Internal carotid artery agenesis disclosed by carotid ultrasonography.

(Upper panels) Ultrasonography showed caliber difference of common carotid arteries (right side: 0.39 cm; left side: 0.70 cm) for right internal carotid artery agenesis. (Lower panels) Bilateral ophthalmic arteries showed anterograde flow with 50% flow reduction over right side (right: peak systolic velocity, PSV [23.3 cm/s]; end diastolic velocity, EDV [7.0 cm/s]; left: PSV [47.0/s] EDV [14.2 cm/s]).

Improving the one-year mortality of stroke patients: an 18-year observation in a teaching hospital.

Long-term follow-up and comparison of serial changes in the one-year mortality after stroke are important in assessing the quality of stroke management. This study determined the one-year survival rate and prognostic factors of hospitalized hemorrhagic and ischemic stroke patients from 1991 to 2008 in a teaching hospital in Taiwan. We also evaluated the improvements in the one-year mortality after stroke during an 18-year study period. Patients admitted for cerebral hemorrhage (n = 3,678) and cerebral infarction (n = 16,010), identified from an in-patient electronic database, were linked to the National Death Registry of Taiwan. Actuarial analysis was used to determine the one-year survival rates, and Cox proportional hazard regression model was used to investigate the predictors for the one-year mortality of stroke patients. For patients with cerebral hemorrhage and infarction and who were admitted from 1991 to 2008, the one-year survival rates were 71% and 84%, respectively. In addition, stroke patients who also suffered from myocardial infarction, chronic renal illness, and pneumonia and had high Charlson comorbidity index scores showed increased risks of mortality due to cerebral hemorrhage and infarction. Compared with the patients admitted from 1991 to 1996, those admitted from 1997 to 2002 and from 2003 to 2008 showed 15%-20% and 20%-25% reduction in one-year mortality risk in cerebral hemorrhage and infarction, respectively. This result demonstrates the continuous quality improvement of stroke management in the hospital from 1991 to 2008. Further reduction in one-year mortality can be achieved by early recognition and prompt treatment of certain comorbidities.

The clinical relevance of vertebral artery hypoplasia.

Congenital vertebral artery (VA) hypoplasia is an uncommon embryonic variation of posterior circulation. The frequency of this congenital variation was reported to be 2-6% from autopsy and angiograms. Is it a congenital risk factor of ischemic stroke? In this review, we gave an overview of the literature concerning vertebral artery hypoplasia. VA hypoplasia served as an independent factor of a reduction of the posterior circulation blood flow velocity. VA hypoplasia can play a negative role in cases of occlusion of a major brain vessel since it limits the potential of compensatory blood circulation. VA hypoplasia may also lead to regional hypoperfusion and complex neurovascular consequences which correspond to vestibular neuronitis and migraine pathogenesis.

More coronary artery stenosis, more cerebral artery stenosis? A simultaneous angiographic study discloses their strong correlation.

Cerebral artery stenosis (CAS) has the same pathogenesis as coronary artery disease (CAD), but the coexistence of these two diseases has been rarely reported. To detect coexistent CAS in CAD patients, we conducted a study of simultaneous coronary and cerebral angiography. Of the 663 consecutive newly diagnosed CAD patients who had not yet been explored to have CAS, 80 were admitted to undergo angiography of bilateral carotid and vertebral system during the same procedure. We defined significant vascular stenosis, either located intracranially or extracranially, as the lesions of diameter stenosis more than 50%. Association between carotid or vertebral stenosis and their potential risk factors were also analyzed. Of our patients, 18 (22.5%) had significant extracranial vascular stenosis, 14 (17.5%) suffered from intracranial stenosis, and 20 (25%) had both. Only 28 patients (35%) had no significant intracranial or extracranial stenosis. None of the demographic parameters as hypertension or diabetes showed significant differences between the cerebral patent group and the CAS group, except for the number of coronary stenotic vessels (1.71 +/- 0.81 versus 2.69 +/- 0.64, P < 0.001). The number of coronary stenotic vessels is correlated well to the number of cerebral stenotic lesions (r = 0.562, P < 0.001). Besides, 8 of the cerebral stenotic patients and 2 of the cerebral patent patients had ischemic stroke previously. We conclude the CAS is coexistent in more than half of the CAD patients in this study. Our study also implies a proportional increase in the severity of CAS to CAD severity.

[Vertigo and dizziness].

Dizziness ranks among the most common complaints in medicine, affecting approximately 20% to 30% of the general population. However, the term dizziness encompasses a variety of different sensations each points in distinct diagnostic direction: rotational vertigo or other illusory sensation of motion indicates vestibular origin, whereas a sensation of light-headedness, giddiness, unsteadiness, drowsiness, or impending faint implies nonvestibular origin. Of patients older than 60 years, 20% have experienced dizziness severe enough to affect their daily activities. This article gives an overview of the historical and physical findings that help guiding to more specific diagnosis of vertigo and dizziness.