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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Current trends in treatment of transient ischemic attacks (TIAs) are reviewed. Patients with TIAs should be treated individually, the main goals of therapy being to avoid cerebral infarction and vascular death. Management of risk factors includes control of high blood pressure, dyslipoproteinemias, diabetes mellitus, atrial fibrillation, cardiac arrhythmias, and overweight. A healthy diet, exercising and non-smoking are additional useful measures. The most commonly used antiplatelet drug is aspirin. Doses of 325 mg per day are as effective as doses of 1,300 mg per day but have fewer side effects. Ticlopidine seems the best antiplatelet drug currently available; it is given in doses of 500 mg per day for a month and then 250 mg per day for the rest of the patient's life. Anticoagulants have not shown their advantages over drugs that prevent platelet aggregation. However, when a patient under treatment with warfarin with an adequate dose range suffers recurrent TIAs, warfarin can be used in association with ticlopidine. On the other hand, if patients under treatment with ticlopidine have further TIAs, they should be switched to anticoagulants for 6 months and then back to antiplatelet drugs. With regard to surgery, an effective means of prolonging survival seems to be the treatment of coronary artery disease before carotid endarterectomy is considered. The effectiveness of carotid endarterectomy is being evaluated in ongoing multicentric, randomized, controlled clinical trials.
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PMID:Current trends in treatment of transient ischemic attacks. 269 4

Cranial computed tomography of 284 patients with transient ischemic attacks (TIAs) and without previous stroke was evaluated. The sample population included patients with carotid and/or vertebrobasilar TIAs. Computed tomography revealed cerebral infarction in 34 patients, including 5 with multiple infarctions. The lesion location was consistent with TIA symptoms in 16 patients. In another 16 patients, however, the lesion location did not correspond to the TIA symptoms; these lesions were attributed to previous silent infarctions. Two patients with multiple infarctions had both symptomatic and asymptomatic lesions. Age and carotid stenosis were each significantly related to an increased chance of detecting cerebral infarction (either symptomatic or asymptomatic). No significant relationship between race, gender, hypertension, diabetes, cardiac disease, or smoking and the incidence of infarction was found by either univariate or multivariate analyses.
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PMID:Cerebral infarction in patients with transient ischemic attacks. 270 69

We investigated the prevalence of stroke in Taiwan in an epidemiologic study of stroke, diabetes, and cardiovascular disease that used a two-phase survey design. The study population was drawn by cluster sampling and consisted of both urban and rural communities from four regions of Taiwan. There were 8,705 people 36 years of age or older interviewed during the period of October 1 to December 31, 1986, and 143 cases of completed stroke were later identified by a neurologist. The point prevalence rate for people aged 36 or older in our study was 1,642/100,000 population (95% confidence interval 1,389-1,942/100,000). Prevalence rates differed significantly among the four study regions and between urban and rural communities; prevalence was greater in northern Taiwan and in urban communities. Percentages of the major types of stroke in 143 stroke survivors were as follows: cerebral infarction 67.1% (96 cases), cerebral hemorrhage 14.0% (20 cases), subarachnoid hemorrhage 4.2% (six cases), and unclassified 14.7% (21 cases). Of the stroke survivors, 67.1% were independent in activities of daily living, and 75.5% were independent in ambulation. Hypertension, heart disease, diabetes mellitus, and a family history of stroke were significantly more common in stroke survivors than in strokefree individuals.
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PMID:Prevalence of stroke in Taiwan. 274 45

Fifty-three patients with infarction of the corona radiata adjacent to the body of the lateral ventricle were clinically evaluated in order to determine the clinical characteristics of this infarction and localization of the pyramidal tract in this area, as well as its somatotopy and etiology. Clinical characteristics included the following: (1) this type of infarction was observed in 9.1% of all patients with cerebral infarction; (2) although 81.1% of the patients of this type had clear consciousness and neuropsychological symptoms in some patients; (3) motor paralysis usually occurred in the upper limbs; (4) monoplegia occurred in 13.2% of patients, with monoplegia of upper and lower limbs being associated with infarction of the anterior and posterior portion, respectively, of the corona radiata adjacent to the body of the lateral ventricle; (5) pure motor hemiplegia was observed in 45.3% of patients; (6) facial paralysis and dysarthria were observed in 54.7% and 58.5% of patients, respectively, and the incidence of these symptoms was the highest in the infarction of the anterior portion of the corona radiata; (7) sensory disturbance, which was usually recognized as a mild subjective feeling of abnormality and localized to the limbs, was reported by 47.2% of patients; (8) risk factors included hypertension, diabetes and high hematocrit and triglyceride levels; (9) arteriosclerosis was often noted in areas between the siphon of the internal carotid artery and the main stem of the anterior and middle cerebral arteries; (10) 64.2% of patients were able to conduct independent activities of daily life (ADL) 1 month after the onset of the disease and more marked paralysis remained in the infarction of the middle portion than in the anterior or posterior portion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical characteristics of infarction of the corona radiata adjacent to the body of the lateral ventricle]. 275 54

We studied 1,273 patients with ischemic cerebral infarction who were entered into the Stroke Data Bank, a prospective, observational study involving four university hospitals and the Biometry and Field Studies Branch of the National Institute of Neurological Disorders and Stroke. Forty patients had noniatrogenic recurrent stroke within 30 days after the index cerebral infarction. Using life tables, the 30-day cumulative +/- SE risk of early recurrence for all infarctions was 3.3 +/- 0.4%. The risk of early recurrence was greatest for atherothrombotic infarction (7.9 +/- 2.2%, eight of 113 patients) and least for lacunar infarction (2.2 +/- 1.2%, eight of 337 patients). Both cardioembolic infarction (4.3 +/- 0.9%, 10 of 246 patients) and infarction of undetermined cause (3.0 +/- 0.5%, 14 of 508 patients) had intermediate risks. History of hypertension and diabetes mellitus, as well as diastolic hypertension and elevated blood sugar concentration at admission, were associated with early recurrence. Logistic regression analysis estimated the risk of early recurrence to be 8.56% in those with coexisting hypertension and a glucose concentration of 300 mg/dl versus 0.77% in the absence of these two abnormalities. Early recurrence was associated with longer median duration of initial hospital stay (27 vs. 14 days) and a higher 30-day case-fatality rate (20% vs. 7.4%). Increased weakness scores were associated with early recurrent stroke. Identification of the determinants of early recurrent stroke may lead to better secondary prevention and may help select high-risk patients for further study.
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PMID:Determinants of early recurrence of cerebral infarction. The Stroke Data Bank. 275 50

Serum sodium and potassium concentrations were measured in 196 patients with acute cerebral infarction and 56 with cerebral hemorrhage. All patients were admitted within 7 days of onset and the data within 2 weeks of admission were recorded. The incidences of hypernatremia (serum Na greater than or equal to 149 mEq/l), hyponatremia (less than or equal to 134 mEq/l), hyperkalemia (serum K greater than or equal to 4.8 mEq/l) and hypokalemia (less than or equal to 3.2 mEq/l) were higher in patients with hemorrhage (18, 7, 13 and 14%, respectively) than infarction (4.5, 4.5, 11 and 6%, respectively). The incidences of hypernatremia and hyponatremia in infarction were higher in those who had cortical lesions than in those who had lesions in the basal ganglia or infratentorium. In cerebral hemorrhage, the incidence of hypernatremia was the highest in those with brain stem lesion. Hypernatremia was found in 27% of large sized hematoma, being significantly higher than that of those with medium (16%) or small (1%) hematoma. A similar tendency was also observed in hyponatremia and hyperkalemia. In elderly patients, electrolyte disturbances were more common than in young or middle-aged patients. Renal insufficiency and diabetes mellitus were frequent complications in stroke patients with hypernatremia (42 and 32%, respectively), of which 57% died within one month of admission.
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PMID:[Disturbances of fluid and electrolyte balance in patients with acute stroke]. 279 72

Ischemic heart disease of elderly patients increased markedly and patients with high risk complications become to be candidates for CABG. Emergent CABG was undergone successfully on the high risk patient of 72 years with severe left ventricular dysfunction (EF 14%), old cerebral infarction, renal dysfunction, and Diabetes Mellitus. From this experience, CABG could be safely performed even in elderly patient with high risk, if the complications were avoided carefully. However, the long term problem may be the multifocal VPC due to left ventricular dysfunction including old myocardial infarction.
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PMID:[A case report of emergency coronary artery bypass grafting (CABG) to an elderly high risk patient with severe left ventricular dysfunction]. 280 31

It is estimated that between 1971 and 1987 the number of carotid endarterectomies has increased from 15,000 to over 85,000 per year. Unless the procedure can be performed safely with a combined morbidity and mortality which is below the yearly risk of stroke (5%) for patients with symptomatic carotid artery disease, one should reconsider this operation as a therapeutic option. We review our experience with 891 carotid endarterectomies performed between January 1979 and June 1987. There were 579 (65%) men and 312 (35%) women of ages from 34 to 82 (median 65); risk factors included diabetes mellitus 213 (14%), hypertension 603 (68%), and smoking 630 (70%). Clinical presentation consisted of transient ischemic attacks 506 (57%), cerebral infarction with minimal neurological residual 252 (28%), stroke in evolution 3 (0.3%) and, asymptomatic stenosis 130 (15%). All patients were operated on under endotracheal anesthesia with transoperative monitoring of intra-arterial pressure, central venous pressure and arterial blood gases. Thiopental (3-5 mg/kg) and lidocaine (1 mg/kg) were given for induction and at 15 minute intervals during carotid cross-clamping. Intraluminal shunts were used in 13 (2%). A conventional (open) endarterectomy was performed in 561 (63%) and a limited endarterectomy (closed) in 330 (37%). Complications included 11 (1%) deaths, 26 (3%) developed a major neurological deficit that persisted, 30 (3%) had perioperative TIA's which resolved completely. Of the patients with preoperative neurological deficits, 33 (4%) recovered. Therefore, at one month after surgery, 854 (96%) were either as well or better than preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pitfalls during carotid endarterectomy. 284 25

Diffuse, alimentary tract ganglioneuromatosis-lipomatosis, bilateral adrenal myelolipomas, pancreatic telangiectasias, and a multinodular thyroid goiter were found at autopsy in a 56-year-old, white male with a history of insulin-dependent diabetes, hypertension, peptic ulcer, and remote cerebral infarction. The degree of atherosclerosis, arterionephrosclerosis, and cardiac disease found at autopsy did not correlate with the patient's history or his sudden death. The typical features of the multiple endocrine neoplasia syndrome, type II-B, were not identified. The findings in this patient may represent a variant of the multiple endocrine neoplasia complex, or a separate, previously unrecognized syndrome.
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PMID:Alimentary tract ganglioneuromatosis-lipomatosis, adrenal myelolipomas, pancreatic telangiectasias, and multinodular thyroid goiter. A possible neuroendocrine syndrome. 286 Aug 6

Mortality from four causes (index stroke, subsequent stroke, cardiac disease and non-cardiovascular causes) was examined during a 5 year follow-up of 1694 cerebral infarction patients admitted to 25 community hospitals between 1969 and 1973. The hazard for mortality from the index stroke was high initially, but declined to a negligible level by 6 months post-stroke. In contrast, hazards for mortality from subsequent strokes, cardiac diseases and non-cardiovascular causes each peaked midway through the first year, declined during the remainder of that year, and then increased in the latter part of the follow-up. Proportional hazards analysis indicated that advanced age and increased stroke severity were the only factors significantly related to increased risk from each of the four causes of death. Other risk factors were significant only for one or two select causes of death. White patients were less likely to die from subsequent strokes, but more likely to die from cardiac diseases, than were non-white patients (primarily blacks). Males were more likely to die from both the index stroke and non-cardiovascular causes than females. A history of cardiac disease increased the risk of death from both the index stroke and from future cardiac events, while a history of hypertension or diabetes increased the risk of death from non-cardiovascular causes, and a history of previous stroke increased the risk of death from subsequent stroke.
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PMID:Cause specific mortality following cerebral infarction. 291 85


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