The aim of this review is to present the current knowledge regarding stroke. It will appear in three parts (in part II the pathogenesis, investigations, and prognosis will be presented, while part III will consist of the management and rehabilitation). In the current part (I) the definitions of the clinical picture are presented. These include: amaurosis fugax, vertebrobasilar transient ischemic attack, and stroke (with good recovery, in evolution and complete). The role of the following risk factors is discussed in detail: age, gender, ethnicity, heredity, hypertension, cigarette smoking, hyperlipidemia, diabetes mellitus, obesity, fibrinogen and clotting factors, oral contraceptives, erythrocytosis and hematocrit level, prior cerebrovascular and other diseases, physical inactivity, diet and alcohol consumption, illicit drug use, and genetic predisposition. In particular, regarding the carotid arteries, the following characteristics are analyzed: atheroma, carotid plaque echomorphology, carotid stenosis, presence of ulcer, local variations in surface deforma bility, pathological characteristics, and dissection. Finally the significance of the cerebral collateral circulation and the conditions predisposing to cardioembolism and to cerebral hemorrhage are presented.
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References
1.
Foulkes MA, Wolf PA, Price TR, et al: The Stroke Data Bank: Design, methods, and baseline characteristics . Stroke19:547-554, 1988.
2.
Sandercock Pag : Incidence of stroke in Oxfordshire: First year's experience of a community stroke register. Br Med J287:713-717, 1983.
3.
Gross CR, Kase CS, Mohr JP, et al: Stroke in South Alabama: Incidence and diagnostic features—a population-based study. Stroke15:249-255, 1984.
4.
Reunanen A., Aho K., Aromaa A., et al: Incidence of stroke in the Finnish Prospective Population Study . Stroke17:675-681, 1986.
5.
Boysen G., Nyboe J., Appleyard M., et al: Stroke incidence and risk factors for stroke in Copenhagen, Denmark. Stroke19:1345-1353, 1988 .
6.
Ricci S., Celani MG, Guercini G., et al: First-year results of a community-based study of stroke incidence in Umbria, Italy. Stroke20:853-857, 1989.
7.
Lauria G., Gentile M., Fassetta G., et al: Incidence and prognosis of stroke in the Belluno Province, Italy. Stroke26:1787-1793, 1995 .
8.
Bamford J., Dennis M., Sandercock P., et al: The frequency, causes, and timing of death within 30 days of a first stroke: The Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatry53:824-829, 1990.
9.
Davis KR, Ackerman RH, Kistler JP, et al: Computed tomography of cerebral infarction: Hemorrhagic, contrast enhancement, and time of appearance. Comput Tomogr11:71-86, 1977.
10.
Special report from the National Institute of the Neurological Disorders and Stroke: Classification of Cerebrovascular Disease III. Stroke 21:637-676, 1990.
11.
Barnett Hjm, Mohr JP, Stein BM, et al: Stroke, Pathophysiology, Diagnosis and Management, ed. 2. New York: Churchill Livingstone, 1992, pp 285-515.
12.
Sacco RL, Benjamin EJ, Broderick JP, et al: American Heart Association Prevention Conference. IV. Prevention and rehabilitation of stroke. Risk factors. Stroke28:1507-1517, 1997.
13.
Kiely DK, Wolf PA, Cupples LA, et al: Familial aggregation of stroke. The Framingham Study. Stroke24:1366-1371, 1993.
14.
Marmot MG, Poulter NR: Primary prevention of stroke. Lancet339:344-347, 1992.
15.
Wolf PA: Prevention of stroke. Lancet352 (suppl III):15-18, 1998.
16.
Collins R., Peto R., MacMahon S., et al: Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: Overview of randomised drug trials in their epidemiological context. Lancet335:827-838, 1990.
17.
Rutan GH, Kuller LH, Neaton JD, et al: Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial. Circulation77:504-514, 1988.
18.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA265:3255-3264, 1991 .
19.
Shinton R., Beevers G.: Meta-analysis of relation between cigarette smoking and stroke. Br Med J25:789-794, 1989.
20.
Klag MJ, Whelton PK: Risk of stroke in male cigarette smokers. N Engl J Med316:628-629, 1987.
21.
Iso H., Jacobs DR Jr, Wentworth D., et al: Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med320:904-910, 1989.
22.
Sacks FM, Pffefer MA, Moye LA, et al: For the Cholesterol and Recurrent Events Trial Investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med335:1001-1009, 1996.
23.
The LIPID Study Group.Design features and baseline characteristics of the LIPID (Long-Term Intervention with Pravastatin in Ischemic Disease) Study: A randomized trial in patients with previous acute myocardial infarction and/or unstable angina pectoris . Am J Cardiol76:474-479, 1995.
24.
Vaughan CJ, Murphy MB, Buckley BM: Statins do more than just lower cholesterol. Lancet348:1079-1082, 1996.
25.
Rosenson RS , Tangney CC: Antiatherothrombotic properties of statins: Implications for cardiovascular event reduction. JAMA279:1643-1650, 1998.
26.
Bostom AG, Gagnon DR, Cupples LA, et al: A prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women. The Framingham Heart Study. Circulation90:1688-1695, 1994 .
27.
Hachinski V. , Graffagnino C., Beaudry M., et al: Lipids and stroke: A paradox resolved . Arch Neurol53:303-308, 1996.
28.
Njolstad I. , Arnesen E., Lund-Larsen PG: Body height, cardiovascular risk factors, and risk of stroke in middle-aged men and women. A 14-year follow-up of the Finnmark Study. Circulation94:2877-2882, 1996.
29.
Burchfiel CM , Curb JD, Rodriguez BL, et al: Glucose intolerance and 22-year stroke incidence. The Honolulu Heart Program. Stroke25:951-957, 1994.
30.
Wannamethee SG, Perry IJ, Shaper AG: Nonfasting serum glucose and insulin concentrations and the risk of stroke. Stroke30:1780-1786, 1999.
31.
Guerrero-Romero F., Rodriguez-Moran M.: Proteinuria is an independent risk factor for ischemic stroke in non-insulin-dependent diabetes mellitus . Stroke30:1787-1791, 1999 .
32.
Shinozaki K. , Naritomi H., Shimizu T., et al: Role of insulin resistance associated with compensatory hyperinsulinemia in ischemic stroke . Stroke27:37-43, 1996.
33.
Howard G., O'Leary DH, Zaccaro D., et al: Insulin sensitivity and atherosclerosis. The Insulin Resistance Atherosclerosis Study (IRAS) Investigators. Circulation93:1809-1817, 1996.
34.
Fitzgerald AP, Jarrett RJ: Body weight and coronary heart disease mortality: An analysis in relation to age and smoking habit. 15 years follow-up data from the Whitehall Study. Int J Obes Relat Metab Disord16:119-123, 1992.
35.
Wilhelmsen L., Svardsudd K., Korsan-Bengtsen K., et al: Fibrinogen as a risk factor for stroke and myocardial infarction. N Engl J Med311:501-505, 1984.
36.
Resch KL, Ernst E., Matrai A., et al: Fibrinogen and viscosity as risk factors for subsequent cardiovascular events in stroke survivors. Ann Intern Med117:371-375, 1992.
37.
Levine SR, Deegan MJ, Futrell N., et al: Cerebrovascular and neurologic disease associated with antiphospholipid antibodies: 48 cases. Neurology40:1181-1189, 1990.
38.
Sacco RL, Owen J., Mohr JP, et al: Free protein S deficiency: A possible association with cerebrovascular occlusion. Stroke20:1657-1661, 1989 .
39.
Kazui S., Kuriyama Y., Sakata T., et al: Accelerated brain infarction in hypertension complicated by hereditary heterozygous protein C deficiency. Stroke24:2097-2103, 1993.
40.
Nagayama T. , Shinohara Y., Nagayama M., et al: Congenitally abnormal plasminogen in juvenile ischemic cerebrovascular disease. Stroke24:2104-2107, 1993.
41.
Simioni P., de Ronde H., Prandoni P., et al: Ischemic stroke in young patients with activated protein C resistance. A report of three cases belonging to three different kindreds. Stroke26:885-890, 1995.
42.
Nabavi DG, Junker R., Wolff E., et al: Prevalence of factor V Leiden mutation in young adults with cerebral ischemia: A case-control study on 225 patients. J Neurol245:653-658, 1998.
43.
Zunker P., Schick A., Padro T., et al: Tissue plasminogen activator and plasminogen activator inhibitor in patients with acute ischemic stroke: Relation to stroke etiology. Neurol Res21:727-732, 1999.
44.
Macko RF, Kittner SJ, Epstein A., et al: Elevated tissue plasminogen activator antigen and stroke risk: The Stroke Prevention In Young Women Study. Stroke30:7-11, 1999.
45.
Johansson L. , Jansson JH, Boman K., et al: Tissue plasminogen activator, plasminogen activator inhibitor-1, and tissue plasminogen activator/plasminogen activator inhibitor-1 complex as risk factors for the development of a first stroke . Stroke31:26-32, 2000.
46.
Stadel BV: Oral contraceptives and cardiovascular disease (first of two parts) . N Engl J Med305 :612-618, 1981.
47.
Hannaford PC , Croft PR, Kay CR: Oral contraception and stroke. Evidence from the Royal College of General Practitioners' Oral Contraception Study. Stroke25:935-942, 1994.
48.
Kannel WB, Gordon T., Wolf PA, et al: Hemoglobin and the risk of cerebral infarction: The Framingham Study. Stroke3:409-420, 1972.
49.
Tohgi H., Yamanouchi H., Murakami M., et al: Importance of the hematocrit as a risk factor in cerebral infarction . Stroke9:369-374, 1978.
50.
Kiyohara Y. , Ueda K., Hasuo Y., et al: Hematocrit as a risk factor of cerebral infarction: Long-term prospective population survey in a Japanese rural community . Stroke17:687-692, 1986.
51.
Wilterdink JL, Easton D.: Vascular event rates in patients with atherosclerotic cerebrovascular disease. Arch Neurol49:857-863, 1992.
52.
Marshall J. , Meadows S.: The natural history of amaurosis fugax. Brain1:419-434, 1968.
53.
Streifler JY , Eliasziw M., Benavente OR, et al: The risk of stroke in patients with first ever retinal vs hemispheric transient ischemic attacks and high-grade carotid stenosis. Arch Neurol52:246-249, 1995.
54.
Donders Rcjm , Kappelle LJ, Algra A., et al: Subtypes of transient monocular blindness and subsequent risk of vascular complications . Cerebrovasc Dis6:241-247, 1996.
55.
Poole Cjm, Russell Rwr: Mortality and stroke after amaurosis fugax. J Neurol Neurosurg Psychiatry48:902-905, 1985.
56.
Hurwitz BJ, Heyman A., Wilkinson WE, et al: Comparison of amaurosis fugax and transient cerebral ischemia: A prospective clinical and arteriographic study. Ann Neurol18:698-704, 1985.
57.
Ostfeld AM, Shekelle RB, Klawans HL: Transient ischemic attacks and risk of stroke in an elderly poor population . Stroke4:980-986, 1973.
58.
Zierler DK, Hassanein RT: Prognosis in patients with transient ischemic attacks. Stroke4:666-673, 1973.
59.
Fields WS, Lemak NA, Frankowski RF, et al: Control trial of aspirin in cerebral ischemia. Stroke8:301-314,1977.
60.
Terent A.: Increasing incidence of stroke among Swedish women. Stroke19:598-603, 1988.
61.
Baker RN, Ramseyer C., Schwartz WS: Prognosis in patients with transient ischemic attacks. Neurology18:1157-1165, 1968.
62.
Karp HR, Heyman A., Heyden S., et al: Transient cerebral ischemia. Prevalence and prognosis in a biracial rural community. JAMA225:125-128, 1973.
63.
Toole JF, Janeway R., Choi K., et al: Transient ischemic attacks due to atherosclerosis. Arch Neurol32:5-12, 1975.
64.
Dennis MS, Bamford JM, Sandercock Pag, et al: Prognosis of transient ischemic attacks in the Oxfordshire Community Stroke Project. Stroke21:848-853, 1990.
65.
Hankey GJ, Slattery JM, Warlow CP: The prognosis of hospital-referred transient ischemic attacks. J Neurol Neurosurg Psychiatry54:793-802, 1991.
66.
Goldner JC, Whisnant JP, Taylor WF: Long term prognosis of transient cerebral ischemic attacks. Stroke2:160-167, 1971.
67.
Cartlidge Nef , Whisnant JP, Elveback LR: Carotid and vertebral-basilar transient cerebral ischemic attacks. Mayo Clin Proc52:117-120, 1977.
68.
Sacco RL, Foulkes MA, Mohr JP, et al: Determinants of early recurrence of cerebral infarction: The Stroke Data Bank. Stroke20:983-989, 1989.
69.
Handa N., Matsumoto M., Maeda H., et al: Ischemic stroke events and carotid atherosclerosis: Results of the Osaka follow-up study for ultrasonographic assessment of carotid atherosclerosis (the OSACA Study). Stroke26:1781-1786, 1995.
70.
Gent M., Blakely JA, Hachinski V., et al: A secondary prevention: Randomized trial of suloctidil in patients with a recent history of thromboembolic stroke. Stroke16:416-424, 1985.
71.
Britton M., Hemers C., Samuelsson K.: High-dose acetylsalicylic acid after cerebral infarction: A Swedish cooperative study. Stroke18:325-334, 1987.
72.
Hier DB, Foulkes MA, Swiontoniowski M., et al: Stroke recurrence within two years after ischemic infarction . Stroke22:155-161, 1991.
73.
Burn J., Dennis M., Bamford J., et al: Long-term risk of recurrent stroke after a first-ever stroke: The Oxfordshire Community Stroke Project. Stroke25:333-337, 1994.
74.
Matsumoto N. , Whisnant JP, Kurland LT, et al: Natural history of stroke in Rochester, Minnesota: 1955 through 1969: An extension of the previous study:1945 through 1954. Stroke4:20-29, 1973.
75.
Whisnant JP , Fitzgibbons JP, Kurland LT, et al: Natural history of stroke in Rochester, Minnesota, 1945 through 1954. Stroke2:11-22, 1971.
76.
Simon RP: Neurosyphilis. Arch Neurol42:606-613, 1985.
77.
Snider WD, Simpson DM, Nielsen S., et al: Neurological complications of acquired immune deficiency syndrome: Analysis of 50 patients. Ann Neurol14:403-418, 1983.
78.
Gillum RF, Mussolino ME, Ingram DD: Physical activity and stroke incidence in women and men. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol143:860-869, 1996.
79.
Stamler J., Rose G., Stamler R., et al: INTERSALT study findings. Public health and medical care implications . Hypertension14:570-577, 1989.
80.
Acheson RM, Williams DR: Does consumption of fruit and vegetables protect against stroke? Lancet28:1191-1193, 1983.
81.
Khaw KT, Barrett-Connor E.: Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med316:235-240, 1987.
82.
Gill JS, Zezulka AV, Shipley MJ, et al: Stroke and alcohol consumption. N Engl J Med315:1041-1046, 1986.
83.
Iso H., Kitamura A., Shimamoto T., et al: Alcohol intake and the risk of cardiovascular disease in middle-aged Japanese men. Stroke26:767-773, 1995.
Caplan LR, Hier DB, Banks G.: Current concepts of cerebrovascular disease—stroke: Stroke and drug abuse. Stroke13:869-872, 1982.
86.
Natowicz M. , Kelley RI: Mendelian etiologies of stroke . Ann Neurol22:175-192, 1987.
87.
Notsu Y., Nabika T., Park HY, et al: Evaluation of genetic risk factors for silent brain infarction . Stroke30:1881-1886, 1999 .
88.
Pedro-Botet J., Senti M., Nogues X., et al: Lipoprotein and apolipoprotein profile in men with ischemic stroke. Role of lipoprotein (a), triglyceride-rich lipoproteins, and apolipoprotein E polymorphism. Stroke23:1556-1562, 1992.
89.
Kessler C., Spitzer C., Stauske D., et al: The apolipoprotein E and beta-fibrinogen G/A-455 gene polymorphisms are associated with ischemic stroke involving large-vessel disease. Arterioscler Thromb Vasc Biol17:2880-1884, 1997 .
90.
Ferrucci L. , Guralnik JM, Pahor M., et al: Apolipoprotein E epsilon 2 allele and risk of stroke in the older population. Stroke28:2410-2416, 1997.
91.
Catto AJ, Carter AM, Stickland M., et al: Plasminogen activator inhibitor-1 (PAI-1) 4G/5G promoter polymorphism and levels in subjects with cerebrovascular disease. Thromb Haemost77:730-734, 1997.
92.
Endarterectomy for asymptomatic carotid artery stenosis.Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA273 :1421-1428, 1995.
93.
Raeth U., Schlaps D., Limberg B., et al: Diagnostic accuracy of computerized B-scan texture analysis and conventional ultrasonography in diffuse parenchymal and malignant liver disease. J Clin Ultrasound13:87-99, 1985.
94.
De Bray JM, Baud JM, Dauzat M.: Consensus concerning the morphology and the risk of carotid plaques . Cerebrovasc Dis7:289-296, 1997.
95.
Leahy AL, Mc Collum PT, Feeley TM, et al: Duplex ultrasonography and selection of patients for carotid endarterectomy: Plaque morphology or luminal narrowing. J Vasc Surg8:558-562, 1988.
96.
Polak JF, O'Leary DH, Kronmal RA, et al: Sonographic evaluation of carotid artery atherosclerosis in the elderly: Relationship of disease severity to stroke and transient ischemic attack. Radiology188:363-370, 1993.
97.
Gray-Weale AC, Graham JC, Burnett JR, et al: Carotid artery atheroma: Comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg29:676-681, 1988.
98.
Langsfeld M. , Lusby RJ: The spectrum of carotid artery disease in asymptomatic patients. J Cardiovasc Surg29:687-691, 1988.
99.
Stephen CM, Gray-Weale AC, Byrne KE, et al: Carotid artery atheroma: Ultrasound appearance in symptomatic and asymptomatic vessels. Aust N Z J Surg59:529-534, 1989.
100.
Geroulakos G., Ramaswami G., Nicolaides A., et al: Characterisation of symptomatic and asymptomatic carotid plaques using high-resolution real-time ultrasonography . Br J Surg80:1274-1277, 1993 .
101.
Holdsworth RJ, Mc Collum PT, Bryce JS, et al: Symptoms, stenosis and carotid plaque morphology. Is plaque morphology relevant. Eur J Vasc Endovasc Surg9:80-85, 1995.
102.
El-Barghouty NE, Nicolaides A., Bahal V., et al: The identification of high risk carotid plaque. Eur J Vasc Endovasc Surg11:470-478, 1996.
103.
Johnson JM , Kennelly MM, Decessare D., et al: Natural history of asymptomatic carotid plaque. Arch Surg120:1010-1012, 1985 .
104.
Langsfeld M., Gray-Weale AC, Lusby RJ: The role of plaque morphology and diameter reduction in the development of new symptoms in asymptomatic carotid arteries . J Vasc Surg9:548-557, 1989.
105.
Bock RW, Gray-Weale AC, Mock PA, et al: The natural history of asymptomatic carotid artery disease. J Vasc Surg17:160-171, 1993.
106.
Belcaro G. , Laurora G., Cesarone MR, et al: Ultrasonic classification of carotid plaques causing less than 60% stenosis according to the ultrasound morphology and events. J Cardiovasc Surg34:287-294, 1993.
107.
Polak JF, Shemanski L., O'Leary DH, et al: Hypoechoic plaque on US of the carotid artery: An independent risk factor for incident stroke in adults 65 years or older. Radiology208:649-654, 1998.
108.
Sterpetti AV , Schultz RD, Feldhaus RJ, et al: Ultrasonographic features of carotid plaque and the risk of subsequent neurologic deficits. Surgery104: 652-660, 1988.
109.
Reilly LM, Lusby RJ, Hughes L., et al: Carotid plaque histology using a real-time ultrasonography. Am J Surg146:188-193, 1983.
110.
Goes E., Janssens W., Maillet B., et al: Tissue characterization of atheromatous plaques: Correlation between ultrasound image and histological findings. J Clin Ultrasound18:611-617, 1990.
111.
Golledge J. , Cuming R., Ellis M., et al: Carotid plaque characteristics and presenting symptom. Br J Surg84:1697-1701, 1997.
112.
Fisher CM, Ojemann RG: Clinico-pathologic study of carotid endarterectomy plaques. Rev Neurol142:573-589, 1986.
113.
Fryer JA, Myers PC, Appleberg M.: Carotid intraplaque hemorrhage: The significance of neovascularity . J Vasc Surg6:341-349, 1987.
114.
Sterpetti AV, Hunter WJ, Schultz RD: Importance of ulceration of carotid plaque in determining symptoms of cerebral ischemia. J Cardiovasc Surg32:154-158, 1991.
115.
Park AE, McCarthy WJ, Pearce WH, et al: Carotid plaque morphology correlates with presenting symptomatology . J Vasc Surg27:872-879, 1998.
116.
Norris JM, Zhu CZ, Bornstein NM, et al: Vascular risks of asymptomatic carotid stenosis. Stroke22:1485-1490, 1991.
117.
Eliasziw M. , Streifler JY, Spence JD, et al: Prognosis for patients following a transient ischemic attack with and without a cerebral infarction on brain CT. Neurology45:428-431, 1995.
118.
Barnett Hjm , Taylor DW, Eliasziw M., et al: North American Symptomatic Carotid Endarterectomy Trial Collaborators: Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med339:1415-1425, 1998.
119.
Meairs S., Hennerici M.: Four-dimensional ultrasonographic characterization of plaque surface motion in patients with symptomatic and asymptomatic carotid artery stenosis . Stroke30:1807-1813, 1999 .
120.
Imparato AM , Riles TS, Gorstein F.: The carotid bifurcation plaque: Pathologic findings associated with cerebral ischemia. Stroke10:238-244, 1979.
Persson AV , Robichaux WT, Silverman M.: The natural history of carotid plaque development . Arch Surg118:1048-1052, 1983 .
123.
Imparato AM , Riles TS, Mintzer R., et al: The importance of hemorrhage in the relationship between gross morphologic characteristics and cerebral symptoms in 376 carotid artery plaques. Ann Surg197:195-203, 1983.
124.
Ammar AD, Wilson RL, Travers H., et al: Intraplaque hemorrhage: Its significance in cerebrovascular disease. Am J Surg148:840-843, 1984.
125.
O'Donnell TF, Erdoes L., Mackey WC, et al: Correlation of B-mode ultrasound imaging and arteriography with pathologic findings at carotid endarterectomy. Arch Surg120:443-449, 1985.
126.
Persson AV : Intraplaque hemorrhage. Surg Clin North Am66:415-420, 1986.
127.
Ammar AD, Ernst RL, Lin JJ, et al: The influence of repeated carotid plaque hemorrhages on the production of cerebrovascular symptoms. J Vasc Surg3:857-859, 1986.
128.
Aburahma AF , Robinson P., Decanio R.: Prospective clinicopathologic study of carotid plaque hemorrhage. Am Surg55:169-173, 1989.
129.
Feeley MT, Leen EJ, Colgan MP, et al: Histologic characteristics of carotid artery plaque. J Vasc Surg13:719-724, 1991.
130.
Avril G., Batt M., Guidoin R., et al: Carotid endarterectomy plaques: Correlations of clinical and anatomic findings. Ann Vasc Surg5:50-54, 1991.
131.
Lennihan L. , Kupsky WJ, Mohr JP, et al: Lack of association between carotid plaque hematoma and ischemic cerebral symptoms. Stroke18:879-881, 1987.
132.
Bassiouny HS, Davis H., Massawa N., et al: Critical carotid stenosis: Morphologic and chemical similarity between symptomatic and asymptomatic plaques. J Vasc Surg9:202-212, 1989.
133.
Leen EJ, Feeley TM, Colgan MP, et al: Hemorrhagic carotid plaque does not contain hemorrhage. Eur J Vasc Surg4:123-128, 1990.
134.
v Maravic C., Kessler C., v Maravic M., et al: Clinical prevalence of intraplaque hemorrhage in the internal carotid artery. Eur J Surg157:185-188, 1991.
135.
Hatsukami TS, Ferguson MS, Beach KW, et al: Carotid plaque morphology and clinical events. Stroke28:95-100, 1997.
136.
Bassiouny HS, Sakaguchi Y., Mikucki SA, et al: Juxtaluminal location of plaque necrosis and neo-formation in symptomatic carotid stenosis . J Vasc Surg26:585-594, 1997.
137.
Seeger JM, Barratt E., Lawson GA, et al: The relationship between carotid plaque composition, plaque morphology, and neurologic symptoms. J Surg Res58:330-336, 1995.
138.
Easton JD, Sherman DG: Cervical manipulation and stroke. Stroke8:594-597, 1977.
139.
Klijn Cjm, Kappelle LJ, Tulleken Caf, et al: Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. Stroke28:2084-2093, 1997 .
140.
Harrison CR, Hearn JB: A new aspect of collateral circulation in occlusion of internal carotid artery . J Neurosurg18:542-545, 1961.
141.
Morgenstern LB , Fox AJ, Sharpe BL, et al: The risks and benefits of carotid endarterectomy in patients with near occlusion of the carotid artery. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Neurology48:911-915, 1997.
142.
Nighoghossian N., Trouillas P., Phillipon B., et al: Cerebral blood flow reserve assessment in symptomatic versus asymptomatic high-grade internal carotid artery stenosis . Stroke25:1010-1013, 1994 .
143.
Muller M., Voges M., Piepgras U., et al: Assessment of cerebral vasomotor reactivity by transcranial Doppler ultrasound and breath holding. Stroke26:96-100, 1995.
144.
Silvestrini M., Troisi E., Matteis M., et al: Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis. Stroke27:1970-1973, 1996 .
145.
Bornstein NM, Gur AY, Shifrin EG, et al: Does carotid endarterectomy modify cerebral vasomotor reactivity? Cerebrovasc Dis7:201-204, 1997.
146.
Cikrit DF, Dalsing MC, Burkhart HM, et al: Acetazolamide SPECT scans in the evaluation of symptomatic and asymptomatic patients with carotid occlusive disease. Vasc Surg33:579-587, 1999.
147.
Archie JP, Feldman RW: Collateral cerebral vascular resistance in patients with significant carotid stenosis. Stroke13:829-831, 1982.
148.
Ringelstein EB, Sievers C., Ecker S., et al: Non-invasive assessment of CO 2 vasomotor response in normal individuals and patients with internal carotid artery occlusions. Stroke19:963-969, 1988.
149.
Muller M., Schimrigk K.: Vasomotor reactivity and pattern of collateral blood flow in severe occlusive carotid artery disease. Stroke27:296-299, 1996.
150.
Derdeyn CP , Yundt KD, Videen TO, et al: Increased oxygen extraction fraction is associated with prior ischemic events in patients with carotid occlusion . Stroke29:754-758, 1998.
151.
Yamauchi H. , Fukuyama H., Nagahama H., et al: Evidence of misery perfusion and risk for recurrent stroke in major cerebral arterial occlusive disease from PET . J Neurol Neurosurg Psychiatry61:18-25, 1996.
152.
Gur AL, Bova I., Bornstein NM: Is impaired cerebral vasomotor reactivity a predictive factor of stroke in asymptomatic patients? Stroke27:2188-2190, 1996.
153.
Kleiser B. , Widder B.: Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke23:171-174, 1992.
154.
Yonas H., Smith HA, Durham SR, et al: Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg79:483-489, 1993.
155.
Webster MW , Makaroun MS, Steed DL, et al: Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid occlusive disease . J Vasc Surg21:338-45, 1995.
156.
Vernieri F. , Pasqualetti P., Passarelli F., et al: Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity. Stroke30:593-598, 1999.
157.
Powers WJ, Tempel LW, Grubb RL: Influence of cerebral hemodynamics on stroke risk: one year follow-up of 30 medically treated patients. Ann Neurol25:325-330, 1989.
158.
Yokota C., Hasegawa Y., Minematsu K., et al: Effect of acetazolamide reactivity and long-term outcome in patients with major cerebral artery occlusive diseases. Stroke29:640-644, 1998.
159.
Hasegawa Y. , Yamauchi T., Tsuchiya T., et al: Sequential change of hemodynamic reserve in patients with major cerebral artery occlusion or severe stenosis. Neuroradiology34:15-21, 1992.
160.
Toyoda K., Minematsu K., Yamauchi T.: Long-term changes in cerebral blood flow according to different types of ischemic stroke. J Neurol Sci121:222-228, 1994.
161.
Skinhoj E. , Hoedt-Rasmussen K., Paulson OB, et al: Regional cerebral blood flow and its autoregulation in patients with focal cerebral ischemic attacks. Neurology20:485-493, 1970.
162.
Paulson OB , Lassen NA, Skinhoj E.: Regional cerebral blood flow in apoplexy without arterial occlusion. Neurology20:125-138, 1970.
163.
Brown MM, Wade Jph, Bishop Ccr, et al: Reactivity of cerebral circulation in patients with carotid occlusion. J Neurol Neurosurg Psychiatry49:899-904, 1986.
164.
Cordes M., Henkes H., Roll D., et al: Subacute and chronic cerebral infarctions: SPECT and gadolinium-DTPA enhanced MR imaging. J Comput Assist Tomogr13:567-571, 1989.
165.
Widder B.: The Doppler CO2 test to exclude patients not in need of extracranial/intracranial bypass surgery. J Neurol Neurosurg Psychiatry52:38-42, 1989.
166.
Widder B., Kleiser B., Krapf H.: Course of cerebrovascular reactivity in patients with carotid artery occlusions . Stroke25:1963-1967, 1994 .
167.
Bullock R. , Mendelow AD, Bone I., et al: Cerebral blood flow and CO2 responsiveness as an indicator of collateral reserve capacity in patients with carotid arterial disease. Br J Surg72:348-351, 1985.
168.
Schroeder T.: Cerebrovascular reactivity to acetazolamide in carotid artery disease. Neurol Res8 :231-236, 1986.
169.
Schneider PA , Rossman ME, Bernstein EF, et al: Effect of the internal carotid artery occlusion on intracranial hemodynamics. Stroke19:589-593, 1988.
170.
Schneider PA , Rossman ME, Torem S., et al: Transcranial Doppler in the management of extracranial cerebrovascular disease: Implications in the diagnosis and monitoring. J Vasc Surg7:223-231, 1988.
171.
Naylor AR, Merrick MV, Gillespie I., et al: Prevalence of impaired cerebrovascular reserve in patients with symptomatic carotid artery disease. Br J Surg81:45-48, 1994
172.
Powers WJ, Press GA, Grubb RL, et al: The effect of hemodynamic significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med106:27-35, 1987.
173.
Levine RL, Dopkin JA, Rozental JM, et al: Blood flow reactivity to hypercapnia in strictly unilateral carotid disease: Preliminary results. J Neurol Neurosurg Psychiatry54:204-209, 1991.
174.
Gibbs JM, Wise Rjs, Leenders KL, et al: Evaluation of cerebral perfusion reserve in patients with carotid artery occlusion. Lancet11:310-314, 1984.
Kaku DA, Lowenstein DH: Emergence of recreational drug abuse as a major risk factor for stroke in young adults. Ann Intern Med113:821-827, 1990.
179.
Tanaka T., Sakai T., Uemura K., et al: MR imaging as predictor of delayed posttraumatic cerebral hemorrhage . J Neurosurg69:203-209, 1988.
180.
Wakai S., Yamakawa K., Manaka S., et al: Spontaneous intracranial hemorrhage caused by brain tumor: Its incidence and clinical significance. Neurosurgery10:437-444, 1982.
181.
Cohen BA, Biller J.: Hemorrhagic stroke due to cerebral vasculitis and the role of immunosuppressive therapy. Neurosurg Clin North Am3:611-624, 1992.
