Migrainous cerebral infarction in a previously healthy 93-year-old female patient with no risk factors for stroke.
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Aged, 80 and over↗
Biomedical subjects
L Thomassen
Publications and source records attributed to L Thomassen.
The yield of expanding the therapeutic time window for tPA.
OBJECTIVES: Intravenous thrombolysis with recombinant tissue plasminogen activator (tPA) for acute ischemic stroke has been proved to be effective when given within 3 h of onset of stroke symptoms. Partly due to this time limit, less than 10% of stroke patients are treated with tPA. This study assessed the potential for increased tPA utilization with a theoretical time limit of 6 h. MATERIALS AND METHODS: A total of 117 patients admitted with a diagnosis of acute cerebrovascular disease were prospectively registered over a 3-month period, with emphasis on timing and criteria for tPA treatment. RESULTS: Eighty-eight of 117 patients (75%) had an acute ischemic stroke. Of these, 23% arrived within 3 h, 8% within 3-6 h, and 69% later than 6 h after symptom onset. Of the seven patients in the 3-6 h group, only one had time delay as the only contraindication to tPA. CONCLUSIONS: This study suggests that reducing patient delay, rather than increasing the time limit for thrombolytic treatment, may increase the frequency of tPA utilization. Changing time limits for thrombolysis may reduce time delay from stroke onset to arrival in hospital due to more rapid handling of patients by the emergency medical services.
Acute Disease↗
Do all young ischemic stroke patients need long-term secondary preventive medication?
After a mean of 6 years, the frequencies of later vascular events (recurrent ischemic stroke or myocardial infarction) in 232 young ischemic stroke patients (younger than 50 years) with none to five traditional risk factors were 2.1%, 6%, 19%, 26%, 30%, and 67% (p < 0.001). Long-term secondary preventive medication may not be indicated in young ischemic stroke patients with no risk factor.
Adolescent↗
Mild depression in young adults with cerebral infarction at long-term follow-up: a population-based study.
We sought to evaluate the prevalence of and risk factors for post-stroke depression (PSD) at long-term follow-up in young adults aged 15-49 years with first-ever cerebral infarction in a population-based study. Scores on Montgomery-Asberg Depression Rating Scale (MADRS) were obtained at follow-up (mean time 6.0 years after the stroke) and analysed in subgroups. MADRS scores were obtained in 196 of 209 surviving patients. PSD (MADRS>or=7) was detected in 56 patients (28.6%). None had severe PSD. Alcoholism (P=0.006), depressive symptoms any time before the index stroke (P=0.016), and severe neurological deficits on admission for the index stroke (P=0.043) were independently associated with PSD. PSD seems milder in young ischaemic stroke patients compared with older patients. Alcoholism, depression any time before the index stroke, and severity of neurological deficits on admission for the stroke increased the risk of developing PSD in the long run.
Adolescent↗
Doppler ultrasound and clinical findings in patients with acute ischemic stroke treated with intravenous thrombolysis.
The aim of this study was to assess cerebral hemodynamics in patients with acute ischemic stroke undergoing thrombolytic therapy and to assess the relationship between cerebral hemodynamics and outcome. Forty-one unselected patients admitted to hospital within 3 h received intravenous thrombolytic therapy and were examined by extracranial and transcranial Doppler ultrasound examinations. Their strokes were clinically graded with the National Institute of Health Stroke Scale. Outcome after 3 months was graded with the modified Rankin Scale. Amongst the 27 patients who had an additional ultrasound examination 24 h after treatment, favorable outcome was significantly more common amongst patients with recanalization than amongst those without (P < 0.004). Thirteen patients with middle cerebral artery occlusions were continuously monitored during thrombolysis and frequently up to 5 h after start of thrombolysis. Early recanalization occurred in nine (69%), at a median delay of 178 min (range 140-287) after stroke onset. All of these nine patients had a favorable outcome. Recanalization within 24 h was associated with favorable outcome. Subgroup analysis suggests that this effect is mostly related to early recanalization within the first 5 h after stroke. Transcranial Doppler may therefore help to identify those patients most probably to benefit from thrombolysis, especially in those patients with a higher potential risk of complications.
Combined Modality Therapy↗
IL-6: an early marker for outcome in acute ischemic stroke.
OBJECTIVES: Inflammation plays an important role in the pathophysiology of stroke. We correlated interleukin (IL)-6, IL-10, C-reactive protein (CRP) and T-lymphocyte subtype levels in acute ischemic stroke patients with stroke volume and clinical outcome. MATERIALS AND METHODS: Blood samples were obtained from 11 patients at defined intervals during 1 year. Nine healthy age-matched subjects served as controls. IL-6, IL-10 and CRP were quantified by enzyme-linked immunosorbent assay and T lymphocytes by flow cytometry. Volume measurement was carried out by computed tomography or magnetic resonance imaging and clinical outcome was scored by the European stroke scale (ESS) and Barthel index (BI). RESULTS: IL-6 levels were increased in the acute phase of stroke compared with healthy controls (P = 0.002) and correlated with larger stroke volume (P = 0.012) and less favorable prognosis after 1 year, measured by ESS (P = 0.014) and BI (P = 0.006). IL-10, CRP and T-lymphocyte subtypes in the acute phase were not correlated with stroke volume or clinical outcome. CONCLUSION: IL-6 seems to be a robust early marker for outcome in acute ischemic stroke.
Acute Disease↗
Etiology of and risk factors for cerebral infarction in young adults in western Norway: a population-based case-control study.
We sought to study the etiology of and risk factors for cerebral infarction in young adults in Hordaland County, Norway. All patients aged 15-49 years living in Hordaland County with a first-ever cerebral infarction during 1988-97 were included. Etiology was analyzed in subgroups defined by sex, age (<40 years versus >/=40 years), circulation territory (anterior versus posterior circulation) and short-term functional outcome [modified Rankin score (mRS) </= 2 versus mRS > 2]. A questionnaire was used to evaluate possible risk factors amongst the patients compared with an age- and sex-matched control group. The distribution of etiology was significantly different in all subgroups. Atherosclerosis was frequent amongst men (22.8% vs. 4.2%) and patients >/= 40 years (20.8% vs. 2.7%). All patients with microangiopathy had favorable short-term outcome. Significant risk factors were smoking more than 15 cigarettes per day (P < 0.001), hypertension (P = 0.001), and myocardial infarction (P = 0.035). Modifiable risk factors were frequent.
Adolescent↗
Long-term outcome of cerebral infarction in young adults.
OBJECTIVES: We analysed the long-term outcome of 232 young adults aged 15-49 years with first-ever cerebral infarction in 1988-1997 in western Norway. MATERIAL AND METHODS: Mortality, recurrence, epilepsy, functional state as evaluated by modified Rankin scale (mRS), and employment were analysed at follow-up (mean time 5.7 years). RESULTS: Twenty-three (9.9%) patients had died. Recurrence occurred in 9.9%, and post-stroke seizures developed in 10.5%. Recurrence was associated with diabetes mellitus (P = 0.005). Favourable functional outcome (mRS = 2) was found in 77.9%. The functional outcome was better in posterior than anterior circulation infarctions (P = 0.011). Unfavourable functional outcome (mRS > 2) was associated with diabetes mellitus (P = 0.001) and severity of neurological deficits on admission for the index stroke (P < 0.001). Only 58.3% were employed at follow-up. CONCLUSION: This population-based study shows that, although the majority had favourable functional outcome, cerebral infarction had major long-term impact on young adults as evaluated by mortality, recurrence and employment status.
Adolescent↗
Acute stroke treatment in Europe: a questionnaire-based survey on behalf of the EFNS Task Force on acute neurological stroke care.
In 1997 the EFNS Task Force on Acute Neurological Stroke Care published its recommendations for acute stroke care (Brainin et al., 1997), which, in 1999, was followed by a stroke care inventory (Brainin et al., 2000) assessing the development of acute stroke care. In 2000 all 33 members of the EFNS Stroke Scientist Panel were asked to complete a questionnaire on the treatment of acute stroke in their country as of 2000. Data were based either on national surveys or a personal estimate of national practice, together with data from the personal practice of the panel member. Data from 22 countries were received. One of the principal findings is the lack of systematic evidence about practice in a significant number of European countries. Results illustrate that neurologists have a leading role in implementing acute stroke treatment guidelines and in adopting new therapeutic methods in most countries, but there is a wide variation in the application of different therapeutic procedures.
Advisory Committees↗
Incidence and short-term outcome of cerebral infarction in young adults in western Norway.
BACKGROUND AND PURPOSE: We sought to determine the incidence and short-term outcome of people aged 15 to 49 years with first-ever cerebral infarction in 1988-1997 in Hordaland County, Norway. METHODS: Cases were found from computer search of hospital registries and detailed review of patient records. Stroke subtype was classified according to the major intracranial artery affected. Short-term outcome was evaluated by the modified Rankin Scale (mRS). RESULTS: A total of 96 women and 136 men met the inclusion criteria. The average annual incidence was 11.4/100 000. Women outnumbered men among those aged <30 years (P=0.059); men predominated among those aged > or =30 years (P=0.004). A total of 148 patients had anterior circulation infarction (64%), and 84 had posterior circulation infarction (36%) (P<0.001). Patients with posterior circulation infarction had better mRS score at discharge (P=0.005). Eighty percent had favorable outcome (mRS score < or =2). The 30-day case fatality rate was 3.4%. The recurrence rate in hospital was 2.2%. CONCLUSIONS: The incidence was in the lower range compared with other reports from western Europe. Although men predominated, there was a strong trend toward more women among patients aged <30 years. Short-term outcome was generally good. Patients with posterior circulation infarction had significantly better short-term outcome.
Adolescent↗
[Intravenous thrombolytic treatment of acute basilar artery occlusion].
BACKGROUND: Acute stroke with basilar artery occlusion is a serious condition with high mortality and severe disability. MATERIAL AND METHODS: We describe three patients with acute artery basilar occlusion treated with thrombolytic agent given intravenously. RESULTS: One patient demonstrated early and considerable clinical improvement parallel to thrombolytic therapy started two and a half hour after ictus, but suffered a new occlusion and died in a "locked-in syndrome". One patient demonstrated moderate clinical improvement after less than six hours and survived with disability. One patient demonstrated no clinical improvement with thrombolytic therapy started six hours after ictus and later died of an injured brainstem. No patients had serious bleeding. INTERPRETATION: Intravenous, systemic thrombolytic treatment may have a beneficial effect in acute basilar occlusion.
Adult↗
[Early CT changes in acute cerebral infarction].
BACKGROUND: The aim of this study was to evaluate neurological clinical findings and cerebral computed tomography (CT) findings in patients with acute stroke within six hours after stroke onset. MATERIAL AND METHODS: 42 patients with presumed stroke in the middle cerebral artery territory were clinically assessed with the Scandinavian Stroke Scale Score. CT scans were assessed in a standardized manner by one neuroradiologist. RESULTS: The clinical deficit did not forecast the CT findings. Patients with several early CT signs of ischaemia, and especially those with hypodensity in less than one third of the middle cerebral artery area had lower clinical scores than patients with fewer signs. Hypodensity in the insular region was the overall most frequent finding. INTERPRETATION: Clinical findings do not give definite information about the ischaemic damage in the acute phase of cerebral infarction. CT scans may give valuable information primarily when there are positive findings.
Acute Disease↗
[Early CT signs in acute cerebral ischemia].
BACKGROUND: Patients who suffer from acute stroke should be examined with computed tomography (CT) of the brain immediately after admission. If evaluated systematically, this examination may give more information than just "bleeding excluded". MATERIAL AND METHODS: CT scans of the brain in four patients with acute ischaemic stroke admitted to our department illustrate the typical early CT signs in acute cerebral ischaemia. RESULTS: This article describes the systematic evaluation of a CT in acute stroke, when the following questions need to be answered: Is there a hyperdense middle cerebral artery sign (HMCAS), or hypodensity in other major intracranial arteries? Is there a hypodensity in the basal ganglia? Is there hypodensity (loss of cortical-subcortical discrimination) or oedema (decreasing volume of the Sylvian fissure) in the insular region? Is there hypodensity (loss of cortical-subcortical discrimination) or oedema (effacement of sulci or compression of ventricles) in other parts of the distribution of the middle cerebral artery or other arteries? INTERPRETATION: An early CT in acute stroke patients may yield valuable information if evaluated properly. The presence or absence of early CT sign have implications for diagnosis, prognosis, choice of supplementary examinations, and choice of treatment.
Acute Disease↗
Thrombolysis for acute ischemic stroke: a consensus statement of the 3rd Karolinska Stroke Update, October 30-31, 2000.
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Brain Ischemia↗
The impact of M-component type and immunoglobulin concentration on the risk of malignant transformation in patients with monoclonal gammopathy of undetermined significance.
BACKGROUND AND OBJECTIVES: In this study the impact of gender, age, type of M-component and concentration of immunoglobulins on the risk of malignant transformation in monoclonal gammopathy of undetermined significance (MGUS) was assessed. DESIGN AND METHODS: We identified 1,247 cases of MGUS in the period 1978 to 1993 in North Jutland County, Denmark. Data on cancer occurrence in the MGUS cohort were obtained from the Danish Cancer Registry. The expected numbers of incident cancer cases were calculated from age-, sex-, county-, and period-specific cancer incidence rates. The impact of the variables mentioned above on the risk of malignant transformation was analyzed in Poisson regression models. RESULTS: The relative risk of IgA compared to IgG was 1.8 (95% confidence interval, 1.1-3.0), while the relative risk of IgM compared to IgG was 1.1 (0.7-1.9). For all three types of MGUS, the risk of malignant transformation was higher among females than among males, and the risk increased with increasing concentration of immunoglobulin with very high risks for the patients with the highest levels of immunoglobulin. Hypogammaglobulinemia was associated with malignant transformation in patients with IgG type MGUS. For IgG and IgM MGUS, the risk decreased with increasing age and with follow-up beyond one year. INTERPRETATION AND CONCLUSIONS: Female sex, IgA M-component type and high concentration of the immunoglobulin comprising the M-component were associated with a high risk of malignant transformation. Hypogammaglobulinemia, young age at diagnosis and short follow-up were risk factors in particular for those with IgG MGUS.
Adolescent↗
[Thrombolysis in cerebral infarction].
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Cerebral Infarction↗
[Thrombolysis in cerebral infarction].
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Cerebral Infarction↗