Transcranial Doppler detection of microembolic signals: a review.

Transcranial Doppler detection of microembolic signals has been described in several clinical conditions such as carotid stenosis, prosthetic heart valves, acute stroke, and carotid surgery. The importance of these events for clinical decision-making is still a matter of debate. The authors review the literature and report their personal experience on the clinical significance of microemboli detection.

Influence of different screening procedures on the stroke prevalence estimates: the Italian Longitudinal Study on Aging.

Stroke prevalence surveys are more and more needed for health care and facility planning. Prevalence estimates and costs of the definition procedure may vary depending on different screening strategies. We evaluated the impact of these different strategies on the overall diagnostic procedure and on stroke prevalence estimates in the Italian Longitudinal Study on Aging.

Migraine with aura and right-to-left shunt on transcranial Doppler: a case-control study.

Right-to-left shunt (RLS), usually due to patent foramen ovale, is a well-established risk factor for ischemic stroke in young patients, while the role of migraine as an independent factor is still debated. We evaluated 44 patients suffering from migraine with aura, and compared them with 73 patients younger than 50 with focal cerebral ischemia, and 50 controls, asymptomatic for cerebrovascular disease, and without a history of migraine. All the subjects underwent bilateral transcranial Doppler with injection of contrast medium in an antecubital vein.

Internal borderzone infarction in patients with ischemic stroke.

Objective: The mechanism underlying cerebral infarction in the borderzone between the territories of deep and superficial perforating arteries has not yet been clarified. This study was performed to investigate the prevalence, volume, site, and etiology of this type of subcortical infarction in a large unselected group of stroke patients.

Methods And Patients: We analyzed a continuous series of 383 patients with recent cerebral infarction observed in our Stroke Unit.

Warfarin, aspirin and microembolic signals in the acute phase of stroke in a patient with mechanical heart valves.

We report the case of a 54-year-old woman, with atrial fibrillation and mechanical heart valves, who suffered a left-hemispheric stroke while she was under warfarin. Daily bilateral simultaneous transcranial Doppler monitoring of the middle cerebral arteries showed the presence of microembolic signals (MES), whose number remained unchanged after adding aspirin 100 mg daily. We conclude that anticoagulant plus antiplatelet therapy does not influence the number of MES in the acute phase of stroke in patients with prosthetic heart valves, suggesting the gaseous origin of MES in these patients.

Role of transcranial Doppler and stump pressure during carotid endarterectomy.

Background And Purpose: The aim of our study was to clarify the pathophysiology of perioperative cerebral complications during carotid endarterectomy in our series.

Methods: By means of transcranial Doppler ultrasonography and stump pressure measurement, we monitored 112 patients who underwent carotid endarterectomy under general anesthesia for symptomatic or asymptomatic severe carotid stenosis.

Results: Of 18 patients who underwent carotid endarterectomy with intra-arterial shunt, 2 (11.

Microembolic signals with serial transcranial Doppler monitoring in acute focal ischemic deficit. A local phenomenon?

Background And Purpose: The occurrence of microembolic signals (MES) in patients with transient ischemic attack (TIA) or stroke has already been described, but the diagnostic and prognostic value of this finding is still debated.

Methods: We evaluated 90 consecutive patients admitted for their first hemispheric TIA or ischemic stroke within 72 hours of onset. All of them underwent 30-minute bilateral transcranial Doppler monitoring of middle cerebral arteries, within 72 hours of onset.

Value of early variables as predictors of short-term outcome in patients with acute focal cerebral ischemia.

Reliable, simple and safe criteria are needed for the early prediction of short-term outcome in patients with acute ischemic stroke. The aim of our study was to evaluate, in terms of their individual and combined power, the prognostic value of a few widely available clinical and instrumental variables obtained during the acute phase. The study involved 351 consecutive patients who were examined within 48 hours of their first ischemic stroke.

Bilateral ophthalmoplegia: an unusual sign of the top of the basilar artery syndrome.

Bilateral ophthalmoplegia may be an unusual sign of vertebrobasilar ischemia. We report the cases of two patients (75 and 73 years old), who suddenly developed drowsiness, bilateral ophthalmoplegia with bilateral ptosis and mild right hemiparesis. In both patients, MRI revealed bilateral thalamic and midbrain infarcts, ECG showed the presence of atrial fibrillation and Doppler study of the extracranial and intracranial vertebral arteries found no significant alterations.

Asymptomatic cerebral infarctions in patients with ischemic stroke.

We studied 383 consecutive patients with stroke and ischemic lesions on CT scan for the presence of symptomatic cerebral infarction (SCI) and asymptomatic cerebral infarction (ACI). We evaluated risk factors as well as volume, site and number of the lesions. ACIs occurred in 34% of the cases (130/383); 88% of ACIs were lacunes and internal borderzone infarctions, with a volume of less than 2 ml.

Normalization of protein equivalent of nitrogen appearance and dialytic adequacy in CAPD.

Caloric-proteic malnutrition is frequently encountered in peritoneal dialysis and is associated with an increased risk of morbidity and mortality. Our paper aims to assess any greater reliability of protein equivalent of nitrogen appearance (PNA) normalization to desirable body weight (dBW) compared to actual body weight (aBW) and resulting implications for the relationship between dialytic adequacy and protein intake in continuous ambulatory peritoneal dialysis (CAPD). We studied 36 patients on CAPD, 24 male and 12 female (aged 66.

Compliance study in peritoneal dialysis using PD Adequest software.

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient. Fifty patients from two dialysis centers, aged 65.

[Ischemic stroke in the young adult].

Ischemic stroke is uncommon in young adults, and its etiologies and prognosis are different from those verified in the cerebrovascular disease of old age. Atherosclerosis is the main cause of stroke in the elderly, while emboligenous cardiopathy is one of the main mechanism underlying this pathology in young adults. Other etiologies include atherosclerosis, coagulopathies, vasculitides, arterial dissection and migraine.

Prevalence and outcome of symptomatic carotid lesions in young adults. National Research Council Study Group.

Objective: To estimate the prevalence and outcome of symptomatic internal carotid artery lesions in young adults.

Design: Multicentre hospital based observational study with five year follow up.

Setting: Seven neurological departments in northern and central Italy.

Motor activation time in Parkinson's disease.

Motor activation time (MAT), considered in the present work as the actual intracerebral processing delay during a reaction time (RT) task, was assessed in 17 patients with Parkinson's disease (PD) and in 7 age-matched healthy volunteers. MAT was calculated by subtracting from the premotor RT the afferent and efferent times obtained by sensory and motor evoked potentials. When compared with healthy volunteers, patients exhibited significantly (p < 0.

Hematocrit has no effect on peritoneal transport indices.

To assess the effect of hematocrit (Hct) on peritoneal transport indices (PTi), we studied the relationship between Hct (mean 28.1 +/- 5.1%, range 19.

Role of automated peritoneal dialysis within a peritoneal dialysis program.

We wished to assess the impact of automated peritoneal dialysis (APD) on the peritoneal dialysis (PD) program. From November 1981 to December 1993, 112 patients were started on hemodialysis (HD) as first treatment and 88 on PD [continuous ambulatory peritoneal dialysis (CAPD): 78, APD: 10]; respective average ages were 61 +/- 14 and 62 +/- 13 years. To December 1985, APD was used as first treatment of PD in 1/29 patients (3.

Twenty-four-hour beta-endorphin secretory pattern in stroke patients.

Background And Purpose: Abnormalities of hypothalamo-pituitary-adrenocortical axis function have been observed frequently in stroke patients. The aim of this study was to investigate plasma beta-endorphin and cortisol 24-hour secretory patterns in patients early after stroke and in the convalescent period to evaluate a possible influence of brain damage on hormonal circadian pattern.

Methods: Patients (n = 15; age, 46 to 75 years) were evaluated in the first 24 hours and 10 days after hospital admission for ischemic cerebral stroke and compared with 15 age- and sex-matched normal subjects.

Multiple sclerosis: assessment of lesional levels by means of transcranial stimulation.

Conduction in the Pyramidal Tracts (PTs) was studied in 30 healthy volunteers and 17 patients with definite Multiple Sclerosis. Central motor conduction time (CMCT) was assessed employing unipolar electrical transcranial stimulation and studies of the peripheral conduction time. Fourteen out of the seventeen studied patients showed CMCT abnormalities.

Focal cerebral ischemia and patent cardiac foramen ovale.

By means of transthoracic contrast echocardiography, the prevalence of a patent foramen ovale (PFO) was studied, in a continuous series of 48 patients aged less than 50 years with a recent episode of acute cerebral ischemia. A PFO was found in 11 subjects (23%). In the subgroup of younger patients (aged less than 30 years), the prevalence was much higher than in those aged 30 or more (58% against 11%, p = 0.

[Changes in dialysis methods. 10 years' experience].

A retrospective survey has been done on 175 chronic patients who underwent dialysis in one center, between January 1982 and June 1992. The purpose of the work was to evaluate the use of the first treatment and the cause which determined a change of treatment. Diffusive haemodialysis and CAPD were the most frequent first choice techniques, respectively in extracorporeal and peritoneal dialysis, whereas changes were conditioned by the need for a more personalized treatment, especially in the filed of extracorporeal dialysis.