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PubMedDate not supplied

Vascular bed specific alterations in coagulation and fibrinolytic parameters in young women following myocardial infarction, lacunar cerebral infarction and deep vein thrombosis.

The possible existence of distinctive, vascular bed specific alterations of coagulation and fibrinolytic parameters associated with three different types of thrombosis was investigated in young women (n = 68, <45 years at onset of the event) following myocardial infarction (MI) (n = 22), lacunar cerebral infarction (LACI) (n = 16), idiopathic deep vein thrombosis (VT) (n = 14) and venous thrombosis due to oral contraceptive use (n = 16) in the stable period after the acute thrombotic event. Coagulation and fibrinolytic parameters, as well as classical metabolic variables, were measured and compared with 52 age-matched, healthy controls. In MI women we observed elevated tissue type plasminogen activator (t-PA) antigen levels, which correlated significantly with parameters of the plurimetabolic syndrome. In LACI women we found elevated fibrinogen, which correlated with D-dimer, systolic blood pressure, smoking, and sedimentation rate. Prolonged euglobulin clot lysis time, elevated t-PA antigen, PAI-1 antigen and activity, which all correlated with parameters of the plurimetabolic syndrome, were found in women with idiopathic VT, who were also clearly obese but not in women in whom oral contraceptives were the triggering factor for VT. Our results showed not parallel, but different profiles of alterations in fibrinolytic and coagulation parameters in line with the prediction of a vascular bed specific thrombosis process.

Adult↗
PubMed1983

[Tomographic analysis of CBF in cerebral infarction].

Cerebral perfusion was examined in various types of occlusive disease by computed tomographic CBF method. The method utilized has several advantages over conventional studies using isotope, providing high resolution images in a direct relation to CT anatomy. Ten representative cases were presented from 25 consecutive cases of occlusive disease studied by this method. The method included inhalation of 40 to 60% xenon with serial CT scanning for 25 min. K (build-up rate), lambda (partition coefficient) and CBF values were calculated from HU for each pixel and Xe in expired air, based on Fick's principle, and displayed on CRT as K-, lambda- and CBF-map separately. CBF for gray matter of normal control was 82 +/- 11 ml/100 gm/min and that for white matter was 24 +/- 5 ml/100 gm/min. The ischemic threshold for gray matter appeared to be approximately 20 ml/100 gm/min, as blood flow in focus of complete infarction was below this level. Blood flow between 20-30 ml/100 gm/min caused some change on CT, such as localized atrophy, cortical thinning, loss of distinction between gray and white matter and decreased or increased density, which were considered to be compatible with pathological changes of laminar necrosis or gliosis with neuronal loss. In a case with occlusion of middle cerebral artery with subsequent recanalization, causing hemorrhagic infarct, hyperemia was observed in the infarcted cortex that was enhanced by iodine. Periventricular lucency observed in two cases, where blood flow was decreased below threshold, could be classified as "watershed infarction" mainly involving white matter. In moyamoya disease, blood flow in the anterior circulation was decreased near ischemic level, whereas that in basal ganglia and territory of posterior cerebral artery was fairly preserved, which was compatible with general angiographic finding of this disease.

Adult↗
PubMed1977

[Radioisotope scanning in the diagnosis of cerebral infarction].

Cerebral scanning was performed in 52 cases of brain infarctions (in 43 cases in the system of middle brain arteries and in 9 cases in the vertebro-basillar basin). For this purpose in 46 of the studied cases human albumin serum, labeled readioactive I131 was used and in 6 cases-Tc 99m. Positive scannograms were received only in 16 patients with infarctions in the system of the middle brain arteries. The clinical picture in both groups of patients with positive and negative scannograms did not differ significantly from each other. This may indicate the fact that the process of accumulating radioactive isotopes in brain infarctions depends upon manifold reasons: the state of collateral circulations, the traits of angioarchitectonics in the affected area, the level of metabolism in the focus of lesions, disturbed permeability of the menatoencephalic barrier, etc. In doubtful cases for the differential diagnosis between brain infactions and tumors the most valid criteria in scanning is the dynamics of the focus of accuumulation of radioactive isotopes.

Adult↗
PubMed2000

[Cerebral perfusion CT: theoretical aspects, methodical implementation and clinical experience in the diagnosis of ischemic cerebral infarction].

Cerebral perfusion CT using dynamic CT after bolus injection of contrast has recently been introduced in the clinical management of stroke patients. Based on the indicator dilution principle various theoretical models can be formulated which all aim at the quantitative determination of cerebral blood flow (CBF). Our Perfusion CT approach is based on the "maximum slope" model and allows in addition to the calculation of CBF parameter images the display of cerebral blood volume (CBV) and "time to peak" as diagnostically meaningful parameters. This approach allows the detection of acute ischemia of the supratentorial brain with a sensitivity of 91% and has proven its value as a routine diagnostic tool for acute stroke. The combination of various functional maps provides excellent information regarding the type of ischemia. Although the direct assessment of ischemia using absolute CBF values is severely restricted by patient dependent systematic errors, the severity of ischemia may reliably be assessed by using relative CBF perfusion indices.

Acute Disease↗
PubMed2002

[Acute promyelocytic leukemia accompanied by retinoic acid syndrome with complications of acute myocardial infarction and cerebral infarction during treatment with all-trans retinoic acid].

A 71-year-old man visited our hospital complaining of fever and a bleeding tendency. The peripheral blood WBC count was 10,400/microliter with 90% promyelocytes. The bone marrow was hypercellular with 88% promyelocytes. Disseminated intravascular coagulation was recognized. The patient was diagnosed as having acute promyelocytic leukemia and was treated with daily oral administration of all-trans retionic acid (ATRA) (45 mg/m2/day) and cytarabine (160 mg/day, intravenous drip infusion for the initial five days). The ATRA treatment induced leukemic cells to undergo mature myeloid differentiation. On day 24 after the start of treatment, the WBC count rapidly increased and acute myocardial infarction appeared, with consciousness disturbance and bilateral Babinski reflex appearing three hours later. Magnetic resonance imaging showed a fresh lacunar infarction of the right lenticular nucleus, and serum levels of IL-6 and PAI-1 were found to be elevated at the onset of infarction. Since there was a possibility that the retinoic acid syndrome (RAS) might have helped bring about the infarctions, we stopped the ATRA treatment and started administration of methyl-prednisolone (500 mg/body/day for 3 days) and gabexate mesilate. The WBC count decreased immediately and the consciousness disturbance improved. In this case, ATRA treatment might have initiated the RAS and resulted in some endothelial damage, thus causing the infarctions.

Aged↗
PubMed1990

Liposome-entrapped superoxide dismutase reduces cerebral infarction in cerebral ischemia in rats.

We studied the role of superoxide radicals in the pathogenesis of ischemic brain injury using a model of focal cerebral ischemia in 102 rats and liposome-entrapped CuZn-superoxide dismutase, which can penetrate the blood-brain barrier and cell membranes efficiently. The bolus intravenous administration of 25,000 units of liposome-entrapped CuZn-superoxide dismutase elevated superoxide dismutase activities in the blood and brain 1, 2, 8, and 24 hours later as well as in the ischemic hemisphere and contralateral cortex. Determined 24 hours after right middle cerebral and bilateral common carotid artery occlusion by the lack of staining for mitochondrial dehydrogenase activity with 2,3,5-triphenyltetrazolium chloride, infarct sizes were reduced by 33%, 25%, and 18% in the anterior, middle, and posterior brain slices, respectively, by treatment with liposome-entrapped CuZn-superoxide dismutase. Our data demonstrate that superoxide radicals are important determinants of infarct size following focal cerebral ischemia and that liposome-entrapped CuZn-superoxide dismutase may have pharmacologic value for the treatment of focal cerebral ischemic injury.

Animals↗
PubMed2004

MR imaging and 1H-MR spectroscopy in a case of cerebral infarction with transient cerebral arteriopathy.

A case of cerebral infarction with transient cerebral arteriopathy in a 12-year-old female is described. The child showed with an acute onset of left hemiplegia, central facial palsy and aphasia. She was diagnosed with right internal carotid artery obstruction with no predisposing factors for cerebral infarction. A serial MR image and MR spectroscopy of the brain was performed. MR angiography revealed reversible vascular changes in the right middle cerebral artery after several months. The ratio of choline/creatine was elevated and that of N-acetylaspartate (NAA)/creatine was depressed in the cerebral lesion, however, they were normalized during the remission phase with long echo time-MR spectroscopy. The elevation of the lactate peak was clarified with short echo time-MR spectroscopy. The longitudinal follow up using MR angiography, and MR spectroscopy with long and short echo time was useful for the evaluation of reversible vascular change with cerebral infarction in children.

Aspartic Acid↗
PubMed2003

Massive cerebral infarctions in main cerebral arteries.

This study was designed to investigate the outcomes in patients with massive cerebral infarction, and to determine the risk factors associated with worse outcomes in the patients with massive cerebral infarction. Twenty-seven patients with acute massive cerebral infarction were hospitalized in our institution. These 10 men and 17 women had an average age of 77.8 years (range, 42 to 97 years). Some patients had multiple infarctions. Thirteen patients had infarctions of the middle cerebral artery, 12 patients had internal carotid artery infarctions, 6 patients had anterior cerebral artery infarctions, and 3 patients had vertebro-basilar artery infarctions. The causes of the main cerebral arterial infarctions were cardiac embolism in 22 patients, atherothrombosis in 4 patients, and unknown in one patient. Fifteen (55%) of the 27 patients died from transtentorial herniation caused by massive cerebral infarction or from general complications. Of the 12 patients (45%) who survived, 8 patients were moderately disabled, 1 patient was severely disabled, and 3 patients existed in a vegetative state. Worse outcomes were more frequent in younger patients with internal carotid artery infarctions related to cardiogenic embolism.

Adult↗
PubMedDate not supplied

[Atrial fibrillation and acute ischemic cerebrovascular disease. Study of 500 cases of cerebral infarction and transient cerebral ischemic attacks].

The prevalence of chronic atrial fibrillation (AF) and the clinical features in 151 patients with transient ischemic attacks (TIA) and in 349 patients with cerebral infarct have been analyzed. AF was found in 11.9% of patients with TIA and in 14.9% of patients with cerebral infarct. The difference was not significant (NS). In patients without AF, the carotid artery TIAs represent 70.6% of all TIAs, while the vertebral basilar artery TIAs account for 29.4%. When AF is present, 88.9% of all TIAs belong to the carotid artery and 11.1% to the vertebral basilar artery circulatory system (NS). TIAs lasting less than 10 minutes are 42.1% when AF is not present, while when AF is present they are only 11.1% (p less than 0.001). In patients without AF 79% of TIAs last less than one hour, while in patients with AF the percentage goes down to 38.9% (p less than 0.001). In patients with or without AF, the chronic digitalis therapy before the hospitalization does not affect in any way the occurrence of TIA or cerebral infarct. These results suggest that emboli from the atrium are more likely to cause cerebral infarcts than TIAs and when they cause TIAs more usually they last hours than minutes.

Atrial Fibrillation↗
PubMed1990

Periventricular lucencies on computed tomography in multiple cerebral infarcts: correlation with cerebral blood flow measurements.

Forty-nine patients with multiple cerebral infarcts with a mean age of 70.2 years were studied to elucidate the effect of periventricular lucencies (PVLs) on cerebral blood flow (CBF). Patients with multiple cerebral infarcts showed significantly lower mean cortical blood flow (F1) values compared to 15 age-matched normal subjects (p less than .01). The mean F1 values were most significantly decreased in severe group of PVLs and moderately decreased in moderate and mild groups (p less than .05 between severe and mild groups); however, no significant differences in mean F1 values were found between severe and moderate groups. Demented patients showed significantly lower F1 values compared to nondemented patients (p less than .001) and normal subjects (p less than .001). There was no significant difference in the degree of PVL between demented and nondemented groups. As well, the mean F1 values were not significantly correlated with either the number of infarcts or ventricular dilatation. These results suggest that PVLs on CT (especially in severe cases of PVLs) may have some role in the reduction of cortical blood flow in patients with multiple cerebral infarcts.

Aged↗