Nonembolic Cerebral Infarction Research Articles

Metabolic Syndrome with Hyperglycemia and the Risk of Ischemic Stroke

PurposeThe association of ischemic stroke and metabolic syndrome (MetSyn) with or without diabetes mellitus (DM) is not clear. The present study aimed to identify the impact of diabetes or hyperglycemia on the risk of MetSyn-associated ischemic stroke.Materials and MethodsThis study comprised an Asian population of 576 patients with acute nonembolic cerebral infarction and 500 controls. MetSyn was defined according to the criteria of the International Diabetes Federation. MetSyn patients were further subgrouped according to their glucose levels: MetSyn with DM, MetSyn with impaired fasting glucose (IFG) and MetSyn with normal glucose tolerance (NGT). The impact of MetSyn on cerebral infarction was then evaluated.ResultsAt baseline, the prevalence of MetSyn in patients with cerebral infarction was higher than that of the controls (57.29% vs. 10.00%, p<0.01). In the stroke group, the prevalences of MetSyn with DM, IFG, and NGT were 25.69%, 8.85% and 22.74%, respectively, all of which were higher than that of the controls (all p-values <0.05). By multiple logistic regression analysis, we discovered that MetSyn was associated with an increased risk of cerebral infarction (odds ratio: 5.73, p<0.01). After adjustment for all the components of MetSyn, the odds ratios of MetSyn with DM, IFG, and NGT were 5.70, 2.24 and 2.19 (all p-values <0.05), respectively.ConclusionIn Asian population, patients with MetSyn accompanied by T2DM are at the greatest risk for acute non-embolic stroke. Additionally, IFG was not observed to be associated with an increased risk for MetSyn-related ischemic stroke.

A prospective study of stroke in young adults in Cantabria, Spain.

The aim of this study was to determine the incidence, type, and prognosis of stroke in young adults in Cantabria, Spain. We investigated prospectively all patients aged 50 years or below who were admitted with the diagnosis of a stroke to the University Hospital "Marqués de Valdecilla" from April 1, 1986, to March 31, 1988. This is the main hospital of the region to which all patients with neurological problems are referred. These patients underwent a complete clinical and laboratory assessment for stroke and had 1-year mean follow-up. The total series included 81 patients. The annual age-specific crude incidence rates of stroke were 17.3 and 10.4 per 100,000 for males and females, respectively. Twenty-four patients (30%) were diagnosed as having nonembolic cerebral infarction, 14 (17%) embolic cerebral infarction, 20 (25%) subarachnoid hemorrhage, 22 (27%) spontaneous cerebral hemorrhage, and one case (1%) cerebral venous thrombosis. Eighteen patients (22%) died within 30 days of the cerebrovascular event, and two others died during the follow-up period. Seventy-nine percent of the survivors recovered and were completely self-sufficient. The incidence of stroke in the young found in Cantabria is comparable with that in previous studies. The initial hospital mortality was not negligible, but the prognosis among the survivors was favorable.

Stroke In Asia: An Epidemiological Consideration

Although the study of the epidemiology of stroke in developed Western countries (as judged from the number of relevant articles published in international medical journals) is extensive, in Asian countries it has been comparatively limited (with the exception of Japan). Many of the studies from Asian countries also appear to be deficient, thus making comparison between the countries difficult. In addition, many of these studies are believed to be published in local journals not usually cited and difficult to retrieve from, and relevant and retrievable data from many developing countries often show considerable time lapse, making a meaningful comparison between countries even more difficult. In Thailand, Public Health Statistics show that stroke has been on the increase. Taken as an example, the death rate from cerebrovascular disease (CVD) was 3.7/100,000 in 1950, rising to 6.7/100,000 in 1970, and to 11.8/100,000 in 1983. In 1984, there were 9,414 cases of CVD admitted to hospitals in Thailand. The incidence (in patients) increased from 12.7/100,000 in 1981 to 18.7/100,000 in 1984. Since 1957, the mortality rate has been steadily increasing, from approximately 1/100,000 to approximately 6/10,000. In a survey taken in 1983 of a medium-size community in Bangkok, it was found that the prevalence of CVD was 6.9/1,000. The same Public Health Statistics also showed that the rate of immediate death after stroke (which is defined as death within 4 weeks after the onset) from nonembolic cerebral infarction, cerebral embolism, and cerebral hemorrhage was reported to be 19.5, 37, and 85% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Regional cerebral blood flow correlates of aphasia outcome in cerebral hemorrhage and cerebral infarction.

The relationship between recovery from aphasia and regional cerebral blood flow (CBF) was compared in 87 patients, 44 with cerebral hemorrhage and 43 with non-embolic cerebral infarction. CBF values correlated poorly with aphasia outcome in patients with cerebral hemorrhage whereas a tight correlation was demonstrated in patients with non-embolic cerebral infarction. A marked variability of CBF values in the acute and subacute stage might account for the poor correlation between CBF and aphasia outcome in patients with cerebral hemorrhage. On the other hand, a sharp discrimination was achieved between those with a good recovery from aphasia and those with a poor recovery by the dimensions of the hematoma on CT. In non-embolic cerebral infarction, a relative frontal ischemia was associated with motor aphasia while a relative temporal ischemia was associated with sensory aphasia. This dichotomy was not demonstrated in the regional CBF values in patients with cerebral hemorrhage.

Cardiac disorders predisposing to development of cerebrovascular diseases in the Japanese. Data obtained at autopsy.

For a clear definition of the influence of cardiac disorders on the development of cerebrovascular diseases in the Japanese, we reviewed 1,162 consecutive autopsy records aged 20 years and over in the Department of Pathology, Kyushu University, Japan. All autopsies had been done between Nov. 1971 and Oct. 1981. Cerebral infarction was found in 101 out of 196 with any type of cardiac disorder. Frequencies of cerebral infarction in those with myocardial infarction, rheumatic heart disease, non-bacterial thromboendocarditis, and atrial fibrillation were higher than in those with no heart disease. These differences can be ascribed to the higher incidence of large and medium-sized cerebral infarction, including many cases of cerebral embolism originating from the heart. Only 3.4% of those with small cerebral infarction were assessed to be cases of embolism. Non-embolic cerebral infarction was more frequently noted in those with myocardial infarction and atrial fibrillation than in those with no heart disease. These differences were probably linked to concomitant progression of arteriosclerosis of the cerebral and coronary arteries. In this consecutive autopsy study, cerebral embolism was found in 35 cases, 10.9% of the total number of those with cerebral infarction.

Prognosis of transient cerebral ischemic attacks (author's transl)

Fourty-nine patinets with focal neurological deficits lasting for less than 24 hours (TIA), were followed up for 6 to 169 months averaging 65 months. During the follow-up period 9 cases (18.4%) developed stroke and 13 cases (26.5%) died. Among the latter 2 died of cerebral infarction. In relation to subsequent stroke, clinical features and angiograms of the TIA-giving artery were analysed. Angiographic findings in 12 patients with non-embolic cerebral infarction preceded by TIA were also studied. Subsequent stroke developed more frequently in patients with more than 10 episodes of TIA and with arterial stenoses of 50% and over in diameter.

Estrogen use and stroke risk in postmenopausal women.

Among postmenopausal women (58-98 years of age) in a retirement community use of oral estrogens was not significantly associated with overall risk of stroke. Estrogen use was significantly associated with blood-pressure status. An observed association between estrogen use and nonembolic cerebral infarction in women aged 70-79 may be secondary to an interaction between hypertension and estrogen usage.

Improvement in Motor Performance in Paretic and Paralyzed Extremities Following Nonembolic Cerebral Infarction

The problems involved in measuring improvement as well as the conceptual difficulties in considering this phenomenon were considered in general terms. Data on 300 patients with nonembolic cerebral infarction followed from five to nine years are presented, indicating that improvement in function of a paralyzed extremity may occur in the early phase after stroke but was extremely unlikely to continue during long-term follow-up from three months to five years. It was concluded that improvement in function might be determined more by retraining of the nonaffected muscles and particularly of the unaffected side rather than by recovery of the area paralyzed.

Age: its significance in nonembolic cerebral infarction.

The frequency of occurrence of nonembolic cerebral infarction is linearly related to age. The sexual frequency of nonembolic cerebral infarction is directly related to the age group of the sample studied. The mortality of nonembolic cerebral infarction and its prognosis are most closely related to the age of the patient at the time of stroke. The older the patient, the higher is the mortality and the poorer the prognosis. The cause of death in nonembolic cerebral infarction is as much a function of age-related concurrent diseases, especially cardiac disease, as it is of stroke itself. The natural history of stroke is more related to the natural history of cardiac disease than it is to cerebral vascular disease. These data may be viewed as lending support to the thesis that nonembolic cerebral infarction and the diseases that are frequently found with it, such as diabetes, cardiac disease and hypertension, are related in their occurrence and mortality to aging and may truly be concurrent events and not etiologically related one to the other.

Seasonal variation of non-embolic cerebral infarction

IT IS well accepted today that the prevalence of diseases caused by microorganisms is altered by climatic fluctuations. The increased incidence of pulmonary infection [l] in the winter and of poliomyelitis and gastro-intestinal infections in the summer are the best examples of this and probably reflect a combination of variations in (1) the host’s susceptibilities; (2) bacterial or viral virulence; and (3) vector availability. Stroke should not have a seasonal variation unless the major causative factors underlying its precipitation, including for instance atherosclerosis and circulatory dynamics, are modified by climate and season. Such factors as eating and drinking habits vary with the temperature; summer dehydration may alter circulatory dynamics and lead to cerebral infarction. There are suggestions of a seasonal variation in cholesterol levels in a stable population of men aged 46-62. Cholesterol levels were found to be highest from November to March and lowest during the summer months, May through August [2, 31. In a similar study involving both sexes, males and females showed seasonal variations of cholesterol levels in opposite directions [4]. Protein bound iodine levels have been found to vary seasonally, the lowest values found during June, July and August with high values in September, October, February and March [4]. The gap between these suggestions of seasonal variation in serum cholesterol and PBI and the occurrence of stroke is too wide for any meaningful connection. Some evidence for a seasonal variation in atherosclerotic disease is found in studies of coronary heart disease. Death from cardiovascular disease in some parts of the United States has a peak during December to April with a low point in August and September [6, 71. The reduction of death rates during the summer months has been confirmed in studies in areas with a marked seasonal climatic variation but not in areas which are continuously warm [S]. In Australia cardiovascular deaths are higher during their winter months, June through September, and lowest during their summer months, January through April [9]. In the field of cerebrovascular disease Takakashi in Japan found that cerebral hemorrhage had a low incidence in the summer months, June to September, and a high incidence in the winter months [IO].

Cerebrovascular diseases in west central India. A report on angiographic findings from a prospective study.

Cerebral angiographic findings in ischaemic stroke are described and discussed in detail. Though the Indian patients studied had altogether different social customs, living standards, and dietary habits from Western people, the relative incidence of various cerebral vascular lesions did not differ significantly. Irrespective of the poor nutritional status of the patients, thrombosis associated with atherosclerosis was chiefly responsible for a non-embolic cerebral infarction. Atherothrombosis in the young normotensive persons not showing any evidence of arteritis, diabetes mellitus, or hypercholesterolaemia was also identified.The grave risks involved in cerebral angiography in cases of acute stroke are re-emphasized.As to prognosis, the nutritional status, the type and territory of an ictal lesion, and the blood levels of sugar and cholesterol had no significant influence on the immediate survival-after a non-embolic cerebral infarction. However, a significantly greater number of deaths were encountered in the hypertensive patients. Female patients and patients with a large cerebral infarction had a poor prognosis.

Epileptic seizures in nonembolic cerebral infarction.

THERE have been few studies of the incidence and prognosis of seizures in patients with nonembolic cerebral infarction. Jackson in 18641was amongst the first to comment upon a relationship between seizures and vascular disease, particularly embolic cerebrovascular occlusion, but he had no pathological confirmation of his diagnosis. Gowers in 18812collected and reported 66 patients with and epilepsy, in some of whom the hemiplegia was thought to have resulted from embolic cerebrovascular occlusion. Two thirds of his patients were less than 5 years of age, and pathological confirmation of the specific cause of was not obtained. Dunham in 19163reported seven patients with epileptic seizures found in a group of 100 patients consecutively admitted because of cerebrovascular accidents. The group was composed of patients with cerebrovascular disease of all sorts, and the fact that four of the seven epileptics also had syphilis