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Biomedical subjects

Olli Häppölä

Publications and source records attributed to Olli Häppölä.

7 recordsLinked to original sources
PubMed2006

Induced hypertension for the treatment of acute MCA occlusion beyond the thrombolysis window: case report.

BACKGROUND: A minority of stroke patients is eligible for thrombolytic therapy. Small pilot case series have hinted that elevation of incident arterial blood pressure might be associated with a favorable prognosis either in acute or subacute stroke. However, these patients were not considered for thrombolytic therapy and were not followed - up systematically. We used pharmacologically induced hypertension in a stroke patient with middle cerebral artery (MCA) occlusion ineligible for thrombolysis that was followed-up by radiological, clinical and functional outcome assessment. CASE PRESENTATION: A patient with acute embolic MCA occlusion producing a large, ischemic penumbra confirmed by perfusion CT was treated by induced hypertension with phenylephrine started within 4 h of admission. Increase in the mean arterial pressure by 20% led to a reduction of neurological deficit by 3 points on the National Institute of Stroke Scale. MRI and CT scans performed during phenylephrine infusion showed the presence of limited subcortical and cortical infarct changes that were clearly less extensive than the perfusion deficit in the brain perfusion CT at baseline, found in the absence of MCA patency. No complications due to induced hypertension therapy occurred. Moderate functional improvement up to modified Rankin scale 2 at follow up took place. CONCLUSION: Induced hypertension in acute ischemic stroke seems clinically feasible and may be beneficial in selected normo- or hypotensive stroke patients not eligible for thrombolytic recanalization therapy.

Acute Disease↗
PubMed2006

Source estimation of spontaneous MEG oscillations in mild cognitive impairment.

Mild cognitive impairment (MCI) is a memory disorder often preceding Alzheimer's disease (AD). AD has been shown to be associated with abnormal generation of spontaneous electromagnetic activity. We investigated whether the cortical generation of spontaneous brain oscillations in MCI shows changes resembling those observed in AD. A minimum current estimates algorithm was applied to identify cortical sources of magnetoencephalographic (MEG) spontaneous brain oscillations in male MCI patients with a clear memory disorder and in healthy elderly controls. This data was subsequently compared to a male subsample of AD patients from an earlier study. While there were clear oscillatory abnormalities in AD patients, there was no evidence of significant changes in the alpha source distribution in MCI patients as compared to healthy controls. Deficits in the distribution of oscillatory sources in the resting state are thus likely to occur at later stages of cognitive impairment than MCI.

Aged↗
PubMed2004

Long-term outcome after intravenous thrombolysis of basilar artery occlusion.

CONTEXT: Basilar artery occlusion (BAO) is an infrequent disease with high morbidity and mortality. Intra-arterial thrombolysis is advocated for treatment but is limited to use at specialized centers. OBJECTIVE: To evaluate outcomes for patients with BAO treated with intravenous thrombolytic therapy. DESIGN, SETTING, AND PARTICIPANTS: During 1995 to 2003, 50 consecutive patients with angiographically proven BAO were treated according to an institutional therapy protocol based on intravenous thrombolysis with recombinant tissue plasminogen activator (alteplase). Patients were treated at an urban university teaching hospital receiving all patients with ischemic stroke who were considered for thrombolysis in a catchment area of 1.5 million inhabitants in Helsinki, Finland. INTERVENTION: Intravenous administration of alteplase (0.9 mg/kg) during a 1-hour infusion. MAIN OUTCOME MEASURES: Basilar artery recanalization determined by magnetic resonance angiography and clinical outcomes at 3 months and at 1 year or longer determined by modified Rankin Scale and Barthel Index scores. RESULTS: Recanalization was studied in 43 patients and verified in 26 (52%) of all patients. By 3 months, 20 patients (40%) had died while 11 had good outcomes (modified Rankin Scale score, 0-2); 12 (24%) reached independence in activities of daily living (Barthel Index score, 95-100), and 6 (16%) were severely disabled (Barthel Index score, 0-50). In the long term (median follow-up 2.8 years), 15 patients (30%) reached good outcomes (modified Rankin Scale score, 0-2) while 23 (46%) died. CONCLUSIONS: Intravenous administration of alteplase for patients with BAO appears to be associated with rates of survival, recanalization, and independent functional outcome comparable with those reported with endovascular approaches. These data suggest that a randomized trial is needed to compare these approaches for treatment of BAO.

Adult↗
PubMed2004

A follow-up study found that cardiovascular risk in middle age predicted mortality and quality of life in old age.

OBJECTIVE: Cardiovascular risk reduction, while saving lives, may prolong the time with disability and impair the quality of life in survivors. We compared the consequences of middle age cardiovascular risk in old age. STUDY DESIGN AND SETTING: In 1974, risk was low in 593 (low-risk group) and high in 610 men (high-risk group). At baseline, all were healthy with similar age and socioeconomic status. Lifestyle and clinical factors, including quality of life (RAND-36), were surveyed with a questionnaire in 2000, and mortality was determined up to 2002. RESULTS: During the follow-up, 303 men died, with mortality 54% higher in the high-risk group (P=.001). In the 2000 survey, high-risk men still had significantly greater BMI, higher blood glucose, higher prevalence of smoking, and more sedentary lifestyle, and they reported more both cardiovascular and noncardiovascular diseases. All the RAND-36 scales were worse in the high-risk group; of the two component summary scores, physical (PCS), but not mental (MCS) score, was significantly lower in the high-risk group. CONCLUSION: Low cardiovascular risk in middle age was associated with lower mortality, morbidity, and better quality of life in old age 26 years later. The results may support the theory of compression of morbidity.

Aged↗
PubMed2003

Community-based thrombolytic therapy of acute ischemic stroke in Helsinki.

BACKGROUND AND PURPOSE: Thrombolysis with alteplase is used in acute ischemic stroke within 3 hours after symptom onset in many stroke centers, but experience remains limited in Europe. METHODS: Using eligibility and management criteria similar to those published by the American Heart Association, we treated 75 consecutive patients aged 21 to 83 years (mean age, 63.6 years; median Scandinavian Stroke Scale score, 32/58) with hemispheric infarction with alteplase in 1998-2001. Their neuroradiological findings (ischemic and hemorrhagic changes) and functional outcome at 3 months were evaluated. RESULTS: Sixty-one percent of the patients had recovered functional independence (Barthel Index 95 to 100) at the 3-month follow-up. On the modified Rankin Scale (mRS), 37% (28/75) of patients had no or minimal symptoms (mRS 0 to 1), while 17% (13/75) remained dependent (mRS 4 to 5) and 5% (4/75) died. Cerebral parenchymal hematomas occurred in 8% (6/75) and hemorrhagic transformation in 8% (6/75) of the patients. Low initial diastolic blood pressure and administration of intravenous antihypertensive medication were associated with unfavorable outcome (mRS 3 to 6). CONCLUSIONS: We conclude that our management protocol for thrombolytic therapy is safe. These rates of functional outcome, case fatality, and hemorrhagic cerebral events compare favorably with those of other published series of stroke thrombolysis with similar time windows and management guidelines. Associations between blood pressure and its treatment during thrombolysis with functional outcome deserve further analysis.

Academic Medical Centers↗