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  • 1
    Online Resource
    Online Resource
    Magnetic Resonance Angiography in Vertebrobasilar Ischemia; Preliminary Experience
    Wiley ; 1993
    In:  Journal of Neuroimaging Vol. 3, No. 2 ( 1993-04), p. 132-138
    Details
    In: Journal of Neuroimaging, Wiley, Vol. 3, No. 2 ( 1993-04), p. 132-138
    Type of Medium: Online Resource
    ISSN: 1051-2284
    URL: Article
    DOI: 10.1111/jon199332132
    Language: English
    Publisher: Wiley
    Publication Date: 1993
    detail.hit.zdb_id: 2035400-9
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  • 2
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    Hemicraniectomy and Durotomy Upon Deterioration From Infarction-Related Swelling Trial : Randomized Pilot Clinical Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 3 ( 2014-03), p. 781-787
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 3 ( 2014-03), p. 781-787
    Abstract: Hemicraniectomy and Durotomy Upon Deterioration From Infarction-Related Swelling Trial (HeADDFIRST) was a randomized pilot study to obtain information necessary to design a Phase III trial to evaluate the benefit of surgical decompression for brain swelling from large supratentorial cerebral hemispheric infarction. Methods— All patients with stroke were screened for eligibility (age 18–75 years, National Institutes of Health Stroke Scale ≥18 with Item 1a 〈 2 [responsive to minor stimulation], and CT demonstrating unilateral, complete middle cerebral artery territory infarction by specific imaging criteria). All enrolled patients were treated using a standardized medical treatment protocol. Those with both ≥4 mm of pineal shift and deterioration in level of arousal or ≥7.5 mm of anteroseptal shift within 96 hours of stroke onset were randomized to continued medical treatment only or medical treatment plus surgery. Death at 21 days was the primary outcome measure. Results— Among 4909 screened patients, only 66 (1.3%) patients were eligible for HeADDFIRST. Forty patients were enrolled, and 26 patients developed the requisite brain swelling for randomization. All who failed to meet randomization criteria were alive at 21 days. Mortality at 21 and 180 days was 40% (4/10) in the medical treatment only and 21% (3/14) and 36% (5/14) in the medical treatment plus surgery arms, respectively. Conclusions— HeADDFIRST randomization criteria effectively distinguished low from high risk of death from large supratentorial cerebral hemispheric infarction. Lower mortality in the medical treatment only group than in other published trials suggests a possible benefit to standardizing medical management. These results can inform the interpretation of recently completed European trials concerning patient selection and medical management. Clinical Trial Registration— This trial was not registered because enrollment began before July 1, 2005.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.003200
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 3
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    The Role of Repeat CT for Predicting Fatal Outcome Following Massive Middle Cerebral Artery Territory Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 381-382
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 381-382
    Abstract: P233 Background Large MCA ischemic stroke when associated with extensive mass effect can result in brain herniation and death. As yet there are no guidelines to aid the selection of patients for decompressive therapies, such as hemicraniectomy. Methods This was a multicentre retrospective study of large MCA infarction requiring neurocritical care. The repeat CT scans performed within 120 hours of stroke onset were assessed for horizontal displacement of septum pellucidum and pineal gland, the size of MCA infarction, involvement of other vascular territories and hydrocephalus. The primary outcome measure was death within 30 days. Results A total of 251 patients fulfilled entry criteria into the study of which 201 received conventional medical therapy alone. Univariate analysis identified the following predictors of early death: NIHSS 〉 16 (P 〈 0.03, OR 2.17 95% CI 1.12–4.2), anteroseptal shift 〉 7 mm (P 〈 0.001, OR 9.2 95% CI 4.1–20.63), pineal shift 〉 3 mm (P 〈 0.001, OR 12.1 95% CI 4.74–30.8), ischemia involving additional vascular territories (P 〈 0.001, OR 7.02 95% CI 3.35–14.7), hydrocephalus (P 〈 0.02, OR 2.13 95% CI 1.15–3.94), and temporal lobe involvement (P 〈 0.001, OR 5.66 95% CI 2.58–12.4). Multivariate analysis was performed but no independent variables were identified because the CT variables were highly correlated. Anteroseptal shift dichotomised into 〈 7 and 〉 7 mm had sensitivity 53%, specificity 93%, positive predictive value (PPV) 88%, negative predictive value (NPV) 69% for neurological death. Pineal shift dichotomised 〈 3 and = 3 mm had sensitivity 45%, specificity 94%, PPV 87% and NPV 66%. Conclusions We identified the role of follow-up CT in predicting early death following massive MCA infarction. Anteroseptal shift 〉 7 mm and pineal shift 〉 3 mm if present were strongly predictive of fatal outcome. These follow-up CT parameters require validation before they impact the decision to perform surgical intervention.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.381-d
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Distinctive RNA Expression Profiles in Blood Associated With White Matter Hyperintensities in Brain
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Stroke Vol. 41, No. 12 ( 2010-12), p. 2744-2749
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 12 ( 2010-12), p. 2744-2749
    Abstract: Background and Purpose— White matter hyperintensities (WMH) are areas of high signal detected by T2 and fluid-attenuated inversion recovery sequences on brain MRI. Although associated with aging, cerebrovascular risk factors, and cognitive impairment, the pathogenesis of WMH remains unclear. Thus, RNA expression was assessed in the blood of individuals with and without extensive WMH to search for evidence of oxidative stress, inflammation, and other abnormalities described in WMH lesions in brain. Methods— Subjects included 20 with extensive WMH (WMH+), 45% of whom had Alzheimer disease, and 18 with minimal WMH (WMH−), 44% of whom had Alzheimer disease. All subjects were clinically evaluated and underwent quantitative MRI. Total RNA from whole blood was processed on human whole genome Affymetrix HU133 Plus 2.0 microarrays. RNA expression was analyzed using an analysis of covariance. Results— Two hundred forty-one genes were differentially regulated at ±1.2-fold difference ( P 〈 0.005) in subjects with WMH+ as compared to WMH−, regardless of cognitive status and 50 genes were differentially regulated with ±1.5-fold difference ( P 〈 0.005). Cluster and principal components analyses showed that the expression profiles for these genes distinguished WMH+ from WMH− subjects. Function analyses suggested that WMH-specific genes were associated with oxidative stress, inflammation, detoxification, and hormone signaling, and included genes associated with oligodendrocyte proliferation, axon repair, long-term potentiation, and neurotransmission. Conclusions— The unique RNA expression profile in blood associated with WMH is consistent with roles of systemic oxidative stress and inflammation, as well as other potential processes in the pathogenesis or consequences of WMH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.591875
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Ischemic Transient Neurological Events Identified by Immune Response to Cerebral Ischemia
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 4 ( 2012-04), p. 1006-1012
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 4 ( 2012-04), p. 1006-1012
    Abstract: Deciphering whether a transient neurological event (TNE) is of ischemic or nonischemic etiology can be challenging. Ischemia of cerebral tissue elicits an immune response in stroke and transient ischemic attack (TIA). This response, as detected by RNA expressed in immune cells, could potentially distinguish ischemic from nonischemic TNE. Methods— Analysis of 208 TIAs, ischemic strokes, controls, and TNE was performed. RNA from blood was processed on microarrays. TIAs (n=26) and ischemic strokes (n=94) were compared with controls (n=44) to identify differentially expressed genes (false discovery rate 〈 0.05, fold change ≥1.2). Genes common to TIA and stroke were used predict ischemia in TIA diffusion-weighted imaging-positive/minor stroke (n=17), nonischemic TNE (n=13), and TNE of unclear etiology (n=14). Results— Seventy-four genes expressed in TIA were common to those in ischemic stroke. Functional pathways common to TIA and stroke related to activation of innate and adaptive immune systems, involving granulocytes and B cells. A prediction model using 26 of the 74 ischemia genes distinguished TIA and stroke subjects from control subjects with 89% sensitivity and specificity. In the validation cohort, 17 of 17 TIA diffusion-weighted imaging-positive/minor strokes were predicted to be ischemic, and 10 of 13 nonischemic TNE were predicted to be nonischemic. In TNE of unclear etiology, 71% were predicted to be ischemic. These subjects had higher ABCD 2 scores. Conclusions— A common molecular response to ischemia in TIA and stroke was identified, relating to activation of innate and adaptive immune systems. TNE of ischemic etiology was identified based on gene profiles that may be of clinical use once validated.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.638577
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Clinical application of CT angiography in acute ischemic stroke
    Elsevier BV ; 2007
    In:  Clinical Neurology and Neurosurgery Vol. 109, No. 2 ( 2007-02), p. 138-145
    Details
    In: Clinical Neurology and Neurosurgery, Elsevier BV, Vol. 109, No. 2 ( 2007-02), p. 138-145
    Type of Medium: Online Resource
    ISSN: 0303-8467
    URL: Article
    DOI: 10.1016/j.clineuro.2006.07.002
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2007
    detail.hit.zdb_id: 2004613-3
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  • 7
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    Online Resource
    Posterior Reversible Encephalopathy Syndrome in the Context of Phentermine Use Resulting in Intracranial Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  The Neurologist Vol. 17, No. 2 ( 2011-03), p. 111-113
    Details
    In: The Neurologist, Ovid Technologies (Wolters Kluwer Health), Vol. 17, No. 2 ( 2011-03), p. 111-113
    Type of Medium: Online Resource
    ISSN: 1074-7931
    URL: Article
    DOI: 10.1097/NRL.0b013e31820a9ddc
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2070987-0
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  • 8
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    Online Resource
    Predictors of Fatal Brain Edema in Massive Hemispheric Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. 9 ( 2001-09), p. 2117-2123
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 9 ( 2001-09), p. 2117-2123
    Abstract: Background and Purpose — Early identification of stroke patients at risk for fatal brain edema may be useful in selecting patients for aggressive interventions. Prior studies suggested that early nausea/vomiting and major hypodensity on baseline computed tomography (CT) were predictive of herniation. Methods — This study was a retrospective multicenter case-control study of patients with large middle cerebral artery (MCA) strokes admitted within 48 hours of symptom onset. Medical records, laboratory data, and CT scans were analyzed. Cases, defined as patients who died of massive brain swelling, were compared with all remaining patients as controls. Results — Two hundred one patients with large MCA strokes were identified: 94 (47%) died of brain swelling, 12 (6%) died of non-neurological causes, and 95 (47%) survived at day 30. Multivariable analysis, adjusted for age and clustered by center, identified the following predictors of fatal brain edema: history of hypertension (OR 3.0, 95% CI 1.2 to 7.6, P =0.02), history of heart failure (OR 2.1, 95% CI 1.5 to 3.0, P 〈 0.001), elevated white blood cell count (OR 1.08 per 1000 white blood cells/μL, 95% CI 1.01 to 1.14, P =0.02), 〉 50% MCA hypodensity (OR 6.3, 95% CI 3.5 to 11.6, P 〈 0.001), and involvement of additional vascular territories (anterior cerebral artery, posterior cerebral artery, or anterior choroidal artery; OR 3.3, 95% CI 1.2 to 9.4, P =0.02). Initial level of consciousness, National Institutes of Health Stroke Scale score, early nausea/vomiting, and serum glucose were associated with neurological death in bivariable but not multivariable analyses. Conclusions — Among patients with large MCA infarctions, an increased risk of fatal brain edema is associated with history of hypertension or heart failure, increased baseline white blood cell count, major early CT hypodensity involving 〉 50% of the MCA territory, and involvement of additional vascular territories. These data confirm and expand on prior research with a broad-based patient population. The presence of these risk factors identifies those stroke patients who may require aggressive therapeutic approaches.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/hs0901.095719
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Online Resource
    Aspirin Plus Dipyridamole Versus Aspirin for Prevention of Vascular Events After Stroke or TIA : A Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Stroke Vol. 39, No. 4 ( 2008-04), p. 1358-1363
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 4 ( 2008-04), p. 1358-1363
    Abstract: Background and Purpose— This meta-analysis systematically reviewed randomized controlled trials comparing aspirin plus dipyridamole with aspirin alone in patients with stroke and TIA to determine the efficacy of these agents in preventing recurrent cerebral and systemic vascular events. Methods— We performed separate analyses of the incidences of stroke alone and composite outcome of stroke, myocardial infarction, or vascular death. We also performed two subset analyses, planned a priori, to examine effect size based on trials using (1) exclusively immediate-release and (2) predominantly extended-release dipyridamole. Results— The summary results indicate a significant reduction in the overall risk ratio in favor of aspirin plus dipyridamole for stroke alone with relative risk 0.77 (0.67 to 0.89) and the composite end point with relative risk 0.85 (0.76 to 0.94). Studies using immediate-release dipyridamole showed a nonstatistically significant trend in favor of the combination for stroke alone with relative risk 0.83 (0.59 to 1.15) and for the composite outcome with relative risk 0.95 (0.75 to 1.19). Studies using predominantly extended-release dipyridamole showed a statistically significant difference in favor of the combination for stroke alone with relative risk 0.76 (0.65 to 0.89) and for the composite outcome with relative risk 0.82 (0.73 to 0.92). Conclusions— The combination of aspirin plus dipyridamole is more effective than aspirin alone in preventing stroke and other serious vascular events in patients with minor stroke and TIAs. The risk reduction was greater and statistically significant for studies using primarily extended release dipyridamole, which may reflect a true pharmacological effect or lack of statistical power in studies using immediate release dipyridamole.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.496281
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
    detail.hit.zdb_id: 1467823-8
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  • 10
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    Online Resource
    Gene Expression in Blood Changes Rapidly in Neutrophils and Monocytes after Ischemic Stroke in Humans: A Microarray Study
    SAGE Publications ; 2006
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 26, No. 8 ( 2006-08), p. 1089-1102
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 26, No. 8 ( 2006-08), p. 1089-1102
    Abstract: Ischemic brain and peripheral white blood cells release cytokines, chemokines and other molecules that activate the peripheral white blood cells after stroke. To assess gene expression in these peripheral white blood cells, whole blood was examined using oligonucleotide microarrays in 15 patients at 2.4 ± 0.5, 5 and 24 h after onset of ischemic stroke and compared with control blood samples. The 2.4 h blood samples were drawn before patients were treated either with tissue-type plasminogen activator (tPA) alone or with tPA plus Eptifibatide (the Combination approach to Lysis utilizing Eptifibatide And Recombinant tPA trial). Most genes induced in whole blood at 2 to 3 h were also induced at 5 and 24 h. Separate studies showed that the genes induced at 2 to 24 h after stroke were expressed mainly by polymorphonuclear leukocytes and to a lesser degree by monocytes. These genes included: matrix metalloproteinase 9; S100 calcium-binding proteins P, A12 and A9; coagulation factor V; arginase I; carbonic anhydrase IV; lymphocyte antigen 96 (cluster of differentiation (CD)96); monocarboxylic acid transporter (6); ets-2 (erythroblastosis virus E26 oncogene homolog 2); homeobox gene Hox 1.11; cytoskeleton-associated protein 4; N-formylpeptide receptor; ribonuclease-2; N-acetylneuraminate pyruvate lyase; BCL6; glycogen phosphorylase. The fold change of these genes varied from 1.6 to 6.8 and these 18 genes correctly classified 10/15 patients at 2.4 h, 13/15 patients at 5h and 15/15 patients at 24 h after stroke. These data provide insights into the inflammatory responses after stroke in humans, and should be helpful in diagnosis, understanding etiology and pathogenesis, and guiding acute treatment and development of new treatments for stroke.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/sj.jcbfm.9600264
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2006
    detail.hit.zdb_id: 2039456-1
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