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 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Stroke is increasingly becoming a major cause of death and morbidity in African population among most of which the frequencies of hypertension are considerable, although hard data based on community surveys are lacking and most of the information available is from hospital data. The epidemiology of stroke in the Africans is reviewed. The frequencies in hospital populations varied from 0.9% to 4.0% and stroke accounted for 0.5% to 45% of neurological admissions. There is male predominance in published series. The main risk factors are hypertension, diabetes mellitus and homozygous sickle cell disease (in children only). Ischaemic stroke is by far the commonest clinical type encountered. These conclusions are further supported by experience at Ibadan, of over 1100 Africans seen over 18 years reported briefly in this communication. The results of the first community study over a 2-year period on the incidence of stroke in an African Urban (Ibadan) Community are presented. The study was carried out as part of a multinational multicentric study initiated and sponsored by the World Health Organization. The male to female ratio was five to two. Incidence rates reached peaks in the eighth decade in males and in seventh decade in females and were higher in males in all age groups, and the rates are comparable with those recorded in European populations, except in those under the age of 40 in Ibadan, in which age-specific incidence rates are considerably lower than in European and Japanese populations. Hypertension, diabetes mellitus constituted the main risk factors. Mortality and recurrence rates are described and are similar to experience in the Caucasians. Hypertension in the Nigerians predispose to a high frequency of cerebrovascular disease other than through mainly cerebral atherosclerosis. With increasing longevity of Nigerians and other Africans, the mortality and morbidity caused by cerebrovascular disease would probably become of enormous dimensions and adequate control of high blood pressure on a community basis may be the only way of preventing this: this would be desirable as myocardial infarction in contradistinction to hypertensive heart disease is an uncommon complication of high blood pressure in the Africans and prevention of hypertensive heart disease as shown by experience elsewhere can be achieved by control of high blood pressure, which does not seem to prevent ischaemic myocardial disease.
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PMID:Stroke in the Africans. 41 66

Ischemic stroke represents a leading cause of death in patients with renovascular hypertension. In the vast majority it is related to obstructive lesions of the extracranial tracts of the carotid arteries. Since no data were previously available on carotid artery lesions in patients (pts) with renovascular hypertension, a prospective case-control study was undertaken to assess the prevalence of carotid artery lesions in renovascular hypertension. Nineteen pts (10 females and 9 males, age: 26-77 yrs) with a diagnosis of renovascular hypertension based on the presence of uni- or bilateral renal artery stenosis and favourable outcome after either percutaneous transluminal renal angioplasty or surgery, and/or renal vein studies, were evaluated. The cause of renal artery stenosis was atherosclerosis in 12 pts and fibrodysplasia in 7. Each pt was matched with a control pt with primary hypertension for sex, race, age, blood pressure levels, smoking habits and serum cholesterol levels. Carotid artery lesions were assessed using a high resolution echo-Doppler (Duplex) system (Biosound 2000, probe 4 cm, 8 mHz). After the matching, the two groups were almost identical in terms of demographic features and risk profile. In the control group the prevalence of carotid artery lesions was similar to that reported in the literature. On the contrary, a highly significant higher prevalence of carotid artery lesions was observed in the pts with renovascular hypertension (92.1 vs 42.1%, respectively; p less than 0.001). Subgroup analysis showed that this difference was found mainly in pts with atherosclerotic renal artery stenoses.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[High prevalence of obstructive lesions of the extracranial carotid arteries in reno-vascular hypertension]. 219 57

The classification, epidemiology, pathophysiology, diagnosis, and treatment of ischemic cerebrovascular disease (ischemic stroke) are reviewed, and the major drugs used in the prevention of this disease are discussed. Ischemic stroke is a major problem in terms of morbidity and mortality because of the high prevalence of atherosclerosis in the United States population. The pathogenesis of cerebral ischemia is multifactorial, beginning with an atherosclerotic plaque on the arterial wall that may result in stenosis or ulceration with subsequent thrombosis or embolization. Platelets may adhere to the exposed arterial wall endothelium, stimulating further platelet aggregation and accumulation of leukocytes and fibrin. Consequences of cerebral ischemia include transient ischemic attacks and brain infarcts. Diagnosis is based mainly on patient history and ancillary radiologic studies. Treatment of ischemic cerebrovascular disease is primarily preventive, since the brain has limited capacity to recover neurologic function after an infarction. Transient ischemic attacks are treated with either antiplatelet agents, anticoagulants, or surgery. Treatment of stroke is also preventive, although anticoagulation is sometimes used to prevent stroke progression. Agents that may reverse neurologic impairment following an acute stroke, such as prostacyclin, calcium-channel blockers, and opiate antagonists, are being investigated. Antiplatelet therapy is indicated in subsets of patients with cerebral vascular insufficiency. Anticoagulation therapy, if needed, should be given for only three to four months.
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PMID:Current concepts in clinical therapeutics: ischemic cerebrovascular disease. 331 77

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

Ischemic stroke, myocardial infarction and peripheral arterial disease are different clinical manifestations commonly due to the same underlying disease, i.e. atherosclerosis with subsequent thrombosis/embolism (atherothrombosis). Many clinical trials of secondary prevention after stroke or TIA have evaluated the benefit of long-term use of antiplatelet drugs in reducing the risk of subsequent vascular events. Aspirin and triclopidine have been shown to be effective in placebo-controlled studies for the composite outcome of stroke, myocardial infarction, or vascular death. Contrasting with these benefits, there were potentially serious, though rare, adverse effects. These considerations certainly justify the development of new antiplatelet agents. Clopidogrel is a new ADP-receptor antagonist, with a greater activity in animal models of thrombosis. CAPRIE (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events) was a randomized, blinded, international trial designed to assess the relative efficacy of clopidogrel and aspirin in reducing the risk of the outcome cluster of ischemic stroke, myocardial infarction, or vascular death, as well as to assess their relative safety. 19,185 patients were recruited. The intention-to-treat analysis showed that the relative risk reduction was 8.7% (95% CI 0.3-16.5, p = 0.043) in favor of clopidogrel from an overall annual event rate of ischemic stroke, myocardial infarction, or vascular death, ranging from 5.83% in the aspirin group to 5.33% in the clopidogrel group. The percentage of adverse events reported was higher in the aspirin group for all categories except rash, diarrhea, and abnormal liver function. It seems likely that clopidogrel will replace ticlopidine for stroke prevention, because of its better safety profile, and comparable efficacy. Clopidogrel probably will not replace aspirin as the first line therapy for many clinicians because of its higher cost and lack of widespread experience. However, other clinicians have already decided that they will use clopidogrel as first choice, because of the significant advantage over aspirin demonstrated in the CAPRIE study.
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PMID:Clopidogrel for cerebrovascular prevention. 1047 7

791 patients aged 15-44 years with different forms of cerebral stroke that accounted for 9.4% from all the patients hospitalized because of stroke were treated. Ischemic stroke (IS) was diagnosed in 477 patients (60.3%), hemorrhagic stroke (HS) in 293 patients (37.3%), thromboses of the sinuses and veins of the brain in 19 patients (2.4%). IS to HS was 1.6:1; cerebral strokes were observed in men twice as frequently as in women. The main causes of HS (180 men, 115 women) were anomalies of cerebral vessels and arterial hypertension. Intracerebral and subarachnoidal hemorrhage occured with the same frequency. 38% of the patients died. The main causes of IS in 477 patients (285 men, 192 women) were arterial hypertension, rheumatism and atherosclerosis of cerebral and precerebral arteries. Embolic strokes occurred 4,5 times more frequently in women, than in men. 6.7% of the patients died. Among the patients with disorders of venous cerebral circulation (13 women, 6 men) 2 women with thrombosis of upper longitidinal sinus died. According to authors' data pregnancy and delivery are a significant risk factor for development of all forms of cerebral stroke.
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PMID:[Cerebral strokes at young age]. 1066 80

Ischemic stroke is a common disorder associated with significant morbidity and mortality. Results of several pivotal clinical trials completed within the last decade have helped refine stroke prevention and treatment strategies. Endarterectomy for symptomatic carotid artery stenosis, anticoagulation in atrial fibrillation, and IV t-PA treatment of hyperacute ischemic stroke may reduce the burden of stroke. Ongoing studies are addressing newly recognized risk factors, such as aortic arch and intracranial atherosclerosis, as well as neuroprotective agents and locally delivered thrombolytics. Successful patient management requires a targeted clinical approach based on vascular localization and risk factor assessment.
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PMID:Ischemic stroke. Clinical strategies based on mechanisms and risk factors. 1073 4

Atherosclerosis of carotid artery, resulting in stenosis is a common cause of cerebral ischaemia. Ischaemic stroke is cause of death in 10% of patients and the leading cause of disability in adults. The risk of stroke increases with the degree of stenosis. The diagnosis of the degree of stenosis is performed by duplex sonography, MR-angiography, CT-angiography and conventional angiography. Carotid endarterectomy is a method of choice in the treatment in the case of high-grade carotid stenosis. The operation was introduced in 1953. Either regional or general anaesthesia is used for the operation. The different monitoring techniques are used for assessment of the need for shunting. Microsurgical technique enables perfect endarterectomy and fine arterial repair without need for patch grafting. Other techniques of the treatment for carotid stenosis, including carotid angioplasty with or without stenting are subject to the evaluation. Carotid endarterectomy is now the method of choice in the treatment of high-grade carotid stenosis.
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PMID:[Advances in carotid endarterectomy--review]. 1080 63

Serum cholesterol traditionally has been considered a poor predictor of total stroke risk; however, it is associated positively with ischemic stroke risk and associated negatively with hemorrhagic stroke risk. Although studies failed to demonstrate stroke reduction using older cholesterol-lowering medications, recent study of the statin class of medications shows both consistent stroke and other cardiovascular benefits. Ischemic stroke and coronary heart disease share similar underlying mechanisms, likely explaining much of the therapeutic benefit from statins. Current research is directed at further determining groups of patients most likely to benefit from lipid reduction in stroke prevention. In the interim, patients with established atherosclerosis should be treated with a statin to achieve a low-density lipoprotein cholesterol level less than 100 mg/dL.
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PMID:Cholesterol, stroke risk, and stroke prevention. 1112 30

Atherosclerosis involves structural change to the intima and media of medium- and large-sized arteries. Although an atherosclerotic plaque may remain clinically silent, it is prone to disruption, leading to local platelet activation and aggregation. Therefore, the major complication of atherosclerosis is thrombosis, with local occlusion or distal embolism - a generalized disease process known as atherothrombosis. The three main clinical manifestations of atherothrombosis are coronary heart disease (myocardial infarction and angina), peripheral arterial disease and cerebral ischaemia. Atherothrombosis is a leading cause of mortality, and stroke is the leading cause of disability in adults, the second most important cause of dementia and the third most common cause of death in Western countries. Ischaemic stroke accounts for 80% of strokes and atherothrombosis accounts for approximately 20% of all strokes. Criteria for atherothrombotic stroke are evidence of a 50% (or greater) stenosis of a cervical artery and exclusion of other potential causes. The incidence of cerebrovascular events is 2,900 per million inhabitants per year, consisting of 500 transient ischaemic attacks and 2,400 strokes, of which 75% are first-ever stroke. The prevalence of stroke in the same population is 12,000, of which 800 patients (7%) per year have recurrences. The risk of ipsilateral stroke is 5% per year and the risk of a cardiac event is higher at 7%. Besides optimal management of risk factors for atherothrombosis and carotid surgery, antiplatelet therapy is the cornerstone of vascular prevention. In secondary prevention, antiplatelet agents are effective in reducing the risk of further ischaemic events in patients with atherothrombosis. Clopidogrel, a newly licensed ADP receptor antagonist, is the only antiplatelet agent to have demonstrated its superiority versus aspirin for the reduction of major ischaemic events (myocardial infarction, ischaemic stroke, vascular death) in patients whose initial manifestation of atherothrombosis was one of the three main clinical manifestations of the disease (recent ischaemic stroke, myocardial infarction, established peripheral arterial disease).
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PMID:Atherothrombosis: a major health burden. 1131 15


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