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PubMed1996

[Clinical procedures in brain infarct and differential diagnosis].

The outcome of stroke improves significantly, when recognized and treated within 3 hours and in certain cases not later than 6 hours. In addition, secondary preventive measures potentially ameliorate the fate of the patient as well, especially when the cause of stroke is known. In this first article we outline the practical diagnosis and evaluation of stroke, both in the acute stage and thereafter. The differential diagnosis is also considered.

Cerebral Infarction↗
PubMed1998

[Hereditary autosomal dominant brain infarction].

Some aspects of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are reviewed. The condition causes stroke and vascular dementia. Pathological examination reveals multiple small, deep infarcts, leukoencephalopathy, and non-atherosclerotic, non-amyloid angiopathy which mainly involve the small cerebral arteries where there are severe alterations in vascular smooth-muscle cells. In hereditary autosomal dominant stroke condition patients with mutations in the human Notch 3 gene on chromosome 19 have been identified. Skin and muscle biopsy may be useful for diagnosing this condition. No causal treatment is available. Hereditary autosomal dominant stroke condition has not been diagnosed in any Norwegian family to date.

Adult↗
PubMed2005

[A study on the significance of plasma thrombospondin1 in thrombotic thrombocytopenic purpura and the relationship between thrombospondin1 and von Willebrand factor cleaving protease (ADAMTS13)].

OBJECTIVE: To measure plasma thrombospondin1 (TSP1) in thrombotic thrombocytopenic purpura (TTP) and other diseases such as idiopathic thrombocytopenic purpura (ITP), systemic lupus erythematosus (SLE), myocardial infarction, brain infarction, and malignant tumor et al. and 8 patients after bone marrow transplantation (BMT) were also investigated. Then to study on the relationship between TSP1 and von Willebrand factor cleaving protease (ADAMTS13); and to identify the significance of plasma TSP1 in TTP. METHODS: TSP1 was measured by a commercial kit and the activity of ADAMTS13 was evaluated by residue collagen binding assay. RESULTS: TSP1 in TTP plasma before plasma exchange or plasma infusion was 6.49 mg/L, and stepping up to 13.02 mg/L after therapy, but still significantly lower than 18.34 mg/L in normal control. While the decrease in different degree of ADAMTS13 activity was observed from 0%-52%, and there were 8 samples whose activity of ADAMTS13 were no more than 10%; the different extent of increase in those patients after therapy was demonstrated to be 2.9%-93.4%, only one patient's ADAMTS13 activity was below 10%. The activity of ADAMTS13 in some ITP and SLE patients were mildly decreased (63% +/- 16% and 70% +/- 14% respectively), TSP1 were also decreased (16 mg/L +/- 8 mg/L). TSP1 in patients of myocardial infarction and brain infarction were increased (24.0 mg/L +/- 2.9 mg/L), while ADAMTS13 activity had no significant change (72% +/- 16%). Same things happened in BMT patients. CONCLUSION: There was some concordance between the decrease of ADAMTS13 activity and TSP1 in plasma of TTP patients. And the change of TSP1 was restricted to TTP. TSP1 may contribute to the episode of TTP in a still unclear fashions.

ADAM Proteins↗
PubMed1992

[Depressive disorders after cerebral infarct. Relations to infarct site, brain atrophy and cognitive deficits].

We studied the effects of the localisation and size of ischemic brain infarcts and the influence of potential covariates (gender, age, time since infarction, physical handicap, cognitive impairment, aphasia, cortical atrophy and ventricular size) on 'post-stroke depression'. During an 18-months period all patients who underwent a CT-scan at the Central Institute of Mental Health and who had a single unilateral ischemic hemisphere infarct were initially included. Patients with severe aphasia or cognitive impairment who could not communicate well enough for the administration of depression rating scales were excluded. This led to a selection bias towards larger infarct sizes in the right hemisphere. In order to overcome this potentially critical selection artefact all patients with infarct sizes over 23 cm2 and/or with 'mini Mental State Scores' under 20 were excluded. The data from the remaining 30 patients (mean age 68 years; 15 male; 13 left hemisphere infarcts were used for the analysis. Their scores on the Hamilton depression rating scale, the Zung self rating depression scale and the von Zerssen clinical self-rating depression scale correlated significantly with one another (r greater than 0.73; p less than 0.001). Backward stepwise regression analysis carried out on the covariates mentioned above demonstrated a significant relationship only between cognitive impairment or cortical atrophy and a higher depression score.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Significance of proton relaxation time measurement in brain edema, cerebral infarction and brain tumors.

We examined the proton relaxation times in vitro in various neurological diseases using experimental and clinical materials, and consequently obtained significant results for making a fundamental analysis of magnetic resonance imaging (MRI) as followings. 1) In the brain edema and cerebral infarction, T1 prolonged and T2 separated into two components, one fast and one slow. Prolongation of T1 referred to the volume of increased water in tissue. The slow component of T2 reflects both the volume and the content of increased edema fluid in tissue. 2) In the edematous brain tissue with the damaged Blood-Brain-Barrier (BBB), the slow component of T2 became shorter after the injection of Mn-EDTA. Paramagnetic ion could be used as an indicator to demonstrate the destruction of BBB in the brain. 3) After the i.v. injection of glycerol, the slow component of T2 became shorter in the edematous brain with the concomitant decrease of water content. The effects of therapeutic drug could be evaluated by the measurement of proton relaxation times. 4) Almost all tumor tissue showed a longer T1 and T2 values than the normal rat brain, and many of them showed two components in T2. It was difficult to determine the histology of tumor tissue by the relaxation time alone because of an overlap of T1 and T2 values occurred among various types of brain tumors. 5) In vivo T1 values of various brain tumor were calculated from the data of MRIs by zero-crossing method, and they were compared with the in vitro T1 values which were measured immediately after the surgical operation. Though the absolute value did not coincide with each other due to differences in magnetic field strength, the tendency of the changes was the same among all kinds of tumors. It is concluded that the fundamental analysis of proton relaxation times is essentially important not only for the study of pathophysiology in many diseases but also for the interpretation of clinical MRI.

Animals↗
PubMed1988

Silent infarction of the brain. Incidental finding demonstrated by SPECT.

Bone imaging of the body is often requested to rule out metastatic disease. A patient with suspected breast carcinoma underwent bone imaging which revealed a focal area of uptake that appeared to be localized in the right posterior calvarium. The initial interpretation was possible solitary metastatic breast carcinoma to the skull. Skull radiographs and head computed tomography (CT) were suggested for follow-up evaluation. The skull series was performed immediately after bone imaging and was negative. Further clinical information revealed that the patient recently had undergone total right internal carotid artery ligation for treatment of a large, surgically inaccessible right cavernous aneurysm. SPECT imaging of the head localized the region of abnormal uptake adjacent to the calvarium, which suggested the uptake was due to a recent brain infarction or metastatic disease to the brain. A CT scan performed 4 days later demonstrated generalized cerebral atrophy, but was otherwise normal, ruling out metastatic breast carcinoma. This case emphasizes the importance of SPECT imaging when a solitary skull lesion is found on bone imaging. SPECT can localize the lesion to be within the brain and/or skull and can aid in further investigative management. A lesion located at the periphery of the brain may be due to an occult stroke. This finding is of particular consideration in the elderly in whom there is a relatively high incidence of coexisting cancer and silent brain infarction.

Aged↗
PubMed1992

[Clinical aspects and pathogenesis of infarction of the brain stem].

Clinical and hemodynamic studies were carried out in 75 patients with stem brain infarction in the acute period, including repeated infarctions. The total rupture of the autoregulatory mechanisms of the brain blood flow was discovered, leading to the development of different phenomena of "brain steal" determining the clinical course of stem brain infarction. In the given pathology, the acute period is characterized by the development of the vicious circle of hemodynamic disorders, which is coupled with pathological dissociation in coagulation hemostasis. The progression of the hemodynamic changes requires pathogenetic correction of central and cerebral circulation.

Acute Disease↗
PubMed2005

[A case of neonatal infarction: early diagnosis by diffusion weighted imaging].

A 2-day-old boy had hemi-convulsion and diagnosed as having neonatal infarction. Brain MRI was performed on the day after the day of onset. Abnormal finding were noted on diffusion weighted imaging, but not on T1 and T2 weighted imaging. During the first few days of life, it is difficult to demonstrate neonatal brain infarction by T1 and T2 weighted imaging. Diffusion weighted imaging is useful for the early diagnosis of neonatal infarction.

Brain↗
PubMed2005

Coronary artery calcium: associations with brain magnetic resonance imaging abnormalities and cognitive status.

OBJECTIVES: To evaluate the association between coronary atherosclerosis and subclinical brain magnetic resonance imaging (MRI) abnormalities and between coronary atherosclerosis and abnormal cognitive function (dementia/mild cognitive impairment). DESIGN: Cross-sectional. SETTING: The Cardiovascular Health Study (CHS), an epidemiological study of risk factors for cardiovascular disease in older adults. PARTICIPANTS: Four hundred nine men and women, mean age 79, recruited from the Pittsburgh center of the CHS. MEASUREMENTS: Coronary atherosclerosis was defined according to the level of coronary artery calcification (CAC), as measured using electronic beam tomography. Subclinical brain MRI abnormalities included ventricular enlargement, white matter hyperintensities, and number of subcortical brain infarcts. Brain MRI and CAC measurements were performed between 1998 and 2000 at the Pittsburgh center of the CHS. Prevalence of brain MRI abnormalities and abnormal cognitive status were examined across quartiles of the CAC score, before and after controlling for age. Multivariate logistic regression models were used to assess whether CAC level was associated with abnormalities of brain MRI or abnormal cognitive status. RESULTS: Older adults with high CAC scores were more likely to have more-severe brain MRI abnormalities, including subcortical infarction and high white matter hyperintensities. The associations between CAC and ventricular enlargement showed a similar but not significant trend. The presence of any of the MRI abnormalities attenuated the association between CAC and abnormal cognitive status. CONCLUSION: Older adults with higher levels of CAC were more likely to have more-severe brain MRI abnormalities and abnormal cognitive status.

Aged↗
PubMed1999

T1rho dispersion of rat tissues in vitro.

The purpose of this study was to demonstrate T1rho dispersion in different rat tissues (liver, brain, spleen, kidney, heart, and skeletal muscle), and to compare the 1/T1rho data to previous 1/T1 data and magnetization transfer of rat tissues at low (0.1 T) B0 field. The 1/T1rho dispersion showed a fairly similar pattern in all tissues. The highest 1/T1rho relaxation rates were seen in liver and muscle followed by heart, whereas the values for spleen, kidney, and brain were quite similar. Compared to 1/T2 relaxation rate, the greatest difference was seen in liver and muscle. The rank order 1/T1rho value at each locking field B1 was the same as the transfer rate of magnetization from the water to the macromolecular pool (Rwm) for liver, muscle, heart, and brain. The potential value T1rho imaging is to combine high T1 contrast of low field imaging with the high signal to noise ratio of high static field imaging. When the T1rho value for a given tissue is known, the contrast between different tissues can be optimized by adjusting the locking time TL. Further studies are encouraged to fully exploit this. Targets for more detailed research include brain infarct, brain and liver tumors.

Animals↗
PubMedDate not supplied

[Potential for organ donation in Sweden. Analysis of five-year registration of all ICU deaths in southern Sweden].

A complete registration of all deceased patients at intensive care units in the Southern Health region of Sweden has shown that 3,114 patients died during the five years from 1999 to 2003. Only 174 cases (5.6 per cent) were classified as potential organ donors according to the definition of total brain infarction (brain death) without medical contra-indications against organ donation. Consent for organ donation was given in slightly more than half of these cases. In 42 per cent of the cases relatives were not aware of the attitude of the deceased, and in 40 per cent of these cases they used their right of veto against organ donation. Corresponding registration, as part of the computerised system for quality assurance for intensive care (PASIVA), may become a national and complete quality assurance for organ donation in Sweden.

Family↗
PubMed2005

[Two cases of top of the basilar syndrome with onset seizure].

We reported 2 patients with top of the basilar syndrome manifested by onset seizure. Patient 1 was a 76-year-old man. When he was sleeping, suddenly he gave a loud cry and went into convulsions. So he was brought to our hospital by ambulance. On admission, he had unconsciousness and left hemiplegia. Patient 2 was a 70-year-old man. When he was bathing, he lost his consciousness and brought to our hospital by ambulance. On admission, he had convulsion and tetraplegia. Both patients had convulsions and palsy when they had brain infarctions. Brain diffusion weighted MR image showed high intensity area in bilateral internal thalamus, brainstem and cerebellum and no high intensity area in cerebral cortex. We know well that Todd's palsy is palsy after convulsion, but vertebro-basilar occlusion also shows convulsion and palsy. Therefore attention should be paid in the case of the patients who had convulsion and palsy.

Aged↗