Prospective comparison of a cohort with asymptomatic carotid bruit and a population-based cohort without carotid bruit.

This study is a prospective analysis of the predictive value of diffuse and localized carotid bruit. Patients with asymptomatic carotid bruits are compared with a population-based age- and sex-matched control group known not to have carotid bruit, in regard to subsequent transient ischemic attack, stroke, and death. Each person was followed until death or for 5 years.

Assessing risk associated with carotid endarterectomy. A statement for health professionals by an Ad Hoc Committee on Carotid Surgery Standards of the Stroke Council, American Heart Association.

This position statement provides guidelines for assessing risk associated with carotid endarterectomy and defines the point at which risk is too high to perform surgery for specific indications described below. Morbidity and mortality levels are discussed. This statement does not address indications for surgery or merits of specific medical or surgical treatments.

Spontaneous dissections of the vertebral arteries.

Clinical and angiographic features and outcome in 25 patients with spontaneous dissections of the vertebral arteries are described. Most patients were in their fourth or fifth decade of life, and women predominated. Forty-eight percent of the patients were hypertensive.

Vascular malformations of the posterior fossa. Clinical and radiologic features.

Thirty-one patients with vascular malformations of the posterior fossa were studied to determine their clinical presentation and radiologic diagnosis. The most common clinical presentations were acute hemorrhage (68%, 21/31) and progressive or fluctuating focal neurologic deficits resembling those found in other pathologic processes (19%, 6/31). Trigeminal neuralgia and hemifacial spasm occurred in these patients, but they were rarely initial presenting symptoms.

Focal encephalitis in a young woman 6 years after the onset of Lyme disease: tertiary Lyme disease?

A 19-year-old woman had severe focal inflammatory encephalitis. Six years previously, she had had classic untreated Lyme disease characterized by erythema chronicum migrans, bilateral facial palsies, and lymphocytic meningitis. During her recent encephalitic illness, Lyme disease serologic tests were positive by indirect immunofluorescence microscopy, enzyme-linked immunosorbent assay, and western blot (immunoblot technique) testing.

Rehabilitation for stroke: a review.

Survivors of stroke are often left with severe mental and physical disabilities, which create a major social and economic burden. Many investigators have attempted to assess the role of rehabilitation in reducing such disability. Few controlled studies provide accurate assessment and documentation of benefit.

Emergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits.

Emergency revascularization procedures for patients with acute stroke are controversial. Thirty-four patients with acute internal carotid artery occlusion documented at the time of emergency endarterectomy were analyzed. Before operation, all these patients had profound neurological deficits including hemiplegia and aphasia.

Complications of cerebral angiography: prospective assessment of risk.

A prospective study of 1,517 consecutive cerebral angiographic examinations is reported. The incidence of all complications was 8.5%, and the incidence of all neurologic complications was 2.

Carotid endarterectomy for unilateral carotid system transient cerebral ischemia.

This study involved 151 consecutive patients who had transient focal cerebral ischemia (TIA) in one carotid arterial system and who had carotid endarterectomy on the side corresponding to the ischemic symptoms. Each patient was examined preoperatively by a neurologist, who also judged the postoperative morbidity and mortality. All patients were operated on by one surgeon.

Fibromuscular dysplasia of the internal carotid artery.

Carotid artery fibromuscular dysplasia is uncommon. Most patients have a benign clinical course so caution should be used in treating these. Treatment for asymptomatic patients is not advised; symptomatic patients with evidence of progressive cerebral ischemia should be treated with medical or surgical therapy based on the presumed responsible pathophysiologic mechanism.

Cerebral ischemic events in patients with mitral valve prolapse.

All patients 20 years old or older referred for echocardiographic examination and found to have mitral valve prolapse during the period January 1975 through December 1979 were included in the study. Of the 1,138 patients, two-thirds were women and one-third were men. Their average age was 48.

Carotid artery bruits: prevalence survey and differential diagnosis.

From a 10% sampling of the Olmsted County, Minnesota, population, persons of age 45 years and older were selected randomly in predetermined age and sex groupings and examined for cervical murmurs. Five hundred nine persons representing approximately 1% of all persons in the population between 45 and 54 years old, 2.5% of those 55 to 64 years old, and 3.

Cerebral ischemic events in patients with carotid artery fibromuscular dysplasia.

From 1962 through 1979, 13,955 cerebral angiograms were made at our institution. Fibromuscular dysplasia (FMD) was identified in 82 (0.6%) patients.

Two-dimensional echocardiography in patients with focal cerebral ischemia.

To assess the use of two-dimensional (2D) echocardiography in demonstrating a cardiac source for cerebral embolization, we studied 138 patients with one or more recent episodes of focal cerebral ischemia, in whom either a cardiac mechanism was suspected or no probable mechanism of ischemia was identified. Intracardiac thrombus was found in nine patients (6.5%); 32 (23.

Subsequent neurological events in patients with atrial myxoma.

Review of 35 patients from the Mayo Clinic with histologically proved atrial myxomas (7 with prior neurological events) who were followed for 12 to 235 months revealed that none had subsequent delayed neurological events attributable to their atrial myxomas.

CNS embolism due to atrial myxoma: clinical features and diagnosis.

The records of 40 patients with pathologically verified atrial myxoma identified during the period 1957 to 1977 were studied. The patients ranged in age from 17 to 77 years; women predominated by a ratio of 3:1. Thirty-five patients had left atrial myxoma, three patients had right atrial myxoma, one patient had bilateral myxomas, and one patient had a right atrial myxoma and subsequent removal of a left atrial myxoma.

Temporal profile (clinical course) of acute vertebrobasilar system cerebral infarction.

Records of 37 consecutive patients with acute brain infarction from vertebrobasilar artery disease, admitted to the cerebrovascular hospital service within 36 hours of the onset of symptoms, were studied to define the temporal profile of clinical events during the first week of illness. A stable course with unchanged neurologic deficit was found in 11% (4 patients). Progressive improvement in symptoms occurred in 35% (13 patients).

Effects of anticoagulants in an animal model of septic cerebral embolization.

The effect of anticoagulation on lesions caused by cerebral emboli of different types was studied in 57 dogs. The resultant arterial and parenchymal lesions were assessed by pathologic and angiographic studies. Embolization with emboli that caused little or no inflammatory response in the artery (12 dogs) was not associated with hemorrhagic infarcts or with subdural or subarachnoid hemorrhage; furthermore, treatment with anticoagulants (9 dogs) did not change the character of the lesions.

Guidelines for the management of transient ischemic attacks.

On the basis of a review of the literature on anticoagulant, antiplatelet, and surgical treatment, supplemented by our personal experience, we have developed guidelines for the management of patients with transient ischemic attacks (TIA). 1. The majority of patients with vertebral-basilar TIA are treated medically.

Cerebral arterial lesions resulting from inflammatory emboli.

In order to study the effects of septic embolism on the brain, silicone rubber emboli of various types were injected into the carotid arteries of 35 dogs. Pathologic and angiographic studies were performed to assess the resultant arterial and parenchymal lesions. Pure silicone rubber emboli (14 dogs) produced occasional intra-arterial thrombosis but no arteritis.

Fatal cerebral embolism following aorto-coronary bypass graft surgery.

In a case of fatal cerebral embolic infarction following aorto-coronary bypass graft (ACBG) surgery, postmortem examination revealed thrombosis of the vein grafts to the left circumflex and left anterior descending coronary arteries. Continguous with the thrombus in the graft to the circumflex artery was thrombotic material adherent to the aortic sutures and extending several millimeters into the lumen of the aorta. A nonadherent thrombus of similar histologic character was found in the right middle cerebral artery, associated with localized brain infarction.