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This Month in Archives of Neurology
Arch Neurol. 2001;58:547-548.
Coiling Aneurysms
Dovey and colleagues (SEE ARTICLE) summarize their extensive and authoritative experience with endovascular therapy
as an alternative therapy for intracranial aneurysms. They feature in this
review their experience with the Guglielmi detachable coil. Surgical and endovascular
therapies need to be compared and contrasted, and this well-focused review
achieves this purpose.
Stroke in Sickle Cell Disease
Adams (SEE ARTICLE) reviews, in a
thorough and comprehensive manner, current knowledge of the prevention and
treatment of stroke in patients with sickle cell disease. This is a critical
and important area that deserves greater attention, and this review sets the
stage for future controlled clinical trials.
The Brain After Cardiac Surgery
Wityk and colleagues (SEE ARTICLE) ,
using diffusion-weighted (DWI) and perfusion-weighted (PWI) magnetic resonance
imaging (MRI), have studied the neurologic complications in patients after
cardiac surgery. The newer MRI modalities indicated significant and important
patterns of ischemic lesions and infarctions not appreciated previously with
standard MRI or computed tomographic (CT) imaging.
Caplan (SEE ARTICLE) , provides critical
editorial assessment.
Arteriolar Hemodynamics and Stroke
Cupini and colleagues (SEE ARTICLE) have described impaired cerebrovascular reserve capacity in patients with
multiple subcortical infarcts involving small vessel vasculopathy and hypoperfusion.
This important study provides insight into the mechanisms of silent infarctions
and the prospect that transcranial Doppler ultrasonography, which is easy
to use, may be of diagnostic value in measuring the presence of subcortical
stroke.
Editorial perspective is provided by Dulli (SEE ARTICLE) .
Stroke Questions Answered With MRI
Tong and colleagues (SEE ARTICLE) ,
in an elegant study, have measured the relationship between acute DWI and
PWI MRI findings and the risk of secondary hemorrhagic transformation in patients
with acute stroke. Both DWI and PWI detect abnormalities associated with hemorrhagic
transformation, and these findings are of value in considering anticoagulation
and/or thrombolytic therapies.
Insight and perspective is provided in an editorial
by Levine (SEE ARTICLE) .
Thinking After Coronary Artery Bypass Surgery
Selnes and colleagues (SEE ARTICLE)
describe cognitive changes in patients after coronary artery bypass surgery.
Specific changes are described in some cognitive domains distinct from those
associated with normal aging. These findings are of considerable value in
deciding on this surgery preoperatively and in treating patients thereafter.
Stroke Patterns With Carotic Stenosis
Tsiskaridze and colleagues (SEE ARTICLE) describe the association of large hemispheral infarct with moderate ipsilateral
extracranial carotid artery stenosis, suggesting large embolism and/or inadequate
collateral supply as the pathogenetic mechanisms. Even moderate stenosis of
about 50% is associated with a risk of stroke. This study provides a broader
perspective in analyzing infarct patterns associated with variable degrees
of carotid artery stenosis.
Evolution of Infarct by Imaging
Lansberg and colleagues (SEE ARTICLE) using DWI, have established daily changes in ischemic cerebral lesion volume.
Ischemic lesions follow a relatively consistent pattern of growth with subsequent
decrease in size over time. This evolutionary natural history of changes in
stroke volume will be of considerable value in designing future therapies
for acute stroke.
DWI in Posterior-Circulation Stroke
Linfante and colleagues (SEE ARTICLE) have studied DWI for evaluating the evolution of stroke in the posterior circulation.
Diffusion-weighted magnetic resonance imaging is indeed more effective in
detecting acute lesions than T2-weighted MRI in patients with acute posterior-circulation
strokes. In this anatomical arena, DWI is the gold standard for the diagnosis
of new lesions.
Multiple Simultaneous Intracranial Hemorrhages
Mauriño and colleagues (SEE ARTICLE) find that patients with simultaneous intracranial hemorrhages have a history
of uncontrolled arterial hypertension. Other potential causes of multiple
simultaneous intracranial hemorrhages were excluded using appropriate diagnostic
tests. New imaging techniques help to elucidate the association between arterial
hypertension and simultaneous intracranial hemorrhages, risk factors, and
the underlying mechanisms of these hemorrhages.
Brain Cardiovascular Health
Longstreth and colleagues (SEE ARTICLE) ,
in the Cardiovascular Health Study Collaborative Research Group, have studied
a large cohort of people aged 65 years and older who underwent cranial MRI.
Cluster analysis was conducted to determine specific risk factors for infarction,
atrophy, and white matter changes associated with age, sex, hypertension,
internal carotid artery wall thickness, and smoking, among other factors.
Patterns of analysis provide important clues about the pathophysiology of
structural brain changes in the elderly.
Cerebrovascular Changes With Cognitive Impairment in Twins
DeCarli and colleagues (SEE ARTICLE) have examined the relative risk of cognitive loss associated with cerebrovascular
risk factors in twins. Hypertension and increased white matter changes increase
the risk for cognitive impairment. Longitudinal evaluation of this twin cohort
will be important in evaluating the influence of cerebrovascular disease on
future cognitive performance.
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