Pub Date : 2002-07-01DOI: 10.1161/01.STR.0000019125.80118.99
T. Kucinski, O. Väterlein, V. Glauche, J. Fiehler, E. Klotz, B. Eckert, C. Koch, J. Röther, Hermann Zeumer
Background and Purpose— Diffusion-weighted MR imaging is very sensitive for the detection of restricted molecular water diffusion in acute ischemic stroke. CT is sensitive to net water uptake in ischemic edema. We compared the decrease in the apparent diffusion coefficient (ADC) in diffusion-weighted MR imaging with CT density changes to study the correlation between diffusion restriction and water uptake in acute stroke patients. Methods— Twenty-five patients with acute ischemic stroke of the anterior cerebral circulation underwent MR and CT imaging 1.3 to 5.4 hours after symptom onset. ADC and CT data were transferred into a common 3-dimensional space, and regions of decreased ADC (dADC) were superimposed onto the corresponding CT. Mean values of ADC and Hounsfield units (HU) were determined in comparison with the nonaffected hemisphere. Results— Mean decrease in ADC (dADC) was 170±53× 10−6 mm2/s and corresponded to a decrease (dCT) in CT density of 1.3±0.7 HU. dCT showed a continuous linear decrease of 0.4 HU/h (r =0.55, P <0.01), whereas the decrease is ADC was almost complete after 1.5 hours. A correlation between the decrease in ADC and dCT was found (r =0.41, P =0.04). Conclusions— The severity of diffusion restriction correlates with net water uptake in acute ischemic stroke. However, the underlying pathophysiology and different time courses indicate a common reason rather than a direct causality for both phenomena. The time delay and low value of CT density changes provide a reasonable explanation for the higher sensitivity of MR imaging in ischemic stroke.
背景与目的——磁共振弥散加权成像对急性缺血性脑卒中受限分子水扩散的检测非常敏感。CT对缺血性水肿的净水分摄取很敏感。我们将弥散加权MR成像中表观弥散系数(ADC)的下降与CT密度变化进行比较，研究急性脑卒中患者弥散限制与水分摄取的相关性。方法:25例急性脑前循环缺血性卒中患者在症状出现后1.3 ~ 5.4小时行MR和CT检查。ADC和CT数据被传输到一个共同的三维空间，并将ADC下降的区域(dADC)叠加到相应的CT上。测定ADC和Hounsfield单位(HU)与未受影响半球的平均值。结果- ADC (dADC)平均降低170±53× 10−6 mm2/s，对应于CT密度降低(dCT) 1.3±0.7 HU。dCT连续线性下降0.4 HU/h (r =0.55, P <0.01)，而ADC在1.5 h后几乎完全下降。ADC降低与dCT降低之间存在相关性(r =0.41, P =0.04)。结论:急性缺血性卒中患者弥散限制的严重程度与净摄水量有关。然而，潜在的病理生理学和不同的时间过程表明一个共同的原因，而不是一个直接的因果关系。CT密度变化的时间延迟和低值为mri在缺血性脑卒中中的高灵敏度提供了合理解释。
{"title":"Correlation of Apparent Diffusion Coefficient and Computed Tomography Density in Acute Ischemic Stroke","authors":"T. Kucinski, O. Väterlein, V. Glauche, J. Fiehler, E. Klotz, B. Eckert, C. Koch, J. Röther, Hermann Zeumer","doi":"10.1161/01.STR.0000019125.80118.99","DOIUrl":"https://doi.org/10.1161/01.STR.0000019125.80118.99","url":null,"abstract":"Background and Purpose— Diffusion-weighted MR imaging is very sensitive for the detection of restricted molecular water diffusion in acute ischemic stroke. CT is sensitive to net water uptake in ischemic edema. We compared the decrease in the apparent diffusion coefficient (ADC) in diffusion-weighted MR imaging with CT density changes to study the correlation between diffusion restriction and water uptake in acute stroke patients. Methods— Twenty-five patients with acute ischemic stroke of the anterior cerebral circulation underwent MR and CT imaging 1.3 to 5.4 hours after symptom onset. ADC and CT data were transferred into a common 3-dimensional space, and regions of decreased ADC (dADC) were superimposed onto the corresponding CT. Mean values of ADC and Hounsfield units (HU) were determined in comparison with the nonaffected hemisphere. Results— Mean decrease in ADC (dADC) was 170±53× 10−6 mm2/s and corresponded to a decrease (dCT) in CT density of 1.3±0.7 HU. dCT showed a continuous linear decrease of 0.4 HU/h (r =0.55, P <0.01), whereas the decrease is ADC was almost complete after 1.5 hours. A correlation between the decrease in ADC and dCT was found (r =0.41, P =0.04). Conclusions— The severity of diffusion restriction correlates with net water uptake in acute ischemic stroke. However, the underlying pathophysiology and different time courses indicate a common reason rather than a direct causality for both phenomena. The time delay and low value of CT density changes provide a reasonable explanation for the higher sensitivity of MR imaging in ischemic stroke.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"210 0 1","pages":"1786-1791"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82877278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1161/01.STR.0000019123.47840.2D
M. Silvestrini, B. Rizzato, F. Placidi, R. Baruffaldi, A. Bianconi, M. Diomedi
Background and Purpose— Epidemiological studies have suggested a pathophysiological link between sleep apnea syndrome and cerebrovascular diseases. The mechanism by which sleep disturbance can affect the predisposition to developing stroke is not clear. The aim of this study was to investigate whether patients with obstructive sleep apnea syndrome have an increase in atherosclerosis indicators at the carotid artery level. Methods— We included 23 male patients with severe obstructive sleep apnea syndrome (respiratory disturbance index >30). Intima-media thickness and the presence of steno-occlusive lesions in the common carotid arteries were investigated with B-mode high-resolution ultrasonography. Results of the ultrasonographic examination were compared with those of a group of 23 subjects without obstructive sleep apnea syndrome who were matched for age and comorbid factors. Results— The intima-media thickness of the common carotid arteries of patients with obstructive sleep apnea syndrome was significantly higher (P <0.0001) than that of control subjects (1.429±0.34 versus 0.976±0.17 mm). Conclusions— Results of the present study show that carotid wall thickness is increased in patients with severe sleep apnea syndrome. There is strong evidence that an increase in the thickness of the carotid artery wall is a valid marker of the risk of stroke. For this reason, our finding seems to further strengthen the hypothesis that patients with obstructive sleep apnea syndrome are at risk of developing cerebrovascular diseases regardless of the association with other vascular risk factors.
背景与目的——流行病学研究表明睡眠呼吸暂停综合征与脑血管疾病之间存在病理生理联系。睡眠障碍影响中风易感性的机制尚不清楚。本研究旨在探讨阻塞性睡眠呼吸暂停综合征患者颈动脉水平动脉粥样硬化指标是否增加。方法:纳入23例重度阻塞性睡眠呼吸暂停综合征(呼吸障碍指数>30)的男性患者。采用高分辨率b超检查颈总动脉内膜-中膜厚度及有无狭窄闭塞病变。将超声检查结果与23例无阻塞性睡眠呼吸暂停综合征且年龄和合并症因素匹配的患者进行比较。结果-阻塞性睡眠呼吸暂停综合征患者颈总动脉内膜-中膜厚度显著高于对照组(1.429±0.34 mm vs 0.976±0.17 mm) (P <0.0001)。结论:本研究结果表明，重度睡眠呼吸暂停综合征患者颈动脉壁厚度增加。有强有力的证据表明，颈动脉壁厚度的增加是中风风险的有效标志。因此，我们的发现似乎进一步强化了阻塞性睡眠呼吸暂停综合征患者无论是否与其他血管危险因素相关，都有发生脑血管疾病的风险的假设。
{"title":"Carotid Artery Wall Thickness in Patients With Obstructive Sleep Apnea Syndrome","authors":"M. Silvestrini, B. Rizzato, F. Placidi, R. Baruffaldi, A. Bianconi, M. Diomedi","doi":"10.1161/01.STR.0000019123.47840.2D","DOIUrl":"https://doi.org/10.1161/01.STR.0000019123.47840.2D","url":null,"abstract":"Background and Purpose— Epidemiological studies have suggested a pathophysiological link between sleep apnea syndrome and cerebrovascular diseases. The mechanism by which sleep disturbance can affect the predisposition to developing stroke is not clear. The aim of this study was to investigate whether patients with obstructive sleep apnea syndrome have an increase in atherosclerosis indicators at the carotid artery level. Methods— We included 23 male patients with severe obstructive sleep apnea syndrome (respiratory disturbance index >30). Intima-media thickness and the presence of steno-occlusive lesions in the common carotid arteries were investigated with B-mode high-resolution ultrasonography. Results of the ultrasonographic examination were compared with those of a group of 23 subjects without obstructive sleep apnea syndrome who were matched for age and comorbid factors. Results— The intima-media thickness of the common carotid arteries of patients with obstructive sleep apnea syndrome was significantly higher (P <0.0001) than that of control subjects (1.429±0.34 versus 0.976±0.17 mm). Conclusions— Results of the present study show that carotid wall thickness is increased in patients with severe sleep apnea syndrome. There is strong evidence that an increase in the thickness of the carotid artery wall is a valid marker of the risk of stroke. For this reason, our finding seems to further strengthen the hypothesis that patients with obstructive sleep apnea syndrome are at risk of developing cerebrovascular diseases regardless of the association with other vascular risk factors.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"62 1","pages":"1782-1785"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76600458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1161/01.STR.0000019910.90280.F1
L. Kammersgaard, Jørgensen Hs, J. Rungby, J. Reith, H. Nakayama, U. Weber, J. Houth, T. S. Olsen
Background and Purpose— Body temperature is considered crucial in the management of acute stroke patients. Recently hypothermia applied as a therapy for stroke has been demonstrated to be feasible and safe in acute stroke patients. In the present study, we investigated the predictive role of admission body temperature to the long-term mortality in stroke patients. Methods— We studied 390 patients with acute stroke admitted within 6 hours from stroke onset. Admission clinical characteristics (age, sex, admission stroke severity, admission blood glucose, cardiovascular risk factor profile, and stroke subtype) were recorded for patients with hypothermia (body temperature ≤37°C) versus patients with hyperthermia (body temperature >37°C). Univariately the mortality rates for all patients were studied by Kaplan-Meier statistics. To find independent predictors of long-term mortality for all patients, Cox proportional-hazards models were built. We included all clinical characteristics and body temperature as a continuous variable. Results— Patients with hyperthermia had more severe strokes and more frequently diabetes, whereas no difference was found for the other clinical characteristics. For all patients mortality rate at 60 months after stroke was higher for patients with hyperthermia (73 per 100 cases versus 59 per 10 cases, P =0.001). When body temperature was studied in a multivariate Cox proportional-hazards model, a 1°C increase of admission body temperature independently predicted a 30% relative increase (95% CI, 4% to 57%) in long-term mortality risk. For 3-month survivors we found no association between body temperature and long-term survival when studied in a multivariate Cox proportional hazard model (hazards ratio, 1.11 per 1°C; 95% CI, 0.82 to 1.52). Conclusion— Low body temperature on admission is considered to be an independent predictor of good short-term outcome. The present study suggests that admission body temperature seems to be a major determinant even for long-term mortality after stroke. Hypothermic therapy in the early stage in which body temperature is kept low for a longer period after ictus could be a long-lasting neuroprotective measure.
{"title":"Admission Body Temperature Predicts Long-Term Mortality After Acute Stroke: The Copenhagen Stroke Study","authors":"L. Kammersgaard, Jørgensen Hs, J. Rungby, J. Reith, H. Nakayama, U. Weber, J. Houth, T. S. Olsen","doi":"10.1161/01.STR.0000019910.90280.F1","DOIUrl":"https://doi.org/10.1161/01.STR.0000019910.90280.F1","url":null,"abstract":"Background and Purpose— Body temperature is considered crucial in the management of acute stroke patients. Recently hypothermia applied as a therapy for stroke has been demonstrated to be feasible and safe in acute stroke patients. In the present study, we investigated the predictive role of admission body temperature to the long-term mortality in stroke patients. Methods— We studied 390 patients with acute stroke admitted within 6 hours from stroke onset. Admission clinical characteristics (age, sex, admission stroke severity, admission blood glucose, cardiovascular risk factor profile, and stroke subtype) were recorded for patients with hypothermia (body temperature ≤37°C) versus patients with hyperthermia (body temperature >37°C). Univariately the mortality rates for all patients were studied by Kaplan-Meier statistics. To find independent predictors of long-term mortality for all patients, Cox proportional-hazards models were built. We included all clinical characteristics and body temperature as a continuous variable. Results— Patients with hyperthermia had more severe strokes and more frequently diabetes, whereas no difference was found for the other clinical characteristics. For all patients mortality rate at 60 months after stroke was higher for patients with hyperthermia (73 per 100 cases versus 59 per 10 cases, P =0.001). When body temperature was studied in a multivariate Cox proportional-hazards model, a 1°C increase of admission body temperature independently predicted a 30% relative increase (95% CI, 4% to 57%) in long-term mortality risk. For 3-month survivors we found no association between body temperature and long-term survival when studied in a multivariate Cox proportional hazard model (hazards ratio, 1.11 per 1°C; 95% CI, 0.82 to 1.52). Conclusion— Low body temperature on admission is considered to be an independent predictor of good short-term outcome. The present study suggests that admission body temperature seems to be a major determinant even for long-term mortality after stroke. Hypothermic therapy in the early stage in which body temperature is kept low for a longer period after ictus could be a long-lasting neuroprotective measure.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"5 1","pages":"1759-1762"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75236565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1161/01.STR.0000019290.25405.83
K. Todo, Manabu Watanabe, R. Fukunaga, Ken Araki, Shiro Yamamoto, Makiko Rai, Taku Hoshi, M. Nukata, A. Taguchi, N. Kinoshita
Background and Purpose— Conventionally, carotid ultrasonography has been performed with a 7.5-MHz linear probe to evaluate the extracranial internal carotid artery (ICA). However, usually only the carotid bulb or proximal portion of the ICA can be evaluated. We attempted to evaluate the distal extracranial ICA with a 3.5-MHz convex probe. Methods— The subjects were 17 consecutive patients with ICAs free of occlusive disease and 3 other patients with distal extracranial ICA stenosis. Using a 7.5-MHz linear probe and a 3.5-MHz convex probe, we performed long-axis B-mode imaging of the ICAs to evaluate the distance between the distal limit of visualized ICA and the bifurcation of the common carotid artery. Results— The distal limit of the ICA, visualized with a 7.5- or a 3.5-MHz probe, was 31±11 or 57±8 mm distal to the common carotid artery bifurcation, respectively. In the 3 patients with distal extracranial ICA stenosis, the lesion could be successfully diagnosed with only the 3.5-MHz probe. Conclusions— This form of carotid imaging is feasible and may be potentially useful in the evaluation of carotid disease.
{"title":"Imaging of Distal Internal Carotid Artery by Ultrasonography With a 3.5-MHz Convex Probe","authors":"K. Todo, Manabu Watanabe, R. Fukunaga, Ken Araki, Shiro Yamamoto, Makiko Rai, Taku Hoshi, M. Nukata, A. Taguchi, N. Kinoshita","doi":"10.1161/01.STR.0000019290.25405.83","DOIUrl":"https://doi.org/10.1161/01.STR.0000019290.25405.83","url":null,"abstract":"Background and Purpose— Conventionally, carotid ultrasonography has been performed with a 7.5-MHz linear probe to evaluate the extracranial internal carotid artery (ICA). However, usually only the carotid bulb or proximal portion of the ICA can be evaluated. We attempted to evaluate the distal extracranial ICA with a 3.5-MHz convex probe. Methods— The subjects were 17 consecutive patients with ICAs free of occlusive disease and 3 other patients with distal extracranial ICA stenosis. Using a 7.5-MHz linear probe and a 3.5-MHz convex probe, we performed long-axis B-mode imaging of the ICAs to evaluate the distance between the distal limit of visualized ICA and the bifurcation of the common carotid artery. Results— The distal limit of the ICA, visualized with a 7.5- or a 3.5-MHz probe, was 31±11 or 57±8 mm distal to the common carotid artery bifurcation, respectively. In the 3 patients with distal extracranial ICA stenosis, the lesion could be successfully diagnosed with only the 3.5-MHz probe. Conclusions— This form of carotid imaging is feasible and may be potentially useful in the evaluation of carotid disease.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"43 1","pages":"1792-1794"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73390475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1161/01.STR.0000019289.15440.F2
S. Lai, S. Studenski, P. Duncan, S. Perera
Background and Purpose— The purpose of this study was to compare disability and quality of life as measured by the Stroke Impact Scale (SIS) of stroke patients deemed recovered (Barthel Index ≥95) with 2 stroke-free populations of community-dwelling elderly. Methods— Eighty-one stroke patients who participated in the Kansas City Stroke Registry and achieved a Barthel Index of ≥95 at 3 months after stroke and 246 stroke-free subjects enrolled in the Community Elders Study were enrolled in this study. The Community Elders Study group was further divided into 2 groups, those recruited from the Department of Veterans Affairs Health System (VA) and a those from a local health maintenance organization (HMO). Stroke patients were administered the SIS ≈90 days after stroke, and the stroke-free community dwellers were administered a version of the SIS adapted for nonstroke subjects, the Health Impact Scale (HIS). A general linear model was used to examine differences in health outcomes measured by the SIS or HIS between the KCSR stroke patients and VA and HMO community-dwelling elders after controlling for medical comorbidities and demographics. Results— Kansas City Stroke Registry participants were significantly older than the community study groups (P =0.0052). Selected medical conditions were similar among the 3 study groups. Old age and a history of diabetes mellitus were more likely to be associated with more deficits and poor quality of life. In stroke patients deemed recovered, stroke still affected hand function, activities and independent activities of daily living, participation, and overall physical function compared with the stroke-free community dwellers in the HMO health system even after adjustment for age and diabetes status. Stroke-free community dwellers in the VA health system also had worse social participation than the stroke-free community dwellers in the HMO health system. Conclusions— Research and clinicians have consistently underestimated the impact of stroke with the Barthel Index. This has major implications for the design of therapeutic trial designs and adequate assessments of social and economic sequelae of stroke.
{"title":"Persisting Consequences of Stroke Measured by the Stroke Impact Scale","authors":"S. Lai, S. Studenski, P. Duncan, S. Perera","doi":"10.1161/01.STR.0000019289.15440.F2","DOIUrl":"https://doi.org/10.1161/01.STR.0000019289.15440.F2","url":null,"abstract":"Background and Purpose— The purpose of this study was to compare disability and quality of life as measured by the Stroke Impact Scale (SIS) of stroke patients deemed recovered (Barthel Index ≥95) with 2 stroke-free populations of community-dwelling elderly. Methods— Eighty-one stroke patients who participated in the Kansas City Stroke Registry and achieved a Barthel Index of ≥95 at 3 months after stroke and 246 stroke-free subjects enrolled in the Community Elders Study were enrolled in this study. The Community Elders Study group was further divided into 2 groups, those recruited from the Department of Veterans Affairs Health System (VA) and a those from a local health maintenance organization (HMO). Stroke patients were administered the SIS ≈90 days after stroke, and the stroke-free community dwellers were administered a version of the SIS adapted for nonstroke subjects, the Health Impact Scale (HIS). A general linear model was used to examine differences in health outcomes measured by the SIS or HIS between the KCSR stroke patients and VA and HMO community-dwelling elders after controlling for medical comorbidities and demographics. Results— Kansas City Stroke Registry participants were significantly older than the community study groups (P =0.0052). Selected medical conditions were similar among the 3 study groups. Old age and a history of diabetes mellitus were more likely to be associated with more deficits and poor quality of life. In stroke patients deemed recovered, stroke still affected hand function, activities and independent activities of daily living, participation, and overall physical function compared with the stroke-free community dwellers in the HMO health system even after adjustment for age and diabetes status. Stroke-free community dwellers in the VA health system also had worse social participation than the stroke-free community dwellers in the HMO health system. Conclusions— Research and clinicians have consistently underestimated the impact of stroke with the Barthel Index. This has major implications for the design of therapeutic trial designs and adequate assessments of social and economic sequelae of stroke.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"34 1","pages":"1840-1844"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80121761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-07-01DOI: 10.1161/01.STR.0000020714.48349.4E
T. Farr, I. Whishaw
Background and Purpose— Skilled reaching movements are an important aspect of human motor behavior but are impaired after motor system stroke. The purpose of this study was to document skilled movements in mice before and after a focal motor cortex stroke for the purpose of developing a mouse model of human stroke. Methods— Male C57/BL6 mice were trained to reach with a forelimb for food pellets and then given a motor cortex stroke, induced by pial stripping, contralateral to their preferred reaching limb. Reaching success and the movements used in reaching were analyzed by frame-by-frame inspection of presurgical and postsurgical video records. Results— Reaching success was severely impaired after the stroke. Improvement in success over 2 postsurgical weeks was moderate. Analysis of 10 movement components comprising reaches pre- and postsurgically indicated that most of the rotatory movements of the limb used for aiming, advancing, pronating, and supinating the paw were impaired. When successful reaches did occur, body movements that compensated for the impairments in limb rotatory movements aided them. Conclusions— The results indicate that skilled reaching in the mouse is impaired by focal motor cortex stroke and they suggest that the mouse, and the skilled reaching task, provides an excellent model for studying impairments, compensation, and recovery after motor system stroke.
{"title":"Quantitative and Qualitative Impairments in Skilled Reaching in the Mouse (Mus musculus) After a Focal Motor Cortex Stroke","authors":"T. Farr, I. Whishaw","doi":"10.1161/01.STR.0000020714.48349.4E","DOIUrl":"https://doi.org/10.1161/01.STR.0000020714.48349.4E","url":null,"abstract":"Background and Purpose— Skilled reaching movements are an important aspect of human motor behavior but are impaired after motor system stroke. The purpose of this study was to document skilled movements in mice before and after a focal motor cortex stroke for the purpose of developing a mouse model of human stroke. Methods— Male C57/BL6 mice were trained to reach with a forelimb for food pellets and then given a motor cortex stroke, induced by pial stripping, contralateral to their preferred reaching limb. Reaching success and the movements used in reaching were analyzed by frame-by-frame inspection of presurgical and postsurgical video records. Results— Reaching success was severely impaired after the stroke. Improvement in success over 2 postsurgical weeks was moderate. Analysis of 10 movement components comprising reaches pre- and postsurgically indicated that most of the rotatory movements of the limb used for aiming, advancing, pronating, and supinating the paw were impaired. When successful reaches did occur, body movements that compensated for the impairments in limb rotatory movements aided them. Conclusions— The results indicate that skilled reaching in the mouse is impaired by focal motor cortex stroke and they suggest that the mouse, and the skilled reaching task, provides an excellent model for studying impairments, compensation, and recovery after motor system stroke.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"8 1","pages":"1869-1875"},"PeriodicalIF":0.0,"publicationDate":"2002-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84475324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1161/01.STR.0000018589.56991.BA
S. Bak, I. Tsiropoulos, J. Kjærsgaard, M. Andersen, E. Mellerup, J. Hallas, L. G. García Rodríguez, K. Christensen, D. Gaist
Background and Purpose— Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs. Methods— We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. Results— Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates. Conclusions— Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.
{"title":"Selective Serotonin Reuptake Inhibitors and the Risk of Stroke: A Population-Based Case-Control Study","authors":"S. Bak, I. Tsiropoulos, J. Kjærsgaard, M. Andersen, E. Mellerup, J. Hallas, L. G. García Rodríguez, K. Christensen, D. Gaist","doi":"10.1161/01.STR.0000018589.56991.BA","DOIUrl":"https://doi.org/10.1161/01.STR.0000018589.56991.BA","url":null,"abstract":"Background and Purpose— Selective serotonin reuptake inhibitors (SSRIs) have been associated with increased risk of bleeding complications, possibly as a result of inhibition of platelet aggregation. Little is known about the risk of intracerebral hemorrhage in users of SSRIs and whether the effect on platelet aggregation reduces the risk of ischemic stroke. We used population-based data to estimate the risk of hemorrhagic and ischemic stroke in users of SSRIs. Methods— We performed a nested case-control study in Funen County (465 000 inhabitants), Denmark. All patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999 were identified, and a validated diagnosis of stroke was reached in 4765 cases. In all, 40 000 controls were randomly selected from the background population. Information on drug use for cases and controls was retrieved from a prescription registry with full coverage of the county. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register data, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. Results— Of 659 patients with hemorrhagic stroke, 21 were current users of SSRIs. The adjusted odds ratio of hemorrhagic stroke in current SSRI users compared with never users was 1.0 [95% confidence interval (CI), 0.6 to 1.6]. Of 2717 patients with ischemic stroke, 100 were current users of SSRIs, and the adjusted odds ratio of ischemic stroke in cases compared with controls was 1.1 (95% CI, 0.9 to 1.4). The survey data indicated that additional confounder control would not have led to an increase in the relative risk estimates. Conclusions— Current exposure to SSRIs is not associated with increased risk of intracerebral hemorrhage and is probably not associated with a decreased risk of ischemic stroke.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"33 1","pages":"1465-1473"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75808534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1161/01.STR.0000016401.49688.2F
Y. Roos, M. Dijkgraaf, K. W. Albrecht, L. Beenen, R. Groen, R. Haan, M. Vermeulen
Background and Purpose— The purpose of this study was to investigate the current direct costs of modern management of patients with aneurysmal subarachnoid hemorrhage in the first year after diagnosis. Methods— During a 1-year period, we studied all admitted patients with subarachnoid hemorrhage from a population of 2 million people. We calculated the direct costs of treatment, which included the costs of medical and nursing care and the related travel expenses of patients. We calculated true costs for all major healthcare resources. National census data, if available, and standard charges were used to determine healthcare resource expenses. Results— Hospital admissions and diagnostic and therapeutic interventions in 110 patients accounted for 85% of all costs; 64% of the total direct medical costs during admission were the medical, nursing, and overhead costs alone. Patients discharged directly to home generated 4% of the total budget, whereas admission to a nursing home accounted for the remaining 11% of the total costs. Of the diagnostic and therapeutic costs, 45% was caused by imaging and 42% by surgery or coiling. Angiography alone accounted for 52% of the total imaging costs and 24% of the total diagnostic and therapeutic costs. Prescribed medication accounted for only 3% of the total budget of diagnostic and therapeutic costs. Conclusions— Most direct costs during the first year after aneurysmal subarachnoid hemorrhage are caused by the hospital inpatient days, accounting for two thirds of the total costs generated during the first year after the initial bleeding. If new costly treatments succeed in reducing the average length of inpatient hospital stays, then progress in therapy may prove cost effective and might even be cost saving.
{"title":"Direct Costs of Modern Treatment of Aneurysmal Subarachnoid Hemorrhage in the First Year After Diagnosis","authors":"Y. Roos, M. Dijkgraaf, K. W. Albrecht, L. Beenen, R. Groen, R. Haan, M. Vermeulen","doi":"10.1161/01.STR.0000016401.49688.2F","DOIUrl":"https://doi.org/10.1161/01.STR.0000016401.49688.2F","url":null,"abstract":"Background and Purpose— The purpose of this study was to investigate the current direct costs of modern management of patients with aneurysmal subarachnoid hemorrhage in the first year after diagnosis. Methods— During a 1-year period, we studied all admitted patients with subarachnoid hemorrhage from a population of 2 million people. We calculated the direct costs of treatment, which included the costs of medical and nursing care and the related travel expenses of patients. We calculated true costs for all major healthcare resources. National census data, if available, and standard charges were used to determine healthcare resource expenses. Results— Hospital admissions and diagnostic and therapeutic interventions in 110 patients accounted for 85% of all costs; 64% of the total direct medical costs during admission were the medical, nursing, and overhead costs alone. Patients discharged directly to home generated 4% of the total budget, whereas admission to a nursing home accounted for the remaining 11% of the total costs. Of the diagnostic and therapeutic costs, 45% was caused by imaging and 42% by surgery or coiling. Angiography alone accounted for 52% of the total imaging costs and 24% of the total diagnostic and therapeutic costs. Prescribed medication accounted for only 3% of the total budget of diagnostic and therapeutic costs. Conclusions— Most direct costs during the first year after aneurysmal subarachnoid hemorrhage are caused by the hospital inpatient days, accounting for two thirds of the total costs generated during the first year after the initial bleeding. If new costly treatments succeed in reducing the average length of inpatient hospital stays, then progress in therapy may prove cost effective and might even be cost saving.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"104 1","pages":"1595-1599"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75899856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1161/01.STR.0000016925.58848.EA
R. Gillum
Background— Monitoring of trends and patterns of stroke mortality will be of utmost importance in the coming decade. Two innovations in vital statistics may complicate this task and must be brought to the attention of both researchers and readers of research reports: the new Year 2000 Age Standard and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Summary of Review— For cerebrovascular diseases, the age-adjusted death rate is 2.4 times higher with the use of the year 2000 standard than with the use of the old 1940 standard. However, if rates for all years are computed with the use of the same age standard, the percent change from 1979 to 1995 is similar according to the 1940 standard (−35.8%) or the year 2000 standard (−34.3%). Another important effect of the change to the year 2000 standard is to reduce black/white differentials in age-adjusted death rates. Major discontinuities are not observed for mortality trends in cerebrovascular disease or heart disease between International Classification of Diseases, Ninth Revision (ICD-9) (1979–1998) and ICD-10 (1999 and following years) classifications. Conclusions— All data users must exercise caution to specify the age standard used when assessing or presenting age-adjusted rates over time or between groups. The comparability of ICD codes chosen for years before 1999 versus 1999 or following years must be checked to distinguish changes due to coding from true changes in mortality levels.
{"title":"New Considerations in Analyzing Stroke and Heart Disease Mortality Trends: The Year 2000 Age Standard and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision","authors":"R. Gillum","doi":"10.1161/01.STR.0000016925.58848.EA","DOIUrl":"https://doi.org/10.1161/01.STR.0000016925.58848.EA","url":null,"abstract":"Background— Monitoring of trends and patterns of stroke mortality will be of utmost importance in the coming decade. Two innovations in vital statistics may complicate this task and must be brought to the attention of both researchers and readers of research reports: the new Year 2000 Age Standard and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Summary of Review— For cerebrovascular diseases, the age-adjusted death rate is 2.4 times higher with the use of the year 2000 standard than with the use of the old 1940 standard. However, if rates for all years are computed with the use of the same age standard, the percent change from 1979 to 1995 is similar according to the 1940 standard (−35.8%) or the year 2000 standard (−34.3%). Another important effect of the change to the year 2000 standard is to reduce black/white differentials in age-adjusted death rates. Major discontinuities are not observed for mortality trends in cerebrovascular disease or heart disease between International Classification of Diseases, Ninth Revision (ICD-9) (1979–1998) and ICD-10 (1999 and following years) classifications. Conclusions— All data users must exercise caution to specify the age standard used when assessing or presenting age-adjusted rates over time or between groups. The comparability of ICD codes chosen for years before 1999 versus 1999 or following years must be checked to distinguish changes due to coding from true changes in mortality levels.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"15 1","pages":"1717-1722"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78141135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1161/01.STR.0000017878.85274.44
K. Rockwood, Murray G. Brown, H. Merry, I. Sketris, J. Fisk
Background and Purpose— The construct of vascular cognitive impairment (VCI) includes many whose care is or will be costly. Nevertheless, estimates of these costs are not well described. We therefore set out to estimate the societal costs of VCI in elderly people. Methods— In a secondary analysis of the Canadian Study of Health and Aging, a representative cohort study, Canadian dollar costs using a societal perspective were estimated by standard methods. Results— The total annual per-patient societal costs for VCI by severity were $15 022 for those with mild disease, $14 468 for those with mild to moderate disease, $20 063 for those with moderate disease, and $34 515 for those with severe disease. The most expensive component per individual was the cost of institutional long-term care. Although severe impairment was associated with higher costs, the extent of institutionalization at all levels of severity and less drug use among those more severely impaired mitigated a severity-cost gradient. Conclusions— The societal costs of VCI are not inconsiderable. In contrast to Alzheimer disease, there is no clear gradient relating cost to severity. Unpaid caregiver costs are an important aspect of societal costs, even in those with only mild impairment.
{"title":"Societal Costs of Vascular Cognitive Impairment in Older Adults","authors":"K. Rockwood, Murray G. Brown, H. Merry, I. Sketris, J. Fisk","doi":"10.1161/01.STR.0000017878.85274.44","DOIUrl":"https://doi.org/10.1161/01.STR.0000017878.85274.44","url":null,"abstract":"Background and Purpose— The construct of vascular cognitive impairment (VCI) includes many whose care is or will be costly. Nevertheless, estimates of these costs are not well described. We therefore set out to estimate the societal costs of VCI in elderly people. Methods— In a secondary analysis of the Canadian Study of Health and Aging, a representative cohort study, Canadian dollar costs using a societal perspective were estimated by standard methods. Results— The total annual per-patient societal costs for VCI by severity were $15 022 for those with mild disease, $14 468 for those with mild to moderate disease, $20 063 for those with moderate disease, and $34 515 for those with severe disease. The most expensive component per individual was the cost of institutional long-term care. Although severe impairment was associated with higher costs, the extent of institutionalization at all levels of severity and less drug use among those more severely impaired mitigated a severity-cost gradient. Conclusions— The societal costs of VCI are not inconsiderable. In contrast to Alzheimer disease, there is no clear gradient relating cost to severity. Unpaid caregiver costs are an important aspect of societal costs, even in those with only mild impairment.","PeriodicalId":22274,"journal":{"name":"Stroke: Journal of the American Heart Association","volume":"81 1","pages":"1605-1609"},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76355730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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