- Email: [email protected]
2-07-15 Stroke in children with sickle disease
Cerebrovascular was observed in October for ischemic stroke and in March and September for cerebral haemorrhage. The highest number of death occurred in winter for ischaemic and haemorrhagic stroke, when the average temperature had the lowest value. The frequency of ischaemic stroke death increased also at high outdoor temperatures in July. Death were clustered around sudden changes of outdoor temperature even within one season. Conclusion: During winter high occurrence of cerebrovascular death (both ischaemic and haemorrhagic type) was experienced with fatal complications such as pneumonia, myocardial infarcts, pulmonary embolism. The possible explanations of our observations are discussed.
I2 07 L. Csiba,
14
Effect of vinpocetine glucose metabolism
L. Kerenyi,
on hemodynamics and of chronic stroke patients
L. Tron, L. Galuska,
B. Gulyas ‘. Dept. of Neuro/og)
University Medical School of Debrecen, Hungary; Europa, Neuroscience Karolinska Institute, Stockholm, Sweden
’ Dept. of
Aim: A single-dose of vinca-alcaloid vinpocetine (20 mg i.v.) was administered and blood flow velocity changes in MCA (by TCD) and glucose metabolism (by l&FDG-PET) were studied in chronic stroke patients. Patients and Methods: 12 chronic ischemic stroke patients were studied. The patients had infarct in the MCA area and neurological symptoms assessed by different clinical scales (Orgogozo and SNNS). The supratentorial hemispheric stroke was confirmed by two independent investigators using MRI. TCD, and PET (18F-FDG) measurements were made. before and after a single dose of 20 mg i.v. vinpocetin. The blood velocity in MCA, global and regional cerebral glucose metabolic rate (CMRgIu), kinetic constants were calculated on the basis of three compartmental tracer kinetic model. The PET results were compared with TCD findings. Results: TCD: after 20 mg vinpocetine percentual blood velocity in MCA decreased by -7.5 f 5.5% and PI increased by 22.3 f 9.6% in the symptomatic hemisphere (p = 0.07). A slight velocity increase could be observed in the contralateral hemisphere (1.6 f 5.3%). PET: The average rCMRglu value in the non-affected hemisphere (6.86 mg/lOO S/min) exceeded that in the affected hemisphere (5.62 mg/lOO g/min) and the difference was significant (p = 0.006). However, the decreased metabolic rate in the affected hemisphere was not homogenous: the stroke region had low metabolic rate (5.47 mg/lOO g/min), whereas the cortical region outside the stroke region but still inside the MCA area had relatively high metabolic rate (8.08 mg/lOO g/min); the difference between these two regions was significant. After vinpocetine the CMRglu did not change significantly but Kl and K2 constants of glucose transport increased significantly in the symptomatic and contralateral hemisphere as well. The correlation between PET findings in MCA area and TCD findings are also discussed. Conduslon: A single dose of 20 mg i.v. vinpocetine significantly influences the hemodynamics and glucose transport in chronic stroke patients.
2 07 15 I__I Carlos
Stroke in children
D. Cuhado,
Bhuwan
Department of Neurology; Indiana, USA
with sickle disease
P. Garg, Jose Biller, Jorge J. Asconape. lndiana
University
School
of Medicine,
Indianapolis,
Background: Stroke is a common complication in sickle cell disease (SCD) occurring in up to 15% of patients. DbJeotivee: To assess the incidence, clinical presentation, neuroimaging findings, responses to therapy, and outcome of cerebrovascular complications in patients with SCD. Material and Methods: We reviewed the medical records of 90 children with SCD followed at Riley Hospital from 1991 to 1996. Variables analyzed included: age, sex, race, type of hemoglobin (Hb), neurologic symptoms at time of the stroke and neurologic sequelae. Reeullults: 65 patients had Hb SS, 25 had Hb SC. 16 of the 90 patients with SCD had a stroke. All patients with stroke had HbSS. Mean age of onset was 6 years; 69% of strokes occurred before age 10 years. Mean Hb value was 8.2 gm/dl (N = 38) in patients without stroke and 7.8 gm/dl (N = 16) in patients with stroke. Mean hematocrit was 30.0 (N = 35) and 28.5 (N 16) in patients without and with strokes respectively. Mean HbS value in patients without stroke was 33% (N = 42) and 28% (N = 16) in patients with stroke. HbAP and leukocyte count were higher in patients with strokes when compared to patients without strokes. This difference was significant only for HbA2 in patients aged l-5 years (p c 0.05). The most common clinical manifestations were hemiparesis (SS)%), seizures (13%), and mental status changes (13%). CT (1 patient) and MRI (15 patients) were abnormal. The most common findings was infarction in the MCA distribution (81%). Three patients (19%) presented with an intracranial hemorrhage. MRA was done in 8 patients; large vessel disease was seen in 5 patients of whom 2 had an angiographic Moyamoya pattern. Thirteen patients received exchange transfusion after onset of their stroke: four of them received
Diseases
s19
long term transfusion therapy. Eight patients had recurrent stroke including two patients who were receiving long term transfusion therapy. Conclusion: Stroke was the most common neurological complication in our series of patients with sickle cell disease. The majorky of patients had the stroke before the age of 10 years. Df all the patients with stroke half had a recurrent stroke. MRA provided useful information for stroke management.
2-07-l 6
Effect of etectroacupuncture on transient focal cerebral ischemia and extracellular amino acid neurotransmttters in rat striatum
Zhao Peng, Cheng Jie-shi. Shanghai
Medical
Univetsity,
(National Laborafory PR China)
of Medical
Neurobiolog)!
Aim: Clinical reports have shown that acupuncture can ameliorate the conditions of stroke patients. The aim of the present study was to detenine the effect of electroacupunctrue (EA) on cerebral infarction dimension changes and extracellular amino acid neurotransmitters in rat strtatum following transient focal cerebral ischemia. Methods: Experimental ischemia was induced by occluding the left middle cerebral arteria (MCA) with a 4.0 nylon suture for 2 hours and reperfusion was accomplished by withdrawing the suture back. The extracellular amino acids level was evaluated directly by employing the intracerebral microdialysis technique. EA was carried out at the points corresponding to “Fengfu” (Du. 15) and ‘Jinsuo” (Du. 7). The dialysate samples were assayed by high-performance liquid chromatography with fluorescence detector. Results: Effect of EA on infarction dimensions: cerebral infarction, measured by 2.3.5-Triphenyltetrazolium chloride (TX) staining for mitochonddal dehydrogenase activity, was significantly reduced in the EA treated ischemia rats (P < 0.01). Effect of EA on extracellular amino acid neurotransmitter levels in ischemic striatum: The ischemia-induced increase of extracellular aspartete was significantly decreased by EA, whereas the ischemia-induced elevation of taurine was substantially enhanced by EA. Conduslon: These results suggest that the neuro-protective effect of EA against cerebral ischemia may be related to a bidirectional regulation of extracellular excitatory and inhibitory amino acid levels.
2-07-l 7
The value of three-phase spiral CT in acute middle cerebral artery terrftory ischemic stroke
Nack-Cheon Choi, Byeong-Hoon Lim, Kwang-Ho Lee ‘, Chin-Sang Chung ‘, Soo-Joo Lee I. Department of Neurology; GyeongSang National Universiiy Hospital,
Chinju, Korea,
’ Samsung
Medical
Center,
Seoul, Korea
Conventional angiography (CA) is a gold standard for the diagnosis of middle cerebral artery (MCA) occlusion. MR angiography (MRA) or spiral CT angiography is an alternative. However, it takes too much time to perform these procedures before thrombolytic therapy. We evaluate the usefulness of 3-phase spiral CT in acute MCA territory ischemic stroke. The initial precontrast CT scan was taken a 5 mm thickness increments from the foramen magnum to the suprasella region and with a 10 mm thickness in the remaining areas. A 3-phase spiral CT with 3 sequential scans was perfoned after the power injector-contmlled i.v. administration of contrast media at a rate of 3 ml per set with the following parameters: 1) early phase: start delay 18 set; 2) middle phase: start delay 30 set; 3) late phase start: delay 80 sec. Total dose of contrast media was 80 ml. It took about 5 minutes for the whole procedure. A 3-phase spiral CT was done within 6 hours of acute MCA territory ischemic stroke in 2.2 patients. CA or MRA was performed in all patients within 15 hours after spiral CT. The occlusion of MCA was confirmed in the stem (8 patients), at the bifurcation (4 patients), and in the superior or inferior division (3 patients) by CA or MRA. In the early and middle phases of spiral CT scan the sites of MCA occlusion could be identified in all 12 patients with the MCA stem or bifurcation occlusion. In the middle and late phases we observed the delayed vascular enhancement in the ischemic areas in 15 of all 22 patients. The delayed vascular enhancement was considered to represent markedly slow aterial collaterals supplying the ischemic areas on CA. Attenuation of lentiform nucleus and loss of gray-white matter differentiation was more evident in the middle phase than on the precontrast CT scan. Our findings suggest that 3-phase spiral CT may be a noninvasive and rapid procedure for the diagnosis of acute MCA territory ischemic stroke.
2-07-l
8
D. Chyatte,
Matrix metalloproteinase activity and the occurrence of intracranial aneurysms G. Bruno, R. Todor, I. Lewis. Department
Cleveland
Clinic, Cleveland,
Background:
Cerebral
Ohio 44195,
aneurysms
of Neurosurgery
The
USA
are associated
with increased
serum levels
I2 07 L. Csiba,
14
Effect of vinpocetine glucose metabolism
L. Kerenyi,
on hemodynamics and of chronic stroke patients
L. Tron, L. Galuska,
B. Gulyas ‘. Dept. of Neuro/og)
University Medical School of Debrecen, Hungary; Europa, Neuroscience Karolinska Institute, Stockholm, Sweden
’ Dept. of
Aim: A single-dose of vinca-alcaloid vinpocetine (20 mg i.v.) was administered and blood flow velocity changes in MCA (by TCD) and glucose metabolism (by l&FDG-PET) were studied in chronic stroke patients. Patients and Methods: 12 chronic ischemic stroke patients were studied. The patients had infarct in the MCA area and neurological symptoms assessed by different clinical scales (Orgogozo and SNNS). The supratentorial hemispheric stroke was confirmed by two independent investigators using MRI. TCD, and PET (18F-FDG) measurements were made. before and after a single dose of 20 mg i.v. vinpocetin. The blood velocity in MCA, global and regional cerebral glucose metabolic rate (CMRgIu), kinetic constants were calculated on the basis of three compartmental tracer kinetic model. The PET results were compared with TCD findings. Results: TCD: after 20 mg vinpocetine percentual blood velocity in MCA decreased by -7.5 f 5.5% and PI increased by 22.3 f 9.6% in the symptomatic hemisphere (p = 0.07). A slight velocity increase could be observed in the contralateral hemisphere (1.6 f 5.3%). PET: The average rCMRglu value in the non-affected hemisphere (6.86 mg/lOO S/min) exceeded that in the affected hemisphere (5.62 mg/lOO g/min) and the difference was significant (p = 0.006). However, the decreased metabolic rate in the affected hemisphere was not homogenous: the stroke region had low metabolic rate (5.47 mg/lOO g/min), whereas the cortical region outside the stroke region but still inside the MCA area had relatively high metabolic rate (8.08 mg/lOO g/min); the difference between these two regions was significant. After vinpocetine the CMRglu did not change significantly but Kl and K2 constants of glucose transport increased significantly in the symptomatic and contralateral hemisphere as well. The correlation between PET findings in MCA area and TCD findings are also discussed. Conduslon: A single dose of 20 mg i.v. vinpocetine significantly influences the hemodynamics and glucose transport in chronic stroke patients.
2 07 15 I__I Carlos
Stroke in children
D. Cuhado,
Bhuwan
Department of Neurology; Indiana, USA
with sickle disease
P. Garg, Jose Biller, Jorge J. Asconape. lndiana
University
School
of Medicine,
Indianapolis,
Background: Stroke is a common complication in sickle cell disease (SCD) occurring in up to 15% of patients. DbJeotivee: To assess the incidence, clinical presentation, neuroimaging findings, responses to therapy, and outcome of cerebrovascular complications in patients with SCD. Material and Methods: We reviewed the medical records of 90 children with SCD followed at Riley Hospital from 1991 to 1996. Variables analyzed included: age, sex, race, type of hemoglobin (Hb), neurologic symptoms at time of the stroke and neurologic sequelae. Reeullults: 65 patients had Hb SS, 25 had Hb SC. 16 of the 90 patients with SCD had a stroke. All patients with stroke had HbSS. Mean age of onset was 6 years; 69% of strokes occurred before age 10 years. Mean Hb value was 8.2 gm/dl (N = 38) in patients without stroke and 7.8 gm/dl (N = 16) in patients with stroke. Mean hematocrit was 30.0 (N = 35) and 28.5 (N 16) in patients without and with strokes respectively. Mean HbS value in patients without stroke was 33% (N = 42) and 28% (N = 16) in patients with stroke. HbAP and leukocyte count were higher in patients with strokes when compared to patients without strokes. This difference was significant only for HbA2 in patients aged l-5 years (p c 0.05). The most common clinical manifestations were hemiparesis (SS)%), seizures (13%), and mental status changes (13%). CT (1 patient) and MRI (15 patients) were abnormal. The most common findings was infarction in the MCA distribution (81%). Three patients (19%) presented with an intracranial hemorrhage. MRA was done in 8 patients; large vessel disease was seen in 5 patients of whom 2 had an angiographic Moyamoya pattern. Thirteen patients received exchange transfusion after onset of their stroke: four of them received
Diseases
s19
long term transfusion therapy. Eight patients had recurrent stroke including two patients who were receiving long term transfusion therapy. Conclusion: Stroke was the most common neurological complication in our series of patients with sickle cell disease. The majorky of patients had the stroke before the age of 10 years. Df all the patients with stroke half had a recurrent stroke. MRA provided useful information for stroke management.
2-07-l 6
Effect of etectroacupuncture on transient focal cerebral ischemia and extracellular amino acid neurotransmttters in rat striatum
Zhao Peng, Cheng Jie-shi. Shanghai
Medical
Univetsity,
(National Laborafory PR China)
of Medical
Neurobiolog)!
Aim: Clinical reports have shown that acupuncture can ameliorate the conditions of stroke patients. The aim of the present study was to detenine the effect of electroacupunctrue (EA) on cerebral infarction dimension changes and extracellular amino acid neurotransmitters in rat strtatum following transient focal cerebral ischemia. Methods: Experimental ischemia was induced by occluding the left middle cerebral arteria (MCA) with a 4.0 nylon suture for 2 hours and reperfusion was accomplished by withdrawing the suture back. The extracellular amino acids level was evaluated directly by employing the intracerebral microdialysis technique. EA was carried out at the points corresponding to “Fengfu” (Du. 15) and ‘Jinsuo” (Du. 7). The dialysate samples were assayed by high-performance liquid chromatography with fluorescence detector. Results: Effect of EA on infarction dimensions: cerebral infarction, measured by 2.3.5-Triphenyltetrazolium chloride (TX) staining for mitochonddal dehydrogenase activity, was significantly reduced in the EA treated ischemia rats (P < 0.01). Effect of EA on extracellular amino acid neurotransmitter levels in ischemic striatum: The ischemia-induced increase of extracellular aspartete was significantly decreased by EA, whereas the ischemia-induced elevation of taurine was substantially enhanced by EA. Conduslon: These results suggest that the neuro-protective effect of EA against cerebral ischemia may be related to a bidirectional regulation of extracellular excitatory and inhibitory amino acid levels.
2-07-l 7
The value of three-phase spiral CT in acute middle cerebral artery terrftory ischemic stroke
Nack-Cheon Choi, Byeong-Hoon Lim, Kwang-Ho Lee ‘, Chin-Sang Chung ‘, Soo-Joo Lee I. Department of Neurology; GyeongSang National Universiiy Hospital,
Chinju, Korea,
’ Samsung
Medical
Center,
Seoul, Korea
Conventional angiography (CA) is a gold standard for the diagnosis of middle cerebral artery (MCA) occlusion. MR angiography (MRA) or spiral CT angiography is an alternative. However, it takes too much time to perform these procedures before thrombolytic therapy. We evaluate the usefulness of 3-phase spiral CT in acute MCA territory ischemic stroke. The initial precontrast CT scan was taken a 5 mm thickness increments from the foramen magnum to the suprasella region and with a 10 mm thickness in the remaining areas. A 3-phase spiral CT with 3 sequential scans was perfoned after the power injector-contmlled i.v. administration of contrast media at a rate of 3 ml per set with the following parameters: 1) early phase: start delay 18 set; 2) middle phase: start delay 30 set; 3) late phase start: delay 80 sec. Total dose of contrast media was 80 ml. It took about 5 minutes for the whole procedure. A 3-phase spiral CT was done within 6 hours of acute MCA territory ischemic stroke in 2.2 patients. CA or MRA was performed in all patients within 15 hours after spiral CT. The occlusion of MCA was confirmed in the stem (8 patients), at the bifurcation (4 patients), and in the superior or inferior division (3 patients) by CA or MRA. In the early and middle phases of spiral CT scan the sites of MCA occlusion could be identified in all 12 patients with the MCA stem or bifurcation occlusion. In the middle and late phases we observed the delayed vascular enhancement in the ischemic areas in 15 of all 22 patients. The delayed vascular enhancement was considered to represent markedly slow aterial collaterals supplying the ischemic areas on CA. Attenuation of lentiform nucleus and loss of gray-white matter differentiation was more evident in the middle phase than on the precontrast CT scan. Our findings suggest that 3-phase spiral CT may be a noninvasive and rapid procedure for the diagnosis of acute MCA territory ischemic stroke.
2-07-l
8
D. Chyatte,
Matrix metalloproteinase activity and the occurrence of intracranial aneurysms G. Bruno, R. Todor, I. Lewis. Department
Cleveland
Clinic, Cleveland,
Background:
Cerebral
Ohio 44195,
aneurysms
of Neurosurgery
The
USA
are associated
with increased
serum levels