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Recent findings on the relation between alcohol abuse and ischaemic brain infarction are reviewed. Much of the association has hitherto been explained by the effects of confounding factors such as smoking. Alcohol increases blood pressure in both hypertensive and normotensive subjects and alcohol induced hypertension enhances the risk of both hemorrhagic and ischaemic strokes. Analysis of case histories shows that alcohol abuse has precipitated cerebral embolism in conjunction with cardiac diseases including alcoholic cardiomyopathy and paradoxical embolism due to deep vein thrombosis via atrial septal defect. Among young adults, falling when intoxicated with alcohol has caused traumatic dissection of the carotid artery and consequent brain infarction. Alcohol may predispose individuals to cerebral embolism, thrombosis and ischaemia via its effects on the coagulation cascade, platelet count and function and contractility of the cerebral vessels. Further studies are needed to prove that these mechanisms are significant and to identify any other mechanisms which may mediate the risk associated with alcohol abuse. On the basis of current data, alcohol should be considered as an independent risk factor for ischaemic cerebral infarction in young adults.
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PMID:Alcohol abuse and brain infarction. 229 43

That non-rheumatic atrial fibrillation is an independent risk factor for cerebral infarction has not been established with certainty. The rationale underlying contemporary clinical trials of warfarin therapy for the prevention of stroke in patients who have non-rheumatic atrial fibrillation is that the majority of strokes in such patients are due to cardiogenic cerebral embolism. However, there is evidence to suggest that the increased probability of stroke attributed to this arrhythmia is due to its association with other risk factors such as hypertension, diabetes mellitus, and atherosclerosis. The question of who should be anticoagulated is a major public health issue since atrial fibrillation is present in approximately ten per cent of the general population aged 65 or more years.
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PMID:Is atrial fibrillation an independent risk factor for stroke? 235 52

The causes, risk factors and outcome of cerebrovascular accidents (CVA) in 150 patients admitted to Tikur Anbessa Hospital, Addis Ababa, Ethiopia, between 1983 and 1985 were studied. Cerebral thrombosis was the commonest cause of CVA (50.6%), followed by cerebral haemorrhage (24%) and cerebral embolism (15%). The single most important risk factor for CVA was hypertension. Mortality was highest with cerebral haemorrhage (89.4%) and lowest with cerebral embolism (13%). An important measure which could reduce the incidence of CVA is the vigorous and sustained control of hypertension.
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PMID:Cerebrovascular accidents in Ethiopia. 236 33

A baseline examination of all residents aged 40 years and over, in the A-I district, Shibata City, Niigata Prefecture, Japan, was conducted in July 1977. The response rate for this examination was 84.5% for males and 92.6% for females. Nine hundred sixty males and 1,339 females, who were initially free from stroke, constituted the stroke cohort. Similarly 984 males and 1,342 females, who were free from myocardial infarction and angina pectoris on effort, made up the ischemic heart disease cohort. Both cohorts were followed for 10 years through June 1987. It is concluded that, in the agricultural community, the strongest risk factor for not only stroke but ischemic heart disease was hypertension, and that the attribution of hypercholesterolemia and obesity was small. The population that was studied experienced a period of relative economic deprivation before 1950, and there seems to be residual effects from this period to this day. The definition of cerebral infarction used in this study includes several pathologically different types (cerebral infarction of the cortical branches, cerebral infarction of the perforating branches, cerebral embolism and so on), and this may affect the results. On the other hand, the strongest risk factor for ischemic heart disease found in the A-I district is hypertension. This differs from the European/American type of ischemic heart disease, to which hypercholesterolemia and obesity are basic. These results also suggest the possibility that there is a difference not only etiologically but pathologically between the two types.
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PMID:Relationship of risk factors to subsequent development of stroke and ischemic heart disease in a rural community. 262 42

A case of anti-phospholipids auto-antibodies syndrome is reported; it was an unusual expression of Systemic Lupus Erythematosus (SLE). The patient is a 38 years old woman, with a history of recurrent peripheral thrombosis, pulmonary and cerebral embolism, thrombocytopenia, abortions; moreover she suffered from arterial hypertension, and headache. Features of onset, with several episodes of relevant clinical severity and the long period without clinical and laboratory hallmarks of SLE suggest a serious caution in the diagnosis of "pure" anti-phospholipids auto-antibodies syndrome.
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PMID:[Antiphospholipid antibody syndrome: description of a case]. 264 52

We studied the mechanism of hemorrhagic infarction after acute cerebral embolism in 160 patients by brain computed tomography and angiography. Hemorrhagic infarction during the month after the embolic event was evident in 65 patients (40.6%). Initial angiography a median of 1.5 (range 1-60) days after the event revealed occlusion of the cerebral arteries in 117 of 142 patients (82.4%), and reopening of the vessels was observed in 56 (94.9%) of 59 patients who had follow-up angiography a median of 20 (range 3-47) days after the event. The incidence of hemorrhagic infarction was higher in patients greater than or equal to 70 years old (31 of 61, 50.8%) than in those aged 50-69 years (27 of 72, 37.5%) or less than 50 years (seven of 27, 25.9%) (greater than or equal to 70 vs. less than 50, p less than 0.05). In patients with moderate or large infarcts, hemorrhagic infarction developed in 50.0% or 51.5%, respectively, while in those with small infarcts it developed in only 2.9% (p less than 0.05). No correlation was found between hemorrhagic infarction and history of hypertension or blood pressure during the acute stage of stroke. Thrombolytic and/or anticoagulant therapy did not affect the incidence of hemorrhagic infarction (40.0% with vs. 40.7% without therapy) but tended to cause massive hematoma. Our results indicate that hemorrhagic transformation in cerebral embolism is caused not only by reopening of the occluded vessels but also by other factors such as age and size of the infarct. Hypertension per se seems to be less important for hemorrhagic infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemorrhagic transformation in cerebral embolism. 271 99

Three different cases of cerebral embolism occurring in combination with hyperthyroidism are reported. Case 1; a healthy 37-year-old woman presented with sudden onset of left hemiparesis and left sided hypoesthesia of all modalities. Embolism in area of the right middle cerebral artery was confirmed by angiography and CT scan. Laboratory examination revealed hyperthyroidism and anemia. Antithyroid treatment brought about euthyroid function while slight hemiparesis remained present. Case 2; a 79-year-old woman who suffered from hypertension for one year had sudden onset of disorientation and left hemiparesis. Electrocardiogram showed atrial fibrillation. The CT scan indicated infarction in the right anterior and middle cerebral artery. The patient was diagnosed as having masked hyperthyroidism. Although antithyroid medication reduced it to euthyroid condition, the patient is now bedridden with hemiparesis. Case 3; a 45-year-old man who had partial thyroidectomy for Basedow's disease and had been treated with antithyroid and antiarrhythmic therapy for 10 years. Suddenly, he was in coma with dilated right pupil and left hemiplegia. Atrial fibrillation and hypothyroid function were observed. CT scan indicated hemorrhagic infarction in the territory of the middle cerebral artery with transtentorial herniation. He died on the 59th day of hospitalization following an episode of bronchopneumonia. On the basis of the cases presented here as well as on the basis of those described in the literature it appears that thyrotoxic patients with atrial fibrillation exhibit high incidence of cerebral embolism, and prophylactic anticoagulant therapy may be recommended.
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PMID:Cerebral embolism and hyperthyroidism. 277 Feb 20

Computed tomography was performed and risk factors evaluated in 100 consecutive adult patients presenting to the two teaching hospitals in Harare with a clinical diagnosis of stroke. The mean age of the patients was 52; only 28 were 65 or older. Non-stroke lesions were found in seven patients and were predicted by a recent history of convulsions (p less than 0.0001). Five lesions (four subdural haematomas and one cerebral cysticercosis) were remediable. Hypertension was present in 27 (93%) of the 29 patients with cerebral haemorrhage and in 49 (53%) of the 93 patients with stroke lesions. In 22 (45%) of these patients the hypertension had not been diagnosed, and another 22 had defaulted from treatment. All 13 patients who died before computed tomography had hypertension, and over half showed evidence of haemorrhagic stroke. There was a cardiac source for all 12 cases of cerebral embolism. In eight of the 100 patients cerebral infarction was attributed to neurosyphilis. None of the patients had clinical evidence of atherosclerosis. Smoking and oral contraceptives did not seem important risk factors for stroke. Detection and control of hypertension remain the most important measures needed to reduce the incidence of and mortality from stroke in Zimbabwe.
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PMID:Strokes among black people in Harare, Zimbabwe: results of computed tomography and associated risk factors. 308 59

Arterial hypertension is the most important risk factor in all types of stroke. The significance of alcohol in the pathogenesis of stroke is less well defined. Chronic alcoholism leads to an elevation of blood pressure. Thus, the association between alcohol and stroke might be the blood pressure effect of alcohol. However, some studies have shown a significant influence of alcohol on the incidence of stroke--especially of intracerebral haemorrhage and subarachnoid haemorrhage--even after adjustment for blood pressure. Many possible pathomechanisms are discussed. Alcohol inhibits aggregation of thrombocytes, and chronic alcohol abuse may induce thrombocytopenia, which could lead to a haemorrhagic stroke. Alcohol withdrawal leads to rebound thrombocytosis. Acute alcohol ingestion induces a decrease in fibrinolytic activity and an increase in factor VIII activity, which enhances the thrombotic potential. Additionally, alcohol increases plasma osmolarity, erythrocyte aggregability, haematocrit and blood viscosity, and decreases deformability of erythrocytes. The effects of alcohol on cerebral blood flow are still under debate; there is a deterioration in autoregulation of cerebral blood flow anyway. In animal studies alcohol induced dose-dependent vasospasm of the cerebral blood vessels, which could be a possible pathomechanism in ischaemic, as well as in haemorrhagic stroke. Chronic alcoholism is the most common cause of secondary non-ischaemic cardiomyopathy, which can lead to cerebral embolism via rhythm disorders or intracardiac thrombus formation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Does alcohol consumption promote the manifestation of strokes? Considerations on pathophysiology]. 328 8

Of 171 patients evaluated prospectively and consecutively for cerebral ischemia, 26 (15%) developed symptoms while hospitalized. Cerebral ischemia complicated operative procedures in 12 patients, unsuccessful cardioversion in one and coronary angiography in another. Twelve patients had apparent cerebral embolism and 14 patients had cerebral thrombosis as a mechanism of their symptoms. Hospitalized patients who suffered cerebral ischemia had one or more of the following: risk factors for stroke including cardiac source of embolus, previous stroke, diagnostic or therapeutic procedures for vascular disease, or chronic hypertension complicated by acute hypotension.
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PMID:Mechanism of in-hospital cerebral ischemia. 371 40


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