Occlusive thromboaortopathy (Takayasu's disease): cervical arterial stenoses, retinal arterial pressure, retinal microaneurysms and prognosis.

Ishikawa, K.; Uyama, M; Asayama, K

doi:10.1161/01.str.14.5.730

Cited by 25 publications

(17 citation statements)

References 24 publications

(11 reference statements)

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“…24 It is widely held that the severity and extension of such CPP reduction depends on the development of collaterals and on the severity of the obstructive lesions upstream from the circle of Willis. 25 " 27 This mechanism accounts for the variable effects of EIAB on the CBF, the latter only rising if the prevailing CPP was below the lower limit of auto-regulation. This interpretation has also been supported by recent studies of the CBF response to Pa CO 2 changes and of the cerebral blood volume in patients with ICA occlusion.…”

Section: Absolute Valuesmentioning

confidence: 99%

Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans.

Samson¹,

Baron²,

Bousser³

et al. 1985

Stroke

124

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SUMMARY Twelve patients, eleven with a carotid obstruction and one with an occlusion of the middle cerebral artery, were studied before and after a successful unilateral extra-intracranial arterial by-pass, (EIAB) using PET and the 15-0 steady-state technique to measure regional cerebral blood flow (CBF), oxygen extraction fraction and oxygen metabolic rate (CMRO 2 ). In the whole group of patients, both CBF and CMRO, increased significantly on both cerebral hemispheres after EIAB, returning toward control levels defined in age-matched subjects. Mean oxygen extraction fraction, on the other hand, was not affected. Individually, three different effects of EIAB emerged: 1) Alleviation of a state of long standing unilateral "misery-perfusion", as reported earlier; 2) parallel increase of CBF and CMRO2 bilaterally, which appeared due to improvement of a hemodynamic depression of metabolism, the precise mechanism of which remains obscure; 3) Complex, unexpected changes in the CBF-CMRO 2 couple again resulting in increases in CMRO 2 . This metabolic improvement afforded by EIAB in our patients has not been reported before; it suggests that long-standing hemodynamic failure may induce a metabolic depression that is still potentially reversible by surgical revascularization. Stroke Vol 16, No 4, 1985 THE CONTINUOUS OXYGEN 15 INHALATION METHOD provides a regional measurement of the cerebral blood flow (CBF) and oxygen metabolic rate (CMRO,). Earlier semi-quantitative studies carried out by this method 1 -2 showed the disappearance, after an extra-intracranial by-pass operation (EIAB), of two different patterns of focal functional anomaly. The first one, termed misery-perfusion, consists of a lowered CBF and an increased oxygen extraction fraction (OEF) downstream from a carotid occlusion. This pattern reflects the relative maintenance of the CMRO, and was interpreted as evidence of a drop in the cerebral perfusion pressure to a point beyond the lower threshold of CBF auto-regulation. For the second type, involving a reduced CBF with no rise in the OEF, no satisfactory pathophysiological interpretation was put forward. 2However in these semi-quantitative studies it was possible neither to measure the CMRO, nor to detect bilateral effects of the EIAB, both of which objectives form the centre of present work. Patients and MethodsThe study involved 12 consecutive patients in whom the permeability of the EIAB was verified. One preoperative study was an isolated CBF measurement (case No. 3). Eleven of these patients suffered from internal carotid artery (ICA) obstruction and the last a middle cerebral artery (MCA) occlusion. Mean age was 56 ± 9.3 years.Individual clinical, angiographic and CT Scan data Received July 16, 1984; revision #1 accepted December 7, 1984. are summed up in table 1. The advisability of EIAB was judged on the basis of clinical and angiographic criteria, independently of pre-operative PET results. Clinical signs of "hemodynamic" ischemia was the deciding factor in 5 cases (patients No. 5,6,9,11,12) ...

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Section: Absolute Valuesmentioning

confidence: 99%

Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans.

Samson¹,

Baron²,

Bousser³

et al. 1985

Stroke

124

View full text Add to dashboard Cite

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“…On the other hand, nonatherothrombotic vascular diseases were detected in young adults when they were carefully examined [17][18][19][20][21][22]. Migraine, mitralvalve prolapse, nonvalvular atrial fibrillation and left ventricular hypertrophy were also fre quently reported in young stroke patients [6,11,16,18,[23][24][25][26], A higher incidence of stroke in women <35 years of age has also been reported [8,27], the preponderance of females in this age subgroup possibly being due to pregnancyrelated hormonal changes and oral contracep tive use [5,8,18,[27][28][29], However, in other large clinical series [13,28], low risks were attributed to either of the latter two factors in young women.…”

mentioning

confidence: 99%

Focal Cerebral Ischemia in Young Adults: A Collaborative Case-Control Study

et al. 1993

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Because there is uncertainty about the role of atherogenic and nonatherogenic risk factors for cerebral ischemia in the young, we carried out a multicenter, hospital-based, case-control study. 333 patients (15–44 years) with focal cerebral ischemia (transient ischemic attack or stroke within 8 weeks of admission) were eligible. 25 patients were excluded, according to the protocol. 308 cases were matched by age and gender to one hospital and one population control. Independent risk was shown by logistic conditional regression for migraine with aura [odds ratio (OR) = 14.8], smoking (OR = 3.7), alcohol (OR = 2.8), serum triglycerides (OR = 1.6), arrhythmias (OR = 9.5), mitral stenosis (OR = 56), coronary heart disease (OR = 4.3) and carotid stenosis or occlusion (OR = 41). Serum HDL-cholesterol had a relative protective effect (OR = 0.8). These data confirm the role of atherosclerosis and cardiac diseases as well as migraine with aura and alcohol consumption in the pathophysiology of cerebral ischemia in the young. More thorough prevention programs may contribute to earlier detection and control of all of these risk factors, but further investigations in patients with as yet unidentified risk factors are warranted because the above-mentioned factors do not account for the total risk of ischemic stroke in the young.

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“…In this disease, headache, syncopes and signs of hypertension with no measurable blood pressure (pulseless disease) are the pre senting symptoms. At the time of diagnosis the complete aortic-arch syndrome has usually developed -an acute vasculitis in this state of the disease is missing [ 12], Strokes are less frequent and appear later in the course of the dis ease. Very seldom the same vessels are involved in the other arteritis characterized by giant cells, temporal arteri tis (TA).…”

Section: Strokementioning

confidence: 99%

Vasculitis, Rheumatic Disease and the Neurologist: The Pathophysiology and Diagnosis of Neurologic Problems in Systemic Disease

1993

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We review cerebrovascular involvement in vasculitides and collagen vascular diseases. Pathogenesis, clinical syndromes, and diagnostic procedures are summarized. Mechanisms of tissue dysfunction in the vasculitides and collagen vascular diseases include vasculitis, vasculopathy, coagulopathies, emboli, compression from granulomas and transient cellular dysfunction. Underlying immune-mediated processes may be immune-complex deposition, T-cell-mediated effects on endothelial cells, monocyte-mediated effects, direct effects of antibodies on cell membranes, and cytokine-associated changes. Clinically, focal neurological deficits are often accompanied by headaches, behavioral changes, memory disturbances and encephalopathy. Strokes associated with seizures and cranial-nerve involvement are especially frequent. In polyarteritis nodosa, isolated angiitis of the CNS, Churg-Strauss angiitis, and Wegener''s granulomatosis strokes may result from vasculitis. Strokes in patients with systemic lupus erythematosus may be attributable to cardiogenic embolism, coagulopathy (antiphospholipid antibodies), and vasculopathy. Diffuse abnormalities in CNS lupus have been attributed to autoantibodies which interact directly with neurons. Both inflammation and thrombosis of the venous system are characteristic in Behçet''s disease. In all vasculitides affecting predominantly large- and medium-sized vessels, angiography is the most important tool for diagnosis. In MRI, both cortical and subcortical bilateral multiocular lesions are suggestive of vasculitis. Since all neuroradiological results are rather nonspecific, histology specimens should confirm the diagnosis before treatment is instituted. In questionable cases, a leptomeningeal biopsy is mandatory. If laboratory tests support the diagnosis of a systemic vasculitis, immunosuppressive therapy should be instituted in close cooperation with the rheumatologist and the clinical immunologist.

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Occlusive thromboaortopathy (Takayasu's disease): cervical arterial stenoses, retinal arterial pressure, retinal microaneurysms and prognosis.

Cited by 25 publications

References 24 publications

Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans.

Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans.

Focal Cerebral Ischemia in Young Adults: A Collaborative Case-Control Study

Vasculitis, Rheumatic Disease and the Neurologist: The Pathophysiology and Diagnosis of Neurologic Problems in Systemic Disease

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