Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 1996
Thermoregulatory vasococonstriction and shivering impede therapeutic hypothermia in acute ischemic stroke patients.
We tested the hypothesis that vasoconstriction and shivering thresholds are sufficiently reduced by acute stroke to permit induction of therapeutic hypothermia without additional pharmacological inhibition of thermoregulatory control. ⋯ Vasoconstriction and shivering were initiated at roughly normal temperatures in ischemic stroke patients, and these thermoregulatory responses prevented induction of therapeutic hypothermia. Pharmacological reduction of the vasoconstriction and shivering thresholds will be required if therapeutic hypothermia for stroke patients is to be induced easily by surface cooling.
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J Stroke Cerebrovasc Dis · Jan 1995
Transcranial Doppler signals during cerebral angiography and cardiac catheterization.
Cerebral angiography is associated with a 0.45-4% risk of neurological complications and a less than 1% risk of permanent neurological deficit. Recently, air embolism has been implicated as a major cause of these complications. Cardiac catheterization is associated with a neurological complication rate of less than 1%; the predominant mechanism appears to be embolic. ⋯ No spontaneous emboli were seen. None of our 42 patients developed any type of neurological symptoms during or after the procedure. These high-intensity signatures do not represent air embolism exclusively; rather, they are likely a combination of turbulence in the bloodstream created during rapid injection, air emboli, and, perhaps, echogenicity of the contrast medium.
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Unilateral oval pupil has numerous causes, and several pathophysiologic mechanisms have been proposed. Prognosis is nearly universally poor. ⋯ Both patients recovered. The prognosis for comatose patients with unilateral oval pupil is not universally poor.
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J Stroke Cerebrovasc Dis · Jan 1995
Prognostic significance of ST-segment depression on continuous electrocardiography in patients with acute ischemic neurologic events.
Patients with a history of ischemic stroke or transient ischemic attack (TIA) are at significant risk of cardiac death. This study reports the prognostic significance of ST-segment depression and ventricular tachycardia on continuous electrocardiography in 48 consecutive patients hospitalized with an acute ischemic stroke or TIA. Thirty-one percent of patients had episodes of asymptomatic ST-segment depression and 6% had transient ventricular tachycardia on continuous electrocardiographic monitoring. ⋯ However, ventricular tachycardia was associated with a higher rate of cardiac death (33% vs. 2%, p < 0.01). Only 27% of patients subsequently found to have coronary artery disease had ST-segment depression by continuous electrocardiography. In contrast to patients with coronary artery disease, ST-segment depression on continuous electrocardiography is not associated with poorer outcome among patients with acute ischemic stroke or TIA.
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J Stroke Cerebrovasc Dis · Jan 1994
White matter lesions on magnetic resonance imaging in a healthy elderly population: Correlations to vascular risk factors and carotid atherosclerosis.
We performed magnetic resonance imaging (MRI) and extensive risk factor evaluation on 196 randomly selected, clinically asymptomatic participants of the Austrian Stroke Prevention Study to determine the clinical correlates of MRI white matter lesions (WML) in normals. WML were present in 103 (52.6%) individuals. ⋯ No other demographic or clinical factors, such as cardiac disease, diabetes mellitus, smoking, lipid status, serum fibrinogen, hematocrit, antiphospholipid antibody titer, or ultrasound results of the carotid arteries entered the model. These data imply the presence of yet undetermined factors in the pathogenesis of WML, probably independent of those known to be associated with atherothrombotic brain infarction.