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Biomedical subjects

P Lyrer

Publications and source records attributed to P Lyrer.

At least 19 recordsLinked to original sources
PubMed2005

IV thrombolysis in patients with acute stroke due to spontaneous carotid dissection.

The authors reviewed the histories of 33 patients (ages 44 to 50 years) treated with IV thrombolysis for acute stroke due to spontaneous cervical carotid artery dissection. Median NIH Stroke Scale (NIHSS) score on admission was 15. No new or worsened local signs, subarachnoid hemorrhage, pseudoaneurysm formation, or rupture of the cervical ICA were observed. At 3 months, median NIHSS was 7 and median modified Rankin Scale (mRS) 2.5; mRS < or = 2 was observed in 17 patients.

Adult↗
PubMed2004

Alpha-1-antitrypsin deficiency alleles are not associated with cervical artery dissections.

The authors searched for the presence of alpha-1-antitrypsin (AAT) deficiency alleles PiZ and PiS in 74 patients with spontaneous cervical artery dissections (sCADs) and in 74 healthy control subjects. In both groups, the authors found four carriers of deficiency alleles. The connective tissue morphology of one additional patient with sCAD with PiZM genotype and her relatives was studied in skin biopsies. The PiZ allele did not segregate with morphologic alterations of the dermal connective tissue in the family. Therefore, AAT deficiency alleles may not play a role in the etiology of sCAD.

Adult↗
PubMed2003

Antiplatelet therapy for preventing stroke and other vascular events after carotid endarterectomy.

BACKGROUND: Antiplatelet drugs are effective and safe in a wide variety of patients at high risk of vascular ischaemic events. Among patients undergoing vascular surgical procedures, these agents significantly reduce the risk of graft or native vessel occlusion. In this context we wished to examine their effects in patients after carotid endarterectomy (CEA). OBJECTIVES: The objective of this review was to evaluate whether antiplatelet agents are safe and beneficial after endarterectomy of the internal carotid artery. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched: 1 October 2002). In addition we performed comprehensive searches of the Cochrane Controlled Trials Register (Cochrane Library Issue 3, 2002), MEDLINE (January 1966 to September 2002) and EMBASE (January 1980 to September 2002), and checked all relevant papers for additional eligible studies. SELECTION CRITERIA: We selected randomised, controlled, unconfounded trials comparing antiplatelet agents with control after carotid endarterectomy in symptomatic or asymptomatic carotid stenosis of different degrees. Treatment duration had to be at least 30 days after CEA. Follow-up should be at least three months. DATA COLLECTION AND ANALYSIS: Two reviewers selected trials for inclusion, assessed trial quality, and extracted data independently from each other. From each trial we extracted, first the number of patients originally allocated to each treatment group, and, second the number of patients who met the criteria for each outcome (intention-to-treat analysis). We calculated a weighted estimate of the odds for each outcome event across studies using the Peto odds ratio method. MAIN RESULTS: Six trials involving 907 patients were identified. For 'death (all causes)' the Peto odds ratio of 0.77 with a 95% confidence interval (CI) of 0.48-1.24 did not show a statistically significant difference between both treatment groups. For 'stroke (any)' the Peto odds ratio of 0.58 (95%CI: 0.34-0.98) indicated a statistically significant benefit in favour of antiplatelet drugs (p=0.04). Concerning the secondary outcome events 'vascular death', 'stroke or vascular death', 'serious vascular events', 'death or dependency', 'myocardial infarction', 'major extracranial haemorrhage', 'local haemorrhage requiring surgery', 'restenosis', 'TIA or amaurosis fugax', neither any benefit nor any hazard of antiplatelet drugs could be shown. For the outcome events 'intracranial haemorrhage', 'ischaemic stroke' and 'occurrence or progression of contralateral stenosis', data were either too sparse for meaningful analyses, or not available at all. REVIEWER'S CONCLUSIONS: Our results may indicate that antiplatelet drugs did not significantly change the odds of 'death' but reduce the outcome 'stroke of any cause' in patients undergoing carotid endarterectomy. However, it can not be excluded that the beneficial effect in reducing stroke is due to chance. There is a suggestion that antiplatelets may increase the odds of haemorrhage, but there are currently too few data to quantify this effect.

Amaurosis Fugax↗
PubMed2003

Recurrent post-partum seizures after epidural blood patch.

There are many causes for headaches after childbirth. Even though postdural puncture headache (PDPH) has to be considered in a woman with a history of difficult epidural anaesthesia, pre-eclampsia should always be excluded as an important differential diagnosis. We report a case with signs of late-onset pre-eclampsia where administration of an epidural blood patch (EBP) was associated with eclampsia. A hypothetical causal relationship between the EBP and seizures was discarded on the basis of evidence presented in this report.

Adult↗
PubMed2002

Transcranial duplex imaging with a sulfurhexafluoride echocontrast agent: enhancement and diagnostic quality.

BACKGROUND AND PURPOSE: The authors investigate characteristics of ultrasound enhancement and diagnostic quality of a sulfurhexafluorides (SF6)-containing echocontrast agent (SonoVue) in cerebrovascular patients with insufficient temporal bone window by transcranial color-coded duplex (TCCD) sonography. METHODS: Thirty patients (mean age = 62.2 +/- 11.1 years) were enrolled. SF6 was administered intravenously in 4 different doses (0.3, 0.6, 1.2, and 2.4 mL). By videotape analysis, time to contrast appearance, duration of contrast enhancement, and duration of clinically useful signal enhancement were measured. Overall quality of ultrasound investigation was also assessed. RESULTS: Time to contrast appearance ranged from 11 to 74 seconds (mean = 26 seconds). For the 0.3, 0.6, 1.2, and 2.4 mL doses, average times to contrast appearance of 30 +/- 12 seconds, 28 +/- 10 seconds, 23 +/- 8 seconds, and 22 +/- 6 seconds were measured. Duration of TCCD signal enhancement was 438 +/- 169 seconds, 483 +/- 195 seconds, 713 +/- 299 seconds, and 788 +/- 344 seconds for the different doses. Clinically useful enhancement was 160 +/- 124 seconds, 200 +/- 157 seconds, 260 +/- 166 seconds, and 327 +/- 239 seconds. CONCLUSIONS: Administration of SonoVue led to a quality improvement in 21 patients. In TCCD, it optimizes visualization of the cerebral arteries in patients with inadequate bone window. A dose of at least 1.2 mL provides the best enhanced images.

Cerebrovascular Circulation↗
PubMed2001

[Anterior spinal artery syndrome: an important differential diagnosis of acute non-traumatic transverse spinal cord syndrome].

We report on a 77-year-old man who was suffering from pain in the chest, which was initially circumferential, along with paresthesia in his left leg, a fluctuating spastic paraparesis and dissociated sensory disturbances caudal to segment T8. In his history, he had received an aortoiliac Y-prothesis for a ruptured retroperitoneal intrarenal aortic aneurysm 39 months previously. Diagnostically, magnetic resonance imaging of the spine revealed advanced degenerative changes with osseous stenoses in segments C5-6 and less pronounced on C6-7. There were no signs of myelopathy. The results of the computerized tomogram of the neurocranium were consistent with the patient's age. The computerized tomogram of the chest and abdomen revealed a left outward bulge in the descending branch of the thoracic artery that was almost 20 mm in length. Based on the differential diagnosis, this was interpreted as an aneurysmatic sacculation with wall thrombosis or a locally circumscribed intramural hematoma upon dissection. Electrophysiologic testing by conduction of magnet-evoked potentials showed no lesions of the pyramidal tract to the extremities above the lumbosacral level. Lumbosacral stimulation evoked potentials on both sides whereas cortical stimulation did not. Based on the patient's history, the clinical findings and additional tests, the diagnosis of anterior spinal artery syndrome was rendered although its cause could not be determined with certainty. The previous transitory ischemic attack and the varying course of the disease is very exceptional in the presented case.

Aged↗
PubMed2000

Antithrombotic drugs for carotid artery dissection.

BACKGROUND: Extracranial internal carotid artery dissection can lead to occlusion of the artery and hence cause an ischemic stroke. It is the underlying stroke mechanism in approximately 2.5% of all strokes, and the second leading cause of stroke in patients younger than 45 years of age. Antithrombotic agents (heparin, oral anticoagulants or antiplatelet drugs) may prevent arterial thrombosis in eICAD, but these benefits may be offset by increased bleeding. OBJECTIVES: To determine whether antithrombotic drugs (antiplatelet drugs, anticoagulation) are effective and safe in treatment of patients with extracranial internal carotid artery dissection, and which is the better treatment. SEARCH STRATEGY: We searched the Cochrane Stroke Group specialised Trials Register for relevant randomised trials and controlled clinical trials. In addition, we performed comprehensive searches of MEDLINE and EMBASE and checked reference lists of all relevant papers for additional eligible studies. SELECTION CRITERIA: Randomised controlled trials, controlled clinical trials assessing the efficacy of antiplatelet drugs or anticoagulants in the treatment of extracranial carotid artery dissection. For non-randomised trials, case series (studies), that reported on antithrombotic treatment with at least 4 patients, were eligible. All trials and studies were assessed for eligibility. Data from all eligible studies were extracted independently by two reviewers. Disagreements were resolved by discussion. DATA COLLECTION AND ANALYSIS: Data on the primary outcome measures were extracted systematically. These were: all deaths, vascular deaths, and disability. Secondary outcomes were: first stroke occurrence, stroke recurrence, any stroke during reported follow-up, extracranial haemorrhage, and intracranial haemorrhage. The first choice treatment was taken for analyses. MAIN RESULTS: No randomised trials and 49 case series (including 683 treated patients) were identified. No reliable comparisons of antiplatelet drugs or anticoagulants with control were available. 24 eligible studies including 286 patients (who either received antiplatelet drugs or anticoagulants) were included in the analysis. There was no significant difference in odds of death comparing antiplatelet drugs with anticoagulants, odds ratio (OR) 2.41, 95% CI 0.27-21.80). There was also no significant difference in the odds of being alive but disabled (OR 1.65, 95% CI 0.50-5.42). Few major haemorrhages were reported. REVIEWER'S CONCLUSIONS: There were no randomised trials comparing either anticoagulants or antiplatelet drugs with control. There is, therefore, no evidence to support their routine use for the treatment of extracranial internal carotid artery dissection. There were also no randomised trials, that directly compared anticoagulants with antiplatelet drugs, and the reported non-randomised studies did not show any evidence of a significant difference between the two. We suggest that a randomised trial including at least 1000 patients in each treatment arm with this condition is clearly needed.

Anticoagulants↗
PubMed2000

Chronic effects of an aminosteroid on microdialytically measured parameters after experimental middle cerebral artery occlusion in the rat.

The effects of the neuroprotective aminosteroid U74006F (tirilazad mesylate, Freedox) were monitored microdialytically in rat cortex during three 4h periods beginning immediately, 25h and 49h after permanent middle cerebral artery occlusion. Either U74006F or vehicle only was administered 15 min, 2h, 6h, 12h and 24h after operation. The dialysate was analysed for on-line pH, ascorbic acid, uric acid, glucose and lactate. The efficacy of post-ischaemic treatment was shown by: a) lesion volume 53h after operation was significantly smaller in U74006F-treated animals; b) microdialytic findings were very similar to those found previously with pre-ischaemic drug application (reduction in release of ascorbic acid, uric acid and lactate, increased pH); c) an effect of U74006F on lactate release could still be seen on days 2 and 3; and d) increases in uric acid on days 2 and 3, possibly reflecting delayed cell death, were smaller in aminosteroid treated animals.

Animals↗
PubMed1999

Acute effects of an aminosteroid on microdialytically measured parameters after experimental middle cerebral artery occlusion in the rat.

The effects of the neuroprotective aminosteroid U74389G were monitored microdialytically in rat cortex during 4 h after permanent middle cerebral artery occlusion. Either U74389G or vehicle only was administered one hour before and 2 h after operation. The dialysate was analysed for on-line pH, ascorbic acid, uric acid, glucose and lactate. In aminosteroid treated animals the levels of ascorbic and uric acids were lower in dialysates after occlusion, total release of lactate was significantly reduced and on-line pH was significantly higher than in control animals. Lesion volume at 4 h, which was significantly reduced in treated animals, correlated positively with ascorbic acid release and on-line pH. Results suggest that neuroprotective effects of aminosteroids might be explained by: (a) preservation of intracellular levels of the radical scavenger ascorbic acid with possible concomitant reduction of glutamate release; and (b) reduced lactate release and increased pH which might influence oedema positively. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed1999

[Area reduction in carotid stenosis of the internal carotid artery].

AIM: In patients with atherosclerotic extracranial internal carotid artery (ICA-) stenosis the diagnostic value of colour Doppler energy (CDE)-coded duplexsonography was compared to three other methods: continuous wave (cw) Doppler peak systolic frequency (pF), pulsed wave (pw) Doppler peak systolic velocity (pV), and intraarterial digital subtraction angiography. METHODS: In 58 patients who suffered from 60 moderate to severe ICA stenoses, B-mode sonography combined with CDE-coded duplex sonography was applied to measure the extent of the stenosis by determining the residual lumen width. Results were correlated to pF and pV and with various angiographic indices. RESULTS: The determined values of the degree of stenosis were correlated to the measurement of pV (r = 0.441, p < 0.01), but not to pF (r = 0.122, n.s.). The best correlation to angiography was obtained when the linear ICA diameter was compared to the distal common carotid artery (common carotid artery index) (r = 0.214, n.s.). Sensitivity, specificity and diagnostic accuracy were comparable to the different frequency-based measurements, but the positive predictive value was lower. CONCLUSIONS: Determination of the degree of stenosis based on CDE alone is not reliable enough to allow correct diagnosis of severe carotid artery stenosis. In combination with the peak frequency method is's diagnostic value could be improved. This requires verification in a separate study.

Aged↗
PubMed1999

Ruptured intracranial dermoid cyst.

Intradural dermoids are rare congenital tumors representing approximately 0.05% of all intracranial lesions. These benign tumors have a typical appearance on CT and MR due to their lipid components. The complication caused by rupture are the spillage of the fatty material into the cerebrospinal fluid. We report a case of a ruptured dermoid cyst showing fat/fluid levels in both side ventricles and fatty material in the subarachnoid space on CT and MR-imaging and the follow-up over four years after incomplete resection of the tumor.

Adult↗