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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

I have discussed the pharmacokinetics, efficacies, and side effects of the various nonnarcotic drugs available for the treatment of patients who have headache. Sumatriptan, the newest one, is expensive but may be cost-effective for those who have failed traditional migraine treatment, who visit the ER frequently, who have potential for drug abuse, or who have to miss time from school or work due to the headache. Studies are in progress to compare sumatriptan with other available drugs such as DHE-45 and to determine its possible role in the prophylaxis of migraine. A new 5-HT1D receptor agonist with more efficacy and fewer side effects may be developed in the future. When sumatriptan and DHE-45 are contraindicated due to hypertension or coronary artery disease, other drugs such as metoclopramide, ketorolac, and butorphanol can be used as alternatives.
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PMID:Recent advances in the acute management of migraine and cluster headaches. 807

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.
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PMID:Stroke in Saudi Arabian young adults: a study of 120 cases. 808 29

Aortic dissection represents a medical and, potentially, surgical emergency. Hypertension and cystic degeneration of the media are predisposing risk factors in the pathogenesis. Sporadic reports of aortic dissection in association with drug abuse especially crack cocaine are now appearing. We present such a patient whom we recently treated at University of Wisconsin Hospital.
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PMID:Crack and aortic dissection. 823 30

Illicit drugs, appetite suppressants, decongestants, and anabolic steroids may cause stroke. Drug abuse is a common cause of stroke in young patients. Mechanisms are varied, but it is particularly important to seek out infective endocarditis and most importantly, cerebral aneurysms, vascular malformations, and cardiac disorders in cocaine abusers. Drug-induced vasoconstriction, hypertension, or vasculitis probably contributes significantly to most patients' strokes. Tobacco smoking and heavy chronic alcohol consumption are independent risk factors for stroke; moderate drinking seems to protect from stroke in white patients. Oral contraceptives may increase the risk of stroke in female patients over 35 years of age who also have other risk factors.
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PMID:Stroke. 837 44

Recent statistics from the National Institute on Drug Abuse indicate that cocaine abuse continues to be a significant public health problem. Between 1988 and 1990 at Grady Memorial Hospital in metropolitan Atlanta, Georgia, we identified 12 patients in whom subarachnoid hemorrhage was temporally related to cocaine abuse. All 12 patients had underlying cerebral aneurysms that had ruptured. Currently, the incidence of ruptured intracranial aneurysms in patients with cocaine-induced subarachnoid hemorrhage is 84.9% (mean age, 31.1 years; overall mortality, 60.5%). Hypertension is the likely precursive factor in cocaine-induced aneurysmal rupture. Cocaine abuse appears to be a significant negative factor in the natural history of cerebral aneurysms, especially in young adults. We review the epidemiology of cocaine-induced subarachnoid hemorrhage and its effects on the cerebral circulation, and suggest guidelines for patient management.
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PMID:Cocaine-induced aneurysmal rupture: an emergent negative factor in the natural history of intracranial aneurysms? 847 41

The incidence of congenital valvular heart disease has not significantly altered in recent decades. Major factors contributing to altered profiles of acquired valvular heart disease in the past few decades include an increased elderly segment of the population and increasing recognition of nonrheumatic forms of valvular heart disease. Mitral valve prolapse, and similar involvement of other valves, together with senile calcific aortic stenosis have emerged as the most common forms of valvular heart disease in developed countries. Body leanness and hypertension are additional etiological factors for senile calcific aortic stenosis. Severe calcification of a congenital bicuspid aortic valve continues to be an important cause of aortic stenosis in the elderly. Idiopathic degeneration of the aortic and mitral valves, apparently a different condition than mitral valve prolapse, has also become recognized. Despite a recent increase in the incidence of acute rheumatic fever in North America, rheumatic heart disease remains an infrequent cause of valvular heart disease in developed nations. Its incidence has diminished in the Middle East, but it is still frequent in underdeveloped countries. Intravenous drug abuse is increasing in importance as a cause of valvular heart disease in urban centers in the United States. Syphilitic heart disease is very rare.
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PMID:Etiology of valvular heart disease. 873 80

The complications of drug abuse encompass a spectrum of glomerular, interstitial, and vascular diseases. They comprise the heroin-associated nephropathy seen in African-American intravenous drug addicts, which, however, has given way in the 1990s to HIV-associated nephropathy. Infections with methicillin-resistant Staphylococcus aureus may cause acute glomerulonephritis by releasing bacterial superantigens. Hepatitis C has supplanted hepatitis B and may give rise to membranoproliferative glomerulonephritis and cryoglobulinemia. Addicts who inject drugs subcutaneously ('skin popping') may develop amyloidosis. Cocaine causes rhabdomyolysis, severe hypertension, occasionally renal failure in the absence of rhabdomyolysis, and may hasten progression to uremia in patients with underlying renal insufficiency. 'Ecstasy', an amphetamine-like recreational drug, has caused acute renal failure, electrolyte disturbances, and malignant hypertension. In Belgium and some other European countries, women taking Chinese herbs in a slimming regimen have developed a severe and irreversible interstitial fibrosis that is assuming epidemic proportions.
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PMID:Drugs of abuse and renal disease. 874 32

Acute intoxication with either cocaine or methamphetamine may contribute to formation and rupture of a berry aneurysm by causing transient hypertension and tachycardia. We report the results of a retrospective study to determine the incidence of acute cocaine or methamphetamine intoxication in deaths due to ruptured berry aneurysm in our jurisdictions. We reviewed all deaths from ruptured cerebral aneurysms that fell within our jurisdictions during the seven years from 1 January 1987 to 31 December 1993 and found 83 cases. The mechanism of death invariably involved subarachnoid hemorrhage, although some cases also had intracerebral hemorrhage. A history of drug abuse was found in 13 cases. Toxicological analysis was performed in 39 cases. Of these methamphetamine was detected in six cases and cocaine in three cases--an incidence of 21%. (In one case both methamphetamine and cocaine were detected). The incidence of acute cocaine intoxication in all autopsies in Jefferson County was 13.6%. The incidence of methamphetamine intoxication in all autopsies in San Diego County was 4.9%. Although the exact mechanism by which berry aneurysms form remains undetermined, research indicates that propagation and rupture of the aneurysm are aggravated by hypertension and tachycardia, both of which are pharmacologic side effects of cocaine and methamphetamine. Based on the preponderance of methamphetamine associated with deaths due to ruptured berry aneurysms it appears that methamphetamine is more toxic than cocaine, perhaps owing to the longer half-life of methamphetamine.
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PMID:The incidence of acute cocaine or methamphetamine intoxication in deaths due to ruptured cerebral (berry) aneurysms. 875 72

A patient with a history of drug abuse and histologically diagnosed hepatitis B-related polyarteritis nodosa was admitted for severe hypertension. After a cesarean section because of worsening of her clinical status with severe proteinuria and edema, she improved dramatically. No sign of acute polyarteritis nodosa occurred.
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PMID:Severe preeclampsia superimposed on polyarteritis nodosa. 906 53

We reviewed our experience with 91 patients aged 15 to 40 years with nontraumatic intracerebral hemorrhage (ICH) from January 1991 through December 1994 and found more than ten presumed causes for the nontraumatic ICH in 68 patients (74.7%). The leading two causes were arterial hypertension and ruptured arteriovenous malformations. Most cases of ICH were lobar and putaminal. Of the lobar hemorrhages, 26.5% resulted from ruptured arteriovenous malformations. Of the putaminal hemorrhages, we found 60% resulted from arterial hypertension. Arteriography was performed in 36 patients, and was diagnostic in 23. A history of drug abuse was found in 3 patients. The survival rate was 82.4% at 1 month, 78.0% at 6 months and 76.9% at 1 year. The in-hospital survival rate of all patients in this study was 78.0%. The outcome was determined at one month after hemorrhage. Thirty-two percent of our cases made a good recovery (back to normality), 35% a fair recovery (moderately disabled but independent), 15% a poor recovery (severely disabled and dependent), and 18% died. Arterial hypertensive hemorrhage accounted for almost 30% of our young ICH patients which reminds us of the importance of regular control of blood pressure even in the young adults. Arteriography performed early in the course of nontraumatic ICH in young adults, particularly in lobar hemorrhages, is a valuable adjunct in determining cause. Although the details of history of drug abuse were frequently lacking, physicians should keep this abuse in mind as a possible cause for nontraumatic ICH.
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PMID:Nontraumatic intracerebral hemorrhage in young adult. 917 85


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