Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2013
Randomized Controlled TrialProof of concept study: relating infarct location to stroke disability in the NINDS rt-PA trial.
The summed Alberta Stroke Program Early CT Score (ASPECTS) for noncontrast head CT scan represents the extent of early brain ischemia and has been shown to be useful for predicting stroke outcome. The ASPECTS template contains information on anatomical location which so far has not been used in analysis. This may not have been done because adjacent brain regions have related functions and share vascular territory. The task of relating neurological deficit to infarct localization requires brain imaging analysis tools which deal with this issue of relatedness or collinearity. We have previously used partial least squares with penalized logistic regression (PLR) to handle this problem of collinearity. A disadvantage of this method is that it cannot be performed at the bedside and requires processing and analysis in the imaging laboratory. PLR is a simpler analytic tool compared to partial least squares with PLR for dealing with this issue of relatedness (collinearity). It provides results in terms of β coefficients related to specific infarct locations in a manner that is intuitively understood by clinicians. In this exploratory analysis, we hypothesized that infarct location as represented by the individual ASPECTS region may be independently related to disability. ⋯ At an older age, specific infarct locations may be associated with a poorer outcome in this exploratory re-analysis of the NINDS rt-PA Study.
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Cerebrovascular diseases · Jan 2013
Genetic susceptibility for ischemic infarction and arteriolosclerosis based on neuropathologic evaluations.
Recent genetic studies of stroke and related risk factors have identified a growing number of susceptibility loci; however, the relationship of these alleles to ischemic stroke is unknown. The challenge in finding reproducible loci of ischemic stroke susceptibility may be in part related to the etiologic heterogeneity in clinically defined stroke subtypes. In this study, we tested whether known single nucleotide polymorphisms (SNPs) associated with stroke or putative stroke risk factors are associated with neuropathologically defined micro- or macroscopic infarcts and with arteriolosclerosis. ⋯ Our results suggest replication of the candidate CDKN2A/B stroke susceptibility locus with directly measured macroscopic stroke neuropathology, and further implicate several diabetes and other risk variants with secondary, pleiotropic associations to stroke-related pathology in our autopsy cohort. When coupled with larger sample sizes, cerebrovascular neuropathologic phenotypes will likely be powerful tools for the genetic dissection of susceptibility for ischemic stroke.
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Cerebrovascular diseases · Jan 2013
Spot signs in intracerebral hemorrhage: useful for identifying patients at risk for hematoma enlargement?
Prognostic signs for the identification of patients with acute spontaneous intracerebral hemorrhage (SICH) prone to hematoma expansion are limited. Contrast extravasation (spot signs, SpS) on computed tomographic angiography (CTA) may be a promising method to predict hematoma expansion in acute SICH. However, prospective data on the predictive value of the SpS on hematoma expansion and clinical outcome are still limited. We aimed to investigate associations between the presence of SpS, hematoma expansion, and clinical outcome in acute SICH. ⋯ The clinical value of SpS needs to be further explored. Future studies should particularly focus on structured training procedures to identify SpS and measure the time needed to precisely assess the presence of SpS and on the prevalence of SpS in consecutive intracerebral hemorrhage populations.
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Cerebrovascular diseases · Jan 2013
Anterior choroidal artery territory infarction: lesions confined to versus beyond the internal capsule.
Studies investigating the clinical features and stroke mechanisms of anterior choroidal artery (AchA) infarction have reported inconsistent results. This may be partly due to different degrees of inclusion of patients with isolated posterior limb of the internal capsule (PLIC) lesions, which may be supplied by lenticulostriate arteries rather than AchA. The purpose of this study was to investigate clinical features and stroke mechanisms of AchA infarction, with particular attention to the above problem. ⋯ In general, SAD was the most important stroke mechanism for AchA infarction followed by LAD. However, dAchA infarction and pAchA infarction differ in that the former was more often associated with cardioembolism, distal ICA steno-occlusion, a worse clinical status and less often associated with SAD than the latter. The different proportion of patients with pure PLIC lesions included in previous studies may have led to inconsistent and confusing results, which should be considered to gain a proper understanding of AchA infarction.
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Cerebrovascular diseases · Jan 2013
Case Reports Clinical TrialPerfusion-weighted magnetic resonance imaging used in assessing hemodynamics following superficial temporal artery-middle cerebral artery bypass in patients with Moyamoya disease.
The best strategy to assess the changes in brain hemodynamics following superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in patients with Moyamoya disease remains unknown. The purpose of the present study was to assess cerebral hemodynamics using perfusion-weighted magnetic resonance imaging (PWI) before and after STA-MCA bypass surgery in patients with Moyamoya disease. ⋯ This study demonstrates that STA-MCA bypass is a safe and effective surgical treatment for Moyamoya disease. PWI enables an effective and objective assessment of hemodynamics before and after STA-MCA bypass surgery in patients with Moyamoya disease.