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PubMed2001

Poor school and cognitive functioning with silent cerebral infarcts and sickle cell disease.

The authors evaluated education attainment and neuropsychological deficits in children with sickle cell disease (SCD) and silent cerebral infarcts. Children with silent infarcts had twice the rate of school difficulties as children without infarcts. Eighty percent of silent infarct cases had clinically significant cognitive deficits, whereas 35% had deficits in academic skills. Children with silent cerebral infarcts show high rates of poor educational attainment, cognitive deficits, and frontal lobe injury. Poor school performance in SCD is one indicator of silent infarcts.

Adolescent↗

PubMed1996

[Cerebral infarctions in young patients related to deficiency of natural anticoagulants. Protein C and protein S].

The possible etiologies of cerebral infarcts (CI) in young patients differ from those in the older stroke population. Recently, deficiencies of fibrinolytic factors emerged as an important etiology of stroke in the young population. The literature has emphasized the diagnosis of such conditions especially in stroke cases of undetermined etiology and with history of recurrent thrombosis. We carried out a research on the serum level of protein C, protein S, and antithrombin III in young patients, between 15 and 40 years, with CI of undetermined cause after application of a standard protocol. Three patients had low levels of these proteins; two had protein C deficiency, and one protein S deficiency. None of them had antithrombin III deficiency. We conclude that systematic investigation of such causes of cerebral infarct will reduce the group of undetermined strokes, and will open the possibility of prophylactic treatment in a non-negligible group of patients.

Adolescent↗

PubMed1999

Body temperature correlates with functional outcome and the lesion size of cerebral infarction.

INTRODUCTION: Experimental studies have demonstrated that mild hyperthermia exacerbates ischemia-induced neuronal injury. MATERIAL AND METHODS: We examined the relationship between body temperature and functional outcome in 183 patients suffering from cerebral infarction, and admitted within 24 h from the onset of stroke. Patients' functional capacities in daily life were evaluated by Rankin's score before the attack (RS0), on the day of admission (RS1), and 3 months after the onset of stroke (RS90). RESULTS: RS90 showed an independent correlation with RS0, RS1, age, infarct size and maximum body temperature recorded within the first 7 days from the onset of stroke by multivariate analysis. History of previous cerebrovascular accidents, atrial fibrillation, hemorrhagic transformation, infection, and a hypothalamic lesion showed significant associations with RS90 by the Mann-Whitney U-test, but not by multivariate analysis. Infarct size correlated with body temperature, atrial fibrillation, and hemorrhagic transformation. CONCLUSION: Body temperature correlated well with both functional outcome and infarct size in patients with an acute cerebral infarction.

Acute Disease↗

PubMed2000

An insertion/deletion polymorphism in intron 18 of the type B human natriuretic peptide receptor gene is not associated with cerebral infarction.

The natriuretic peptide (NP) system may play a crucial role in the development of cardiovascular and renal diseases. C-type NP dilates arteries and lowers blood pressure, and it inhibits the proliferation of vascular smooth muscle cells via the type B NP receptor (NPRB). We determined and analyzed the structure of the NPRB gene and found an insertion/deletion (I/D) polymorphism in intron 18. In this experiment, we studied this I/D polymorphism in the NPRB gene in 241 subjects, including 118 patients with cerebral infarction (the CI group) and 123 control subjects (the non-CI group). Our goal was evaluate the association of this polymorphism with cerebral infarction. Our findings showed that genotype frequencies of the I/D polymorphism were in Hardy-Weinberg equilibrium. The frequencies for the II, ID, and DD alleles were 0.569, 0.374, and 0.057, respectively, in the non-CI group and 0.576, 0.356, and 0.068, respectively, in the CI group. No association was found between this polymorphism and cerebral infarction. These results suggest that this polymorphism in the NPRB gene is not linked to a pathogenic CI gene.

Aged↗

PubMed2003

Neonatal cerebral infarction and visual function at school age.

OBJECTIVE: To assess various aspects of visual function at school age in children with neonatal cerebral infarction. PATIENTS AND METHODS: Sixteen children born at term, who had cerebral infarction of perinatal onset on neonatal magnetic resonance imaging (MRI) were assessed using a battery of visual tests. This included measures of crowding acuity (Cambridge Crowding Cards), stereopsis (TNO test), and visual fields. The results of the visual assessment were compared with the type and the extent of the lesion observed on neonatal MRI. RESULTS: Only six of the 16 children (28%) had some abnormalities of visual function on these tests. Visual abnormalities were more common in children with more extensive lesions involving the main branch of the middle cerebral artery and were less often associated with lesions in the territory of one of the cortical branches of the middle cerebral artery. The presence of visual abnormalities was not always associated with the involvement of optic radiations or occipital primary visual cortex. Abnormal visual fields were only found in children who also developed hemiplegia. CONCLUSIONS: Abnormality of visual function is not common in children who had neonatal infarction and, when present, tends to be associated with hemiplegia and more extensive lesions.

Cerebral Infarction↗

PubMed2006

[Two cases of Duchenne muscular dystrophy complicated with dilated cardiomyopathy and cerebral infarction].

We report two cases of Duchenne muscular dystrophy (DMD) complicated with dilated cardiomyopathy (DCM), who were affected with cerebral infarction. Case 1 suddenly developed dysarthria and right facial weakness at age 21. Cranial CT study disclosed a low density area in the left basal ganglia and internal capsule. Case 2 had a history of transient ischemic attack (TIA) at age 21. Five months after the TIA, he developed right hemiplegia and dysarthria, and a low density area in the corona radiate in left cerebral hemisphere was observed in cranial CT. These two cases showed the radiographic cardiomegaly with cardio thoracic ratio (CTR) of 72.8% and 66.6%, the decreased echocardiographic left ventricular ejection fraction below 20%, and the elevated titer of thrombin-anti-thrombin III complex (TAT) and D-dimer. The autopsy of Case 2 at age 26 disclosed the remarkable degeneration and fibrosis of myocardium and old ischemic lesion in the left cerebral frontal cortex. Despite the negative finding of the emboli in the left heart, cardiogenic cerebral infarction secondary to DCM was strongly suspected in both cases.

Adult↗

PubMed1993

Multiple cerebral infarctions in a young patient with secondary thrombocythemia due to iron deficiency anemia.

A 30-year-old woman developed multiple cerebral infarctions. In the absence of other risk factors, thrombocythemia secondary to iron deficiency anemia due to polymenorrhoea was considered to underlie the cerebral infarctions. Platelet count was normalized after iron therapy. The importance of vigorous treatment of iron deficiency anemia in preventing complications of secondary thrombocythemia is emphasized.

Adult↗

PubMed2001

Massive cerebral infarction as a feature of pituitary apoplexy.

A patient with pituitary apoplexy is reported who, in addition to the clinical features of apoplexy, developed a cerebral infarct secondary to compression of the internal carotid artery. The mechanisms of a cerebral infarct associated with pituitary apoplexy are discussed.

Adenoma↗

PubMed2005

[Association study of apolipoprotein e gene polymorphism and cerebral infarction in type 2 diabetic patients].

In order to explore the association of apolipoprotein E (ApoE) gene polymorphism with cerebral infarction in type 2 diabetic patients of Han nationality in Northeast China , the genotypes of ApoE gene were analyzed by polymerase chain reaction -restriction fragment length polymorphism (PCR-RFLP) in the 208 cases, including 69 cases in control (CON) group and 67 in type 2 diabetes mellitus (T2DM) group as well as 72 in type 2 diabetes mellitus with cerebral infarction (T2DMCI) group. Plasma lipid content in T2DMCI was also detected for 70 cases. The distribution of genotypes in ApoE gene,epsilon(2)epsilon(3),epsilon(3)epsilon(3) as well as epsilon(3)epsilon(4) was no significant difference in three groups (epsilon(2)epsilon(3) : 13.2%,epsilon(3)epsilon(3) : 67.6%,epsilon(3)epsilon(4) : 16.2%in CON group;epsilon(2)epsilon(3) : 19.4%,epsilon(3)epsilon(3): : 70.1%epsilon(3)epsilon(4) : 9%in T2DM group;epsilon(2)epsilon(3) : 15.2%,epsilon(3)epsilon(3) : 75%,epsilon(3)epsilon(4) : 4.2%in T2DMCI group). The allele frequencies of epsilon(2),epsilon(3) and epsilon(4) were not significantly different in the three groups, either(epsilon(2) : 9.6%,epsilon(3) : 82.4%,epsilon(4) : 8.1%in CON group; epsilon(2) :10.5%,epsilon(3) :84.3%,epsilon(4) : 5.2%in T2DM group; epsilon(2) :11.8%,epsilon(3) :84.7%,epsilon(4) : 3.5%in T2DMCI group). The levels of total cholesterol (TC), tryglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) were not significantly different among the different genotypes in T2DMCI group. The study confirmed that the polymorphisms of ApoE gene are neither associated with the T2DMCI, nor with the levels of plasma lipid in T2DMCI.

Apolipoproteins E↗

PubMed1997

Sensitivity and specificity of 99mTc-HMPAO SPECT cerebral perfusion measurements during the first 48 hours for the localization of cerebral infarction.

BACKGROUND AND PURPOSE: There is no routinely used method for imaging the location of the extent and severity of cerebral tissue perfusion changes during the first hours of ischemic stroke, the period during which therapeutic intervention is most likely to be successful. Cerebral perfusion measurements with single-photon emission CT (SPECT) may potentially provide this information rapidly and noninvasively. In this study, the sensitivity and specificity of 99mTc-hexamethylpropyleneamine oxime (HMPAO) SPECT cerebral perfusion measurements during the first 48 hours of cerebral ischemia for the localization of cerebral infarction were determined. METHODS: One hundred and four patients with acute ischemic stroke underwent 99mTc-HMPAO SPECT and CT scanning during the first 48 hours. In each patient, the location of the SPECT perfusion abnormality was compared with the location of infarction on a second brain CT acquired at a mean of 8 days after stroke. RESULTS: During the first 48 hours of ischemic stroke, the sensitivity of 99mTc-HMPAO SPECT in locating the site of infarction was 79% (110/139), and the specificity was 95% (362/381). SPECT was more sensitive in the localization of the vascular territory of cortical infarction (sensitivity, 93%) than pure subcortical infarcts (sensitivity, 47%). During the first 48 hours, SPECT was significantly more sensitive than brain CT (sensitivity of brain CT during the first 48 hours, 35%; P < .001, Mann-Whitney U test). CONCLUSIONS: HMPAO SPECT measurement provides a widely available and practical technique of locating cerebral ischemia acutely and demonstrates high sensitivity and specificity within the first 48 hours for the localization of the vascular territory of cerebral infarction. It is most sensitive for cortical ischemia but is limited by its resolution in the subcortex, particularly of white matter perfusion changes.

Aged↗

PubMed1999

Recurrent cerebral infarctions and del(10)(p14p15.1) de novo in HDR (hypoparathyroidism, sensorineural deafness, renal dysplasia) syndrome.

We report on a Japanese boy with HDR syndrome (hypoparathyroidism, sensorineural deafness, renal dysplasia) and recurrent cerebral infarctions in the basal ganglia. The patient experienced cerebral infarctions four times between age 7 months and age 20 months. Chromosome analysis of the patient demonstrated a 46,XY, del(10)(p14p15.1) de novo. This suggests that the putative gene responsible for HDR syndrome is located at 10p14-p15.1.

Adult↗

PubMed2006

[Effects of transcranial magnetic stimulation on recovery of neural functions and changes of synaptic interface and dendritic structure in the contralateral brain area after cerebral infarction: experiment with rats].

OBJECTIVE: To evaluate the effects of transcranial magnetic stimulation (TMS) on the brain plasticity and its role in functional outcome in cerebral infarction. METHODS: Twenty male SD rats underwent suture of the unilateral middle cerebral artery (MCA) so as to establish focal cerebral infarction models and then were randomly divided into 2 equal groups: model group, to be reared in the original living state, and TMS group, given in addition TMS treatment 1 day after infarction 2 times per day and 30 pulses per time for 4 weeks. Twenty-eight days after the rats were killed. Four rats from each group underwent microscopy of the brain to measure the dendritic structure of the pyramidal cells quantitatively. Other 4 rats from each group underwent electron microscopy of the brain to measure the parameters of synaptic interface in the sensorimotor cortex. Neural function scoring was conducted 24 hours after the establishment of model and before being killed. RESULTS: There was no significant difference in the neural function 24 h after the establishment of models, however, 28 days after the score of neural function of the TMA group was 0.58 +/- 0.49, significantly lower than that of the model group (0.92 +/- 0.28, P < 0.05). The total dendritic length, number of dendritic branching points, and dendritic density in layer V pyramidal cells within the undamaged motor cortex of the TMS group were 898 microm +/- 127 microm, 6.6 +/- 1.5, and 0.75/microm +/- 0.19/microm, all significantly higher than those of the model group (788 microm +/- 112 microm, 5.8 +/- 1.5, and 0.60/microm +/- 0.16/microm, P < 0.05 or < 0.01). Electron microscopy showed that the synaptic curvatures and post-synaptic density of the TMS group were 1.06 +/- 0.08 and 64 +/- 13 respectively, both significantly higher than those of the model group (1.02 +/- 0.06 and 54 +/- 12 nm respectively, P < 0.05 and P < 0.01), and the synapse cleft width of the TMS group was 19.5 +/- 2.1, significantly narrower than that of the model group (23.3 +/- 2.3, P < 0.01). CONCLUSION: TMS promotes the improvement of neural functions of the rats with cerebral ischemia by the potential mechanism that TMS strengthen the compensatory roles of the synaptic interface and dendritic structure in the undamaged sensorimotor cortex area and increase synaptic plasticity.

Animals↗

PubMed1979

Cerebral infarcts with arterial occlusion in neonates.

Among 592 infants examined at autopsy during a four-year period, 32 (5.4%) had cerebral infarcts. Excluded were cases of traumatic hemorrhages and softening, periventricular leukomalacia, venous lesions, and any mass, including encephaloceles, with arterial distortion and infarction. Histological abnormalities were similar to those of infarcts in adults. Relatively advanced histopathological changes in some infants living only a few hours indicated that some infarctions may have occured in utero. The most common cause of arterial occlusion was embolization, with sepsis and disseminated intravascular coagulation playing a major role. The brains of term neonates were more frequently involved than those of premature infants. Multiple small infarcts occurred more often in premature infants. In most cases autonomic dysfunction with prolonged apnea, episodic seizures, and metabolic acidosis were the major associated clinical features, rather than focal neurological deficits. Similar cerebral infarcts in infants who survive with less severe systemic complications may lead to porencephaly, hemiplegia, mental and motor retardation, and recurrent seizures.

Brain↗

PubMed1987

Venous cerebral infarctions in an infant with chronic subdural hematoma.

An infant with multiple cerebral infarctions and chronic subdural hematoma is reported. The infarctions were found after repeated tappings of the hematoma. Angiography did not demonstrate any occlusion of the main arteries. The infarctions were thought to be caused by thrombosis of the hanging cerebral veins. The pathogenesis and significance of the venous infarctions in an infantile subdural hematoma are discussed.

Brain Injuries↗

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↗

PubMed2003

[Proliferation and differentiation of neural stem cells after cerebral infarction: an experimental study of adult rats].

OBJECTIVE: To investigate the proliferation and differentiation of neural stem cells after cerebral infarction(CI) in adult rats. METHODS: CI animal model was made by ligating the common carotid artery and external carotid artery and inserting a piece of nylon thread into the internal carotid artery among 100 male Wistar rats. Then the rats were randomly divided into 5 groups: group of I day after brain infarction (n = 20), group of 3 days after brain infarction (n = 20), group of 7 days after brain infarction (n = 20), group of 14 days after brain infarction (n = 20), and group of 28 days after brain infarction (n = 20). Twelve rats undergoing sham operation with a piece of nylon thread inserted only into the common carotid artery were used as controls. The rats were killed at different time points and their brains were taken out. The expression of bromodeoxyuridine (BrdU) and Musashil (both used to mark the dividing neural stem cells), and of glial fibrillary acidic protein (GFAP) and neuronal nuclear antigen (NeuN) (both used to mark the differentiating neural stem cells) were determined by immunohistochemistry and immunofluorescence staining. RESULTS: In the normal brain tissues, only a small amount of BrdU(+) cells were found in the hippocampus. One day after CI the number of BrdU(+) cells began to increase in the hippocampus at the CI side (P < 0.05), peaked 7 days after CI with a number 6 times that at the normal side, began to decrease 14 days after, and almost reached normal 28 days after. The number of BrdU(+)/Musashil(+) cells began to increase 1 day after CI (P < 0.05), peaked 7 days after, began to decrease 14 days after, and almost reached normal 28 days after. The number of BrdU(+)/GFAP(+) cells at the CI side remained almost unchanged after CI. The number of BrdU(+)/NeuN(+) cells began to increase 14 days after CI (P < 0.05) and peaked 38 days after. CONCLUSION: Cerebral infarction stimulates the proliferation of inherent neural stem cells and most proliferated neural stem cells differentiate into neurons.

Animals↗

PubMed1976

A quantitative study of the EMI values obtained for normal brain cerebral infarction and certain tumours.

A quantitative study has been made of the EMI numbers of normal brain, cerebral infarction and certain tumours. The scans were recorded on magnetic tape and analysed using a minicomuter linked to a graphic display unit. This system not only yielded 16 grey scales compared with the ten currently available, but was programmed to allow selected regions of the scans to be outlined. From these regions the computer calculated the area, the mean EMI number and its standard deviation. It was found that in 15 normal brain scans, the EMI values obtained for normal frontal and temporal lobes were similar, but that the values for the basal ganglia and occipital lobes were significantly different from the first two regions and from each other. Ten cases of cerebral infarction and 30 cases of cerebral tumour were analysed, and it was shown that analysing representative areas was more informative than surveying the whole lesion. Whilst only half of the scans of brain tumours had a significantly altered EMI number compared with that of normal brain, enhancement of tumour density with sodium iothalamate revealed a consistent and significant elevation of the EMI number for all tumours. In particular, the value for enhanced meningiomas was almost double and malignant tumours more than a third larger than normal brain. It was not possible to differentiate quantitatively between astrocytomas and metastases.

Brain↗

PubMed2002

Cyclooxygenase-1 and bicistronic cyclooxygenase-1/prostacyclin synthase gene transfer protect against ischemic cerebral infarction.

BACKGROUND: We tested the hypothesis that bicistronic cyclooxygenase-1 (COX-1)/prostacyclin synthase (PGIS) and COX-1 gene transfer reduce cerebral infarct volume by augmenting synthesis of protective prostaglandins. METHODS AND RESULTS: We infused into lateral ventricle of a rat stroke model recombinant adenoviruses (rAd) containing COX-1 (Adv-COX-1), COX-1 and PGIS (Adv-COX-1/PGIS), or Adv-PGK control vector, and we determined COX-1 and PGIS protein and eicosanoid levels and infarct volume. COX-1 and PGIS proteins were increased in a time-dependent manner. Adv-COX-1/PGIS infusion selectively augmented prostacyclin levels, with reduction of other eicosanoids in ischemic cortex and a significant reduction of infarct volume, even when the rAd was administered 5 hours after ischemia. Infusion of Adv-COX-1 also increased prostacyclin, suppressed leukotriene levels, and achieved a similar degree of cerebral protection. Its neuroprotection was abrogated by treatment with a selective COX-1 inhibitor. CONCLUSIONS: COX-1/PGIS and COX-1 gene transfer reduce cerebral infarct volume by augmenting prostacyclin and suppressing leukotriene productions. COX-1-based gene transfer has potential for treating ischemic stroke.

Adenoviridae↗