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PubMed2001

[Myocardial infarction due to cocaine].

Cocaine is a common drug. Myocardial infarcts and brain infarcts related to the use of cocaine were previously reported in the medical literature. We report a 34 year old patient admitted for severe chest pain, a few minutes after cocaine use. He was found to have an acute myocardial infarction with significant left ventricle dysfunction. Coronarography conducted a few days later was found to be normal. Cocaine use may cause acute myocardial infarction in young and healthy people with no other risk factors.

Adult↗
PubMed1985

[Weak chemiluminescence from infarcted rat brain and basic studies on the generation of chemiluminescence].

Chemiluminescence measurement in vivo system and its related studies on free radical reaction were reported. Weak chemiluminescence from rat brain surface subjected to ischemic cerebral stroke could be detected. It was observed just after embolization and lasted at least four hours. In order to investigate the mechanism of the generation of chemiluminescence and a side reaction of lipid peroxidation, several studies were made using 10% brain homogenate under oxygenated conditions at 37 degrees C. Brain homogenate showed increasing chemiluminescence that reached a plateau level a few hours later. Chemiluminescence, accompanying with thiobarbituric acid reactive substance (TBARS) formation, was based on free radical reaction with requirement of oxygen. Time course increase in TBARS formation, however, revealed some differences from that of integrated light intensity. Chemiluminescence spectrum in the visible region showed that excited indole chemicals (triplet states) generated in the present system emitted light during their return to ground state, but not singlet molecular oxygen. Suspension of acetone powder in Tris-HC1 buffer prepared from brain homogenate also disclosed chemiluminescence to some extent, whereas liposomes made of extracted brain lipid did not. These results probably indicate that proteins are essential for luminescence, but not lipid only, and involves the lipid-protein interaction in oxygenated brain homogenate. In the process of lipid-protein interaction, neither fatty acids composition nor protein molecules significantly altered, except for a newly-appeared high molecular weight protein. On the other hand, SH group was suggested to be quite vulnerable to free radical attack.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1978

[Cerebral magnification angiography (author's transl)].

The advantages of magnification angiography for diagnosis of cerebral diseases are reported. Following description of the physical basics and our own examination technique, the indications are enumerated which necessitate modern magnification angiography in neuroradiological diagnosis. These are mainly all those tumors whose location and nature are not definitely demonstrable by conventional angiography, furthermore tumor recurrency, vascular alterations of arteriosclerotic genesis and arteriovenous malformations. Magnification angiography under hyperventilation may also be used for differential diagnosis between brain infarct and brain tumor. The author uses this examination technique for 7 years and emphasizes that without magnification angiography optimal neuroradiology is not possible anymore.

Brain Neoplasms↗
PubMed1994

The Japanese experience in hemorrhagic stroke.

AIM: To review current problems with hemorrhagic stroke in Japan and to explore possible explanations for a change not only in the incidence but also the severity of hemorrhagic stroke in recent years in Japan. METHODS: Mortality statistics, community-based registries and hospital records were used. RESULTS AND CONCLUSIONS: The age-adjusted stroke mortality rate in Japan has declined over the last 20 years by approximately 75%, a very strong decline compared with other countries. The reduction was much more marked for hemorrhagic stroke than for ischemic stroke. Community-based registries for recent years show that the incidence ratio of brain infarction to brain hemorrhage is 1.5-4.0; this is about one-half, or even less than one-half of the rates reported in Western populations. The incidence of subarachnoid hemorrhage in Japan is 7-12% of total strokes. The growing popularity of antihypertensive treatment and changes in lifestyle, including nutrition, are considered responsible for the marked change observed in the stroke figures. Furthermore, mild to moderate cases of brain hemorrhage have been seen more frequently in recent years than severe cases.

Adult↗
PubMed1996

99Tcm-HMPAO SPET and 1H-MRS (proton magnetic resonance spectroscopy) in patients with ischaemic cerebral infarction.

Brain 99Tcm-HMPAO single photon emission tomography (SPET) and 1H-MRS (proton magnetic resonance spectroscopy) were used to determine correlations between alterations in regional cerebral blood flow (rCBF) and changes in neuronal metabolites in 21 patients (28 examinations) with ischaemic cerebral infarction examined in different phases. rCBF was determined semi-quantitatively using Lassen's linearization algorithm. SPET provided evidence of the hypoperfused site of necrosis within a few hours after the acute event and alterations in rCBF were detected in both the infarcted and diaschistic areas at all stages. 1H-MRS was used to monitor the concentration of the following metabolites: N-acetyl-aspartate (NAA), creatine and phosphocreatine (CR + PCr), compounds containing choline (Cho) and lactate (Lac). A significant correlation was found between reduction in rCBF and a fall in NAA and Cr + PCr in both the acute and chronic phases, but not during "luxury perfusion' in the subacute phase. The presence of LAC in the infarcted area up to 9 months post-ictus was totally unexpected. Simultaneous SPET and 1H-MRS thus provides additional information regarding the physiopathogenesis of cerebral ictus by clarifying the relation between alterations in rCBF and biochemical neuronal changes. We believe that NAA and Cr + PCr concentrations are the best expression of agreement between flow and metabolism in infarcted areas, particularly with regard to hypoperfused areas not clearly detectable by magnetic resonance imaging in the early post-ictus stage.

Adult↗
PubMed1997

A close association between brain lacuna infarction and renal surface irregularity.

This study was undertaken to examine the association between brain lacunae examined by magnetic resonance imaging (MRI), and the severity of renal ischemia, evaluated by computed tomography (CT). We reviewed 114 cases, out of 1694 brain MRI studies and 2861 kidney CT studies undertaken between May 1994 and March 1996 in which both brain MRI and kidney CT were examined. Brain lacunae were defined as low intensity areas between 5 mm and 10 mm in diameter with the T1-weighted image. The severity of irregularity of the renal surface was classified as one of three grades: absent, mild, or severe. The prevalence of brain lacunae in cases with the renal surface irregularity classified as absent, mild, or severe was six of 45, 14 of 45, and 17 of 24, respectively. There was a highly significant relationship (P < .001) between the prevalence of brain lacunae and the severity of the renal surface irregularity. This relationship persisted, even when the subjects were restricted to include hypertensive patients > 60 years old. The irregularity of the renal surface is mainly caused by ischemia due to arteriosclerosis in the renal arteries. The results reported here suggest that brain lacuna infarcts are closely associated with renal ischemia, implicating a causative role of renal ischemia for brain lacunae.

Adult↗
PubMed2000

MRI pontine hyperintensity after supratentorial ischemic stroke relates to poor clinical outcome.

BACKGROUND AND PURPOSE: MRI studies in patients with atherosclerosis often reveal ill-defined hyperintensity in the pons on T2-weighted images. This pontine hyperintensity (PHI) does not fulfill the criteria of a brain infarct, and its clinical relevance is not established. We examined the frequency, as well as the radiological and clinical correlates, of PHI in poststroke patients. METHODS: Three hundred nineteen patients were studied 3 months after supratentorial ischemic stroke with the use of 1.0-T MRI. Brain infarcts, atrophy, white matter hyperintensities, and PHI were registered. The clinical outcome was assessed 3 and 15 months after the stroke. RESULTS: Of the patients, 152 (47.6%) had PHI. The risk factors for stroke did not differ in patients without or with PHI. PHI was related to a higher frequency (P=0.002) and larger volume (P<0.001) of supratentorial brain infarcts, to parietal (P=0.020) and temporal (P=0.002) atrophy, to central atrophy (P< or =0.040), and to white matter hyperintensity grade (P<0.001). Brain infarcts that affected the corpus striatum (putamen, caudate, and pallidum) (P< or =0. 011) or pyramidal tract (P<0.001) were more frequent in patients with PHI. The 3- and 15-month outcomes were worse in patients with PHI (P< or =0.004). The total volume of brain infarcts (OR 1.22), mean atrophy (OR 3.59), and PHI (OR 3.76) were independent correlates of a poor 15-month outcome. CONCLUSIONS: PHI after supratentorial ischemic stroke deserves attention because it relates to poor clinical outcome.

Activities of Daily Living↗
PubMed1983

Brain stem infarction due to chiropractic manipulation of the cervical spine.

A case of brain stem infarction after chiropractic manipulation of the cervical spine is presented. Proposed mechanisms and sites of possible arterial injury are discussed. A diagnosis of vertebral artery occlusion was made using conventional brachial angiography. Digital intravenous angiography, a relatively new and less invasive vascular imaging technique which was used as an adjunct for evaluating the remainder of the cervicocephalic vessels, documented the vertebral occlusion. Chiropractic manipulation, which is increasing in popularity, may be a cause of potentially devastating neurologic disease.

Adolescent↗
PubMed2004

Poststroke depression and lesion location revisited.

Seventy patients with one brain infarct on magnetic resonance imaging (MRI) were studied 3 months after ischemic stroke by a standardized protocol to detail side, site, type, and extent of the brain infarct, as well as severity of white matter lesions and brain atrophy. Depression was diagnosed by DSM-III-R and DSM-IV criteria. The brain infarcts that affected structures of the frontal-subcortical circuits, (i.e., the pallidum and caudate, especially on the left side) predisposed stroke patients to depression. The size of the infarcts at these sites in the depressed patients was larger. Using a logistic regression analysis, the authors found that a brain infarct that affected pallidum was a strong independent MRI correlate for poststroke depression (odds ratio = 7.2).

Aged↗
PubMed2000

Incidence and long-term prognosis of initial stroke and acute myocardial infarction in Okinawa, Japan.

We performed a cross-sectional survey of the incidence of stroke and acute myocardial infarction (AMI) in Okinawa, Japan, with a census population of about 1.2 million. A total of 3,644 cases of first-ever stroke and 898 cases of initial AMI were detected. The age-adjusted annual incidence rate of stroke was 105 per 100,000 of the standard population of Japan based on census population taken in 1985, and that of AMI was 26 per 100,000. The case-fatality rate of stroke within 28 days of onset was 12.8%, and that of AMI was 22.2%. Of the stroke cases, 51.4% were diagnosed as brain infarctions, 38.7% as brain hemorrhages, and 9.3% as subarachnoid hemorrhages. The diagnoses of stroke subtypes were confirmed by computed tomography or magnetic resonance imaging in 98.4% of all stroke cases. The long-term prognosis of patients with stroke and AMI was studied by examining their 10-yr survival rates (follow-up rate 89.8%). The cumulative survival rate was 38.2% in brain infarction cases, 40.4% in brain hemorrhage cases, and 38.2% in AMI cases. The 50% reduction of survival had occurred at 2,880 days after onset in brain infarction cases, at 2,764 days in brain hemorrhage cases, and at 2,658 days in AMI cases. In Okinawa, the incidence rate of AMI was still considerably lower than that in the Western population, and the rate of stroke was similar to that in the Western population. The ten-year survival rates were quite similar in AMI and stroke, and both were unexpectedly high.

Adult↗
PubMed1998

The protective effect of a persistent trigeminal artery on brain stem infarctions: a follow-up case report.

A persistent trigeminal artery (PTA) represents an embryonic vascular anastomosis connecting the carotid and basilar arterial systems. Little is known about its protective role in cases of basilar artery occlusion. We followed up a 63-year-old man who had suffered a brain stem infarction due to basilar artery stenosis and was found to have a PTA. Although a second brain stem infarction due to basilar artery occlusion developed, the circulation to the brain stem was well maintained via collateral flow from the PTA, and the patient demonstrated good recovery. A PTA may function as an anastomosis between the carotid and basilar systems, thus preventing a more serious infarction.

Arteriosclerosis↗
PubMed1990

[Proton and phosphorus-31 nuclear magnetic resonance spectroscopy in experimental cerebral infarction in rats].

Longitudinal study of metabolic change after cerebral infarction was done using nuclear magnetic resonance spectroscopy (MRS). Localized completed infarction model induced by intra-cranial ligation of the middle cerebral artery and extra-cranial ligation of common carotid artery in rats was utilized. In acute study the proton MRS revealed a sharp increase of lactic acid but the phosphorus -31 MRS did not show prominent changes. This increase of lactic acid persists 24 hours after the induction of infarction. In chronic study the spectroscopic pattern of the infarcted brain showed minimum difference from the control normal brain. However the signal intensity of phosphomonoester was significantly higher in the infarcted brain. Our study in acute phase suggests that the proton MRS is a sensitive probe to detect an early metabolic deterioration induced by ischemic insult. And the increase of phosphomonoester in chronic infarcted brain may imply that a gliosis seen in chronic infarction has a metabolic resemblance to neonate brain and neoplasm.

Animals↗
PubMed1996

Protective effect of the novel cerebrovascular-selective calcium antagonist (+/-)-(E)-1-(3-fluoro-6, 11-dihydrodibenz[b,e]-oxepine-11-yl)-4-(3-phenyl-2-propenyl)-piperazine dimaleate on ischemic brain damage after permanent middle cerebral artery occlusion in rats.

In this study the effect of post-ischemic treatment of AJ-3941 ((+/-)-(E)-1-(3-fluoro-6,11-dihydrodibenz [b,e]-oxepine-11-yl)-4-(3-phenyl-2-propenyl)-piperazine dimaleate, CAS 143110-70-7) a cerebrovascular-selective calcium antagonist, on brain infarction and edema in a rat model of focal cerebral ischemia with permanent middle cerebral artery occlusion (MCAo) was evaluated. Brain infarct size was determined at 24 h after MCAo by measuring 2,3,5-triphenyltetrazolium chloride-negative stained area of the serial brain sections. Post-ischemic treatment of AJ-3941 (3 mg/kg p.o.), 10 min and 3 h after the insult, significantly reduced brain infarct size by 44-80%, compared to vehicle control. The reducing effect was observed both in the cortical and subcortical regions. Three days after MCAo, contents of water and Na+ in the ipsilateral hemisphere significantly increased comparing with those in control rats. Post-ischemic treatment with AJ-3941 (3 and 10 mg/kg twice daily p.o. for 2 days) markedly inhibited the increase in water content and suppressed the increase in Na+ content. In the contralateral hemisphere, these contents showed no significant differences between vehicle-treated group and either control (non-operated) or AJ-3941-treated group. AJ-3941 had only minimum effect on body temperature and physiological parameters, such as blood pressure, blood gases and glucose, even when the maximum dose used (10 mg/kg) was repeatedly administered. These results indicate that post-ischemic treatment with AJ-3941 may ameliorate the brain infarction and edema after permanent focal cerebral ischemia, and they also suggest that AJ-3941 has a beneficial effect in the treatment of ischemic cerebral damage.

Animals↗
PubMed1994

Pretreatment with a competitive NMDA antagonist D-CPPene attenuates focal cerebral infarction and brain swelling in awake rats.

The purpose of the study was to assess effects of the competitive N-methyl-D-aspartate (NMDA) receptor antagonist D-(E)-4-(3-phosphonoprop-2-enyl)piperazine-2-carboxylic acid (D-CPPene) upon focal cerebral infarction and brain oedema in the rat. Focal cerebral ischaemia was produced by permanent occlusion of the middle cerebral artery under halothane anaesthesia. The anaesthetic gas was discontinued immediately after the occlusion and the rats were killed 24 hours later. Cerebral infarction and brain swelling were each assessed on the frozen brain sections at 8 predetermined coronal planes. Pretreatment with D-CPPene (4.5 mg/kg i.v. followed by continuous infusion at 3 mg/kg/h until sacrifice) 15 minutes prior to MCA occlusion, significantly reduced the volume of infarction in the cerebral hemisphere by 29% (p < 0.05). Brain swelling, obtained by subtracting the nonischaemic hemispheric volume from the ischaemic hemispheric volume, was significantly reduced with D-CPPene treatment and the mean reduction in swelling (34% less than the controls: p < 0.001) proportionately similar to the decrease in infarct volume in the same animals. These data indicate that systemic administration of the competitive NMDA receptor antagonist D-CPPene has neuroprotective effects against ischaemic brain damage, and the reduction in brain swelling occurs in parallel with the reduction in ischaemic damage.

Animals↗
PubMed2000

Auditory P300 event related potential in minor ischemic stroke.

OBJECTIVE: Various degenerative cerebral diseases and even depression may cause abnormalities of the cognitive event related potentials (ERPs). We conducted the present study to elucidate the effects of ischemic stroke on the P300 ERP component. MATERIAL AND METHODS: We recorded the P300 wave using an auditory oddball paradigm in 38 consecutive brain infarct patients with mild neurological deficits at 3 and 12 months post-stroke, and in 29 healthy control subjects. RESULTS: Brain infarction slightly prolonged the P300 latency, and the observed delay was related to the presence and degree of post-stroke depression evaluated with the Zung Depression Scale and the DSM-III criteria. Infarction did not affect the P300 amplitude or its distribution on the scalp. The results of the patients with hemispheric brain infarction and those of the patients with brainstem infarction were similar, and also the values of the patients with the left- and right-sided lesions. The normal physiological correlation between subject age and the P300 latency was absent at 3 months post-stroke, but was present at 12 months post-stroke. CONCLUSION: Brain infarction delays the P300 ERP and temporarily distorts its age-related physiology. The increase of the P300 latency seems to be associated with the post-stroke depression.

Acute Disease↗
PubMed2001

Patterns of brain computed tomography infarction and carotid plaque echogenicity.

PURPOSE: It was suggested that in the absence of cardioembolism the discrete subcortical and cortical infarctions on brain computed tomography (CT) are most likely associated with carotid atheroma, whereas the hemodynamic infarctions, diffuse widespread white matter lesions, lacunae and basal ganglia infarctions are most likely associated with other pathologic conditions. The aim of this study was to determine the ultrasonic characteristics of carotid plaques and the degree of stenosis that were associated with the different brain CT infarction patterns and normal CT (pattern A, discrete subcortical and cortical infarctions; pattern B, hemodynamic infarctions, diffuse widespread white matter lesions, lacunae and basal ganglia infarctions). METHODS: Four hundred nineteen carotid plaques (315 patients), producing 50% to 99% stenosis on duplex scanning, were studied. These plaques were imaged on duplex scanning, captured, digitized, and normalized (standardized) in a computer. Subsequently, their gray scale median (GSM) was evaluated to distinguish quantitatively the hypoechoic (low GSM) from the hyperechoic (high GSM) plaques. The brain CT infarction patterns of A, B, or normal CT on the ipsilateral hemisphere were noted. RESULTS: The pattern A brain CT infarction was associated with carotid plaques having median GSM of 11 and median degree of stenosis of 80%, as contrasted with pattern B (median GSM, 28.5; median degree of stenosis, 75%) or normal CT (median GSM, 22; median degree of stenosis, 75%) (Kruskal-Wallis test, P <.001 for the GSM and P =.002 for the degree of stenosis). In the logistic regression analysis only the GSM and not the degree of stenosis distinguished the plaques associated with the three CT patterns. CONCLUSIONS: The pattern A brain CT infarction was associated with hypoechoic plaques suggesting an involvement of extracranial carotid artery embolization, whereas the pattern B was associated with hyperechoic plaques suggesting an involvement of other mechanisms (hemodynamic, intracranial small and large vessel disease).

Adult↗
PubMed1985

[Brain stem infarction, systemic lupus erythematosus and circulating lupus anticoagulant].

A 30 year old man admitted with a brain stem infarct presented with intellectual deterioration. A diagnosis of systemic lupus erythematosus (S.L.E.) was based on the presence of five A.R.A. criteria :photosensitivity, arthralgia, leukopenia and thrombopenia, false positive syphilitic serology, antinuclear factors on immunofluorescence. A lupus type circulating anticoagulant (L.C.A.) was no longer detected after corticotherapy. This appears to be a case of the "hematologic" form of S.L.E. in which the presence of L.C.A. predisposes towards thrombosis, not only of veins--which is typical--but also of arteries. These may be isolated and reveal the underlying disease as in the present case. The L.C.A. is an antibody possessing antiphospholipid specificity which explains the anticoagulant action in vitro and the thrombogenic effect in vivo. Some authors consider this to be sufficient justification for administration of anticoagulants and/or antiplatelet agents, but corticotherapy may be effective.

Adult↗