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)

When a physician is faced by a patient suffering from transient ischemic attacks, the diagnosis is almost invariably determined by the clinical history. It becomes necessary to eliminate certain other medical conditions including migraine, focal epilepsy and cardiac disorders. Once he is satisfied with the diagnosis of TIA, then he must consider whether to employ medical or surgical therapy or a combination of both. It must be recognized that TIAs are not benign events since more than 50 p. 100 of individuals who develop completed strokes will have antecedent TIAs. Identification of the pathogenetic mechanism becomes important in choosing the specific therapy. Where the origin of the attacks is clearly thromboembolic, secondary to atherosclerosis, surgical intervention may be appropriate if the lesion is readily accessible. However, consideration of surgery is also determined by the risk of post-operative stroke or death at the hands of less experienced surgeons. The risk of stroke in a patient who is having frequent TIAs may be reduced initially by utilizing anticoagulants for a limited period. Long-term medical therapy requires the use of anti-platelet agents which have been shown to have a more beneficial effect in preventing strokes in men. The evidence for protection in females is less satisfactory. Surgical treatment should be followed by long-term medical therapy since it is very unlikely that only one lesion is present in a high-risk patient. It is still clear that the best way to manage cerebro-vascular accidents is to prevent them. This requires education of the public, as will as physicians, with respect to risk factors and the value of various modes of therapy.
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PMID:[Medical or chirurgical treatment in transient cerebral ischemia? (author's transl)]. 702 7

We have reviewed the clinical records and histology of 135 patients who underwent temporal artery biopsy between 1973 and 1978. Biopsies were classified histologically as giant-cell arteritis (17%), atypical arteritis (6%), healed arteritis (2%), arteriosclerosis (67%), atherosclerosis (5%), or normal (3%). Most of the histological diagnoses made at the time of biopsy were confirmed but eight cases which had originally been reported as atypical or healed arteritis were classified as arteriosclerosis when reviewed. All 33 patients with histological evidence of arteritis were accepted as clinical cases of temporal arteritis (31) or polymyalgia rheumatica (2) and treated with steroids. A further 24 patients had negative biopsies (arteriosclerosis or atherosclerosis) but were considered on clinical grounds to have cranial arteritis. They too were treated and made a full recovery. In 43 cases, all of whom had negative biopsies, a final diagnosis was reached which was thought to account for the clinical symptoms (e.g., cerebrovascular accident, rheumatoid disease, migraine, etc.). As less than 60% of patients with clinical temporal arteritis had positive biopsies, we suggest that this procedure could be omitted and replaced by a trial of steroid therapy. Biopsy should be reserved for patients with a strong medical contraindication to steroid therapy, or who fail to respond to treatment promptly.
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PMID:Temporal artery biopsy in giant-cell arteritis. A reappraisal. 727 Jul 80

THe records of 78 young adults, who had suffered cerebral infarction, were reviewed with regard to possible pathogenetic mechanisms. Atherosclerosis risk factors appeared to play a major role between the age of 40 and 50, especially in males. Non atherosclerotic factors of cerebral ischemia were found predominant among females under 40, owing to contribution of migraine, oral contraceptive use and pregnancy/puerperium. In 18% of the patients no etiology could be identified.
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PMID:[Juvenile cerebral infarct. Retrospective analysis of risk factors in 78 cases]. 730 Nov 82

56 cerebral ischemia patients up to the age of 40 were investigated using a strict clinical and instrumental protocol in order to elicit the relative importance of the various iatrogenic factors involved. In addition to atherosclerosis risk factors (smoking, hypertension, ischemic heart disease, diabetes, dyslipidemia) other possible causes of cerebral ischemia were sought (arteritis, migraine, head injury, oral contraceptives, coagulation disorders, cardiogenic embolism, etc.). 50% of the patients examined had at least two atherosclerosis risk factors and 55% had other causes singly or in association with atherosclerosis.
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PMID:Cerebral ischemia in young adults. 733 59

Calcium antagonists block calcium entry into cells, resulting in relaxation of smooth muscle and limitation of the cytotoxic effects of ischaemia in various organ systems. They are most frequently used for clinical conditions requiring vasodilatation, i.e. hypertension and Raynaud's phenomenon, and this also suggests that the most common adverse effect of these drugs for noncardiovascular indications is an unwanted decline in blood pressure. Other uses include treatment of supraventricular arrhythmias and angina. There is some evidence that these drugs retard the development of atherosclerosis. Calcium channel blockers also improve renal reperfusion and may reduce renal insufficiency due to various nephrotoxins, and are particularly useful in renal transplantation for protection against cyclosporin toxicity and post-transplant acute tubular necrosis. These drugs are also useful in pregnancy-induced hypertension and unwanted uterine contraction. Affective disorders and malignancies may be other conditions which benefit from calcium antagonist therapy. Calcium antagonists, in particular nimodipine which is most selective for the cerebral vasculature, have been approved for treating vasospasm after subarachnoid haemorrhage. They are probably also effective for treatment of migraine. Calcium channel blockers may be effective for treating acute cerebral infarction, but results of clinical trials to date have been equivocal, largely because it has been difficult to recruit patients within the short interval after the onset of stroke when these drugs would be most effective, and because of the unwanted hypotensive effect of high doses.
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PMID:New uses for calcium channel blockers. Therapeutic implications. 751 Jun 13

Dihydropyridines are the most numerous available calcium antagonists. While belonging to the same group these drugs have physical, chemical, pharmacokinetic or pharmacodynamic properties which are sometimes specific and can explain differences in the targets and the vascular selectivity. These properties can be related to lipophilic or hydrophilic characteristics, existence or lack of 'use-dependence', possible liaison to membrane phospholipids, and differences in elimination half lives. Selectivity of dihydropyridines also depends on the nature of the target structure (amount of intra-cellular calcium storage and mechanism of its release, electrophysiological properties of these cells) and of its pathological state (atherosclerosis and/or hypertension). Some of these properties could explain the anti-atherogenic effects, myocardial impact, cerebral and renal vascular flow and action in some pathological situations (Raynaud's syndrome, chronic arteriopathy, migraine...). A better knowledge of these different properties could lead to a more accurate choice of the drugs and to a decrease in the incidence of their side effects.
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PMID:[Vascular effects of dihydropyridines]. 763 Dec 83

Because there is uncertainty about the role of atherogenic and nonatherogenic risk factors for cerebral ischemia in the young, we carried out a multicenter, hospital-based, case-control study. 333 patients (15-44 years) with focal cerebral ischemia (transient ischemic attack or stroke within 8 weeks of admission) were eligible. 25 patients were excluded, according to the protocol. 308 cases were matched by age and gender to one hospital and one population control. Independent risk was shown by logistic conditional regression for migraine with aura [odds ratio (OR) = 14.8], smoking (OR = 3.7), alcohol (OR = 2.8), serum triglycerides (OR = 1.6), arrhythmias (OR = 9.5), mitral stenosis (OR = 56), coronary heart disease (OR = 4.3) and carotid stenosis or occlusion (OR = 41). Serum HDL-cholesterol had a relative protective effect (OR = 0.8). These data confirm the role of atherosclerosis and cardiac diseases as well as migraine with aura and alcohol consumption in the pathophysiology of cerebral ischemia in the young. More thorough prevention programs may contribute to earlier detection and control of all of these risk factors, but further investigations in patients with as yet unidentified risk factors are warranted because the above-mentioned factors do not account for the total risk of ischemic stroke in the young.
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PMID:Focal cerebral ischemia in young adults: a collaborative case-control study. The National Research Council Study Group. 823 6

In young patients episodes of amaurosis fugax usually correspond to processes not related with atherosclerosis of the extracranial vessels such as migraine, cardiac embolism, vasospasm, vasculitis, oral contraceptives or hematologic disease. In 11% of the cases, however, no cause can be found. These idiopathic cases generally have a benign course and their frequency decreases spontaneously allowing them to be described as benign amaurosis fugax. We describe four cases of amaurosis fugax in which no responsible cause was found despite extensive clinical, laboratory ultrasonographic and angiographic studies. The episodes progressively remitted. In these cases of benign amaurosis fugax the risk of a permanent deficit is exceptional and treatment is not necessary.
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PMID:[Benign amaurosis fugax]. 820 61

Fifteen consecutive patients with a diagnostic problem of ischaemia-induced migraine with aura (symptomatic migraine) or migraine-associated ischaemia (migrainous infarction) were studied in order to elucidate the mechanisms. Three had a 1 month flurry of daily attacks of migraine auras with or without headache. A severe internal carotid stenosis/occlusion and reduced regional cerebral blood flow (rCBF) was demonstrated. Borderline ischaemia may thus prime the brain for developing migrainous aura with or without migraine (symptomatic migraine). Four patients had a combination of permanent deficits after the very first migraine attack, severe atherosclerosis, risk factors for stroke, high age and no family history of migraine. In these cases the evidence indicates that thromboembolic ischaemia had triggered an attack of migraine with aura (likely symptomatic migraine). Three young females presented long-lasting typical and severe idiopathic migraine with aura. Attack-associated rCBF reduction was likely to have caused permanent, mild, visual or somatosensory deficits (migrainous infarction). In five patients the relationship between migraine and stroke remained unresolved. It seems that ischaemia-induced migraine attacks may be more frequent than migraine-induced ischaemic insults. Therefore, migraine is not as strong a risk factor for stroke as indicated by the mere coincidence of the two disorders.
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PMID:Ischaemia-induced (symptomatic) migraine attacks may be more frequent than migraine-induced ischaemic insults. 845 56

Ischemic stroke is uncommon in young adults, and its etiologies and prognosis are different from those verified in the cerebrovascular disease of old age. Atherosclerosis is the main cause of stroke in the elderly, while emboligenous cardiopathy is one of the main mechanism underlying this pathology in young adults. Other etiologies include atherosclerosis, coagulopathies, vasculitides, arterial dissection and migraine. Ischemic stroke in young adults must thus be studied with a different protocol from that used for the elderly.
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PMID:[Ischemic stroke in the young adult]. 864 31


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