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PubMed2006

Accuracy of transcranial Doppler sonography for predicting cerebral infarction in aneurysmal subarachnoid hemorrhage.

PURPOSE: To evaluate the accuracy of transcranial Doppler (TCD) sonography using different criteria for predicting cerebral infarction due to symptomatic vasospasm. METHODS: We retrospectively evaluated the clinical and radiologic data of consecutive patients admitted with acute aneurysmal subarachnoid hemorrhage (SAH) in the anterior cerebral circulation between January 2001 and June 2002. TCD sonographic examinations were performed on alternate days up to 20 days after admission. Cerebral infarction was defined on CT as a new hypodensity in the vascular distribution with corresponding clinical symptoms. Vasospasm was diagnosed as mild or severe when TCD sonography revealed a mean blood flow velocity (MBFV) greater than 120 and 180 cm/s in the middle or anterior cerebral artery and in the intracranial part of the internal carotid artery, respectively. RESULTS: A total of 93 patients with aneurysmal SAH in the anterior cerebral circulation were included. Vasospasm was demonstrated by TCD sonography in 60 patients (64.5%) and was shown via multivariable logistic regression analysis to be predictive of cerebral infarction (OR 3.11, 95% CI 1.46-6.59), with an 82.6% and 69.6% sensitivity, a 41.4% and 77.1% specificity, a 31.7% and 50.0% positive predictive value, and an 87.9% and 88.5% negative predictive value when the MBFV was greater than 120 and 180 cm/s, respectively. CONCLUSIONS: Vasospasm on TCD was found to be predictive of symptomatic cerebral infarction on CT, but its positive predictive value remained low despite the adoption of restrictive TCD criteria for vasospasm.

Adult↗
PubMed2003

Brachial-ankle pulse wave velocity and symptomatic cerebral infarction in patients with type 2 diabetes: a cross-sectional study.

BACKGROUND: Recently a new automatic device that measures brachial-ankle pulse wave velocity using an oscillometric method has been developed. However, the practical significance of brachial-ankle pulse wave velocity measurement remains uncertain. The purpose of this study was to examine the association between brachial-ankle pulse wave velocity and symptomatic cerebral infarction in patients with type 2 diabetes. METHODS: One thousand sixty six patients with type 2 diabetes were studied cross-sectionally. Measurements of brachial-ankle pulse wave velocity were made using the automatic device. Logistic regression analysis was used to calculate the odds ratio for cerebral infarction. RESULTS: The presence of symptomatic cerebral infarction was confirmed in 86 patients. In these patients brachial-ankle pulse wave velocity was found to be significantly higher than in patients without cerebral infarction (18.94 +/-; 4.95 versus 16.46 +/-; 3.62 m/s, p < 0.01). The association between brachial-ankle pulse wave velocity and cerebral infarction remained significant after adjustment for traditional risk factors. There was an increasing odds ratio for each tertile of brachial-ankle pulse wave velocity, from the second tertile (odds ratio, 2.28; 95% confidence interval, 1.05 to 4.94), to the third (odds ratio, 2.53; 95% confidence interval, 1.09 to 5.86). CONCLUSION: Overall, we conclude that an increase in brachial-ankle pulse wave velocity is associated with symptomatic cerebral infarction in patients with type 2 diabetes.

Journal Article↗
PubMed1988

[Effect of calcium antagonists of the verapamil type on regional cerebral blood flow and bioelectric activity of the brain in patients with cerebral infarction].

The authors have studied the regional volume cerebral blood flow (RVCBF) in 25 patients with acute cerebral infarction before and after the intravenous administration of 5-7.5 mg of isoptin and carried out quantitative frequency analysis of the EEG in 20 patients prior to and following the administration of 5 mg of finoptin. It has been revealed that isoptin augments the RVCBF in the infarcted zone, particularly when patients with extensive infarction, edema and atrophy of the cerebral tissue (according to findings of computer-aided tomography) have low baseline levels of the RVCF and somewhat decreases the blood flow in intact zones. The administration of finoptin tended to normalize the EEG, particularly in the infarcted area in patients with a severe clinical picture of infarction. Calcium antagonists of the verapamil type exert a favourable effect on perfusion and bioelectrical activity of the brain; as a result their use is indicated in the patients with acute cerebral infarction.

Action Potentials↗
PubMed2005

[Effects of different point association needling methods on IL-1, sICAM-1 and sVCAM-1 in the patient of cerebral infarction].

OBJECTIVE: To observe effects of acupuncture on serum interleukin-1 (IL-1) and soluble intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) in the patient of cerebral infarction. METHODS: Eighty-two cases of cerebral infarction were randomly divided into a treatment group treated by balanced muscular tension needling method, and a control group by traditional needling method. The levels of serum IL-1, sICAM-1 and sVCAM-1 were determined with enzyme-linked immunosorbent assay (ELISA). RESULTS: The levels of serum IL-1, sICAM-1 and sVCAM-1 in the patient of cerebral infarction were significantly higher than those in the healthy persons (P < 0.01); there were positive correlation between sICAM-1 or sVCAM-1 level and IL-1 level (r = 0.743, P < 0.001; r = 0.862, P < 0.001). The three indexes improved to a certain extent in the two groups, with the treatment group superior to the control group (P < 0.01). CONCLUSION: The improvement of nervous function by the balanced muscular tension needling method in the patient of cerebral infarction is possibly related with decrease of IL-1, sICAM-1 and sVCAM-1 levels.

Cerebral Infarction↗
PubMed2004

[Diagnosis and prognosis of neonatal cerebral infarction].

OBJECTIVE: To analyze the relationship between clinical characteristics and prognosis of neonatal cerebral infarction and to draw attention to the disease to improve the long-term outcome through early diagnosis and intervention. METHODS: The clinical characteristics of 6 confirmed cases were summarized. Perinatal conditions and other factors were analyzed for possible causes of the disease. The survived patients were followed-up for 6-8 months. RESULTS: The authors diagnosed 6 cases of neonatal cerebral infarction in one year, which accounted for 0.6% (6/969) of all the in-patients in the same time period. Among them 3 cases were confirmed as cerebrovascular malformations by magnetic resonance angiography (MRA), In 1 case the infarction was due to severe bilateral intraventricular hemorrhage, and in another case the disease was related to comprehensive factors such as prematurity, maternal pregnancy induced hypertension and respiratory failure secondary to bronchopulmonary dysplasia (BPD), and in 1 case the cause was undetermined. Four out of the 6 patients presented with varied forms of convulsions, which became the second leading cause for all the neonatal convulsive events (20%). None of the patients had localized neurological signs in the early course except for abnormal muscular tone of some extent. Cerebral ultrasound scanning in 5 out of 6 cases showed positive results. The diffusion-weighted magnetic resonance imaging (DW-MRI) was highly valuable for early confirmative diagnosis. Only one case was found normal within one year of follow-up and all the other 5 cases had unfavorable prognoses of varied severity. CONCLUSION: Neonatal cerebral infarction is not a rare condition and should be considered as one of the important causes for neonatal convulsion. Imaging study is the main technique for diagnosis. The prognoses were poor for those cases for whom early diagnosis and treatment can not be made or those with widespread cerebral lesions.

Brain↗
PubMed2000

Reduced IL-2 but elevated IL-4, IL-6, and IgE serum levels in patients with cerebral infarction during the acute stage.

Cytokines in the central nervous system (CNS) may play an important role in functioning as intercellular signals that orchestrate the response to injury. Whether this is a cause or result of the brain disease process is uncertain. We investigated IFN-gamma, IL-2, IL-4, IL-6, and IgE in the sera of 38 patients with cerebral infarction during the acute stage and 10 normal controls using an originally devised sensitive sandwich enzyme-linked immunosorbent assay (ELISA). We found that serum levels of IL-2 derived from T helper 1 (Th1) cells were slightly reduced in patients with cerebral infarction, whereas serum levels of IL-4 and IL-6 derived from Th2 cells were elevated significantly. IL-4 induces synthesis of IgE in human B cells. Endogenous IL-6 plays an obligatory role in IL-4-dependent human IgE synthesis. We observed that serum IgE levels were elevated significantly in patients with cerebral infarction. However, serum IFN-gamma levels were not elevated significantly in cerebral infarction patients. These findings suggest that elevated IL-4, IL-6, and IgE levels in the human serum may be an important factor in cerebral infarction during the acute stage. Decrease of IL-2 levels in the serum of patients with cerebral infarction may be a regulatory mechanism.

Acute Disease↗
PubMed1994

Validation of a clinical classification for subtypes of acute cerebral infarction.

The validity of a clinical classification system was assessed for subtypes of cerebral infarction for use in clinical trials of putative stroke therapies and clinical decision making in a population based stroke register (n = 536) compiled in Perth, Western Australia in 1989-90. The Perth Community Stroke Project (PCSS) used definitions and methodology similar to the Oxfordshire Community Stroke Project (OCSP) where the classification system was developed. In the PCSS, 421 cases of cerebral infarction and primary intracerebral haemorrhage (PICH), confirmed by brain imaging or necropsy, were classified into the subtypes total anterior circulation syndrome (TACS), partial anterior circulation syndrome (PACS), lacunar syndrome (LACS), and posterior circulation syndrome (POCS). In this relatively unselected population, relying exclusively on LACS for a diagnosis of PICH had a very low sensitivity (6%) and positive predictive value (3%). Comparison of the frequencies and outcomes (at one year after the onset of symptoms) for each subgroup of first ever cerebral infarction in the PCSS (n = 248) with the OCSP (n = 543) registers showed uniformity only for LACI. For example, there were 27% of cases of TACI in the PCSS compared with 17% in the OCSP (difference = 10%; 95% confidence interval (95% CI) 4% to 16%) and 15% of cases in the PCSS compared with 24% in the OCSP were POCI (difference = 9%; 95% CI 3% to 15%). Case fatalities and long-term handicap across the subgroups were not significantly different between studies, but the frequencies of recurrent stroke were significantly greater for POCI in the OCSP compared with the PCSS. Although this classification system defines subtypes of stroke with different outcomes, simple clinical measures-level of consciousness, paresis, disability, and incontinence at onset-are more powerful predictors of death or dependency at one year. It is concluded that simple clinical measures that reflect the severity of the neurological deficit should complement this classification system in clinical trials and practice.

Acute Disease↗
PubMed1983

The effects of chronic alcoholism on development of ischemic cerebral infarcts following unilateral carotid artery ligation in gerbils.

To test if chronic alcoholism potentiates mortality and accentuates cerebral infarcts associated with ischemia, 32 male and 33 female Mongolian gerbils were chronically fed ethanol in their diet for 6 weeks. Cerebral ischemia was then induced by ligation and sectioning of the right common carotid artery. Postoperatively, there was a mean difference in survival in the control versus the alcoholic gerbils. Whereas 76% of controls survived the operation, only 55% of alcoholic gerbils survived. Also, the alcoholic gerbils died earlier, usually in the initial 3 postoperation days. The incidence of cerebral infarcts was identical (52%) in both control and alcohol-treated gerbils. There was, however, a difference in the extent (size) of the infarcts and tolerance to them. The alcoholic gerbils tended to develop either large infarcts which were usually lethal, or smaller infarcts but with decreased tolerance. The cerebral infarcts in the controls tended to be smaller with better survival. These findings suggest that chronic alcohol consumption contributes significantly to the risk of mortality associated with ischemic brain infarction reported in human alcoholics, and indicate that the alcoholic gerbil is a good experimental model to study the pathophysiology of this phenomenon.

Alcoholism↗
PubMed1989

[Therapy of cerebral infarction by infusion of plasma substitutes].

In a total of 152 cases of severe cerebral infarction intravascular infusion of plasma substitutes was a part of combined therapy. Hemostasis studies in these patients allowed us to detect various degrees of hypercoagulation as a response to hemodilution. In cases of most pronounced post-hemodilution++ hypercoagulation (77 patients) complications, including those of thrombohemorrhagic nature, were increased in rate (74%) with more severe course of cerebral infarction. Of these 77 patients 46 died (59.7%). In 75 cases with no substantial hypercoagulation, the disease had a more benign course with 2 casulties (2.7%). The hemodilution tests should precede the therapeutic use of plasma substitutes in cerebral infarct patients.

Blood Coagulation Tests↗
PubMed1998

Increased cerebral infarction by cyclic flow reductions: studies in the guinea pig MCA thrombosis model.

We have developed a photochemical model of thrombotic middle cerebral artery (MCA) occlusion in the guinea pig for investigating factors contributing to the development of cerebral infarction. In this model, cyclic flow reductions (CFRs) after recanalization of the MCA are a common observation and might contribute to the development of cerebral infarction. Therefore, we sought to measure the time course of recanalization of the guinea pig MCA after the artery had been occluded by a thrombus. Thrombotic occlusion of the MCA was induced by photochemical reaction between intravenously administered rose bengal and transluminal green light for 10, 15, 20, or 30 min. After the thrombotic occlusion of MCA and subsequent spontaneous thrombolysis, blood flow in the MCA gradually recovered to preocclusion level but with frequent CFRs. The recovery of MCA blood flow or duration of CFRs was dependent on the duration of photochemical reaction (extent of endothelial injury); thus, for a 30-min photochemical reaction, CFRs were still observed 24 h after photochemical reaction. In separate experiments, we also investigated the effect of permanent occlusion of the MCA, which was induced by electrocoagulation in the vessel on cerebral infarction. The infarct volume in the permanent occlusion model was smaller than the maximum value in the thrombotic occlusion model (12.5 vs. 17.4%; P < 0.05, n = 6). CFRs may constitute an important factor contributing to the extent of cerebral infarction.

Animals↗
PubMed2003

Cerebral infarct in head injury: relationship to child abuse.

BACKGROUND: To determine whether CT-detected cerebral infarct in young children is associated more often with abuse or unintentional head injury. METHODS: Retrospective case-control study of injured children under age 6 who had abnormal initial head CT scans and who were admitted to the only Level I pediatric trauma center in Washington State for closed head injury (CHI) from January 1, 1992 to December 31, 1998. RESULTS: Fifteen children developed cerebral infarct after CHI during the 7 year period. These cases were compared to 53 controls (those who did not develop infarct). After adjusting for the presence of SDH and for severity of injury, patients with infarcts were six times more likely to have been abused than patients without infarcts (OR 6.1; 95% CI, 1.02-36.0). CONCLUSIONS: Cerebral infarct after CHI appears to result more frequently from abuse than unintentional injury in young children.

Brain Injuries↗
PubMed1989

Incidence of cerebral infarction after radiotherapy for pituitary adenoma.

The incidence of cerebral infarction was studied in 156 patients irradiated for treatment of pituitary adenomas. Seven patients experienced strokes at intervals of 3.2 to 14.6 years after irradiation. The observed incidence was not significantly greater than the expected value of 3.5 strokes (P = 0.078). Six strokes occurred in patients receiving equivalent doses (ED) of 1070 ret or more (observed to expected ratio 3.87, significantly elevated; P less than 0.001). Univariate log-rank analysis showed that the risk of stroke was significantly higher (P = 0.010) in patients receiving an ED of 1070 ret or more (4180 cGy/22 fractions) than those receiving lower doses. Multivariate analysis, however, demonstrated that the increased risk of stroke was associated only with increasing age (P less than 0.0001), not ED (P = 0.148). Due to these inconsistent statistical results, no definitive conclusions could be reached about the relationship between radiation dose to the pituitary and subsequent cerebral infarction.

Adenoma↗
PubMed1987

[Is drug therapy possible in the acute stage of a cerebral infarct?].

To assess the possibilities of treatment of acute cerebral infarction the results of clinical trials, performed during the past 30 years, are reviewed. Only a few studies fulfil basic requirements for a clinical trial, such as sufficient sample size. A therapeutic effect could not be proven in any of these studies. On the other hand, because of the small number of patients, therapeutic inactivity equally could not be established. In conclusion, present knowledge does not justify any treatment for acute cerebral infarction. In the near future well organized clinical trials will have to provide more definite results.

Adrenal Cortex Hormones↗
PubMed1979

Cerebral infarction and migraine: clinical and radiologic correlations.

Cerebral infarction was documented by arteriography and serial computed cranial tomography (CT) in four young adults (ages 16 to 32 years) with migraine. In one case, posterior cerebral artery occlusion produced a deep parietotemporal infarct. The other three cases all had frontotemporal infarcts (one hemorrhagic) in the territory of the middle cerebral artery, without major arterial occlusion. Two infarcts produced lasting neurologic deficits; one was associated with mild, transitory symptoms, and one was asymtomatic. Laboratory investigations in two cases revealed no hematologic or cardiovascular predisposition to cerebrovascular disease. Cerebral infarction, as revealed by CT, may be more prevalent in "complicated" migraine than is generally appreciated. Such lesions may or may not develop in chronologic and anatomic relationship to the headache, and may involve either large or small arteries. The prognosis for functional recovery, based on this limited sample, seems favorable.

Adolescent↗
PubMedDate not supplied

Prognostic value of hyperattenuating middle cerebral artery sign at CT in cerebral infarction.

PURPOSE: To assess the prognostic value of hyperattenuating middle cerebral artery sign at CT in acute cerebral infarction. MATERIALS AND METHODS: Ninety-two patients with acute cerebral infarction in the sylvian area were retrospectively reviewed. All patients underwent unenhanced CT 12-24 hours after the onset of symptoms and follow-up CT within 48-72 hours. Initial CT scans were evaluated by consensus by three radiologists to confirm or exclude the presence of hyperattenuating middle cerebral artery sign. History, cardiovascular risk factors and neurological impairment at discharge (mean 25 days) were recorded for each patient. The degree of disability was graded 0 (no disability) to 6 (death). Patients were divided into two groups: patients without (group A) and patients with (group B) hyperattenuating middle cerebral artery sign. A logistic regression analysis was performed to compare the two groups. Results were correlated with cardiovascular risk factors. Kaplan-Meier survival curves were calculated for each group. RESULTS: Hyperattenuating middle cerebral artery sign was present in 18 patients (19.6%) (group B). The percentage of neurological deficits was significantly higher in group B than in group A (p<0.05). Sixteen (88.9%) of the 18 patients in group B had a poor prognostic index (score 3 - 6) with a significantly higher percent difference (41.6%, p<0.05) than patients of group A. Within 10 days of admission, 3 patients (16.7%) died in group A and 6 (8.1%) in group B. However, no significant differences were observed in the Kaplan-Meier survival curves. No correlation with cardiovascular risk factors was observed. CONCLUSIONS: Besides having an important diagnostic value, hyperattenuating middle cerebral artery sign is a reliable predictor of prognosis in terms of disability rather than mortality, as it reflect the larger extension of infarction.

Acute Disease↗
PubMed1987

Hyperbaric oxygen and cerebral infarction in the gerbil.

The effectiveness of hyperbaric oxygen in reducing the incidence of cerebral infarction during the first 36 hours after occlusion of the right common carotid artery was investigated in gerbils. After carotid ligation, the gerbils were divided into four groups: controls, which breathed air at ambient pressure; group 1, which received hyperbaric oxygen at 1.5 atmospheres absolute pressure (ATA) for 36 hours, with a 5-minute, 1.5-ATA air break each hour; group 2, which received hyperbaric oxygen at 1.5 ATA for 1 hour alternating with 1 hour air at 1 ATA, for 36 hours; and group 3, which received hyperbaric oxygen at 1.5 ATA with hourly 5-minute air breaks for 18 hours, and ambient air for the second 18 hours. Neurological evaluations and staining of the brain with tetrazolium revealed the following results at 36 hours after carotid ligation: 72% of the controls had cerebral infarcts; 26% of the gerbils in group 1 had infarcts, but all animals died at 24-36 hours after beginning hyperbaric oxygen exposure from oxygen toxicity; 44% of the gerbils in group 2 had infarcts; 11% of the gerbils in group 3 had infarcts during the first 18 hours after carotid ligation, and no infarcts developed in the 18 hours that followed. Hyperbaric oxygen reduces the incidence of cerebral infarction after carotid artery ligation, presumably by allowing time for collateral circulation to develop.

Animals↗
PubMed2006

Gamma-Hydroxybutyrate (GHB), gamma-butyrolactone (GBL), and 1,4-butanediol (1,4-BD) reduce the volume of cerebral infarction in rodent transient middle cerebral artery occlusion.

gamma-Hydroxybutyric acid (GHB), an endogenous organic acid catabolite of gamma-aminobutyric acid (GABA), has been shown to have tissue-protective effects in various organs, including the brain. We examined the potential neuroprotective effect of GHB and its chemical precursors, gamma-butyrolactone (GBL) and 1,4-butanediol (1,4-BD), in the rodent ischemic stroke model by intraluminal filament middle cerebral artery occlusion (MCAO). Adult male Sprague-Dawley rats underwent transient left-sided MCAO and received intraperitoneal treatment with 300 mg/kg of GHB, GBL, 1,4-BD, or control vehicle given at 30 min before, as well as 180 and 360 min after the onset of ischemia. Infarct volumes were determined 24 h after MCAO. In transient MCAO, the mean volume of infarction for control rats was 464.4 +/- 17.9 cu.mm versus 273.6 +/- 53.1, 233.3 +/- 44.7, and 275.4 +/- 39.9 cu.mm for rats treated with 1,4-BD (P < 0.05), GBL (P < 0.05), and GHB (P < 0.05), respectively. We conclude that GHB, GBL, and 1,4-BD protect against rat focal cerebral ischemia from transient MCAO.

4-Butyrolactone↗
PubMed2001

Traumatic bilateral carotid dissection with concomitant cerebral infarction.

A 40-year-old man presented with a major nondominant hemisphere stroke syndrome after a road traffic accident. Cranial computed tomography scan revealed an extensive right hemisphere infarction involving the entire anterior and middle cerebral artery territories. Duplex Doppler ultrasound and cerebral angiography revealed bilateral internal carotid artery dissection with evidence of underlying fibromuscular dysplasia. Anticoagulation with heparin was commenced despite the coexisting large cerebral infarction, with the objective of protecting the uninjured but at-risk left cerebral hemisphere from ischemic injury. Patients with multiple cerebral arterial dissections complicated by cerebral infarction present a significant management dilemma. Our literature review revealed a lack of clear management guidelines for such cases.

Accidents, Traffic↗