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N M Bornstein

Publications and source records attributed to N M Bornstein.

65 records · Page 4Linked to original sources
PubMed1988

Deep vein thrombosis after ischemic stroke: rationale for a therapeutic trial.

Deep venous thrombosis (DVT) in the legs occurs in 23% to 75% of patients with acute ischemic stroke, and pulmonary embolism accounts for about 5% of deaths. New heparinoid substances, lacking the hazards of more established anticoagulants, raise the question of DVT prophylaxis for these patients. Two hundred fifty consecutive acute ischemic stroke patients were evaluated for the presence of DVT of the legs in a feasibility study for a trial of low-molecular-weight heparin prophylaxis. Forty-nine patients were found suitable for the study, of whom 11 (22.5%) developed DVT. All patients underwent clinical examination, I-125 fibrinogen leg scanning, and impedance plethysmography. Five patients were sufficiently alert and without serious neurologic deficits to justify DVT prophylaxis. Recent advances in noninvasive diagnostic techniques to detect DVT early and the development of relatively safe heparinoid compounds increase the need for a prophylactic study in patients with ischemic stroke.

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PubMed1988

The value of carotid Doppler ultrasound in asymptomatic extracranial arterial disease.

Carotid Doppler is an accurate, safe and repeatable method of assessing arterial calibre, for distinguishing harmless neck bruits and to identify the stroke prone individual. It is completely non-invasive and can be used serially to monitor progression in carotid stenosis. It is a valuable clinical tool in diagnosis and management in patients at risk of stroke, but has definite limitations, such as in differentiating carotid occlusion from severe stenosis. B-mode imaging, although valuable in identifying arterial anatomy, and detecting plaques, cannot accurately evaluate the degree of stenosis. It is of limited value in identifying plaque hemorrhage and ulceration. Doppler ultrasound technology has advanced rapidly in the last decade, especially in the combination of B-mode imaging and Doppler (Duplex), as well as in evaluating of the intracranial circulation (transcranial Doppler). In the next decade, it may become the new gold standard for evaluating the extracranial and intracranial circulation.

Arterial Occlusive Diseases↗
PubMed1988

Basilar artery blood flow in subclavian steal.

Subclavian "steal", when blood siphons from one vertebral artery to the other, has been suggested as a cause of brain stem ischaemia and stroke. We investigated 33 patients using transcranial Doppler to determine the direction and velocity of basilar blood flow. All patients had severe subclavian stenosis with reversed vertebral blood flow in the ipsilateral artery previously demonstrated by extracranial Doppler. Basilar flow was normal in direction in all cases, but its velocity was significantly increased (p less than 0.0008) compared to age- and sex-matched controls. These findings, in conjunction with previous observations using extracranial Doppler techniques, suggest that subclavian steal is little more than a harmless haemodynamic phenomenon.

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PubMed1986

Subclavian steal: a harmless haemodynamic phenomenon?

500 patients with asymptomatic neck bruits were followed prospectively for up to 4 years with periodical standardised clinical assessments and continuous-wave carotid doppler ultrasonography, a reliable method for detecting subclavian steal. 9% of patients (45/500) had severe subclavian stenosis, and 64% of these (32/45) had a positive subclavian-steal test, with a preponderance of left-sided lesions (27/32). No patients had symptoms as a result of arm exercise during the steal test, and no patients had stroke during follow-up. Although reversed flow down one vertebral artery is relatively common in patients with generalised extracranial atherosclerosis, it is usually asymptomatic or causes, at most, vertebrobasilar transient ischaemic attacks.

Acute Disease↗
PubMedDate not supplied

Stroke during sleep: epidemiological and clinical features.

Stroke during sleep is an unexplored area of vascular neurology and its pathogenesis; clinical significance and prevention still remain uncertain. The aim of our study was to determine the epidemiological and clinical patterns of ischemic stroke occurring during sleep. Consecutive patients (n = 1822) with acute ischemic stroke recorded in the Tel Aviv Stroke Register were studied. Stroke during sleep was determined whenever focal neurological deficit was verified to have occurred while the patient had been asleep. The comparisons between patients with stroke during sleep and while awake were performed using the t test with Bonferroni correction and the chi(2) test for age, sex, vascular risk factors (i.e. ischemic heart disease, myocardial infarction, atrial fibrillation, arterial hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, smoking), vascular distribution (carotid versus vertebrobasilar) and severity of stroke (mild, moderate or severe). Data regarding the onset of stroke (during sleep or while awake) were available for 1,671 patients. A minority of strokes occurred during sleep (n = 311, 18.6%), and stroke during sleep was severer (chi(2) = 11.9, p < 0.002). No significant differences were found in terms of age, sex and vascular distribution between the two groups. None of the vascular risk factors was found to be more frequent in stroke during sleep. Strokes occurring during sleep were found to be severer than those with onset while awake. However, no specific clinical patterns of risk factor profiles could be identified in these patients. Hemodynamic factors may play an important role in the occurrence of stroke during sleep, and this issue should be further investigated.

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