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Adams, J.G. and Chisholm, C.D. (2003), The society for academic emergency medicine position on optimizing care of the stroke patient. Academic Emergency Medicine, 10 (7), 805

Keywords: emergency/emergency medicine/MI/PA/patient/position/stroke/stroke patient/USA

Summers, R.L., Shoemaker, W.C., Peacock, W.F., Ander, D.S. and Coleman, T.G. (2003), Bench to bedside: Electrophysiologic and clinical principles of noninvasive hemodynamic monitoring using impedance cardiography. Academic Emergency Medicine, 10 (6), 669-680.

Abstract: The evaluation of the hemodynamic state of the severely ill patient is a common problem in emergency medicine. While conventional vital signs offer some insight into delineating the circulatory pathophysiology, it is often impossible to determine the true clinical state from an analysis of blood pressure and heart rate alone. Cardiac output measurements by thermodilution have been the criterion standard for the evaluation of hemodynamics. However, this technology is invasive, expensive, time-consuming, and impractical for most emergency department environments. Impedance cardiography (ICG) is a noninvasive method of obtaining continuous measurements of hemodynamic data such as cardiac output that requires little technical expertise. ICG technology was first developed by NASA in the 1960s and is based on the idea that the human thorax is electrically a nonhomogeneous, bulk conductor. Variation in the impedance to flow of a high-frequency, low-magnitude alternating current across the thorax results in the generation of a measured waveform. from which stroke volume can be calculated by a modification of the pulse contour method. To adequately judge the possible role of this technology in the practice of emergency medicine, it is important to have a sufficient understanding of the basic scientific principles involved as well as the clinical validity and limitations of the technique

Keywords: analysis/blood/blood pressure/cardiac/cardiac output/CARDIAC-OUTPUT/cardiography/circulatory/clinical/common/CRITICALLY ILL/EJECTION FRACTION/emergency/emergency department/emergency medicine/EMERGENCY PATIENTS/evaluation/expertise/flow/heart/heart rate/hemodynamic/hemodynamic monitoring/hemodynamics/human/ICG/impedance/impedance cardiography/METAANALYSIS/monitoring/MS/noninvasive/PA/pathophysiology/patient/practice/PREDICTION/PRESSURE/pulse/results/standard/stroke/STROKE VOLUME/technique/technology/thermodilution/THORACIC ELECTRICAL BIOIMPEDANCE/TIME INTERVALS/understanding/USA/validity/volume

Clayton, D.B. and Lenkinski, R.E. (2003), MR imaging of sodium in the human brain with a fast three- dimensional gradient-recalled-echo sequence at 4 T. Academic Radiology, 10 (4), 358-365.

Abstract: Rationale and Objectives. Sodium ions play a vital role in cellular homeostasis and electrochemical activity throughout the human body. However, the in vivo detection of sodium (Na- 23) with magnetic resonance (MR) techniques is hindered by the fast transverse relaxation, low tissue equivalent concentration, and small gyromagnetic ratio of sodium ions compared with protons (H-1). The goals of this study were to acquire MR images of sodium in the whole human brain by using a fast three-dimensional gradient-recalled-echo sequence and to investigate the effect that restrictions on specific absorption ratio have on MR imaging of sodium at 4 T. Materials and Methods. A three-dimensional gradient-recalled-echo sequence with short echo time was developed for MR imaging of sodium. Slab encoding was removed and a hard excitation pulse was used. Five healthy human volunteers were examined in a whole-body MR imager with the use of a custom transmit-and-receive birdcage coil. Fields of view were selected to cover the entire brain: 38 X 38 cm in the axial plane, with 24 sections of 5.8 mm each or 12 sections of 1.1 cm each. The in-plane acquisition matrix was 64 X 128, and voxel size was 0.2 cm(3). Results. Sodium in white matter was depicted with an acceptable signal-to-noise ratio of 20-25. The echo time, and hence the signal-to-noise ratio, was limited by the MR imager's maximum allowable gradient strength. To keep the specific absorption ratio below 3 W/kg (the limit established by the Food and Drug Administration), it was necessary to prolong the repetition time to 30 msec. Conclusion. The MR imaging protocol used in this study provided acceptable visualization of sodium in the whole brain in a tolerable total acquisition time of 15 minutes

Keywords: 1.5 T/activity/brain/cellular/detection/effect/electrochemical/H-1/healthy human/homeostasis/human/human brain/imaging/in vivo/IN-VIVO/INTRACELLULAR SODIUM/INVIVO/ions/limit/magnetic/magnetic resonance/MAGNETIC-RESONANCE/MR/MR imaging/NA-23/NMR RELAXATION/pulse/relaxation/SIGNAL/signal-to-noise ratio/size/small/sodium/sodium studies/strength/STROKE/techniques/three-dimensional/TISSUE SODIUM/USA/use/white matter

Swan, J.S., Sainfort, F., Lawrence, W.F., Kuruchittham, V., Kongnakorn, T. and Heisey, D.M. (2003), Process utility for imaging in cerebrovascular disease. Academic Radiology, 10 (3), 266-274.

Abstract: Rationale and Objectives. The morbidity associated with a diagnostic test can influence its cost-effectiveness, but the quantification of that morbidity is controversial. Accounting for pain and invasiveness requires the measurement of "process utility" in addition to the expected value of testing. An original time trade-off variant was applied to the imaging evaluation of cerebrovascular disease, for which differences in morbidity are important to patients. Materials and Methods. A "waiting trade-off' (WTO) was used to evaluate the preferences of 89 patients for magnetic resonance (MR) angiography and conventional x-ray angiography. Patients were experienced with both tests. A weighted difference was calculated between the period a patient was willing to wait for a test result and treatment after a hypothetical "ideal" test and the choice to undergo conventional angiography or MR angiography with immediate treatment. A rating scale was used to check the convergent validity of the WTO. Results. Paired data showed a highly significant difference (P =.0001) between the mean preference for conventional and MR angiography, favoring the latter and translating into a difference of 5 quality-adjusted life days. The more negatively patients judged their conventional angiographic experience, the longer they were willing to wait for the ideal test result. Conclusion. The WTO provides a reasonable estimate of the relative morbidity of more invasive conventional angiographic procedures and provides a quality-adjustment term for economic analysis. Such an approach may enable more complete evaluation of the effects of other processes on medical care

Keywords: addition/analysis/angiography/approach/cerebrovascular/cerebrovascular disease/cost effectiveness/COST-EFFECTIVENESS/diagnostic/disease/economic/economic analysis/effects/evaluation/experience/HEALTH-STATE/imaging/magnetic/magnetic resonance/magnetic resonance (MR)/measurement/medical/morbidity/MR/MR angiography/MR-ANGIOGRAPHY/outcomes studies/pain/patient/patients/period/preference/PREFERENCES/processes/quantification/RADIOLOGY/radiology and radiologists/rating scale/STROKE/testing/tests/treatment/USA/utility/validity/vascular studies

Nozaki, J., Kitahata, H., Tanaka, K., Kawahito, S. and Oshita, S. (2003), Effects of acute normovolemic hemodilution on ventriculoarterial coupling in dogs. Acta Anaesthesiologica Scandinavica, 47 (1), 46-52.

Abstract: Background: Acute normovolemic hemodilution (ANH) causes a decrease in systemic vascular resistance. Similar to vasodilating drugs, ANH might modify ventriculoarterial coupling. Left ventricular elastance (Ees), effective arterial elastance (Ea), stroke work (SW), and pressure volume area (PVA) were used as indicators to examine the effects of ANH on this coupling. Methods: After institutional approval eight dogs were anesthetized with isoflurane and subjected to measurements including aortic pressure, left ventricular (LV) pressure, and LV volume. Left ventricular volume was measured with a conductance catheter. Ees was determined as the slope of the end-systolic pressure-volume relationship. Ea was determined as the ratio of LV end-systolic pressure to stroke volume. Ventriculoarterial coupling was evaluated as the ratio of Ees to Ea. Mechanical efficiency, another criterion for ventriculoarterial coupling, was calculated as the ratio of SW to PVA. Data are expressed as mean+/-SD, and P <0.05 was considered significant. Results: Normovolemic exchange of 50 ml kg(-1) of blood for 6% hydroxyethyl starch (ANH60) reduced hemoglobin concentration from 12.8+/-3.0 g dl(-1) to 6.4+/-1.3 g dl(-1) . Acute normovolemic hemodilution 50 did not change Ees significantly although it significantly decreased Ea. Left ventricular elastance/Ea did not change after ANH (1.0+/-0.4 at baseline and 1.2+/-0.5 at ANH60). Acute normovolemic hemodilution 50 significantly increased SW and PVA, preventing SW/PVA from changing significantly after ANH (0.57+/-0.10 at baseline and 0.62+/-0.14 at ANH60). Conclusion: Before ANH, ventriculoarterial coupling was so matched as to maximize SW at the expense of the work efficiency. This relation was preserved at ANH60

Keywords: acute/AFTERLOAD/anemia/aortic/aortic pressure/arterial/arterial elastance/blood/CANINE LEFT-VENTRICLE/cardiac performance/catheter/causes/conductance/conductance catheter/CONDUCTANCE CATHETER/COPENHAGEN/coupling/DENMARK/dogs/drugs/effective arterial elastance/effects/EFFICIENCY/elastance/end-systolic pressure-volume relationship/ENERGY/HEART-RATE/hemodilution/hemoglobin/HUMANS/hydroxyethyl starch/indicators/isoflurane/Japan/left/left ventricular/OXYGEN- CONSUMPTION/pressure/resistance/slope/stroke/stroke volume/stroke work/systemic/systemic vascular resistance/vascular/vascular resistance/ventricular/ventricular volume/ventriculoarterial coupling/VOLUME/work

Sellgren, J., Soderstrom, S., Johansson, G., Biber, B., Haggmark, S. and Ponten, J. (2003), Preload changes by positive pressure ventilation can be used for assessment of left ventricular systolic function. Acta Anaesthesiologica Scandinavica, 47 (5), 541-548.

Abstract: Background: Assessment of preload independent left ventricular function with conductance volumetry is traditionally accomplished by inflating a balloon in the inferior caval vein. Our aim was to investigate if a similar change in preload could be achieved by positive pressure ventilation with large tidal volume. Methods: Conductance volumetry generating left ventricular pressure-volume loops was used in seven pentobarbital-anesthetized pigs. Changes in preload recruitable stroke work were studied, comparing the effects of inferior vena cava occlusion (IVCO) or large tidal volume (LTV). Cardiodepression was induced by halothane anesthesia and halothane + phenylephrine, and stimulation by epinephrine infusion. Results: Although the decreasis in left ventricular end diastolic volume was slightly less with LTV (16.5 +/- 1.7 ml, mean +/- SEM) than with IVCO (22.4 +/- 1.7 ml) (P < 0.0001) the PRSW-slopes showed a high degree of correlation (r= 0.80, P < 0.0001). Although peak tracheal pressures increased significantly to 27.8 +/- 0.9 mmHg during LTV, esophageal pressures (used as an indicator of pericardial pressure) were unchanged. Conclusions: Positive pressure ventilation with LTV is similar to IVCO in creating transient changes in preload, necessary for assessment of left ventricular systolic function. This observation was valid also during drug-induced cardiac depression and stimulation. The preload recruitable stroke work used for this validation was shown to be a reliable and stable method

Keywords: anesthesia/assessment/balloon/cardiac/changes/conductance/CONDUCTANCE CATHETER TECHNIQUE/COPENHAGEN/correlation/creating/DENMARK/depression/diastolic/drug-induced/effects/epinephrine/function/halothane/HEART/induced/left/left ventricular/left ventricular function/left ventricular systolic function/observation/occlusion/pericardial pressure/phenylephrine/pigs/positive-pressure respiration/preload/preload recruitable stroke work/pressure/pressures/RECRUITABLE STROKE WORK/stimulation/stroke/stroke work/Sweden/swine/systolic/systolic function/tidal volume/tracheal/transient/validation/vein/ventilation/ventricular/ventricular function/VOLUME/volumetry/work

Tuz, M., Erodlu, F., Dodru, H., Uygur, K. and Yavuz, L. (2003), Transient locked-in syndrome resulting from stellate ganglion block in the treatment of patients with sudden hearing loss. Acta Anaesthesiologica Scandinavica, 47 (4), 485-487.

Abstract: Stellate ganglion blockage (SGB) is a local anesthetic procedure intended to block the lower cervical and upper thoracic sympathetic chain and is one of the treatment modalities for a wide range of disorders such as sudden hearing loss, Menier's disease, stroke, sudden blindness, shoulder/hand syndrome and vascular headache. The complications of SGB are recurrent laryngeal or phrenic nerve block, pneumothorax, unconsciousness, respiratory paralysis, convulsions and sometimes severe arterial hypotension. We present a case with transient locked-in syndrome following SGB for the management of sudden hearing loss. The risk of an intra-arterial injection can be eliminated by rotating the needle, as is described in this report

Keywords: arterial/arterial hypotension/blindness/block/cervical/complication/complications/convulsions/COPENHAGEN/DENMARK/disease/disorders/headache/hearing/hearing loss/hypotension/intra-arterial/intraarterial/laryngeal/locked-in syndrome/loss/lower/management/needle/nerve/paralysis/patients/phrenic nerve/procedure/range/recurrent/risk/severe/stellate ganglion/stellate ganglion block/stroke/sudden/sudden hearing loss/sympathetic/syndrome/thoracic/transient/transient locked-in syndrome/treatment/vascular

Huber, J., Stollberger, C., Finsterer, J., Schneider, B. and Langer, T. (2003), Quality of blood pressure control and risk of cerebral bleeding in patients with oral anticoagulation. Acta Medica Austriaca , 30 (1), 6-9.

Abstract: Background: We assessed how many patients on long-term oral anticoagulation (OAC) (i) suffer from arterial hypertension (AH), (ii) are aware of AH, (iii) need improvement of their therapy and (iv) suffer from cerebral bleeding. Methods: Outpatients on long-term OAC were asked to measure blood pressure at least 4 times. Blood pressure was classified as normotensive if at least 75 % of all measurements were < 139/89 mm Hg; as mild/moderate AH if > 25 % of all measurements were 140 - 179 mm Hg systolic or 90 - 109 mm Hg diastolic; and as severe AH if > 25 % of all measurements were > 180 mm Hg systolic or > 110 mm Hg diastolic. Bleeding complications were registered. Results: Of the 235 patients (108 female, 67 +/- 12 years), 80 % suffered from AH. Severe AH was present in 5 %. Only 56 % were aware of suffering from AH. An improvement of antihypertensive therapy was needed in 64 %. Over 225 days, only one cerebral bleeding occurred. Blood pressure was normotensive in 30 % with known AH. Conclusions: Blood pressure control seems better in OAC patients than in normals, if the patient is aware of AH. Patients with AH on OAC are not aware of AH in > 50 %. Repeated blood pressure measurements in OAC are recommended, even if patients are not aware of AH

Keywords: anticoagulation/antihypertensive/antihypertensive therapy/ANTITHROMBOTIC THERAPY/arterial/arterial hypertension/Austria/AWARENESS/bleeding/blood/blood pressure/blood pressure control/cerebral/cerebral bleeding/CHRONIC ATRIAL-FIBRILLATION/COMPLICATIONS/control/diastolic/female/GERMANY/HYPERTENSION/measure/oral/oral anticoagulation/patient/patients/pressure/PREVALENCE/PREVENTION/risk/severe/STROKE/systolic/therapy/UNIVERSITY HOSPITALS/WARFARIN USE

Pniewski, J., Chodakowska-Zebrowska, M., Wozniak, R., Stepien, K. and Stafiej, A. (2003), Plasma homocysteine level and the course of ischemic stroke. Acta Neurobiologiae Experimentalis, 63 (2), 127-130.

Abstract: Increased level of homocysteine (Hcy) in blood seems to influence negatively the course of ischemic stroke (IS), the possible mechanism of this action could be acceleration of oxidative stress. The aim of this study is to assess the influence of Hcy level in patients with IS on the prognosis 3 months after the stroke onset. 75 patients aged 68.27 +/- 12.62 years, with the diagnosis of first ever IS were examined. Patients with the symptoms corresponding with TACS at the beginning of stroke and with diminished level of consciousness were not included. The level of Hcy over 15 mumol/l was assessed as mild hiperhomocysteinemia (MHcy). 74 (98.7%) patients were assessed 3 months after IS onset in the Rankin scale. Recovery was assessed, according to Rankin Scale: good recovery (GR) 0-2, bad recovery (BR) 3-5 and death. MHcy was seen in 9 (14.5%) with GR and in 8 (66.7%) with BR (P=0.0005). MHcy increases the risk of BR 11.78 times (95%CI 2.93-47.42)

Keywords: acceleration/action/ACUTE CORONARY SYNDROMES/aged/ARTERY DISEASE/BIOLOGY/blood/CARDIOVASCULAR-DISEASE/consciousness/death/diagnosis/HOMOCYST(E)INE/homocysteine/ischemic/ischemic stroke/mechanism/METAANALYSIS/mild/MORTALITY/oxidative stress/patients/Poland/prognosis/Rankin scale/recovery/RISK/stress/stroke/stroke onset/SUBTYPES/symptoms/TRENDS

Vuorinen, V., Hinkka, S., Farkkila, M. and Jaaskelainen, J. (2003), Debulking or biopsy of malignant glioma in elderly people - a randomised study. Acta Neurochirurgica, 145 (1), 5-10.

Abstract: Background. Patients with radiologically (MRI and/or CT images) suspected malignant glioma is referred to radiotherapy after craniotomy and resection of the tumour or after diagnostic biopsy. Patients with poor preoperative status and elderly patients are diagnosed more often by biopsy and treated by radiotherapy rather than by craniotomy and tumour resection. However, based on previous retrospective studies it is not possible to conclude which procedure is better for elderly patients. Thus a prospective study comparing these two procedures with elderly patients was planned. Methods. 30 patients older than 65 years with radiologically (CT and/or MRI) obvious malignant glioma were randomised into two groups: I) stereotactic biopsy and II) open craniotomy and resection of the tumour. Nineteen patients were diagnosed to have grade IV glioma and four patients grade III glioma. Seven out of 30 (23%) were followed in the "intention-to-treat" group with diagnosis of stroke (n = 3), metastasis (n = 2), malignant lymphoma (n = 1) and one with out histological diagnosis. Patients with histologically verified malignant glioma (grade III-IV) were diagnosed by stereotactic biopsy (n = 13) or by open craniotomy and resection (n = 10) and all the patients were referred to radiotherapy. Survival and time of deterioration were followed. Findings. The overall median survival time was 146 (95%, CI 89-175) days after the procedure. The estimated median survival time was 171 (95%, CI 146-278) days after the craniotomy versus 85 (95% CI 55-157) days after the biopsy (p = 0.035). The estimated survival time was 2.757 times longer (95% CI 1.004-7.568, p = 0.049) after craniotomy. However, there was no significant difference in the time of deterioration between these two treatments (p = 0.057). Amount of radiotherapy given had a significant effect on survival (p = 0.001). Interpretation. Longer survival time is achieved after open craniotomy and resection of tumour. However, overall benefit of open surgery to patient seems to be modest. while time of deterioration did not differ between two treatment groups. Our results support previous studies on the benefit of radiotherapy in the treatment of malignant glioma

Keywords: ASTROCYTOMAS/biopsy/CHEMOTHERAPY/craniotomy/CT/deterioration/diagnosis/diagnostic/effect/elderly/elderly patients/elderly people/Finland/GLIAL NEOPLASMS/GLIOBLASTOMA/glioma/II/lymphoma/malignant/malignant glioma/MANAGEMENT/MRI/older/patient/patients/procedure/prospective/prospective study/radiotherapy/resection/RESECTION/results/retrospective studies/SPECTROSCOPY/status/stereotactic biopsy/stroke/support/SURGERY/SURVIVAL/survival time/THERAPY/treatment/tumour

Westermaier, T., Hungerhuber, E., Zausinger, S., Baethmann, A. and Schmid-Elsaesser, R. (2003), Neuroprotective efficacy of intra-arterial and intravenous magnesium sulfate in a rat model of transient focal cerebral ischemia. Acta Neurochirurgica, 145 (5), 393-399.

Abstract: Background. Many neurovascular procedures necessitate temporary occlusion of cerebral arteries. In this situation neuroprotective drugs may increase the safety of the procedures. Magnesium may inhibit ischemic damage by anti- excitotoxic, calcium channel blocking and vasodilatory action. Some evidence suggests that intra-arterial administration might provide a much higher degree of protection than intravenous treatment. In this study the neuroprotective efficacy of intra- arterial and intravenous magnesium administration was examined in a rat model of transient focal ischemia. Methods. 34 male Sprague-Dawley rats were subjected to 90 minutes of middle cerebral artery occlusion (MCAO) by an intraluminal thread. Before ischemia, animals received an infusion of either (1) vehicle (0.9% NaCl) (2) MgSO4 intra-arterially or (3) MgSO4 intravenously. Local cortical blood flow (LCBF) was continuously measured by laser-Doppler flowmetry. Functional deficits were quantified daily, infarct volumes were assessed histologically after 7 days. Findings. There was no difference between the treatment groups concerning LCBF. Magnesium serum levels increased from similar to1 mmol/l to similar to1.8 mmol/l by either route of administration. Both intra-arterial and intravenous treatment improved neurological recovery and equally reduced total infarct volume by similar to25%. Interpretation. The results indicate that there is no advantage of intra-arterial over intravenous magnesium administration. A comparison with previous studies suggests that even within the normal range of serum magnesium concentrations, low-normal levels may be hazardous and high-normal levels may be protective in transient focal ischemia

Keywords: action/animals/arterial/arteries/artery/ARTERY OCCLUSION/blood/blood flow/BRAIN/CALCIUM/cerebral/cerebral arteries/cerebral artery/cerebral artery occlusion/cerebral ischemia/CEREBROSPINAL-FLUID/comparison/cortical/deficits/drugs/efficacy/excitotoxic/flow/focal/focal cerebral ischemia/focal ischemia/Germany/HIPPOCAMPAL SLICES/infarct/INFARCT VOLUME/intra-arterial/intraarterial/intraluminal thread/intravenous/ischemia/ischemic/laser Doppler flowmetry/laser-Doppler/laser-Doppler flowmetry/magnesium/magnesium sulfate/male/MCAO/MECHANISMS/middle cerebral/middle cerebral artery/middle cerebral artery occlusion/model/neurological/neuroprotection/neuroprotective/neuroprotective drugs/normal/occlusion/protection/range/rat/rats/recovery/REPERFUSION/results/safety/serum/SPREADING DEPRESSION/STROKE/sulfate/transient/transient focal cerebral ischemia/transient focal ischemia/treatment/vasodilatory/vehicle/volume

Laloux, P. (2003), Statins and stroke prevention. Acta Neurologica Belgica, 103 (1), 13-18

Keywords: ATHEROSCLEROSIS/cerebrovascular disease/CHOLESTEROL LEVELS/CORONARY-HEART-DISEASE/hydroxymethylglutaryl-CoA reductase inhibitors/MEN/MYOCARDIAL-INFARCTION/PRAVASTATIN/prevention/REDUCTION/RISK-FACTORS/SERUM-CHOLESTEROL/statins/stroke/stroke prevention/TRIALS

Appelros, P., Hogeras, N. and Terent, A. (2003), Case ascertainment in stroke studies: the risk of selection bias. Acta Neurologica Scandinavica, 107 (2), 145-149.

Abstract: Objectives - The purpose was to compare the completeness of case ascertainment in two stroke registers, one local population-based, the other a national quality register (Riks- Stroke), and to examine if patient characteristics could be affected by selection bias. Material and methods - By the way of linking and matching computer files, the completeness of case ascertainment was evaluated. Results - In the local stroke incidence study 377 patients were included. Of them, 63% were reported to the hospital-based national quality register. The case-fatality was lower in the national register. A larger proportion of the patients in the national register appeared to have been treated in a stroke unit and undergone rehabilitation, and computerized tomography seemed to have been performed in a larger proportion. Conclusions - Because of selection bias, outcome data get skewed when case ascertainment does not embrace all stroke cases. A community-based stroke register is the golden standard when measuring stroke incidence

Keywords: bias/case fatality/case-fatality/cerebrovascular disorders/computer/computerized/computerized tomography/COPENHAGEN/DENMARK/epidemiology/EXPERIENCE/incidence/lower/methods/outcome/patient/patients/POPULATION/population-based/quality/quality control/register/REGISTRY/rehabilitation/risk/selection/selection bias/standard/stroke/stroke incidence/stroke studies/stroke unit/Sweden/tomography/two stroke/two-stroke/when

Ardehali, M.R. and Rondouin, G. (2003), Microsurgical intraluminal middle cerebral artery occlusion model in rodents. Acta Neurologica Scandinavica, 107 (4), 267-275.

Abstract: Objectives - Focal brain ischemia induced in rodents by occlusion of the middle cerebral artery (MCA) is a widely used paradigm of human brain infarct. The objective of this study is to compare the effectiveness and reproducibility of MCA filament occlusion model in rats and mice. Materials and methods - A total of 140 rodents (69 rats and 71 mice) were operated. Ninety-five animals were subjected to MCA occlusion; the surgical procedure consisted of introducing an uncoated surgical nylon monofilament into the cervical common carotid artery (CCA) and advancing it intracranially to permanently block blood flow into the right MCA. Forty-five sham-occluded rodents underwent CCA ligation. Surgical success, autopsy confirmed success and mortality rate were evaluated. Effective MCA occlusion was confirmed by the evidence of motor neurological deficit, by histopathology, immunohistochemistry (IHC) and reverse transcriptase-polymerase chain reaction (RT- PCR). IHC was performed in a randomly selected number of animals to detect the protein product of monocyte chemoattractant protein-1. The brain tissue in mice was examined by RT-PCR for the expression of macrophage inflammatory protein-1 alpha mRNA. Results - Surgical success rate was 89% in the rats, significantly lower than that in the mice (100%, P < 0.05). Autopsy confirmed success rate in the rats, 60%, was also significantly different from that in the mice (92.5%, P < 0.001). The operative mortality rate was 4.3% in the rats and 15% in the mice. Conclusion - The present study demonstrates that the microsurgical filament occlusion of the MCA can be more successfully performed in mice. The lower rate of success in rats seems to be as a result of the architecture of the carotid canal in this animal. No previous reports, using a considerable number of animals, have compared the feasibility of intraluminal model in the rat with that in the mouse

Keywords: animal/animals/artery/autopsy/blood/blood flow/BP/BRAIN/brain infarct/brain ischemia/carotid/carotid artery/cerebral/cerebral artery/cerebral artery occlusion/cerebral ischemia/common/common carotid artery/COPENHAGEN/DENMARK/effectiveness/flow/France/histopathology/human/human brain/immunohistochemistry/induced/infarct/INFARCT VOLUME/inflammatory/ISCHEMIA/lower/macrophage/MACROPHAGE INFLAMMATORY PROTEIN-1/MCA/MCA occlusion/MCP1/MESSENGER-RNA EXPRESSION/methods/MICE/mice/middle cerebral/middle cerebral artery/middle cerebral artery occlusion/middle cerebral artery occlusion model/MIP1 alpha/model/monocyte/MONOCYTE CHEMOATTRACTANT PROTEIN-1/monofilament/mortality/mortality rate/motor/MOUSE/MR/mRNA/neurological/neurological deficit/occlusion/PCR/procedure/protein/rat/RATS/rats/reproducibility/right/rodents/RT-PCR/STROKE/surgical

Gariballa, S.E. (2003), Potentially treatable causes of poor outcome in acute stroke patients with urinary incontinence. Acta Neurologica Scandinavica, 107 (5), 336-340.

Abstract: Objective - To identify potentially treatable clinical risk factors responsible for poor outcome in acute stroke patients with urinary incontinence. Material and methods - All acute stroke patients admitted to our hospital within a 12-month period were considered for inclusion in this observational prospective study. Their clinical details were recorded prospectively during the hospital stay and at 3 months. Results - Two hundred and fifteen patients with complete records were enrolled in the study. After adjusting for age, disability, and comorbidity, urinary incontinence at admission was a significant predictor of stroke death at 3 months [hazard ratio 2.8 (95% CI 1.3-5.8), P = 0.006]. Stroke patients incontinent of urine were malnourished and had an increased risk of infective complications during the hospital stay compared with those without incontinence. Conclusion - Part of the poor outcome associated with incontinence of urine after acute stroke may be due to treatable conditions such malnutrition and infections

Keywords: acute/acute stroke/age/causes/clinical/comorbidity/complications/COPENHAGEN/death/DENMARK/disability/England/hospital/incontinence/infections/malnutrition/malnutrition infection/methods/NUTRITIONAL-STATUS/outcome/patients/period/predictor/prospective/prospective study/records/risk/risk factors/risk-factors/stroke/stroke patients/TRIAL/urinary/urinary incontinence/urine

Jaracz, K. and Kozubski, W. (2003), Quality of life in stroke patients. Acta Neurologica Scandinavica, 107 (5), 324-329.

Abstract: Objectives - To describe global and domain-specific quality of life (QOL) after stroke and to identify the factors that are important for post-stroke QOL. Material and methods - A hospital-based sample of 72 stroke patients was followed up for 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index. Regression analysis was performed to identify the variables that best predicted QOL. Results - The overall QOL of stroke patients was relatively good, although worse than that of subjects in a comparison group. The highest QOL was found in the 'Family' domain, and the lowest in the 'Health and functioning' domain. Emotional support, depression and functional disability were three separate variables explaining 38% of the variance in QOL. Conclusions - Strengthening of family support, treatment of depression and reduction of physical dependence may be the decisive factors in improving post-stroke QOL

Keywords: analysis/comparison/COPENHAGEN/DENMARK/dependence/depression/disability/ELDERLY PEOPLE/family/functional/global/INDEX/methods/OF-LIFE/patients/physical/Poland/poststroke/quality/quality of life/SCALES/social support/stroke/stroke onset/stroke patients/support/treatment

Konrad, C., Nabavi, D.G., Junker, R., Dziewas, R., Henningsen, H. and Stogbauer, F. (2003), Spontaneous internal carotid artery dissection and alpha-1- antitrypsin deficiency. Acta Neurologica Scandinavica, 107 (3), 233-236.

Abstract: Spontaneous cervical arterial dissection is an important cause of juvenile stroke. However, etiopathology and genetic background remain poorly understood. We report on a 45-year- old-male patient with homozygous alpha-1-antitrypsin (alpha-1- AT) deficiency in whom internal carotid artery dissection occurred in the absence of any other known risk factors. The relevance of alpha-1-AT deficiency for spontaneous cervical arterial dissections is discussed

Keywords: acute cerebral infarction/acute stroke syndromes/alpha-1-antitrypsin deficiency/arterial/arterial dissection/artery/artery dissection/carotid/carotid and vertebral artery dissections/carotid artery/carotid artery dissection/cause/cervical/COPENHAGEN/deficiency/DENMARK/dissection/dissections/genetic/Germany/internal/internal carotid/internal carotid artery/internal carotid artery dissection/juvenile stroke/patient/risk/risk factors/risk factors for stroke/risk-factors/spontaneous/stroke

Masana, Y. and Motozaki, T. (2003), Emergence and progress of white matter lesion in brain check-up. Acta Neurologica Scandinavica, 107 (3), 187-194.

Abstract: White matter lesion (WML) is thought to emerge and progress with increasing age but has not yet been well investigated. In this study of WML, risk factors and prevalence added to emergence rate (%/person year) and progress speed [increase of leukoencephalopathy score (LES)/person year] were investigated in 1674 brain check-up subjects from August 1993 to August 2001. Significant (P < 0.01) risk factors were aging and hypertension. Prevalence rate (%) was 0 in 20-29 years, 1.4 in 30-39 years, 4.2 in 40-49 years, 20.9 in 50-59 years, 42.6 in 60-69 years, and 73.9 in 70-years. Emergence rate was 0 in 20- 29 years, 0.7 in 30-39 years, 1.5 in 40-49 years, 3.4 in 50-59 years, 6.0 in 60-69 years, and 20 in 70-years. And progress speed was 0.12 in 40-49 years, 0.15 in 50-59 years, 0.21 in 60- 69 years, and 0.21 in 70-years. WML begins to emerge early in middle age and both prevalence and severity increase with age

Keywords: age/aging/BLOOD-PRESSURE/brain/brain check-up/COPENHAGEN/DENMARK/ELDERLY SUBJECTS/emergence/FOLLOW-UP/hypertension/INFARCTION/Japan/lesion/leukoencephalopathy/MRI/prevalence/progress/risk/risk factor/risk factors/risk-factors/ROTTERDAM/score/SIGNAL HYPERINTENSITIES/speed/STROKE PATIENTS/VASCULAR RISK-FACTORS/VOLUNTEERS/White/white matter/white matter lesion

McCarron, M.O., Weir, C.J., Muir, K.W., Hoffmann, K.L., Graffagnino, C., Nicoll, J.A.R., Lees, K.R. and Alberts, M.J. (2003), Effect of apolipoprotein E genotype on in-hospital mortality following intracerebral haemorrhage. Acta Neurologica Scandinavica, 107 (2), 106-109.

Abstract: Objective - To determine the relationship between the apolipoprotein E (APOE ) epsilon4 allele and in-hospital mortality from intracerebral haemorrhage (ICH). Material and methods - Patients admitted to two acute stroke units with ICH were prospectively evaluated and APOE genotyped. In-hospital survival was recorded in 176 patients. Results - There were 85 men and 91 women, mean age 68 years. Fifty-two (30%) of the 176 patients died in hospital. After adjusting for sex, age, hospital, and race, increased age (P = 0.009) and the presence of the APOE epsilon4 allele (P = 0.026) significantly reduced in-hospital survival. Conclusion - The APOE epsilon4 allele in this population may be associated with poor survival following ICH

Keywords: acute/acute stroke/age/ALLELE/APOE/apolipoprotein/apolipoprotein E/apolipoprotein E genotype/apolipoprotein-E/ASSOCIATION/CEREBROVASCULAR-DISEASE/COPENHAGEN/DEATH/DENMARK/E POLYMORPHISM/genotype/haemorrhage/HEMORRHAGE/hospital/in-hospital mortality/intracerebral/intracerebral haemorrhage/Ireland/men/methods/mortality/outcome/patients/population/race/sex/STROKE/stroke units/survival/SURVIVAL/women

Nolfe, G., D'Aniello, A.M., Muschera, R. and Giaquinto, S. (2003), The aftermath of rehabilitation for patients with severe stroke. Acta Neurologica Scandinavica, 107 (4), 281-284.

Abstract: Objective - The study evaluates the aftermath of stroke in patients with very severe disability after their first ever stroke and dismissed after rehabilitation. Materials and methods - Sixty-nine inpatients were studied, who were highly disabled at discharge with a Functional Independence Measure (FIM) score in the range of 18-39. Their rehabilitation program had lasted 60 days. The degree of functional independence was measured by means of the FIM at the beginning of treatment, at discharge and at follow-up. The data collected were examined by using parametric and distribution-free statistical methods. The role of age in the process of recovery was also evaluated. Results - All patients were discharged home after 2 months. At 6 month follow-up, 15 patients (21.7%) were lost, 27 (39.1%) had died and 27 (39.1%) lived at home. Among stroke survivors a clear trend toward an improvement was detected during the 6 months observation period. Indeed, the third quartile changed from 33 to 63 and a patient approached to independence (FIM 87). None underwent a rehabilitation program at home beside the relatives' assistance. Conclusions - Highly disabled stroke patients are probably to undergo unfavourable outcome but unexpected recovery cannot be ruled-out on the basis of cut-off parameters measured after the acute phase of stroke. Multivariate statistical methods can identify factors which can interfere with functional recovery but are error-prone in setting individual prognosis. Moreover the recovery process may develop in a long period of time. Taking into consideration the spontaneous recovery observed during the follow-up period after the dismissal from rehabilitation ward, a suitable rehabilitation at home might be fruitful in these patients, who should not be considered as "lost"

Keywords: acute/age/COPENHAGEN/DENMARK/disability/ER/FIM/follow up/follow-up/functional/Functional Independence Measure/functional recovery/HOME/independence/inpatients/Italy/methods/observation/outcome/patient/patients/period/prognosis/range/recovery/rehabilitation/rehabilitation program/score/severe/severe stroke/spontaneous/spontaneous recovery/statistical/stroke/stroke patients/stroke survivors/treatment/unexpected functional recovery

Rasmussen, A., Christensen, J., Clemmensen, P.M., Dalsgaard, N.J., Dam, H., Hindberg, I., Lunde, M., Plenge, P. and Mellerup, E. (2003), Platelet serotonin transporter in stroke patients. Acta Neurologica Scandinavica, 107 (2), 150-153.

Abstract: Objectives - Post-stroke depression can be treated with serotonin transport inhibitors suggesting a role for the serotonin system in these patients. The number of platelet serotonin transporters in stroke patients and in control subjects have been measured in this study. Materials and methods - Newly admitted stroke patients who did develop or who did not develop a post-stroke depression, non-acute patients who previously had had a stroke and control subjects were compared. The number of platelet serotonin transporters was analysed by ligand binding methodology. Results - The number of platelet serotonin transporters was low shortly after a stroke compared with normal subjects; no difference was found between the stroke patients who developed a post-stroke depression and those who did not. Conclusion - A low number of platelet serotonin transporters may be a non-specific state marker for a condition as acute stroke

Keywords: acute/acute stroke/ANTIDEPRESSANT TREATMENT/condition/control/COPENHAGEN/Denmark/depression/DEPRESSION/H-3- IMIPRAMINE BINDING/inhibitors/marker/methodology/methods/normal/normal subjects/patients/platelet/platelet serotonin transporter/post stroke depression/post-stroke depression/poststroke/poststroke depression/serotonin/stroke/stroke patients/transport/TRITIATED IMIPRAMINE BINDING

Roby-Brami, A., Feydy, A., Combeaud, M., Biryukova, E.V., Bussel, B. and Levin, M.F. (2003), Motor compensation and recovery for reaching in stroke patients. Acta Neurologica Scandinavica, 107 (5), 369-381.

Abstract: Objectives - To examine the mechanisms of alternative strategies developed by stroke patients to compensate their motor impairment and their role in recovery. Material and methods - The three-dimensional kinematics of the upper limb were quantified during unconstrained reaching movements in seven healthy individuals and in 15 stroke patients. Nine patients were followed-up. Individual observations were correlated with anatomical and functional brain imaging described elsewhere (Feydy et al. Stroke 2002;33 :1610). Results - Healthy subjects used mainly elbow extension and shoulder flexion, scaled to movement distance. Patients with hemiparesis because of stroke used different patterns of joint recruitment with different scaling rules. Patients with the greatest impairment compensated by recruiting extra degrees of freedom, particularly trunk bending. Improvement was because of a restoration towards a normal movement pattern (recovery) and/or to a reinforcement of compensation, which led to a poorer outcome. Conclusion - Individual behavioural data are necessary to discuss the mechanisms of functional improvement following stroke with respect to recovery and/or compensation

Keywords: ADULT NORMS/ARM/brain/brain imaging/compensation/COORDINATION/COPENHAGEN/DEFICITS/DENMARK/DEXTERITY/disability/elbow/France/functional/functional brain imaging/HEMIPARESIS/hemiplegia/imaging/impairment/kinematics/mechanisms/methods/motor/motor impairment/movement/movements/normal/outcome/PATHWAYS/patients/patterns/POINTING MOVEMENTS/prehension/reaching/recovery/RECRUITMENT/REORGANIZATION/scaling/shoulder/stroke/stroke patients/three-dimensional/three-dimensional movement recording/trunk/upper limb

Studer, A., Georgiadis, D. and Baumgartner, R.W. (2003), Ischemic infarct involving all arterial territories of the thalamus. Acta Neurologica Scandinavica, 107 (6), 423-425.

Abstract: Ischemic infarcts of the thalamus involve one or two of its four arterial territories that are usually supplied by the posterior cerebral (PCA) and the posterior communicating (PCoA) arteries. We report a patient who suffered ischemic infarcts in all arterial territories of the right thalamus. Magnetic resonance (MR) angiography showed an occlusion of the right PCA and failed to visualize a PCoA. We assume that the absence of a relevant thalamic blood supply deriving from the PCoA enabled PCA occlusion to cause infarcts in all thalamic territories

Keywords: ANATOMY/angiography/arterial/arteries/blood/cause/cerebral/cerebrovascular disease/stroke/cognitive disorders/dementia/COPENHAGEN/DENMARK/infarct/infarcts/ischemic/MR/occlusion/patient/right/Switzerland/thalamus

Sumer, M.M., Ozdemir, I. and Tascilar, N. (2003), Predictors of outcome after acute ischemic stroke. Acta Neurologica Scandinavica, 107 (4), 276-280.

Abstract: The aim of this study was to determine which variables should be the predictors for clinical outcome at discharge and sixth month after acute ischemic stroke. Methods - Two hundred and sixty-six consecutive patients, each with an acute ischemic cerebrovascular disease, were evaluated within 24 h of symptom onset. We divided our patients into two groups; 1 - Independent (Rankin scale RS less than or equal to 2) and, 2 - Dependent (RS>3) and death. Baseline characteristics, clinical variables, risk factors, infarct subtypes and radiologic parameters were analyzed. Results - Canadian Neurological Scale (CNS) on admission <6.5 [odds ratio (OR) 22] and posterior circulation infarction (OR 4.2) were associated with a poor outcome at discharge from hospital whereas only a CNS score <6.5 (OR 14) was associated with a poor outcome at 6 months. Conclusions - Severity of neurologic deficit is the most important indicator for clinical outcome in acute ischemic stroke both at short- term and at sixth month, whereas posterior circulation infarction also predicts a poor outcome at discharge

Keywords: acute/acute ischemic/acute ischemic stroke/Canadian Neurological Scale/CEREBRAL-ARTERY SIGN/cerebrovascular/cerebrovascular disease/circulation/clinical/clinical outcome/CNS/COPENHAGEN/death/DENMARK/disease/functional outcome/hospital/infarct/INFARCT VOLUME/infarction/ischemic/ischemic cerebrovascular disease/ischemic stroke/MORTALITY/neurologic/neurologic deficit/outcome/patients/posterior circulation/predictors/prognosis/Rankin scale/RECURRENCE/risk/risk factors/risk-factors/SCALE/SCORE/stroke/subtypes/SURVIVAL/TEMPORAL PROFILE/TERRITORY/TRIALS

Szczudlik, A., Turaj, W., Slowik, A. and Strojny, J. (2003), Microalbuminuria and hyperthermia independently predict long- term mortality in acute ischemic stroke patients. Acta Neurologica Scandinavica, 107 (2), 96-101.

Abstract: Objectives - To investigate the association between microalbuminuria (MA) and hyperthermia in acute ischemic stroke and to evaluate their significance as the predictors of long- term mortality after stroke. Material and methods - We assessed neurologic deficit, urinary albumin excretion and body temperature in 60 patients admitted within 24 h after the onset of their first ischemic stroke. Outcome was assessed by 90-day and 1-year mortality. Results - MA was found in 46.7% of patients. Hyperthermia was found in 18.3% patients on Day 1 and in 25% patients on Day 2. The correlation between albuminuria on Day 2 and the body temperature on Days 1 and 2 was found (r = 0.45, and r = 0.30, respectively; both P < 0.05).The mortality was significantly higher in the group of patients with both MA and hyperthermia on Day 2 (73% vs 10% after 90 days; P < 0.0001 and 73% vs 18% after 1 year, P < 0.005). In the logistic regression analysis, albuminuria (P = 0.017), hyperthermia on Day 1 (P = 0.028) and neurologic deficit on admission (P = 0.044) independently predicted 1-year mortality after ischemic stroke. Conclusion - Daily urinary albumin excretion correlates with the body temperature in acute stroke patients, but the predictive power of both these variables is independent of that association

Keywords: acute/acute ischemic/acute ischemic stroke/ACUTE MYOCARDIAL-INFARCTION/acute stroke/albumin/ALBUMINURIA/analysis/association/body temperature/BODY-TEMPERATURE/BRAIN TEMPERATURE MODULATION/CEREBRAL-ISCHEMIA/COPENHAGEN/correlation/DAMAGE/DENMARK/FEVER/hyperthermia/HYPOTHERMIA/ischemic/ischemic stroke/logistic regression/methods/microalbuminuria/mortality/neurologic/neurologic deficit/patients/Poland/power/predictive/predictors/prognosis/regression/regression analysis/SEVERITY/stroke/stroke patients/temperature/urinary/urinary albumin excretion/VASCULAR-PERMEABILITY

Weise, J., Bahr, M., Strayle-Batra, M. and Kuker, W. (2003), Detection of acute thalamo-mesencephalic infarction: diffusion abnormality precedes T2 hyperintensity. Acta Neurologica Scandinavica, 108 (1), 52-54.

Abstract: Objective - To examine the time course of signal changes in diffusion-weighted magnetic resonance imaging (DW-MRI) and T2- weighted MRI in a case of cerebral infarction in the posterior circulation territory. Materials and methods - Diffusion- and T2-weighted MRI and comparison of signal changes in these sequences at 4 h, 1 day and 4 days after the onset of clinical symptoms caused by acute thalamomesencephalic infarction. Results - Four hours after the onset of symptoms, signal changes in DW-MRI revealed an infarction in the territory of the posterior perforating thalamic artery, whereas no signal changes were detected in T2-weighted MRI. In follow-up MRI 1 an 4 days after infarction, however, a marked hyperintensity matching the location of the diffusion deficit could be identified in T2 images. Conclusion - Signal changes in DW-MRI precede T2 hyperintensity after infarction in the posterior circulation territory after hemispheric infarction

Keywords: acute/artery/cerebral/cerebral infarction/cerebral ischemia/changes/circulation/clinical/clinical symptoms/comparison/COPENHAGEN/DENMARK/diffusion/diffusion weighted/diffusion- weighted MRI/diffusion-weighted/diffusion-weighted magnetic resonance/diffusion-weighted magnetic resonance imaging/DW-MRI/follow up/follow-up/Germany/imaging/infarction/ISCHEMIC-INJURY/location/magnetic/magnetic resonance/magnetic resonance imaging/methods/MRI/posterior circulation/posterior circulation territory/resonance imaging/STROKE/symptoms/T2-WEIGHTED MRI/time course

Alexander, M., Forster, C., Sugimoto, K., Clark, H.B., Vogel, S., Ross, M.E. and Iadecola, C. (2003), Interferon regulatory factor-1 immunoreactivity in neurons and inflammatory cells following ischemic stroke in rodents and humans. Acta Neuropathologica, 105 (5), 420-424.

Abstract: Interferon regulatory factor-1 (IRF-1), a transcription factor that controls the expression of genes related to inflammation and injury, may be involved in the mechanisms of cerebral ischemia. In this study, we used immunohistochemistry to determine whether IRF-1 protein is up-regulated after cerebral ischemia, and to define the identity of the cells that express IRF-1 in the postischemic brain. In mice, IRF-1 immunoreactivity was present in intravascular neutrophils 24 h after middle cerebral artery occlusion. At 96 h, immunoreactivity was observed in neutrophils infiltrating the ischemic tissue and in neurons at the outer border of the ischemic territory. IRF-1 immunoreactivity was also found in neurons and inflammatory cells in the brain of patients who died 1-2 days after ischemic stroke. The neuronal expression of IRF-1, in conjunction with the finding that IRF-1 deletion is beneficial to the post-ischemic brain, suggests that expression of IRF-1-dependent genes in neurons plays a role in ischemic neuronal death



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