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M Brainin

Publications and source records attributed to M Brainin.

At least 19 recordsLinked to original sources
PubMed1998

[Medial medullary infarct].

Medial medullary infarct is a rare type of brain stem infarction first described in 1908. It was only since the broad use of MRI that an accurate clinical topographical correlation could be documented in survivors. We observed two patients; one of them had an anteromedial unilateral infarction in the upper medulla, and the clinical picture was characterized by contralateral hemiparesis, facial weakness, dysarthria and palatal weakness. The outcome was good. The second patient however showed a severe tetraparesis with only minor brain stem signs, secondary to bilateral anteromedian infarction with a large craniocaudal extension. He survived with severe residual impairment. The most likely cause of infarction was arteriosclerosis of the A. vertebralis and A. spinalis anterior, respectively. These two different cases suggest that the medial medullary syndrome is heterogeneous comprising small unilateral infarctions with mild clinical signs as well as large bilateral infarctions with a poor outcome.

Aged↗
PubMed1998

Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. ELAT Study Group. Embolism in Left Atrial Thrombi.

BACKGROUND: Transesophageal echocardiography visualizes the left atrium and its appendage, thrombi, and spontaneous echocardiographic contrast. OBJECTIVE: To assess the association of transesophageal echocardiographic characteristics with stroke or embolism in atrial fibrillation. DESIGN: Multicenter observational follow-up study. SETTING: Hospitals in Austria and Slovakia. PATIENTS: 409 outpatients with nonrheumatic atrial fibrillation and without recent stroke. INTERVENTION: Patients with thrombi received anticoagulation, and patients without thrombi received aspirin. MEASUREMENTS: Primary events were stroke or embolism. Secondary events were death not caused by stroke or embolism and need for anticoagulation. RESULTS: In the left atrium or left atrial appendage, 10 patients (2.5%) had thrombi and 47 (12%) had spontaneous echocardiographic contrast. The appendage had a mean (+/- SD) length of 44+/-10 mm, a mean width of 23+/-6 mm, and a mean area of 5.8+/-2.5 cm2. Follow-up ranged from 1 to 74 months (mean, 58 months). Fifty patients had stroke or embolism, 53 died of a cause other than stroke or embolism, and 38 required anticoagulation. On univariate analysis, thrombi (risk ratio, 3.9 [95% CI, 1.4 to 10.1]; P = 0.009), length of the left atrial appendage (risk ratio, 1.6 [CI, 1.05 to 2.5]; P = 0.03), and width of the left atrial appendage (risk ratio, 2.4 [CI, 1.2 to 4.81; P = 0.01) were associated with stroke or embolism. Multivariate analysis identified hypertension (risk ratio, 3.6 [CI, 1.8 to 8.4]; P = 0.001), previous stroke (risk ratio, 3.7 [CI, 1.5 to 7.5]; P = 0.002), and age (risk ratio, 1.1 [CI, 1.0 to 1.11; P < 0.001) as risk factors for stroke or embolism and provided evidence of an association between thrombi and stroke or embolism (risk ratio, 2.4 [CI, 0.9 to 6.9]; P = 0.09). CONCLUSIONS: In outpatients with atrial fibrillation and without recent stroke, thrombi of the left atrium or left atrial appendage and length and width of the left atrial appendage were associated with stroke or embolism in univariate analysis. In a multivariate analysis, age, hypertension, and previous stroke were risk factors for stroke or embolism, and thrombi of the left atrium or left atrial appendage were possible risk factors. In these patients, history may be more useful than transesophageal echocardiography for the assessment of embolic risk.

Atrial Fibrillation↗
PubMed1998

Parkinsonism and dystonia in central pontine and extrapontine myelinolysis.

Parkinsonism as well as dystonic signs are rarely seen in central pontine myelinolysis and extrapontine myelinolysis. A 51 year old woman developed central pontine myelinolysis and extrapontine myelinolysis with parkinsonism after severe vomiting which followed alcohol and drug intake, even though marked hyponatraemia had been corrected gradually over six days. Parkinsonism resolved four months after onset, but she then exhibited persistent retrocollis, spasmodic dysphonia, and focal dystonia of her left hand. Although the medical literature documents three similar patients, this patient is different as dystonic symptoms only developed four months after parkinsonian signs had resolved.

Caudate Nucleus↗
PubMed1998

Hypervolemic hemodilution in acute ischemic stroke: the Multicenter Austrian Hemodilution Stroke Trial (MAHST).

BACKGROUND AND PURPOSE: Experimental studies suggest a beneficial effect of hemodilution on acute ischemic stroke. This was not proven by previous multicenter trials in the clinical setting. Various reasons have been suggested for the failure of these studies, which we attempted to consider in the Multicenter Austrian Hemodilution Stroke Trial (MAHST). METHODS: MAHST is a randomized, double-blind, placebo-controlled study of hypervolemic hemodilution (HHD) within 6 hours of a clinically first ischemic stroke localized in the middle cerebral artery territory. The treatment consisted of 10% hydroxyethyl starch 200/0.5 (HES) and was tested against pure rehydration with Ringer's lactate over a period of 5 days. Our primary outcome measure was clinical improvement within 7 days as measured by the Graded Neurologic Scale (GNS). We performed an adaptive interim analysis to reevaluate the study goal after entering half of the projected number of patients (n = 200). At least 600 patients per group would have been required for significant results, and therefore we decided to terminate the trial. RESULTS: Ninety-eight patients received HHD and 102 patients placebo. The baseline characteristics were comparable between both groups. In the HHD group the absolute reduction of the hematocrit was 2.5% on day 2 with a maximum of 3.7% on day 5, which compares with a reduction in the placebo group of 1% and 1.9%, respectively. Intention-to-treat analysis showed no significant difference of the change of the GNS scores between HHD-treated (median, -8.5; 95% confidence interval, -14.2 to -4.0) and placebo-treated patients (median, -6.0; 95% confidence interval, -11.0 to 0.0) on day 7, and GNS scores remained similar in both treatment groups throughout the trial. At 3 months, slightly more HHD patients showed complete independence on the Barthel Index (28 versus 24), and fewer HHD than placebo patients had died (13 versus 17), but these differences were not statistically significant. HHD treatment was not associated with any specific adverse event. CONCLUSIONS: Mild HHD is safe but failed to demonstrate a significant beneficial effect over the pure rehydration regimen in patients with acute ischemic stroke.

Aged↗
PubMed1998

Patent foramen ovale size and embolic brain imaging findings among patients with ischemic stroke.

BACKGROUND AND PURPOSE: Although the cause of stroke among patients with patent foramen ovale (PFO) may be due to paradoxical cerebral embolism (PCE), this mechanism is often difficult to prove. The aim of our study was to evaluate the association between brain imaging findings suggestive of embolism and PFO among ischemic stroke patients. METHODS: As part of the Northern Manhattan Stroke Study, 95 patients with first ischemic stroke over age 39 underwent transesophageal echocardiography (TEE) for evaluation of a cardiac source of embolism. The stroke subtype was determined by modified NINDS Stroke Data Bank criteria. Stroke subtype and MRI/CT imaging data were evaluated blind to the presence of a PFO. These findings were compared between two groups: patients with medium to large PFO (> or =2 mm) and small (<2 mm) or no PFO. RESULTS: Of the 95 patients who underwent TEE, 31 (33%) had a PFO. The frequency of PFO was significantly greater among patients with cryptogenic infarcts (19 of 42; 45%) compared with patients with determined cause of stroke (12 of 53, 23%; P=0.02). Medium to large PFOs were found more often among cryptogenic strokes than among infarcts of determined cause (26% versus 6%; P=0.04). Superficial infarcts occurred more often in the group with larger PFOs than in the group with small or no PFOs (50% versus 21%; P=0.02). Patients with medium or large PFOs more frequently had occipital and infratentorial strokes (57% versus 27%; P=0.02). CONCLUSIONS: Stroke patients with larger PFOs show more brain imaging features of embolic infarcts than those with small PFOs. Larger PFOs may be more likely to cause paradoxical embolization and may help explain the stroke mechanism among patients with no other definite cause.

Aged↗
PubMed1997

[Research possibilities of stroke databanks].

Stroke data banks (SDBS) have a growing importance in clinical research. They can be applied to a multitude of clinical issues. Hospital-based uni- or multicentered SDBS usually focus on syndromatology, pathogenesis and etiology. In contrast, classical epidemiological studies center upon complete case ascertainment within a geographically defined area (stroke registry). SDBS differ from conventional case series by their systematic collection of data within a specified time frame. Their main importance is the possibility to generate hypotheses quickly and cost-effectively. These hypotheses can serve as a basis for further prospective clinical studies. SDBS also show an important interaction with the design and conduct of clinical trials.

Austria↗
PubMed1997

[Stroke prevention with a high risk strategy of treating hypertension in patients after a transient ischemic attack].

High-risk strategies represent important preventive measures that focus on individuals with a defined high risk of suffering a chronic disease. They are valuable in addition to measures of prevention within the general population. One example for a high-risk approach for stroke prevention is the treatment of hypertension in individuals that have previously suffered a transient ischemic attack (TIA). Data from the Klosterneuburg Stroke Data Bank and other sources enable an estimate of 2000 TIAs occurring in Austria each year, half of them being hypertensives that are mostly not treated or not sufficiently treated for their hypertension. A high-risk programme that implies forced and effective treatment of hypertension would prevent some 400 strokes or 3% of 16,000 first-ever strokes per year. Costs for preventing one stroke by means of Betablocker agents would amount to ATS 3500 and by ACE-inhibitor agents ATS 11,500, respectively. In addition to general preventive measures, such a programme would have an important impact on stroke incidence and public health.

Adrenergic beta-Antagonists↗
PubMed1997

[Modification of risk factors after cerebral infarct: results of the Klosterneuburg Stroke Databank].

A number of studies have shown that reduction of elevated blood pressure and other major risk factors are essential for the primary prevention of stroke. In contrast, only sparce data exist as to the reduction of risk factors in secondary prevention although many patients are only ready to modify their lifestyle after having suffered a stroke. This study reports the results of the one-year follow-up examinations from the Klosterneuburg Stroke Data Bank, a prospective, hospital-based registry. Out of 870 stroke survivors (97.4% follow-up rate) registered between 1988 and 1994 575 patients (69%) had been hypertensive before their index stroke. Out of these, 112 hypertensives (19.7% of all hypertensives) had not received antihypertensive treatment before their index stroke. Compared to all other hypertensive stroke patients they were significantly younger (p = 0.01), more often regular drinkers (p = 0.01), and regular smokers (p = 0.007). They showed significantly less heart diseases (p = 0.03) as well as prior strokes (p = 0.006). 12 months after the index-stroke the rate of untreated hypertension in this group fell to 6.0% (34 patients). In the latter group there were more frequent prior strokes compared to those hypertensives who started regular treatment after their index stroke (p = 0.003). Out of 221 smokers only 115 (52%) had quit smoking within one year after the index-stroke and 110 out of 270 (40.7%) stroke patients that had had regular alcohol intake had stopped drinking. 42 out of 118 (36%) patients who had been regular drinkers and smokers continued to drink and smoke. Regular intake of aspirin was noted more often in those patients who also had regular blood pressure checks (p = 0.009) and regular antihypertensive treatment (p = 0.001). It is concluded that there is insufficient modification of risk factors after stroke and controlled interventional studies in secondary stroke prevention are an important issue.

Aged↗
PubMed1997

[Embolism in left-atrial thrombi (ELAT Study): are spontaneous echo contrast, thrombi in the left atrium/appendage and size of the left atrial appendage predictors of possible embolisms?].

Transesophageal echocardiography visualizes the left atrium, the left atrial appendage, thrombi and spontaneous echo contrast within them. The role of these findings as predictors for embolism in atrial fibrillation is unknown. We performed transesophageal echocardiography in 409 non-rheumatic atrial fibrillation outpatients (62 +/- 12 years, 36% female) with no recent (< 1 year) history of embolism. Patients with left atrial/appendage thrombi received oral anticoagulation, those without thrombi Aspirin. The patients were followed up over 2 years. Primary events were stroke, embolism and non stroke/embolism related deaths. Secondary events were initiation of anticoagulation in patients primarily assigned to Aspirin. Left atrial/appendage thrombi were diagnosed in 2.5%. They were associated with diabetes, heart failure and decreased left ventricular fractional shortening (p < 0.05 for each variable). Spontaneous echo contrast was diagnosed in 12%. It was associated with increased age, constant atrial fibrillation, hypertension, heart failure, valvular abnormalities and increased left atrial diameter (p < 0.05 for each variable). Increased left atrial appendage size was associated with constant atrial fibrillation, etiology of atrial fibrillation and valvular abnormalities (p < 0.05 for each variable). Follow-up was 25 +/- 7 months. 29 patients suffered a stroke, 33 further patients died of non stroke/embolism related causes. Secondary events occurred in 19 patients. Neither left atrial/appendage thrombi nor left atrial appendage size were predictors for embolism. Predictors for embolism were increased age (p = 0.003), hypertension (p = 0.01) and increased diastolic blood pressure (p = 0.04). In non-rheumatic atrial fibrillation outpatients with no recent history of embolism, transesophageal echocardiography is of limited value to assess embolic risk. Hypertension and increased diastolic blood pressure have been confirmed in their significance as clinical predictors for embolism.

Aged↗
PubMed1995

Embolic stroke and transoesophageal echocardiography: can clinical parameters predict the diagnostic yield?

The study was performed to determine whether age, cardiovascular risk factors or the stroke syndrome might define patients with embolic stroke for whom transoesophageal echocardiography (TEE) would prove to be useful. Of 256 patients from the Klosterneuburg Stroke Data Bank, 105 (40%) were included because of suspected embolic stroke (59 female, 46 male, mean age 64 years). A positive TEE finding was defined as the presence of left heart thrombus, valvular vegetation, right to left shunting or spontaneous echo contrast. TEE detected potential sources for embolism in 35 of the 105 patients. These were left atrial/appendage thrombi (n = 18), valvular vegetations (n = 4), right to left shunting (n = 10), and spontaneous echo contrast (n = 5). Only the presence of atrial fibrillation showed a significant association with the presence of a cardiac source of embolism (18/35 versus 22/70, P < 0.02). Age, cardiac disease, cardiovascular risk factors and the stroke syndrome did not help in distinguishing stroke patients with and without a positive TEE finding.

Adult↗
PubMed1995

Silent brain infarcts and transient ischemic attacks. A three-year study of first-ever ischemic stroke patients: the Klosterneuburg Stroke Data Bank.

BACKGROUND AND PURPOSE: We undertook to study the clinical relevance of silent strokes and history of transient ischemic attacks (TIAs) and their individual and combined effects on outcome variables of neurological and epidemiological interest in first-ever stroke patients. METHODS: We performed univariate and multivariate analyses of data prospectively collected in the Klosterneuburg Stroke Data Bank, a hospital-based registry in Austria that includes a 3-year follow-up program. RESULTS: Of 728 patients (mean age, 68 +/- 10 years) with a first-ever ischemic stroke, 110 (15%) had had a previous TIA, and 66/618 (11%) patients did not have a history of TIA but showed evidence of silent brain infarct on CT. Outcome variables of neurological interest were not significantly different between groups, including time between stroke and study entry, activities of daily living status at first presentation, median time of hospitalization, 30-day mortality, or 3-year mortality. Univariate analyses of epidemiologically important risk factors showed either history of TIA or evidence of silent infarct to be more frequently associated with hypertension (P = .007). Cox models of survival showed that neither history of TIA nor evidence of silent infarct were significantly associated with an increase in 3-year mortality. CONCLUSIONS: Over a period of 3 years, neither history of TIA nor evidence of silent infarct diagnosed at the time of the presenting major stroke in first-ever ischemic stroke patients exert an important influence on neurological or epidemiological outcome variables.

Adult↗
PubMed1995

[Antihypertensive therapy in stroke: acute therapy, primary and secondary prevention].

Arterial hypertension represents the single most important treatable risk factor for stroke, therefore antihypertensive treatment is crucial. Observational studies have shown that in the acute phase of an ischemic stroke blood pressure is elevated during the first few days and helps to restore cerebral perfusion, activates collateral arterial supply and enhances the treatment goal of minimizing infarct size. Especially for acute ischemic strokes with stable deficits drug treatment of hypertension therefore is recommended only at systolic pressures of > or = 220 mm Hg or with diastolic pressures of > or = 120 mm Hg except when heart, lung or renal failure are also present. In primary prevention of stroke there is a large potential for hypertension treatment which reduces the relative risk by 42%. Especially elderly people with moderate hypertension should be treated. One vascular event per year can be avoided in 100 patient treatment years. Only scarce data exist on secondary prevention of stroke which show that hypertension treatment has a major importance for the modification of risk factors.

Acute Disease↗
PubMed1994

Overview of stroke data banks.

Stroke data banks (SDBs) used for clinical research are between traditional case series and population-based studies. They can serve a multitude of purposes: estimating the burden of disease treated in one or several centers, calculating the recruitment rates for clinical trials, or for the detection of stroke incidence or time trends by means of a long-time observation in a defined geographical area. Some SDBs restrict themselves to the systematic collection of rare cases of stroke or to recurring strokes. The strength of an SDB lies in its ability to accumulate a large set of data within specified time frames using a defined set of diagnostic procedures. One of the most attractive features of an SDB is its generation of research hypotheses that allow one to look for similar patterns in related and in unrelated disorders. The overview in this volume is based on a literature search of SDBs published since 1980 and a questionnaire sent to the principal investigators applying ten criteria considered essential for clinical research: diagnostic criteria, separate analysis of first-ever strokes, CT investigation rate > 70%, integration of autopsy data, collection of prospective data wherever possible, planning of a pilot phase and interrater studies, constant screening procedures to identify patients enrolled and constant time frame of examinations, a large spectrum of clinical and investigative data, 12 months' follow-up examinations, and a baseline paper describing the procedures used. When applying these criteria to the literature only 8 SDBs fulfilled them.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain↗
PubMed1994

Cardioembolic stroke: results from three current stroke data banks.

About 17% of all transient ischemic attacks (TIA) and ischemic strokes were due to cardiogenic embolism in three prospective stroke registries (Berlin, Giessen, Klosterneuburg). Most of these patients can be identified by history, clinical examination, conventional ECG, and appropriate use of echocardiography. Widespread screening of stroke patients with transesophageal echocardiography, as intented in the protocol of two registries, did not appreciably increase the portion of patients with the final diagnosis of cardiogenic embolism, although, in many cases, minor-risk embolic sources can be identified. Prognosis for death or early recurrence after cardiogenic brain embolism was not worse than assumed previously.

Adult↗
PubMed1992

Stroke subtype is an age-independent predictor of first-year survival.

The short-term outcome after acute stroke is known to be strongly dependent on stroke subtype, especially favoring patients having suffered a lacunar stroke. The value of stroke subtypes as long-term predictors of survival has not been firmly established. We therefore examined the 1-year survival from acute stroke in the Klosterneuburg Stroke Data Bank, which since 1988 systematically collects data on acute stroke patients treated in one center in Lower Austria. The cumulative survival of 398 consecutive patients (mean age 67.7 +/- SD 11.6) 1 year after a first-ever stroke was not only adversely related to age but also appeared to be age independent when compared according to stroke subtypes. The cumulative survival rates (CSR) ranged from 88.7 [95% confidence interval (CI): 82-92] for lacunar strokes (n = 107) to 68.1 (CI: 50-79) for atherothrombotic strokes (n = 69). Cardiogenic embolism (n = 68) showed a CSR of 72.1 (CI: 61-83) similar to the group of cryptogenic strokes (n = 121, CSR: 74.4, CI: 67-82). The CSR for primary intracerebral hemorrhage (n = 33) was 68.8 (CI: 53-85). It is concluded that the comparatively favorable prognosis of lacunar strokes must be recognized in trials designed to evaluate efficacy in terms of 1-year mortality. Furthermore, as cryptogenic stroke has an almost identical survival rate when compared to strokes caused by cardiogenic embolism it may be assumed that a considerable number of strokes for which no cause can be found are, in fact, cardiogenic embolic.

Age Factors↗
PubMed1992

[Clinical aspects and diagnosis of cerebral hemorrhage].

Primary intracerebral hemorrhages are often dramatic and lethal. Therapeutic possibilities are limited. Multivariate studies show that patient age, hematoma volume, ventricular extension of the hemorrhage, and level of consciousness are the decisive prognostic parameters. This overview shows that the etiological spectrum is larger than suggested by the classic paradigm of "either hypertensive or cryptic angioma". The variability of clinical presentation can be put into a systematic order by means of clinical neurological examination and imaging techniques. Experiences with 62 consecutive cases from the Klosterneuburg Stroke Data-Bank are reported.

Cerebral Hemorrhage↗