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PubMed1981

Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction.

Although cerebral cholesterol embolism is a well-known process, the range of clinical manifestations has not been established. In the present case, the occurrence of transient ischemic attacks in association with cerebral cholesterol embolism is described for the first time. A 69-year-old man experienced multiple 5- to 8-minute spells of numbness or weakness involving one or the other hand in 3 years. The attacks continued despite warfarin therapy. When the left arm became permanently paralyzed, an ulcerative plaque was removed from the right internal carotid artery, but the neurologic deficits increased. Progressive renal failure developed, and he died 5 months after the initial medical evaluation. Neuropathologic examination disclosed multiple small infarcts in both cerebral hemispheres, predominantly in the border-zone territory on the right side. Many small cerebral arteries were occluded by cholesterol emboli. Anticoagulant therapy appeared to exert an adverse affect.

Aged↗
PubMedDate not supplied

[Angiography in the diagnosis of cerebrovascular pathology. Current indications and controversies].

The role of cerebral angiography in the diagnosis of cerebrovascular disease is currently being questioned due to both the increasing availability of carotid sonography and the recent introduction of Magnetic Resonance Angiography (MRA). After a technical foreword about the different modalities available today in Cerebral Angiography, we discuss its present indications (Conventional or Digital subtraction by intra-arterial route), in patients with extra and intra cranial atherosclerotic cerebro vascular disease, subarachnoid hemorrhage and arterial aneurysms, in vascular malformations, particularly arterio-venous malformations (AVM's), in occlusive non-atherosclerotic non hypertensive arteriopathies and in occlusive venous pathology. Although it is possible that the future will show us the progressive replacement of the invasive technologies by MRA, at the present stage of Magnetic Resonance development there is still an important role, if not crucial, for catheter angiography in the diagnosis of most of the diseases producing stroke syndromes.

Arteriosclerosis↗
PubMed1986

Nonhemorrhagic cerebral infarction in young adults.

We evaluated 144 patients (81 males and 63 females) aged 15 to 45 years who had nonhemorrhagic cerebral infarction. Atherosclerotic cerebral infarction was diagnosed in 38 patients. Potential cardiac causes of cerebral embolism were found in 33 patients. Only three events could be attributed to mitral valve prolapse. Hematologically related disorders were diagnosed in 21 patients, while 38 patients had nonatherosclerotic vasculopathies. Young patients with cerebral infarction are a heterogeneous group. A potential cause can be found in most patients. We found more than 40 possible etiologies among our patients. Mitral valve prolapse apparently is not a common cause of cerebral infarction among young adults. Cerebral infarction should not be ascribed to oral contraceptives or migraine until other possible causes have been eliminated.

Adolescent↗
PubMed1988

[Flow patterns at the bifurcation and curving portion of the human cerebral artery--in reference to the localization of atherogenesis].

To elucidate the connection between blood flow and the localized genesis and development of atherosclerosis and thrombosis at the bifurcation and curving portion of the human cerebral artery, detailed studies of the flow patterns were carried out by directly observing and photographing the behavior of tracer particles flowing through the isolated transparent segment of the middle cerebral artery, prepared from a human subject post-mortem. It was found that a standing recirculation zone consisting of a pair of complex spiral secondary flow, located on both sides of the common median plane of the bifurcation, was formed in the lateral side of the daughter vessels over wide ranges of inflow Reynolds numbers, Re0, and flow rate ratios, Q1/Q0, The formation and the size of the recirculation zone were largely dependent on Q1/Q0, as well as on Re0. Also a eddy formation was observed in the inner side at the curving portion as well as at the bifurcation of the middle cerebral artery. The results suggest that, under physiological conditions, a standing recirculation zone exists in the bifurcation and bending portion of the middle cerebral artery, thereby affecting local mass transfer and interactions of blood cells with the vessel wall, which may lead to the incidence of atherosclerosis and thrombosis in these region.

Arteriosclerosis↗
PubMed1994

[Prevalence and prognostic value of transient ischemic complication preceding cerebral infarction].

To evaluate the prevalence, the aetiological profile and the neurological consequences at day 15 of a transient ischaemic attack (TIA) before a cerebral infarction, we undertook survey from 1985 to 1991, on 1,149 cases with cerebral infarction observed on the population of Dijon. On 1,149 cases, 275 (24%) were preceded by a TIA. Fifty seven cases were lacunar infarcts (20.7%) and 218 were cortical infarcts (79.3%). On the aetiological point of view, the group with 275 infarctions preceded by a TIA was statistically different from the group of 874 infarctions without any TIA, with higher blood pressure, cardiac arrhythmia, tobacco abuse and ischaemic cardiac disease history. Only 65 out of 275 infarctions preceded by one TIA (23.6%) had a perfect territorial relationship between the 2 attacks, and 210 out of 275 (76.4%) had no territorial relationship. While the Barthel score at day 15 was similar within the 2 groups, inversely, pseudo-bulbar syndrome was significantly more frequent in the first group. Former TIA does not increase the general handicap resulting from a cerebral infarct, nevertheless it gives rise to a pseudo-bulbar syndrome.

Aged↗
PubMed1979

[Quantitative analysis of lipoproteins in hyperlipoproteinemias of type IIa, IIb and IV (author's transl)].

Cholesterol and triglyceride content of serum lipoprotein fractions isolated by ultracentrifugation have been studied in 33 healthy subjects and in 56 subjects affected by hyperlipoproteinemia of type IIa, IIb and IV. Patients with atherosclerotic disease were characterized by a general decrease of HDL cholesterol and by a negative correlation between HDL cholesterol and VLDL triglycerides; patients with type IIb and IV showed an increase of LDL lipoproteins. The increase of triglycerides in type IIb and IV was caused by elevation of VLDL triglycerides or LDL triglycerides, and the increase of cholesterol in type IIb is sometimes caused by elevation of VLDL cholesterol. It is evident that several subtypes exist within Fredrickson's classification. Patients with cerebral arterial disease when compared with patients affected by non-ischaemic disease, showed a negative and significant correlation between HDL cholesterol and total cholesterol.

Adult↗
PubMed1996

[Etiology and mechanism in cerebral infarction].

Cerebrovascular disease is the 3rd leading cause of death and an important cause of hospital admission and long-term disability in most industrialized populations. Many studies have shown that brain infarct is the most frequent form of cerebrovascular disease (83%). Brain infarct is a heterogeneous entity with several etiologies (mainly large-artery disease, small-artery disease, cardiac embolic disease). Different mechanisms are involved including arterial occlusion, thrombosis (atherosclerosis), embolism (from a cardiac or intraarterial source), and hemodynamic mechanisms (systemic hypoperfusion). Careful neurological assessment (cerebral computed tomogram, magnetic resonance imaging, Doppler ultrasound and angiography in selected cases) provides greater precision regarding these mechanisms and the choice of treatment.

Aortic Dissection↗
PubMed1992

An autopsied case of interferon encephalopathy.

A 78-year-old male with renal carcinoma was treated with a high dose infusion of interferon-alpha (IFN-alpha) for eight months. The patient had evidence of organic brain syndrome such as dysfunction of memory, slowing of behavior, and development of mental confusion that appeared eight months after the treatment. MRI at the time of mental confusion revealed diffuse white matter lesions. Neuropathologic findings were compatible to Binswanger's disease and Senile Dementia of Alzheimer Type (SDAT), Preexisting neurologic abnormalities including intracerebral arteriosclerosis and cerebral atrophy may increase susceptibility to unacceptably severe IFN neurotoxicity.

Aged↗
PubMed1998

Hepatic infarction caused by an embolus from an atherosclerotic lesion--a case report.

Although it has been reported that emboli from atherosclerotic disease may be more frequent than commonly appreciated, hepatic infarction caused by an arterial embolus is an unusual but serious complication. The authors describe a patient who had a secondary liver infarct during anticoagulant treatment for cerebral infarction. The thrombus causing the liver infarction was detected as a low echoic mass by transesophageal echocardiography at the right coronary sinus.

Aged↗
PubMed1985

Assessment of vascular involvement in hypertension.

Vascular disease in hypertension is of two types. Disease of arterioles and small arteries affects predominantly the kidney and brain, and is due directly to the hypertension itself. Atheroma mainly affects large and medium size arteries and hypertension is only one of several factors involved in its causation. Clinical evidence of small vessel disease includes retinopathy, proteinuria and lacunar cerebral infarction. Assessment of atheromatous disease usually involves angiography. The recent development of non-invasive techniques such as digital subtraction angiography and ultrasound imaging promises to improve the assessment of vascular disease.

Arterioles↗
PubMed1993

[Role of deficient cerebral circulation in selecting the treatment methods for patients with circulatory encephalopathy].

The results of studying the pathophysiologic mechanisms of the impairement in cerebral circulation in 244 patients with atherosclerotic discirculatory encephalopathy with the use of the ultrasound and radiopaque investigation, electroencephalography and computed tomography of the brain are presented. The prevalent role of vascular damage of the brachiocephalic trunk in the genesis of the different stages of atherosclerotic discirculatory encephalopathy is noted. The influence of arterio-venous cerebral hemodynamics on the development and progressing of discirculatory encephalopathy was established. The topographic correlations of the basin of the arteries affected and neurologic and morphologic signs of discirculatory encephalopathy were revealed.

Adult↗
PubMedDate not supplied

Frequency and clinical correlates of occlusive lesions of cerebral arteries in Japanese patients without stroke. Evaluation by MR angiography.

To determine the frequency and clinical correlates of intra- and extracranial arterial occlusive lesions in a stroke-free population, we studied cerebral arteries in 156 subjects with no evidence of stroke who presented at a neurologic clinic with concerns about a possible stroke (104 males ranging in age from 37 to 83 years, with a mean age of 63.0) by using MR angiographies (MRAs). According to a validated rating scheme of MRAs for occlusive lesions, the degree of stenoses in the cervical portion of the carotid artery and of the intracranial arteries including the intracranial portion of the internal carotid artery, the middle cerebral artery stem, and the basilar artery were evaluated. Stenoses (>25% narrowing in diameter) were found in 18 patients (11.5%) in the cervical carotid artery, and in 23 patients (14.7%) in the intracranial arteries. Multiple logistic regression analysis showed that age and hyperlipidemia were significant and independent predictors for cervical carotid artery stenoses, and that age and hypertension were predictors for intracranial artery stenoses. Our data based on this special cohort of stroke-free patients suggested that the risk factors for extra- and intracranial artery lesions were different, and that MRA is possibly efficient in those patients in whom cerebral artery occlusive lesions may be suspected. e.g. in hyperlipidemic or hypertensive elderly. Larger population-based studies are needed to confirm these results.

Adult↗
PubMed1981

[Juvenile cerebral infarct. Retrospective analysis of risk factors in 78 cases].

THe records of 78 young adults, who had suffered cerebral infarction, were reviewed with regard to possible pathogenetic mechanisms. Atherosclerosis risk factors appeared to play a major role between the age of 40 and 50, especially in males. Non atherosclerotic factors of cerebral ischemia were found predominant among females under 40, owing to contribution of migraine, oral contraceptive use and pregnancy/puerperium. In 18% of the patients no etiology could be identified.

Adult↗
PubMed1984

[Preliminary observations, at the ultrastructural level, on the reactivity of cerebral arteries from New Zealand rabbits to combined atherogenic stimuli (hypercholesterol diet and hypertension)].

Both in monkeys (Rhesus and Cynomolgus) and in New Zealand rabbits fed an atherogenic diet, a marked delay in the appearance of atherosclerotic lesions of the cerebral arteries in comparison with other arterial districts has been observed. This appearance has been described in monkeys as relatively earlier if hypertension is added to the atherogenic diet. Preliminary observations on a little group of rabbits on a 3 months hypercholesterolic diet, subjected to Goldblatt aortic coarctation, have shown an increase of blood pressure and a severe gross atherosclerotic involvement of aorta, resembling the one obtainable after 6 months of atherogenic diet. Histologically, the aorta predominantly shows lesions of the fatty streaks type with necrotic areas in the deep; the carotid lesions show some lipid in smooth muscle cells disseminated in a sub-endothelial "edematous" space (rich in protein). The cerebral arteries do not show any lesion. At TEM, the aortic lesions look sometimes as advanced plaques with an initial fibrosis at the surface; the carotid lesions are characterized by a granular deposit in the sub-endothelial space in which some smooth muscle cells (with lipid in the cytoplasm) are present; in the cerebral arteries only the presence of collagen fibers among the smooth muscle cells of the media, never observed in the animals fed the atherogenic diet alone, has sometimes been noted.

Animals↗
PubMedDate not supplied

Artery-to-artery embolism from a thrombus formed in stenotic middle cerebral artery. Report of an autopsy case.

The authors report an autopsy case with repeated transient ischemic attacks and subsequent strokes demonstrating evidence of artery-to-artery embolism from thrombi generated in the stenotic middle cerebral artery to the distal cortical branches. This case substantiates the existence of intracranial artery-to-artery embolism as a cause of transient ischemic attacks and subsequent strokes, and has potential relevance for therapy.

Aged↗