Placebo-controlled clinical trials with nimodipine in acute ischemic stroke have not fulfilled the early optimistic expectations. Nimodipine has in some experimental studies, when administered either before or up to 90 min after induction of cerebral ischemia, resulted in a reduction of infarct size. No studies on the effects of nimodipine on infarct size in man have been published. We measured the infarct volumes in the admission and control CT examinations 3 weeks to 3 months later in 153 patients who had participated in a multicenter, randomized and placebo-controlled study. No statistically significant differences overall were found within or between the treatment groups. Subgroup analyses revealed in the placebo, but not in the nimodipine arm, an increase in the median infarct volumes if the treatment was started within 24 h of onset, and if the volume in the admission CT was less than median. A beneficial effect of nimodipine in prevention of infarct size increase in these circumstances cannot be excluded.

Adolescent↗

PubMedDate not supplied

Subarachnoid hemorrhage in middle-Finland: incidence, early prognosis and indications for neurosurgical treatment.

The incidence of subarachnoid hemorrhage (SAH) in Middle-Finland 1976-78 was 19.4/100,000/year. The incidence increased consistently with age. The early prognosis was similar to that in earlier studies, with 25% dying on the first day, and 49% during the first 3 months after the initial bleeding. The fatality rate decreased sharply after the bleeding: of all deaths during the first 3 months, the weekly fatality rate was 65% during the 1st week, 12% during the 2nd, and 4% during the 3rd. Thereafter the weekly fatalities up to 3 months averaged 1.6%. Only 20% of the patients of the entire series were assessed as being eligible for neurosurgical treatment. Intercurrent fatal rebleeds further reduced this number. The chances of increasing the number of SAH patients suitable for neurosurgery are discussed. The timing of surgery should be earlier than in the present study (median 15 days after the bleeding) in order to avoid frequently fatal recurrences. Vertebral angiograms should be obtained from patients with no aneurysms found by bilateral carotid angiography. The upper age limit of 60 years should be abolished. By these means the proportion of SAH patients potentially eligible for neurosurgery could be increased to about 40%.

Adolescent↗

PubMedDate not supplied

Prognosis of patients with unilateral extracranial occlusion of the internal carotid artery.

One hundred fifty-five patients (121 men and 34 women) had an angiographically verified unilateral internal carotid artery (ICA) occlusion immediately after carotid bifurcation. The median follow-up period was 53 months. Forty-five percent of the patients were fully independent in the activities of daily living (ADL), 22% required assistance in ADL, 11% were disabled, and 22% died within the follow-up period. The mortality rate was exceptionally low compared with previous series. A life-table analysis of the material gave a 94% probability of surviving the first year, 84% the third year, and 78% the fifth year. Young age was favorable in regard to functional recovery, but it had no influence on mortality. The condition at the acute stage was the most important clinical sign in predicting the prognosis. The prognosis of mortality and functional recovery was poorer for smokers than for nonsmokers, and hypertension had no effect on prognosis. Cerebrovascular disease and coronary heart disease were found to be the cause of death with equal frequency in this study.

Activities of Daily Living↗

PubMedDate not supplied

Incidence and early prognosis of stroke in Espoo-Kauniainen area, Finland, in 1972.

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Age Factors↗