Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2002
Comparative StudyEarly detection of cerebral arterial occlusion on magnetic resonance angiography: predictive value of the baseline NIHSS score and impact on neurological outcome.
The presence of a thrombus on initial arteriography is directly related to the baseline NIHSS score. Magnetic resonance angiography (MRA) offers a noninvasive and rapid assessment of large cerebral vessel patency. We aimed at evaluating (1) the baseline NIHSS score as a tool for predicting the likelihood of an occluded artery on MRA and (2) the course of stroke within the first week according to the presence of a cerebral arterial occlusion. ⋯ Median day 0, day 1 and day 7 NIHSS score were, respectively, 18, 16 and 13 in patients who had an occlusion versus 7, 4 and 0 in patients who had no visible occlusion (p < 0.01). A direct relation between the baseline NIHSS score and the likelihood of the presence of an occlusion on initial MRA is demonstrated. The presence of a cerebral arterial occlusion on MRA is significantly linked to a poor neurological outcome.
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Cerebrovascular diseases · Jan 2002
Comparative StudyBlood pressure in acute stroke. The Copenhagen Stroke Study.
This study examines blood pressure (BP) and independent factors related to BP in the acute phase of stroke. The study is part of the community-based Copenhagen Stroke Study. In a multivariate regression model we analyzed the impact of clinical and medical factors on admission BP. ⋯ BP is not related to stroke severity. Several factors are independently related to the BP level in acute stroke. The clinical significance of this is yet to be tested, but these factors may contribute to the seemingly complex relation between BP and outcome.
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Cerebrovascular diseases · Jan 2002
ReviewFrom CURE to MATCH: ADP receptor antagonists as the treatment of choice for high-risk atherothrombotic patients.
Patients with a clinical manifestation of atherothrombosis such as a recent ischaemic cerebrovascular event are at high risk of subsequent events. Atherothrombosis often reflects disseminated disease; thus, further events may occur not only in the same arterial distribution but also in other vascular beds. To achieve adequate secondary prevention in these patients, long-term antiplatelet therapy with consistent benefit across the atherothrombosis spectrum is required. ⋯ Approximately 7,600 patients will be enroled, with treatment and follow-up for each patient lasting 18 months. The primary combined efficacy endpoint will be the first occurrence of an event in the composite of IS, MI, vascular death or rehospitalization for an acute ischaemic event during the follow-up period. MATCH will explore the potential benefit of clopidogrel in high-risk stroke/TIA patients and together with CAPRIE and CURE could provide further evidence of the long-term benefit of clopidogrel in patients with major atherothrombotic manifestations.
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Cerebrovascular diseases · Jan 2002
Comparative StudyCT patterns and long-term outcome in patients with an aneurysmal type of subarachnoid hemorrhage and repeatedly negative angiograms.
The fate of patients with subarachnoid haemorrhage, an aneurysmal pattern of haemorrhage on CT and two or more negative angiographies is unknown. We studied the long-term outcome of patients with three negative angiograms (n = 15) and compared the pattern of hemorrhage of these patients with that of patients with perimesencephalic hemorrhage (n = 73). We reviewed the CT scans of all patients and we followed up the patients with three negative angiograms. ⋯ Three patients subsequently had serious vascular events; one patient (with an extended perimesencephalic pattern) died suddenly; two patients with a pattern of hemorrhage suggestive of an anterior circulation aneurysm were left disabled, one from two episodes of cerebral ischemia and another from a spontaneous intracerbral hemorrhage. In contrast to patients with perimesencephalic hemorrhage who have an uneventful clinical course and an excellent outcome, patients with three negative angiograms and an aneurysmal pattern of hemorrhage are still at some risk of vascular complications and poor outcome. Subdivisions according to the center of hemorrhage once the anterior cisterns are involved is not helpful in identifying patients with good or poor outcome.
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Cerebrovascular diseases · Jan 2002
Dynamic single-section CT demonstrates reduced cerebral blood flow in acute intracerebral hemorrhage.
Optimum blood pressure (BP) management in acute intracerebral hemorrhage (ICH) remains controversial. BP reduction may limit hematoma expansion, but may also exacerbate ischemia. Reduced regional cerebral blood flow (rCBF) has been reported in ICH. ⋯ We conclude that CTP identifies a rim of reduced rCBF in ICH. A gradient of hypoperfusion appears to extend at least 4 mm beyond the hematoma edge and may be time dependent. Whether reduced CBF is associated with perihematoma ischemia requires additional study.