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PubMed1999

Prediction of cerebral infarct sizes by cerebral blood flow SPECT performed in the early acute stage.

Cerebral infarct due to embolic stroke without recanalization was examined by cerebral blood flow (CBF) SPECT in the early acute stage, and the possibility of predicting the size it will reach in the later stages was evaluated. Twenty patients (67 +/- 13 years) were examined by CBF SPECT with 99mTc-ECD 4.5 +/- 3.1 hours after the onset of cardiogenic cerebral embolism. The ratio of the anteroposterior length of the cerebral hemisphere to that of the severe ischemic region, which was defined as an area of clear-cut severe reduction in CBF as observed by SPECT, was calculated. One week after the onset, the cerebral infarct was measured in the same manner by CT, and the relationship between the two measurements was evaluated. The CBF in the region of severe ischemia and the surrounding region was determined by the Patlak plot method, and the affected/non-affected (A/NA) ratio was calculated. In severe ischemic regions the CBF ranged from 1.7 ml/100 g/min to 20 ml/100 g/min (mean, 11 +/- 5 ml/100 g/min), whereas the A/NA ratio ranged from 4% to 45% (mean, 26 +/- 11%). On the other hand, the CBF in the surrounding regions ranged from 20 ml/100 g/min to 52 ml/100 g/min (mean, 34 +/- 8 ml/100 g/min) whereas the A/NA ratio ranged from 52% to 104% (mean, 77 +/- 11%). The coefficient of correlation between the infarct size predicted by SPECT and that measured by CT was r = 0.986, and the correlation equation was Y = 1.047X - 2.969. CBF SPECT performed in the early acute stage can be used to predict the size of cerebral infarct.

Aged↗
PubMedDate not supplied

Relative role of factors associated with cerebral infarction and cerebral hemorrhage. A matched pair case-control study.

Comprehensive ascertainment of all possible new cases of stroke appearing between January 1, 1970 and June 30, 1971, and admitted to three major hospitals in Winnipeg, Manitoba, has been achieved by reviewing the Manitoba Health Services Commission claim reports. The medical records of these cases were reviewed, pertinent data were abstracted, and rigid criteria for diagnosis were followed. Also, data were obtained from death certificates, autopsy reports and long-term hospital records. A total of 606 ascertained cases (410 infarction, 137 hemorrhage, and 59 undetermined type) were matched for age, sex, residence and year of admission with 606 controls from admissions for other than cardiovascular and cerebrovascular disorders. The data were analyzed for elucidating the possible risk factors for infarction (INF) and hemorrhage (HGE). The findings suggested that hypertension was the main risk factor in hemorrhage, whereas in infarction, along with hypertension, other factors such as diabetes, heart enlargement in chest x-ray, ECG abnormalities, and smoking were suggested as risk factors. There was an association also between infarction, on one hand, and the history of receiving anticoagulants, diuretics, and medications for the heart, and the occurrence of myocardial infarction, on the other hand. These features indicate that infarction and ischemic heart disease have similar risk factors. Hemoglobin and hematocrit were higher in infarction cases than in their controls only when measured at stroke admission. No difference was revealed when they were measured prior to stroke. Their association with infraction therefore may be secondary to other factors and of no significance for its risk.

Aged↗
PubMed1988

High NaCl predisposes Dahl rats to cerebral infarction after middle cerebral artery occlusion.

High (8%) and low (0.3%) NaCl diets were administered for 3 weeks before testing inbred Dahl salt-sensitive (SS/Jr) or salt-resistant rats (SR/Jr) for altered susceptibility to cerebral infarction after occlusion of the middle cerebral artery. At occlusion time, mean systolic blood pressure (BP) was 201 +/- 7 mm Hg in SS/Jr fed a high NaCl diet. Two weeks later an atrophied infarct was present in the territory of the occluded artery of all (n = 10) hypertensive SS/Jr, and infarct size was correlated with BP at occlusion time (p less than 0.01). In normotensive control SS/Jr fed a low NaCl diet (n = 11), BP (118 +/- 3 mm Hg), frequency of infarction (18%), and infarct size were all significantly less (p less than 0.05) than in the hypertensive rats. In SR/Jr fed a high (n = 11) or low (n = 10) NaCl diet, BP was not statistically different (112 +/- 4 vs 116 +/- 4 mm Hg). Cerebral infarction frequency was significantly (p less than 0.05) greater in SR/Jr fed a high NaCl diet (73%) than in SR/Jr receiving a low NaCl diet (20%), but infarct size was not correlated with BP in SR/Jr (p greater than 0.05). Thus, elevated NaCl intake in SS/Jr and SR/Jr before middle cerebral artery occlusion predisposes to cerebral infarction, but differences in infarct size and its correlation with BP suggest the controlling factors are not identical in the two strains.

Animals↗
PubMed1993

[Common acute lymphoblastic leukemia showing hypo-gamma-globulinemia and cerebral infarction due to cerebral artery obstruction].

A patient who developed hypo-gamma-globulinemia and cerebral infarction during the treatment for acute lymphoblastic leukemia (ALL) is reported. In this patient fever and rash during radio-therapy for central nervous system (CNS) prophylaxis and nausea and vomiting were observed during maintenance therapy. On the laboratory findings high level of the protein level in the cerebrospinal fluid and the eosinophil count of the peripheral blood were found in every examination. We attempted to isolate various viruses in consideration of the possibility of infection, but no virus could be detected. The effects of methotrexate (MTX) and l-asparaginase were also suspected. Since nausea and vomiting disappeared after discontinuation of MTX administration, the drug may had some effect, and the possibility of cerebral damage by MTX can not be excluded. Complication of irradiation are reported to occur often more than 10 years after the treatment, but this patient had the onset only 2 years after the treatment. Therefore, irradiation was unlikely to be responsible for the symptoms. The relation between the hypo-gamma-globulinemia and cerebral infarction was also unknown.

Adolescent↗
PubMed1997

Secondary thalamic degeneration after cerebral infarction in the middle cerebral artery distribution: evaluation with MR imaging.

PURPOSE: To evaluate secondary degeneration of the ipsilateral thalamus after cerebral infarction in the middle cerebral artery (MCA) distribution by using magnetic resonance (MR) imaging. MATERIALS AND METHODS: Thirty patients (17 men, 13 women; aged 30-85 years) with embolic cerebral infarction in the MCA distribution underwent serial MR imaging 2 hours to 12 months after a stroke. In 23 of the 30 patients, the authors evaluated cerebral blood flow with single photon emission computed tomography (SPECT). RESULTS: T2-weighted spin-echo images disclosed a hyperintense area in the ipsilateral thalamus in 14 patients (47%) 1-12 months after stroke. The hyperintense area was confined to the dorsomedial or anterior and dorsomedial nuclei of the thalamus in nine of the 14 patients; it extended from the dorsomedial or anterior and dorsomedial nuclei to the ventral lateral nucleus or pulvinar in the remaining five patients. Hypoperfusion of the ipsilateral thalamus was observed in 21 of the 23 patients who underwent SPECT. Twelve of the 21 patients also showed a hyperintense area in the ipsilateral thalamus on the MR images. CONCLUSION: MR imaging is useful in evaluating secondary thalamic degeneration after cerebral infarction. In clinical practice, this secondary degeneration should not be mistaken for other lesions such as further cerebral infarction.

Adult↗
PubMedDate not supplied

Age and cerebral infarction: a postmortem study of 77 cases of cerebral infarcts in the middle cerebral artery territory.

Adverse effect of age on ischemic stroke short-term mortality was reported in some studies and attributed either to more frequent extracerebral causes of death or to an increased severity of ischemia in the aged brain. Relationship between age, size of infarcts, and causes of death were studied in 77 consecutive patients who died from infarction in the middle cerebral artery territory. Area of infarcts was assessed by planimetry, and results were expressed as an index of infarcted area. No significant relationship was found between age and the size of infarcts, the cause of death, or the interval from stroke to death. These results do not support the hypothesis of an increased severity of ischemia in the aged brain.

Aged↗
PubMed1984

[Prophylactic external decompression for massive cerebral infarction].

When cerebral infarct extends over a wide area and severe cerebral edema follows, there may be some cases where external decompression is necessarily indicated. Decompression is generally performed when signs of tentorial herniation appear and brainstem damage seems to be still reversible. We have been performing operations in such indication, but result of operations were poor. We were led to search for a accurate way to save acute massive cerebral infarction. A prophylactic external decompression being carried out just when a tentorial herniation is certainly imminent, could be an option. Analysis of serial CT scannings on infarction cases definitely revealed that before cerebral edema became manifest and tentorial herniation developed, there was a period when there were such findings as uniform: low density appears over the whole middle cerebral artery territory. this low density is homogeneous. lateral ventricle is slightly compressed and cortical sulci disappear suggesting slight cerebral edema. We have tried external decompression on three cases as soon as we found these CT findings, before there were signs of tentorial herniation and the outcome were satisfactory.

Adult↗
PubMed1999

[Decompression craniectomy--life-saving treatment in acute cerebral infarction].

Massive cerebral infarction is often accompanied by early death secondary to transtentorial herniation. Decompressive hemicraniectomy has been suggested as a lifesaving procedure. We report the case of a 61 year old man who had an acute infarction in the distribution area of the right middle cerebral artery. Initially, he was awake and suffered from total left-sided hemiparalysis. Over the next two days, his level of consciousness deteriorated to a Glasgow Coma Scale score of 5. Intracranial pressure (ICP) monitoring was then established. Three days later, the ICP increased from 20 to 40 mm Hg. We performed a right-sided decompressive hemicraniectomy, and the ICP was normalized immediately. Ten months after surgery the patient was at home and functioning with minimal assistance. He had moderate paresis of the left leg and was able to walk, but his left arm was paralytic. The presented case confirms that decompressive hemicraniectomy may prevent death and allow survival without severe disability in patients with massive cerebral infarction.

Acute Disease↗
PubMed2005

Candidate genes of cerebral infarction and traditional classification in Koreans with cerebral infarction.

Sasang constitutional medicine is a major branch of Korean traditional Oriental medicine. The differences of disease susceptibility to be shown in Sasang constitution may be due to genetic factors. Therefore, the authors examined relationship between candidate genes of cerebral infarction (CI) and Sasang constitution. The homozygous deletion allele of the angiotensin converting enzyme gene (ACE/DD), homozygous threonine allele of the angiotensinogen gene (AGN/TT), and the e4 allele of the apolipoprotein E gene (ApoE/e4) are reported to be associated with ischemic heart disease. CI is another atherosclerotic disease; and the effects of these polymorphisms on CI have been confusing. This study investigated whether ACE/DD, AGN/TT, and ApoE/e4 genotypes are associated with CI and whether genetic risk is enhanced by Sasang constitutional classification. The authors ascertained these genotypes in patients with CI (N=211), diagnosed by brain computed tomography. Control subjects for the infarction group were randomly selected from 319 subjects matched for age, sex, and history of hypertension with patients. The ACE/DD genotype was not associated with CI. However, there was significant association between ApoE polymorphism and CI (chi2=15.089, p<.05). Furthermore, frequency of AGN/TT genotype was higher in the patients with CI than in the controls (chi2=20.072, p<.05). The frequency of T allele was 0.91 in patients and 0.82 in controls (chi2=17.237, p<.05). However, Sasang constitutional classification did not increase the relative risk for CI in the subjects with ApoE/e4 or AGN/T allele. These results suggest that ApoE and AGN polymorphism predict CI, but Sasang constitutional classification does not enhance the risk for CI associated with ApoE/e4 or AGN/TT in a Korean population.

Angiotensinogen↗
PubMed2002

Portal vein thrombosis causing neonatal cerebral infarction.

Neonatal cerebral infarction often occurs in the absence of known risk factors. Two such cases are described in which portal vein thrombosis was documented during two dimensional echocardiography. In both cases, infarcts were consistent with embolic events. A novel mechanism is proposed, which may explain some cases of "idiopathic" neonatal cerebral infarction.

Adult↗
PubMed2006

[Early subarachnoid hemorrhage from a bacterial aneurysm of the middle cerebral artery bifurcation following cerebral infarction caused by a septic embolism: case report].

A 38-year-old left-handed male, with a past history of ventricular septal defect, presented to our hospital with complaints of sudden onset of right hemiparesis and restlessness. Computed tomography (CT) showed a hypodense area in the left insular cortex and corona radiata. The symptoms worsened on the next day, and CT demonstrated a new hypodense area in the left temporal lobe. Echocardiography showed vegetation on the mitral valve, so the patient was treated with a high dose of antibiotics under a diagnosis of infective endocarditis. Although the course was uneventful, subarachnoid hemorrhage was observed on the 4th day, which was followed by hemorrhagic infarction. Cerebral angiography revealed an aneurysm of the bifurcation of the middle cerebral artery and occlusion of the superior trunk of the M2 portion. T he aneurysmwas successfully obliterated, and histological examinationestablished the diagnosis of a bacterial aneurysm caused by septic embolism. Septic embolism originating from infectious endocarditis is likely to be followed by acute hemodynamic changes and fatal events. Therefore, the possibility of bacterial aneurysm should be considered immediately in patients with neurological deficits caused by septic embolism.

Adult↗
PubMed1984

[Protective effect of mannitol in cerebral infarction--CT findings and physiological observation in experimental cerebral infarction in dogs].

Sequential changes of low density area in CT scan and sequential changes of neurons in light microscopical study following occlusion were investigated. Similar observations were also made with the administration of 20% mannitol (2g/kg) prior to occlusion to determine the effect in preventing cerebral infarction. In these experiments we used our previously published "complete cerebral hemispheric infarction model in dogs" which was produced by ipsilateral occlusion of the A1 and A2 segment of anterior cerebral artery, ophthalmic artery, internal carotid artery, middle cerebral artery and the junction of the posterior communicating artery and posterior cerebral artery. Sequential changes in CT findings of 4 untreated control animals showed a low density area 3 hours after the occlusion in each animals. After 6 hours, these areas became more distinct. On the other hand in 3 mannitol treated animals, the low density area was not distinct 6 hours after the occlusion. In light microscopical study of 5 untreated control animals, no normal neurons were seen 4 hours after occlusion, and shrinkage and swelling was seen in roughly 80% of the neurons 6 hours after the occlusion. However, in 2 mannitol treated animals, 30% normal neurons were seen 4 hours after occlusion, and shrinkage and swelling was seen only 10-20% 6 hours after the occlusion.

Animals↗
PubMed1984

'Idiopathic' neonatal cerebral infarction.

Neonatal cerebral infarction is infrequently reported in the living newborn and is usually associated with perinatal risk factors, trauma, and asphyxia. This report describes two cases of full-term newborns with no predisposing problems who had unequivocal left cerebral infarctions associated with seizures in the first 24 hours of life. Radiological studies suggested an embolic cause in one case.

Adult↗