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Robert A. Kuhn

are now agreed that all patients with “spontaneous” intracranial bleeding should ideally be screened by complete cerebral angiography including vertebral-basilar opacification. Vertebral angiography has also become important in management of the patient with ischemicstroke.” Duffy and Jacobs, 8 using autopsy-controlled cases of thrombosis of a single vertebral artery, showed that clinical symptoms of basilar-artery insufficiency are indistinguishable from those produced by vertebral-artery thrombosis or basilar-artery thrombosis. Since vertebral

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Toru Hayakawa and Arthur G. Waltz

A cute occlusion of a major cerebral artery can cause cerebral edema; 1, 10, 21, 29 in humans, swelling of the brain may be the chief cause of death early after an ischemic stroke. 19, 26 Previous studies of brain swelling and intracranial pressure (ICP) in experimental models of acute focal cerebral ischemia in animals have been complicated by the anesthesia and surgical procedures required for the production of ischemia. During occlusion of one middle cerebral artery (MCA), for example, anesthesia, an open cranium, or drainage of cerebrospinal fluid (CSF

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Richard D. Penn, Randal Walser, Diane Kurtz and Laurens Ackerman

edge of tumor. Blood Volume Changes with Pathology Subtraction CAT has been extremely useful in differentiating hemorrhagic from ischemic strokes. Case 2 . This 69-year-old woman developed a right-sided headache and then a left hemiparesis; on examination her eyes were tonically deviated to the right and a left homonymous hemianopsia was present. A regular CAT scan done 3 days later showed a large lesion in the right hemisphere of below normal density consistent with an ischemic cerebral vascular accident of the middle cerebral distribution ( Fig. 5

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Cerebral artery spasm

A histological study at necropsy of the blood vessels in cases of subarachnoid hemorrhage

J. Trevor Hughes and Pietro M. Schianchi

Neurosurg 41: 49–58, 1974 10. Hughes JT , Oppenheimer DR : Superficial hemosiderosis. Siderosis of the central nervous system. A report on nine cases with autopsy. Acta Neuropathol 13 : 56 – 74 , 1969 Hughes JT, Oppenheimer DR: Superficial hemosiderosis. Siderosis of the central nervous system. A report on nine cases with autopsy. Acta Neuropathol 13: 56–74, 1969 11. Matthews WB , Oxbury JM , Grainger KMR , et al : A blind controlled trial of Dextran 40 in the treatment of ischaemic stroke

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Ranjit K. Laha, Manuel Dujovny, Pedro J. Barrionuevo, Samuel C. DeCastro, Harold R. Hellstrom and Joseph C. Maroon

treatment of ischaemic stroke. Brain 99 : 193 – 206 , 1976 Matthews WB, Oxbury JM, Grainger KMR, et al: A blind controlled trial of dextran 40 in the treatment of ischaemic stroke. Brain 99: 193–206, 1976 38. McConn R : The oxyhemoglobin dissociation curve in acute disease. Surg Clin North Am 55 (3) : 627 – 658 , 1975 McConn R: The oxyhemoglobin dissociation curve in acute disease. Surg Clin North Am 55 (3): 627–658, 1975 39. McGraw CP , Fleming DF Jr , Spruil JH : Effect of

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Joe S. Robinson, Daniel D. Arzola and Robert A. Moody

, Hawkins D, Duguid W, et al: Acute renal failure and nephrotic syndrome after angiocardiography with meglumine diatrizoate. N Engl J Med 284: 592–593, 1971 6. Chiu LC , Fodor LB , Cornell SH , et al: Computed tomography and brain scintigraphy in ischemic stroke. Am J Roentgenol 127 : 481 – 486 , 1976 Chiu LC, Fodor LB, Cornell SH, et al: Computed tomography and brain scintigraphy in ischemic stroke. Am J Roentgenol 127: 481–486, 1976 7. Dean RE , Andrew JH , Read RC , et al: The red

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Thomas H. Jones, Richard B. Morawetz, Robert M. Crowell, Frank W. Marcoux, Stuart J. FitzGibbon, Umberto DeGirolami and Robert G. Ojemann

L ack of an ideal model has hampered investigation of ischemic stroke. 19 We have recently developed a model of stroke involving awake primates; this model overcomes some important problems. 16, 20 A snare ligature permits reversible, minimally traumatic occlusion of the middle cerebral artery (MCA) in the unanesthetized state. Local cerebral blood flow (CBF) is determined serially at multiple brain loci. Ischemia-modifying variables are monitored sequentially. Neuropathological evaluation 2 weeks after the insult identifies infarction and local CBF

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James H. Wood, Lauri L. Snyder and Frederick A. Simeone

trial of dextran 40 in the treatment of ischaemic stroke. Brain 99 : 193 – 206 , 1976 Matthews WB, Oxbury JM, Grainger KMR, et al: A blind controlled trial of dextran 40 in the treatment of ischaemic stroke. Brain 99: 193–206, 1976 49. McDowall DG , Harper AM : Blood flow and oxygen uptake of the cerebral cortex of the dog during anaesthesia with different volatile agents. Acta Neurol Scand 41 ( Suppl 14 ): 146 – 151 , 1965 McDowall DG, Harper AM: Blood flow and oxygen uptake of the cerebral cortex of the

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Intracranial pressure changes following aneurysm rupture

Part 2: Associated cerebrospinal fluid lactacidosis

Bo Voldby and Erna M. Enevoldsen

Granholm, et al. , 10 measured the lactate/pyruvate ratio in the lumbar CSF of 34 patients with SAH, and demonstrated a significant increase in seven patients with clinical signs of vasospasm. Our results support the view that arterial vasoconstriction of 50% or more significantly diminishes cerebral perfusion and consequently oxygen supply. This is further supported by the fact that cerebral infarction almost invariably developed in patients with severe spasm. Studies concerning patients with ischemic stroke have also shown elevated CSF lactate with cerebral

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Results and complications of surgical management of 809 intracranial aneurysms in 722 cases

Related and unrelated to grade of patient, type of aneurysm, and timing of surgery

Thoralf M. Sundt Jr., Shigeaki Kobayashi, Nicolee C. Fode and Jack P. Whisnant

patients (10% of patients who were in Grade 2 on admission). Ten additional Grade 2 patients deteriorated in our hospital as a result of a rebleed that occurred before referral. Thus, in Grade 2 patients, deterioration from ischemia following hospital admission was a greater risk than a rebleed. Two Grade 2 patients treated with Amicar had major ischemic strokes that were sudden in onset, did not have the temporal profile of spasminduced ischemia, and suggested a thrombotic major vessel occlusion. Twenty-four of the Grade 1 patients deteriorated to Grade 2, and 16