BACKGROUND AND PURPOSE: Understanding the mechanisms underlying stroke can aid the development of therapies and improve the final outcome. The purposes of this study were to establish whether there are characteristic mechanistic differences in the frequency, severity, functional outcome, and mortality between left- and right-hemisphere ischemic stroke and, given the velocity differences in the carotid circulation and direct branching of the left common carotid artery from the aorta, whether large-vessel ischemia (including cardioembolism) is more common in the territory of the left middle cerebral artery. METHODS: Trial cohorts were combined into a data set of 476 samples. Using Trial of Org 10172 in Acute Stroke Treatment criteria, ischemic strokes in a total 317 patients were included in the analysis. Hemorrhagic stroke, stroke of undetermined etiology, cryptogenic stroke, and bilateral ischemic strokes were excluded. Laterality and vascular distribution were correlated with outcomes using a logistic regression model. The etiologies of the large-vessel strokes were atherosclerosis and cardioembolism. RESULTS: The overall event frequency, mortality, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale score, and rate of mechanical thrombectomy interventions differed significantly between the hemispheres. Left-hemispheric strokes (54%) were more common than right-hemispheric strokes (46%; p=0.0073), and had higher admission NIHSS scores (p=0.011), increased mortality (p=0.0339), and higher endovascular intervention rates (p< or =0.0001). ischemic strokes were more frequent in the distribution of the left middle cerebral artery (122 vs. 97; p=0.0003) due to the higher incidence of large-vessel ischemic stroke in this area (p=0.0011). CONCLUSIONS: Left-hemispheric ischemic strokes appear to be more frequent and often have a worse outcome than their right-hemispheric counterparts. The incidence of large-vessel ischemic strokes is higher in the left middle cerebral artery distribution, contributing to these hemispheric differences. The hemispheric differences exhibit a nonsignificant trend when strokes in the middle cerebral artery distribution are excluded from the analysis.
Aorta ; Atherosclerosis ; Carotid Artery, Common ; Chondroitin Sulfates ; Cohort Studies ; Dermatan Sulfate ; Glasgow Coma Scale ; Heparitin Sulfate ; Humans ; Incidence ; Ischemia ; Logistic Models ; Middle Cerebral Artery ; National Institutes of Health (U.S.) ; Stroke ; Thrombectomy

This article describes a straightforward method to measure the dimensions and identify morphological variations in the cerebral arterial circle using the general-purpose software program Osiris. This user-friendly and portable program displays, manipulates, and analyzes medical digital images, and it has the capability to determine morphometric properties of selected blood vessels (or other anatomical structures) in humans and animals. To ascertain morphometric variations in the cerebral arterial circle, 132 brains of recently deceased fetuses, infants, and adults were dissected. The dissection procedure was first digitized, and then the dimensions were measured with Osiris software. Measurements of each vessel's length and external diameters were used to identify and classify morphological variations in the cerebral arterial circle. The most commonly observed anatomical variations were uni- and bilateral hypoplasia of the posterior communicating artery. This study demonstrates that public domain software can be used to measure and classify cerebral arterial circle vessels. This method could be extended to examine other anatomical regions or to study other animals. Additionally, knowledge of variations within the circle could be applied clinically to enhance diagnostic and treatment specificity.
Adult ; Animals ; Arteries ; Blood Vessels ; Brain ; Circle of Willis ; Fetus ; Humans ; Infant ; Public Sector ; Sensitivity and Specificity

Background: This study was carried out on Iranian female adolescents to understandhealth needs for the purpose of designing health promoting intervention in schools.Methods: In this exploratory qualitative study, two focus group discussion (15 teachers)and 30 individual in-depth interviews were conducted among female adolescents in the eighthgrade in Zahedan, Iran. Qualitative content analysis was used for data evaluation.Results: The views of students and teachers demonstrated nine of needs including:informing students about the schools’ health project aims, education and training all dimensionsof health with an emphasis on mental health, use of experts in various fields for education fromother organisations, employing capable and trusted counselors in schools, utilisation of a varietyof teaching methods, activating reward systems for encouraging students’ participation in groupactivities, teaching communication and the ability to establish good relationships with parents andstrategies for resolving family conflict, teaching parents and students high-risk behaviours andstrategies for handling them as well as reforming wrong attitudes and indigenous sub-culture.Conclusion: This study found the different needs of Iranian female students comparedto other cultures about a health promoting school programme. Therefore, their contribution canprovide an insight for formulating policies and intervention in schools.