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PubMed2002

[Change of serum soluble intercellular adhesion molecule and basic fibroblast growth factor in patients with acute cerebral infarction and its clinical significance].

OBJECTIVE: To explore the changes of the levels of soluble intercellular adhesion molecule-1 (sICAM-1) and basic fibroblast growth factor (bFGF) in serum of patients with acute cerebral infarction, and the effects of sICAM-1 and bFGF on cerebral infarction. METHODS: ELISA was used to detect the serum sICAM-1 and bFGF of 55 patients with acute cerebral infarction (within 2 days) as well as 32 patients diagnosed as with other neurologic diseases (20 patients with sciatica and 12 with trigeminal neuralgia) and 30 healthy persons as controls. RESULTS: (1) Both serum sICAM-1 and bFGF in the infarction group were significantly higher [(766.2 +/- 178.8) micro g/L and (17.4 +/- 8.2) micro g/L respectively] than in other disease control group [(529.6 +/- 76.7) micro g/L and (8.3 +/- 2.8) micro g/L respectively] and normal control group [(520.7 +/- 115.9) micro g/L and (5.8 +/- 2.7) micro g/L respectively] (P = 0.000). (2) Correlation analysis showed that there was a positive correlation between the level of serum sICAM-1 and bFGF (r = 0.471, P = 0.000), the level of sICAM-1 was also positively correlated with the number of leukocytes at acute stage (r = 0.285, P = 0.035), and a negative correlation between sICAM-1 and European stroke scale (r = -0.333, P = 0.013) was found. No significant correlation was observed between the level of sICAM-1 and the levels of serum cholesterol (r = -0.042, P = 0.758) or triglyceride (r = 0.061, P = 0.675). (3) Blood pressure seemed to have no influence on the content of sICAM-1 and bFGF after cerebral infarction, while the level of serum bFGF with large infarct size was obviously higher at acute stage. CONCLUSION: The levels of sICAM-1 and bFGF increase significantly in the patients with acute cerebral infarction. sICAM-1 and bFGF mayin participate in the pathophysiologic process through inflammatory mechanism. The detection of serum sICAM-1 will be helpful in estimating the clinical severity and the determination of bFGF will be helpful in estimating the size of infarct lesion at acute stage of cerebral infarction.

Acute Disease↗
PubMed1991

[Anticardiolipin antibody in cerebral infarction].

We investigated the anticardiolipin antibody (ACA) in a series of patients with cerebral infarction without systemic lupus erythematosus (SLA). Clinical and laboratory data were assessed from a series of 250 non-SLE patients with cerebral infarction who visited our clinic from 1988 to 1990. The concentration of anticardiolipin IgG antibody was measured by an enzyme-linked immunosorbent assay technique. An elevated ACA level was defined as one which was greater than 3 standard deviations above the mean level for normal controls. We examined the CT findings and risk factors for stroke such as hypertension, diabetes mellitus, hyperlipidemia and cardiac disease. Laboratory data such as the platelet count, the presence of lupus anticoagulant and a biologic false-positive test for syphilis were also investigated. Among the 250 patients with infarction, IgG ACA was detected in 22 (8.8%). There was no significant difference in incidence of ACA between the patients with cerebral thrombosis and those with cerebral embolism. On CT scan, multiple cerebral infarcts were noted in 18 of the 22 patients. As regards the location of the infarct, the cerebral cortex together with the basal ganglia was more common than isolated lesions of the cortex or basal ganglia. Concerning the risk factors for stroke, hypertension was noted in 12, diabetes mellitus in 2, hyperlipidemia in 2 and cardiac disease in 2. Lupus anticoagulant and thrombocytopenia were not detected in any of the cases. A biologic false-positive test for syphilis was observed in one case. Dementia was present in 12 of the 22 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Acute therapy of ischemic cerebral infarct].

The ischaemic cerebral attack is a disease prevailingly of older age. Its prognosis is distinguished by a mortality rate as high as ever. From 1975 to 1985, 520 patients with ischaemic cerebral attack have been treated in hospital, with specific acute therapy changing from the so-called vasodilator therapy via osmotherapy into haemodilution therapy with lowmolecular dextrane. Since during vasodilator therapy any early mobilisation nor continuous physiotherapy were carried out and the patients prevailingly died of bronchopneumonia, the significantly lower mortality rate under osmotherapy and haemodilution therapy cannot be attributed to the specific drug therapy. In all probability it is a result of the improvement of care and of the active early mobilisation of the patients.

Acute Disease↗
PubMedDate not supplied

Asymptomatic cerebral infarction in Kawasaki disease.

Meningitis, facial palsy, subdural effusion, and cerebral infarction have been reported to be some of the nervous system complications of Kawasaki disease which usually are clinically obvious. A 22-month-old boy with Kawasaki disease, who developed asymptomatic cerebral infarction, is reported. Hyperpyrexia persisted for 57 days; echocardiography and magnetic resonance imaging revealed the presence of aneurysms in the coronary, axillary, and internal iliac arteries. This study indicates that patients with Kawasaki disease may have silent cerebral infarction.

Caudate Nucleus↗
PubMed1998

[Usefulness of positron emission tomography to STA-MCA anastomosis for the case with cerebral infarction].

The ischemic area surrounding the cerebral infarction in the eloquent area was salvaged by STA-MCA bypass surgery. Both the misery perfusion area evaluated by positron emission tomography (PET) using the [15O] gas inhalation steady-state method and clinical symptoms improved within a year after surgery. To confirm the ischemic area and select the suitable recipient artery was important for successful bypass surgery, because only an artery covering the ischemic area is expected to have low resistance. In this case a large ischemic area with disturbed, vasodilatation by Diamox was detected on the SPECT. However, PET clearly exposed the localized misery perfusion area in the overestimated ischemic area by SPECT. We describe our experience and discuss the technique and efficacy of PET for STA-MCA anastomosis surgery.

Cerebral Arteries↗
PubMed2006

Carotid vulnerable lesions are related to accelerated recurrence for cerebral infarction magnetic resonance imaging study.

RATIONALE AND OBJECTIVES: We sought to test the hypothesis that magnetic resonance imaging (MRI)-defined vulnerable plaques correlate to accelerated reoccurrence of cerebrovascular events and to evaluate the potential use of MRI in secondary prevention of ischemic stroke. MATERIALS AND METHODS: Fifty-three symptomatic participants were recruited from patients sustaining their second MRI-confirmed cerebral infarction. Nine participants were women and 44 were men; the mean age was 69.2 years (range, 55-94 years). Patients were imaged within 7 days after the reoccurrence of cerebral infarction. The MRI diagnostic signals defined a classification of lesion type. We compare the interval between two cerebral infarctions with plaque vulnerability defined by the MRI lesion type. We used a Cox proportional hazards model to calculate the relationship between vulnerable lesions and the interval of cerebral infarction, and we followed these patients for 180 days and compared the recurrent rate for the third-time cerebral infarction between patients with and without vulnerable plaque. RESULTS: The mean infarction recurrence interval for patients with vulnerable lesions was shorter than the mean interval for patients without vulnerable lesion (310.1 versus 1697.2, P< .001). In patients with recurrent cerebral infarction within 1 year, vulnerable lesions were more frequently detected (76% versus 19%, P< .001). The patients with vulnerable lesions had an 8.8-fold higher hazard risk (8.8; P< .001, 95% confidence interval, 3.9-19.7) than those without vulnerable lesions after adjustment for risk factors. For those with vulnerable plaque, the morbidity of third-time cerebral infarction was higher than those without (24% versus 3%, P = .023). CONCLUSION: MRI-defined vulnerable lesions in carotid arteries are related to accelerated recurrent cerebral infarction and high recurrent rate. MRI demonstrates clinical value in the secondary prevention of cerebral infarction.

Aged↗
PubMed1996

[Cerebral infarction: ultrasonic diagnosis and semeiologic peculiarities in premature newborn infants].

BACKGROUND: Cerebral infarction in the preterm neonate is rarely associated with focal seizures. Its diagnosis is usually made on a routinely performed ultrasound scan. CASE REPORTS: Case no 1: A wedge-shaped area of increased echogenicity in the left parietal region suggesting a localized cerebral infarction was diagnosed on ultrasound scan performed in a preterm neonate born at 33 weeks of gestational age (GA) in whom electrical activity showed bilateral spiked theta-waves. The diagnosis was confirmed by CT scan and MRI. At 3 years of age, neurological and psychological evaluation was normal. Case no 2: This patient with intrauterine growth retardation was born at 31 weeks of GA after elective cesaerean section for Rhesus incompatibility. Two exchange-transfusions had been performed in utero. At day one an increased area of echogenicity lining a hypoechogenic parenchyma was noted in the parietal region suggesting its antenatal origin. The child died on day 8. CONCLUSIONS: Against other causes of parenchymal hyperechogenicity diagnosed on ultrasound scan such as periventricular leucomalacia or venous infarction--the long term prognosis of cerebral infarction, if the child survives, is usually good in the premature neonate.

Cerebral Infarction↗
PubMed1996

The relative effect of carotid plaque heterogeneity and echogenicity on ipsilateral cerebral infarction and symptoms of cerebrovascular disease.

OBJECTIVE: To determine the relative effect of carotid plaque heterogeneity and echogenicity as measured by computer on the incidence of ipsilateral cerebral infarction and symptoms of cerebrovascular disease. MATERIALS AND METHODS: 138 patients with 209 carotid plaques producing > 50% stenosis were studied. 110 plaques were from symptomatic sides. All patients had computer tomography (CT) brain scans. Images of the carotid plaques obtained by duplex scanner were transferred to a computer. Using an image analysis program plaque echogenicity, measured as the grey scale median (GSM) and heterogeneity, evaluated as the heterogeneity index (HI) was calculated. RESULTS: 42% of plaques were associated with cerebral infarction. Symptomatic plaques and those associated with cerebral infarction were more echolucent and less heterogeneous than asymptomatic plaques and those not associated with cerebral infarction. Plaques with GSMs below or equal to 32 were associated with a significantly higher incidence of cerebral infarction. Plaques with GSMs below or equal to 32 were associated with a significantly higher incidence of cerebral infarction and symptoms of cerebrovascular disease than those with GSMs above this level (p < 0.01). Plaques with HIs below or equal to 20 were associated with a significantly higher incidence of symptoms of cerebrovascular disease as compared to those with HIs above this level (p < 0.01). CONCLUSIONS: Computer analysis of carotid plaque morphology is an objective tool that can identify high risk plaques. The potential of such analysis in the identification of asymptomatic patients with advanced carotid stenosis at a high risk of stroke should be explored in a natural history study.

Arteriosclerosis↗
PubMed1997

Cerebral arteriovenous oxygen difference: a predictor of cerebral infarction and outcome in patients with severe head injury.

Jugular bulb oxygen monitoring can be used to estimate the adequacy of cerebral blood flow to support cerebral metabolism after severe head injury. In the present study, the authors studied the cerebral arteriovenous oxygen difference (AVDO[2]) before and after treatment in 32 head-injured patients (Glasgow Coma Scale scores < or = 8) to examine the relationships among AVDO and cerebral perfusion pressure (CPP), delayed cerebral infarction, and outcome. Fifteen patients (Group A) underwent craniotomy for hematoma evacuation and 17 (Group B) received mannitol for sustained intracranial hypertension (intracranial pressure > 20 mm Hg, > 10 minutes). Radiographic evidence of delayed cerebral infarction was observed in 14 patients. Overall, 17 patients died or were severely disabled. Cerebral AVDO(2) was elevated before craniotomy or mannitol administration; the mean AVDO(2) for all patients before treatment was 8.6 +/- 1.8 vol%. Following craniotomy or mannitol administration, the AVDO(2) decreased in 27 patients and increased in five patients (mean AVDO(2) 6.2 +/- 2.1 vol% in all patients; 6 +/- 1.9 vol% in Group A; and 6.4 +/- 2.4 vol% in Group B). The mean CPP was 75 +/- 9.8 mm Hg and no relationship with AVDO(2) was demonstrated. Before treatment, the AVDO(2) was not associated with delayed cerebral infarction or outcome. By contrast, a limited improvement in elevated AVDO(2) after craniotomy or mannitol administration was significantly associated with delayed cerebral infarction (Group A: p < 0.001; Group B: p < 0.01). Similarly, a limited improvement in elevated AVDO(2) after treatment was significantly associated with an unfavorable outcome (Group A: p < 0.01; Group B: p < 0.001). In conclusion, these findings strongly indicate that, despite adequate cerebral perfusion, limited improvement in elevated cerebral AVDO(2) after treatment consisting of either craniotomy or mannitol administration may be used to help predict delayed cerebral infarction and poor outcome after traumatic brain injury.

Adult↗
PubMed1995

Accuracy of neurologic examination and history in detecting evidence of MRI-diagnosed cerebral infarctions in children with sickle cell hemoglobinopathy.

We determined the accuracy of neurologic examination and the history of a previous neurologic event in detecting clinical evidence of a magnetic resonance imaging (MRI)-diagnosed cerebral infarction in 30 children with sickle cell hemoglobinopathy. Each patient had an MRI of the brain, neurologic examination, chart review, and psychometric evaluation. Seventeen children (57%) had MRI evidence of cerebral infarction based on demonstration of parenchymal abnormalities in a vascular distribution. Among the 17 children with MRI evidence of cerebral infarction, only 12 (71%) had an abnormal neurologic examination, and 11 (65%) had a history of a prior neurologic event. In contrast, among the 13 children with normal MRIs, 12 (92%) had normal neurologic examinations, and no child had a previous history of a neurologic event. Multiple, bilateral, heterogeneous cerebral infarctions frequently occur without overt neurologic signs or symptoms in children with sickle cell hemoglobinopathy. Previous studies that relied on a focal neurologic examination or a history of a neurologic event to identify cerebral infarctions in patients with sickle cell hemoglobinopathy most likely underrepresented the true frequency of cerebral infarctions in this population. Future prospective studies of cerebral infarctions in children with sickle cell hemoglobinopathy should include MRIs for identification and classification, rather than neurologic examination or clinical history alone.

Adolescent↗
PubMed1995

[Effect of Allitridi on deforming of peripheral leucocytes in patients with acute cerebral infarction].

To prove the effect of Allitridi in treating acute cerebral infarction, millipore membrane filter technique was adopted in systematically observing the blood rheology and the peripheral WBC filter index of 53 healthy subjects and that of 33 patients before and after treatments, who suffered from acute cerebral infarction and were confirmatorily diagnosed through CT. As a result, the filtered index of peripheral WBC during the acute period of cerebral infarction rose significantly (6.1397 +/- 4.4602), and the difference was significant compared with that of the healthy subjects (0.8651 +/- 0.4603, P < 0.01). Having been treated with Allitridi, the patients' symptoms improved and at the same time the filtered index of WBC lowered markedly (1.6261 +/- 1.3472). The conditions of the patients before and after treatments were obviously different (P < 0.01). And also the index of the whole blood rheology improved significantly. Therefore, it denoted that Allitridi could effectively improve the WBC deformation and the whole blood rheology as well, and alleviate the clinical symptoms.

Aged↗
PubMed2002

Pre-treatment with melatonin reduces volume of cerebral infarction in a permanent middle cerebral artery occlusion stroke model in the rat.

We investigated whether pre-treatment with melatonin, a potent free radical scavenger and antioxidant, would protect against permanent focal cerebral ischemia without reperfusion in a rat middle cerebral artery occlusion (MCAO) model. A single dose of melatonin at 5, 15, or 50 mg/kg or the vehicle alone was given via an intraperitoneal injection at 0.5 h before permanent MCAO. Relative infarction volumes on day 3 were significantly reduced in the groups treated with melatonin at 5 (mean+/-SEM, 17.0+/-6.5%), 15 (18.1+/-5.8%), or 50 (20.6+/-5.0%) mg/kg when compared with the vehicle-treated group (37.1+/-2.8%) and so melatonin treatment achieved a relative reduction in infarct volume by 54.2, 51.2 and 44.5%, respectively. Melatonin did not affect the hemodynamic parameters. Thus, pre-treatment with melatonin at a dose between 5 and 50 mg/kg protects against focal cerebral ischemia without reperfusion.

Animals↗
PubMed1988

Cerebral infarction in juvenile rheumatoid arthritis.

Cerebral involvement associated with juvenile rheumatoid arthritis is rare. It is not influenced by treatment and the presentation can be varied. We describe a case of cerebral infarction secondary to vasculitis in a child with juvenile rheumatoid arthritis.

Arthritis, Juvenile↗
PubMed1991

[Genetic factor in arteriosclerotic cerebral infarction].

The family information from a group of patients with arteriosclerotic cerebral infarction and their matched controls is reported. The prevalence rate for arteriosclerotic cerebral infarction in the first-degree relatives of the cases was higher than that in the first-degree relatives of the controls. The heritability was estimated as 41 +/- 7%. No significant difference of heritability between males and females was found. The subgroup of less than 65 years of age was most closely associated with genetic factor in the three subgroups. These results suggest that genetic factor plays an important role in the etiology of arteriosclerotic cerebral infarction, especially in those with middle ages of onset.

Aged↗
PubMed1999

Computerized tomographic angiography in the evaluation of cerebral infarction.

BACKGROUND: To evaluate the feasibility of computerized tomographic angiography (CTA) for the diagnosis of cerebral infarction. METHODS: Fourteen patients (nine men, five women; average age, 60 years) who presented with symptoms of acute cerebral infarction underwent computerized tomography (CT) and CTA, using a Picker PQ 2000 Spiral CT. The infarcted area was first evaluated by CT and then occlusive sites of arteries were evaluated by CTA. RESULTS: In seven patients in the very early stage of acute cerebral infarction involving the middle cerebral artery (MCA) territory, the initial CT did not clearly demonstrate the infarcted area. CTA detected the occlusive site of the MCA and helped anticipate the area of infarction. Follow-up CT confirmed the infarction clearly. CTA was not useful for small infarctions in the basal ganglia, thalamus or brainstem. CONCLUSIONS: CTA in association with CT is a feasible and good technique for the diagnosis of early-stage acute cerebral infarction. It can detect the occlusive sites in the main arteries, especially the middle cerebral artery, and as of benefit for anticipation of the ensuing edematous area. However, for small infarcts in the basal ganglia, CTA does not provide good diagnostic images.

Adult↗
PubMed2004

[The impact of stroke unit on early outcome of cerebral infarction patients].

OBJECTIVE: To investigate the early therapeutic effect of stroke unit on cerebral infarction patients. METHODS: 285 of acute cerebral infarction were admitted into our department from December 2001 to January 2003. All the patients were assigned either into stroke unit (SU) or general ward (GW) randomly to receive treatment and the data of the patients of the two groups were compared. The key indexes recorded were mortality and hospitalization time and other aprameters observed were Barthel Index (BI), National Institutes of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS). All the patients or their family members were asked to have the Visual Analogue Scales (VAS), which reflects patient satisfaction, at the time of discharge. All these data, incorporated with cost and effect, were analyzed with SPSS soft packs. RESULTS: There was no statistical difference between the two groups, but the mean gap scores between the day of admission and discharge demonstrated significant difference (P < 0.01) in BI (SU 21.01 +/- 24.4, GW 8.49 +/- 22.39), NIHSS (SU -2.53 +/- 5.73, GW 0.27 +/- 6.80) or OHS (SU -0.79 +/- 0.95, GW -0.23 +/- 0.97). Mortality rate was less (P < 0.05) and patient satisfaction higher in SU than in GW (P < 0.01). The ratio of rehabilitation was higher (P < 0.01) and complications less in SU than in GW (P < 0.01). Moreover, the cost of hospitalization was less in SU. CONCLUSION: For cerebral infarction patients, SU is able to improve the daily activities in early stage, reduce neurological defects and restore social abilities with less expenses.

Adult↗
PubMed1993

[Morphological study on acupuncture in interfering experimental cerebral infarction in rats. II. Change of ischemic area in cerebral interior].

Occluding unilateral middle cerebral artery (MCAO) of rat, the ischemic volume within cerebrum shown by nitroblue tetrazolium (N-BT) histochemistry method and effect of acupuncture were observed dynamically. 18 hs after MCAO, the ischemic area began to extend from cerebral cortex into subcortical area. 36 hs after MCAO, there was a large ischemic area in cortical and subcortical area, whose volume occupied 20.7 percent of the whole. Whereas the ischemic area in the cortex disappeared in the acupuncture group, the ischemic volume reduced to 6.3 percent of the whole. The experiment pointed out that the acupuncture is an effective therapeutic procedure for cerebral infarction.

Acupuncture Therapy↗