Antiplatelet treatment for secondary prevention of acute ischemic stroke and transient ischemic attacks: mechanisms, choices and possible emerging patterns of use.
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Out of 75 patients with TIA or PRIND we selected 9 TIAs and 6 PRINDs with normal EEGs and CCTs, full recovery of neurological function, no history of amaurosis fugax and no findings of visual impairments. PVEPs were derived from 01-02 to Fz and Cz as ground following binocular pattern reversal visual stimuli of 1.9 Hz. Interhemispheric differences of the latencies of P60, N80, P100 and of the amplitudes N80/P100 and P100/N140 were compared with the corresponding parameters of 22 age matched controls. In contrary to the latency differences the interhemispheric difference of the amplitude N80/P100 was highly significantly larger (33.5 +/- 16.0%) in patients than in the control group (12.8 +/- 9.8%) (p < or = .0005). The amplitude P100/N140 behaved the same way (p < or = .025); the amplitude of the affected side being smaller. There were no statistical differences between TIAs and PRINDs and a tendency was seen for normalization of the differences with increasing time distances between the onset of the ischemic attack and the point of time of the recordings.
The prognosis for 281 patients with cerebrovascular stroke and 44 patients with TIA is presented. These patients were registered during a prospective epidemiological survey of cerebrovascular diseases in the community of Söderhamn. There was an average population of about 32, 000 during the study period. More than 30% of the stroke patients died during the first 3 months. After 4 years the mortality was about 70% in stroke and 40% in TIA patients. The prognosis was tested towards symptoms and signs. Eleven signs were significantly correlated to adverse outcome in the stroke group, e. g. Babinski's sign present, complete extremity paresis, lowered level of consciousness, fever, tachycardia, anemia and elevated systolic blood pressure. During follow-up at intervals of 1, 2 and 3 years about 60% of the stroke survivors were at home, 20% in old age homes, and 20% in hospitals.
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The rheological properties of blood were studied in patients supported by both the Jarvik-7 total artificial heart (TAH) and Novacor left ventricular assist device (LVAD) as a bridge to cardiac transplantation. Both groups of patients had abnormalities in blood rheology which differed according to the type of device implanted as well as on the clinical state of the patient. The rheology of individual patients correlated well with their clinical status and outcome, with incidences of TIA's and/or stroke being accompanied by marked increases in relative blood viscosity, erythrocyte rigidity, fibrinogen concentration and platelet aggregation in varying combination. Observed abnormalities in blood rheology were also crucial to thrombus formation on artificial heart valves as well. Our results show that the therapeutic management of rheological parameters should prove to be a unique and clinically rewarding approach to these patients.
Rapid but precise evaluation of patients presenting with cerebral infarction is essential to determine immediate intervention. Initial assessment should include history taking, physical examination, routine laboratory testing, electrocardiography, chest radiology, and noncontrast head CT. Localizing the event to the appropriate arterial circulation (anterior versus posterior) and determining topography (subcortical versus cortical) guide sequential testing to ascertain the mechanism of cerebral infarction. Diagnostic testing focuses on selectively identifying potential cardiac, large-vessel, small-vessel, or hematologic causes. Although diagnostic tools are evolving, 15% of cerebral infarctions still have an unknown cause or multiple potential sources.
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INTRODUCTION: A significant number of patients who have had cerebrovascular illness apparently recover their former abilities completely but return to normal life with subtle cognitive deficits which may affect their daily lives. Such is the situation of patients with transitory ischemic accidents who present with sustained, undiagnosed attention deficits. OBJECTIVES: To identify subclinical alterations due to attention deficits in patients with transitory ischemic accidents, and to contribute to the study of the physiopathological mechanisms involved in the integration of this function. PATIENTS AND METHODS: We examined 44 persons, divided into three groups for this study: one group had vertebro-basilar transitory ischemic accidents, a second group had supratentorial infarct and a third was healthy. All were given a specially designed computerized test of continuous work to evaluate the sustained attention component. RESULTS: Significant differences were found between the transitory ischemic accidents and healthy groups, regarding the variables including correct answers, omissions and indications of attention. This was not seen with the variables involving reaction time and number of errors. This demonstrated the existence of attention disorders involving omission in the group of patients with transitory ischemic accidents. CONCLUSION: These findings suggest the hypothesis that in the vertebro-basilar region there are important mechanisms involved in the process of sustained attention.