Werner Hacke

Association Between Acute Cerebrovascular Ischemia and Chronic and Recurrent Infection

BACKGROUND AND PURPOSE We performed a case-control study to investigate whether chronic or recurrent respiratory, ear-nose-throat (ENT), and dental infections are risk factors for cerebrovascular ischemia. METHODS Using a standardized questionnaire we investigated past infectious diseases in 166 consecutive patients with acute cerebrovascular ischemia and in 166 age- and sex-matched nonstroke neurological patient controls. In subgroups, we performed standardized ENT (69 patients, 66 control subjects) and dental examinations including orthopantomography (66 patients, 60 control subjects). Dental status was determined by a total dental index (TDI) that reflects caries, periapical lesions, periodontitis, and other dental lesions and by an orthopantomography index (OPGI) that was assessed blinded. RESULTS Frequent (> or = 2 episodes in each of the 2 preceding years) or chronic bronchitis was associated with cerebrovascular ischemia in age-adjusted multiple logistic regression analysis (odds ratio, OR, 2.2; 95% confidence interval, CI, 1.04 to 4.6). Groups were not different in ENT examination. Patients tended to have a worse dental status (TDI: P = .070; OPGI: P = .062) and had more severe periodontitis (P = .047) and periapical lesions (P = .027) than control subjects. In age-adjusted multiple logistic regression analysis with social status and established vascular risk factors, poor dental status (TDI) was independently associated with cerebrovascular ischemia (OR, 2.6; 95% CI, 1.18 to 5.7). CONCLUSION Recurrent or chronic bronchial infection and poor dental status, mainly resulting from chronic dental infection, may be associated with an increased risk for cerebrovascular ischemia.

Lack of Evidence for Pulmonary Venous Thrombosis in Cryptogenic Stroke A Magnetic Resonance Angiography Study

Background— Even after extensive evaluation, the etiology of ischemic stroke remains undefined in a considerable proportion of cases, suggesting that causes of stroke may exist that have not yet been established. We tested the hypothesis that pulmonary venous thrombosis (PVT) is a potential source of brain embolism in patients with cryptogenic stroke. Summary of Report— Within 7 days after mild to moderately severe ischemic stroke or transient ischemic attack, 18 patients (9 women, 9 men; mean age, 48 years) were studied in whom the etiology remained undefined despite complete workup. All patients received high-resolution pulmonary venography with the use of multiple-bolus, multiphase, 3-dimensional, gadolinium-enhanced MR angiography (MRA). Overall quality of the MRA was good in 14 and insufficient in 4 patients, mainly as a result of breathing artifacts. Visualization of the main and segmental veins and evaluability of their patency were good for most right pulmonary veins but often inadequate for left pulmonary veins, particularly for those in the left lower lobe. There was no evidence for PVT in any of the sufficiently visualized pulmonary veins. Conclusions— The results do not support the hypothesis of PVT as a contributor to the etiology of ischemic stroke. However, the study was limited regarding scan volume, spatial discrimination, patient selection, and delay between ischemia and MRA. Therefore, further investigations, including postmortem studies, are needed to resolve the question of whether PVT may contribute to ischemic stroke.

Spinal Vascular Malformations and Ischemic Lesions of the Spinal Cord

Acute paraplegia of vascular origin is one of the most serious emergencies in neurology. It is usually the result of spinal cord ischemia rather than bleeding. The ratio of cerebral ischemia to spinal ischemia varies from center to center (depending on whether open heart surgery is done at the center) but in general is 10:0.3. For neurocritical care, the most important syndromes are the anterior spinal artery syndrome and the radicular magna artery syndrome.

Schlaganfall-Therapie: „Time is brain“

ZusammenfassungIn Deutschland erleiden pro Jahr etwa 250.000 Patienten einen Schlaganfall. Das medizinische Verständnis dafür hat sich in den letzten Jahrzehnten stark verändert. Der Schlaganfall wird heute als akuter Notfall verstanden, „time is brain“. Das Rezidivrisiko ist hoch. Alle Patienten sollten auf einer Stroke Unit behandelt werden. Wichtig ist eine schnelle Diagnose, um rasch und zielgerichtet mit der Therapie beginnen zu können. Die bildgebende Diagnostik ist dabei unverzichtbar. Der vorliegende Beitrag erläutert das aktuelle Wissen über Ursachen, Syndrome, Notfalldiagnostik und Therapie des Schlaganfalls.