Thrombolysis therapy in octogenarians.

Octogenarians can be selected for thrombolysis therapy after CT scan without a detrimental effect on outcome

Magnetic resonance imaging, magnetic resonance and catheter angiography for diagnosis of cervical artery dissection.

Catheter angiography has been considered the standard of reference for the diagnosis of spontaneous cervical artery dissection (CAD), but carries a risk of complications and does not demonstrate the arterial wall. The most common angiographic finding is a relatively smooth or slightly irregular tapered arterial narrowing. Conversely, angiographic appearance of cervical artery occlusion due to CAD is nonspecific, because other causes such as thromboembolism or atherosclerotic disease may present very similar angiographic characteristics.

Environmental factors and cervical artery dissection.

A history of a minor precipitating event is frequently elicited in patients with a spontaneous dissection of the carotid or vertebral artery. Other precipitating events associated with hyperextension or rotation of the neck include practicing yoga, painting a ceiling, coughing, vomiting, sneezing, the receipt of anesthesia, and the act of resuscitation. Chiropractic manipulation of the neck has been associated with carotid artery dissection and, particularly, vertebral artery dissection.

Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke: a meta-analysis of randomized controlled trials.

Background And Purpose: The role of anticoagulant treatment for acute cardioembolic stroke is uncertain. We performed an updated meta-analysis of all randomized trials to obtain the best estimates of the efficacy and safety of anticoagulants for the initial treatment of acute cardioembolic stroke.

Methods: Using electronic and manual searches of the literature, we identified randomized trials comparing anticoagulants (unfractionated heparin or low-molecular-weight heparin or heparinoids), started within 48 hours, with other treatments (aspirin or placebo) in patients with acute ischemic cardioembolic stroke.

Prior use of antithrombotic agents and neurological functional outcome at discharge in patients with ischemic stroke.

Background: Studies in experimental animals have suggested that antithrombotic agents may have a neuroprotective effect after an ischemic injury. The aim of this study was to analyze the effect of prior use of antithrombotic agents (antiplatelets or anticoagulants) on neurological functional outcome in patients with acute ischemic stroke.

Subjects And Methods: Consecutive patients included in the Perugia Stroke Registry were considered for this analysis.

First-ever stroke and outcome in patients admitted to Perugia Stroke Unit: predictors for death, dependency, and recurrence of stroke within the first three months.

Predictors of poor outcome after first-ever stroke within 3 months in consecutive patients admitted to our Stroke Unit were defined. Factors included age, sex, risk factors, occurrence of transient ischemic attacks, extension of cerebral infarction, presumed cause of stroke, clinical findings, and demographic characteristics. Multiple regression models were used to analyze predictors of mortality, dependency and stroke recurrence.

MTHFR 677 TT genotype and hyperhomocysteinaemia: an underestimated risk TANDEM for patients with stroke.

Synergy between hyperhomocysteinaemia and conventional risk factors for stroke

Early admission to stroke unit influences clinical outcome.

An improvement in patient arrival time to stroke unit (SU) is recommended, since earlier stroke management seems to improve 'per se' functional outcome. The objective of this study was to determine if early admission influences the outcome, reduces disability and mortality at discharge and three months later independent of tlirombolytic treatment. Consecutive acute stroke patients admitted to SU between January 1st 2000 and December 31st 2003 were studied in order to analyze the actual role of acute management independent specific pharmacological treatment, we excluded subjects who underwent rt-PA.

Seasonal variability in spontaneous cervical artery dissection.

We examined the seasonal variability of spontaneous cervical artery dissection (sCAD) by analysing prospectively collected data from 352 patients with 380 sCAD (361 symptomatic sCAD; 305 carotid and 75 vertebral artery dissections) admitted to two university hospitals with a catchment area of 2,200,000 inhabitants between 1985 and 2004. Presenting symptoms and signs of the 380 sCAD were ischaemic stroke in 241 (63%), transient ischaemic attack in 40 (11%), retinal ischemia in seven (2%), and non-ischaemic in 73 (19%) cases; 19 (5%) were asymptomatic sCAD. A seasonal pattern, with higher frequency of sCAD in winter (31.

Velocity imaging for the liquid-gas interface in the near field of an atomizing spray: proof of concept.

We describe adaptation of ballistic imaging for the liquid core of an atomizing spray. To describe unambiguously the forces that act to break apart the liquid core in a spray, one must directly measure the force vectors themselves. It would be invaluable, therefore, to obtain velocity and acceleration data at the liquid-gas interface.

Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study.

Because of the presumed non-atherosclerotic pathogenesis, the potential link between spontaneous cervical artery dissection (sCAD) and common risk factors for atherosclerosis has never been investigated systematically. Therefore, this prospective, multicentre, case-control study compared the frequency of tobacco use, hypertension, diabetes mellitus, and hypercholesterolaemia among a group of consecutive patients with sCAD (n = 153), a group of patients with ischaemic stroke, not related to CAD (non-CAD), and a group of controls. As opposed to the other variables, a trend towards a significant association was seen when the prevalence of hypertension was compared among patients with sCAD and controls (26.

Ballistic imaging of the liquid core for a steady jet in crossflow.

A time-gated ballistic imaging instrument is used to obtain high-spatial-resolution, single-shot images of the liquid core in a water spray issuing into a gaseous crossflow. We describe further development of the diagnostic technique to improve spatial resolution and present images and statistics for various jets under crossflow experimental conditions (different Weber numbers). Series of these images reveal a near-nozzle flow field undergoing breakup and subsequent droplet formation by stripping.

Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures.

Current available data do not seem to support the strategy for carotid endarterectomy prior to surgical intervention in patients with asymptomatic carotid stenosis. However, in patients with coronary artery disease, synchronous carotid endarterectomy and coronary artery bypass grafting should be considered where there is a proven surgical risk of <3% with unilateral asymptomatic stenosis >60% or bilateral carotid stenosis >75% on the same side as the most severe stenosis. Clarification of the optimal strategy requires an adequately powered, multicentre, randomised clinical trial.

Outcome in patients with stroke associated with internal carotid artery occlusion.

Background: The clinical outcome in patients with stroke associated with internal carotid artery (ICA) occlusion is poor, although a minority may recover without dependency. The purposes of this study were (1) to assess the predictive factors of adverse outcome in patients with stroke associated with an occlusion of the ICA and (2) to evaluate the rate of spontaneous recanalization of an occluded ICA.

Methods: A total of 177 consecutive patients with first-ever ischemic stroke associated with ICA occlusion were prospectively examined from the Perugia Stroke Registry.

Isolated monoparesis following stroke.

Background: Some investigators have stated that monoparesis is almost never the result of a lacunar infarct or cerebral haemorrhage.

Objective: To describe the topography and aetiology in a consecutive population where first ever stroke was manifested by isolated monoparesis.

Methods: Patients with motor paresis of only one limb were included consecutively in the study.

Atrial fibrillation in patients with first-ever stroke: frequency, antithrombotic treatment before the event and effect on clinical outcome.

Background And Purposes: Atrial fibrillation (AF) is an independent risk factor for stroke. The aims of this study were to assess: (i) the frequency of known or unknown AF in patients admitted to the hospital for a first-ever ischemic stroke and whether AF is associated with an adverse outcome at discharge (death or disability); (ii) the rates and determinants for the use of antithrombotic agents before stroke in patients with known AF and the adherence to the current treatment guidelines; and (iii) whether the lack of adherence to the current guidelines is associated with adverse outcome at discharge.

Methods: Consecutive patients with acute first-ever stroke admitted to an individual Stroke Unit between January 2000 to December 2003, were included in the study.

Single-shot, two-dimensional ballistic imaging through scattering media.

Imaging through scattering materials is an important research area that is generally limited to medical diagnostic applications. Published techniques typically use a method of time- or coherence-gating of ballistic photons that separates these early photons in order to acquire an image without the large background created by the later-arriving diffuse light. Because of the limited number of ballistic photons and the typically low signal-to-noise ratios of these schemes, a large number of averages or scans is necessary.

Different cytokine levels in thrombolysis patients as predictors for clinical outcome.

Thrombolytic therapy not always improves clinical outcome in ischemic stroke patients. This could cause lymphomonocyte accumulation in the infarcted brain area. These produce an excessive amount of proinflammatory cytokines, such as IL-1 beta, IL-6 and TNF-alfa.

Dysphagia following Stroke.

Background: Dysphagia is common after stroke. We aimed to study the prognosis of dysphagia (assessed clinically) over the first 3 months after acute stroke and to determine whether specific neurovascular-anatomical sites were associated with swallowing dysfunction.

Methods: We prospectively examined consecutive patients with acute first-ever stroke.

Recanalization of cervical artery dissection: influencing factors and role in neurological outcome.

Background And Purpose: Generally, the prognosis for cervical artery dissection (CAD) is uncertain. The recanalization rate of CAD can be up to 85% within 3 months. This study evaluates the variables that might affect recanalization and the role of recanalization as a predictor for neurological outcome.

Neurovascular territory involved in different etiological subtypes of ischemic stroke in the Perugia Stroke Registry.

Unlabelled: We studied the correlation between the potential causes of stroke (TOAST etiological groups) and the involvement of different vascular territories seen on computed tomography (CT) scans in patients with ischemic stroke. Information from consecutive patients with a first-ever stroke have been prospectively coded and entered into a computerized data bank (Perugia Stroke Registry). A population of 1,719 patients were evaluated: 1,284 patients (74.

Magnetization transfer changes of grey and white matter in Parkinson's disease.

Since the attempt to evidence structural brain damage in Parkinson's disease (PD) by conventional magnetic resonance imaging (MRI) is usually disappointing, we have investigated whether the magnetization transfer ratio (MTR) can reflect changes in grey and white matter of PD patients. MTR was quantified in 44 regions of interest (ROIs) in both grey and white matter of 11 non-demented PD patients, ranging from 2 to 4 on the Hoehn and Yahr Scale, and eight age-matched healthy subjects. MTR differences between patients and controls were found in the supratentorial white matter and in the brainstem.