Effect of intravenous tirofiban and aspirin in reducing short-term and long-term neurologic deficit in patients with ischemic stroke: a double-blind randomized trial.

BACKGROUND: Thrombolysis with rt-PA is the only approved pharmacological therapy for acute ischemic stroke presently administrable in a 3-hour window (very recently extended to 4.5 h). After this time, the choice is limited to endovascular treatment and antiplatelet drugs, mainly aspirin (ASA), the efficacy of which in the acute phase of stroke has poorly been evaluated. We compared the efficacy of tirofiban, a GP-IIb/IIIa inhibitor, and ASA, with both drugs being administered within 6 h. METHODS: 150 patients were randomly assigned to treatment with tirofiban or ASA, both given for 3 days in a double-blind regimen. Major inclusion criteria were stroke onset within 6 h and a baseline National Institute of Health Stroke Scale (NIHSS) score of 5-25. Outcome variables were the proportion of patients with a NIHSS score reduction of > or =4 points after 72 h, and the proportion of patients with an mRS score of 0-1 at 3 months. RESULTS: The trial, originally planned to enroll 300 patients, was halted after enrollment of 150 patients at interim analysis due to the lack of a trend difference between the 2 treatment groups. Neurological improvement at 72 h was observed in 56% of the patients in each group. At the 3-month follow-up, minimal or absent disability was seen in 45% of the patients in the tirofiban group and 53% in the ASA group; these differences were not statistically significant. Three-month mortality was the same in both groups (10.6%); the rates of symptomatic intracranial hemorrhage were 1% (tirofiban) and 4% (ASA). CONCLUSION: In spite of the fact that the null hypothesis was not supported by our data, we found results supporting the safety (and potential efficacy) of ASA and tirofiban when used in the first hours of acute ischemic stroke. However, this needs to be confirmed by further studies.

Ataxic hemiparesis syndrome clinical and CT study of 20 new cases.

Twenty patients suffering from ataxic hemiparesis caused by lacunar infarcts were studied using computerized tomography. Supratentorial lesions were found in nineteen patients (95%) while subtentorial lesion was found in only one patient (5%). In all cases the lesions were localized along the corticopontine pathways, making the hypothesis of injury to this pathway the most valid explanation of ataxia.

[Study of simple reaction time to lateralized visual stimuli]. / Studio del tempo di reazione semplice a stimoli visivi lateralizzati.

Simple reaction time with manual response (right and left hand) to visual stimuli lateralized was studied in 20 normal subjects at 5, 20 and 35 degree in the nasal and temporal hemifields of the right eye. The reaction time was studied as a function of stimulus eccentricity. Uncrossed and crossed reaction times were examined with particular attention. No prevalence was found, neither of one hand, or of one hemisphere. The global speed of the two hemiretinas was the same, but reaction time increased as a function of stimulus eccentricity; moreover a better performance was obtained stimulating the nasal hemiretina at 35 degrees. Uncrossed reactions, considered on the whole, were faster than crossed ones (7,4 msec); the delay between crossed and uncrossed responses remained constant regardless of the degree of the visual stimuli eccentricity. The AA. concluded that such a difference is mainly dependent upon anatomical structures. The AA. also discuss several and often conflicting literature data and conclude that either the attentional model of the orienting responses as proposed by Kinsbourne, or the stimulus-response conpatibility effects, can be taken into consideration to explain some conflicting results; these results have been obtained by methods in some way different from those performed with present report (choice reaction times, absulute randomisation of the stimuli, response by crossed hands, choice verbal responses).

[Functional differences between superior and inferior visual hemifields obtained with non-structural stimuli]. / Differenze funzionali tra emicampi visivi superiore ed inferiore per stimoli non strutturati.

Functional differences between superior and inferior visual hemifields to dot stimuli projected at 5 degrees and 20 degrees from the horizontal meridian, have been studied in 10 subjects. The reaction time method (uncrossed response only) has been employed, by projecting the dot stimuli in each quadrant. The reaction time at 5 degrees is the same in the 4 quadrants, but it increases in each quadrant at 20 degrees stimulation; at 20 degrees a greater speed of the superior hemiretina also results.

[Hemispheric specialization in recognition of alphabetic material]. / Specializzazione emisferica nel riconoscimento di materiale alfabetico.

Choice reaction time with manual response (right and left hand) to alphabetic stimuli (capital letters A-E = positive stimulus, and R-F = negative stimulus) projected at 5 degrees in the nasal and in temporal hemisfield of the right eye (half of the subjects) and of the left eye (the remaining half) was studied in 12 normal subjects (6 males and 6 females). The RT mean values were the result of the mean of the median of each block of trial, repeated in 4 sessions. The percentage of errors was also considered. The mean RT was calculated for each of the possible 4 experimental conditions hand-hemifield, in the males and females separately, and in all the cases. The data obtained, submitted to the statistical analysis, show a significant superiority of the left hemisphere in the recognition of the alphabetic stimuli, both in males and females, despite the prevalence of the right hand.