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PubMed1997

Intracisternal basic fibroblast growth factor enhances functional recovery and up-regulates the expression of a molecular marker of neuronal sprouting following focal cerebral infarction.

Focal cerebral infarction (stroke) due to unilateral occlusion of the middle cerebral artery in mature rats produces deficits in sensorimotor function of the contralateral limbs that recover partially over time. We found that biweekly intracisternal injection of basic fibroblast growth factor (bFGF; 0.5 microg/injection), a potent neurotrophic polypeptide, markedly enhanced recovery of sensorimotor function of the contralateral limbs during the first month after stroke without apparent adverse side effects. Immunostaining for growth-associated protein 43 (GAP-43), a molecular marker of axonal sprouting, showed a selective increase in GAP-43 immunoreactivity in the intact sensorimotor cortex contralateral to cerebral infarcts following bFGF treatment. These results show that bFGF treatment can enhance functional recovery after stroke, and that the mechanism may include stimulation of neuronal sprouting in the intact brain.

Animals↗
PubMed1998

[Multiple cerebral infarction associated with cerebral vasculitis in rheumatoid arthritis].

A 64-year-old woman was suffering from rheumatoid arthritis since the age of 57. At the age of 62, she manifested episcleritis of the eyes and rheumatoid nodules in the skin, and rheumatoid factor in the blood became high. These findings indicated the presence of systemic vasculitis, and she was treated with prednisolone. At the age of 64, she suddenly became delirious, and T2-weighted and diffusion-weighted MR images revealed fresh infarctions in bilateral temporal and parietal lobes of the cerebrum. MR angiography failed to show any narrowing or obstruction of large cerebral arteries. She had also high fever and arthralgia, and her blood showed elevated levels of white blood cells, erythrocyte sedimentation rate, C-reactive protein, IgG-rheumatoid factor and immune complex. Lumbar puncture revealed an elevated protein level in CSF. A daily dose of 60 mg prednisolone ameliorated these clinical and laboratory findings as well as her consciousness, disclosing disturbances in higher cortical functions including Wernicke aphasia, disorientation, and ideomotor, ideational, and constructional apraxia. Previous 13 reported cases of cerebral infarction complicating rheumatoid vasculitis were mostly described as showing multiple infarctions in cerebral hemisphere, disturbance of consciousness, elevated protein in CSF, and effectiveness of steroid therapy. The present case had these characteristics, and the cerebral vasculitis mediated by IgG-rheumatoid factor and immune complex was indicated as a probable cause of multiple cerebral infarctions.

Arthritis, Rheumatoid↗
PubMed1990

Cortical-evoked potentials and cerebral infarction in temporary middle cerebral artery occlusion in the cat.

Somatosensory-evoked potentials (SSEP) and cerebral infarct size were measured in nine cats in which the middle cerebral artery (MCA) was clip-occluded for 3 h followed by an equal period of recirculation. During MCA occlusion, there was a reduction in the mean amplitude of the major cortical wave (MCW) to less than 50% of the pre-occlusion value. There was no significant improvement in this amplitude after clip release. Cerebral infarction was detected in eight of the animals and the mean (+/- s.d.) infarct size was 27.8 +/- 19.6%. A good negative correlation between the MCW amplitude and infarct size was apparent as early as 15 min into the period of occlusion (r = -0.87, P less than 0.01). In this model of focal cerebral ischaemia, the 15-min MCW amplitude is a good predictor of cerebral infarction.

Animals↗
PubMed2000

Neonatal cerebral infarction.

Neonatal cerebral infarction in term infants has many possible causes, including bacterial meningitis, inherited or acquired coagulopathies, trauma, and hypoxia-ischemia. However, a specific cause often cannot be identified. Neurologic symptoms in the neonatal period are often subtle and nonspecific, even in infants with large infarctions involving an entire cerebral artery distribution. The most common presenting symptom is focal motor seizures of the contralateral limbs. Cranial magnetic resonance imaging, especially with diffusion-weighting, is the most sensitive imaging modality, although ultrasonography with Doppler imaging of cerebral blood flow is useful in the neonate who is too ill to transport. Neurodevelopmental outcome is often surprisingly good, with many infants making a complete recovery of motor function. The effect of neonatal stroke on cognitive function, especially language acquisition and emotional and social development, has not been fully established.

Cerebral Infarction↗
PubMed2004

Hemodilution during cardiopulmonary bypass increases cerebral infarct volume after middle cerebral artery occlusion in rats.

Although the optimal hematocrit during cardiopulmonary bypass (CPB) is not defined, excessive hemodilution may lead to organ ischemia via a reduction in oxygen-carrying capacity uncompensated by autoregulatory and/or rheologic increases in organ blood flow. As a result, the consequences of hemodilution in patients at risk for cerebral ischemia are not clearly understood. We designed this study to evaluate the effects of hemodilution in the setting of focal cerebral ischemia during CPB. Wistar rats surgically prepared for CPB were randomized to either hemodilution (hemoglobin (Hb), 6 g/dL; n = 9) or control (Hb, 11 g/dL; n = 8) groups and subsequently exposed to focal cerebral ischemia induced by middle cerebral artery occlusion (MCAO). Immediately after the onset of MCAO (maintained for 90 min), 65 min of hypothermic (28 degrees C) CPB was initiated. Twenty-four hours later, functional neurological outcome and cerebral infarct volume were determined. Compared with controls, the hemodilution group had worse neurological performance (new score = 8 [2], hemodilution; versus 10 [2], control; P = 0.030) and larger total cerebral infarct volumes (182 +/- 84 mm(3), hemodilution; versus 103 +/- 58 mm(3), control; P = 0.043). In this experimental model of CPB with reversible MCAO-induced focal cerebral ischemia, hemodilution worsened neurological function and increased cerebral infarct volume.

Animals↗
PubMed1982

Contrast enhancement of cerebral infarcts. Incidence and clinical value in different states of cerebral infarction.

Information obtained from CT scan after contrast administration was evaluated in 59 consecutive stroke patients. CT scans before and after contrast administration were performed 3 days and 2 1/2 weeks after stroke. A plain CT scan was repeated 6 months later. Contrast enhancement was practically not seen on the first examination, but was seen in 46% on the second examination. There was a close relationship between the occurrence of contrast enhancement and the socalled "fogging effect". Contrast scanning gave additional information only when this effect was present. Plain CT scans 3 days after stroke were superior to contrast scans taken at any time for detecting and visualizing cerebral infarcts.

Aged↗
PubMed2026

Integrated analysis of gut microbiota, serum metabolomics, and proteomics reveals novel associations with clinical symptoms in patients with cerebral infarction.

BACKGROUND: Cerebral infarction (CI) is a major cause of adult disability and mortality worldwide. Mounting evidence supports the critical role of the gut-brain axis in cerebrovascular disease progression. This study aimed to characterize the alterations in gut microbiota, serum metabolome, and serum proteome in patients with CI, and to identify multi-omics signatures associated with clinical symptoms. METHODS: A total of 20 CI patients and 20 healthy controls (HC) were enrolled. Fecal microbiota was profiled using 16&#xa0;S rRNA gene high-throughput sequencing. Serum metabolomics and proteomics were analyzed using ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) and data-independent acquisition (DIA) proteomics, respectively. Spearman correlation and multi-omics integration were applied to explore the associations among microbiota, metabolites, proteins, and clinical indicators. RESULTS: CI patients displayed significant gut microbiota dysbiosis, with a markedly lower gut microbiota health index (GMHI) and higher microbiota disorder index (MDI) compared with HC (P&#x2009;<&#x2009;0.001). The genera g_norank_o_RF39 and Oxalobacter were significantly enriched in CI patients, whereas Clostridium_sensu_stricto_1 and Agathobacter were enriched in HC. Metabolomic analysis identified 445 differential metabolites, mainly involved in glycerophospholipid metabolism, phenylalanine metabolism, and caffeine metabolism. Proteomic analysis revealed 140 differentially expressed proteins linked to inflammatory responses, calcium signaling, and NF-&#x3ba;B signaling. Multi-omics integration showed that signature gut microbiota was strongly correlated (P&#x2009;<&#x2009;0.005) with key serum metabolites and proteins implicated in CI pathogenesis. CONCLUSIONS: This integrated multi-omics study revealed distinct gut microbiota, serum metabolomic, and proteomic alterations in CI patients. The microbiota-metabolite-protein regulatory axes provide novel insights into the gut-brain axis in CI and may serve as potential diagnostic biomarkers or therapeutic targets.

Humans↗
PubMed1993

[Internal decompression with hippocampectomy for massive cerebral infarction].

Massive cerebral infarction due to the occlusion of a main cerebral artery is often unresponsive to medical treatment. Internal decompression with hippocampectomy was tried for two patients and satisfactory results were obtained without advancing cerebral edema. External decompression was also performed on 12 patients, but it was accompanied by intensified edema postoperatively. Satisfactory results were obtained in four cases, but three patients remained in vegetative states, and five patients died. The internal decompression with immediate hippocampectomy resolves compression to the brain stem without aggravating cerebral edema and may be more effective in preserving life than external decompression.

Aged↗
PubMed1989

[Magnetic resonance imaging of cerebrovascular disorders; cerebral infarction].

Patients with cerebral infarction and with suspicion of cerebral infarction were studied with magnetic resonance imaging (MRI) and correlative CT scans. MRI was more sensitive than CT for detecting cerebral infarction, and T2-weighted spin echo pulse sequence was most sensitive in the diagnosis of cerebral infarction except some lacunar infarctions and some cortical and subcortical infarctions. MRI using Gd-DTPA was more sensitive than contrast CT for detecting fresh infarcted areas, especially in the cases with multiple cerebral infarcted areas and cortical and subcortical infarcted areas, and many offer some informations in evaluating the state of circulation.

Adult↗
PubMedDate not supplied

CT findings in hemorrhagic cerebral infarct.

Hemorrhagic cerebral infarcts can be detected by computer tomography (CT) as a high density lesion in the margins or inside a low density infarcted area. However the CT features are not always characteristic and the specific diagnosis is sometimes impossible. We describe the CT findings in initial and follow-up examinations of three arterial and one venous hemorrhagic infarcts and discuss the diagnostic problems.

Adult↗
PubMed2000

Cerebral blood flows in the acute and chronic stages of cerebral infarction.

Regional cerebral blood flows (rCBFs) were studied in the acute and the chronic stages of 8 patients with supratentorial cerebral infarction. In 2 patients with cardioembolic infarction, the rCBF increased in one patient and decreased in the other during the chronic stage. This decrease was explained by the risk factors of the latter patient because the patient had more risk factors than the former patient with increased rCBF. In 6 patients with lacunar infarction, the rCBF increased in 2 patients and decreased in 4 during the chronic stage. In all the patients with decreased rCBF, the number of lacunar infarction and/or the degree of leuko-araiosis on MRI increased during the chronic stage. Therefore, the decrease in rCBF during the chronic stage in lacunar infarction is considered to be due to the increase in the number of lacunar infarction, the increased degree of leuko-araiosis or both.

Acute Disease↗
PubMed2002

Scorpion bite and multiple cerebral infarcts.

Multiple cerebral infarcts, bilateral optic neuropathy with limb ischemia, following scorpion bite is documented. Vasospasm and autonomic storm due to envenomation is a plausible explanation for this symptom complex.

Adolescent↗
PubMedDate not supplied

Mechanisms of perioperative cerebral infarction.

Perioperative cerebral infarction occurs in less than 1% of general surgical procedures; the mechanism is usually unknown. The clinical features of 12 consecutive perioperative strokes were retrospectively reviewed. Although intraoperative hypotension was frequent, onset of deficit occurred postoperatively in 83% and intraoperatively in 17%. Cardiogenic embolism was a common cause of stroke (42%), with atrial fibrillation present in 4 patients (33%) at the time of stroke. The potential roles of hypercoagulability, hypotension and carotid occlusive disease are discussed. Future reports concerning perioperative stroke should consider the multiple mechanisms and temporal relationship of stroke to the operative procedure.

Aged↗
PubMedDate not supplied

Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction.

Cardioembolic cerebral infarction is a subtype of stroke with a high mortality. The purpose of this study was to determine predictors of in-hospital mortality in 231 consecutive patients with cardioembolic stroke by means of a multivariate analysis. Three predictive models were constructed. A first model was based on demographic, anamnestic and clinical variables collected at the bedside examination (total 8 variables). A second model was based on clinical and neuroimaging variables (total 10 variables). A third model was based on the aforementioned clinical and neuroimaging variables and the presence of early recurrent embolism (total 11 variables). Deteriorated level of consciousness, limb weakness, presence of congestive heart failure, male gender, and age appeared to be independent prognostic factors of in-hospital mortality in the predictive model based on clinical variables and in the predictive model based on clinical and neuroimaging variables. In addition to these variables, early recurrent embolization was selected in the third predictive model. In the first two models, setting a cut-off point of 0.50 for predicting vital status at hospital discharge resulted in a sensitivity of 60%, a specificity of 89% and a total correct classification of 81%. The corresponding values of the third model were 62, 89 and 81%, respectively. These data may help clinicians to establish an early prognosis of this stroke subtype more accurately as well as to allocate patients with cardioembolic stroke in clinical trials correctly.

Cerebral Infarction↗
PubMed1994

[Coronary artery bypass grafting in the patients with previous cerebral infarction: the risk of perioperative cerebral complications].

From Oct. 1987 to Apr. 1992, coronary artery bypass grafting (CABG) was performed in 33 patients who had a history of previous cerebral infarction. Two patients associated with severe carotid disease underwent combined carotid endarterectomy and CABG. There have been no perioperative cerebral complications. On the other hand, in 199 patients without a history of previous cerebral infarction, three patients (1.5%) suffered perioperative cerebral infarction. In two of these patients, the etiology was felt to be calcific and atherosclerotic debris from the ascending aorta and in the remaining patient, to be arterial hypotension during cardiopulmonary bypass. In conclusion, no direct relationship has been found between previous cerebral infarction and incidence of perioperative cerebral complications.

Aged↗
PubMed2002

Early effects of acid-base management during hypothermia on cerebral infarct volume, edema, and cerebral blood flow in acute focal cerebral ischemia in rats.

BACKGROUND: Although the frequency for the use of moderate hypothermia in acute ischemic stroke is increasing, the optimal acid-base management during hypothermia remains unclear. This study investigates the effect of pH- and alpha-stat acid-base management on cerebral blood flow (CBF), infarct volume, and cerebral edema in a model of transient focal cerebral ischemia in rats. METHODS: Twenty Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion (MCAO) for 2 h during normothermic conditions followed by 5 h of reperfusion during hypothermia (33 degrees C). Animals were artificially ventilated with either alpha- (n = 10) or pH-stat management (n = 10). CBF was analyzed 7 h after induction of MCAO by iodo[(14)C]antipyrine autoradiography. Cerebral infarct volume and cerebral edema were measured by high-contrast silver infarct staining (SIS). RESULTS: Compared with the alpha-stat regimen, pH-stat management reduced cerebral infarct volume (98.3 +/- 33.2 mm(3) vs. 53.6 +/- 21.6 mm(3); P > or = 0.05 mean +/- SD) and cerebral edema (10.6 +/- 4.0% vs. 3.1 +/- 2.4%; P > or = 0.05). Global CBF during pH-stat management exceeded that of alpha-stat animals (69.5 +/- 12.3 ml x 100 g(-1) x min(-1) vs. 54.7 +/- 13.3 ml x 100 g(-1) x min; P > or = 0.05). The regional CBF of the ischemic hemisphere was 62.1 +/- 11.2 ml x 100 g(-1) x min(-1) in the pH-stat group versus 48.2 +/- 7.2 ml x 100 g(-1) x min(-1) in the alpha-stat group ( P> or = 0.05). CONCLUSIONS: In the very early reperfusion period (5 h), pH-stat management significantly decreases cerebral infarct volume and edema as compared with alpha-stat during moderate hypothermia, probably by increasing CBF.

Acid-Base Equilibrium↗