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Stroke is the third most common overall cause of death and the leading cause of adult disability in the United States. New therapeutic interventions instituted in the period immediately after a stroke have revolutionized the approach to ischemic cerebrovascular disease. Recognition of a transient ischemic attack provides an opportunity to prevent a subsequent stroke. Specific stroke prevention treatment depends on the cause of the transient ischemic attack, its cerebrovascular localization and the presence of associated coexisting medical problems. Modification of stroke risk factors is the principal therapeutic approach. Antiplatelet agents and anticoagulants have been shown to be effective in reducing the occurrence of stroke in certain populations. Several well-designed studies have recently demonstrated the effectiveness of carotid endarterectomy in preventing strokes related to extracranial carotid artery disease.

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A 45-year-old woman sustained two ischemic cerebral infarctions 16 years after ileal resection for Crohn's disease. Her evaluation showed an elevated random serum homocystine level, a low serum vitamin B12 level, and an increased mean corpuscular volume (MCV) without anemia. A methionine-loading test resulted in a marked increase in the homocystine levels 2, 4, and 6 hours after the load. A Schilling test demonstrated a malabsorption of vitamin B12. Vitamin B12 injections normalized her fasting homocystine level and her MCV. She has had no recurrent strokes during a year follow-up.

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Susceptibility to audiogenic seizures (AGS) was investigated in Sprague-Dawley rats subjected to cardiac arrest cerebral ischemia (CACI), produced by compression of the major cardiac vessels. The onset of AGS was regularly observed 1 day after CACI of > 5 min duration. The duration of postischemic susceptibility to AGS was directly related to the density of cerebral ischemia, with 50% of more severely ischemic animals still showing AGS susceptibility 8 weeks after CACI. Lesioning of the inferior colliculi (IC) abolished the onset of AGS; no such effect was observed after lesioning the medial geniculate (MG). Glutamic acid decarboxylase (GAD) immunochemistry revealed approximately 50% loss of GAD-positive neurons in the IC, which was similar in animals with various durations of AGS susceptibility. Otherwise, there was a conspicuous sprouting of gamma-aminobutyric acid (GABA)-ergic terminals in the ventral thalamic nuclei, which peaked approximately 1 month after the CACI. Evaluation of GABA-A inhibitory function in the hippocampus by the paired pulse stimulation revealed changes indicating loss of GABA-A inhibition coinciding with the onset of AGS, and its return in animals tested 2 months after CACI. Our observations suggest a potential role of GABA-ergic dysfunction in the postischemic development of AGS.

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The nitric oxide (NO) synthase inhibitor N omega-nitro-L-arginine (NNA) and the putative brain-selective NO synthase inhibitor 7-nitroindazole (7-NI) were used to determine the role of endogenous NO on seizures induced by kainic acid (KA) in rats and KA, pilocarpine, bicuculline, picrotoxin and pentylenetetrazole (PTZ) in mice. Rats given a subconvulsant dose of KA (6 mg/kg, i.p.) had seizures after they had been pretreated with NNA (50 mg/kg, i.p.). With a higher dose of KA (12 mg/kg, i.p.), NNA caused an increase in wild running seizures and mortality. Unlike NNA, 7-NI had no effect on KA-induced seizures. Similarly, NNA but not 7-NI caused a worsening of seizures in mice measured as a shortening of seizure latency and an increase in wild running and mortality. The effect of NNA on seizure latency was completely reversed by the competitive substrate for NO synthase, L-arginine. NNA had no effect on seizure latency following any of the other convulsants and increased mortality following pilocarpine and picrotoxin alone. Our results indicate that NNA may enhance the severity of KA-induced seizures through suppression of NO synthase activity in the vascular endothelium. The resulting impairment of cerebrovascular autoregulation may cause a mismatch between metabolic demand and blood flow during seizures leading to facilitation of spread. The absence of a comparable effect of NNA on other seizure models may indicate differences in the degree to which seizure activity in different models is influenced by the metabolic impairment secondary to decreased blood flow.

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We used a 24 h perforant path stimulation model of status epilepticus to study the role of non-NMDA receptors in the loss of hilar interneurons and paired pulse inhibition associated with the model. In one experiment, NBQX administered i.v. at 1.0 mg/kg/h significantly reduced the loss of hematoxylin and eosin-stained hilar neurons from 360.2 to 125.3 but failed to protect against the loss of paired pulse inhibition. In a second experiment, i.v. NBQX at 1.5 mg/kg/h significantly protected against loss of SS- and NPY-positive hilar interneurons but also failed to protect against loss of paired pulse inhibition. These results demonstrate that the neuronal loss associated with sustained stimulation of this excitatory pathway is mediated in part through non-NMDA receptors. The lack of protection against loss of paired pulse inhibition suggests that SS- and NPY-immunoreactive interneurons may not be responsible for frequency-dependent paired-pulse inhibition of dentate granule cells.

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1 Experiments were performed to determine the effects of intravenously applied bicuculline and strychnine on the click-evoked brain stem auditory evoked potentials (BAEP) of cats. 2 The BAEP was not affected by bicuculline (0.5 mg/kg, i.v.) administration. Strychnine (0.2 mg/kg, i.v.) administration caused a significant increase in the amplitude of peak 4, which is thought to be produced by potentials in the superior olive, lateral lemniscus and inferior colliculus. 3 These results suggest that strychnine blocks glycinergic inhibitory inputs to these auditory structures.

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