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13 S34-S39.

Abstract: The region surrounding a focal cerebral infarct shows selective rather than generalized neuronal damage. The ''ischemic penumbra'' has been defined electrophysiologically as that region which shows a loss of electrical activity while retaining some metabolic viability (Astrup et al., Stroke, 1981; 6:723-5). How factors that contribute to ischemic damage may cause such selective damage to subpopulations of neurones will be discussed. Particular attention will be directed to the cortical pyramidal cells, thought to be a major component of cerebral electrical activity. The N-methyl-D-aspartate (NMDA) class of glutamic acid receptors appears to have a role in certain aspects of ischemic damage, mediated through excitotoxins and calcium ions. The regulation of this receptor complex appears to be unaffected by ischemia, and thus it may provide a target for possible therapeutic interventions. Selective neuronal loss tends to be associated with neurotransmitter imbalance; therefore, treatments designed to correct this imbalance by affecting the activity of those cells less sensitive to ischemia may provide an alternative approach to establish normal cerebral function


Bentueferrer, D., Decombe, R., Reymann, J.M., Schatz, C. and Allain, H. (1990), Progress in Understanding the Pathophysiology of Cerebral- Ischemia - the Almitrine Raubasine Approach. Clinical Neuropharmacology, 13 S9-S25.

Abstract: Cerebral ischemia occurs frequently and is disabling. In addition to preventing and correcting risks factors, drugs prevent cell death induced by ischemia-hypoxia. Precise knowledge of the pathophysiology of cerebral ischemia is the prerequisite for drug development, and the main proofs of efficiency are histopathological and clinical (i.e., the results of controlled studies). Different animal models are considered valid for global, focal, or multifocal ischemia. These models have enabled the identification of deleterious phenomena that could be corrected or neutralized by drugs: hypoxia, lactic acidosis, release of neurotransmitters, influx of calcium, activation of phospholipase A2, release of excitatory amino acids, excess of free radicals, and neuronal cell metabolic paralysis (decrease of oxygen and glucose consumption). The chronology of these events clearly described herein will prompt the choice of the best drug, based on the delay between the ischemic event and the decision to treat. The main pharmacological effects required are the following: antagonism of hypoperfusion, oxygenation improvement, blockade of calcium influx and neurotransmitters action, reduction of acidosis and potassium efflux, blockade of arachidonic cascade and free radicals production, and antiedematous effect. The analysis of almitrine-raubasine (Duxil) pharmacological properties will be used as an example of these potentially anti-ischemic drugs. Almitrine-raubasine pharmacological studies indicate that this drug has several beneficial effects on cerebral ischemic processes. These studies have dealt with effects of hypobaric hypoxia on deoxyglucose uptake in the rat, protective effects on permanent or temporary cerebral ischemia- induced neurobehavioral problems in the gerbil, and preservation of the glycogen content and of the swelling in astrocytes after bilateral occlusion of the carotid arteries in the rabbit


Oliver, J., Shaller, C.A., Majovski, L.V. and Jacques, S. (1982), Stroke Mechanisms - Neuropsychological Implications. Clinical Neuropsychology, 4 (2), 81-84

Demeurisse, G.L., Patte, M.J. and Verhas, M.J. (1983), Bilateral Cerebral Functional Reorganization After A Stroke in A Patient with Alexia Without Agraphia. Clinical Neuropsychology, 5 (4), 179-180

Hoff, J.T. and Iannotti, F. (1982), Surgical Frontiers in Stroke Management. Clinical Neurosurgery, 29 534-542

Mustard, J.F., Kinloughrathbone, R.L. and Packham, M.A. (1982), Atherogenesis and Its Relation to Stroke. Clinical Neurosurgery, 29 417-436

Tonami, N., Taki, J., Hisada, K. and Katsuki, K. (1985), Diffuse Lung Uptake of Technetium-99M Tin Colloid in Heat- Stroke - Case-Report. Clinical Nuclear Medicine, 10 (11), 769-771

Oshima, M., Tadokoro, M., Makino, N. and Sakuma, S. (1990), Role of Fast Data Acquisition Method with Tc-99M Hmpao Brain Spect in Patients with Acute Stroke. Clinical Nuclear Medicine, 15 (3), 172-174

Keenan, M.A., Perry, J. and Jordan, C. (1984), Factors Affecting Balance and Ambulation Following Stroke. Clinical Orthopaedics and Related Research, (182), 165-171

Slager, U.T., Hsu, J.D. and Jordan, C. (1985), Histochemical and Morphometric Changes in Muscles of Stroke Patients. Clinical Orthopaedics and Related Research, (199), 159-168

Roper, B.A. (1987), The Orthopedic Management of the Stroke Patient. Clinical Orthopaedics and Related Research, (219), 78-86

Tenorio, G.M., Nazvi, M., Bickers, G.H. and Hubbird, R.H. (1988), Intrauterine Stroke and Maternal Polydrug Abuse. Clinical Pediatrics, 27 (11), 565-567

Mann, H.J., Fuhs, D.W. and Cerra, F.B. (1988), Effect of Infusion Pump Fill-Stroke Flow Interruption on Response to Sodium-Nitroprusside in Surgical Patients. Clinical Pharmacy, 7 (3), 214-219

Milsom, I., Sivertsson, R., Biber, B. and Olsson, T. (1982), Measurement of Stroke Volume with Impedance Cardiography. Clinical Physiology, 2 (5), 409-417

Ohlsson, J., Hlastala, M.P., Tranesjo, J. and Wranne, B. (1983), Non-Invasive Determination of Effective Stroke Volume - Evaluation of A Co2-Rebreathing Method in Normal Subjects and Patients. Clinical Physiology, 3 (1), 9-18

Tayeb, O.S. and Marzouki, Z.M.H. (1989), Tympanic Thermometry in Heat-Stroke - Is It Justifiable. Clinical Physiology and Biochemistry, 7 (5), 255-262

Fulop, T., Wei, S.M., Robert, L. and Jacob, M.P. (1990), Determination of Elastin Peptides in Normal and Arteriosclerotic Human Sera by Elisa. Clinical Physiology and Biochemistry, 8 (6), 273-282.

Abstract: The degradation of elastin during various pathological processes such as emphysema or arteriosclerosis was demonstrated by several investigators. In the present work, we adapted an ELISA technique for the determination of elastin peptide (EP) levels in human sera and plasma, in healthy and arteriosclerotic subjects. This test makes use of human aorta elastin hydrolyzed by a chemical procedure (kappa-elastin) instead of EP produced by pancreatic or leukocyte elastase. Polyclonal antibodies to this antigen were obtained in rabbits. The indirect ELISA procedure is sensitive, specific and reproducible. No correlation could be demonstrated between EP level and anti-EP antibody concentration of IgG or IgM types determined in the same serum samples. These antibodies did not interfere with EP determinations. EP concentration did not change with age in control subjects. In obliterative arteriosclerosis of the legs and in type IIb hyperlipoproteinemia, EP levels showed a marked increase, while in hypertension, ischemic heart disease and diabetes mellitus, the increase was moderate. In stroke, only slight changes were observed. In type IV hyperlipoproteinemia, EP levels were lower than in controls


Clark, J.D.A., Freer, C.E.L. and Wheatley, T. (1987), Pituitary Apoplexy - An Unusual Cause of Stroke. Clinical Radiology, 38 (1), 75-77

Rascher, W., Weidmann, E. and Gross, F. (1981), Vasopressin in the Plasma of Stroke-Prone Spontaneously Hypertensive Rats. Clinical Science, 61 (3), 295-298

Dietz, R., Schomig, A., Rascher, W., Strasser, R., Ganten, U. and Kubler, W. (1981), Partial Replacement of Sodium by Potassium in the Diet Restores Impaired Noradrenaline Inactivation and Lowers Blood-Pressure in Stroke-Prone Spontaneously Hypertensive Rats. Clinical Science, 61 S69-S71

Luft, F.C., Steinberg, H., Ganten, U., Meyer, D., Gless, K.H., Lang, R.E., Fineberg, N.S., Rascher, W., Unger, T. and Ganten, D. (1988), Effect of Sodium-Chloride and Sodium-Bicarbonate on Blood- Pressure in Stroke-Prone Spontaneously Hypertensive Rats. Clinical Science, 74 (6), 577-585

Sahetchian, K., Rigny, R. and Blin, N. (1988), Evaluation of Hydroperoxide Concentrations During the Delay of Autoignition in An Experimental 4 Stroke Engine - Comparison with Cool Flame Studies in A Flow System. Combustion Science and Technology, 60 (1-3), 117-124

Christie, D. and Weigall, D. (1984), Social-Work Effectiveness in 2-Year Stroke Survivors - A Randomized Controlled Trial. Community Health Studies, 8 (1), 26-32

Midolmonnet, M., Heimburger, M., Davy, M., Beslot, F. and Cohen, Y. (1987), Tissue Distribution of Acebutolol in Mature Normotensive and Stroke-Prone Spontaneously Hypertensive Rats. Comparative Biochemistry and Physiology C-Pharmacology Toxicology & Endocrinology, 87 (1), 83-86

Robinson, R.G., Kubos, K.L., Starr, L.B., Rao, K. and Price, T.R. (1983), Mood Changes in Stroke Patients - Relationship to Lesion Location. Comprehensive Psychiatry, 24 (6), 555-566

Messner, M. and Messner, E. (1988), Mood Disorder Following Stroke. Comprehensive Psychiatry, 29 (1), 22-27

Iwasaki, Y. and Kinoshita, M. (1988), The Cranial Computed Tomographic Findings in Patients with Pure Sensory Stroke. Computerized Medical Imaging and Graphics, 12 (6), 375-378

Torack, R.M. (1982), Computed-Tomography and Stroke Edema - Case-Report with An Analysis of Water in Acute Infarction. Computerized Radiology, 6 (1), 35-41

Avinash, G., Myers, J.H. and Rawlings, C.A. (1988), A Computer-Model to Study Norepinephrine-Induced Oscillations of Contraction in Tail Arteries of Spontaneously Hypertensive Stroke-Prone Rats. Computers and Biomedical Research, 21 (4), 324-333

Berkeley, E.C. (1982), Stroke, Intelligence, and Computers. Computers and People, 31 (1-2), 19-24

Thompson, S.B.N. (1987), A System for Rapidly Converting Quadriceps Contraction to A Digital Signal for Use in Microcomputer-Oriented Muscle Therapy and Stroke Patient Assessment Schedules. Computers in Biology and Medicine, 17 (2), 117-125

Carlsen, O. (1988), Evaluation of Forward Stroke Volume in 1St-Pass Radionuclide Cardiography. Computers in Biology and Medicine, 18 (4), 231-239

Rancurel, G., Kieffer, E. and Buge, A. (1985), Apoplectic Stroke and Synthetic Estroprogestogens. Contraception Fertilite Sexualite, 13 (1), 137-146

Goyan, J.E. (1989), The Trials of A Long-Term Clinical-Trial - the Ticlopidine Aspirin Stroke Study and the Canadian American Ticlopidine Study. Controlled Clinical Trials, 10 (4), S236-S244

Dequardo, J.R. and Tandon, R. (1988), Ect in Post-Stroke Major Depression. Convulsive Therapy, 4 (3), 221-224

Niederle, P., Starek, A., Jezek, V., Jezkova, J., Hes, I. and Michaljanic, A. (1988), Assessment of Stroke Volume and Cardiac-Output by Doppler Echocardiography. Cor et Vasa, 30 (5), 338-344

Riege, W.H., Klane, L.T., Metter, E.J. and Hanson, W.R. (1982), Decision Speed and Bias After Unilateral Stroke. Cortex, 18 (3), 345-355

Pieniadz, J.M., Naeser, M.A., Koff, E. and Levine, H.L. (1983), Ct Scan Cerebral Hemispheric-Asymmetry Measurements in Stroke Cases with Global Aphasia - Atypical Asymmetries Associated with Improved Recovery. Cortex, 19 (3), 371-391

Schanfald, D., Pearlman, C. and Greenberg, R. (1985), The Capacity of Stroke Patients to Report Dreams. Cortex, 21 (2), 237-247

Moya, K.L., Benowitz, L.I., Levine, D.N. and Finklestein, S. (1986), Covariant Defects in Visuospatial Abilities and Recall of Verbal Narrative After Right-Hemisphere Stroke. Cortex, 22 (3), 381-397

Basso, A., Bracchi, M., Capitani, E., Laiacona, M. and Zanobio, M.E. (1987), Age and Evolution of Language Area Functions - A Study on Adult Stroke Patients. Cortex, 23 (3), 475-483

Sandler, H. (1983), Stroke of Genius - Inhome Keyboard for the Atari-400. Creative Computing, 9 (9), 52-&

Zimpfer, M., Khosropour, R. and Lackner, F. (1982), Effect of Dobutamine on Cardiac-Function in Man - Reciprocal Roles of Heart-Rate and Ventricular Stroke Volume. Critical Care Medicine, 10 (6), 367-370

Bastulli, J.A. and Orlowski, J.P. (1985), Stroke As A Complication of Carotid-Sinus Massage. Critical Care Medicine, 13 (10), 869

Bernstein, D.P. (1986), A New Stroke Volume Equation for Thoracic Electrical Bioimpedance - Theory and Rationale. Critical Care Medicine, 14 (10), 904-909

Bernstein, D.P. (1986), Continuous Noninvasive Real-Time Monitoring of Stroke Volume and Cardiac-Output by Thoracic Electrical Bioimpedance. Critical Care Medicine, 14 (10), 898-901

Barsan, W.G., Olinger, C.P., Adams, H.P., Brott, T.G., Eberle, R., Biller, J., Biros, M. and Marler, J. (1989), Use of High-Dose Naloxone in Acute Stroke - Possible Side- Effects. Critical Care Medicine, 17 (8), 762-767

Channa, A.B., Seraj, M.A., Saddique, A.A., Kadiwal, G.H., Shaikh, M.H. and Samarkandi, A.H. (1990), Is Dantrolene Effective in Heat-Stroke Patients. Critical Care Medicine, 18 (3), 290-292

Huang, K.C., Stoddard, M., Tsueda, K., Heine, M.F., Thomas, M.H., White, M. and Wieman, T.J. (1990), Stroke Volume Measurements by Electrical Bioimpedance and Echocardiography in Healthy-Volunteers. Critical Care Medicine, 18 (11), 1274-1278

Keywords: CARE

Brunner, H.R. (1982), Citation Classic - Essential-Hypertension - Renin and Aldosterone, Heart-Attack and Stroke. Current Contents/Clinical Practice, (40), 20

Marmiroli, N. and Lodi, T. (1984), Effect of Erythromycin Upon the Protein Pattern of Heat Shocked S-Cerevisiae - Identification of New Classes of Heat-Shock and Heat-Stroke Products. Current Genetics, 8 (6), 429-437

Ketel, W.B. and Kolb, M.E. (1984), Long-Term Treatment with Dantrolene Sodium of Stroke Patients with Spasticity Limiting the Return of Function. Current Medical Research and Opinion, 9 (3), 161-169

Levine, S.R. and Welch, K.M.A. (1988), Patho-Physiology of Stroke in the Light of Modern Techniques. Current Opinion in Neurology and Neurosurgery, 1 (1), 49-56

Sandercock, P. (1988), Aspirin After Stroke and Transient Ischemic Attack. Current Opinion in Neurology and Neurosurgery, 1 (1), 93-99

Wise, R.J.S. (1989), The Patho-Physiology of Cerebral-Ischemia and Stroke. Current Opinion in Neurology and Neurosurgery, 2 (1), 47-51

Wade, D.T. (1989), Stroke Rehabilitation. Current Opinion in Neurology and Neurosurgery, 2 (5), 736-738

Wolf, P.A. (1989), The Epidemiology of Stroke Syndromes. Current Opinion in Neurology and Neurosurgery, 2 (1), 42-46

Hogan, M.J. and Hakim, A.M. (1990), Pathophysiology of Stroke - Laboratory and Clinical Insights. Current Opinion in Neurology and Neurosurgery, 3 (1), 46-49

Keywords: BRAIN

Hewer, R.L. (1990), Stroke - Sequelae and Rehabilitation. Current Opinion in Neurology and Neurosurgery, 3 (5), 719-721

Pelz, D.M. (1990), Cerebral Blood-Flow and Other Imaging in Stroke. Current Opinion in Neurology and Neurosurgery, 3 (1), 50-54

Wiebers, D.O. and Meissner, I. (1990), Epidemiology of Stroke. Current Opinion in Neurology and Neurosurgery, 3 (1), 39-45

Daoud, Z.F. and Saleh, G. (1987), Stroke and Hypertension. Current Therapeutic Research-Clinical and Experimental, 41 (3), 335-341

Hogan, B.J. (1985), Micro-Based System Speaks for Cerebral-Palsy Stroke Victims. Design News, 41 (8), 128-129

Hogan, B.J. (1985), Contoured Drums Reverse Pumps Stroke Without Force Input. Design News, 41 (4), 124-126

Hempel, G. and Haller, H. (1981), The Stroke Resulting from Physical Or Psychological Stress As An Industrial Accident. Deutsche Gesundheitswesen-Zeitschrift fur Klinische Medizin, 36 (51), 2162-2164

Eisenberg, B.M., Linss, G., Fuchs, P., Stern, L., Durrenberg, D., Drescher, E., Vollmar, R., Furst, G. and Lieback, E. (1982), Comparison Between Impedance Cardiography, Isotope-Dilution Method and Ultrasonic Echocardiography for Measuring Stroke Volume. Deutsche Gesundheitswesen-Zeitschrift fur Klinische Medizin, 37 (6), 259-264

Funke, K., Bischoff, J. and Erkens, R. (1982), Myocardial Damage After Lightning-Stroke. Deutsche Gesundheitswesen-Zeitschrift fur Klinische Medizin, 37 (38), 1667-1671

Zippel, C. (1984), Modern Principles in the Rehabilitation of Patients with Cerebrovascular Stroke. Deutsche Gesundheitswesen-Zeitschrift fur Klinische Medizin, 39 (2), 58-60

Kaiser, H., Langer, R. and Langer, U. (1984), Infarction and Stroke Register of 1982 in the Aue District. Deutsche Gesundheitswesen-Zeitschrift fur Klinische Medizin, 39 (33), 1307-1311

Waiblinger, G. and Kornhuber, H.H. (1985), Events Resembling A Stroke with Negative Ct Findings. Deutsche Medizinische Wochenschrift, 110 (2), 47-49

Dizinger, H.G. and Ringelstein, E.B. (1985), Diagnosis of Stroke in Young-Adults. Deutsche Medizinische Wochenschrift, 110 (46), 1759-1765

Haass, A., Kroemer, H., Jager, H., Muller, K., Decker, I., Wagner, E.M. and Schimrigk, K. (1986), Dextran-40 Or Hes 200/0.5 - Hemorheology on Long-Time Treatment of Ischemic Stroke. Deutsche Medizinische Wochenschrift, 111 (44), 1681-1686

Hornig, C.R., Dorndorf, W. and Busse, O. (1986), Extra-Intracranial Anastomosis in the Prophylaxis of Stroke. Deutsche Medizinische Wochenschrift, 111 (7), 243-246

Heiss, W.D. (1986), Carotid Endarterectomy - Stroke Prevention in Symptomatic and Asymptomatic Stenoses. Deutsche Medizinische Wochenschrift, 111 (49), 1867-1868

Haupts, M., Amoiridis, G., Blickle, W. and Kissler, M. (1987), On the Differential-Diagnosis of Juvenile Stroke - A Case of Moyamoya. Deutsche Medizinische Wochenschrift, 112 (31-32), 1213-1215

Rossi, L.N., Penzien, J.M., Deonna, T., Goutieres, F. and Vassella, F. (1990), Does Migraine-Related Stroke Occur in Childhood. Developmental Medicine and Child Neurology, 32 (11), 1016-1021

Miller, S. and Hammond, G.R. (1981), Neural Control of Arm Movement in Patients Following Stroke. Developments in Neuroscience, 13 259-274

Sadoshima, S., Busija, D., Brody, M. and Heistad, D. (1982), Protection Against Stroke by Sympathetic-Nerves. Developments in Neuroscience, 14 309-315

Lithner, F., Asplund, K., Eriksson, S., Hagg, E., Strand, T. and Wester, P.O. (1988), Clinical Characteristics in Diabetic Stroke Patients. Diabetes & Metabolism, 14 (1), 15-19

Emara, M.K., Saadah, A.M., Tohfa, Y.A., Guindi, R.T., Gupta, R.K. and Senthilselvan, A. (1989), The Hematocrit Value in Diabetic-Patients with Ischemic Stroke. Diabetes Research Clinical and Experimental, 12 (4), 189-192

[Anon]. (1990), Uk Prospective Diabetes Study .6. Complications in Newly Diagnosed Type-2 Diabetic-Patients and Their Association with Different Clinical and Biochemical Risk-Factors. Diabetes Research Clinical and Experimental, 13 (1), 1-11.

Abstract: The prevalence of various diabetic complications, their association with each other and with many risk factors, has been assessed in 2,337 newly diagnosed Type 2 diabetic patients. The patients entered into the UK Prospective Diabetes Study were aged between 25 and 65 (mean age 52 yr) and 33% had either an abnormal ECG or retinopathy. Different macrovascular complications such as strokes, heart attacks or abnormal ECG, and peripheral vascular disease showed little association one with another, and each was associated predominantly with different risk factors, e.g., strokes with hypertension, heart attacks with hypertriglyceridaemia and peripheral vascular disease with smoking and a low HDL cholesterol. Retinopathy was associated with reduced vibration perception but not with other complications. Reduced vibration perception and absent reflexes were associated with absent foot pulses and ischaemic skin changes, raising the possibility of a macrovascular, as well as microvascular, contribution to peripheral neuropathy. Microalbuminuria was associated with hypertension, which might be a factor predisposing to renal microvascular disease or be a consequence of it. Microalbuminuria was also associated with an abnormal ECG. Retinopathy, with exudates and or haemorrhages rather than just microaneurysms, was associated with hyperglycaemia. The occurrence of a particular complication in a diabetic patient is probably dependent on a combination of specific risk factors, many of which are related to, and probably affected by, potentially avoidable factors such as hyperglycaemia, obesity, smoking and hypertension


Ohlson, L.O., Svardsudd, K., Welin, L., Eriksson, H., Wilhelmsen, L., Tibblin, G. and Larsson, B. (1986), Fasting Blood-Glucose and Risk of Coronary Heart-Disease, Stroke, and All-Cause Mortality - A 17-Year Follow-Up-Study of Men Born in 1913. Diabetic Medicine, 3 (1), 33-37

Gray, C.S., Taylor, R., French, J.M., Alberti, K.G.M.M., Venables, G.S., James, O.F.W., Shaw, D.A., Cartlidge, N.E.F. and Bates, D. (1987), The Prognostic Value of Stress Hyperglycemia and Previously Unrecognized Diabetes in Acute Stroke. Diabetic Medicine, 4 (3), 237-240

Olsson, T., Viitanen, M., Asplund, K., Eriksson, S. and Hagg, E. (1990), Prognosis After Stroke in Diabetic-Patients - A Controlled Prospective-Study. Diabetologia, 33 (4), 244-249

Koshelev, V.B., Krushinskii, A.L. and Sotskaia, M.N. (1984), Preliminary Hypoxia Adaptation Protecting Effect on the Animal Mortality-Rate Under the Cerebrovascular Stroke Provoked by the Brain Powerful Acoustic Stimulation. Doklady Akademii Nauk Sssr, 276 (5), 1274-1276

Taran, I.N., Sobolev, V.V., Gubenko, S.I. and Slobodskoi, V.J. (1987), Formation of Metastable Carbides in Iron by Wave-Stroke Compression. Doklady Akademii Nauk Sssr, 296 (5), 1164-1167

Malherbe, E., Baranes, J., Lehegarat, M., Clostre, F. and Defeudis, F.V. (1985), Differences in the Cardiac Effects of Isoproterenol Between Stroke-Prone and Control Rats. Drug Development Research, 6 (1), 85-89

Porschewiebking, E. (1989), New N-Methyl-D-Aspartate Antagonists for the Treatment of Stroke. Drug Development Research, 17 (4), 367-375

Masui, M., Kawakami, M., Nakajima, M., Hara, S., Ito, H. and Ueda, M. (1990), Prophylactic Effects of Novel Dihydropyrazolopyridine (83-0256) and Dihydrothienopyridine (83-0312, 83-0327) Calcium- Antagonists in Stroke-Prone Spontaneously Hypertensive Rats. Drug Development Research,

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