RESUMEN
We compared clinical and radiologic features between 246 cardiac embolism (EMB) and 66 arterial embolic (tandem arterial pathology [TAP]) patients selected from the 1,273 patients with cerebral infarction in the Stroke Data Bank. Diagnostic definitions accounted for the increased frequency of cardiac disease among patients with EMB compared with TAP (78.4% versus 29.3%), while transient ischemic attacks (32.3% versus 13.1%) and carotid artery bruit (15.1% versus 3.3%) were more prevalent in TAP than in EMB. Multiple logistic regression differentiated TAP and EMB further. The probability of a TAP diagnosis was increased by the CT finding of a superficial infarct alone (odds ratio [OR] = 4.6; 95% CI = 1.5 to 13.7) or by a higher admission hematocrit. The probability of EMB was greater in patients with an initial decreased consciousness (OR = 39.2; 95% CI = 4.0 to 381.3) or with an abnormal first CT (OR = 3.2; 95% CI = 1.2 to 8.6). These findings indicate that the two infarct subtypes differ in the location and extent of the cortical infarction, which argues for a smaller particle size, with smaller and more distal infarction in embolism from an arterial source compared with cardiogenic embolism.
Asunto(s)
Estenosis Carotídea/complicaciones , Enfermedades Arteriales Cerebrales/complicaciones , Infarto Cerebral/etiología , Embolia/complicaciones , Cardiopatías/complicaciones , Anciano , Estenosis Carotídea/diagnóstico , Angiografía Cerebral , Enfermedades Arteriales Cerebrales/diagnóstico , Infarto Cerebral/diagnóstico por imagen , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía Ambulatoria , Embolia/diagnóstico , Femenino , Cardiopatías/diagnóstico , Humanos , Modelos Logísticos , Masculino , Examen Neurológico , Oportunidad Relativa , Estudios Prospectivos , Análisis de Regresión , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND PURPOSE: Hyperacute cerebral infarction trials require early differentiation of infarction subtype. Our aim was to determine clinical factors predictive of infarction subtype from data collected in the early hours of admission. METHODS: Using the 1,273 patients enrolled in the Stroke Data Bank, stroke risk factors and demographic, clinical, and radiological features were compared between the 246 cardioembolic and 113 large-vessel atherosclerotic cerebral infarcts. RESULTS: Stroke Data Bank definitions ensured more transient ischemic attacks in atherosclerotic infarcts and more cardiac disease in cardioembolic infarcts, but the diagnosis was distinguished further using a logistic regression model. Fractional arm weakness (shoulder different from hand) (odds ratio 3.1, 95% confidence interval [CI] 1.6-5.8), hypertension (odds ratio 2.8, CI 1.4-5.3), diabetes (odds ratio 2.5, CI 1.2-5.1) and male gender (odds ratio = 2.2, CI 1.2-4.1) occurred more frequently in patients with atherosclerotic than cardioembolic infarcts. Reduced consciousness (odds ratio = 3.2, CI 1.4-7.3) was more frequent in cardioembolism. For a male patient with hypertension, diabetes, and fractional arm weakness, the estimated odds of an atherosclerotic infarction were 47-fold that of a cardioembolic infarction. Patients with atherosclerotic infarcts were more likely to have a fractional arm weakness regardless of infarct size, whereas, for those with cardioembolic infarctions, fractional weakness was more frequent in infarcts less than 20 cc in volume. CONCLUSIONS: Clinical features that are observed at stroke onset can help distinguish cerebral infarction subtypes and may allow for early stratification in therapeutic trials.
Asunto(s)
Infarto Cerebral/etiología , Enfermedad Coronaria/complicaciones , Embolia/complicaciones , Arteriosclerosis Intracraneal/complicaciones , Anciano , Angiografía Cerebral , Infarto Cerebral/complicaciones , Infarto Cerebral/diagnóstico por imagen , Constricción Patológica/complicaciones , Femenino , Predicción , Humanos , Ataque Isquémico Transitorio/complicaciones , Trastornos del Lenguaje/etiología , Masculino , Persona de Mediana Edad , Modelos Teóricos , Trastornos del Movimiento/etiología , Análisis de Regresión , Tomografía Computarizada por Rayos XRESUMEN
We used both the polymerase chain reaction (PCR) and in situ hybridization to search for the presence of proteolipid protein (PLP) gene transcripts in the developing mouse. Total brain RNA extracted from 13-19-day embryos, analyzed by PCR, demonstrated the presence of a single transcript that was unambiguously identified with the DM-20 mRNA. RNA samples from postnatal day 2 animals also showed a signal corresponding to the PLP transcript, in addition to the DM-20 message. By in situ hybridization of 10-day embryos using a DM-20 antisense cRNA probe, we showed that the localization of the DM-20 message was restricted to the diencephalic basal plate. On the same embryo sections, in addition to the brain localization, an intense hybridizing signal was also detected in the trigeminal and spinal ganglia, the vagal glossopharyngeal ganglion, and the sympathetic ganglion chain. The demonstration of transcription of the PLP gene, long before the beginning of the myelination process, suggests that in addition to a structural function in myelin compaction, some of the products of the PLP gene (DM-20) may have a role during the compartmentalization and differentiation of the neural tube.
Asunto(s)
Desarrollo Embrionario y Fetal/fisiología , Proteína Proteolipídica de la Mielina , Proteínas del Tejido Nervioso , Sistema Nervioso/embriología , Proteolípidos/genética , ARN Mensajero/metabolismo , Animales , Apoproteínas/genética , Secuencia de Bases , Ratones , Datos de Secuencia Molecular , Proteínas de la Mielina/genética , Hibridación de Ácido Nucleico , Sondas de Oligonucleótidos/genética , Reacción en Cadena de la PolimerasaRESUMEN
BACKGROUND AND PURPOSE: We sought first to characterize the clinical syndromes of patients found to have angiographic, computed tomographic, or magnetic resonance imaging scan indexes of anterior choroidal artery territory infarction and then to determine the frequency of involvement of the periventricular corona radiata in such patients. METHODS: Sixteen patients were selected based on angiographically, or surgically, documented occlusion of the anterior choroidal artery or based on infarcts whose minimal lesions included the anterior choroidal territory as defined by Kolisko and Beevor. We mapped the lesions using the templates of the Matsui and Hirano atlas and entered them into a computer using a program allowing overlapping diagrams of the cases. RESULTS: The anatomic distributions were fairly uniform, all involving the lower portion of the posterior limb of the internal capsule, the medial pallidum (75% of cases), cerebral peduncle in 44%, thalamus in 37%, and the medial temporal lobe in 38%. None extended outside these areas to include the upper corona radiata. The clinical picture corresponded to the well-established neurological syndrome featuring motor deficits with varying degrees of visual field and sensory impairments. Only two showed hypesthetic ataxic hemiparesis. CONCLUSIONS: Our findings indicate that the syndrome of anterior choroidal artery infarction is fairly uniform; ataxic hemiparesis occurs infrequently; and lesions in the lateral ventricular wall and the corona radiata are not part of the territory supplied by the anterior choroidal artery.