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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cerebrovascular disease is one of the most common causes of epilepsy in the elderly. Most of the studies published relate to cortical infarction, subarachnoid, and intracranial hemorrhage, whereas the incidence of epilepsy from subcortical ischemia, i.e. deep lacunar infarctions and diffuse white matter lesions, is obscure. Therefore, we prospectively examined 18 patients with the precisely defined diagnosis of subcortical vascular encephalopathy (SVE), who were admitted to our hospital due to epileptic seizures (group A), and compared them to a similarly selected group matched for age, sex, risk factors, and neurological deficits with an equivalent severity of SVE but without seizures (group B). Subcortical lacunar infarctions were significantly more frequent in group A than group B (15/18 versus 4/18, p < 0.001), whereas neither the extension, degree, distribution of periventricular white matter changes, nor the presence of internal hydrocephalus, focal or diffuse cortical atrophy showed any statistical significance. However, a temporal constant theta or delta EEG focus was present in 10/18 patients in group A but only in 1/18 patients from group B (p < 0.005). 10/18 patients developed epilepsy with further seizures during follow-up. The association of SVE, multiple subcortical lacunas, and temporal EEG abnormalities are suggestive for an increased risk for epileptic seizures, which is particularly important for the treatment of patients with SVE if uncertain paroxysmal episodes occur, e.g. transient ischemic attacks, seizures, or cardiac syncope.
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PMID:Epileptic seizures in subcortical vascular encephalopathy. 858 82

The authors describe a rare case of pulmonary thromboembolism with unusual clinical findings and emphasized the large difficulty encountered in formuling a correct diagnosis in a reasonable time. A man, 60 years old, was admitted to a Medical Division of our hospital for the appearance of chest pain and epigastric pain during effort in the last year. He smoked 20 cigarettes a day and drank wine (1 or 2 litres a day). He was affected by hypercholesterolemia and in the past reported relapsed thrombophlebitis in the left leg. Four years before admission to our hospital he underwent large and small left saphenectomy. He had no cardiac events in the past. After a non significant exercise stress test the patient was treated with nitrates and asa and was discharged from the hospital. At home the symptoms increased and after 8 months the patient was admitted again to the Cardiologic Division of the hospital. At admission he reported dyspnea and chest pain at rest, not only during effort and the ECG showed negative T waves in anterior and inferior leads. Intravenous heparine, nitrates and calcium antagonists stabilized the clinical picture. The following examinations revealed: reduction of the T wave negativity at the ECG registered during chest pain; mild enlargement of the heart at the chest roentgenogram; normal value of the left ventricle and apical and midseptal by ipokinesia at the transthoracic echocardiogram; normal coronary artery at the coronary arteriography. "Vasospastic angina" was diagnosed and the patient was discharged after 20 days, asymptomatic. After 15 days he returned to the hospital again for chest pain, dyspnea, hypotension and syncope despite therapy. At physical examination he showed a painful left tibio-tarsal tumefaction, an increased and splitting second heart sound in the pulmonary area and a systolic murmur in the third and fourth left interspace. The ECG showed a severe anterior ischemia, while a new transthoracic echocardiogram revealed a considerable dilatation of the right atrium, right ventricle and the main pulmonary artery with severe tricuspid regurgitation and pulmonary hypertension (mean PAP about 50 mmHg). The following pulmonary perfusion scintigraphy confirmed the diagnosis of pulmonary embolism and the selective right and left pulmonary arteriography exhibited multiple thrombi and large intravascular filling defects. The right heart catheterization confirmed a chronic precapillary pulmonary hypertension (mean PAP = 55 mmHg). About 24 hours after these examinations the patient died because of a cardiac arrest with electromechanical dissociation. Pulmonary thromboembolism is a potentially fatal disease characterized by a largely variable clinical presentation. Frequently pulmonary embolism diagnosis is difficult especially when clinical findings are unusual. In the case observed the "typical" chest and epigastric pains associated with the electrocardiographic findings directed diagnosis towards myocardial ischemia. Also after the coronary arteriography that showed normal coronary artery, the erroneous diagnosis persisted. Pulmonary embolism was correctly diagnosed too late to begin an effective therapy. These unusual clinical findings and diagnostic mistakes are stressed and critically reviewed in the article.
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PMID:[Pulmonary thromboembolism. A clinical case with unusual presentation]. 871 Jan 39

This report describes a 34-year-old female with an exercise-induced atrioventricular block resulting from transient ischemia caused by a radiation-induced ostial stenosis of the right coronary artery. Patient first underwent coronary artery surgery with a right internal mammary artery to the right coronary artery. After 18 months she was readmitted with exercise-induced syncope due to graft occlusion. This time a successful rotablator procedure was performed on the ostial stenosis.
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PMID:Exercise-induced syncope as late consequence of radiotherapy. 902 19

History of diagnostic ultrasound begins with the Austrian physicist Christian Doppler, who described in 1842 the Doppler principle. 40 years later, the Curies discovered the reverse piezoelectric effect that produces ultrasound. The first ultrasonic devices were designed at the beginning of the 20th century and were used among other things for detection of submarines. Development during World War II permitted the construction of the first transcranial (1940) and extracranial (1949) ultrasound imaging units. Continuous-wave Doppler sonography was introduced in clinical practice 20 to 30 years later. Due to its high validity, this technique has become the standard method for evaluation of extracranial occlusive cerebrovascular disease. Further ultrasonic developments like duplex and color duplex sonography have increased the diagnostic possibilities but did not replace continuous-wave sonography in many European ultrasound laboratories. Transcranial ultrasound studies are performed by means of pulsed-wave Doppler or color duplex sonography. It is likely that power Doppler and transpulmonary contrast agents will further increase diagnostic confidence in neurovascular ultrasound. The search for a source of arterio-arterial embolism in case of ocular and cerebral ischemia remains the main indication for neurovascular ultrasonography. Additional indications are repetitive studies in dissection, vasospasm, endovascularly treated vascular malformations and stenoses, intracranial pressure monitoring, examination of cerebrovascular reactivity in suspicion of hemodynamic ischemia, and diagnostic work-up of cough syncope, pulsatile tinnitus and cardiac right-left shunt.
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PMID:[History of neurovascular ultrasonography]. 906 95

Extracranial-intracranial (EC-IC) bypass grafting procedures were specially designed for treatment of bilateral internal carotid artery occlusion. When performed in an expeditious manner, EC-IC bypass procedures have produced effective and durable results, despite the recent disfavor given to this procedure. This communication reports a 68-year-old white man who developed generalized cerebral ischemia manifested as confusion, incoherence, disorientation, ataxia, and numerous episodes of syncope daily. A cerebral angiogram revealed bilateral external carotid arteries and left solitary vertebral artery critical stenosis. Transcranial Doppler study demonstrated reduction of cerebral and vertebral-basilar perfusion. However, the patient's EC-IC bypass graft had remained patent since 1985. The patient's recurrent symptoms of global ischemia and syncope resolved after carotid endarterectomy, vein patch external carotid artery, and vertebral-to-common carotid artery transposition. This report reiterates the value of the EC-IC bypass procedure and presents the surgical management of symptomatic external carotid and vertebral artery stenosis in patients after EC-IC bypass procedures.
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PMID:Revascularization of cerebral ischemia after previous bilateral extracranial-intracranial bypass procedures. 947 4

Electroencephalographic (EEG) findings in syncope are reviewed. There are four major categories of syncope: neurally mediated (neurocardiogenic), neurologic, decreased cardiac output, and orthostatic hypotension. However, regardless of cause, whether the syncope is due to a vasovagal effect, a cardiac arrhythmia, an epileptic seizure, or hypotension, EEG findings are similar and reflect cerebral hypoperfusion. Initially there may be a slowing of background rhythms. This is followed by high amplitude delta activity, maximal anteriorly. If the hypoperfusion persists there is subsequent flattening of the EEG. The EEG returns to normal in the reverse sequence. In cases with severe and prolonged ischemia, convulsive syncope may occur at the time of the EEG flattening. Although not an epileptic phenomena, clinically this is often mistaken for epilepsy. Conversely, epileptic disorders, such as the ictal bradycardia syndrome, may occasionally mimic syncope. Therefore, in patients in whom EEGs are performed for the evaluation of an episode of loss of consciousness, simultaneous ECG should be used.
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PMID:Electroencephalography in syncope. 924 59

Mortality in the total occlusion of the left main coronary artery is very high, and the few cases who lived reported were very ill and symptomatic patients. We present a case with angiographic documentation of total occlusion of the left main coronary artery in a patient without angina and with a normal rest electrocardiogram in which a syncope was the only symptom. Severe isolated silent ischemia was induced during an exercise test. Total occlusion of the left main coronary artery associated to silent myocardial ischemia without cardiac failure has never been previously reported.
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PMID:[Occlusion of the left main coronary artery with silent ischemia and syncope]. 928 Oct 18

A 67 year-old normotensive woman had a syncope followed by shock and remained anuric after hemodynamic stabilization. Paraplegia and paresis of the right upper limb, as well as signs of ischemia of the distal lower limbs were noted. The possibility of acute aortic dissection was raised and confirmed by computed tomography. The paraplegia was attributed to an ischemic infarction of the spinal cord. The patient died on the fourth hospital day due to a pericardial temponade. This rare and not well recognized complication of aortic dissection is briefly reviewed.
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PMID:[Acute paraplegia. A rare complication of aortic dissection]. 968 28

The most common initial symptom of aortic dissection is chest pain. Other initial symptoms include pain in the neck, throat, abdomen and lower back, syncope, paresis, and dyspnoea. Headache as the initial symptom of aortic dissection has not been described previously. A 61-year-old woman with a history of migraine and arterial hypertension developed continuous bifrontal headache. Two hours later, right-sided thoracic pain and a diastolic murmur were suggestive of aortic dissection that was confirmed by echocardiography and subsequent surgery. The dissection commenced in the ascending aorta and involved all cervical arteries until the base of the skull. Headache as the initial manifestation of aortic dissection was assumed due to either vessel distension or pericarotid plexus ischemia. Aortic dissection has to be considered as a rare differential diagnosis of frontal headache, especially in patients who develop aortic regurgitation or chest pain for the first time.
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PMID:Headache as the initial manifestation of acute aortic dissection type A. 982 52

Dobutamine echocardiography was performed in 55 patients with syncope which was clinically suspected to be angina-related. We evaluated the value of using a single test, dobutamine echocardiography, in differentiating real ischemia-related from vasovagal syncope which was diagnosed by a tilt test. During testing, supraventricular arrhythmia was provoked in four (7.2%) patients. Dobutamine echocardiography identified all of six (10.9%) patients (sensitivity 100%), who were found with significant coronary stenosis by coronary angiograms. The etiology of syncope in the remaining 45 patients was investigated further by tilt testing, the findings of hypotension and bradycardia during which were compared head to head with those of dobutamine echocardiography. Tilt testing diagnosed vasovagal syncope in 31 patients, in whom only 19 (61.3%) patients developed vasovagal reflex during dobutamine echocardiography. Conclusively, dobutamine echocardiography had a high sensitivity in identifying syncope related to myocardial ischemia in patients with coronary stenosis, but a low sensitivity (61.3%), high specificity (90.5%) and high positive predictive value (81.8%) in detecting the syncope patients with angina caused by vasovagal effect.
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PMID:Diagnostic value of dobutamine echocardiography in patients with angina-like symptoms preceding syncope. 989 48


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