Natural history of nonbacterial thrombotic endocarditis treated with warfarin.

We report on the natural history of a cohort of patients presenting with transient ischemic attack or stroke and nonbacterial thrombotic endocarditis treated with warfarin.Patients with valvular vegetations on echocardiography, stroke, or transient ischemic attack presenting to a single neurologist were included. All patients were treated with warfarin until the vegetation resolved or for two years, then were switched to aspirin and had at least one clinical and echocardiographic follow-up.

Predictors for the extent of pial collateral recruitment in acute ischemic stroke.

Background: Pial arterioles can provide a variable degree of collateral flow to ischemic vascular territories during acute ischemic stroke. This study sought to identify predictive factors of the degree of pial collateral recruitment in acute ischemic stroke.

Methods: Clinical information and arteriograms from 62 consecutive patients with stroke due to either middle cerebral artery (MCA) M1 segment or internal carotid artery (ICA) terminus occlusion within 6 h following symptom onset were retrospectively reviewed.

Factors associated with rapid neurological improvement 24 h following intra-arterial thrombolytic treatment for acute ischemic stroke.

Background And Purpose: Significant 24 h improvement is the strongest indicator of functional recovery following thrombolytic treatment for acute ischemic stroke. This study sought to analyze factors contributing to rapid neurological improvement (RNI) following intra-arterial thrombolytic treatment (IATT).

Methods: Angiograms and clinical information derived from consecutive patients receiving treatment initiated within 6 h of stroke onset were retrospectively reviewed.

An endovascular canine middle cerebral artery occlusion model for the study of leptomeningeal collateral recruitment.

Objectives: This work aimed to refine a large animal in minimally invasive reversible middle cerebral artery (MCA) occlusion (MCAO) model to account for leptomeningeal collateral formation.

Materials And Methods: An angiographically based methodology allowed for transient MCA and carotid terminus occlusion in 12 mongrel dogs and assessment of pial collateral recruitment. Outcome measures included 1- and 24-hour magnetic resonance imaging-based infarct volume calculation, a behavioral scale and histopathologic sections.

Qureshi grading scheme predicts subsequent volume of brain infarction following intra-arterial thrombolysis in patients with acute anterior circulation ischemic stroke.

Background: The importance of the site of occlusion and the presence or absence of collaterals on initial angiography in patients with acute ischemic stroke has been recognized. Qureshi recently proposed a scheme that categorizes patients with ischemic stroke based on findings observed on initial angiography.

Methods: We determined the relationship between severity of angiographic occlusion using Qureshi grading scheme and volume of brain infarction on follow-up computed tomography in 55 patients with anterior circulation ischemic stroke who underwent intra-arterial thrombolysis.

Clinical predictors of cerebrovascular occlusion for patients presenting with acute stroke.

Objective: We sought to determine clinical predictors of vascular occlusion in patients with stroke.

Methods: From November 1994 to December 1999, 88 patients who were thrombolytic candidates and seen within 6 hours of stroke symptom onset had cerebral angiography. The Oxford Community Stroke Project clinical classification system, admission National Institutes of Health Stroke Scale score, and time from symptom onset until angiography were used to predict vascular occlusion.

Effect of propranolol on naming in chronic Broca's aphasia with anomia.

Previous research suggests that the noradrenergic system modulates flexibility of access to the lexical-semantic network, with propranolol benefiting normal subjects in lexical-semantic problem solving tasks. Patients with Broca's aphasia with anomia have impaired ability to access appropriate verbal output for a given visual stimulus in a naming task. Therefore, we tested naming in a pilot study of chronic Broca's aphasia patients with anomia after propranolol and after placebo in a double-blinded crossover manner.

Intra-arterial thrombolysis of a distal internal carotid artery occlusion in an adolescent.

Introduction: This article describes the first reported case of an adolescent being treated with intra-arterial urokinase for a distal internal carotid artery occlusion.

Methods: A 15-year-old male presenting with an acute ischemic stroke caused by a distal internal carotid artery occlusion was treated with intra-arterial urokinase at 5 hours and 45 minutes after symptom onset.

Results: The artery completely recanalized, and the patient improved significantly from an admission National Institutes of Health Stroke Scale (NIHSS) score of 28 to a NIHSS score of 8 at a 2.

Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke.

Background And Purpose: This study examines whether anatomic extent of pial collateral formation documented on angiography during acute thromboembolic stroke predicts clinical outcome and infarct volume following intra-arterial thrombolysis, compared with other predictive factors.

Methods: Angiograms, CT scans, and clinical information were retrospectively reviewed in 65 consecutive patients who underwent thrombolysis for acute ischemic stroke. Clinical data included age, sex, time to treatment, National Institutes of Health Stroke Scale (NIHSS) score on presentation of symptoms, NIHSS score at the time of hospital discharge, and modified Rankin scale score at time of hospital discharge.

Clinical and imaging outcomes after stroke with normal angiograms.

Background And Purpose: Information about the prognosis of patients with acute ischemic stroke and normal angiography is limited. We report clinical and imaging outcomes of patients seen within 6 hours of symptom onset who were considered candidates for thrombolysis.

Methods: Between November 1994 and December 1999, patients with stroke onset of less than 6 hours who were thrombolytic candidates underwent cerebral angiography.

Intraarterial thrombolytic therapy within 3 hours of the onset of stroke.

Objective: The National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator Stroke Study Group showed that recombinant tissue plasminogen activator (rt-PA) administered intravenously within 3 hours of the onset of ischemic stroke can improve clinical outcome. Intraarterial (IA) thrombolysis has been shown to offer advantages over intravenous (IV) thrombolysis, but experience with this type of therapy within 3 hours of the onset of symptoms has not been reported previously. This study is the first retrospective analysis of a two-institution experience with IA thrombolysis within 3 hours of stroke onset.