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Monika Turk, Marjan Zaletel, Janja Pretnar Oblak
OBJECTIVE: The diagnosis of ischemic leukoaraiosis (ILA) is based on head magnetic resonance imaging (MRI) and exclusion of other causes of white matter hyperintensities (WMHs). Recent studies have shown increased arterial stiffness and diminished carotid flow in ILA patients. So far, there are very little data on intracerebral hemodynamic parameters in ILA. Due to the specific structure of the intracranial arteries, our aim was to investigate intracerebral hemodynamic parameters in ILA patients and, possibly, to find a reliable ultrasound index of combined intra- and extracranial cerebral arteries...
April 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Daniel J Miller, Jennifer R Simpson, Brian Silver
Intravenous recombinant tissue plasminogen activator (r-tPA) was approved for use in acute ischemic stroke in the United States in 1996. Approximately 2% to 5% of patients with acute ischemic stroke receive r-tPA. Complications related to intravenous r-tPA include symptomatic intracranial hemorrhage, major systemic hemorrhage, and angioedema in approximately 6%, 2%, and 5% of patients, respectively. Risk factors for symptomatic hemorrhage include age, male gender, obesity, increased stroke severity, diabetes, hyperglycemia, uncontrolled hypertension, combination antiplatelet use, large areas of early ischemic change, atrial fibrillation, congestive heart failure, and leukoariosis...
July 2011: Neurohospitalist
Kirk M Welker, Reordan O De Jesus, Robert E Watson, Mary M Machulda, Clifford R Jack
PURPOSE: To test the hypothesis that leukoaraiosis alters functional activation during a semantic decision language task. MATERIALS AND METHODS: With institutional review board approval and written informed consent, 18 right-handed, cognitively healthy elderly participants with an aggregate leukoaraiosis lesion volume of more than 25 cm(3) and 18 age-matched control participants with less than 5 cm(3) of leukoaraiosis underwent functional MR imaging to allow comparison of activation during semantic decisions with that during visual perceptual decisions...
October 2012: Radiology
Sebastian Koch, Mark S McClendon, Rita Bhatia
BACKGROUND: In acute lacunar infarction, MRI may overestimate eventual infarct size and the imaging evolution of acute lesions is not fully understood. Our objective was to examine eventual infarct size, the incidence of cavity formation, and factors associated with cavitation in patients presenting with acute lacunar infarction. METHODS: Patients with acute diffusion-weighted imaging (DWI) infarcts ≤25 mm in diameter, in the distribution of a penetrating artery, who had a follow-up MRI or CT at least 1 month or longer from stroke onset were retrospectively included...
September 13, 2011: Neurology
Reinhold Schmidt, Stefan Ropele, José Ferro, Sofia Madureira, Ana Verdelho, Katja Petrovic, Alida Gouw, Wiesje M van der Flier, Christian Enzinger, Leonardo Pantoni, Domenico Inzitari, Timo Erkinjuntti, Philip Scheltens, Lars O Wahlund, Gunhild Waldemar, Egill Rostrup, Anders Wallin, Frederik Barkhof, Franz Fazekas
BACKGROUND AND PURPOSE: The mechanisms by which leukoariosis impacts on clinical and cognitive functions are not yet fully understood. We hypothesized that ultrastructural abnormalities of the normal-appearing brain tissue (NABT) assessed by diffusion-weighted imaging played a major and independent role. METHODS: In addition to a comprehensive clinical, neuropsychologic, and imaging work-up, diffusion-weighted imaging was performed in 340 participants of the multicenter leukoariosis and disability study examining the impact of white matter hyperintensities (WMH) on 65- to 85-year old individuals without previous disability...
May 2010: Stroke; a Journal of Cerebral Circulation
Clinton B Wright, Yeseon Moon, Myunghee C Paik, Truman R Brown, LeRoy Rabbani, Mitsuhiro Yoshita, Charles DeCarli, Ralph Sacco, Mitchell S V Elkind
BACKGROUND AND PURPOSE: Inflammatory biomarkers, including lipoprotein-associated phospholipase A2 (Lp-PLA2), myeloperoxidase (MPO), and high-sensitivity C-reactive protein (hsCRP) are associated with ischemic stroke risk. White matter hyperintensities (WMH) seen on brain MRI scans are associated with vascular risk factors and an increased risk of incident stroke, but their relation to inflammatory biomarkers is unclear. METHODS: The Northern Manhattan Study includes a stroke-free community-based sample of Hispanic, black, and white participants with quantitative measurement of WMH volume (WMHV) and inflammatory biomarkers...
November 2009: Stroke; a Journal of Cerebral Circulation
Gillian M Sare, Philip M W Bath, Laura J Gray, Thierry Moulin, France Woimant, Timothy England, Chamila Geeganage, Hanne Christensen, Peter Paul De Deyn, Didier Leys, Desmond O'Neill, E Bernd Ringelstein
BACKGROUND AND PURPOSE: High blood pressure (BP) is present in approximately 80% of patients with acute ischemic stroke and is independently associated with poor outcome. There are few data examining the relationship between admission BP and acute CT findings. METHODS: TAIST was a randomized controlled trial assessing 10 days of treatment with tinzaparin versus aspirin in 1489 patients with acute ischemic stroke (<48 hr) with admission BP of </=220/120 mmHg...
January 2009: Stroke; a Journal of Cerebral Circulation
Saeed Bohlega, Asmahan Al Shubili, Abdulrahman Edris, Abdulrahman Alreshaid, Thamer Alkhairallah, M Walid AlSous, Samir Farah, Khaled K Abu-Amero
BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is increasingly recognized as an inherited arterial disease leading to a step-wise decline and eventually to dementia. CADASIL is caused by mutations in NOTCH3 epidermal growth factor-like repeat that maps to chromosome 19. CADASIL cases have been identified in most countries of Western and Central Europe, the Americas, Japan, Australia, the Caribbean, South America, Tanzania, Turkey, South Africa and Southeast Asia, but not in Arabs...
November 9, 2007: BMC Medical Genetics
Oliver C Singer, Marek C Humpich, Jens Fiehler, Gregory W Albers, Maarten G Lansberg, Andiras Kastrup, Alex Rovira, David S Liebeskind, Achim Gass, Charlotte Rosso, Laurent Derex, Jong S Kim, Tobias Neumann-Haefelin
OBJECTIVE: The risk for symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic treatment has not been evaluated in large studies using diffusion-weighted imaging (DWI). Here, we investigated the relation between pretreatment DWI lesion size and the risk for sICH after thrombolysis. METHODS: In this retrospective multicenter study, prospectively collected data from 645 patients with anterior circulation stroke treated with intravenous or intraarterial thrombolysis within 6 hours (<3 hours: n = 320) after symptom onset were pooled...
January 2008: Annals of Neurology
Usman Khan, Ahamad Hassan, Patrick Vallance, Hugh S Markus
BACKGROUND AND PURPOSE: Endothelial dysfunction may play a causal role in cerebral small vessel disease (SVD). Asymmetric dimethylarginine (ADMA), a circulating endogenous inhibitor of nitric oxide, has been implicated in endothelial dysfunction, particularly in hyperhomocystinemia, a known risk factor for SVD. We determined if ADMA was elevated in SVD, correlated with disease severity, and interacted with homocysteine. METHODS: ADMA and homocysteine levels were determined in 47 consecutive symptomatic SVD patients and 38 controls...
February 2007: Stroke; a Journal of Cerebral Circulation
A L Boxer, J H Kramer, K Johnston, J Goldman, R Finley, B L Miller
An elevated serum homocysteine level is a risk factor for the development of cognitive impairment. Reported is a late-onset case of hyperhomocystinemia due to a vitamin B12 metabolic deficit (cobalamin C) with cognitive impairment, primarily in frontal/executive function. After homocysteine-lowering therapy, the patient's functional and neuropsychological status improved in conjunction with a decrease in leukoariosis on his MRI scan. These findings suggest that homocysteine-related cognitive impairment may be partially reversible...
April 26, 2005: Neurology
Stephen T Turner, Myriam Fornage, Clifford R Jack, Thomas H Mosley, Sharon L R Kardia, Eric Boerwinkle, Mariza de Andrade
We measured 366 microsatellite markers genome-wide to search for loci contributing to subcortical white matter ischemic damage (leukoariosis) and brain atrophy in 488 non-Hispanic white subjects (193 men, 295 women; mean age+/-SD=64.1+/-7.7 years; 79% hypertensive) from 223 sibships recruited through > or =2 members with essential hypertension diagnosed before age 60. Leukoariosis was quantitated by magnetic resonance imaging (MRI), brain atrophy by the difference between intracranial and brain volumes, and calculated mean arterial pressure and pulse pressure provided measures of steady-state level and pulsatile components of blood pressure...
April 2005: Hypertension
J Harbison, G J Gibson, D Birchall, I Zammit-Maempel, G A Ford
OBJECTIVE: To assess sleep-disordered breathing (SDB) in patients with acute stroke and its relationship to prestroke cerebrovascular disease, particularly leukoariosis. METHODS: The authors studied SDB and CT evidence of prestroke cerebrovascular disease, nonacute brain infarction, and white matter disease (WMD) in 78 previously independent patients with acute stroke. Subjects underwent respiratory sleep studies to determine the Apnea-Hypopnea Index (AHI) and Desaturation Index (DI) 7 to 14 days following stroke...
October 14, 2003: Neurology
Sharon Reutens, Perminder Sachdev
OBJECTIVE: There is increasing interest in homocysteine as a risk factor for neuropsychiatric disorders such as stroke, dementia, depression and Parkinson's disease. This article reviews the current literature on the relationship between homocysteine and these disorders to ascertain if any clinical recommendations can be made. METHOD: A MEDLINE and EMBASE search was made for English language publications between 1966 and 2002 using the search terms 'Homocysteine' and 'Stroke', 'Dementia', 'Vascular Dementia', 'Alzheimer's dementia', 'Cognition disorders or cognitive decline or memory disorders', 'Depression or depressive disorders' or 'Parkinson's disease'...
September 2002: International Journal of Geriatric Psychiatry
Anne Rita Øksengård, Monika Haakonsen, Reidar Dullerud, Almira Babovic, Knut Laake, Knut Engedal
BACKGROUND: Neuroimaging can provide valuable information in the diagnostic work-up of patients presenting with suspected dementia. MATERIAL AND METHODS: Based on our experience from a memory clinic at Ullevål University Hospital in Oslo, Norway and on relevant literature identified on Medline, we give an overview of the use of neuroimaging methods in patients with suspected dementia. RESULTS AND INTERPRETATION: CT of the brain should be offered to all patients with suspected dementia as CT can provide essential diagnostic information regarding focal cerebral pathology (tumour, haemorrhage, normal pressure hydrocephalus)...
March 10, 2002: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
Dong-Eog Kim, Hee-Joon Bae, Seung-Hoon Lee, Ho Kim, Byung-Woo Yoon, Jae-Kyu Roh
BACKGROUND: Multifocal signal loss lesion (MSLL) on gradient echo magnetic resonance imaging (GE-MRI) may reflect bleeding-prone microangiopathy. However, MSLLs are also known to be associated with leukoariosis; leukoariosis is commonly associated with occlusive-type vascular lesions. OBJECTIVE: To determine whether MSLL on GE-MRI is significantly associated with the type of stroke--intracerebral hemorrhagic (ICH) stroke more often than an ischemic stroke (infarction)--regardless of the extent of leukoariosis...
March 2002: Archives of Neurology
P K Pal, P N Jayakumar, A B Taly, D Nagaraja, S Rao
Computed tomographic (CT) studies in olivopontocerebellar atrophies (OPCA) and 'early onset cerebellar ataxia with retained tendon reflexes (EOCA)' are few and vary widely in methodology and criteria for cerebellar and brainstem atrophy. In this prospective study, CT scan observations on 26 patients (EOCA-11, OPCA-15) were compared with 31 controls using qualitative and quantitative assessment of cisterns, ventricles and atrophy of brain. Vermian and/or cerebellar hemispheric (predominantly anterior) atrophy was present in 80...
December 1999: Neurology India
J V Bowler, D G Munoz, H Merskey, V Hachinski
OBJECTIVES: To assess the role of cerebrovascular disease, sex, education, occupation, year of birth, leukoaraiosis, congophilic angiopathy, family history, and other demographic factors on the reported age of onset and rate of progression of Alzheimer's disease. METHODS: Analysis of data from the University of Western Ontario Dementia Study, a prospective longitudinal study of dementia patients with clinical and 6 monthly psychometric follow up to postmortem based in a university memory disorders clinic with secondary and tertiary referrals...
August 1998: Journal of Neurology, Neurosurgery, and Psychiatry
K Blennow, A Wallin
When the symptomatology in probable Alzheimer's disease (AD) was studied, two subgroups emerged: one with predominant cortical symptoms of parietal type (AD type I) and another with general cognitive symptoms but absence of or only mild cortical symptoms (AD type II). In AD type I, the age at onset was significantly lower, confusional symptoms and leukoariosis on computerized tomographic scan were less frequent, and the ganglioside GM1 concentration in cerebrospinal fluid was significantly higher than in AD type II...
April 1992: Journal of Geriatric Psychiatry and Neurology
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