Influence of impaired acetazolamide reactivity on silent brain infarction and white matter abnormalities in patients with major cerebral artery occlusive diseases.
スポンサーリンク
概要
- 論文の詳細を見る
Brain infarction may occur in patients with severe stenosis or occlusion of the proximal cerebral arteries and an inadequate collateral blood supply, when cerebral perfusion is critically decreased. Our previous stud-ies failed to demonstrate any relationships between cerebral vasodilatory capacity and stroke recurrence, although the clinical significance of the cerebral vasodilatory capacity remains unclear. We performed a prospective study on ischemic stroke patients with occlusive large-artery diseases to determine whether or not white matter abnormalities and silent brain infarction were associated with a reduced cerebral vasodilatory capacity. During the period from 1987 to 1995, we examined the cerebral vasodilatory capacity by single-photon emission CT and acetazolamide challenge in 105 consecutive stroke patients with severe stenosis (>75% in diameter) or occlusion of the internal carotid artery or the trunk of the middle cerebral artery. Ninety patients (age, 64±8y.o.; M/F, 76/14) who underwent MRI studies within 3 months after the onset of the index stroke were enrolled in the present study. Based on the criteria reported earlier, the patients were divided into 2 groups : a normal (negative ACZ, n=41) and a reduced ACZ reactivity (positive ACZ, n=49). The severity of the white matter abnormalities on MRI at entry was evaluated according to the grading scale reported by Fazekas et al. The observations were terminated when stroke recurred, a surgical treatment such an extracranial-intracranial bypass and carotid endarterectomy was performed, or the patient died. There were no significant differences in severity of white matter abnormalities or number of silent brain in-farcts at entry between the ACZ-positive and negative groups. During the observation period, 13 patients suf-fered stroke recurrence, 13 were treated surgically, 8 died, and 28 dropped out of the follow-up study. Finally, 37 patients who were followed for a median of 2.8 years underwent MRI studies without recurrence. New silent brain infarctions were documented with a follow-up MRI in 1 patient, who had been assigned to the ACZ-positive group at entry. The severity of white matter abnormalities did not change during the follow-up period in all patients. In conclusion, we found no evidence that a reduced vasodilatory capacity plays a role in the development of white matter abnormalities or silent brain infarction in patients with occlusive large-artery diseases.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
- Two cases with aphasia in the left putaminal damage and one case with visuospatial neglect in the right putaminal damage
- Alterations of plasma von Willebrand factor activity and the influence of anti-platelet drugs in acute cerebral infarction
- Carotid endarterectomy plaques correlation of clinical events and morphology.
- Stenting for stenosis of major cerebrovascular arteries.
- Cerebral infarction following antihypertensive therapy.