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PubMed1997

Psychosocial stressors in patients with major depression and silent cerebral infarction.

BACKGROUND AND PURPOSE: We previously found that silent cerebral infarction (SCI) was present in most of the patients older than 50 years with major depression who were examined. The present study was designed to clarify the relationship between psychosocial stressors and SCI in patients with major depression. METHODS: Forty-two patients with unipolar depression underwent MRI and were classified as SCI-negative (n = 19) or SCI-positive (n = 23). The SCI-positive group was subclassified into those with moderate SCI (n = 16) and those with severe SCI (n = 7). The relationship between the patients' DSM-III-R axis IV scores and SCI was evaluated. RESULTS: The axis IV score was significantly lower in the SCI-positive group than in the SCI-negative group (P < .05). Within the SCI-positive group, the mean axis IV score was significantly lower in those with severe SCI than in those with moderate SCI (P < .05). CONCLUSIONS: Our findings suggest that depression in patients with SCI involves more neurological factors than psychosocial stressors.

Age Factors↗
PubMed1993

[A case of pseudoxanthoma elasticum associated with asymptomatic multiple cerebral infarction, hypothyroidism, glucose tolerance abnormality and multiple congenital anomalies].

We report a case of pseudoxanthoma elasticum (PXE) associated with asymptomatic multiple cerebral infarction on magnetic resonance imaging (MRI), endocrinological abnormalities and multiple congenital physical anomalies. A 40-year-old woman suddenly developed paresthesia in the right half of the body. Physical examination demonstrated loosening of the skin and yellowish papules in the neck and axilla, retinal angioid streaks, cardiac mitral regurgitation, congenital aplasia of the uterus and vagina, and congenital abduction palsy of the right eye. The biopsy of the papules in the neck showed typical features of PXE. Laboratory tests revealed positive antibodies to thyroglobulin and microsome, high TSH level with normal free T3 and T4, and impaired glucose tolerance. The laboratory data and the findings of ultrasonic examination on the thyroid suggested presence of Hashimoto's disease. MRI of the brain demonstrated multiple cerebral infarcts through they were asymptomatic. MRI failed to clarify the lesion responsible for the hemiparesthesia. Carotid arteriography showed slight stenosis with ulceration near the origin of the right internal carotid artery, and severe stenosis of the horizontal portion of the right middle cerebral artery. MRI study of the brain is recommended in PXE patients since the complication of brain pathology worsens the prognosis of the disease.

Abnormalities, Multiple↗
PubMed1980

[Production of various cerebral infarction models in the dog by means of occlusion of intracranial trunk arteries (author's transl)].

Knowing that, by use of a surgical microscope and a unilateral temporal approach, all of the bilateral trunk arteries at the base of the skull in dogs can be identified and treated, we succeeded in producing various infarction models by means of simultaneously occluding the vessels in various combinations. These infarction models include: unilateral or bilateral complete cerebral hemisphere infarction models, a unilateral hemispheric and contralateral cerebral mantle infarction model, a unilateral thalamic and contralateral cerebral mantle infarction model, etc. In the anterior thalamic infarction model, the severity of infarction foci can be regulated by the time of vessel occlusion, and chronic experiments achieved. In the other infarction models, however, severe edema is seen following recirculation after more than one hour occlusion, making them unsuitable as models for chronic infarction. Nontheless, it is thought that such models have great value as models of brain edema and these various models for cerebral infarction in the dog will prove valuable in clarifying many of the outstanding problems with regard to the basic science of the cerebral hemispheres.

Animals↗
PubMed1998

Cigarette smoking and other risk factors for silent cerebral infarction in the general population.

BACKGROUND AND PURPOSE: Silent cerebral infarctions (SCIs) have a prevalence between 10% and 40% in the transient ischemic attack population and have been associated with increased mortality and morbidity; however, little is known about the prevalence and risk factors for SCI in the general population. This report focuses on the role of cigarette smoking and other risk factors for SCI in the general population. METHODS: MRI scans were performed on 1737 participants selected from the general population as part of the Atherosclerosis Risk in Communities Study. Smoking status and other major cerebrovascular risk factors were assessed, and associations between smoking status and SCIs were established with the use of ANCOVA. RESULTS: Overall, the prevalence of SCI in this population aged 55 to 70 years was 11%. Cigarette smoking had an ordered association (P=0.029) with the presence of SCI, with the odds ratio (OR) of nonsmoking participants exposed to environmental tobacco smoke being 1.06 (95% confidence interval [CI], 0.64 to 1.75) times as great as for nonsmokers not exposed; the OR of past smokers was 1.16 (95% CI, 0.74 to 1.83) times greater, and the OR of current smokers was 1.88 (95% CI, 1.13 to 3.13) times greater. An increased prevalence was also noted among black, older, and hypertensive participants. CONCLUSIONS: This report is among the first to examine the risk factors for SCI in the general population and finds a relatively high overall prevalence (11%). There is an ordered relationship between increasing exposure to cigarette smoke and the presence of SCI that parallels the relationship between smoking and carotid atherosclerosis. The magnitude of the association with smoking is substantial compared with the effect of hypertension and other traditional cerebrovascular risk factors. The reduction in prevalence of SCI between current and past smokers and the trend that increased pack-years of smoking is related to increased prevalence of SCI are both additional arguments for smoking avoidance and cessation.

Age Factors↗
PubMed1998

Diffusion-weighted MR of acute cerebral infarction: comparison of data processing methods.

BACKGROUND AND PURPOSE: Some investigators have proposed that either calculated diffusion trace images or apparent diffusion coefficient (ADC) maps, which require imaging with multiple diffusion sensitivities and/or postacquisition image processing, are essential for the accurate interpretation of diffusion-weighted images in acute stroke because of the possible pitfalls of regional diffusion anisotropy, magnetic susceptibility artifacts, and confounding T2 effects, all of which alter signal on diffusion-weighted MR images. The purpose of our study was to compare the sensitivity, specificity, and accuracy of simple, orthogonal-axis diffusion-weighted imaging for the diagnosis of early cerebral infarction with three other sets of postacquisition-processed images: isotropic diffusion-weighted, diffusion trace-weighted, and diffusion trace images. METHODS: Twenty-six consecutive adult patients with signs and symptoms consistent with a clinical diagnosis of early cortical and/or subcortical cerebral infarction and 17 control subjects were studied with multisection, single-shot, spin-echo echo-planar diffusion-weighted imaging at 1.5 T to generate a set of three orthogonal-axis diffusion-weighted images. Isotropic diffusion-weighted, diffusion trace-weighted, and diffusion trace (mean ADC) images were then generated off-line and all four sets of images were interpreted blindly by two neuroradiologists. RESULTS: The average sensitivity, specificity, and accuracy for the orthogonal-axis diffusion-weighted images were 98.1%, 97.1%, and 97.7%, respectively. The average sensitivity, specificity, and accuracy for isotropic diffusion-weighted images were 88.5%, 100%, and 93% respectively. The average sensitivity, specificity, and accuracy for diffusion trace-weighted images were 82.7%, 73.6%, and 79.1%, respectively. The average sensitivity, specificity, and accuracy for diffusion trace images were 50.0%, 85.3%, and 64.0%, respectively. CONCLUSION: Orthogonal-axis diffusion-weighted images have the highest sensitivity and accuracy and very high specificity for early cerebral infarction. Our data contradict the contention that quantitative diffusion maps, requiring imaging with multiple diffusion sensitivities and/or subsequent image processing, are necessary for clinical stroke imaging.

Acute Disease↗
PubMed1990

Epidemiologic features of asymptomatic cerebral infarction in patients with nonvalvular atrial fibrillation.

We performed unenhanced computed tomographic scans on 141 asymptomatic patients with nonvalvular atrial fibrillation. Thirty-six patients (26%) had hypodense areas consistent with cerebral infarction. The majority of these were small deep infarcts, seen in 29 patients (21%), but 13 patients (9%) had cortical or large deep infarctions. Twelve patients had more than one infarct on computed tomographic scan. Increasing age and increased left atrial diameter were the only clinical features associated with asymptomatic infarction. Patients older than 65 years with a left atrial diameter greater than 5.0 cm (n = 23) had a 52% prevalence of asymptomatic infarction. Patients younger than 65 years with a left atrial diameter less than 5.0 cm (n = 38) had an 11% prevalence of silent infarction. Patients with only one of these risk factors (n = 72) had a 24% prevalence of silent infarction. Infarction was more common in those with chronic (34%) as opposed to intermittent (22%) nonvalvular atrial fibrillation, but this difference was not significant. Hypertension, diabetes, duration of atrial fibrillation, congestive heart failure, history of myocardial infarction, and echocardiographic evidence of left ventricular dysfunction were not associated with asymptomatic infarction. A history of hypertension was present in only 35% of our patients with small-deep asymptomatic infarction, similar to the percentage in patients without stroke. Asymptomatic cerebral infarction is common in nonvalvular atrial fibrillation. The association with enlarged left atria and the lack of correlation with major cerebrovascular risk factors suggests a cardioembolic mechanism. Further study is needed to determine the functional and prognostic significance of these strokes.

Aged↗
PubMed1986

Magnetic resonance imaging of hemorrhagic cerebral infarction.

A comparative study between magnetic resonance (MR) and computed tomography (CT) showed MR to be more sensitive than CT for detecting subacute and chronic hemorrhage into cerebral infarction. The hemorrhage appeared as either high signal on T1 weighted images or low signal on T2 weighted images, depending on the age of the hemorrhage. Cortical hemorrhagic infarction showed a characteristic gyral pattern. Methemoglobin and hemosiderin served as markers of previous hemorrhage into cerebral infarcts.

Adolescent↗
PubMed1992

The effect of enalapril maleate on cerebral blood flow in chronic cerebral infarction.

UNLABELLED: The influence of long-term oral administration of enalapril maleate (an angiotensin II-converting enzyme inhibitor) on regional cerebral blood flow (rCBF) was studied in 10 patients with chronic cerebral infarction. The rCBF was measured by a 133Xe inhalation method before and after a mean of sixty-five days' administration of 5 mg of enalapril. RESULTS: Mean arterial blood pressure (MABP) was mildly decreased in 6 patients, but the average change in MABP was not significant (Endtidal partial pressure of carbon dioxide (PeC02) was not changed significantly. The mean rCBF was increased by 8% after administration of enalapril (0.05 less than p less than 0.1) There was no significant correlation between percent change in MABP and the percent change in rCBF. These results indicate that enalapril has not only antihypertensive action but also a beneficial effect on the cerebral circulation in patients with chronic cerebral infarction.

Administration, Oral↗
PubMed2005

[Experimental research on effect of human mesenchymal stem cells induced by shenqi fuzheng injection in cerebral infarction].

OBJECTIVE: To investigate the effect of shenqi fuzheng injection (SFI) in inducing differentiation of human mesenchymal stem cells (hMSCs) in brain stem and its effect on nervous function in model rats of cerebral infarction. METHODS: Middle cerebral artery occlusion model rats were made, and hMSCs was injected into their brain after being amplified in vitro and incubated with SFI for 0.5 h, then the survival, migration and differentiation of hMSCs in brain stem as well as the change of nervous function in model rats were observed. RESULTS: The post-transplantation reject reaction to hMSCs was low, it could survive as long as 6 weeks or more. No difference in area of infarction was shown before and after transplantation. Immunohistochemical staining showed that hMSCs expressed human neuron specific enolase (NSE), neurofilament (NF) and glial fibrillary acid protein (GFAP). The limb-kinetic function and tactile perception were improved in the model rats. CONCLUSION: SFI can induce hMSCs differentiate into neurons in vivo, and hMSCs may be the ideal germinal cells for treating cerebral infarction.

Animals↗
PubMed2004

Acute aortic dissection with new massive cerebral infarction - a successful repair with ligature of the right common carotid artery.

It remains unclear whether or not the infarcted brain caused by aortic dissection should be reperfused when an emergency operation is needed for aortic arch dissection. A 64-year-old woman presented with severe back pain and syncope with a sudden left hemiplegia. CT scan demonstrated an aortic dissection of the entire aorta, obstruction of the right common carotid artery by extended aortic dissection, cerebral infarction of the right middle cerebral artery territory, brain edema and pericardial effusion. Though she was unable to communicate with us, she underwent an emergent aortic arch replacement and ligature of the right common carotid artery nine hours after the onset of stroke, when massive cerebral infarction was established. She survived the operation and regained full consciousness. When brain infarction was established by extended aortic dissection in emergent aortic surgery, concomitant ligature of the responsible artery to the brain infarction may be allowed for avoiding cerebral damage leading to brain death.

Aorta, Thoracic↗
PubMed2006

Acupuncture treatment of acute cerebral infarction by the 'Three-Step Needling' method.

OBJECTIVE: To observe the therapeutic effects of acupuncture treatment by the 'Three-Step Needling' Method for acute cerebral infarction. METHOD: While receiving the routine medical treatment, 68 cases were treated by the acupuncture method of 'Three-Step Needling'. RESULTS: 27 of the 68 cases were basically cured, 23 markedly improved, 15 improved, and 3 failed, the total effective rate being 95.59%. CONCLUSION: The acupuncture method of 'Three-Step Needling' can give quite good therapeutic effects for acute cerebral infarction.

Acupuncture Therapy↗
PubMed2000

Diffusion-weighted imaging in neonatal cerebral infarction: clinical utility and follow-up.

We describe the clinical utility of echo-planar diffusion-weighted imaging in neonatal cerebral infarction. Eight full-term neonates aged 1 to 8 days referred for neonatal seizures were studied. Patients were followed for a mean of 17 months with detailed neurologic examinations at regular intervals. Head computed tomography (CT) and conventional magnetic resonance (MRI) and diffusion-weighted images were obtained. Percent lesion contrast was evaluated for 19 lesions on T2-weighted and diffusion-weighted images. Follow-up conventional MRIs were obtained in seven patients. The findings on diffusion-weighted imaging were correlated with CT and conventional MRI findings as well as with short-term neurodevelopmental outcome. Four patients had focal cerebral infarctions. Four patients had diffuse injury consistent with hypoxic-ischemic encephalopathy. Percent lesion contrast of all 19 lesions was significantly higher on diffusion-weighted images when compared with T2-weighted images. In five patients, there were lesions visualized only with diffusion-weighted imaging. In all patients, there was increased lesion conspicuity and better definition of lesion extent on the diffusion-weighted images compared with the CT and T2-weighted MR images. In seven of eight patients follow-up imaging confirmed prior infarctions. Short-term neurologic outcome correlated with the extent of injury seen on the initial diffusion-weighted imaging scans for all patients. Diffusion-weighted imaging is useful in the evaluation of acute ischemic brain injury and seizure etiology in neonates. In the acute setting, diffusion-weighted imaging provides information not available on CT and conventional MRI. This information correlates with short-term clinical outcome.

Brain↗
PubMed1983

In vivo 31P NMR studies on experimental cerebral infarction.

Sequential metabolic changes in rat brain were monitored by in vivo measurements of 31P NMR spectra using a topical magnetic resonance (TMR) spectrometer, during the course of experimentally induced cerebral infarction and also during recovery produced by restoration of circulation. The experimental cerebral infarction was rendered by a slightly modified version of the method of Pulsinelli and Brierley (1979). The bilateral coagulation of the vertebral arteries at the level of alar foramina of the first cervical vertebra (preinfarction) did not show any change in NMR spectrum, but the subsequent bilateral ligation of internal carotid arteries produced a decrease in the peaks of ATP and phosphocreatine and a concomitant increase in the peak of inorganic phosphate within a few minutes. Intracellular pH, calculated from the chemical shift of inorganic phosphate, declined. These changes became maximal at approximately 30 min after the infarction. Reinstatement of blood flow to the cerebrum, produced by untying the ligature of internal carotid arteries, resulted in an immediate restoration of the peaks of ATP and phosphocreatine, which was followed by a reduction in the peak of inorganic phosphate within a few minutes. The spectrum recovered to its preinfarction pattern about 30 min after the restoration of the circulation. These experiments demonstrate that phosphorus compounds change very rapidly during infarction, and that these changes were reversible at least during a 30 min period.

Adenosine Triphosphate↗
PubMed1992

Delayed onset hand tremor caused by cerebral infarction.

BACKGROUND AND PURPOSE: Hand tremor has been rarely described as a manifestation of stroke. CASE DESCRIPTIONS: Three patients developed delayed onset hand tremor due to cerebral infarctions on the contralateral side, two in the caudate nucleus and the third in the thalamus. The tremors of all three patients were similar to parkinsonian tremor, but less monotonous. CONCLUSIONS: Delayed-onset hand tremor should be considered as one of the movement disorders caused by cerebral infarction.

Aged↗
PubMed2001

Different patterns of silent cerebral infarct in patients with coronary artery disease or hypertension.

The aim of the present study was to clarify the differences in the progression and the characteristics of silent cerebral infarcts (SCI) between patients with coronary artery disease (CAD) and hypertensive patients. Silent cerebral infarcts, a powerful prognostic indicator for stroke, are frequently found in patients with CAD and in hypertensives. However, the differences in the characteristics of SCI and related risk factors between CAD and hypertensive patients have not been thoroughly investigated. We evaluated the number of SCI and their distribution using brain magnetic resonance imaging (T1- and T2-weighted images) in 107 patients with CAD (validated by coronary angiography) and 101 hypertensive patients without history of clinical stroke. The prevalence of multiple SCI (three or more infarcts per person) in patients with CAD and with hypertension was significantly higher than in hypertensives without CAD (46% v 21%; P = .001), whereas that of patients with CAD without hypertension was intermediate (31%). The patients with multi- (two- or three-vessel) vessel diseases (VD) had a significantly higher prevalence of multiple SCI than the hypertensives and the no-stenosis or 1-VD group (68.1% in the 3-VD group, 52.0% in the 2-VD group, 26.8% in the 1-VD group, and 21.0% in the no-stenosis group). Multiple logistic regression analysis revealed that in the CAD group, the number of involved coronary arteries was an independent determinant of SCI (P < .005), whereas in the hypertensive group, age was an independent determinant of SCI (P < .005). When we investigated the distribution of SCI, in the CAD group, SCI in the deep perforator territory (the basal ganglia and the thalamus) were independently associated with the number of involved coronary arteries (P < .005), whereas SCI in the white matter were independently associated with age only (P < .005). In conclusion, SCI were more advanced in the patients with multivessel CAD than in the hypertensive patients, and were more common in patients with CAD and hypertension than in those without hypertension. Coronary atherosclerosis was independently and specifically associated with SCI located in the deep perferator territory but not of SCI located in the white matter. The CAD-atherosclerosis and hypertension may be independently involved in the pathologic process of SCI.

Arteriosclerosis↗
PubMed1999

Factor V1691 G-A, prothrombin 20210 G-A, and methylenetetrahydrofolate reductase 677 C-T variants in Turkish children with cerebral infarct.

Inherited gene defects related to the coagulation system have been reported as risk factors for ischemic stroke. These gene defects include a G-A transition at nucleotide 1691 in exon 10 of the Factor V gene causing activated protein C resistance; a G-A transition in the 3' untranslated region of the prothrombin gene at nucleotide position 20210 (G-A), which is associated with increased levels of prothrombin activity; and a C-T polymorphism at nucleotide 677 in the methylenetetrahydrofolate reductase gene responsible for an alanine to valine substitution, resulting in the synthesis of a thermolabile form of methylenetetrahydrofolate reductase that causes increased levels of homocysteine. The case-control study included 28 patients with cerebral infarction; all were 18 years of age or younger (range, 10 months to 18 years). Seven (25%) of the 28 patients were heterozygous for the FV1691 mutation. Five (17.8%) of the patients carried the PT20210A mutation. Two (7.1%) of the patients carried both mutations. When compared to controls, the difference was significant for both mutations (P = .007; .04). The frequency of allele T of methylenetetrahydrofolate reductase 677 was 0.3214, which was not significant when compared to controls (0.231; P = .3). A total of 12 (42.8%) patients carried one or both of the mutations FV1691 G-A and PT20210 G-A. From our data, it appears that FV1691 G-A and PT20210 G-A are associated with cerebral infarct risk independently. Risk assessment of double prothrombotic gene alterations did not reveal synergy between these mutations. In conclusion, the presence of FV1691 A and PT20210 A mutations but not the methylenetetrahydrofolate reductase 677 TT mutation correlate with the occurrence of cerebral infarction in children.

Adolescent↗
PubMed1996

Population-based study of seizure disorders after cerebral infarction.

We performed the first population-based study that determined the magnitude of the risk and identified the factors predictive of developing seizure disorders after cerebral infarction. Five hundred thirty-five consecutive persons without prior unprovoked seizures were followed from their first cerebral infarctions until death or migration out of Rochester, Minnesota. Thirty-three patients (6%) developed early seizures (within 1 week), 78% of which occurred within the first 24 hours after infarction. Using multivariate analysis, the only factor predictive of early seizure occurrence was anterior hemisphere location of infarct (odds ratio 4.0; 95% CI 1.2 to 13.7). Twenty-seven patients developed an initial late seizure (past 1 week), whereas 18 developed epilepsy (recurrent late seizures). Compared with the population in the community, the risk during the first year was 23 times higher for initial late seizures and 17 times higher for epilepsy. The cumulative probability of developing initial late seizures was 3.0% by 1 year, 4.7% by 2 years, 7.4% by 5 years, and 8.9% by 10 years. Independent predictive factors on multivariate analysis for initial late seizures were early seizure occurrence (hazard ratio of 7.8 [95% CI 2.8 to 21.7]) and stroke recurrence (3.1 [1.2 to 8.3]). Both early seizure occurrence (16.4 [5.5 to 49.2]) and stroke recurrence (3.5 [1.2 to 10.5]) independently predicted the development of epilepsy as well. We also found that early seizure occurrence predisposed those with initial late seizures to develop epilepsy.

Adolescent↗
PubMed2006

Acetylcholinesterase inhibitor acting on the brain improves detrusor overactivity caused by cerebral infarction in rats.

PURPOSE: The functional contribution of the cholinergic pathway in the frontal cortex to micturition was evaluated following cerebral ischemia. Furthermore, it was examined whether reactivation of this regulatory system using acetylcholinesterase inhibitor could improve detrusor overactivity. METHODS: Left middle cerebral artery occlusion (MCAO) was performed in female Sprague-Dawley rats. Choline acetyltransferase (ChAT) activities after MCAO were assayed to assess the damage to cholinergic neurons. ChAT activities in the bilateral cortex, hippocampus, and pons were calculated by measuring the conversion of 1-[14C] acetyl-coenzyme A to [14C] acetylcholine. Effects on cystometrography of i.v. or i.c.v. donepezil hydrochloride (DON), a centrally acting acetylcholinesterase inhibitor, were investigated in conscious sham-operated (SO) and cerebral infarcted (CI) rats. To investigate whether DON in the forebrain was affected, we decerebrated rats after CI or SO, and investigated the effects on cystometrography of i.v. DON. RESULTS: Bladder capacity was markedly decreased after MCAO, and remained below half of the pre-occlusion capacity. The greatest increase in bladder capacity was attained at 1.2 x 10(-2) nM/kg of DON given i.v., with a change of 52.8% (P < 0.05). In cases of i.c.v. DON, the greatest increase in bladder capacity was at the dose of 6 x 10(-2) pmol with the change of 95.8% (P < 0.01). The activity of ChAT was decreased in the left cortex and hippocampus 24 h after MCAO (P < 0.05). In decerebrated rats, low dose of DON did not change micturition parameters. CONCLUSIONS: These results suggest that by upregulation of the forebrain muscarinic inhibitory mechanism, acetylcholinesterase inhibitor improves detrusor overactivity by cerebral infarction.

Analysis of Variance↗