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PubMed1984

Mitochondrial encephalomyopathy with lactate-pyruvate elevation and brain infarctions.

We studied a patient with somatic growth failure with easy fatigability, myopathy with mitochondrial abnormality, increased lactate and pyruvate in blood and CSF, mental retardation, seizure, myoclonus, deafness, cerebellar ataxia, and blindness with macular degeneration and optic atrophy. Pathologic findings included multiple brain infarctions and massive calcification in the basal ganglia. Biochemical studies of isolated mitochondria revealed decreased oxygen consumption in skeletal muscle, diaphragm, and brain, suggesting an abnormality in the respiratory chain.

Adolescent↗
PubMed1992

The topography of microthrombi in ischemic brain infarct.

Following cerebral ischemia a tendency to increased coagulation can be detected. Vascular occlusion may develop either as a result of local thrombus formation or from emboli caused by circulating platelet aggregates. We studied the localization of microthrombi and their effects on tissue in double-hemisphere sections. Fresh brain infarcts showed a large number of microthrombi limited to the ischemic region. In more advanced infarcts they were found mainly at the border of the necrosis and diffusely distributed over both hemispheres. Older, subsiding infarcts showed only isolated microthrombi limited to the area of the necrosis. This indicates that great importance must be attached to microthrombi in infarct progression.

Aged↗
PubMed1994

Computerized electroencephalographic assessment of congenital brain infarction.

We studied 12 children (8 female and 4 male) aged 2.2-14.3 years, whose computed tomographic (CT) examination had shown evidence of malacic and/or porencephalic outcomes of early vascular brain infarction. Topographic spectral electroencephalographic (EEG) analysis was performed in all patients in the awake state. The following spectral EEG variables were studied: topography, absolute and relative power of delta, theta, alpha, beta bands, overall power, and peak alpha frequency asymmetries. The results of topographic spectral EEG analysis were compared with the localization and nature of lesions as detected by CT scans. Depending on the nature of the lesions, we were able to identify two different spectral patterns. Porencephalic cysts were characterized by an increase in delta and theta bands in the areas surrounding the lesion sites, as identified by CT. Spectral EEG patterns of malacic outcomes resulted in a focal increase in theta and delta band power, corresponding to the topography of lesions. Moreover, in 9/12 subjects an asymmetry of alpha rhythm in occipital leads was found homolaterally to the lesion sites, associated with a decrease in power, without any CT evidence of an occipital lesion.

Adolescent↗
PubMed1987

Low platelet arachidonic acid in young patients with brain infarction.

Fatty acid patterns of plasma and platelet lipids, platelet aggregation and thromboxane A2 (TxA2) production were studied in young patients (n = 12) with brain infarction and in healthy controls (n = 13). Platelet arachidonic acid content was significantly reduced in the stroke patients, but in vitro platelet aggregation was similar in the two groups. A low dose of acetosalicylic acid (ASA) (100 mg) suppressed thromboxane production and normalized the platelet arachidonic acid values. The low arachidonic acid in platelets is probably due to its increased consumption, indicating platelet activation in vivo.

Adult↗
PubMed1986

The silent brain infarct in carotid surgery.

The destructive potential of carotid artery disease is underestimated by the clinical classification that surveys only that part of the brain with clear somatic representation. Asymptomatic patients are found to have brain infarctions on CT scan for which there is no history or symptom. To assume "benign" behavior of a carotid lesion, a patient must be both asymptomatic and "asignomatic." Likewise, when the morbidity of carotid operations is reported, silent infarcts must somehow be taken into account. We investigated this "silent" disease in a prospective study of 100 carotid operations done on 91 patients over a 9-month period in our service. All patients had arch and four-vessel selective arteriography. Detailed neurologic examinations and CT scans were done before and after surgery. Of the 91 patients, 78 (86%) had a history of neurologic problems. Preoperative CT scans showed infarction in 21 patients, but only 57% of the infarctions correlated with symptoms and/or history. Among patients with a history of transient ischemic attack (TIA), 19% had an infarction seen on CT scan; however, among those patients who had lateralizing TIAs, the incidence of unsuspected infarction was higher (26%). Arteriography showed a lesion in all carotid systems supplying a symptomatic or infarcted hemisphere. Following 100 operations, four patients had neurologic abnormalities--two had transient hemianopsia and two had hemiparesis. CT scan showed a new infarct in all four patients as well as in eight other patients without neurologic findings; two of these silent postoperative infarctions were found in the hemisphere opposite the side of the operated carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Diseases↗
PubMed1994

Multiple brain infarction and hemorrhage by nonbacterial thrombotic endocarditis in occult lung cancer--a case report.

A fifty-four-year-old woman died from multiple brain infarction and hemorrhage in the bilateral cerebrum, cerebellum, and brainstem, with renal infarction. She developed hematuria and transient blindness sixteen days before admission. Low-grade fever, heart murmur, and aortic valve vegetation on ultrasonic cardiography suggested infectious endocarditis. Autopsy study revealed occult adenocarcinoma in the lung and nonbacterial thrombotic endocarditis, but infective endocarditis was not histologically confirmed. The patient was considered to be a rare case of nonbacterial thrombotic endocarditis who developed multiple small infarctions mainly in the brainstem and cerebellum. Nonbacterial thrombotic endocarditis seems to be still an important disease as the embolic source, even if cryptic, of systemic thromboembolism.

Adenocarcinoma↗
PubMed2002

Reduction of new coronary events and new atherothrombotic brain infarction in older persons with diabetes mellitus, prior myocardial infarction, and serum low-density lipoprotein cholesterol >/=125 mg/dl treated with statins.

BACKGROUND: We report the incidence of new coronary events and new atherothrombotic brain infarction (ABI) in older men and women with diabetes mellitus, prior myocardial infarction, and a serum low-density lipoprotein (LDL) cholesterol of >/=125 mg/dl treated with statins and with no lipid-lowering drug. METHODS: The incidence of new coronary events and of new ABI was investigated in an observational prospective study of 529 diabetics, mean age 79 +/- 9 years, with prior myocardial infarction and a serum LDL cholesterol of >/=125 mg/dl treated with statins (279 persons or 53%) and no lipid-lowering drug (250 persons or 47%). Follow-up was 29 +/- 18 months. RESULTS: At follow-up, the stepwise Cox regression model showed that after controlling for other risk factors, the use of statins was associated with a 37% significant independent reduction in the incidence of new coronary events and with a 47% significant independent reduction in the incidence of new ABI. CONCLUSIONS: Use of statins was associated with a 37% significant, independent reduction in new coronary events and a 47% significant, independent reduction in new ABI in older men and women with diabetes mellitus, prior myocardial infarction, and a serum LDL cholesterol of >/=125 mg/dl. Elderly diabetics with prior myocardial infarction and increased serum LDL cholesterol should especially be treated with statins.

Aged↗
PubMed1991

Transcranial Doppler in acute hemispheric brain infarction.

We studied cerebrovascular anatomy using intra-arterial digital angiography, and blood flow velocity in the middle cerebral artery (MCA) using transcranial Doppler (TCD) ultrasonography in 42 patients with acute hemispheric ischemic brain infarction. We compared angiography with TCD and the clinical findings within 6 hours of the onset of symptoms. The location and extent of the chronic ischemic brain damage was assessed by CT performed 1 to 3 months after the ictus. Abnormal TCD, as manifested by either an unobtainable MCA flow signal or a significantly depressed MCA flow velocity, was highly associated with proximal MCA occlusions demonstrated by angiography. Abnormal TCD predicted both larger chronic CT lesions and more extensive ischemic change within the MCA territory. These data demonstrate that early TCD conveys useful information concerning cerebral tissue prognosis following hemispheric ischemia.

Adult↗
PubMed1993

[Central type benzodiazepine receptor and cerebral blood flow in experimental chronic brain infarction--evaluation using a double-tracer autoradiography technique].

Double tracer autoradiography was performed to measure regional cerebral blood flow (rCBF) and the binding of central type benzodiazepine receptors (BZR) in infarction by means of permanent occlusion of the unilateral middle cerebral arteries (MCA) in rat. Iodine-125 Iomazenil and 99mTc-HMPAO was used to label BZR and rCBF respectively. In the chronic phase of infarction 21 to 28 days after occlusion (5 rats), rCBF in the left MCA territory was decreased to 62% of the sham control (4 rats), while BZR was more decreased to 45% of the control. In remote areas from the MCA lesion, the ipsilateral thalamus showed 28% decrease of BZR as compared to the control, though the decrease of rCBF was not significant. Iomazenil distribution may represent neuron density or BZR density on a neuron, since central type BZR is reported to be located on neurons. These results suggest that central type BZR imaging is more useful tool for the evaluation of brain tissue viability and transneuronal degeneration than rCBF imaging in brain infarction.

Animals↗
PubMed2002

Incidence of new atherothrombotic brain infarction in older persons with prior myocardial infarction and serum low-density lipoprotein cholesterol >or=125 mg/dl treated with statins versus no lipid-lowering drug.

BACKGROUND: We report the incidence of new atherothrombotic brain infarction (ABI) in older men and women with prior myocardial infarction and a serum low-density lipoprotein (LDL) cholesterol of >or=125 mg/dl treated with statins and with no lipid-lowering drug. METHODS: The incidence of new ABI was investigated in an observational prospective study of 1410 men and women, mean age 81 +/- 9 years, with prior myocardial infarction and a serum LDL cholesterol of >or=125 mg/dl treated with statins (679 persons or 48%) and with no lipid-lowering drug (731 persons or 52%). Follow-up was 36 +/- 21 months. RESULTS: At follow-up, the stepwise Cox regression model showed that significant independent predictors of new ABI were age (risk ratio = 1.04 for a 1-year increase in age), cigarette smoking (risk ratio = 3.5), hypertension (risk ratio = 3.1), diabetes mellitus (risk ratio = 2.3), initial serum LDL cholesterol (risk ratio = 1.01 for each 1 mg/dl increase), initial serum high-density lipoprotein cholesterol (risk ratio = 0.97 for each 1 mg/dl increase), prior stroke (risk ratio = 2.5), and use of statins (risk ratio = 0.40). The Cochran-Armitage test showed a trend in the reduction of new ABI in persons treated with statins as the level of serum LDL cholesterol decreased ( p <.0001). CONCLUSIONS: Use of statins caused a 60%, significant, independent reduction in new ABI in older men and women with prior myocardial infarction and a serum LDL cholesterol of >or=125 mg/dl.

Aged↗
PubMed1984

Brain infarction and hemorrhage in young and middle-aged adults.

Of 131 young (17 to 44 years) and middle-aged (45 to 55 years) adults who had brain infarction or hemorrhage, the most common etiologic factors were rheumatic heart disease, migraine and oral contraceptive use among the younger group. In contrast, atherosclerotic, hypertensive and diabetes-associated cerebrovascular were the most common causes in the middle-aged group. Patients who have a stroke before age 45 should have prompt, complete laboratory and radiologic testing to define a possible treatable cause.

Adolescent↗
PubMed2002

[Multicenter survey on clinical features and regional variations in acute brain infarction].

To assess the clinical features and regional variations in clinical profile of and managements for acute ischemic stroke patients, 14,864 patients with 3 major clinical categories of brain infarction (lacunar, atherothrombotic and cardioembolic stroke), among the acute ischemic stroke patients registered by 156 representative hospitals all over Japan (Japan Multicenter Stroke Investigators' Collaboration: J-MUSIC) during a period of one year from May 1999 to April 2000, were subjected to the study. Data were analyzed in each 7 geographic district (Hokkaido, Tohoku, Kanto, Chubu, Kinki, Chugoku/Shikoku and Kyushu). As for overall proportions of 3 major categories, lacunar stroke was the most common type (41.3%), followed by atherothrombotic (35.4%) and cardioembolic stroke (23.3%). In Kanto, Kinki and Chugoku/Shikoku Districts, however, proportion of atherothrombotic stroke was larger than that of lacunar stroke, which seemed to correspond to the higher frequency of patients with diabetes mellitus and hyperlipidemia in these 3 districts. Drug treatments, care and hospital facilities varied among districts considerably. Nation-wide consensus for ideal treatments by each stroke category is therefore needed.

Aged↗
PubMed1996

[Cheiro-oral syndrome following a cortical brain infarction in the precentral gyrus and at the base of the central sulcus. A case report].

We report a patient who manifested cheiro-oral syndrome following a cortical brain infarction without involvement of postcentral gyrus. A 67-year-old man was admitted to our hospital because of sudden paresthesia in his right face and right thumb and index finger. His cranial magnetic resonance imaging disclosed that the infarction was located in the left precentral sulcus and at the base of the central sulcus, while the left postcentral gyrus was not involved. His sensory symptom was attributed to the lesion of the Brodmann's area 3a, which is located at the base of the central sulcus. We postulate that the lesions responsible for cortical cheiro-oral syndrome are dispersed more widely than those for thalamic or pontine ones, since the somatotopy of face and hand in the cortex is distributed more extensively than that in the thalamus or pons.

Aged↗
PubMed1999

[Computed tomography of brain infarct with special reference to vascular territories and collateral pathways].

The essential approach to CT diagnosis is to evaluate precise radiological findings. However, in some cases, other additional information may play an important role in the detection of disease itself. In brain infarct, this can include clinical symptoms, the hemodynamics of cerebral circulation, and other factors. From this point of view, the normal vascular territories of the brain and collateral pathways in cerebral stenotic or occlusive vascular diseases are described, and representative cases are presented.

Cerebral Angiography↗
PubMed1998

Prevalence of coronary artery disease, atherothrombotic brain infarction, and peripheral arterial disease: associated risk factors in older Hispanics in an academic hospital-based geriatrics practice.

OBJECTIVE: To investigate the prevalence of coronary artery disease (CAD), atherothrombotic brain infarction (ABI), and peripheral arterial disease (PAD) in older Hispanics and the association with risk factors in this population. DESIGN: A retrospective analysis of charts from all Hispanics seen during January 1996 through July 1997 at an academic hospital-based geriatrics practice. SETTING: An academic, hospital-based, primary care geriatrics practice staffed by fellows in a geriatrics training program and by full-time faculty geriatricians. PATIENTS: One hundred sixty women and 53 men, mean age 80 +/- 8 years (range 64 to 100), were included in the study. MEASUREMENTS AND MAIN RESULTS: Of 213 Hispanics in the study, 59 (28%) had documented CAD, 43 (20%) had ABI, 34 (16%) had PAD, and 90 (42%) had either CAD, ABI, or PAD. Serum total cholesterol and triglycerides were measured in 202 of 213 subjects (95%). Serum high-density lipoprotein cholesterol was measured in 137 of 213 patients (64%). Other risk factor data were documented in all patients. Multiple logistic regression analysis performed in 202 patients using the variables age, gender, cigarette smoking, hypertension, diabetes mellitus, obesity, serum total cholesterol, and serum triglycerides showed statistically significant associations between prevalent CAD, ABI, or PAD and age (P = .002, odds ratio (OR) = 1.083), cigarette smoking (P = .002, (OR) = 3.865), hypertension (P = .007, (OR) = 2.749), diabetes mellitus (P = .028, (OR) = 2.386), obesity (P = .014, (OR) = 2.608), serum total cholesterol (P < 0.001, (OR) = 1.025), and serum triglycerides (P = .017, (OR) = .993). CONCLUSIONS: Either CAD, ABI, or PAD was present in 42% of 213 older Hispanics. There were statistically significant associations between prevalent CAD, ABI, or PAD in older Hispanics and risk factors, including age, cigarette smoking, hypertension, diabetes mellitus, obesity, and serum total cholesterol.

Academic Medical Centers↗
PubMed1997

Silent brain infarction on magnetic resonance imaging and neurological abnormalities in community-dwelling older adults. The Cardiovascular Health Study. CHS Collaborative Research Group.

BACKGROUND AND PURPOSE: Infarctlike lesions are frequently detected in symptomatic and asymptomatic older persons undergoing cerebral MRI, but their significance in older adults has not been examined. We determined the prevalence of MRI infarcts in a population-based sample of men and women aged > or = 65 years and related these findings to demographic, cognitive, and neurological status. METHODS: MRI scanning was performed in 3660 Cardiovascular Health Study (CHS) participants after brief neurological examinations and tests of cognitive function. MRIs were read centrally for the presence of an infarct > or = 3 mm in diameter or smaller infarctlike lesions. RESULTS: MRI infarcts were detected in 1131 of 3647 participants with readable infarct information (31%) and in 961 of the subgroup of 3397 participants (28%) without known prior stroke ("silent" MRI infarcts). Smaller infarctlike lesions were found in 196 of 2516 participants who had no MRI infarcts > or = 3 mm. MRI infarcts were more common in participants who were older, had prior stroke, impaired cognition, visual field deficits, slowed repetitive finger tapping (all P < .0001), weakness on toe and heel walking, and history of memory loss, coma, or migraine headaches. Multivariate analysis in those without prior stroke showed strong associations of silent MRI infarcts with older age, history of migraines, lower digit symbol scores, and more abnormalities on neurological examination. CONCLUSIONS: MRI evidence of brain infarction is common in older men and women without a clinical history of stroke. Their strong associations with impaired cognition and neurological deficits suggest that they are neither silent nor innocuous.

Aged↗
PubMed2007

Limb ataxia and proximal intracranial territory brain infarcts: clinical and topographical correlations.

BACKGROUND: Limb ataxia is classically attributed to cerebellar hemispheric lesions, although isolated lesions of the inferior cerebellar peduncle (ICP) in the medulla may also cause this sign. It is still unclear why only some patients with acute cerebellar infarcts in the posterior inferior cerebellar artery (PICA) territory present with limb ataxia. The proximal intracranial posterior circulation (P-PC) territory includes structures fed by the intracranial vertebral arteries (ICVAs): the medulla, supplied by small ICVAs branches, and posterior inferior portion of the cerebellum, fed by PICA. ICP and PICA territory cerebellar infarcts most often occur independently but occasionally occur together. OBJECTIVE: To identify structures responsible for limb ataxia in acute P-PC brain infarcts, correlating clinical and topographical findings. METHODS: Sixteen patients (8 women) were included, aged 30-82 years (mean 62 years), with isolated acute strokes in the P-PC territory. RESULTS: The cases reported here indicate that limb ataxia in acute P-PC territory infarcts may be associated with damage to the ICP in the dorsolateral medulla, regardless of a hemispheric cerebellar lesion. In fact, among the nine patients with PICA stroke, limb ataxia was observed only in the two patients who also presented damage to the dorsolateral medulla involving the ICP. Of the seven patients with isolated dorsolateral medullary infarct, only five patients with ICP damage had limb ataxia. CONCLUSIONS: When correlating limb ataxia and acute P-PC infarcts, it is important to take into account the entire ICVA territory.

Adult↗
PubMed1992

Catecholamine histofluorescence depletion in the infarcted brain parenchyma but not in the adventitia of the occluded cerebral arteries in rats.

The effect of acute cerebral ischemia on the catecholamine-containing nerve fibers in the brain parenchyma and in the adventitia of the cerebral arteries was studied in the rat. Unilateral cerebral ischemia was produced with an intraluminal thread technique which does not damage the adventitia of cerebral arteries. One to three days after surgery the ischemic damage of the brain was consistently observed in the territory of the middle cerebral artery of the operated side. Depletion of catecholamine histofluorescence was observed in the infarcted brain parenchyma. However, in the adventitia of the middle cerebral arteries of the operated side, catecholamine histofluorescence remained intact. No detectable changes in fluorescence were observed in the brain parenchyma or adventitia of the cerebral arteries in the contralateral side. The results indicate that the perivascular catecholamine-containing nerve fibers are not impaired by the intraluminal occlusion of the cerebral artery in the early stage of ischemia.

Animals↗