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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

(1) Neurologic complications remain a significant problem in bacterial endocarditis. Of 218 patients with endocarditis, 84 (39%) had a neurologic complication and 58% of these 84 patients died. In contrast, the mortality rate was only 20% among those endocarditis patients without neurologic complications. (2) Of the neurologic complications, cerebral embolism is the most frequent and important. An embolic stroke occurred in 37 (17%) of our patients, with 30 of these patients dying. Emboli are important not only in terms of the direct morbidity and mortality they cause via cerebral infarction, but also because of their role in the causation of mycotic aneurysms, brain abscesses, and abnormal CSF formulae. (3) Cerebral emboli are particularly common in patients with mitral valve infection, and in patients with infection due to virulent organisms, particularly S. aureus and enteric gram-negative bacilli. (4) Mycotic aneurysms occur more frequently in the course of acute endocarditis rather than late in the course of subacute disease. Management of angiographically demonstrated mycotic aneurysms is dependent upon the presence or absence of hemorrhage, the anatomic location of the aneurysm, and the clinical course of the patient. Healing of mycotic aneurysms can occur during the course of effective antimicrobial therapy, thus obviating the need for neurosurgical intervention in all such patients. (5) Macroscopic brain abscess is a rare complication of bacterial endocarditis. Miliary microscopic abscesses are more common than larger abscesses, particularly in patients with acute disease and miliary infection in other organs of the body. (6) Focal seizures occur most commonly in endocarditis patients with acute embolic disease; generalized seizures are of diverse etiologies, with metabolic factors being most important. Penicillin neurotoxicity should be considered in patients with impaired renal function who are receiving high dose penicillin. (7) With the exception of hemorrhagic complications, lumbar puncture results tend to reflect the nature of the infecting organism rather than the nature of the neurologic complication. Endocarditis due to virulent organisms such as S. aureus is usually associated with a purulent CSF formula while nonvirulent organisms, such as viridans streptococci, susually have aseptic or normal CSF formulae.
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PMID:Neurologic complications of bacterial endocarditis. 58 Jul 94

Information obtained during the past decade suggests that the onset of myocardial infarction and sudden cardiac death is frequently triggered by daily activities. The importance of physical or mental stress in triggering coronary thrombosis is supported by finding that (1) the frequencies of the onset of myocardial infarction, sudden cardiac death, and stroke show marked circadian variations, with similar increases in the period from 6 AM to noon; (2) the frequency of transient myocardial ischemia shows a similar increase in the morning, and episodes are often preceded by mental or physical triggers; (3) a ruptured atherosclerotic plaque, often nonobstructive by itself, lies at the base of most coronary thrombi; (4) a number of physiologic processes that could lead to plaque rupture, a hypercoagulable state, or coronary vasoconstriction, are accentuated in the morning; and (5) aspirin and beta-adrenergic blocking agents that affect certain of these processes have been shown to prevent disease onset. The hypothesis presented is that occlusive coronary thrombosis occurs when (1) an atherosclerotic plaque becomes vulnerable to rupture; (2) mental or physical stress causes the plaque to rupture; and (3) increases in coagulability or vasoconstriction, triggered by daily activities, contribute to complete occlusion of the coronary artery lumen. Recognition of the circadian variation--and the possibility of frequent triggering--of the onset of acute disease suggests the need for pharmacologic protection of patients during the vulnerable periods and provides clues to the mechanism of disease onset, the investigation of which may lead to improved methods of prevention.
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PMID:Triggering and hourly variation of onset of arterial thrombosis. 134 90

Critical conditions that develop because of hypoxia of different genesis are accompanied by endogenous intoxication induced to a considerable degree by the appearance in the blood of an excess amount of medium-sized molecules (MSM). An appreciable increase of the content of MSM was demonstrated since the very first days after the brain stroke as a result of examining 100 patients who suffered brain stroke, including 83 patients during the first week of the disease and 17 patients of the reference group with a history of acute impairment of cerebral circulation which had occurred over a month before. A reverse correlation was established between the level of endogenous intoxication and the clinical status of the patients which could be observed every day during the acute disease phase. The critical level of MSM was determined in the patients' blood plasma. In the majority of cases, the attainment of the above level resulted in a lethal outcome irrespective of the pattern of acute impairment of cerebral circulation. The data obtained make it possible to recommend using the level of MSM as one of the simple and rapid quantitative methods for assessment of the patients' status gravity and monitoring of persons with acute impairment of cerebral circulation.
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PMID:[Endogenous toxemia in acute disorders of cerebral circulation]. 217 80

Activities of catalase, superoxide dismutase, glyceraldehyde phosphatedehydrogenase and glucose-6-phosphate dehydrogenase implicated in the process of hemoglobin oxygenation were studied and compared in 40 patients with ischemic and in 30 patients with hemorrhagic brain strokes in the most acute disease period (days 1-2). A well-defined relationship was revealed between the brain stroke pattern and enzymatic activity which is likely to be determined by varying degree of body adaptation under hypoxia developing in ischemic and hemorrhagic brain strokes. It is assumed that the clinico-enzymatic correlations discovered might be employed as additional criteria in the differential diagnosis of the brain stroke pattern.
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PMID:[Value of the study of various erythrocyte enzymes in determining the nature of cerebral stroke in the acute period]. 217 84

In years 1984-1986 582 men and 338 women have been registered with clinical diagnosis of cerebral stroke. The respective numbers in the Tarnobrzeg province were 340 and 263. Preliminary diagnosis of cerebral stroke was confirmed according to criteria of registration in 82% of men or women from Warsaw and in 81% of men and 84% of women in the Tarnobrzeg province . Standardized incidence due to cerebral stroke was significantly higher in every of analysed years in the Warsaw population both among men and women in compare with that in the Tarnobrzeg province . In both population studied the incidence was significantly higher among men than among women. Standardized fatality during 28 days from the start of sickness was higher in the Tarnobrzeg province population than in the Warsaw population so far as both men and women are concerned. In both populations among men and women the most frequently diagnosis was acute disease of cerebral vessels.
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PMID:[Stroke incidence and mortality among urban and rural populations during the 3-year period]. 226 61

Information obtained during the past decade suggests the need to reexamine the possibility that the onset of myocardial infarction and sudden cardiac death is frequently triggered by daily activities. The importance of physical or mental stress in triggering onset of coronary thrombosis is supported by the findings that 1) the frequencies of onset of myocardial infarction, sudden cardiac death, and stroke show marked circadian variations with parallel increases in the period from 6:00 AM to noon, 2) transient myocardial ischemia shows a similar morning increase, and episodes are often preceded by mental or physical triggers, 3) a ruptured atherosclerotic plaque, often nonobstructive by itself, lies at the base of most coronary thrombi, 4) a number of physiologic processes that could lead to plaque rupture, a hypercoagulable state or coronary vasoconstriction, are accentuated in the morning, and 5) aspirin and beta-adrenergic blocking agents, which block certain of these processes, have been shown to prevent disease onset. The hypothesis is presented that occlusive coronary thrombosis occurs when 1) an atherosclerotic plaque becomes vulnerable to rupture, 2) mental or physical stress causes the plaque to rupture, and 3) increases in coagulability or vasoconstriction, triggered by daily activities, contribute to complete occlusion of the coronary artery lumen. Recognition of the circadian variation--and the possibility of frequent triggering--of onset of acute disease suggests the need for pharmacologic protection of patients during vulnerable periods, and provides clues to mechanism, the investigations of which may lead to improved methods of prevention.
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PMID:Circadian variation and triggers of onset of acute cardiovascular disease. 229 45

We studied the incidence and mortality of stroke in northern Israel to determine possible reasons for the differences previously found in mortality from this condition between the sex and ethnic groups in Israel as a whole. We identified 1,149 cases of stroke during 1984. While the age-standardized incidence was higher in men, the case-fatality rate was twice as high in women. After controlling for ethnic origin, we found that incidence was higher only in men of Western origin, while the female rates were higher in women of Asian and North African extraction. The case-fatality rate was substantially higher in women in all ethnic groups. These differences, especially in relation to the case-fatality rate, have important implications for health services in relation to both possible preventive action and to management of the acute disease phase.
Stroke 1989 Jun
PMID:Incidence, mortality, and case-fatality rate of stroke in northern Israel. 272 36

The acute toxic effects of excess glutamate exposure on cortical neurons in culture was followed using a novel adaptation of the 51chromium efflux assay. Although the acute, sodium-dependent phase of glutamate neurotoxicity may contribute to several acute disease settings, including sustained seizures and stroke, functional aspects of the phenomenon have not been previously studied. We report here that the earliest morphologic sign of glutamate neurotoxicity, neuronal swelling, is accompanied by a large efflux of complexed 51chromium from preloaded neurons in the first hour after exposure, and that this efflux is detectable as early as 15 min after the onset of glutamate exposure. We suggest that this pathological burst of 51chromium may result from glutamate-induced "leakiness" of neuronal cell membranes.
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PMID:Cortical neurons exposed to glutamate rapidly leak preloaded 51chromium. 288 19

Using computerized methods the authors have analyzed formalized case histories of three variants of an acute disorder of the cerebral circulation in the matter of the cerebral hemispheres verified by pathoanatomical studies: (1) cerebral infarction with a hemorrhagic component (n = 88), (2) a gray ischemic cerebral stroke (n = 80), (3) parenchymatous hemorrhage (n = 71). The informative symptoms and symptom complexes identified can be employed for the differentiation between cerebral infarction with a hemorrhagic component and other types of strokes.
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PMID:[Diagnosis of a cerebral infarct with a hemorrhagic component]. 332 96

Alpha 1-acid glycoprotein (AAG) concentrations and propranolol binding were investigated in the serum of elderly hospitalized patients with acute illness, and healthy elderly and young subjects. Significantly greater AAG concentrations and reduced unbound propranolol fraction were observed in the elderly with acute disease compared to the elderly controls. The greatest changes (up to five-fold) occurred with cancer, with lesser changes associated with myocardial infarction and ischaemic heart disease, acute infection, heart failure, chronic obstructive respiratory disease, and cerebrovascular accident. Various miscellaneous conditions were also associated with high AAG concentrations and enhanced propranolol binding. The healthy elderly had higher AAG concentrations and lower unbound propranolol fractions than the healthy young group. Overall there was a highly significant correlation between the propranolol binding ratio (bound/free) and the serum AAG concentration. These results suggest that the elderly population may be particularly susceptible to changes in AAG concentrations, and that during acute illness interpretation of serum concentrations of drugs which bind mainly to AAG, may require knowledge of their free fractions.
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PMID:Alpha 1-acid glycoprotein concentrations and propranolol binding in elderly patients with acute illness. 650 90


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