Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Contrary to a common view, ischemic stroke under the age of 45 is not rare. In the Lausanne Stroke Registry, more than 10% of the patients were within this age limit. Overall, in Occidental countries the causes of stroke in the young adult do not really differ from those in the older individual; it is only the relative frequency of stroke that is not the same. Cardiac embolism, arterial dissection, and migraine represent the most common etiologic factors, while atherosclerosis is much more unusual. The etiologic aspects and their therapeutic implications justify an active investigative attitude in young adults with recent ischemic stroke. After the acute phase of stroke, prognosis is reasonable.
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PMID:Ischemic stroke in patients under age 45. 155 98

Etiology and longterm prognosis were prospectively investigated in 155 consecutive patients (96 men, 50 women) ages 16-45 years who were referred to the Neurosurgical Unit with cerebral transient ischemic attacks or infarction during the period 1978-88. All patients underwent neurological and medical-cardiological evaluation, cerebral computerized tomography scanning, electrocardiogram, and laboratory tests. 2-dimensional echocardiography was performed in 123 cases (79%), cerebral angiography in 147 (95%). Atherosclerosis was the leading etiology, occurring in 48 patients (31%). A cardioembolic disorder was considered the probable cause of ischemia in 8 cases (5.1%). Further possible etiologies were though to be: oral contraceptives (5.8% of the total, but 15.3% within the females), spontaneous arterial dissection (4.5%), migraine (4%), puerperium (2.6%), cervical trauma (2.6%), and other, more uncommon conditions. Despite extensive evaluation, the cause of cerebral ischemia remained unknown in 40% of the cases. All patients received antiplatelet medication and 16 underwent surgery. The longterm outcome at a mean followup of 5.8 years was favorable in that 91% of the subjects resumed their workload on a full or parttime basis.
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PMID:Etiopathogenesis and prognosis of cerebral ischemia in young adults. A survey of 155 treated patients. 177 5

There has been a recent increase in the number of studies dealing with migraine-stroke. I describe five patients in whom migraine-stroke was the clinical diagnosis but in whom the subsequent clinical events or autopsy showed a different mechanism for the cerebral infarction. Three patients had arterial dissection (one proven at autopsy), one had marantic endocarditis that had been missed on two echocardiograms (proven at autopsy), and one had generalized atherosclerosis and diabetes. These patients demonstrate that important and different etiologies may produce what seems to be the migraine-stroke syndrome. The result may be failure to recognize specific therapeutic measures that could have vitally important benefit to the patient.
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PMID:Stroke from other etiologies masquerading as migraine-stroke. 186 54

The aetiology of strokes was studied in a hospital based series of patients aged up to 40 years with precise clinical and radiological criteria. One hundred and forty five patients (75 males and 73 females) aged five to 40 years with cerebral ischaemia were evaluated. Aetiology was heterogeneous and could be classified into seven groups. Cerebral arteriograms were performed in all cases and indicated the aetiological diagnosis in most patients. Embolism was the most frequent recognised abnormality (38.4%). There were no complications of arteriography. Arterial dissections discovered by arteriography were the cause of the stroke in 10.1% of the patients. Atherosclerosis was diagnosed in 32 cases and was the commonest cause (21.6%). In one fifth of cases no cause was found. Contraceptive drugs were considered as potential cause of ischaemic stroke in 11.5%, cardiac diseases in 12.8% and haematological disorders in 8.1%. Other potential causes included migraine, inflammatory diseases, pregnancy and lacunas. Follow up in 126 cases showed that many patients had good functional recovery.
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PMID:Cerebral infarction in young people. A study of 148 patients with early cerebral angiography. 189 19

A survey shall be given on the physiological, pathophysiological and pharmacotherapeutic backgrounds of the biogenic amine 5-hydroxytryptamine (serotonin; 5HT), to be preceded by a few historical remarks. 5HT is biosynthesized from L-tryptophan via hydroxylation and subsequent decarboxylation. 5HT is predominantly found in enterochromaffin cells, platelets and in various structures of the central nervous system. Its concentration in circulating blood is low and probably subthreshold. Whereas the physiological role of 5HT is rather unclear, 5HT appears to play a relevant role in certain psychiatric disorders, in migraine and the carcinoid syndrome. Its role in essential hypertension remains uncertain. However, 5HT appears to contribute to and to exacerbate the damage to blood vessels which were already predamaged by atherosclerosis, diabetes mellitus or possibly old age as such. A major breakthrough in the pharmacology of the serotonergic system was achieved by the discovery of several subtypes of 5HT receptors, with a corresponding collection of selective agonists and antagonists towards these receptor subtypes. This development is the basis of various drugs which interact with the serotonergic system and its receptors, like the various 5HT2 receptor antagonists (of which ketanserin is the prototype), methysergide, pizotifen, urapidil, flesinoxan and a variety of psychoactive drugs. The most important of these drugs and their potential application will be discussed with an emphasis on cardiovascular disorders.
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PMID:Pathophysiological and pharmacotherapeutic aspects of serotonin and serotonergic drugs. 213 70

Ovarian steroids have effects on blood circulation involving the mechanisms which control blood flow and the changes that occur in the pathogenesis of atherosclerosis. Estrogens appear to protect women from cardiovascular disease through their effects on lipid metabolism as well as more direct effects on arterial walls which appear to inhibit atherosclerotic plaque formation. There is increasing evidence that estrogen replacement after menopause can markedly reduce female mortality due to vascular disease. Effects of hormone imbalance and deficiency on vasomotor control are clinically significant and hormone treatment appears to be effective in the management of a variety of conditions due to abnormal blood flow including vasomotor instability, migraine, vaginal dryness and, perhaps, some forms of angina. Most review articles have focused on the effects of ovarian steroids and lipid metabolism as well as the findings of recent epidemiologic studies. This is understandable as those investigations have proved so valuable in understanding the protective effects of estrogens. The present discussion, in contrast, focuses on the effects of ovarian steroids, estrogens in particular, on circulatory mechanisms. At the present time there is increasing interest in these studies. Findings thus far appear to contribute to understanding estrogen cardioprotection and also raise awareness of a variety of clinical conditions in which estrogen treatment could be indicated because of its effects on circulation.
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PMID:Ovarian hormones and the circulation. 221 71

Strokes in young adults are uncommon and often a diagnostic challenge. A retrospective study of strokes due to intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction was undertaken. We reviewed the medical records of 113 young patients aged 15-45 years who were admitted to the Medical Center Hospital of Vermont with a diagnosis of stroke between 1982 and 1987. This group comprised 8.5% of patients of all ages admitted for stroke, 2.3 times the proportion observed in the National Survey of Stroke. Nontraumatic intracerebral hemorrhage was diagnosed in 46 young patients (41%); the main causes included aneurysms, arteriovenous malformations, hypertension, and tumors. Subarachnoid hemorrhage was found in 19 young patients (17%); the majority were due to aneurysms. The remaining 48 young patients (42%) had cerebral infarction, the majority due to cardiogenic emboli and premature atherosclerosis. Mitral valve prolapse, the use of oral contraceptives, alcohol drinking, and migraine were infrequent sole causes of cerebral infarction in the absence of other risk factors. The case-fatality rate for this group of young patients with stroke was 20.4% compared with 23.9% for the National Survey of Stroke. Young adults with stroke deserve an extensive but tailored evaluation, which should include angiography and echocardiography.
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PMID:Stroke in young adults. 230 61

The authors investigated 100 patients (55 males and 45 females) aged 16 to 45 years who experienced cerebral ischemic attack, excluding venous thrombosis. Transient ischemic attacks accounted for 12% only. Attacks were related to usual causes of brain ischemia in 49 cases (premature atherosclerosis in 26, cardiopathy in 20 and lacunar stroke in 3). Thirty-eight events were attributed to most uncommon etiologies. Nonatherosclerotic arteriopathies (10 cases) such as spontaneous dissection, dysplasia or megadolichoarteries were easily diagnosed by angiography. Oral contraceptives (14 cases) and migraine (2 cases) were diagnosis of exclusion. Hematological disorders were a possible cause in 10 patients. Etiology remained undetermined in 13 cases. Four patients died acutely. Follow-up data were obtained in 93 survivors with a mean duration of 26 months (range, 6 to 60 months). Four subjects died during follow-up and 6 experienced recurrent stroke (annual recurrence rate: 3%). In activities of daily living, 64% of patients had complete autonomy while 13% had mild residual disability and 23% had severe handicap.
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PMID:[Cerebral arterial ischemic complications in young adults. Etiology and prognosis]. 232 55

Fifty six patients aged 17 to 45 years who had Ischemic Cerebral Infarction (I.C.I.) were studied. The following etiologies were established: 1. Juvenile atherosclerosis (21 patients); 2. Cerebral embolism either from cardiac (10 patients) and from unknown source (3 patients); 3. Secondary coagulopathies (4 patients); 4. Non atherosclerotic vasculopathies (6 patients); 5. Traumas of skull and neck (3 patients); 6. Migraine (2 patients); 7. Oral contraceptives use (1 patient). In 6 cases the etiology remained unknown. Young subjects with I.C.I. are a heterogeneous group: however in most of them a reasonable cause can be found. The occurrence of acute death (14%) was high, while recurrent stroke (5%) and non acute death (3%) were rare when compared to older patients. At the follow-up 80% had a very little residual motor deficit but only 43% were able to return to previous work.
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PMID:Ischaemic cerebral infarction in young adults. 236 Apr 74

Calcium-channel blockers may well be the drugs of choice for treating angina, hypertension, and supraventricular arrhythmia in the elderly. They are effective, have no serious side effects, and when wisely matched to the patient, are very well tolerated. Most calcium-channel blockers can be administered once or twice daily. A choice of four is available; only verapamil and diltiazem hydrochloride are useful for supraventricular arrhythmia. All four, however, are effective for the treatment of hypertension and angina. Expanding uses of calcium-channel blockers include peripheral vascular disease and migraine. There may be a theoretical advantage in humans from the point of view of the anti-atherosclerosis demonstrated in animals.
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PMID:Calcium-channel blockers and the elderly. 237 3


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