Stroke; a journal of cerebral circulation
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Elevated glutamate levels are thought to be a primary cause of neuronal death after global cerebral ischemia. The purpose of this study was to investigate the potential neuroprotective effects of lamotrigine, a novel antiepileptic drug that inhibits the release of glutamate in vitro, with both behavioral and histological measures of global ischemia in gerbils. ⋯ Lamotrigine had neuroprotective effects in a gerbil model of global cerebral ischemia. Lamotrigine protected gerbils against behavioral deficits resulting from 15 minutes of carotid occlusion and also prevented histological damage resulting from 5 and 15 minutes of global cerebral ischemia.
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Comparative Study
Transcranial Doppler sonography and magnetic resonance angiography in the assessment of collateral hemispheric flow in patients with carotid artery disease.
The aim of this investigation was to compare the respective efficacy of transcranial Doppler sonography (TCD) and magnetic resonance angiography (MRA) for the assessment of intracranial hemodynamics in patients with extracranial occlusion or severe stenosis of the internal carotid artery (ICA). ⋯ TCD and MRA should be considered complementary techniques. Combining the findings of both examinations may help to better understand the changes in intracranial hemodynamics produced by extracranial carotid occlusion. The contribution of the ophthalmic pathway, although important for the intraorbital structures, is probably of limited functional significance to the hemispheric blood supply.
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In Lithuania, only routine mortality statistics have thus far provided data on the epidemiology of stroke. This study aims to assess the mortality, incidence, and case-fatality rate of stroke in the city of Kaunas, Lithuania, during 1986 to 1988. ⋯ The findings from this first assessment of the incidence and mortality of stroke show that in the mid-1980s both were high in Kaunas compared with other countries. The case-fatality rate was similar to that reported for most other European countries. Further investigations are being carried out to assess the trends in mortality, incidence, and risk factors of stroke in the Kaunas population.
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Free radical scavengers enhance neuronal survival in some models of transient forebrain ischemia. Recent experiments have suggested that N-acetylcysteine prevents cellular injury after a reperfusion injury. No information is available regarding the neuroprotective potential of the free radical scavenger N-acetylcysteine after transient forebrain ischemia. In this study we evaluated the potential of N-acetylcysteine to improve hippocampal neuronal survival after transient forebrain ischemia in the rat. ⋯ N-Acetylcysteine partially improved neuronal survival when administered before or after ischemia following transient cerebral ischemia (mean arterial blood pressure, 45 mm Hg) but not with a more severe ischemic insult of 10 minutes of transient cerebral ischemia with a mean arterial blood pressure of 30 mm Hg.
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Acute ischemia in the territory of the carotid artery can lead to massive cerebral edema with raised intracranial pressure and progression to coma and death due to uncal, cingulate, or tonsillar herniation. Thus far, only anecdotal experience with supratentorial ischemia treated by decompressive craniectomy has been reported; and there are no published experimental data dealing with this kind of therapy in acute supratentorial stroke. In this study, we present our results on the effect of decompressive craniectomy in an endovascular model of cerebral infarction in rats. ⋯ Our results suggest that decompressive craniectomy for cerebral ischemia not only reduces mortality but also significantly improves outcome and reduces infarction size, probably because of increased perfusion pressure through leptomeningeal collaterals. This experimental study suggests that a controlled study of decompressive craniectomy in patients with acute internal carotid or middle cerebral artery occlusion would be worthwhile. By performing decompressive craniectomy in a small, selected group of patients, neurosurgeons may play an important role in the management of these patients.