Reversed ophthalmic blood flow in the occlusions (33 patients) and stenoses (11 patients) of the internal carotid artery (ICA) was examined using the ultrasonic Doppler technique. The Doppler shift frequencies of the blood flow signal were analyzed to obtain their sound spectrogram. In stenosis of the ICA, "presystolic notch" was more frequently observed and "d/S" value (S, d; maximum blood flow velocity at systolic and diastolic) was smaller than in occlusion. These two characteristics of stenosis distinguish it from occlusion with 89% accuracy although this method is applicable only for the patients with reversed ophthalmic blood flow.

Blood Flow Velocity↗

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Angiographical analysis of acute cerebral infarction followed by "cascade"-like deterioration of minor neurological deficits. What is progressing stroke?

In order to understand the mechanism of clinical worsening in patients with cerebral infarction, attention was focused on the changes in cerebral angiograms obtained repeatedly before and after neurological deterioration. Among 212 stroke patients with minor neurological deficits, incomplete hemiparesis progressed to complete hemiplegia in 15 patients several days after the beginning of symptoms. On admission, 3 had internal carotid artery occlusion, 2 had stenosis of the internal carotid artery, 5 had occlusion of the middle cerebral arterial trunk, 2 had occlusion of the middle cerebral arterial branch, and 3 had no angiographically visible occlusion. The changes between the first and the second angiograms were of different varieties: another recurrent occlusion, progression of occlusion, new occlusion in the cerebral arteries opacified through the collateral pathway, recanalization of the initially occluded artery, and no change. Such different patterns of pathophysiological events show that the mechanism of neurological worsening in infarcted patients is not uniform. Based on the results from the present study, several problems which arose during the investigation and the somewhat vague definition of "progressing stroke" currently in use are discussed.

Acute Disease↗

PubMedDate not supplied

Cardiac abnormalities in ischemic cerebrovascular disease studied by two-dimensional echocardiography.

In the study of cardiac abnormalities responsible for the development of cerebral embolism two-dimensional echocardiography was performed on 350 patients with ischemic cerebrovascular disease. The results were compared with those obtained from 350 controls without any history of stroke. Atrial fibrillation was detected on ECG in 115 cases (33%) of the patients and in 35 cases (10%) of the controls (p less than 0.001). The structural cardiac diseases observed in stroke patients were: rheumatic heart disease (RHD) in 37, congestive cardiomyopathy (CCM) in 7, hypertrophic cardiomyopathy (HCM) in 19, mitral annulus calcification (MAC) in 29, mitral valve prolapse (MVP) in 9, and myocardial infarction (MyI) in 10 patients. Controls were found to have these lesions in 11, 2, 3, 12, 4 and 9 patients respectively. RHD (p less than 0.001), HCM (p less than 0.01) and MAC (p less than 0.01) were significantly more frequent in patients with ischemic cerebrovascular disease, but not MyI, CCM or MVP. Intracardiac thrombi were diagnosed in 29 cases of patients and in 4 cases of controls (p less than 0.001). Our data suggested that nonrheumatic heart diseases such as MAC and HCM could also be considered as causes of embolic stroke. The reasons for the variable frequencies of cardiac abnormalities reported in the literature for stroke patients are discussed.

Adult↗

PubMedDate not supplied

Positive scans in angiographically proved cases of recanalized cerebral infarction.

In 20 patients with acute major cerebral arterial occlusion, follow-up angiograms were obtained to inspect the occluded artery. These angiograms were compared with brain scans in the fourth week after the stroke. The angiograms revealed that frequent recanalization of the occluded arteries occurred within a week after the onset. On the other hand, brain scans showed the increased uptake of radioisotopes even in the patients with angiographically demonstrated arterial recanalization. The present study clarified that positive scans could be obtained in the patients with and without recanalization, and emphasized the diagnostic value of brain scans in the subacute or chronic stage of cerebral infarction, especially in patients with no arterial occlusion appearing on the angiograms.

Acute Disease↗