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Biomedical subjects

N M Bornstein

Publications and source records attributed to N M Bornstein.

At least 55 records · Page 3Linked to original sources
PubMed1995

Parkinsonism in patients with lucanar infarcts of the basal ganglia.

Forty-five patients with CT findings of lucanar infarcts in the basal ganglia (LIBG) were included in this study. The patients were divided into those with lacunes in the caudate nucleus, lentiform nucleus or both caudate and lentiform nuclei. Linear measurements of ventricular spaces were also performed. Clinical evaluation disclosed parkinsonism in 17 patients (38%), strokes with contralateral hemiparesis in 14 (31%), while 9 (20%) had both parkinsonism and hemiparesis. The location and number of infarcts did not correlate with the clinical presentation. We conclude that LIBG are commonly associated with parkinsonism and that CT studies may help in the delineation of vascular parkinsonism.

Aged↗
PubMed1994

EEG as predictor of dementia following first ischemic stroke.

INTRODUCTION: Predictive factors for occurrence of vascular dementia may help identify patients at increased risk of developing this condition. Our purpose was to evaluate the prognostic value of early EEG findings in patients after first ischemic cerebral stroke on the development of dementia. MATERIAL AND METHODS: We performed routine EEG recordings in 199 consecutive non-demented patients with first-ever ischemic stroke, within 48 h of the event. The patients were subsequently followed for their mental state for 2 years. Survival analysis, wherein onset of dementia was the end-point, was performed on the total sample population and conducted separately on those who had normal EEG at time of the event and on those who had abnormal EEG findings (focal or diffuse slowing). RESULTS: Patients with abnormal EEG at baseline had 2.6 times the risk of developing dementia than those who had normal EEG; this odds ratio was statistical significant (CL: 1.3-5.1, p = 0.003). Development of dementia was not related to any specific EEG abnormal pattern. CONCLUSIONS: Abnormal EEG performed close to the first ischemic stroke appears to be an indicator of subsequent cognitive decline, probably because it indicates cortical involvement by the stroke or an underlying indolent cerebral degeneration.

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PubMed1994

Basal ganglia lacunes and parkinsonism.

'Arteriosclerotic' parkinsonism is still a subject of debate. The aim of this study was to investigate whether parkinsonism associated with basal ganglia lacunes possesses peculiar clinical features and a clinical course which enables its distinction from idiopathic Parkinson's disease (IPD). 106 consecutive ambulatory patients with the clinical diagnosis of parkinsonism were referred for CT examination. Patients in whom isolated basal ganglia lacunes were found were interviewed and examined, and their clinical characteristics were compared to those of patients suffering from IPD without lacunes (controls). In 20 patients, isolated basal ganglia lacunes were detected; all had risk factors for stroke (significantly more than controls) and 7 of them had had clinically diagnosed strokes. The extrapyramidal disability evolved slowly in all. The clinical picture was indistinguishable from IPD in individual patients. However, tremor was significantly less frequent in this group. Lower body parkinsonism was not observed. Extra-pyramidal signs were frequently asymmetrical (55%), with no consistent relationship to the side of the lacune. Asymmetrical pyramidal signs were present in 30% of those with unilateral lacunes, always on the appropriate side. Only 1 patient was an L-dopa nonresponder. Patients with parkinsonism associated with basal ganglia lacunes showed tremor less frequently than other IPD patients; otherwise, clinical features and course of the disease were indistinguishable from IPD. In these cases, parkinsonism and basal ganglia lacunes might have occurred independently of each other and tremor might have been prevented by ischemic events.

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PubMed1994

Failure of aspirin treatment after stroke.

BACKGROUND AND PURPOSE: Despite its low efficacy, aspirin is the most widely used drug for secondary stroke prevention. The reasons why stroke recurs while patients are on aspirin are unknown. We have analyzed a series of patients who had recurrent strokes while on aspirin. METHODS: Out of 2231 consecutive patients who were admitted to the Tel Aviv Medical Center from May 1988 through December 1992 with the diagnosis of ischemic stroke, 129 admissions were due to recurrent ischemic strokes while the patients were already on aspirin, and these were defined as aspirin failures. The clinical characteristics of those patients in whom aspirin treatment failed were compared with three control groups, each comprising 129 patients who had had only a single ischemic stroke and were then taking aspirin. One control group was matched for aspirin dose and date of first stroke; another control group was matched for age, sex, and date of first stroke; and a third control group was matched for age, sex, date of first stroke, and aspirin dose. Statistical analysis was carried out by two-tailed Student's t test and chi 2 test. RESULTS: The average period until stroke was longer for patients on higher aspirin doses. Patients matched for aspirin dose and date of first stroke did not differ significantly in age (72.4 years in aspirin failures versus 74.2 years in the first control group) and sex (89 versus 94 men, respectively). Matching for age, sex, and date of first stroke but not for aspirin dose demonstrated a trend toward high frequency of aspirin failure in patients taking lower doses of aspirin (chi 2 test for trend = 3.5; P = .06). Comparison of aspirin-failure patients with a control group matched for age, sex, date of first ischemic stroke, and aspirin dose demonstrated that these patients more commonly had statistically significant hyperlipidemia (odds ratio, 2.6; 95% confidence interval, 1.0 to 6.8; P = .04) and ischemic heart disease (odds ratio, 2.3; 95% confidence interval, 1.3 to 3.9; P = .002). CONCLUSIONS: We conclude that age and sex do not influence the efficacy of aspirin. Lower aspirin dose in patients with stroke recurrence suggests that aspirin doses of 500 mg daily or more should be used in secondary stroke prevention. Hyperlipidemia and ischemic heart disease are risk factors for stroke recurrence despite aspirin treatment, which requires further clinical and laboratory evaluation.

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PubMed1994

Interrater agreement in evaluation of stroke patients with the unified neurological stroke scale.

BACKGROUND: We sought to determine interrater agreement in evaluation of stroke patients with the Unified Form for Neurological Stroke Scales (UFNSS). SUMMARY OF REPORT: Fifty inpatients were independently examined by three neurologists. Kendall coefficients of concordance were computed for the different items of the UFNSS. There was a high concordance among the raters. The best agreements were obtained for motor functions and the worst for grading of eye movements. CONCLUSIONS: The UFNSS was shown to be reliable for evaluation of motor functions, verbal communication, orientation, and vigilance in stroke patients.

Arousal↗
PubMed1993

The use of transcranial Doppler in the hemodynamic assessment of implanted pacemakers.

Twenty patients with DDD pacemakers had their intracranial cerebral circulation assessed in different pacing modes, using transcranial Doppler. The studies were performed at the vertebral artery in a sitting position. Although DDD pacing was preferred to VVI pacing in 18 of the 20 patients, the figures did not reach statistical significance. There was no statistical difference in maximal blood flow velocity between DDD pacing at 60 and 80 beats/min. Varying the AV interval from 150-250 msec also demonstrated no clear difference in maximal peak Doppler velocity, in the group as a whole, though there was a greater individual preference for 150 msec. Transcranial Doppler assessment of the hemodynamics of the cerebral circulation is of limited value as an indicator of mode or rate preference in the pacemaker population.

Adult↗
PubMed1993

Evolution and management of asymptomatic carotid stenosis.

About 4% of adults have asymptomatic neck bruits, and this frequency increases with age. Only a small number of these (about 25%), however, have asymptomatic carotid stenosis (ACS), and only 10% of these have stenoses > 75%. The vascular outcome for patients with ACS depends upon the severity of carotid stenosis, all outcomes worsening after 75-80% stenoses. For stenoses < 50%, annual stroke rate is about 1% and does not change in stenoses 50-75%, but over 75%, annual stroke rate increases to 3.3% per year. Ischaemic cardiac event rate is 2.7% annually for stenoses < 50%, 6.6% for those 50-75%, and 8.3% for stenoses > 75%. Annual vascular death rates also rise from 1.8%, 3.3% and 6.5% respectively. Stroke risk factors such as hypertension and smoking are important in early plaque formation, but when plaques become stenosing, local hemodynamic factors such as turbulence are the major factors in arterial remodelling. No medical or surgical therapy has yet been found effective, but current surgical randomized trials may reveal the answer in the near future.

Adult↗
PubMed1992

Management of patients with asymptomatic neck bruits and carotid stenosis.

The role of extracranial occlusive lesions in the pathogenesis of ischemic stroke is well established. The management of asymptomatic carotid bruit or stenosis is still highly controversial, however. This article reviews in detail the currently available data in order to assist clinicians in the management of patients with asymptomatic neck bruits or stenosis.

Auscultation↗
PubMed1991

Vascular risks of asymptomatic carotid stenosis.

BACKGROUND AND PURPOSE: We sought to determine the risks of stroke, myocardial ischemia, and vascular death in patients with asymptomatic carotid stenosis. METHODS: Six hundred ninety-six patients with asymptomatic carotid stenosis referred to the Doppler laboratory were followed prospectively for a mean time of 41 months. These patients were studied both clinically and by carotid Doppler ultrasound, including evaluation of the effect of stroke risk factors. RESULTS: Transient ischemic attacks occurred in 75 patients and stroke in 29, while 132 had ischemic cardiac events. Five patients died from stroke and 59 from cardiac causes. Annual stroke rate was 1.3% in patients with carotid stenosis less than or equal to 75% and 3.3% in those with stenosis greater than 75%. Ipsilateral stroke rate was 2.5% in patients with greater than 75% carotid stenosis. Annual cardiac event rate was 8.3% and death rate 6.5% in patients with severe carotid stenosis. CONCLUSIONS: With carotid stenosis less than or equal to 75%, the stroke rate is negligible (1.3% annually) whereas the combined risk of cardiac ischemia and vascular death is as high as 9.9%. With stenosis greater than 75%, combined transient ischemic attack and stroke rate is 10.5% per year, with 75% of events ipsilateral to the stenosed artery.

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PubMed1990

Clinical significance of carotid plaque hemorrhage.

We correlated the clinical and pathologic findings in 77 consecutive carotid plaques removed at endarterectomy to determine the clinical role of intraplaque hemorrhage. Intraplaque hemorrhages of various severity were seen in 86% of plaques. They were, for the most part, deeply located (63%) and infrequently connected with the lumen. They related closely to the severity of carotid stenosis, but bore no relationship to the timing of symptoms. Luminal thrombus was infrequently seen, and was always microscopic. Hemorrhage into carotid plaque appears to represent an index of the severity of the stenosis and plaque instability rather than to play a direct role in the pathogenesis of transient ischemic attacks or stroke.

Aged↗
PubMed1990

The clinical role of the cerebral collateral circulation in carotid occlusion.

The occurrence and severity of ischemic cerebral symptoms after carotid occlusion depends on the interdependency of cerebral collateral blood supply. Only those with the "fittest" collateral capacity survive this process of natural selection. Using the transcranial Doppler method in 55 patients with unilateral carotid occlusion, we tested the dependency of each cerebral hemisphere on the remaining patent carotid artery by digital carotid compression, and in 41 of these patients we also tested the carbon dioxide reactivity in each hemisphere. Both hemispheric dependency and carbon dioxide reactivity were compared to 15 healthy controls. Mean blood flow velocities in the middle cerebral artery were lower on the occluded side than on the patent side (p less than 0.003). When the patent carotid artery was compressed middle cerebral artery blood flow velocities on the occluded side were mainly independent of the patent carotid artery, but on the patent side there was a high degree of dependency (p less than 0.0001). Carbon dioxide reactivity did not differ between the hemispheres, but in hemispheres with total dependency, carbon dioxide reactivity was inversely proportional to the severity of stenosis (r = -0.63). Tests of cerebral collateral reserve in patients with unilateral carotid occlusion evaluated by carotid compression and cerebral carbon dioxide reactivity may discriminate between survivors and potential nonsurvivors before the patent carotid artery occludes.

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PubMed1989

Cerebrovascular symptoms in thromboangiitis obliterans.

Forty-six consecutive patients with thromboangiitis obliterans were evaluated and examined for the presence of neurological symptoms during a cumulative follow-up period of 833 patient-years. Only one patient (2%), with no other risk factor for stroke, suffered an episode of transient aphasia and right hemiparesis at the age of 59. The diagnostic difficulties in the delineation of cerebral thromboangiitis obliterans are discussed. The rarity of the cerebral manifestations make it difficult to conclude that cerebrovascular manifestations are part of this disease.

Adult↗
PubMed1989

Benign outcome of carotid occlusion.

We followed 40 patients with unilateral carotid occlusion by serial clinical and Doppler evaluation for over 6 years. Two groups were identified: 19 patients had already occluded their arteries on entry to the study, and 21 progressed to occlusion during the course of the study. No strokes occurred in the first group during follow-up, and the annual stroke rate in the second group was 3.8% for the territory of the occluded artery and 5.7% for all vascular territories. Death rate was 6.6% annually for both groups, mainly cardiac. Transcranial Doppler with digital compression of each carotid artery demonstrated middle cerebral artery (MCA) dependent on the patent carotid being total in 50% and partial in 30%. There was no correlation between degree of stenosis and MCA dependency (r = -0.24). Our data on stroke risk in asymptomatic patients with unilateral carotid artery occlusion indicate a benign outcome.

Aged↗
PubMed1988

Increased platelet aggregation and release reaction in myotonic dystrophy.

Platelet aggregation (PA) induced by (-)-epinephrine and adenosine diphosphate (ADP) was studied in 16 patients with myotonic dystrophy (MyD) and 14 healthy subjects. Plasma beta-thromboglobulin level (beta-TG), a useful marker of in vivo platelet release reaction, as well as in vitro 5-[14C]hydroxytryptamine (5-HT) release, were also studied. The extent of PA induced by (-)-epinephrine at 1 and 3 min and by ADP at 3 min was significantly higher in the patients than in controls. Plasma beta-TG and ADP- or epinephrine-induced platelet 5-HT release were also increased in MyD patients. These results suggest that an abnormality in release as well as in alpha 2-receptor functioning occurs in the platelets of MyD patients. The relation of this abnormality to changes in Ca2+ fluxes through the platelet membrane is discussed.

Adenosine Diphosphate↗
PubMed1988

The limitations of diagnosis of carotid occlusion by Doppler ultrasound.

Duplex scanning has been advocated as an acceptable alternative to angiography in the preoperative evaluation of carotid artery stenosis. To evaluate the accuracy of carotid Doppler in differentiating severe carotid stenosis from occlusion, we compared the results of angiography with duplex scanning in 124 carotid arteries (62 patients) and with continuous-wave Doppler in 662 carotid arteries (331 patients). The specificity was 95-99%, sensitivity was 86-96%, and accuracy was 95-98%. Duplex scanning wrongly identified occlusion in four arteries and failed to detect occlusion in one artery. In making decisions prior to carotid endarterectomy, even infrequent errors are unacceptable. We recommend angiography of all surgical candidates with apparent severe stenosis when the internal carotid artery cannot be clearly identified on duplex, or to distinguish apparent occlusion from undetectably low blood flow.

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