| 1. |
- Carlberg, B, et al.
(författare)
-
Factors influencing admission blood pressure levels in patients with acute stroke.
- 1991
-
Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 22:4, s. 527-30
-
Tidskriftsartikel (refereegranskat)abstract
- In clinical practice, patients with acute stroke often have high blood pressure. The aim of this study was to investigate factors correlated with blood pressure elevation in 843 consecutive stroke patients on hospital admission to a nonintensive stroke unit. Using a multivariate analysis model, we analyzed the influence on admission blood pressure of sex, age, previous hypertension, cardiac failure, diabetes, type of stroke, impaired consciousness, and latency between onset of symptoms and admission. Previous hypertension was the strongest predictor (p less than 0.001) of elevated blood pressure on admission, followed by the presence of intracerebral hemorrhage (p less than 0.001). The latency between onset of symptoms and admission showed no correlation with blood pressure levels at hospitalization. Previously, high blood pressure levels on hospital admission have been shown to decline within a few days in hospital. We therefore hypothesize that mental stress on hospital admission may be a major factor in the blood pressure elevation seen in acute stroke.
|
|
| 2. |
- Carlberg, B, et al.
(författare)
-
The prognostic value of admission blood pressure in patients with acute stroke.
- 1993
-
Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 24:9, s. 1372-5
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Patients with acute stroke are often found to have high blood pressures at hospital admission. Previous studies have shown variable results regarding the prognostic value of high blood pressure in acute stroke. The aim of this study was to investigate the prognostic value of admission blood pressure in a population-based sample of patients with acute stroke.METHODS: Eighty-five patients with intracerebral hemorrhage and 831 with ischemic disease were included in the study. The relations between admission blood pressure and 30-day mortality were studied by logistic regression analyses.RESULTS: High blood pressure in patients with impaired consciousness on hospital admission was significantly related to 30-day mortality in patients with intracerebral hemorrhage (P = .037) and in patients with ischemic disease (P < .0001). In patients without impaired consciousness, high blood pressure at time of admission was not related to increased mortality at 30 days.CONCLUSIONS: High admission blood pressure in alert stroke patients was not related to increased mortality. Stroke patients with impaired consciousness showed higher mortality rates with increasing blood pressure. However, this does not provide a basis for recommending antihypertensive therapy for such patients.
|
|
| 3. |
- Grabowski, Martin, et al.
(författare)
-
Paw-reaching, sensorimotor, and rotational behavior after brain infarction in rats
- 1993
-
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 24:6, s. 889-895
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Functional tests that are stable and consistent over time are an advantage for long-term evaluation of treatment in experimental stroke research. Because little information on this subject is available in rodents with focal cerebral ischemia, we investigated the outcome of three behavioral tests for a period of 3 months after the insult. METHODS: Spontaneously hypertensive rats were sham-operated (n = 27) or underwent an occlusion (n = 36) of the right middle cerebral artery. Before surgery all rats were tested for amphetamine-induced rotational behavior, and half of the rats were trained in a paw-reaching task. One, 2, and 3 months after surgery the tests were repeated, together with a test for sensorimotor function. Infarct size was measured morphometrically. RESULTS: In the lesion group, total hemisphere area was reduced by 22%, caudate putamen by 47%, and the thalamus by 24%. Contralateral to the lesion, paw-reaching was highly impaired, regardless of whether or not the rats had been pretrained, and lesion size correlated significantly to paw-reach performance. Ipsilateral rotation increased and sensorimotor function recovered with time in infarcted rats. CONCLUSIONS: In contrast to amphetamine-induced rotation and sensorimotor behavior, the paw-reaching test provides a stable behavioral parameter after a middle cerebral artery occlusion. Moreover, the lesion-induced deficit in paw-reaching is highly correlated to the extent of the infarct, suggesting that this test is useful in evaluating treatment effects for a longer period of time.
|
|
| 4. |
- Lindgren, Arne, et al.
(författare)
-
Carotid artery and heart disease in subtypes of cerebral infarction
- 1994
-
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 25:12, s. 2356-2362
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The aim of the study was to determine the prevalences of carotid artery disease and major and minor potential cardioembolic sources (1) in patients with cerebral infarction and age-matched control subjects and (2) in different clinical subtypes of cerebral infarction. METHODS: A series of 166 consecutive patients with cerebral infarction and 59 control subjects was examined. The study protocol included clinical subtyping of the cerebral infarctions, ultrasonography of the carotid arteries, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), ECG, and examination of the brain with computed tomography, magnetic resonance imaging, or autopsy. RESULTS: Carotid artery stenosis > or = 80% or occlusion was present in 35 (21%) patients but in no control subjects (P < .001; chi 2 test). A major potential cardioembolic source was detected in 65 (39%) patients and 3 (5%) control subjects. Atrial fibrillation was present in 35 (21%) patients and 3 (5%) control subjects at initial ECG (P < .01) and in 47 (28%) patients at repeat examination; 17 patients had paroxysmal atrial fibrillation. Sinus rhythm and a major potential cardioembolic source were detected in 18 (11%) patients but in no control subjects (P < .01) at TTE (all patients and control subjects examined) or TEE (118 patients and 52 control subjects examined). The frequency of a minor potential cardioembolic source detectable at TTE or TEE was similar in the patient and control groups (51% and 53%, respectively [NS]) and increased significantly with age. A finding of carotid artery stenosis > or = 80% or occlusion, atrial fibrillation, or a major cardioembolic source detected at TTE or TEE was more frequent among patients with cortical symptoms from anterior or middle cerebral artery territories than among those with lacunar syndromes (66% versus 22%, respectively). The probable source of cerebral infarction was identified in most of the 166 patients: cardiac embolism in 28% of cases (n = 46), carotid artery disease in 8% (n = 14), both cardiac embolism and carotid artery disease in 7% (n = 11), and lacunar infarction in 23% (n = 38). In 57 (34%) of the patients no unequivocal cause of the cerebral infarction was found. CONCLUSIONS: The prevalences of carotid artery and heart disease differ significantly between clinical subtypes of cerebral infarction. The cause of cerebral infarction remains uncertain in one third of patients. Because a minor potential cardioembolic source occurs in about 50% of both patients and control subjects, this finding is of questionable value as a risk factor for stroke in the elderly.
|
|
| 5. |
- Lindgren, Arne, et al.
(författare)
-
Cerebral lesions on magnetic resonance imaging, heart disease, and vascular risk factors in subjects without stroke. A population-based study
- 1994
-
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 25:5, s. 929-934
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: To assess the prevalence of asymptomatic abnormalities on magnetic resonance imaging of the brain and their possible relation to hypertension, heart disease, and carotid artery disease, we studied 77 randomly selected subjects (mean age, 65.1 years; range, 36 to 95 years) with no history of focal brain lesions. METHODS: The study protocol included magnetic resonance imaging of the brain, transthoracic and transesophageal echocardiography, ultrasonography of the carotid arteries, and electrocardiographic recording. Deep and periventricular white matter hyperintensities on magnetic resonance imaging were assessed both separately and together. RESULTS: On magnetic resonance imaging of the brain 62.3% (95% confidence interval [CI], 51.5% to 73.2%) of the subjects had white matter hyperintensities. These abnormalities increased significantly with age (chi 2 test; P = .0001), from 13.6% (95% CI, 0% to 28.0%) of subjects aged younger than 55 years to 85.2% (95% CI, 71.8% to 98.6%) of subjects aged 75 years or older. Six subjects had deep gray matter hyperintensities localized in the basal ganglia, and one had a cerebellar infarction. Stepwise logistic regression analysis identified age and a history of heart disease (but not echocardiographic findings) to be independently associated with deep and periventricular white matter hyperintensities. Hypertension was only independently associated with periventricular white matter hyperintensities. Of the 68 subjects examined with both transthoracic and transesophageal echocardiography, potential cardioembolic sources were detected in 38.2% (95% CI, 26.7% to 49.8%) of the subjects with transthoracic echocardiography and in 47.1% (95% CI, 35.2% to 58.9%) of those with transthoracic and transesophageal echocardiography combined. In subjects aged 75 years or older, a possible cardiac embolic source was detected in 64.0% on transthoracic echocardiography and in 72.0% on transthoracic and transesophageal echocardiography combined, compared with 5.3% and 15.8%, respectively, in subjects aged younger than 55 years. CONCLUSIONS: White matter hyperintensities and potential cardioembolic sources are frequently present in asymptomatic individuals, stressing the need for age-matched control subjects in studies of patients with stroke or dementia.
|
|
| 6. |
- Lindgren, Arne, et al.
(författare)
-
Comparison of clinical and neuroradiological findings in first-ever stroke. A population-based study
- 1994
-
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 25:7, s. 1371-1377
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: To determine how a recently proposed clinical stroke subclassification corresponds to specific findings on computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. METHODS: Two hundred twenty-eight patients with first-ever stroke were divided into four clinical subgroups: (1) total anterior circulation syndrome: both cortical and subcortical symptoms from anterior and middle cerebral artery territory; (2) partial anterior circulation syndrome: more restricted and predominantly cortical symptoms from the same arterial territories; (3) lacunar syndrome; and (4) posterior circulation syndrome: vertebrobasilar or posterior cerebral artery symptoms. The imaging protocol included CT of the brain on day 0 through 15 and a second CT and an MRI of the brain on day 16 through 180 after acute stroke onset. RESULTS: There were 200 patients with cerebral infarction and 28 patients with intracerebral hemorrhage. Intracerebral hemorrhage was found in 19% of patients with total anterior circulation syndrome and in no patients with lacunar syndrome (chi 2 test; P < .01 for the difference between the four clinical subgroups). Of the 200 patients with cerebral infarction, 27% had total anterior circulation, 30% partial anterior circulation, 26% lacunar, and 16% posterior circulation syndromes. CT within 2 days revealed a visible lesion in about two thirds of patients with infarctions of total or partial anterior circulation syndrome type, compared with only 22% of patients with lacunar infarction (chi 2 test; P = .02 for the difference between the four subgroups). The mean volume of the symptomatic infarction on CT within 15 days was 95 mL for total anterior circulation, 20 mL for partial anterior circulation, and 2.5 mL for lacunar syndrome (one-factor ANOVA; P = .0001). A cortical involvement of the infarction on CT day 16 through 180 was seen in 81% of patients with total anterior circulation syndrome and 58% of those with partial anterior circulation syndrome, compared with only 8% of patients with lacunar syndrome (chi 2 test; P = .0001). MRI more often than CT showed a cortical involvement of lacunar infarctions and also revealed more silent lesions. CONCLUSIONS: The described clinical subgroups significantly differed in frequencies of intracerebral hemorrhage, cortical involvement, and lesion volume on CT and MRI.
|
|
| 7. |
- Magnusson, Måns, et al.
(författare)
-
Sensory stimulation promotes normalization of postural control after stroke
- 1994
-
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 25:6, s. 1176-1180
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: In a randomized study of hemiparetic stroke patients with a median age of 75 years, functional recovery was significantly better in those who received additional sensory stimulation (n = 38), including electrostimulation, than in control patients (n = 40) given the same physiotherapy and occupational therapy; group differences for balance, mobility, and activities of daily living were significant. The present study was designed to investigate postural control in patients who survived more than 2 years after stroke onset. METHODS: The 48 survivors (mean, 2.7 years; range, 2.0 to 3.8 years), 22 from the treatment group and 26 from the control group, were compared with 23 age-matched healthy subjects. Subjects were perturbed by vibrators applied to calf muscles or with galvanic vestibular stimulation. We evaluated postural control in terms of sway variances or sway velocities and the dynamics of postural control as a feedback system using system identification with a model previously validated for human postural control. RESULTS: Significantly more patients of the treatment group than of the control group maintained stance during perturbations (P < .01). Among patients capable of maintaining stance during perturbation, the control patients were characterized by significant divergence from normal values in two of the three characteristic parameters of dynamic postural control (ie, swiftness and stiffness; P < .05) compared with the treatment subgroup or age-matched subjects. CONCLUSIONS: The course of sensory stimulation enhanced recovery of postural function, an enhancement still significant 2 years after the lesion and treatment. The differences and near normalization of characteristic parameters of dynamic postural control among treated patients suggest that improved recovery after sensory stimulation may be achieved by patients regaining normal or near normal dynamics of human postural control.
|
|
| 8. |
- Szabo, Csaba, et al.
(författare)
-
Uptake and release of serotonin in rat cerebrovascular nerves after subarachnoid hemorrhage
- 1992
-
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 23:1, s. 54-61
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Serotonin released from platelets has been suggested as one substance causing the vasospasm following subarachnoid hemorrhage. We studied whether such serotonin is able to constrict pial vessels. METHODS: We studied the uptake of serotonin in pial perivascular nerves by immunohistochemistry. We measured the contractile response in rat basilar artery after in vitro incubation with serotonin and during electrical field stimulation of perivascular nerves following experimental subarachnoid hemorrhage. RESULTS: After incubation with serotonin, electrical field stimulation caused a tetrodotoxin- and ketanserin-blockable contractile response. We observed no such response in vessels from rats treated with 6-hydroxydopamine or after blockade of serotonin uptake. After subarachnoid hemorrhage, a pronounced network of serotonin-immunoreactive nerve fibers was demonstrated in the vessel wall. In vessels from control rats, no serotonin fibers were seen, and in vessels from 6-hydroxydopamine-treated animals with subarachnoid hemorrhage only a few such fibers were seen. Electrical field stimulation of the basilar artery from rats tested 2 or 16 hours (but not 10 minutes or 24 hours) after subarachnoid hemorrhage showed contractile responses that were prevented by tetrodotoxin, ketanserin, and prior 6-hydroxydopamine treatment. CONCLUSIONS: Our study demonstrates a capacity of the perivascular sympathetic nerves to take up serotonin both in vitro and during the early phase of subarachnoid hemorrhage. Such uptake may help to remove excess serotonin from the subarachnoid space. Only if serotonin is subsequently released upon nerve activation may minor smooth muscle contraction develop.
|
|
| 9. |
- Åström, Monica, 1941-, et al.
(författare)
-
Different linkage of depression to hypercortisolism early versus late after stroke : A 3-year longitudinal study
- 1993
-
Ingår i: Stroke. - : American Heart Association. - 0039-2499 .- 1524-4628. ; 24:1, s. 52-57
-
Tidskriftsartikel (refereegranskat)abstract
- Using the dexamethasone suppression test, we studied the suppressibility of the cortisol axis and its clinical determinants at various time points after stroke. A major aim was to examine the dexamethasone test as a diagnostic tool for the diagnosis of major depression in stroke patients.The dexamethasone suppression test, major depression, functional ability, and disorientation were assessed in a cohort of 70 patients with acute stroke and after 3 months (n = 63) and 3 years (n = 43).Early after stroke, 24% of the patients were nonsuppressors, with about the same proportion at 3 months (22%) and 3 years (21%). None of the controls (17 healthy elderly volunteers) were nonsuppressors. High cortisol levels early after stroke were significantly associated with functional impairment (r = 0.35; p = 0.003) and disorientation (r = 0.27; p = 0.03). Three years after stroke, high postdexamethasone cortisol levels were significantly associated with major depression (r = 0.57; p < 0.001). The sensitivity of the dexamethasone test was 70% and the specificity 97%. In a longitudinal analysis of the long-term survivors (n = 42), postdexamethasone cortisol values at 3 months predicted major depression at 3 years.Hypercortisolism is associated with major depression late (3 years) but not early (0-3 months) after stroke. Patients with hypercortisolism 3 months after stroke are at risk of major depression later in the course and warrant careful follow-up from a psychiatric viewpoint.
|
|
| 10. |
- Åström, Monica, 1941-, et al.
(författare)
-
Major depression in stroke patients : A 3-year longitudinal study
- 1993
-
Ingår i: Stroke. - : American Heart Association. - 0039-2499 .- 1524-4628. ; 24:7, s. 976-982
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied. METHODS: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years. RESULTS: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19% at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60% of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression. CONCLUSIONS: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based or the period of time since the stroke event.
|
|
