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PubMed1990

[Application of the box plot to evaluate serum lipid levels and apolipoprotein levels in patients with cerebral infarction and diabetes mellitus].

Serum levels of lipids and apolipoproteins were determined in patients with cerebral infarction during the chronic stage three months after onset, and these patients were classified into the group with diabetes mellitus and that without diabetes mellitus. These levels were compared with the levels observed in the control group and the diabetes mellitus-only group using the box plot which is a procedure employed in exploratory data analysis. a. Compared to the control group, the levels of T.G., apo B, Apo C-II and Apo C-III were higher, that of HDL-C, was lower, that of LDL-C, tended to be higher and that of Apo A-I tended to be lower in the diabetes mellitus-only group without treatment or under diet treatment alone. b. Compared to the control group, the levels of LDL-C, and Apo B were higher, while those of HDL-C., Apo A-I, and APO A-II were lower in the cerebral infarction-only group. c. Compared to the control group, the level of Apo B was higher, those of T.G. tended to be higher, and that of HDL-C, tended to be lower in the cerebral infarction group with diabetes mellitus, but when compared to the cerebral infarction-only group, the levels of T.G., HDL-C, Apo A-II, Apo C-II and Apo C-III tended to be higher. d. Compared to the control group, the ratio of LDL-C. to Apo B was lower (p less than 0.05) in the cerebral infarction group with diabetes mellitus and tended to be lower even in the diabetes mellitus-only group.

Adult↗
PubMed2004

[Clinical study of zhuyutongmai capsule on treating senile cerebral infarction and effect on function of vascular endothelium].

OBJECTIVE: To evaluate the clinical study of Zhuyutongmai (ZYTM) Capsule in treating senile cerebral infarction and effect on function of vascular endothelium. METHODS: Sixty-four aged patients with cerebral infarction were randomly divided into the treated group treated with ZYTM and the control group treaded with Naoluotong. The clinical effect was observed. The hemorrheologic and hemodynamic parameters, the blood levels of endothelin (ET) and nitric oxide (NO) were determined before and after treatment. RESULTS: After treatment of ZYTM, the hemorrheologic and hemodynamic parameters were all significantly improved (P < 0.01 or P < 0.05), the therapeutic effect of ZYTM was better than that of Naoluotong (P < 0.05), compared with the control group after treatment, the level of ET in the treated group were lower (P < 0.01), and level of NO were higher (P < 0.01). CONCLUSION: ZYTM has good effect in treating senile cerebral infarction.

Aged↗
PubMed1984

[Secondary prevention of cerebral infarction caused by atherosclerosis. 3-year comparison of flurbiprofen and an ergot derivative].

A multicentre controlled trial was conducted on 383 patients to compare the effectiveness of flurbiprofen (100 mg/day) and an ergot derivative in preventing cerebral infarction. The end-point of the trial was recurrence within 3 years of treatment with one or the other drug of a fatal or non-fatal cerebral infarction. Only those patients who had already experienced an established and disabling ischaemic accident in the carotid or vertebro-basilar territory were included; 88% of these entered the trial less than 6 weeks after the accident. Sixty-one patients had recurrent cerebral infarction during the 3-year observation period: 22 in the flurbiprofen group and 39 in the ergot derivative group (p less than 0.02 log rank test adjusted by centre). The actuarial recurrence rates in the two groups were 13% and 21% respectively. These results concur with those of other trials involving aspirin to demonstrate the value of antiplatelet aggregation drugs in the secondary prevention of atherothrombotic cerebral infarction.

Arteriosclerosis↗
PubMed2004

Oxidized low-density lipoprotein is present in astrocytes surrounding cerebral infarcts and stimulates astrocyte interleukin-6 secretion.

Ischemic injury to brain is associated with both disruption of the blood-brain barrier and increased oxidative stress. Given the neurotoxicity associated with exposure to oxidized low-density lipoprotein (oxLDL) in vitro, we tested the hypothesis that oxLDL may be present in parenchymal cells of cerebrum after infarction and that oxLDL may influence the pathophysiology of cerebral infarction. Our results showed that the subacute phase of cerebral infarction in patients was characterized by the appearance of oxLDL epitopes in astrocytes, but not neurons or microglia, in the perinecrotic zone. We further demonstrated that minimally oxLDL was most effectively internalized by primary cultures of rat astrocytes, and that exposure to minimal oxLDL stimulated astrocyte interleukin-6 secretion but did not alter nitric oxide production. These results demonstrate for the first time that oxLDL is present in brain parenchyma of patients with ischemic infarction and suggest a potential mechanism by which oxLDL may activate innate immunity and thereby indirectly influence neuronal survival.

Adult↗
PubMed2004

Severe delayed diffuse cerebral vasospasm and cerebral infarctions following spinal subdural hemorrhage.

BACKGROUND: We report a rare case of severe delayed cerebral vasospasm with cerebral infarctions after spinal subdural hemorrhage. CASE REPORT: A 56-year-old woman presented with an acute onset of paraplegia. MR-imaging revealed an extensive intraspinal hemorrhage reaching from T1 to L1. The hematoma was evacuated via a T8-laminectomy. At the 7th postoperative day the patient developed visual disturbances. MR-scanning revealed extensive infarctions and cerebral angiography showed severe diffuse vasospasms. INTERPRETATION: This case demonstrates that cerebral vasospasm may be caused by a spinal subdural hemorrhage, supporting the hypothesis that cerebral vasospasm may be triggered by factors from a remote site and that a direct contact of blood clots with the vessel is not mandatory.

Cerebral Infarction↗
PubMed1999

The relationship between cerebral infarction and angiographic characteristics in childhood moyamoya disease.

BACKGROUND AND PURPOSE: In childhood-onset moyamoya disease, the angiographic disease process of stenoocclusive lesions is progressive, and cerebral infarctions often develop as a result of ischemia. Our purpose was to determine how the severity of stenoocclusive lesions in the anterior and posterior circulations affects the distribution of cerebral infarction in patients with childhood-onset moyamoya disease. METHODS: In 69 patients with childhood-onset moyamoya disease, angiograms were reviewed for stenoocclusive lesions, and CT scans, MR images, or both were reviewed for the sites and extent of cerebral infarction. The relationship between the angiographic and CT/MR findings was examined. RESULTS: The prevalence and degree of stenoocclusive lesions of the posterior cerebral artery (PCA) significantly correlated with the extent of lesions around the terminal portion of the internal carotid artery (ICA). The prevalence of infarction significantly correlated with the degree of stenoocclusive changes of both the ICA and PCA. Infarctions tended to be distributed in the anterior borderzone in less-advanced cases, while in more advanced cases lesions were additionally found posteriorly in the territory of the middle cerebral artery, the posterior borderzone, and the PCA territory. CONCLUSION: Our results indicate that progressive changes of the anterior and posterior circulations are associated with the distribution of cerebral infarction, culminating in a patchily disseminated or honeycomb pattern of infarction on CT and MR studies in late stages of the disease.

Adolescent↗
PubMed1999

Early prognostic indicators of outcome in infants with neonatal cerebral infarction: a clinical, electroencephalogram, and magnetic resonance imaging study.

OBJECTIVE: The aim of this study was to identify prognostic factors in newborns with cerebral infarction. DESIGN: Antenatal and perinatal factors and early clinical, electroencephalogram (EEG), and magnetic resonance imaging (MRI) findings were compared with neurodevelopmental outcome in 24 children with evidence of cerebral infarction on neonatal MRI. RESULTS: Out of 24 infants, 19 had an infarction in the territory of a major cerebral vessel and 5 in the borderzone between cerebral arteries. Neuromotor outcome was normal in 17 and abnormal in 7 infants. Of these 7 infants, 5 infants showed a definite hemiplegia, whereas the other 2 showed some asymmetry of tone or function but no definite hemiplegia. None of the adverse antenatal or perinatal factors was significantly associated with abnormal outcome. Neonatal clinical examination was also not always predictive of the outcome. The extent of the lesion on MRI was a better predictor. In particular, it was the concomitant involvement of hemisphere, internal capsule and basal ganglia that was always associated with an abnormal outcome whereas the involvement of only one or two of the three tended to be associated with a normal outcome. EEG was also very helpful. Abnormal background activity either unilateral or bilateral was found in 6 infants and 5 out of 6 developed hemiplegia. In contrast, the presence of seizure activity in presence of a normal background was not related to abnormal outcome. CONCLUSIONS: Early MRI and EEG can help to identify the infants with cerebral infarction who are likely to develop hemiplegia.

Cerebral Infarction↗
PubMed1997

Insulin resistance is related to silent cerebral infarction in patients with essential hypertension.

Recently, hyperinsulinemia or insulin resistance has been suggested to be a risk factor for cardiovascular diseases. We evaluated the role of insulin resistance in the occurrence of silent cerebral infarction in 28 patients with essential hypertension (40 to 75 years, 157 +/- 4/89 +/- 2 mm Hg). Patients with diabetes mellitus or obesity (BMI > or = 30) were excluded. Insulin resistance was evaluated by means of constant glucose infusion rate (M value) during euglycemic-hyperinsulinemic glucose clamp test. Infarction was defined as a focal area with prolonged T1 and T2 relaxation times that was > 5 mm in diameter on brain magnetic resonance imaging. The severity of periventricular hyperlucency was evaluated by the distribution of the high intensity area. The number of silent infarctions significantly correlated only with the M value (F = 7.58, R2 = 0.23, P = .01) in multiple regression analysis using all variables: age, blood pressure, smoking history, lipid profile, levels of plasma glucose and insulin on fasting, and total amounts during 75-g OGTT. However, the severity of periventricular hyperlucency did not show a correlation with any factors. The occurrence of cerebral infarction was significantly correlated with thickening of the intima-media complex (IMC) of the common carotid artery on B-mode ultrasonography (F = 8.43, R2 = 0.25, P < .01). In conclusion, insulin resistance and thickening of IMC show a close relationship with the occurrence of silent cerebral infarction. Therefore, it may be important to improve insulin resistance for prevention of cerebral infarction in essential hypertensives.

Carotid Arteries↗
PubMed1996

Cerebral infarction and antiphospholipid syndrome in children.

OBJECTIVE: To investigate the prevalence of antiphospholipid antibodies (aPL) in children with acute cerebral infarction. METHODS: The study was carried out in 10 consecutive patients during the first days of neurological symptoms. aPL detected as lupus anticoagulant or anticardiolipin antibodies (aCL) and natural anticoagulant proteins C, S, and antithrombin III were determined in all patients. RESULTS: Seven patients had acute cerebral infarctions associated with aCL; 4 of these patients had high serum aCL concentrations in 2 different determinations (antiphospholipid syndrome). Two patients had temporary protein C deficiency. In one patient with negative aCL, protein C, S, and antithrombin III determinations were not carried out. No patient had evidence of connective tissue disease or family history of hypercoagulable state. After followup of 15.7 months, no patient had recurrent infarction while taking aspirin. CONCLUSION: Our study demonstrates high prevalence of aCL in children who suffer acute cerebral infarction and our results suggest aspirin may be effective therapy to prevent recurrences.

Adolescent↗
PubMed1994

A simple practical classification of cerebral infarcts on CT and its interobserver reliability.

PURPOSE: To test the interobserver reliability of a simple method of classifying cerebral infarcts as seen on CT brain scans, which might allow differentiation of the site and size of the infarct from infarct swelling and hemorrhagic transformation. METHOD: Two experienced neuroradiologists independently reviewed 119 CT brain scans showing recent small to large cortical and subcortical cerebral infarcts and classified each for site and size, amount of swelling, and hemorrhagic transformation blind to clinical information. Six less experienced general radiologists in training classified 33 of the CT scans blind to clinical information. Interobserver agreement was calculated using unweighted kappa statistics. RESULTS: The kappa statistics between the two experienced neuroradiologists were: (a) 0.78 for site and size (95% confidence interval 0.69-0.87); (b) 0.8 for swelling (95% confidence interval, 0.68-0.92); and (c) 0.3 for hemorrhagic transformation (95% confidence interval, 0-0.77); indicating "good," "excellent," and "fair" agreement, respectively. Agreement for the less experienced radiologists was fair to excellent. CONCLUSION: The cerebral infarct morphologic classification is simple, quick, and reliable and therefore practical. It usefully distinguishes between infarcts of similar site and size but with different amounts of swelling and hemorrhagic transformation, thus facilitating study of factors such as the influence of drug treatment on infarct swelling, which might influence clinical outcome. Although developed for CT, it could be used equally for MR imaging and has applications in research and clinical practice.

Adult↗
PubMed1991

[Cerebral infarction during operation on the neck of the femur under epidural anesthesia: a report of two cases].

Cerebral infarction occurred during operation in two cases. An 83-year-old senile demented female underwent osteosynthesis with Ender pins under epidural anesthesia. Soon after Ender pins were inserted, her systolic blood pressure fell from 180 mmHg to 140 mmHg. The patient complained of chest pain and developed disturbed consciousness and right hemiparesis. On the second postoperative day, CT scanning showed the infarction of a left middle cerebral artery region. A 93-year-old female was another patient. She underwent a cup arthroplasty of the right hip bone fracture. Soon after bone cement was applied, she developed a mental confusion and her blood pressure increased from 120/60 mmHg to 160/80 mmHg. CT scanning on the first postoperative day showed the infarction of a left middle cerebral artery region. Sudden changes in systolic blood pressure and changes of mental status are possible signs of cerebral infarction not to be neglected. If elderly patients with any episodes of cerebral function troubles would undergo operation of the hip fracture, it is necessary to pay a particular attention to possible cerebral infarction.

Aged↗
PubMed1998

Natural history of the spontaneous reperfusion of human cerebral infarcts as assessed by 99mTc HMPAO SPECT.

OBJECTIVE: Little is known about the effect of spontaneous reperfusion of human cerebral infarcts. Single photon emission computerised tomography (SPECT) data were analysed from a study using 99Tc(m) HMPAO (99Tc(m) hexamethylpropyleneamine oxime) in human cerebral infarction for the frequency of reperfusion and to see if it affected infarct size, oedema, haemorrhagic transformation, or functional outcome. METHODS: Fifty sequential cases of ischaemic stroke were studied with 124 99Tc(m) HMPAO SPECT at around one day, one week, and three months after stroke along with detailed clinical and functional assessments. RESULTS: Visually apparent reperfusion occurred in 14 of 50 patients (28%) with a mean delay of 5.8 days and reperfusion was seen in seven others in whom it was identified on the basis of changes in perfusion deficit volume. It occurred in 13 of 23 embolic events but only in three of 23 other events. In only two cases did spontaneous reperfusion occur early enough to preserve tissue or function. Reperfusion did not otherwise reduce infarct size, or improve clinical or functional outcome, and was not associated with oedema but an association with haemorrhagic transformation was suggested. Reperfusion significantly decreased the apparent perfusion defect as measured by SPECT one week from the ictus, but was mostly non-nutritional and transient. The mean volume of tissue preserved by nutritional reperfusion was 10 cm3, but this was unequally distributed between cases. Late washout of 99Tc(m) HMPAO from areas of hyperaemic reperfusion may be a good prognostic marker but is a rare phenomenon and too insensitive to be of general applicability. CONCLUSIONS: Spontaneous reperfusion after cerebral infarction occurs in 42% of cases within the first week but is associated with clinical improvement in only 2%. It has few adverse consequences although it may be associated with haemorrhagic transformation.

Activities of Daily Living↗
PubMed1991

Change of accumulation and filling pattern in evolution of cerebral infarction with I-123 IMP brain SPECT.

Twenty-eight patients with cerebral infarction were examined by brain SPECT with I-123 IMP a total of 46 times from Day 2 to Day 84 after the onset of stroke. Depending on the pattern of change in the abnormal accumulation of I-123 IMP between the early and delayed images, the patients were classified into one of five types. The number of patients in each type and the number of days after infarction at which each type occurred were as follows: Type (I), n = 5 and 4 +/- 2 days; Type (II), n = 8 and 12 +/- 4 days; Type (III), n = 17 and 21 +/- 11 days; Type (IV), n = 13 and 38 +/- 18 days; and Type (V), n = 3 and 60 +/- 16 days. In 12 patients, 30 brain SPECT were performed that showed the chronological evolution of infarction in sequence from Types (I) to (IV). Hyperactivity in the early image was seen in Type (I) with a subsequent image defect, while in Type (II) there was persistent hyperactivity. Hypoactivity in the early image was seen in Types (III), (IV), and (V), and the activity in the delayed image gradually decreased as the process of infarction terminated. The early image reflected the distribution of lipophilic I-123 IMP, indicating regional cerebral blood flow, while the delayed image showed the distribution of hydrophilic I-123 IMP metabolites superimposed on that of lipophilic I-123 IMP which had accumulated in the brain at the first extraction. Combining the early and delayed images of I-123 IMP brain SPECT may help to understand the evolution of cerebral infarction.

Adult↗
PubMed1993

Patterns of vascular pathology in acute, first-ever cerebral infarction.

This was a preliminary study to see whether patterns of vascular pathology correlated with a simple clinical classification of acute cerebral infarction. Thirty-two patients with acute, first-ever hemispheric cerebral infarction were prospectively studied clinically together with an extra- and transcranial Doppler ultrasound. All 14 patients with the triad of ipsilateral motor/sensory deficit, homonymous hemianopia and higher cortical dysfunction (Total Anterior Circulation Infarction, [TACI]) had occlusion of the symptomatic middle cerebral artery and/or internal carotid artery, or a severe middle cerebral artery stenosis. Three patients with lacunar infarction had no evidence of major vessel occlusion. Eleven of thirteen patients with Partial Anterior Circulation, Infarction (PACI) I (i.e. only one or two clinical features of the TACI triad) had patent symptomatic major vessels, with indirect evidence to suggest distal branch occlusion(s) of the middle cerebral artery in six. The remaining two PACI patients had major vessel occlusions. Two patients were not clinically classifiable, but both had significant vascular pathology on ultrasound. The findings of this preliminary study therefore suggest that a simple clinical classification was generally capable of predicting patterns of vascular pathology in patients with acute cerebral infarction, which could have implications for the selection of patients for clinical trials of thrombolytic therapy.

Acute Disease↗
PubMed2004

Correlation between serum level of neuron-specific enolase and long-term functional outcome after acute cerebral infarction: prospective study.

OBJECTIVE: To determine the value of measuring serum levels of neuron-specific enolase in predicting extent of disease and short- and long-term functional outcome after acute cerebral infarction. DESIGN: Prospective study. SETTING: Neurology departments at two university teaching hospitals, Shanghai. PATIENTS: Thirty-eight patients who presented for acute cerebral infarction between October 1998 and October 2000 were divided into two groups: those whose infarction extended to the cerebral cortex in the carotid artery region (cortical group) and those with an infarction in the subcortical carotid artery region (subcortical group). MAIN OUTCOME MEASURES: Using a solid-phase enzyme immunoassay, we measured serum levels of neuron-specific enolase on admission and on days 2, 3, and 15. Infarct volume was measured by computed tomography on day 5. The Activities of Daily Living scale was used to assess the clinical outcome at 1-, 3-, and 6-month follow-up after onset. RESULTS: Mean (standard deviation) serum neuron-specific enolase levels were significantly higher among patients with acute cerebral infarction than among controls (18.48 [16.61] ng/mL versus 9.00 [2.70] ng/mL; P<0.001). The neuron-specific enolase level was also higher in the cortical group than in the subcortical group (33.54 [29.71] ng/mL versus 15.97 [5.91] ng/mL; P<0.01). Levels peaked after 2.11 (0.86) days and correlated positively with the infarct volume (r=0.81; P<0.01) and negatively with clinical outcome at 1 month (r= -0.37; P<0.05), 3 months (r= -0.45; P<0.01), and 6 months (r= -0.65; P<0.001), as assessed on the Activities of Daily Living scale. CONCLUSION: Serum neuron-specific enolase levels after cerebral infarction may be a useful marker to predict infarct volume and short- or long-term functional outcome.

Activities of Daily Living↗
PubMed1989

Nonvalvular atrial fibrillation as a cause of fatal massive cerebral infarction in the elderly.

By studying 3,408 consecutive autopsied elderly patients, we found that two thirds of the 132 massive cerebral infarctions (86) were embolic, of cardiac origin. Embolic infarction associated with nonvalvular atrial fibrillation was seen in 48 cases (36%), half due to the first stroke. Embolic infarction associated with heart disease other than nonvalvular atrial fibrillation was seen in 23 cases (17%), and that from nonbacterial thrombotic endocarditis was seen in 15 cases (11%). Thrombotic infarction or infarction of nonembolic cardiac origin was found in only 39 cases (30%). Of 56 patients with fatal massive cerebral infarction who died less than or equal to 2 weeks after their stroke, 25 (45%) had embolic strokes associated with nonvalvular atrial fibrillation. Our study shows that nonvalvular atrial fibrillation is a very important cause of fatal massive cerebral infarction in the elderly.

Aged↗
PubMed1990

Early detection of cerebral infarction by 31P spectroscopic imaging.

Recent advances in magnetic resonance spectroscopy permit noninvasive study of brain metabolism in vivo, 31P spectroscopic imaging being the method for evaluation of localized phosphorous metabolism. Experimentally, an ischemic-hypoxic brain insult is characterized by depletion of high energy metabolites. These changes are seen immediately after an ischemic insult. We had the opportunity of carrying out 31P spectroscopic imaging of hyperacute cerebral infarction, while MRI and CT were negative. Cerebral infarction of the middle cerebral artery territory was suggested by 31P spectroscopic imaging, which was closely consistent with a later-developing region of low density on CT. In cerebral infarction, early detection of the lesion is a useful pointer to the patient's prognosis, making 31P spectroscopic imaging a potential tool.

Aged↗
PubMed2006

Gene transfer of hepatocyte growth factor gene improves learning and memory in the chronic stage of cerebral infarction.

There is no specific treatment to improve the functional recovery in the chronic stage of ischemic stroke. To provide the new therapeutic options, we examined the effect of overexpression of hepatocyte growth factor (HGF) in the chronic stage of cerebral infarction by transferring the HGF gene into the brain using hemagglutinating virus of Japan envelope vector. Sixty rats were exposed to permanent middle cerebral artery occlusion (day 1). Based on the sensorimotor deficits at day 7, the rats were divided equally into control vector or HGF-treated rats. At day 56, rats transfected with the HGF gene showed a significant recovery of learning and memory in Morris water maze tests (control vector 50+/-4 s; HGF 33+/-5 s; P<0.05) and passive avoidance task (control vector 132.4+/-37.5 s; HGF 214.8+/-26.5 s; P<0.05). Although the total volume of cerebral infarction was not related to the outcome, immunohistochemical analysis for Cdc42 and synaptophysin in the peri-infarct region revealed that HGF enhanced the neurite extension and increased synapses. Immunohistochemistry for glial fibriary acidic protein revealed that the formation of glial scar was also prevented by HGF gene treatment. Additionally, the number of the arteries was increased in the HGF group at day 56. These data demonstrated that HGF has a pivotal role for the functional recovery after cerebral infarction through neuritogenesis, improved microcirculation, and the prevention of gliosis. Our results also provide evidence for the feasibility of gene therapy in the chronic stage of cerebral infarction.

Animals↗