranial pressure, and outcome.
Transcranial Doppler parameters, intracranial pressure, arterial blood pressure, and PaCO2 were measured simultaneously in 40 patients. To determine CO2 reactivity, the initial PaCO2 of each patient was lowered by at least 6 mm Hg by controlled hyperventilation. Relative CO2 reactivity was defined as the percent change in mean flow velocity per mm Hg PaCO2 (averaged during 20 heart cycles before and after approximately 15 minutes of increased hyperventilation).
A significantly reduced relative CO2 reactivity was observed in the patient group compared with a healthy, age-matched control group. Relative CO2 reactivity was maintained significantly better in patients with moderate intracranial pressure than in patients with markedly increased intracranial pressure. An indirect correlation was found between intracranial pressure and relative CO2 reactivity (r = -0.89; p less than 0.001). Clinical outcome was significantly related to the initial relative CO2 reactivity. Whereas the patients with good recovery had shown a largely preserved reactivity (mean +/- SD, 3.4 +/- 0.7%) that did not differ significantly from the control group, there was a continuous decrease up to the patients who died (0.8 +/- 0.3%).
Transcranial Doppler CO2 testing in patients with severe cerebral disease and elevated intracranial pressure provides useful information regarding hemodynamic state, prognosis, and determination of beneficial effects of specific therapy.
Cerebral plasminogen activator activity in spontaneously hypertensive stroke-prone rats.
Authors: Matsuo O , Okada K , Fukao H , Suzuki A , Ueshima S 
Published: June 2011

In the spontaneously hypertensive stroke-prone rat, it is unclear whether plasminogen activator plays a role in the development of stroke. The present study was undertaken to investigate brain levels of plasminogen activator activity in spontaneously hypertensive stroke-prone rats and Wistar-Kyoto rats.
Plasminogen activator was purified from the brains of rats of both strains. The purification involved used ammonium sulfate precipitation, gel filtration, a zinc chelate-Sepharose column, and a concanavalin A-Sepharose column. Fraction I (0.15 M KCl-soluble fraction) and fraction II (2 M KCl plus 6 M urea-soluble fraction) were purified from both strains.
Total plasminogen activator activity in the original homogenates for fractions I and II derived from spontaneously hypertensive stroke-prone rats was increased to twice the level found in Wistar-Kyoto rats. The final product purified from fractions I and II in both strains of rats revealed single bands of plasminogen activator activity on enzymatic analysis with a molecular weight of 72,000. The purified product had stronger S-2288 amidolytic activity than S-2444 amidolytic activity, and it also displayed fibrin-binding ability.
The study demonstrated that there is an increased content of plasminogen activator in the brains of spontaneously hypertensive stroke-prone rats that might be related to the development of stroke.
Serum autoantibodies in patients with Alzheimer's disease and vascular dementia and in nondemented control subjects.
Authors: Lopez O L , Rabin B S , Huff F J , Rezek D , Reinmuth O M 
Published: June 2011

In this study we sought to evaluate the clinical significance of serum autoantibodies to dementing processes.
We assessed 40 age-matched subjects: 10 patients with probable Alzheimer's disease, 10 with possible Alzheimer's disease with cerebrovascular disease, 10 with vascular dementia, and 10 nondemented control subjects. Serum from each subject was tested for the presence of antithyroglobulin antibody, thyroid antimicrosomal antibody, gastric anti-parietal cell antibody, anti-smooth muscle antibody, antinuclear antibody, rheumatoid factor, antineuronal antibody, and anticardiolipin antibody. In addition, we investigated the sera of these patients for the presence of an antivascular antibody directed against the vascular basement membrane proteoglycan antigen and for circulating immune complexes.
Autoantibodies were present in 100% of the patients with possible Alzheimer's disease with cerebrovascular disease, 80% of those with vascular dementia, 40% of those with probable Alzheimer's disease, and 30% of the nondemented control subjects. The highest number of autoantibodies was observed in patients with vascular dementia and possible Alzheimer's disease with cerebrovascular disease. Antinuclear antibody was present in 60% of vascular dementia patients and antineuronal antibody in 50% of these patients. However, no individual autoantibody could differentiate Alzheimer's disease from cerebrovascular disorders. Immune complexes were detected in the serum of 20-30% of each patient group. Neither the patient nor the control sera was found to contain antiendothelial antibody.
Despite the relatively small number of individuals examined in each category, the elevated number of autoantibodies associated with possible Alzheimer's disease with cerebrovascular disease and vascular dementia indicates a possible link between the presence of autoantibodies and cerebrovascular disorders in dementia.
Facilitating postischemic reduction of cerebral lactate in rats.
Authors: Dimlich R V , Nielsen M M 
Published: June 2011

Dichloroacetate facilitates a decrease in brain lactate during reperfusion after incomplete ischemia. This study examined the possible activation of pyruvate dehydrogenase enzyme by dichloroacetate to explain this effect. Because the duration of ischemia and hyperglycemia exacerbate ischemic brain damage, the effect of both of these factors on lactate reduction with and without dichloroacetate treatment after ischemia also was explored.
The two-vessel occlusion and controlled blood loss model of stroke was applied to anesthetized rats. Samples of cerebral cortex were analyzed for lactate by enzyme fluorometry and for pyruvate dehydrogenase activity by radioassay.
Treatment with dichloroacetate produced no significant stimulation of pyruvate dehydrogenase after ischemia. When the duration of ischemia was increased or 50% glucose was infused before ischemia, brain lactate was significantly higher (p less than 0.01, Duncan's test). After 30 minutes of ischemia, treatment with a low dose of dichloroacetate (25 mg/kg) improved the reduction in lactate (p less than 0.01, Duncan's test).
These results indicate that although dichloroacetate reduces brain lactate after cerebral ischemia, the mechanism of action does not involve dichloroacetate's known ability to stimulate pyruvate dehydrogenase. However, these data support the use of dichloroacetate to lower cerebral lactate, especially in cases where ischemia is greater than or equal to 30 minutes in duration. They also suggest that early restoration and maintenance of perfusion after ischemia and discontinuing the use of 50% glucose before impending ischemia likewise would facilitate reduction of postischemic brain lactate.
Incidence of stroke in Taiwan.
Authors: Hu H H , Sheng W Y , Chu F L , Lan C F , Chiang B N 
Published: June 2011

Few epidemiological studies concerning the incidence of stroke have been conducted in Taiwan. In an attempt to investigate this common disease, we studied the incidence of stroke in Taiwan in a prospective incidence study.
A cohort of 8,562 stroke-free people were followed up for 4 years to observe new stroke occurrence. The methods of sampling the study population have been reported elsewhere. In addition to the help of local doctors, who reported the new stroke cases, we also sent public nurses to visit the study population annually to screen the new cases of stroke.
There were 104 (61 men and 43 women) first-ever stroke cases identified by a neurologist in a period between October 1, 1986 and December 31, 1990. The average annual incidence rate of first-ever stroke for people aged 36 years or older in this study was 330 per 100,000. Incidence rate was higher in eastern Taiwan and in rural communities. Percentages of the major types of stroke were as follows: cerebral infarction, 71%; cerebral hemorrhage, 22%; subarachnoid hemorrhage, 1%; and unclassified, 6%. The significant risk factors for stroke were hypertension and intake of food with a high sodium content.
The age-specific incidence rates in this study are higher than those reported from the United Kingdom and the United States. The rates are close to those in a report from Japan and a report from a city in mainland China at the same latitude. Cerebral hemorrhages are more common among people in Taiwan than among Occidental people.
Hyperhidrosis as a reflection of autonomic failure in patients with acute hemispheral brain infarction. An evaporimetric study.
Authors: Korpelainen J T , Sotaniemi K A , Myllylä V V 
Published: June 2011

Sweating dysfunction is one of the most frequently encountered symptoms of autonomic failure but has received scant attention in patients with cerebrovascular diseases. Our purpose was to evaluate the prevalence, pathogenesis, and clinical correlates of sweating dysfunction in stroke.
We studied sweating at baseline and after a heating stimulus in 53 patients with acute hemispheral brain infarction and in 40 healthy control subjects by using a quantitative evaporimetric method.
Significant hyperhidrosis on the paretic side of the body was verified in 55% of the patients at baseline, in 74% after 5 minutes of heating, and in 77% after 10 minutes of heating. Hyperhidrosis was established throughout the body and correlated with the severity of paresis, the presence of reduced muscle tone, and the extensor plantar response.
The phenomenon of hyperhidrosis in hemiparetic patients reflecting autonomic dysfunction seems to be a common manifestation that should be listed among the expected consequences of brain infarction. This sweating disturbance might be attributed to a lesion of a putative sympathoinhibitory pathway controlling sweating. The failure of this pathway could also be related to other manifestations of sympathetic hyperfunction, e.g., cardiac complications. Therefore, assessment of sweating may provide a new, important aspect in the evaluation of stroke patients.
Evaluation of the vertebrobasilar-posterior system by transcranial color duplex sonography in adults.
Authors: Schöning M , Walter J 
Published: June 2011

The transcranial color duplex sonography technique was applied to the vertebrobasilar-posterior system to provide normal data for clinical application.
The intracranial posterior circulation was studied in 49 healthy volunteers (mean +/- SD age, 35 +/- 12 years) by a transcranial and suboccipital approach with a 2.0-MHz sector transducer of a computed sonography system.
The posterior cerebral artery and the vertebrobasilar system were depicted clearly in the color Doppler mode. Pulsed Doppler signals could be recorded in the posterior cerebral (100%), basilar (92%), and vertebral arteries (89%). The following normal values were provided for all vessels: systolic peak, end-diastolic maximum, time-averaged, and time-averaged maximum velocities; resistance and pulsatility indexes; and a spectral broadening index. Mean +/- SD values were 45.9 +/- 9.6, 45.5 +/- 10.8, and 39.2 +/- 10.6 cm/sec for time-averaged maximum velocity, and 28.3 +/- 6.5, 30.6 +/- 7.2, and 24.7 +/- 8.4 cm/sec for time-averaged velocity in the posterior cerebral, basilar, and vertebral arteries, respectively. In a reproducibility study, duplex measurements of the posterior cerebral arteries were repeated in 27 subjects. The correlation between the two examiners was high (r = 0.56, p less than or equal to 0.0001 for time-averaged maximum velocity).
Color duplex sonography of the vertebrobasilar-posterior system is a new, noninvasive, bedside investigative technique. It permits visualization of artery flow in real time, relating these to adjacent brain and cranial structures, as well as angle-corrected duplex measurement of "true" flow velocities at defined sites of the vessels. Thus, it will open new diagnostic possibilities in disorders of the posterior circulation.
Reperfusion increases neutrophils and leukotriene B4 receptor binding in rat focal ischemia.
Authors: Barone F C , Schmidt D B , Hillegass L M , Price W J , White R F , Feuerstein G Z , Clark R K , Lee E V , Griswold D E , Sarau H M 
Published: June 2011

Neutrophils are critically involved with ischemia and reperfusion injury in many tissues but have not been studied under conditions of reperfusion after focal cerebral ischemia. The present studies were conducted to confirm our previous observations quantifying neutrophils in rat permanent focal stroke using a myeloperoxidase activity assay and to extend them to transient ischemia with reperfusion. In addition, leukotriene B4 receptor binding in ischemic tissue was evaluated as a potential marker for inflammatory cell infiltration.
Histological, enzymatic, and receptor binding techniques were used to evaluate neutrophil infiltration and receptor binding in infarcted cortical tissue 24 hours after permanent middle cerebral artery occlusion (n = 25) or temporary occlusion for 80 (n = 12) or 160 (n = 22) minutes followed by reperfusion for 24 hours in spontaneously hypertensive rats.
Sham surgery (n = 26) produced no changes in any parameter measured. After permanent middle cerebral artery occlusion, neutrophil accumulation was observed histologically, but the infiltration was moderate and typically within and adjacent to blood vessels bordering the infarcted cortex. After temporary middle cerebral artery occlusion with reperfusion, marked neutrophil infiltration was observed throughout the infarcted cortex. Myeloperoxidase activity was increased (p less than 0.05) after permanent occlusion and to a greater extent after temporary occlusion with reperfusion. Myeloperoxidase activity (units per gram wet weight) in ischemic cortex was increased over that in nonischemic (control) cortex 32.2-fold, 54.6-fold, and 92.1-fold for permanent occlusion and 80 and 160 minutes of temporary occlusion with reperfusion, respectively (p less than 0.05). Sham surgery produced no changes in myeloperoxidase activity. Leukotriene B4 receptor binding also was increased (p less than 0.05) after focal ischemia and paralleled the increases in myeloperoxidase activity. Ischemic cortex-specific receptor binding (femtomoles per milligram protein) was 3.87 +/- 0.63 in sham-operated rats and 4.57 +/- 0.98, 8.98 +/- 1.11, and 11.12 +/- 1.63 for rats subjected to permanent occlusion and 80 and 160 minutes of temporary occlusion with reperfusion, respectively (all p less than 0.05 different from sham-operated). Cortical myeloperoxidase activity was significantly correlated with the degree of cortical leukotriene B4 receptor binding (r = 0.66 and r = 0.79 in two different studies, p less than 0.01).
These data indicate that neutrophils are involved in focal ischemia and that there is a dramatic accumulation of neutrophils in infarcted tissue during reperfusion that can be quantified using the myeloperoxidase activity assay. Leukotriene B4 receptor binding increases in infarcted tissue in a parallel manner, which suggests that the increased leukotriene B4 binding is to receptors located on the accumulating neutrophils.
Caudate hemorrhage with moyamoya-like vasculopathy from atherosclerotic disease.
Authors: Steinke W , Tatemichi T K , Mohr J P , Massaro A , Prohovnik I , Solomon R A 
Published: June 2011

Caudate hemorrhage usually results from hypertension, rupture of arteriovenous malformation or aneurysm, or rarely, moyamoya disease. Moyamoya-like changes related to severe atherosclerotic occlusive disease, usually causing ischemic stroke, have been reported.
A 51-year-old normotensive patient was admitted with headache due to a left caudate hematoma with ventricular extension. There was a history of smoking, leg claudication, elevated cholesterol, and coronary artery disease. Angiography demonstrated complete extracranial carotid occlusion on the left and atherosclerotic stenosis at the bifurcation on the right, with supraophthalmic occlusion distally. At the base of the brain, bilateral moyamoya-like vessels, presumed to be secondary to atherosclerotic occlusion, were evident, but neither aneurysm nor arteriovenous malformation was present. Cerebral blood flow and transcranial Doppler studies indicated severely impaired cerebral perfusion that improved after bilateral extracranial-to-intracranial bypass surgery.
Atherosclerotic occlusive carotid disease with moyamoya-like changes may be a rare cause of caudate hemorrhage. A decrease in moyamoya vessels with bypass surgery may reduce the risk of recurrent hemorrhage.
Postpartum cerebral angiopathy with cerebral infarction due to ergonovine use.
Authors: Barinagarrementeria F , Cantú C , Balderrama J 
Published: June 2011

Earlier cases of stroke due to postpartum cerebral angiopathy have been reported. The mechanism of this angiopathy has not been explained.
We present a case of cerebral infarction with evidence of occlusive change in the vertebrobasilar system as a complication of intravenous ergonovine use after cesarean section delivery.
Ergonovine therapy is a likely cause of so-called postpartum cerebral angiopathy and stroke.
Autosomal dominant leukoencephalopathy and subcortical ischemic stroke. A clinicopathological study.
Authors: Baudrimont M , Dubas F , Joutel A , Tournier-Lasserve E , Bousser M G 
Published: June 2011

We recently described an autosomal dominant syndrome characterized mainly by recurrent strokes and neuroimaging evidence of leukoencephalopathy. We now report the pathological findings in one of the affected subjects.
A 40-year-old woman experienced her first grand mal seizure in 1971. From 1983 on she suffered recurrent strokes, seizures, and psychiatric disturbances with depressions, manic episodes, and dementia. In 1988, after her fourth stroke, she became tetraplegic with a severe pseudobulbar palsy, and she died in 1990. Pathological examination disclosed a recent capsulolenticular hematoma, multiple small deep infarcts, a diffuse myelin loss and pallor of the hemispheric white matter, and a widespread vasculopathy of the small arteries penetrating the white matter. The arterial wall was markedly thickened with an extensive nonamyloid eosinophilic deposit in the media and reduplication of the internal elastic lamella.
The underlying lesion of this hereditary disorder is located in the small arteries and is of unknown etiology. It differs from arteriosclerotic and amyloid angiopathies but is similar to that described in some cases of hereditary multi-infarct dementia.
Lobar hemorrhage in the elderly. The undiminishing importance of hypertension.
Authors: Broderick J , Brott T , Tomsick T , Leach A 
Published: June 2011

We sought to determine whether hypertension is less common in primary lobar hemorrhage than intracerebral hemorrhage in other locations and whether the frequency of hypertension in lobar hemorrhage diminishes with advancing age.
We identified all cases of intracerebral hemorrhage in Greater Cincinnati during 1988 by review of hospital and autopsy records as well as computed tomographic and magnetic resonance scans.
During 1988, 66 primary lobar hemorrhages occurred, constituting 46% of all intracerebral hemorrhages in those under 75 years of age and 34% in those age 75 and older. A history of hypertension was present in 67% of patients with lobar, 73% of those with deep, 73% of those with cerebellar, and 78% of those with pontine hemorrhages. Left ventricular hypertrophy was present in 21% of patients with lobar, 27% of those with deep, and 47% of those with pontine/cerebellar hemorrhages. The frequency of hypertension in patients with lobar hemorrhage did not decrease with advancing age.
The proportion of all intracerebral hemorrhages that are lobar does not increase with advancing age. Hypertension is nearly as common in primary lobar hemorrhage as in deep, cerebellar, and pontine hemorrhages, and its importance as an associated condition for lobar hemorrhage does not diminish with advancing age.
Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment.
Authors: Gowland C , Stratford P , Ward M , Moreland J , Torresin W , Van Hullenaar S , Sanford J , Barreca S , Vanspall B , Plews N 
Published: June 2011

The Chedoke-McMaster Stroke Assessment measures the physical impairments and disabilities that impact on the lives of individuals with stroke. This measure has three overall purposes: 1) to stage motor recovery to classify individuals in terms of clinical characteristics, 2) to predict rehabilitation outcomes, and 3) to measure clinically important change in physical function. This study was carried out to evaluate the ability of this measure to yield reliable and valid results.
Thirty-two subjects from a stroke rehabilitation treatment unit were assessed by research and treating physical therapists using multiple measures on multiple occasions. The measure's three purposes dictated the study objectives and design.
Intrarater, interrater, and test-retest reliabilities of the impairment and disability inventories were estimated. Reliability coefficients for the total scores ranged from 0.97 to 0.99. Construct and concurrent validities were studied by examining the correlations between this and other measures. A priori hypothetical constructs stated that these correlations should exceed 0.60. These constructs were confirmed; the impairment inventory total score was found to correlate with the Fugl-Meyer Test (r = 0.95, p < 0.001) and the disability inventory with the Functional Independence Measure (r = 0.79, p < 0.05). Additional study hypotheses were also substantiated.
This study confirms that the Chedoke-McMaster Stroke Assessment yields both reliable and valid results. With the evaluation study now completed, the Chedoke-McMaster Stroke Assessment can be used with confidence as both a clinical and a research tool that can discriminate among subjects and evaluate patient outcomes.
Efficacy of ticlopidine and aspirin for prevention of reversible cerebrovascular ischemic events. The Ticlopidine Aspirin Stroke Study.
Authors: Bellavance A 
Published: June 2011

This subgroup analysis from the Ticlopidine Aspirin Stroke Study (TASS) compared ticlopidine, a new antiplatelet agent, with aspirin for the prevention of recurrent transient ischemic attacks in patients who had a recent reversible cerebrovascular event.
This was a multicenter, double-blind, randomized trial in patients with a recent cerebral ischemic history. Patients with a reversible cerebral ischemic event within 3 months of enrollment were eligible for the study. All patients received either aspirin 650 mg twice daily or ticlopidine 250 mg twice daily for up to 5.8 years. The primary end point in this analysis was the first occurrence of a reversible ischemic event either alone or combined with nonfatal stroke or death and fatal or nonfatal stroke.
Overall, ticlopidine was better than aspirin for reducing the risk of reversible ischemic events either alone or as a composite with death and/or stroke or with fetal and/or nonfatal stroke (P = .007 to P < .001). The risk reductions with ticlopidine were maintained for the duration of the 5-year follow-up. The most frequent or clinically important adverse effects associated with ticlopidine were diarrhea, rash, and neutropenia. Neutropenia was severe in 13 patients but resolved promptly with discontinuation of therapy.
The results in this subgroup of patients with reversible ischemic disease, as well as the overall analysis of TASS, suggest that ticlopidine is a more effective agent than aspirin for the prevention of recurrent transient ischemic attacks.