Acute gastric changes in patients with acute stroke. Part 1: with reference to gastroendoscopic findings. (41/698)

A gastroendoscopic study was performed on 177 patients with acute stroke. Gastric changes were found in 92 among them (52%), including ten with acute ulcer. A high frequency of gastric changes was found in patients with serious stroke and/or in patients whose cerebral lesions were located close to the hypothalamus or its centrifugal tract. The mortality in patients with gastric changes was high, especially in patients with acute ulcers, multiple erosions and petechiae. The frequency of brown gastric juice and coffee grounds at gastroendoscopic examination (gastric hemorrhage) was three times as high as that of melena and/or hematoemesis. On the other hand, the mortality of patients with gastric hemorrhage differed little from that of patients with melena and/or hematoemesis.  (+info)

Fatal cerebral embolism following aorto-coronary bypass graft surgery. (42/698)

In a case of fatal cerebral embolic infarction following aorto-coronary bypass graft (ACBG) surgery, postmortem examination revealed thrombosis of the vein grafts to the left circumflex and left anterior descending coronary arteries. Continguous with the thrombus in the graft to the circumflex artery was thrombotic material adherent to the aortic sutures and extending several millimeters into the lumen of the aorta. A nonadherent thrombus of similar histologic character was found in the right middle cerebral artery, associated with localized brain infarction. In addition to the risks of cerebral complication associated with other types of open-heart surgery, the location of the vein grafts in patients undergoing ACBG operations seems to offer a unique mechansim for the occurrence of systemic and cerebral embolism, which may be operational in other cases.  (+info)

Transcranial Doppler evaluation of blood flow velocity changes in basal cerebral arteries in cerebral AVMs following embolisation and surgery. (43/698)

Blood flow velocities in the basal cerebral arteries were evaluated in 41 patients with supratentorial arteriovenous malformation (AVM), using a transcranial doppler 64-B instrument. The AVM was surgically excised in 20 patients and embolised in 21 patients. Blood flow velocities in feeding basal cerebral arteries were found markedly decreased in both the groups, at 24 hours after intervention. On follow up study at 3 months, blood flow velocity in feeding cerebral artery was found to be increased in 47 percent of patients who were embolised, but remained normal in all the patients who underwent surgery.  (+info)

Pathogenesis of the "sentinel headache" preceding berry aneurysm rupture. (44/698)

Pathologic examination in a case of fatal intracerebral hemorrhage from a berry aneurysm showed that the "sentinel" or warning headache in this patient was due to the leakage of blood into the subarachnoid space through a previous small tear in the wall of her saccular aneurysm. Oribital pain, transient, dysphasia, dizziness and, later, meningismus might have prompted the performing of a lumbar puncture to determine the presence of blood in the cerebrospinal fluid. This type of event is the likely pathogenetic mechanism for the premonitory headache that may precede a lethal rupture of a saccular aneurysm.  (+info)

High speed diffusion magnetic resonance imaging of ischemia and spontaneous periinfarct spreading depression after thromboembolic stroke in the rat. (45/698)

Spontaneous episodes of transient cell membrane depolarization (spreading depression [SD]) occur in the surroundings of experimental stroke lesions and are believed to contribute to infarct growth. Diffusion-weighted imaging (DWI) is capable of detecting the water shifts from extracellular to intracellular space associated with SD waves and ischemia, and can make in vivo measurements of these two features on a pixel-by-pixel basis with good temporal resolution. Using continuous high speed DWI with a temporal resolution of 12 seconds over a period of 3 hours, the in vivo contribution of spontaneous SDs to the development of ischemic tissue injury was examined in 8 rats using a thromboembolic stroke model. During the observation period, the initial lesion volume increased in 4 animals, remained unchanged in 1 animal, and decreased in 3 animals (most likely because of spontaneous clot lysis). Irrespective of the lesion evolution patterns, animals demonstrated 6.5 +/- 2.1 spontaneous SDs outside of the ischemic core. A time-to-peak analysis of apparent diffusion coefficient (ADC) changes for each SD wave demonstrated multidirectional propagation patterns from variable initiation sites. Maps of the time constants of ADC recovery, reflecting the local energy supply and cerebral blood flow, revealed prolonged recovery times in areas close to the ischemic core. However, repetitive SD episodes in the periinfarct tissue did not eventually lead to permanent ADC reductions. These results suggest that spontaneous SD waves do not necessarily contribute to the expansion of the ischemic lesion volume in this model.  (+info)

The effects of an antimetastatic agent, (plus or minus)-1,2-bis(3,5-dioxopiperazin-1-yl)propane (ICRF 159), on platelet behavior. (46/698)

Some agents that inhibit platelet aggregation, e.g., aspirin and dipyridamole, ahve been reported to prevent metastasis formation. To see whether inhibition of platelet aggregation could account for the antimetastatic action of (plus or minus)-1,2- bis(3,5-dioxopiperazin-1-yl)propane, this compound was investigated in vivo for any effects on platelet behavior and thrombogenesis. (plus or minus)-1,2-Bis(3,5-dioxopiperazin-1-yl)propane inhibited the formation of platelet thrombi in blood vessels on the surface of the rat brain and in the hamster cheek pouch. 1,2-Bis(dioxo-4-methylpiperazin-1-yl)ethane, a closely related analog of (plus or minus)-1,2-bis(3,5-dioxopiperazin-1-yl)propane, but without antimetastatic action, inhibited thrombus formation in vivo as effectively as (plus or minus)-1,2-bis(3,5-dioxopiperazin-1-yl)propane. It seems unlikely therefore that the antimetastatic action of (plus or minus)-1,2-bis(3,5-dioxopiperazine-l-yl)propane derives from its effects on thrombogenesis. Neither platelet numbers nor the ionized plasma calcium concentrations were changed after (plus or minus)-1,2-bis(3,5-dioxopiperazin-l-yl)propane administration.  (+info)

Positive scans in angiographically proved cases of recanalized cerebral infarction. (47/698)

In 20 patients with acute major cerebral arterial occlusion, follow-up angiograms were obtained to inspect the occluded artery. These angiograms were compared with brain scans in the fourth week after the stroke. The angiograms revealed that frequent recanalization of the occluded arteries occurred within a week after the onset. On the other hand, brain scans showed the increased uptake of radioisotopes even in the patients with angiographically demonstrated arterial recanalization. The present study clarified that positive scans could be obtained in the patients with and without recanalization, and emphasized the diagnostic value of brain scans in the subacute or chronic stage of cerebral infarction, especially in patients with no arterial occlusion appearing on the angiograms.  (+info)

Brain scanning in cerebral vascular disease: a reappraisal. (48/698)

The frequency of abnormal brain scans in patients with cerebral vascular disease admitted to a stroke intensive care unit has been evaluated in relation to diagnosis, time after onset of symptoms, effect of delayed imaging and the degree of clinical neurological recovery. In patients with completed thromboembolic infarction, 33% had abnormal scans including 39% of those with hemispheric lesions and 14% with posterior fossa lesions. Completed hemorrhagic infarction occurred in seven patients, and three (43%) had abnormal brain scans. Of 14 patients with either transient ischemic attacks or reversible ischemic neurological deficit, two (14%) had abnormal scans. Twenty-seven percent of brain scans in patients with completed thromboembolic infarction were abnormal in the first two days after infarction, a higher frequency than previously reported. Delayed images confirmed the initial interpretation that the scan was either normal or abnormal in 71% of the cases while in 10% of the cases only the delayed views were abnormal. The frequency of abnormal scans was significantly greater in patients who died or had a large neurological deficit at discharge than in patients with lesser residual deficit.  (+info)