1/52. Cerebrovascular disease in neonates. Evaluation of four cases.The clinical and neurological study in four neonates infants with cerebral infarction are reported. The purpose of this study is to call attention for the clinical course, cranial ultrasound, computed tomography and laboratories tests, in order to evaluate the neurological sequelae. A careful evaluation has be taken in order to determine the significance of clinical and laboratory tests for syndromic, topographic and etiologic diagnosis after one year ambulatorial follow-up.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/52. Extracranial-intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy.OBJECTIVE: To examine the potential role of cerebral revascularization in the treatment of patients with symptomatic occlusive cerebrovascular disease refractory to medical therapy. methods: Twenty patients with symptomatic occlusive cerebrovascular disease underwent 22 extracranial-intracranial bypass procedures after failing maximal medical therapy. The average follow-up time was 3.5 years, and no patient was lost to follow-up. RESULTS: All patients presented with repeated transient ischemic attacks refractory to medical therapy. Angiographic findings included internal carotid artery occlusion in 8 patients, middle cerebral artery stenosis or occlusion in 4, moyamoya disease in 4, internal carotid artery dissection in 2, and supraclinoid internal carotid artery stenosis in 2. Outcome was excellent in 17 patients and good in 3. The only surgical complication occurred in one patient, who experienced postoperative seizures and required anticonvulsant therapy. There were no deaths in this series. CONCLUSION: Although the Cooperative Study on Extracranial-Intracranial Bypass failed to show a benefit from the bypass procedure, we have continued to perform the operation in selected cases. Carefully selected individuals with occlusive cerebrovascular disease and persistent ischemic symptoms, despite maximal medical therapy, seem to obtain demonstrable and durable benefit from cerebral revascularization.- - - - - - - - - - ranking = 1.75keywords = vascular disease (Clic here for more details about this article) |
3/52. Altered hemodynamic responses in patients after subcortical stroke measured by functional MRI.BACKGROUND AND PURPOSE: Blood oxygenation level-dependent (BOLD) functional MRI (fMRI) is a promising method for defining brain recovery after stroke quantitatively. Applications thus far have assumed that the BOLD hemodynamic response in patients after stroke is identical to that in healthy controls. However, because of local vascular compromise or more diffuse vascular disease predisposing to infarction, this assumption may not be justified after stroke. We sought to test whether patients who have suffered a lacunar stroke show BOLD fMRI response characteristics identical to those of healthy controls. methods: We measured the BOLD fMRI signal time course in the sensorimotor cortex contralateral to the affected hand with finger- or hand-tapping tasks for minimally or mildly impaired right-handed patients (n=12) after lacunar strokes causing limb weakness and for healthy controls (n=20). RESULTS: With a right-handed sequential finger-tapping task, the rate of rise and maximum increase of the BOLD signal in the contralateral sensorimotor cortex were > 30% lower (P< or =0.01) in the stroke patients. Similar relative decreases were found for the same task performed with the left hand. These changes were found in patients both in the hemisphere affected by stroke and in the unaffected hemisphere, suggesting that the BOLD fMRI time course differences observed arise from a diffuse functional pathology. The difference between patients and controls is not a result of age alone, since differences were not found between the younger (n=10; aged 22 to 38 years) and the older (n=10; aged 56 to 83 years) healthy controls. The effect also does not seem to be dependent on the specific hand movement task used. CONCLUSIONS: The magnitude of the BOLD fMRI response can be reduced in stroke patients even if infarcts do not involve the cortex. This may be a consequence of the stroke, but the observation that the BOLD signal time course is similar in the affected and unaffected hemispheres suggests that it also could result from preexisting pathophysiological changes in the cerebral microvasculature.- - - - - - - - - - ranking = 0.25keywords = vascular disease (Clic here for more details about this article) |
4/52. COX-2 inhibitor for the treatment of idiopathic stabbing headache secondary to cerebrovascular diseases.The idiopathic stabbing headache (ISH) is characterized by a stabbing pain of short duration, variable localization and an errant evolution pattern. As its biological mechanisms are unknown and the treatment options are little effective, this disorder shows a strong impact on the patient's life. Two females and one male, aged 76, 66 and 72 years, respectively, started presenting ISH within 20 days after the onset of a stroke. All the patients were treated for the ISH with celecoxib, a COX-2 specific inhibitor, with full recovery from ISH up to 6 days after it was first administered. The interruption of the drug 60 days after the treatment with celecoxib induced again the appearance of algic symptoms in two patients. We concluded that cerebrovascular diseases (CD) can lead to ISH and that the COX-2 inhibitor can be an effective prophylactic drug for ISH after CD.- - - - - - - - - - ranking = 1.25keywords = vascular disease (Clic here for more details about this article) |
5/52. poems syndrome associated with ischemic stroke.BACKGROUND: A syndrome variously combining peripheral neuropathy, visceromegaly, endocrinopathy, monoclonal gammopathy, and skin changes (poems syndrome) is a rare variant of plasma cell dyscrasia with multisystemic manifestations. Acute ischemic strokes in patients with poems syndrome have rarely been reported, and the pathophysiologic mechanism of this disease is unknown. fibrinogen is reported to be an independent risk factor for cerebrovascular disease and is correlated with the interleukin 6 level in the plasma. The serum level of interleukin 6 is high in the active stage of poems syndrome. OBJECTIVE: To describe the neuroimaging findings and fibrinogen levels in patients with poems syndrome. DESIGN: Case series. SETTING: The neurology department of a tertiary referral center. methods: Three patients with an acute cerebral infarction associated with poems syndrome underwent magnetic resonance imaging, diffusion-weighted imaging, magnetic resonance angiography, transcranial Doppler ultrasonography, and serum fibrinogen level and serum c-reactive protein level analysis. The serum fibrinogen level before the stroke was collected retrospectively from the hospital medical records. RESULTS: There was an elevated fibrinogen level in all of the patients. In 2 patients, unilateral or bilateral end artery border-zone infarcts were observed on the brain magnetic resonance imaging scan. The serum fibrinogen level was high before the stroke in 2 patients. CONCLUSIONS: The poems syndrome can be associated with stroke, particularly end artery border-zone infarctions. We suggest that an elevated fibrinogen level might play a role in the pathogenesis of stroke.- - - - - - - - - - ranking = 0.25keywords = vascular disease (Clic here for more details about this article) |
6/52. Sneddon's syndrome associated with anticardiolipin antibody: a case report.We report the case of a young man suffering from the rare combination of livedo reticularis and recurrent ischemic cerebrovascular disease (Sneddon's syndrome). He also had a circulating anticardiolipin antibody. in the absence of systemic lupus erythematosus, we suggest the likelihood of a primary antiphospholipid syndrome.- - - - - - - - - - ranking = 0.25keywords = vascular disease (Clic here for more details about this article) |
7/52. risk of ischemic stroke in patients with symptomatic vertebrobasilar stenosis undergoing surgical procedures.BACKGROUND AND PURPOSE: There is little information to provide an estimate for stroke risk in patients with established stenosis or occlusion in the basilar or intracranial vertebral arteries undergoing surgical procedures. The objective of this study was to determine the ischemic stroke risk in this specific patient population. methods: A medical records linkage system retrospectively identified patients with a diagnosis of symptomatic vertebrobasilar stenosis or occlusion matched with surgical procedures. patients were selected if they had stenosis or occlusion of the basilar or intracranial vertebral arteries identified on vascular imaging before undergoing surgical procedures under general anesthesia. Clinical and radiographic features were reviewed, along with the nature of the surgeries and details of the perioperative management. Records were reviewed for the diagnosis of stroke occurring within 1 month of surgery. RESULTS: Thirty-eight patients with a history of symptomatic vertebrobasilar ischemia underwent 50 operations under general anesthesia, and 3 had ischemic strokes in the vertebrobasilar territory immediately after surgery, a per-procedure rate of 6.0% (95% confidence interval, 1.2 to 16.6) All 3 had episodes of prolonged hypotension (systolic blood pressure <100 mm Hg for >10 minutes) during surgery. CONCLUSIONS: The risk of perioperative stroke in patients with vertebrobasilar stenosis undergoing surgery under general anesthesia is 6.0%, which is notably higher than the risk for patients with other patterns of cerebrovascular disease.- - - - - - - - - - ranking = 0.25keywords = vascular disease (Clic here for more details about this article) |
8/52. Vascular pseudoparkinsonism.Vascular pseudoparkinsonism may be confused with idiopathic Parkinson's disease. patients may be unnecessarily treated with anti-parkinsonian drugs while their underlying vascular disease is ignored. We investigated 250 parkinsonian patients seen in our movement disorders Clinic for a possible vascular etiology. After excluding those with a known secondary cause such as drug-induced parkinsonism, progressive supranuclear palsy, multiple system atrophy and hyperparathyroidism, brain computed tomography and/or magnetic resonance imaging were performed on those who showed poor or no response to levodopa. In those with an ischemic lesion demonstrated on neuroimaging, anti-parkinsonian drugs were stopped and the patients were reassessed. Eleven patients (4.4%) had ischemic brain lesions accounting for their parkinsonism. All were initially diagnosed as Parkinson's disease because of the prominence of bradykinesia and rigidity. gait disturbance was also common, but resting tremor was distinctly absent. Three anatomical patterns with different prognosis were identified. Three patients with basal ganglia lacunar infarct recovered spontaneously, three with frontal lobe infarcts remained static and five with periventricular and deep subcortical white matter lesions had progressive deterioration. autopsy in one patient confirmed bilateral frontal lobe watershed infarcts and the absence of brain stem lewy bodies. Parkinsonian patients with poor or no response to levodopa therapy should be investigated for a vascular etiology.- - - - - - - - - - ranking = 0.25keywords = vascular disease (Clic here for more details about this article) |
9/52. Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery.OBJECTIVE: In this retrospective study we wanted to determine the role of cerebral revascularization in patients with symptomatic occlusive cerebrovascular disease. Special emphasis was put on subsequent cerebrovascular events, benefit in neurological functioning and bypass patency, as evaluated during the follow-up period. methods: A total of 73 superficial temporal artery to the middle cerebral artery bypasses were performed on 67 patients from 1986-2000. All patients exhibited a symptomatic occlusion of the internal carotid artery verified by angiography. All patients in our group were refractory to medical treatment. 65 patients (69 bypasses) with a mean age of 61 years (range: 38-79 years) were followed up over an average time of 44 months (range: 1.5-150 months). RESULTS: The peri-operative morbidity rate was 3% with no mortality. 55 patients (85%) had no further cerebrovascular events after surgery, and only 7 (11%) patients experienced another cerebrovascular event. 57 (88%) patients showed an improvement of symptoms after surgery and only 1 patient fared worse during the follow-up period due to a stroke he suffered two years after bypass surgery. 90% of all bypasses remained patent during the follow-up. CONCLUSIONS: Although bypass surgery for occlusive cerebrovascular disease is still controversial, our retrospective study suggests both an improvement of symptoms and signs and a risk-reduction for future cerebrovascular events after surgery.- - - - - - - - - - ranking = 0.5keywords = vascular disease (Clic here for more details about this article) |
10/52. Differences in diffusion-weighted and T2-weighted magnetic resonance imaging findings in the acute and chronic stages of ischemic cerebrovascular disease--two case reports.A 71-year-old man presented with sudden onset of vertigo and a 77-year-old man suffered consciousness disturbance. diffusion-weighted magnetic resonance (MR) imaging on admission showed hyperintense areas in the left cerebellar hemisphere in the first patient and in the brainstem in the second patient. Both patients were treated with argatroban and edaravone, and the neurological deficits markedly improved one month after admission. T2-weighted MR imaging one month after the onset showed much smaller hyperintense areas compared with the findings on admission in both patients. These results indicate that findings of hyperintense areas by diffusion-weighted MR imaging in the acute stage of ischemic cerebrovascular disease indicate not only the ischemic core but also parts of the reversible incomplete ischemic lesion and suggest that intensive treatment in the acute stage might reverse ischemic brain damage in some patients.- - - - - - - - - - ranking = 1.25keywords = vascular disease (Clic here for more details about this article) |
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