Dovey and colleagues summarize their extensive and authoritative experience with endovascular therapy as an alternative therapy for intracranial aneurysms. They feature in this review their experience with the Guglielmi detachable coil. Surgical and endovascular therapies need to be compared and contrasted, and this well-focused review achieves this purpose.
Adams reviews, in a thorough and comprehensive manner, current knowledge of the prevention and treatment of stroke in patients with sickle cell disease. This is a critical and important area that deserves greater attention, and this review sets the stage for future controlled clinical trials.
Wityk and colleagues, using diffusion-weighted (DWI) and perfusion-weighted (PWI) magnetic resonance imaging (MRI), have studied the neurologic complications in patients after cardiac surgery. The newer MRI modalities indicated significant and important patterns of ischemic lesions and infarctions not appreciated previously with standard MRI or computed tomographic (CT) imaging.
Caplan, provides critical editorial assessment.
Cupini and colleagues have described impaired cerebrovascular reserve capacity in patients with multiple subcortical infarcts involving small vessel vasculopathy and hypoperfusion. This important study provides insight into the mechanisms of silent infarctions and the prospect that transcranial Doppler ultrasonography, which is easy to use, may be of diagnostic value in measuring the presence of subcortical stroke.
Editorial perspective is provided by Dulli.
Tong and colleagues, in an elegant study, have measured the relationship between acute DWI and PWI MRI findings and the risk of secondary hemorrhagic transformation in patients with acute stroke. Both DWI and PWI detect abnormalities associated with hemorrhagic transformation, and these findings are of value in considering anticoagulation and/or thrombolytic therapies.
Insight and perspective is provided in an editorial by Levine.
Selnes and colleagues describe cognitive changes in patients after coronary artery bypass surgery. Specific changes are described in some cognitive domains distinct from those associated with normal aging. These findings are of considerable value in deciding on this surgery preoperatively and in treating patients thereafter.
Tsiskaridze and colleagues describe the association of large hemispheral infarct with moderate ipsilateral extracranial carotid artery stenosis, suggesting large embolism and/or inadequate collateral supply as the pathogenetic mechanisms. Even moderate stenosis of about 50% is associated with a risk of stroke. This study provides a broader perspective in analyzing infarct patterns associated with variable degrees of carotid artery stenosis.
Lansberg and colleagues using DWI, have established daily changes in ischemic cerebral lesion volume. Ischemic lesions follow a relatively consistent pattern of growth with subsequent decrease in size over time. This evolutionary natural history of changes in stroke volume will be of considerable value in designing future therapies for acute stroke.
Linfante and colleagues have studied DWI for evaluating the evolution of stroke in the posterior circulation. Diffusion-weighted magnetic resonance imaging is indeed more effective in detecting acute lesions than T2-weighted MRI in patients with acute posterior-circulation strokes. In this anatomical arena, DWI is the gold standard for the diagnosis of new lesions.
Mauriño and colleagues find that patients with simultaneous intracranial hemorrhages have a history of uncontrolled arterial hypertension. Other potential causes of multiple simultaneous intracranial hemorrhages were excluded using appropriate diagnostic tests. New imaging techniques help to elucidate the association between arterial hypertension and simultaneous intracranial hemorrhages, risk factors, and the underlying mechanisms of these hemorrhages.
Longstreth and colleagues, in the Cardiovascular Health Study Collaborative Research Group, have studied a large cohort of people aged 65 years and older who underwent cranial MRI. Cluster analysis was conducted to determine specific risk factors for infarction, atrophy, and white matter changes associated with age, sex, hypertension, internal carotid artery wall thickness, and smoking, among other factors. Patterns of analysis provide important clues about the pathophysiology of structural brain changes in the elderly.
DeCarli and colleagues have examined the relative risk of cognitive loss associated with cerebrovascular risk factors in twins. Hypertension and increased white matter changes increase the risk for cognitive impairment. Longitudinal evaluation of this twin cohort will be important in evaluating the influence of cerebrovascular disease on future cognitive performance.
Missing Article Title. Arch Neurol. 2001;58(4):547-548. doi:10.1001/archneur.58.4.547