Articles: stroke.
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J Stroke Cerebrovasc Dis · Jan 1993
Diagonal earlobe creases and ischemic stroke: Preliminary report.
Diagonal earlobe creases are associated with coronary arterial disease, cardiac morbidity and mortality, and all-cause mortality. We studied the influence of earlobe creases on the incidence of ischemic stroke as well as the relationship between earlobe creases and gender, coronary arterial disease, hypertension, diabetes mellirus, and hypercholesterolemia. Data were obtained prospectively from the medical records of 116 patients with ischemic stroke and 232 age- and gender-matched patients without ischemic stroke. ⋯ In those with ischemic stroke, earlobe creases were significantly related to coronary arterial disease, diabetes mellitus, and nonlacunar ischemic stroke. The cumulative incidences of coronary arterial disease, hypertension, diabetes mellitus, and hypercholesterolemia were also significantly higher in those patients with earlobe creases who also had ischemic stroke. When controlled for coronary arterial disease, earlobe creases, in those with ischemic stroke, continued to be significantly related to nonlacunar ischemic stroke.
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Magnetic resonance imaging (MRI) findings in a group of 60 ambulatory elderly individuals (average age, 75.8 yr) were characterized as normal (grade 0), periventricular changes only (grade 1 ). small punctate lesions (grade 2), and confluent or large (> 2 mm) punctate lesions (grade 3). Patients were characterized by stroke risk factors, cardiolipin antibodies, coagulation factors (fibrinogen and plasminogen activator inhibitor-1 ). and Doppler ultrasound findings in the carotid and middle cerebral arteries. ⋯ There was no significant association between variables and MRI grade. These findings suggest that ischemia is not a major cause of MRI signal abnormalities in neurologically asymptomatic elderly individuals.
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Tha pathophysiology of brain injury in patients undergoing cardiopulmonary bypass remains unclear despite several decades of inquiry. The advent of noninvasive high-resolution brain and cerebrovascular imaging by magnetic resonance, computed tomography, and pulsed Doppler ultrasonography now permits in vivo assessment of pathophysiological mechanisms. Neuroradiographic and carotid duplex studies were performed in patients who developed neurological deficits following cardiopulmonary bypass. ⋯ Watershed injury was the predominant finding in a single patient, while findings consistent with global anoxia were present in another patient. Carotid atheroemboli were excluded as a possible source of embolism in 11 patients whose carotid duplex studies were unremarkable preoperatively as well as in 3 further patients whose neuroradiographic findings did not correspond with their moderate carotid disease. It is concluded that infarction due to noncarotid embolism is the primary pathophysiology of neurological deterioration following cardiopulmonary bypass.
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Atrial fibrillation and congestive heart failure are risk factors for ischemic stroke usually attributed to cardiac embolism. To define potential alternative mechanisms, patients with atrial fibrillation and congestive heart failure were investigated by transcranial Doppler. Middle cerebral artery (MCA) blood flow velocities were analyzed in neurologically asymptomatic patients with nonvalvular (n = 10) and valvular (n = 13) atrial fibrillation, patients in normal sinus rhythm with congestive heart failure (n = 13), and control subjects (n = 11). ⋯ Peak, mean, and diastolic MCA velocities in patients with atrial fibrillation and those with congestive heart failure were significantly less than those in control subjects. Patients with nonvalvular atrial fibrillation had a higher pulsatility index compared to each of the other three groups. These findings demonstrate substantial nonemboligenic alterations of the intracranial circulation associated with atrial fibrillation and congestive heart failure, and also provide an intracranial hemodynamic profile that may distinguish valvular from nonvalvular atrial fibrillation.