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PubMed1975

[Cerebral infarctions. Study of their prevention].

1) In 113 patients with cerebral infarction, the cause of infarction was cardiac embolism in 35, atherosclerotic thromboembolism in 45. It was either cardiac embolism or atherosclerosis but undetermined in 30. 2) Seven risk factors have been analysed. Eight patients (7 p.cent) had none of these factors. In the 105 remaining patients risk factors were: a) atrial fibrillation in 36, diagnosed in 21. Efficient treatment was applied in 1 or perhaps in 2 patients; b) High blood pressure in 39, diagnosed in 32, efficiently treated in 5; c) dyslipidemia in 42, diagnosed in 9, efficiently treated in 3; d) obesity in 50, efficiently tackled in 2; e) diabetes in 24, diagnosed in 11, efficiently treated in 2; f) hyperuricemia in 28, diagnosed in 1 with no efficient treatment; g) smoking in 44, abandonned by 1 only. 3) The high frequency of cardiac embolism is briefly commented. 4) Non diagnosis or unefficient treatment was present in a high proportion of cases. Realizing this regrettable state of affairs should result in better preventive diagnosis and treatment which, is assumed, could significantly reduce cerebral infarction.

Adult↗
PubMed2004

The prostacyclin analogue beraprost sodium prevents development of arterial stiffness in elderly patients with cerebral infarction.

Prostacyclin (PGI(2)) inhibits platelet aggregation, smooth muscle cell proliferation, and vasoconstriction. Arterial stiffness assessed by pulse wave velocity (PWV) predicts mortality in various cardiovascular diseases. To study the preventive effects of a prostacyclin analogue, beraprost sodium, on arterial PWV values in elderly patients with cerebral infarction. Forty-four patients with a history of cerebral infarction received beraprost sodium (120 microg/day p.o.) or no beraprost sodium (control) for 3 months. Arterial PWV and ankle brachial indices (ABI) were determined prior to starting the medication and after 3 months of medication. Initially, there were no differences in age, blood pressure, and body mass index. Further, PWV or ABI did not differ between the beraprost sodium group (n = 22) and the control group (n = 22). After 3 months, PWV in beraprost sodium group was significantly reduced (-123 +/- 282) when compared with the control group (147 +/- 274)(P = 0.006). ABI was not significantly different when comparing the two groups at 3 months. Long-term administration of beraprost sodium prevents the decline in arterial biomechanics in elderly patients with cerebral infarction.

Administration, Oral↗
PubMed1987

Multivariate analysis of the effect of climatic factors on the probability of cerebral infarction according to age.

This study investigates the effects of: the mean daily air temperature; the mean daily atmospheric pressure; and the temperature evolution (cooling, stable or reheating) on the probability of cerebral infarction. Data were collected during a three-year period in a country with a mild, maritime temperate climate. In men younger than 70, the probability of cerebral infarction mainly depends on temperature. Temperature is also the main statistically significant factor affecting the rate of cerebral infarction in women under 75; this effect is modulated by temperature evolution. Conversely, no clear effect of climatic factors could be found either on men older than 70 or women older than 75.

Adult↗
PubMed1993

Embolic cerebral infarction: MR findings in the first 3 hours after onset.

OBJECTIVE: MR imaging has a high sensitivity for detecting ischemic brain parenchyma. The aim of this study was to evaluate the changes in the signal intensity of infarcted brain parenchyma on MR images obtained within the first 3 hr after the onset of signs and symptoms in patients with embolic cerebral infarction. MATERIALS AND METHODS: We studied MR images of 16 patients who had a diagnosis of embolic cerebral infarction (highly probable according to criteria of the National Institute of Neurological and Communicative Disorders and Stroke). T1-weighted, T2-weighted, and proton density-weighted MR images were obtained within 3 hr after the onset of symptoms. Two neuroradiologists who had no knowledge of the diagnoses reviewed the MR images of these 16 patients and 20 control subjects in random order and evaluated signal-intensity changes in the gray and white matter. RESULTS: On proton density-weighted images, the central and cortical gray matter showed increased signal intensity in 63-69% and 88-94% of the patients, respectively. No abnormalities of the brain parenchyma were apparent on T1-weighted and T2-weighted images obtained within 3 hr after the onset of symptoms. The adjacent white matter appeared hyperintense on long TR images in only a few cases. CONCLUSION: An increased signal intensity in the gray matter on proton density-weighted images was the most characteristic parenchymal change seen on MR images of the brain obtained within 3 hr after embolic cerebral infarction.

Aged↗
PubMedDate not supplied

Cerebral infarction in the Mongolian gerbil exacerbated by phenoxybenzamine treatment.

In a double-blind study, the effects of a large dose (20 mg per kilogram) of phenoxybenzamine (PBZ) on cerebral infarction were evaluated in 120 Mongolian gerbils. The left common carotid artery was ligated in 100 animals; a sham operation was done in 20 animals. One hour later, 25 animals were given 2 mg per kilogram of PBZ, 25 animals were given 20 mg per kilogram of phenoxybenzamine, and 50 animals were given 0.5 cc of nomal saline, all doses being repeated at 24, 48, and 72 hours. Five sham-operated animals were given 2 mg per kilogram of phenoxybenzamine, five were given 20 mg per kilogram of phenoxybenzamine and ten were given 0.5 cc of normal saline on the same treatment schedule. Morbidity and mortality were recorded for one week and then all surviving animals wer killed. All brains were studied for signs of infarction. Of the saline-treated animals, 32% had cerebral infarction and 81% of these died. Of the animals treated with phenoxybenzamine, 36% of those receiving 2 mg per kilogram and 68% (p less than 0.05) of those receiving 20 mg per kilogram had cerebral infarction and all of those with infarction died during the observation period. The animals receiving phenoxybenzamine had a larger stroke index than those treated with saline. The authors concluded that phenoxybenzamine is harmful in postischemic treatment of strokes.

Animals↗
PubMed1993

[A new parameter for evaluating platelet aggregation in patients with chronic cerebral infarction].

We present a new sensitive parameter for evaluating ADP- and collagen-induced platelet aggregations. This parameter was used to re-evaluate platelet functions in chronic cerebral infarction. This parameter, the platelet aggregatory threshold index (PATI), was determined by the platelet aggregation curves obtained with four concentrations of two inducers (ADP; 0.5, 1.0, 2.0, 4.0 mumol/l and collagen; 0.125, 0.25, 0.5, 1.0 microgram/ml), and it indicated the concentration of the inducer that produced 50% of the aggregation rate at 5 min of ADP (4.0 mumol/l) or collagen (1.0 microgram/ml) induced aggregation curve. PATI was significantly correlated with the minimum concentration in ADP and collagen-induced aggregation, at which irreversible aggregation was induced. A negative correlation was shown between PATI and the rate of ADP (4.0 mumol/l)-induced maximum aggregation determined by the ordinary method, while no correlation was found between PATI and the rate of collagen (1.0 microgram/ml)-induced maximum aggregation. In normal elderly individuals, PATI obtained with ADP decreased significantly with age and showed no sex difference. Patients who had chronic cerebral infarction showed a significantly lower PATI with both inducers when compared to healthy elderly individuals, but the maximum aggregation rates obtained from the same platelet aggregation curves induced by ADP (4.0 mumol/l) or collagen (1.0 microgram/ml) showed no difference between the two groups. PATI reflects to be a more quantitative sensitivity of platelet than ordinary parameters such as the maximum aggregation rate. Determination of PATI may allow the detection of activated platelets in patients with chronic cerebral infarction.

Aged↗
PubMed1996

Single-photon emission computed tomography using hexamethylpropyleneamine oxime in the prognosis of acute cerebral infarction.

BACKGROUND AND PURPOSE: The role of single-photon emission CT (SPECT) in the prognosis of cerebral infarction is controversial, but most studies report that SPECT using a variety of radiopharmaceutical agents gives useful prognostic information. Only one study has questioned whether acute perfusion deficits independently add to a valid clinical prognostic score. This study was limited to middle cerebral artery territory infarcts and was negative. We present data on the prognostic utility of SPECT using 99mTc-hexamethylpropyleneamine oxime (HMPAO) in cerebral infarction, unselected by site. METHODS: Fifty consecutive unselected patients admitted to the hospital with acute cerebral infarction, of whom 10 died and 7 withdrew, had SPECT performed serially at onset and at 1 week and 3 months after stroke onset using 99mTc-HMPAO and the NOVO 810 dedicated high-resolution head tomograph. Clinical severity at presentation and outcome was measured with the Canadian Neurological Scale and the Barthel Index. Infarct volumes were measured from both the SPECT and CT scans. The data for the 43 subjects who completed the study or died were evaluated to determine the most powerful prognostic measures. Predictors were the Canadian Neurological Scale score at onset and 1 week, the Barthel Index at 1 week, the CT infarct volume typically done between 3 and 7 days after stroke onset, and the infarct volumes at the first and second SPECT. Outcome measures were the Canadian Neurological Scale score and Barthel Index score at 3 months, scored as zero for those patients who died. RESULTS: The clinical prognostic indicators correlated with the outcome measures, with coefficients between .617 and .821 (P < .0006 in all cases). The Canadian Neurological Scale score measured at 1 week was the best of these. Infarct volumes measured from SPECT correlated less well (coefficients between -.518 and -.683, P < .0019 in all cases). CT infarct volume was the poorest predictor. Although SPECT infarct volumes predicted outcome, they did so less well than clinical examination. Spontaneous infarct reperfusion did not affect outcome. CONCLUSIONS: Although the measurement of infarct volume on SPECT using 99mTc-HMPAO provides a predictor of stroke outcome, it is not a better predictor than the Canadian Neurological Scale score.

Acute Disease↗
PubMed2000

Computer-assisted ultrasonographic analysis of carotid plaques in relation to cerebrovascular symptoms, cerebral infarction, and histology.

The objective of this study was to determine the relationship between plaque echogenicity as measured by computer and the incidence of cerebrovascular symptoms and cerebral infarction. The correlation between carotid plaque echogenicity and plaque histology was also evaluated. In this prospective nonrandomized study, 38 consecutive patients with 54 atherosclerotic carotid plaques producing 50-99% stenosis were reviewed. The ultrasonic images of the plaques were digitized and transferred to a computer. A histogram for each plaque representing its composition was obtained. The median of the gray scale (GSM) of each histogram was used as measure of plaque echogenicity. All patients had a computed tomography (CT) brain scan performed to determine the presence of cerebral infarction. Twenty-eight plaques were examined histologically to determine the deposition of calcium, hemorrhage, cholesterol, and amorphous granular material. It is possible to identify carotid plaques at high risk for development of cerebrovascular symptoms and cerebral infarction by the computerized measurement of plaque echogenicity. This method may be used to improve the criteria of patients selection for carotid endarterectomy.

Aged↗
PubMed1991

A new prognostic index--leucocyte infiltration--in human cerebral infarcts by 99Tcm-HMPAO-labelled white blood cell brain SPECT.

Twenty-six patients with acute cerebral infarction were imaged by 99Tcm-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cell brain (Tc-WBC) single photon emission computed tomography (SPECT). The regions of interest were equally placed in the whole hemispheres of both sides with summation of all transaxial slices in the Tc-WBC SPECT. The asymmetric indices (AI) were calculated as 200[[(right - left)]/(right + left)]. Grouping of patients with cerebral infarction was based on activities of daily living (ADL) at outcome. The results showed that the poor outcome patient group had a higher AI of Tc-WBC than that of the other patients (13.0 +/- 3.0 S.E.M. versus 5.4 +/- 1.0 S.E.M., and P less than 0.05 by Wilcoxon rank sum test). In conclusion, the Tc-WBC SPECT may be considered as a new prognostic index to predict patient outcome in human cerebral ischaemic infarctions consistent with newly established ischaemic injury theories.

Acute Disease↗
PubMed2006

[Evolution rules and clinical value of apparent diffusion coefficient in cerebral infarction].

OBJECTIVE: To determine the rules that apparent diffusion coefficient (ADC) changes with time and space in cerebral infarction, and to provide the evidence in defining the stage, guiding treatment or judging the prognosis in infarction. METHODS: Eighty-eight work-ups in 69 patients with cerebral infarction (8 hyperacute, 35 acute, 20 subacute, and 25 chronic infarctions) were imaged with both conventional MRI and diffusion weighted imaging. The average ADC, the average relative ADC (rADC), and the ADC or rADC from the center to the periphery of the lesion were calculated. RESULTS: The average ADC and the average rADC of hyperacute and acute infarction lesion depressed obviously. The average ADC and the average rADC of subacute infarction lesion were significantly higher than those of hyperacute and acute infarction lesion (P < 0.05), and some approached the values of uninjured side which appeared "pseudonormal values" at 10 to 14 days. The average ADC and the average rADC in chronic infarction lesion were the highest (P < 0.05). The longer the prognosis, the higher the average ADC and the average rADC of infarction lesion. The ADC and the rADC in 7 hyperacute and 26 acute lesions had gradient signs that these lesions increased from the center to the periphery. The ADC and the rADC in 15 subacute lesions had adverse gradient signs that these lesions decreased from the center to the periphery. CONCLUSION: The ADC and the rADC of infarction lesions have evolution rules with time and space corresponding to the pathophysiological foundation. The evolution rules with time and those in space can be helpful to decide the clinical stage and pathophysiological phase of infarction, and to provide the evidence in guiding the treatment or judging the prognosis in infarction.

Aged↗
PubMed1998

Cerebral infarcts in patients with autopsy-proven Alzheimer's disease: CERAD, part XVIII. Consortium to Establish a Registry for Alzheimer's Disease.

OBJECTIVE: To study the relation between cerebral infarction and clinical and neuropsychologic manifestations in patients with autopsy-proven Alzheimer's disease (AD) enrolled in the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). BACKGROUND: Prior studies report that subjects with neuropathologic evidence of AD and concomitant brain infarcts had poorer cognitive function and higher frequency of dementia than those with AD alone. METHODS: Clinical and neuropsychologic manifestations of dementia were studied in 74 subjects with neuropathologic findings of AD alone and 32 with AD and concomitant cerebral infarcts or lacunar lesions. RESULTS: The 32 patients with both AD and vascular lesions were significantly older at time of death (median age, 81 years) than the 74 patients with AD alone (76 years; p = 0.02). At the final follow-up visit, the severity of the dementia was greater in AD patients with vascular lesions (median Clinical Dementia Rating [CDR] = 3) than in those with AD alone (CDR = 2; p = 0.03). Patients with AD and vascular lesions performed significantly worse on verbal fluency, Boston Naming, and Mini-Mental State Examination (MMSE) tests. No differences between the groups were observed, however, in the semiquantitative measures of frequency of neuritic plaques or neurofibrillary tangles. CONCLUSIONS: The clinical-neuropathologic correlations in CERAD patients generally confirm those in prior studies, indicating that the presence of cerebral infarction in patients with AD is associated with greater overall severity of clinical dementia and poorer performance on specific tests of language and cognitive function.

Aged↗
PubMed1981

[Fogging effect in the ischemic cerebral infarction to computerized tomography (author's transl)].

We have examined, with systematic serial computerized tomography (CT) studies, 6 patients with persistent ischemic cerebral infarction. The CT of the ischemic cerebral infarction shows, during the third week, an isodense area. We have called this phenomenon "fogging effect" because at this effect and the CT report could be negative. The possibility of a false negative can be avoided by a control study with contrast medium: the infarction has an intensive contrast enhancement.

Adolescent↗
PubMed2005

Effects of paeoniflorin on the cerebral infarction, behavioral and cognitive impairments at the chronic stage of transient middle cerebral artery occlusion in rats.

In the present study, the effects of paeoniflorin (PF), a characteristic monoterpene glucoside isolated from Paeoniae Radix, on cerebral infarction, neurological symptoms, tongue protrusion (TP) and performance in the water maze were examined at the chronic stage (4 weeks) of transient cerebral ischemia using a rat middle cerebral artery occlusion (MCAO) model. One-day (10 mg/kg, twice, s.c.) or seven-day (2.5-10 mg/kg, twice a day, s.c.) injection of PF significantly reduced the infarct volume as well as ameliorated the deficits in neurological symptoms caused by transient MCAO at chronic stage. Transient MCAO also induced impairments in TP and performance in the water maze. Treatment with PF was able to reverse or alleviate these impairments. These results indicate that PF may be effective for treatment of stroke.

Animals↗
PubMed1978

CT contrast enhancement in cerebral infarction.

Computed tomography was used to study 100 patients with ischemic cerebral infarcts. All cases were documented by autopsy, radionuclide imaging, cerebral angiography, or clinical course. Vascular distribution of infarcts was varied and included infarcts of cerebral hemispheres, basal ganglia, and cerebellum. Distinct patterns of enhancement are seen following administration of intravenous contrast material: predominantly peripheral, central, homogeneous, or heterogeneous. Enhancement of the infarcted area usually occurs 1-4 weeks after the onset of clinical symptoms, but was seen as early as the first day or as late as several months after the onset of symptoms. Infarcts showing contrast enhancement may or may not revert to a nonenhanced pattern on follow-up examination for several months. Lesions demonstrating contrast enhancement in cerebrovascular disease may at times be indistinguishable from tumor. Contrast enhancement was the only manifestation of infarction in some instances, and an infarcted area may be completely missed if a postcontrast examination is not performed.

Adolescent↗
PubMed1989

[Subacute cerebral infarct: native and contrast medium-enhanced MRT].

Twenty-five patients with clinical and CT findings indicating supratentorial cerebral infarct were prospectively studied with MR. MR examinations were performed between the 3rd and 150th day after stroke. T2-weighted axial images were compared with T1-weighted sequences after i.v. administration of Gd-DTPA. T2-weighted images demonstrated parenchymal lesions in all 25 patients. Postcontrast T1-weighted images, however, displayed pathologic contrast enhancement in only 19 areas of infarction. In 5 of the 25 patients, the use of Gd-DTPA provided additional diagnostic information by demonstrating gyral contrast enhancement as a pattern typical for ischemia. In 2 of the 25 patients, pathologic contrast enhancement was observed in an area that was isointense to the surrounding brain tissue on the T2-weighted images. In one patient, Gd-DTPA improved differentiation between areas of subacute and chronic infarction. At present, in the patient with suspected cerebral infarction, MR imaging after i.v. administration of Gd-DTPA appears recommended when clinical findings and CT are equivocal.

Acute Disease↗
PubMed2000

Cerebral infarctions: evaluation with single-axis versus trace diffusion-weighted MR imaging.

OBJECTIVE: Our purpose was to determine the usefulness of single-axis diffusion-weighted imaging versus trace diffusion-weighted imaging in the evaluation of cerebral infarctions. SUBJECTS AND METHODS: Twenty-six patients harboring 34 infarctions were examined using single-axis and trace diffusion-weighted imaging within 48 hr of the onset of symptoms. Two neuroradiologists who were not aware of the clinical findings reviewed all images obtained with both techniques and noted the following: type of infarction (small [<15 mm] versus territorial), location of infarction, presence of infarction (seen only on single-axis images, seen only on trace images, seen on both), lesion conspicuity (better on single-axis images, better on trace images, or equal on both), and lesion size (larger on single-axis images, larger on trace images, or equal on both). Differences in opinion were resolved by consensus. RESULTS: Of the 18 small and 16 territorial infarctions, all were identified on both single-axis and trace imaging. Lesion conspicuity was judged to be slightly better on trace images for both types of infarctions. Lesion size was judged to be larger on single-axis images for territorial infarctions. CONCLUSION: Both single-axis and trace diffusion-weighted imaging showed all small and territorial cerebral infarctions. Both types of infarctions were slightly larger on single-axis images but this did not affect correct interpretation in any case. The single-axis technique provided sufficient information for the diagnosis of cerebral infarction in our clinical settings.

Acute Disease↗
PubMed2005

[Ischemic cerebral infarction in a young woman undergoing gonadotropin treatment for infertility].

We describe a case of a 27-year-old previously healthy woman with a homonymous hemianopsia caused by thrombosis of a branch of the posterior cerebral artery. The woman had been treated with gonadotropin due to infertility and gone through in vitro fertilisation before the symptoms started. She was pregnant in the first trimester when we first saw her. We did not find any predisposing factors, and the clinical examination, including biochemical analysis, MRI arteriography and echocardiography, did not reveal any cause for the cerebral infarction (CI). The risk of CI during pregnancy itself is less than among non-pregnant women (0, 7) but increases in the postpartum period (8, 7). The cause of cerebral infarction in this case was idiopathic, but we must be aware of the possible link between treatment with gonadotropin for infertility and the development of cerebral infarction.

Adult↗
PubMed1978

Treatment of experimental cerebral infarction in rats with levodopa or with glycerol.

Administration of large amounts of levodopa did not improve survival rates of rats after acute cerebral infarction induced by injection of carbon microspheres. However, when 10% glycerol was used, the number of rats that survived after cerebral infarction was significantly greater than in the control or in the levodopa-treated rats. Combination of levodopa and glycerol therapy also significantly improved the survival rate of beneficial effect. Pathological findings (gross or microscopic) indicate striking changes in brain tissue after embolization. Development of brain edema of the infarcted left hemisphere corresponded to the type of treatment and to the length of animal survival. Brain-tissue histology indicates that glycerol-treated animals developed less severe edema and had less tissue disruption than control animals. The results suggest that treatment of edema should be one of the primary steps in therapy after acute cerebral infarction.

Animals↗