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  • 1
    Online Resource
    Online Resource
    Conversion of Ischemic Brain Tissue Into Infarction Increases With Age
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Stroke Vol. 36, No. 12 ( 2005-12), p. 2632-2636
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 12 ( 2005-12), p. 2632-2636
    Abstract: Background and Purpose— Brain regions normal on diffusion-weighted imaging (DWI) but abnormal on mean transit time (MTT) maps represent tissue at risk of infarction, yet the fate of these regions is quite variable. The imperfect correlation between tissue outcome and initial imaging parameters suggests that each patient’s brain may have different susceptibility to ischemic stress. We hypothesize that age is a marker for tissue susceptibility to ischemia and thus plays a role in determining tissue outcome in human stroke. Methods— Sixty patients with acute ischemic stroke and a region of DWI/MTT mismatch that was 〉 20% of the DWI volume were included. All patients were scanned twice, within 12 hours of symptom onset and on day 5 or later. The percentage mismatch lost (PML) was calculated as percentage of initial DWI/MTT mismatch volume that was infarcted on the follow-up MRI. The statistical analysis explored relationships among the covariates age, Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes, time-to-MRI, and initial DWI, MTT volume, mean arterial blood pressure and blood glucose level at admission, and previous history of hypertension and diabetes mellitus. Results— Univariate comparisons showed that age ( P =0.003), hypertension ( P =0.009), and diabetes mellitus ( P =0.0002) were significantly associated with PML. Regression analyses showed age to be a significant covariate ( P =0.02). The regression model predicted a change in PML of ≈0.65% per year. The adjusted proportion of variance ( R 2 ) in PML that could be explained by age alone was 14%. Conclusion— Age-dependent increase in conversion of ischemic tissue into infarction suggests that age is a biological marker for the variability in tissue outcome in acute human stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000189991.23918.01
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    Transient ischemic attack with infarction: A unique syndrome?
    Elsevier BV ; 2006
    In:  International Congress Series Vol. 1290 ( 2006-06), p. 45-55
    Details
    In: International Congress Series, Elsevier BV, Vol. 1290 ( 2006-06), p. 45-55
    Type of Medium: Online Resource
    ISSN: 0531-5131
    URL: Article
    DOI: 10.1016/j.ics.2006.04.007
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2006
    detail.hit.zdb_id: 2112888-1
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  • 3
    Online Resource
    Online Resource
    Heterogeneous spatial-temporal evolution of DWI/PWI in human cerebral ischemia
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 348-348
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 348-348
    Abstract: P53 Purpose: To characterize on a voxel-by-voxel basis salvageable from irreversibly-damaged ischemic tissue in human ischemic stroke using serial diffusion (DWI) and perfusion (PWI) weighted imaging. We sought to correlate tissue outcome with heterogeneity in the evolution of DWI and PWI. Methods: Patients with strokes involving the MCA territory who had been enrolled in a serial DWI and PWI study recording the natural history of human cerebral ischemia were retrospectively analyzed (n=6). Patients had received follow-up studies at predefined intervals. For each patient, maps of the apparent diffusion coefficient (ADC), fractional anisotropy (FA), cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and follow-up T2 FSE (F/U) were spatially coregistered (using AIR 3.08). Time to reach minimum/maximum values, time-to-normalization (or pseudonormalization), and minimum/maximum values were calculated for the DWI/PWI parameters. The ischemic core was operationally defined as the initial DWI abnormality, rim tissue as the mismatch between F/U and initial DWI, and salvaged-at-risk tissue as the mismatch between initial PWI and F/U. Values in core, rim and salvaged tissue were compared using standard two-sample t-tests. All significant findings were at p-values 〈 0.05. Results: Pooling the six patients’ data, the depth of reduction at the acute stage of ADC, CBF and CBV values were found to be significantly greater in core than rim. MTT was found to be significantly elevated. Acutely, CBF was found to be significantly higher in salvaged tissue compared to rim; however no significant difference was found for MTT values (p=0.8). The time for ADC to reach its minimum value is faster in the core compared to rim as well as pseudonormalizing sooner. Elevated FA was found to occur earlier in core tissue than in the rim followed by a more rapid decrease. Pseudonormalization of FA occurred sooner than of ADC values. CBF and MTT recovered earlier in salvaged tissue versus rim tissue. Conclusion: Intralesional heterogeneity in the evolution of DWI/PWI may assist in the identification of salvageable tissue.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.348-d
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
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  • 4
    Online Resource
    Online Resource
    Magnetic Resonance Spectroscopy Study of Oxygen Therapy in Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Stroke Vol. 38, No. 10 ( 2007-10), p. 2851-2854
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 10 ( 2007-10), p. 2851-2854
    Abstract: Background and Purpose— Recent studies suggest that normobaric oxygen therapy (NBO) is neuroprotective in acute ischemic stroke. Methods— We performed multivoxel magnetic resonance spectroscopic imaging and diffusion/perfusion MRI in patients with stroke treated with NBO or room air. Imaging was performed before, during, and after therapy. Results— Voxel-based analysis showed excellent correlation between apparent diffusion coefficient values, lactate, and N -acetyl-aspartate levels at all time points. Lactate decreased during NBO and increased post-NBO. N -acetyl-aspartate decreased in patients receiving room air but not in NBO-treated patients. Conclusion— These data suggest that NBO improves aerobic metabolism and preserves neuronal integrity in the ischemic brain.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.487280
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1467823-8
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  • 5
    Online Resource
    Online Resource
    Transient ischemic attack with infarction: A unique syndrome?
    Wiley ; 2005
    In:  Annals of Neurology Vol. 57, No. 5 ( 2005-05), p. 679-686
    Details
    In: Annals of Neurology, Wiley, Vol. 57, No. 5 ( 2005-05), p. 679-686
    Abstract: It is debated whether transient symptoms associated with infarction (TSI) are best considered a minor ischemic stroke, a subtype of transient ischemic attack (TIA), or a separate ischemic brain syndrome. We studied clinical and imaging features to establish similarities and differences among ischemic stroke, TIA without infarction, and TSI. Eighty‐seven consecutive patients with TIA and 74 patients with ischemic stroke were studied. All underwent diffusion‐weighted imaging on admission. Symptom duration and infarct volume were determined in each group. Thirty‐six patients (41.3%) with TIA had acute infarct(s). Although TIA‐related infarcts were smaller than those associated with ischemic stroke (mean, 0.7 vs 27.3ml; p 〈 0.001), there was no lesion size threshold that distinguished ischemic stroke from TSI. In contrast, the symptom duration probability density curve was not broad, but instead peaked early with only a few patients having symptoms for longer than 200 minutes. The probability density function for symptom duration was similar between TIA with or without infarction. The in‐hospital recurrent ischemic stroke and TIA rate was 19.4% in patients with TSI and 1.3% in those with ischemic stroke. TIA with infarction appears to have unique features separate from TIA without infarction and ischemic stroke. We propose identifying TSI as a separate clinical syndrome with distinct prognostic features. Ann Neurol 2005;57:679–686
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Issue
    URL: Article
    DOI: 10.1002/ana.v57:5
    DOI: 10.1002/ana.20465
    Language: English
    Publisher: Wiley
    Publication Date: 2005
    detail.hit.zdb_id: 2037912-2
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  • 6
    Online Resource
    Online Resource
    A Computerized Algorithm for Etiologic Classification of Ischemic Stroke : The Causative Classification of Stroke System
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Stroke Vol. 38, No. 11 ( 2007-11), p. 2979-2984
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 11 ( 2007-11), p. 2979-2984
    Abstract: Background and Purpose— The SSS-TOAST is an evidence-based classification algorithm for acute ischemic stroke designed to determine the most likely etiology in the presence of multiple competing mechanisms. In this article, we present an automated version of the SSS-TOAST, the Causative Classification System (CCS), to facilitate its utility in multicenter settings. Methods— The CCS is a web-based system that consists of questionnaire-style classification scheme for ischemic stroke (http://ccs.martinos.org). Data entry is provided via checkboxes indicating results of clinical and diagnostic evaluations. The automated algorithm reports the stroke subtype and a description of the classification rationale. We evaluated the reliability of the system via assessment of 50 consecutive patients with ischemic stroke by 5 neurologists from 4 academic stroke centers. Results— The kappa value for inter-examiner agreement was 0.86 (95% CI, 0.81 to 0.91) for the 5-item CCS (large artery atherosclerosis, cardio-aortic embolism, small artery occlusion, other causes, and undetermined causes), 0.85 (95% CI, 0.80 to 0.89) with the undetermined group broken into cryptogenic embolism, other cryptogenic, incomplete evaluation, and unclassified groups (8-item CCS), and 0.80 (95% CI, 0.76 to 0.83) for a 16-item breakdown in which diagnoses were stratified by the level of confidence. The intra-examiner reliability was 0.90 (0.75–1.00) for 5-item, 0.87 (0.73–1.00) for 8-item, and 0.86 (0.75–0.97) for 16-item CCS subtypes. Conclusions— The web-based CCS allows rapid analysis of patient data with excellent intra- and inter-examiner reliability, suggesting a potential utility in improving the fidelity of stroke classification in multicenter trials or research databases in which accurate subtyping is critical.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.107.490896
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
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  • 7
    Online Resource
    Online Resource
    A Pilot Study of Normobaric Oxygen Therapy in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Stroke Vol. 36, No. 4 ( 2005-04), p. 797-802
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 4 ( 2005-04), p. 797-802
    Abstract: Background and Purpose— Therapies that transiently prevent ischemic neuronal death can potentially extend therapeutic time windows for stroke thrombolysis. We conducted a pilot study to investigate the effects of high-flow oxygen in acute ischemic stroke. Methods— We randomized patients with acute stroke ( 〈 12 hours) and perfusion-diffusion “mismatch” on magnetic resonance imaging (MRI) to high-flow oxygen therapy via facemask for 8 hours (n=9) or room air (controls, n=7). Stroke scale scores and MRI scans were obtained at baseline, 4 hours, 24 hours, 1 week, and 3 months. Clinical deficits and MR abnormalities were compared between groups. Results— Stroke scale scores were similar at baseline, tended to improve at 4 hours (during therapy) and 1 week, and significantly improved at 24 hours in hyperoxia-treated patients. There was no significant difference at 3 months. Mean (±SD) relative diffusion MRI lesion volumes were significantly reduced in hyperoxia-treated patients at 4 hours (87.8±22% versus 149.1±41%; P =0.004) but not subsequent time points. The percentage of MRI voxels improving from baseline “ischemic” to 4-hour “non-ischemic” values tended to be higher in hyperoxia-treated patients. Cerebral blood volume and blood flow within ischemic regions improved with hyperoxia. These “during-therapy” benefits occurred without arterial recanalization. By 24 hours, MRI showed reperfusion and asymptomatic petechial hemorrhages in 50% of hyperoxia-treated patients versus 17% of controls ( P =0.6). Conclusions— High-flow oxygen therapy is associated with a transient improvement of clinical deficits and MRI abnormalities in select patients with acute ischemic stroke. Further studies are warranted to investigate the safety and efficacy of hyperoxia as a stroke therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000158914.66827.2e
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
    detail.hit.zdb_id: 1467823-8
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