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  • 1
    Online Resource
    Online Resource
    Long-term prognosis and the effect of carotid endarterectomy in patients with recurrent ipsilateral ischemic events
    Ovid Technologies (Wolters Kluwer Health) ; 1996
    In:  Neurology Vol. 47, No. 5 ( 1996-11), p. 1158-1162
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 5 ( 1996-11), p. 1158-1162
    Abstract: Background and purpose: The present study examines how the prognosis of patients who present with an ischemic event (TIA or nondisabling stroke) referable to a 70 to 99% carotid artery stenosis is modified by the pattern of their ischemic history. We also examined the benefits of performing carotid endarterectomy on the recently symptomatic artery. Methods: A total of 608 patients was divided into two groups. The recent group (N = 444) consisted of patients who became newly symptomatic within the previous 6 months of their presenting event. Prior to this, they were asymptomatic. The recurrent group (N = 164) consisted of patients who had one or more ischemic events within the previous 6 months of their presenting event, as well as one or more within the previous 7 to 12 months. All events were ipsilateral to the presenting event. Results: Kaplan-Meier risk estimates of ipsilateral stroke at 2 years for medically treated patients were 18.6 +/- 3.3% in the recent group and 41.2 +/- 6.9% in the recurrent group (p = 0.0002, logrank test). For patients who underwent carotid endarterectomy, the risks were 7.8 +/- 2.0% and 10.8 +/- 3.4% (p = 0.36, logrank test). Multivariate analyses did not identify any baseline patient characteristics as confounders nor any statistical interactions. Conclusions: There is a need for urgency in considering carotid endarterectomy for patients with 70 to 99% carotid artery stenosis who have had recurrent ipsilateral ischemic events extending back more than 6 months. These patients are at more than twice the risk of stroke as those who are newly symptomatic. NEUROLOGY 1996;47: 1158-1162
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.47.5.1158
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 1996
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  • 2
    Online Resource
    Online Resource
    ASPECTS on CTA Source Images Versus Unenhanced CT : Added Value in Predicting Final Infarct Extent and Clinical Outcome
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Stroke Vol. 35, No. 11 ( 2004-11), p. 2472-2476
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 11 ( 2004-11), p. 2472-2476
    Abstract: Background and Purpose— The Alberta Stroke Program Early CT Score (ASPECTS) is a grading system to assess ischemic changes on CT in acute ischemic stroke. CT angiography–source images (CTA-SI) predict final infarct volume. We examined whether the final infarct ASPECTS and clinical outcome were more related to acute CTA-SI ASPECTS than to the acute noncontrast CT (NCCT) ASPECTS. Methods— ASPECTS was assigned by 2 raters on the acute NCCT, CTA-SI, and follow-up imaging. The mean baseline ASPECTS of acute NCCT and CTA-SI was compared with the follow-up ASPECTS. Rate ratios (RRs) were used to quantify the relationship between the dichotomized baseline ASPECTS (categorized as 0 to 7 versus 8 to 10) and favorable patient outcome. Results— Thirty-nine patients were recruited. Proximal occlusion (internal carotid artery or middle cerebral artery) was seen in 62%, M2 occlusion in 18%, and no occlusion was seen in 20% of patients. The median time between symptom onset and imaging was 1.9 (1.2 to 2.5) hours. There was a significantly larger difference of 1.4 between the mean baseline NCCT and CTA-SI ASPECTS in patients who had more ischemic changes (follow-up ASPECTS=0 to 3) than a difference of 0.6 in patients who had near-to-normal CT scans (follow-up ASPECTS=8 to 10). The rate of favorable outcome for acute NCCT ASPECTS of 8 to 10 was 51.8% versus 25.0% for 0 to 7 (RR, 2.1, 95% CI: 0.7 to 5.9, P =0.12). For acute CTA-SI ASPECTS of 8 to 10, the rate of favorable outcome was 58.8% versus 31.8% for 0 to 7 (RR, 1.8, 95% CI: 0.9 to 3.8, P =0.09). Conclusions— CTA-SI ASPECTS provides added information in the prediction of final infarct size.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000145330.14928.2a
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
    detail.hit.zdb_id: 1467823-8
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    Online Resource
  • 3
    Online Resource
    Online Resource
    MR Perfusion and Diffusion in Acute Ischemic Stroke: Human Gray and White Matter have Different Thresholds for Infarction
    SAGE Publications ; 2005
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 25, No. 10 ( 2005-10), p. 1280-1287
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 25, No. 10 ( 2005-10), p. 1280-1287
    Abstract: It is thought that gray and white matter (GM and WM) have different perfusion and diffusion thresholds for cerebral infarction in humans. We sought to determine these thresholds with voxel-by-voxel, tissue-specific analysis of coregistered acute and follow-up magnetic resonance (MR) perfusion- and diffusion-weighted imaging. Quantitative cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and apparent diffusion coefficient (ADC) maps were analyzed from nine acute stroke patients (imaging acquired within 6 h of onset). The average values of each measure were calculated for GM and WM in normally perfused tissue, the region of recovered tissue and in the final infarct. Perfusion and diffusion thresholds for infarction were determined on a patient-by-patient basis in GM and WM separately by selecting thresholds with equal sensitivities and specificities. Gray matter has higher thresholds for infarction than WM ( P 〈 0.009) for CBF (20.0 mL/100 g min in GM and 12.3 mL/100 g min in WM), CBV (2.4 mL/100 g in GM and 1.7 mL/100 g in WM), and ADC (786 × 10 −6 mm 2 /s in GM and 708 × 10 −6 mm 2 /s in WM). The MTT threshold for infarction in GM is lower ( P = 0.014) than for WM (6.8 secs in GM and 7.1 secs in WM). A single common threshold applied to both tissues overestimates tissue at risk in WM and underestimates tissue at risk in GM. This study suggests that tissue-specific analysis of perfusion and diffusion imaging is required to accurately predict tissue at risk of infarction in acute ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/sj.jcbfm.9600135
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2039456-1
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  • 4
    Online Resource
    Online Resource
    Assessing the benefits of hemicraniectomy: what is a favourable outcome?
    Elsevier BV ; 2007
    In:  The Lancet Neurology Vol. 6, No. 7 ( 2007-07), p. 580-
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 6, No. 7 ( 2007-07), p. 580-
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(07)70160-6
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2007
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  • 5
    Online Resource
    Online Resource
    Trial of Minocycline in a Clinically Isolated Syndrome of Multiple Sclerosis
    Massachusetts Medical Society ; 2017
    In:  New England Journal of Medicine Vol. 376, No. 22 ( 2017-06), p. 2122-2133
    Details
    In: New England Journal of Medicine, Massachusetts Medical Society, Vol. 376, No. 22 ( 2017-06), p. 2122-2133
    Type of Medium: Online Resource
    ISSN: 0028-4793 , 1533-4406
    URL: Article
    DOI: 10.1056/NEJMoa1608889
    RVK:
    XA 10000
    Language: English
    Publisher: Massachusetts Medical Society
    Publication Date: 2017
    detail.hit.zdb_id: 1468837-2
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  • 6
    Online Resource
    Online Resource
    Tests of Motor Function in Patients Suspected of Having Mild Unilateral Cerebral Lesions
    Cambridge University Press (CUP) ; 2002
    In:  Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques Vol. 29, No. 4 ( 2002-11), p. 337-344
    Details
    In: Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, Cambridge University Press (CUP), Vol. 29, No. 4 ( 2002-11), p. 337-344
    Abstract: Bien que différents manuels décrivent les manoeuvres cliniques qui aident à détecter des déficits moteurs subtiles, leur sensibilité, leur spécificité et leur valeur prédictive n’ont pas été déterminées. Nous avons examiné la sensibilité, la spécificité et la valeur prédictive de différentes manoeuvres dans le but de déterminer quel est l’épreuve ou la combinaison d’épreuves la plus sensible et fiable. Méthodes: Le chute lente d’un bras maintenu en extension (Barré), le pronation involontaire d’un bras maintenu en extension, la manoeuvre de Mingazzini, le finger tap, le forearm roll, la force segmentaire et les réflexes ostéotendineux ont été évalués chez 170 patients avec (86) et sans (84) lésion prouvée dans les zones motrices, confirmées par CT scan. Résultats: La force motrice segmentaire avait une bonne spécificité (97,5%) mais une faible sensibilité (38.9%) et une valeur prédictive négative (VPN) (58,7%). Le forearm roll avait un profile semblable. Le finger tap avait une sensibilité de 73,3% et une spécificité de 87,5%. Le Barré et le pronator drift avaient une sensibilité et une spécificité de 92,2% et 90,0% respectivement. L’hyperréflexie avait une sensibilité de 68,9% et une spécificité de 87,5%. Une anomalie du pronateur, des réflexes ou du finger tap avait une sensibilité de 97% et, quand ces épreuves étaient toutes positives, une spécificité de 97%. Quand les 6 épreuves étaient positives, la valeur prédictive positive (VPP) était de 100%, alors que quand les 6 épreuves étaient négatives, la VPN était de 100%. Conclusion: L’examen segmentaire détaillé a une très bonne spécificité pour détecter les déficits moteurs, mais la sensibilité et la VPN sont faibles et inacceptables. La combinaison d’épreuves la plus fiable et la plus efficace pour détecter des lésions motrices subtiles est le pronator drift, le finger tap et les réflexes. Cette combinaison pourrait remplacer l’examen moteur segmentaire comme outil de dépistage de lésions motrices.
    Type of Medium: Online Resource
    ISSN: 0317-1671 , 2057-0155
    URL: Article
    DOI: 10.1017/S0317167100002201
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2002
    detail.hit.zdb_id: 2577275-2
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  • 7
    Online Resource
    Online Resource
    Selection of Acute Ischemic Stroke Patients for Intra-Arterial Thrombolysis With Pro-Urokinase by Using ASPECTS
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 8 ( 2003-08), p. 1925-1931
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 8 ( 2003-08), p. 1925-1931
    Abstract: Background— Previous studies have suggested that baseline computed tomographic (CT) scans might be a useful tool for selecting particular ischemic stroke patients who would benefit from thrombolysis. The aim of the present study was to assess whether the baseline CT scan, assessed with the Alberta Stroke Program Early CT Score (ASPECTS), could identify ischemic stroke patients who might particularly benefit from intra-arterial thrombolysis of middle cerebral artery occlusion. Methods— Baseline and 24-hour follow-up CT scans of patients randomized within 6 hours of symptoms to intra-arterial thrombolysis with recombinant pro-urokinase or control in the PROACT-II study were retrospectively scored by using ASPECTS. Patients were stratified into those with ASPECTS 〉 7 or ≤7. Independent functional outcome at 90 days was compared between the 2 strata according to treatment assignment. Results— The analysis included 154 patients with angiographically confirmed middle cerebral artery occlusion. The unadjusted risk ratio of an independent functional outcome, in favor of treatment, in the ASPECTS 〉 7 group was 5.0 (95% confidence interval [CI], 1.3 to 19.2) compared with 1.0 (95% CI, 0.6 to 1.9) in the ASPECTS ≤7 group. After adjustment for baseline characteristics, the risk ratio in the ASPECTS score 〉 7 was 3.2 (95% CI, 1.2 to 9.1). Similar favorable treatment effects were observed when secondary outcomes were used, but these did not reach statistical significance. Conclusions— Ischemic stroke patients with a baseline ASPECTS 〉 7 were 3 times more likely to have an independent functional outcome with thrombolytic treatment compared with control. Patients with a baseline ASPECTS ≤7 were less likely to benefit from treatment. This observation suggests that ASPECTS can be both a useful clinical tool and an important method of baseline risk stratification in future clinical trials of acute stroke therapy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000082483.37127.D0
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1467823-8
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  • 8
    Online Resource
    Online Resource
    A Novel Method to Derive Separate Gray and White Matter Cerebral Blood Flow Measures from MR Imaging of Acute Ischemic Stroke Patients
    SAGE Publications ; 2005
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 25, No. 9 ( 2005-09), p. 1236-1243
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 25, No. 9 ( 2005-09), p. 1236-1243
    Abstract: Perfusion-weighted imaging (PWI) measures can predict tissue outcome in acute ischemic stroke. Accuracy might be improved if differential tissue susceptibility to ischemia is considered. We present a novel voxel-by-voxel analysis to characterize cerebral blood flow (CBF) separately in gray (GM) and white matter (WM). Ten patients were scanned with inversion-recovery spin-echo EPI (IRSEPI), diffusion-weighted imaging (DWI), PWI 〈 6 h from onset and fluid attenuated inversion-recovery (FLAIR) at 30 days. Image processing included coregistration to PWI, automatic segmentation of IRSEPI into GM, WM and CSF and semiautomatic segmentation of DWI/FLAIR to derive the acute and 30-day lesions. Five tissue compartments were defined: (1) ‘Core’ (abnormal acutely and at 30 days), (2) ‘Growth’ (or ‘infarcted penumbra', abnormal only at 30 days), (3) ‘Reversed’ (abnormal acutely but normal at 30 days), (4) ‘MTT-Delayed ‘ (tissue with delayed mean transit time but not part of the acute or 30-day lesion), and (5) ‘Normal’ brain. Cerebral blood flow in GM and WM of each compartment was obtained from quantitative maps. Gray matter and WM mean CBF in the growth region differed by 5.5 mL/100 g min ( P = 0.015). Mean CBF also differed significantly within normal and MTT-Delayed compartments. The difference in the reversed region approached statistical significance. In core, GM and WM CBF did not differ. The results suggest separate ischemic thresholds for GM and WM in stroke penumbra.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/sj.jcbfm.9600130
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2039456-1
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  • 9
    Online Resource
    Online Resource
    Throw Away the Aspirin and Take Nonsteroidal Anti-Inflammatory Drugs for the Primary Prevention of Myocardial Infarction
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Circulation Vol. 109, No. 7 ( 2004-02-24)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 109, No. 7 ( 2004-02-24)
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.0000116422.70266.A8
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
    detail.hit.zdb_id: 1466401-X
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  • 10
    Online Resource
    Online Resource
    Triaging transient ischemic attack and minor stroke patients using acute magnetic resonance imaging
    Wiley ; 2005
    In:  Annals of Neurology Vol. 57, No. 6 ( 2005-06), p. 848-854
    Details
    In: Annals of Neurology, Wiley, Vol. 57, No. 6 ( 2005-06), p. 848-854
    Abstract: We examined whether the presence of diffusion‐weighted imaging (DWI) lesions and vessel occlusion on acute brain magnetic resonance images of minor stroke and transient ischemic attack patients predicted the occurrence of subsequent stroke and functional outcome. 120 transient ischemic attack or minor stroke (National Institutes of Health Stroke Scale ≤ 3) patients were prospectively enrolled. All were examined within 12 hours and had a magnetic resonance scan within 24 hours. Overall, the 90‐day risk for recurrent stroke was 11.7%. Patients with a DWI lesion were at greater risk for having a subsequent stroke than patients without and risk was greatest in the presence of vessel occlusion and a DWI lesion. The 90‐day risk rates, adjusted for baseline characteristics, were 4.3% (no DWI lesion), 10.8% (DWI lesion but no vessel occlusion), and 32.6% (DWI lesion and vessel occlusion) ( p = 0.02). The percentages of patients who were functionally dependent at 90 days in the three groups were 1.9%, 6.2%, and 21.0%, respectively ( p = 0.04). The presence of a DWI lesion and a vessel occlusion on a magnetic resonance image among patients presenting acutely with a transient ischemic attack or minor stroke is predictive of an increased risk for future stroke and functional dependence. Ann Neurol 2005;57:848–854
    Type of Medium: Online Resource
    ISSN: 0364-5134 , 1531-8249
    URL: Issue
    URL: Article
    DOI: 10.1002/ana.v57:6
    DOI: 10.1002/ana.20497
    Language: English
    Publisher: Wiley
    Publication Date: 2005
    detail.hit.zdb_id: 2037912-2
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