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Biomedical subjects

J C Grotta

Publications and source records attributed to J C Grotta.

118 records · Page 7Linked to original sources
PubMed1979

Cerebral mucormycosis: an unusual case.

A 36-year-old obese woman with hyperglycemia and immunosuppression died of bilateral internal carotid artery occlusion associated with mucormycosis. This report describes a rare case in which cerebral mucormycosis occurred without the usual preceding clinical evidence of nasal and orbital infection.

Adult↗
PubMedDate not supplied

Baseline hemodynamic state and response to hemodilution in patients with acute cerebral ischemia.

Hemodynamic data were obtained in 9 patients (mean age 65 yrs) with carotid territory cerebral infarct within the preceding 24 hours (mean 14 +/- 8) as part of a pilot study testing the feasibility and safety of hypervolemic hemodilution. Pulmonary arterial catheters (PACs) were placed without complication in all patients, and after baseline measurements were obtained, up to 1500 cc of 6% hetastarch in 0.9% sodium chloride was administered the first day and up to 1000 cc per day the second and third days. Pulmonary wedge pressure (PWP) rose from 6.3 +/- 3.5 to 14.4 +/- 3.4 mm Hg (p less than 0.001) without development of congestive heart failure in any patient. This was accompanied by a drop in hematocrit (Hct) from 40.3 +/- 3.4 to 32.9 +/- 2.0 (p less than 0.001) and rise in cardiac output (CO) from 4.3 +/- 1.0 to 5.3 +/- 0.6 (p less than 0.05). Phlebotomy of 250 cc was performed in 2 patients and 500 cc in one in order to reduce Hct to desired levels. The volume of fluid needed to raise PWP to 15 was unpredictable (2361 +/- 1106 cc) and therefore PACs were necessary to monitor the rate and volume of fluid administration. The data show that PWP is sufficiently low and Hct sufficiently high following stroke in most patients that hemodilution by volume expansion with phlebotomy added if necessary can be undertaken safely with appropriate monitoring of hemodynamic function, and that this therapy results in optimal reduction of Hct and increased CO without risk of hypotension.

Acute Disease↗
PubMedDate not supplied

Can raising cerebral blood flow improve outcome after acute cerebral infarction?

Cerebral blood flow correlates poorly with outcome after stroke, and most therapies aimed at increasing cerebral perfusion have not succeeded in predictably reducing neurological deficit. Newer approaches such as hemodilution and thrombolysis may prove to be more effective but might be most advantageous if combined with efforts to correct postischemic disturbances in cellular metabolism.

Blood Viscosity↗
PubMedDate not supplied

Graded neurologic scale for use in acute hemispheric stroke treatment protocols.

A standardized neurologic assessment scoring instrument was developed and tested for use in a multicenter trial of hypervolemic hemodilution in acute hemispheric stroke. Components of the neurologic examination pertinent to hemispheric stroke syndromes were emphasized. The scale was evaluated using 16 acute stroke patients for concurrent validity (Pearson coefficient r = 0.89 compared with global assessments by neurologists or neurosurgeons) and interobserver reliability (r = 0.95 interobserver reliability estimate). Such a scale should prove useful in quantifying neurologic deficits in hemispheric stroke and in following changes in neurologic status during multicenter acute treatment protocols.

Acute Disease↗
PubMedDate not supplied

Spontaneous internal carotid artery dissection associated with fibromuscular dysplasia.

Spontaneous dissection of the internal carotid artery is a rare condition. It is not usually associated with underlying arterial disease. A case of spontaneous dissection associated with fibromuscular dysplasia of the internal carotid artery is described. After complete resolution of the dissection the patient was left with a classic picture of fibromuscular dysplasia on cerebral angiography. This was treated with a graduated dilatation of the right internal carotid artery with resolution of symptoms.

Adult↗