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

We observed significant lesions of the carotid artery siphon in two young subjects with fatal stroke. Because stroke in children and adolescents is uncommon and poorly understood, we examined the internal carotid artery in the 'siphon' of the skull in 24 unselected, but nearly consecutive autopsies. The age range was 10 days to 38 years, with 11 males and 13 females, six blacks, and 18 whites. In no case was stroke the cause of death. Intimal lesions of two types were found in the carotid siphon of all cases. (1) The first was focal splitting and/or duplication of the internal elastic lamina with variable proliferation of smooth muscle. The resulting 'fibrous' plaques or cushions, when severe, were usually found at natural bends in the artery. The number and severity of this type of lesion increased with age, but there were no differences in severity or distribution when compared by sex, race, or mode of death. (2) The second was internal elastic calcification which was found in all cases older than 9. This was increasingly severe with age. Although the frequency of the vascular lesions was surprisingly high, the relationship of either type to dissecting aneurysm or other stroke lesion remains unclear.
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PMID:The internal carotid artery siphon in children and adolescents. 186 91

Cardiovascular disease, the major cause of death in the elderly, is mostly ascribable to complications of coronary atherosclerosis: angina pectoris, myocardial infarction, and sudden death. However, other degenerative diseases involving several cardiac structures exist, and should be distinguished from age-related cardiac changes. Extensive dystrophic calcification determines aortic stenosis, and may affect either a normally tricuspid or a congenitally bicuspid valve. Surgical valve replacement is now a low risk option, even in elderly persons, whereas the efficacy of balloon valvuloplasty is questionable. Aortic incompetence in adults and aged persons is mostly the consequence of aortic tunica media atrophy with anular ectasia, in the setting of nearly normal aortic leaflets. Mitral valve prolapse is the main cause of mitral incompetence; spontaneous cordal rupture is a late complication in the natural history of this disease, thus warranting prompt surgical valve repair or replacement. The entire spectrum of cardiomyopathies is observed in the elderly: dilated, hypertrophic, restrictive, arrhythmogenic. Cardiac amyloidosis is by far the most frequent secondary form and leads to congestive heart failure by impairing ventricular compliance. Idiopathic fibrosis of the specialized AV junction or dystrophic calcification of central fibrous body are the usual substrates of AV block, which requires pace-maker implantation. Nonrheumatic atrial fibrillation, due to fibro-fatty degeneration of the atrial musculature or dilated left atrium, carries a high risk of thromboembolic complications and cerebral accidents; oral anticoagulants have proven to be effective in preventing stroke. Aortic dissecting aneurysm is a spontaneous laceration, and usually a complication of longstanding systemic hypertension; exceptionally, spontaneous dissection may primarily occur in the coronary arteries. In conclusion, longevity at present is mostly threatened by cardiovascular disease, among which the role of degenerative, non-atherosclerotic disorders may be greater than thought.
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PMID:Degenerative, non-atherosclerotic cardiovascular disease in the elderly: a clinico-pathological survey. 209 63

We describe two patients with rebleeding from intracranial vertebral artery dissecting aneurysms during the acute stage. One patient had excellent results after emergency surgery. A review of recent reports including 60 patients with this disorder revealed a rebleeding rate of 30%, mostly during the acute stage. This suggests that a ruptured dissecting aneurysm in the vertebral artery is at risk for rebleeding during the acute stage, similar to a saccular aneurysm in the same location.
Stroke 1990 Nov
PMID:Rebleeding from intracranial dissecting aneurysm in the vertebral artery. 223 59

We report 133 cases of strokes in patients aged 9-45 (male: 68, female: 65), mean age: 33.5 years. There were 112 arterial infarcts (84%), 9 venous infarcts (7%), 12 hemorrhages (9%). Among the arterial infarcts, 23 (20.5%) were due to a dissecting aneurysm, 17 (15%) to atherosclerosis, 13 (12%) to cardiac embolism. Echocardiography with contrast was performed in 69 patients showing a patent foramen ovale in 15. Mitral valve prolapse was present in 8, among which 5 had in addition a patent foramen ovale. Among 16 migrainous patients there were 7 dissecting aneurysms and 3 patent foramen ovale. Twenty two of 65 women were taking oral contraceptives at the time of the stroke. Strokes in patients taking oral contraceptives or during the puerperium accounted for 43% of the strokes in women. Ten cases (9%) have had no explanation. Venous infarctions were mainly due to puerperium and oral contraceptives. Hemorrhages were mainly due to arterial hypertension. No cause was found in 4/12 cases. The most useful investigations were angiography and echocardiography with contrast. This study confirms that extensive and early investigations are necessary in strokes in the young and particularly in women taking oral contraceptives, migraine patients and patients with mitral valve prolapse.
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PMID:[Cerebral vascular accidents in young subjects. A study of 133 patients 9 to 45 years of age]. 279 9

We studied by angiography 80 patients within 6 hours from the onset of symptoms of supratentorial ischaemic stroke. Occlusion of the internal carotid artery in the extracranial segment was found in 19 patients, at the bifurcation in 11 and at the cervical level in 8. While in the chronic phase of stroke, internal carotid artery occlusion in the cervical segment is an uncommon angiographic finding, we found a high frequency of occlusion at this level (8 out of 19) in our patients. Cervical segment occlusion may be due to a dissecting aneurysm or to an intracranial carotid artery occlusion (embolic or atherothrombotic) with subsequent migration of the clot down to this level. A direct embolic occlusion may be postulated as well.
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PMID:Occlusion of the extracranial internal carotid artery in the acute stroke; angiographic findings within 6 hours. 281 33

We describe five patients with blunt traumatic carotid dissection with delayed clinical presentation that varied from 2 weeks to 6 months. Four patients had severe head injury, and one patient had direct blunt trauma to the neck. Cerebrovascular symptoms developed in four patients. The fifth patient suffered loss of vision as a result of a concurrent giant intracranial dissecting aneurysm. Arteriography demonstrated a "string sign" in two cases and a cervical carotid aneurysm in three; two of the latter also had siphon occlusion, and one of these had a superimposed supraclinoid dissecting aneurysm. One patient was treated by thromboendarterectomy, one by aneurysmorraphy, another by carotid ligation, and the other two patients were treated medically. Mechanisms of injury, forensic problems, and therapeutic options are discussed.
Stroke 1989 Mar
PMID:Blunt traumatic carotid dissection with delayed symptoms. 292 83

A 35-year-old woman with 3 weeks of cervical pain developed ischemia in the basilar artery territory following cervical manipulation. At autopsy, there was a dissecting aneurysm within the third segment of the right vertebral artery. The pathologic changes in the lower and the upper part of the dissecting aneurysm were different, indicating recurring bleeding. Cervical manipulation could have accounted for one recent dissection, but not for another, which was a few weeks old. This suggests that cervical pain, which prompted the manipulation, may have been the first symptom of the dissection, and manipulation of the neck precipitated the stroke by inducing bleeding within the dissecting aneurysm.
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PMID:Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy. 292 75

More than half of the United States population over 65 years of age has essential hypertension. In 1984, there were 10 million elderly hypertensive persons and this number will reach 25 million in the near future. These patients are at high risk for congestive heart failure, stroke, heart attack, and dissecting aneurysm. Successful reduction of blood pressure can lower these risks considerably, but rational treatment depends on understanding the complex pathophysiology of hypertension in older patients. In fact, treatment that does not take into account the combined effects of aging and hypertension on the cardiovascular system and the kidneys may do more harm than the hypertension itself. Among the prominent age-related cardiovascular changes are stiffening of the arterial tree, with or without a contribution from atherosclerosis. This reduces arterial compliance and increases afterload, resulting in the left-ventricular hypertrophy seen in old age and leading to a progressive rise in systolic pressure. There is considerable shrinkage of the kidneys, due primarily to loss of glomerular and tubular tissue in the cortex, along with sclerosis of the glomeruli and formation of tubular diverticula. Arteriolar changes lead to reduced renal blood flow, the shunting of blood around the glomeruli, and thus a reduction in glomerular filtration rate. Renal water and electrolyte excretion are changed, making homeostasis more difficult to maintain, and the renin-angiotensin system is altered, helping to blunt the kidneys' response to pressure changes. Essential hypertension superimposed on all the foregoing effects exacerbates them. Peripheral resistance is usually markedly elevated in older hypertensive persons, which increases afterload directly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology of hypertension in older patients. 304 95

Two cases of dissecting aneurysm of the vertebral artery are reported and the 70 cases reported previously are reviewed. Case 1 showed Wallenberg's syndrome following sudden headache on the right side without SAH. Angiograms demonstrated the "pearl and string sign" on the right vertebral artery, characteristic of a dissecting aneurysm. Through a right suboccipital craniectomy, the right vertebral artery was found to be discolored purplish-red and swollen, so the proximal vertebral artery was clipped. The postoperative course was uneventful. Case 2 showed Wallenberg's syndrome with antecedent headache. CT scan was normal and lumber puncture revealed xanthochromic CSF, which was attributed to a SAH several days before. Angiograms disclosed the "pearl and string sign" on the right vertebral artery, and right vertebral artery clipping was performed. Postoperatively it was uneventful. Intracranial dissecting aneurysms of the vertebrobasilar system are not as rare as previously thought. They can often be overlooked as fusiform aneurysms or as thrombosis associated with SAH and/or ischemic attacks. The difficulty in diagnosis, leads to a high morbidity and mortality rate. Recently many cases have been reported in sequence. These cases involving SAH were successfully treated by surgical procedure. However in addition to our cases, only two cases of successful surgical treatment after ischemic stroke, have been reported. We emphasize that surgical intervention should be carried out for dissecting aneurysms of the vertebro-basilar system, even without SAH, to prevent further dissection which could cause SAH or/and further brainstem infarction. Proximal vertebral artery occlusion is the most beneficial treatment of choice.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dissecting aneurysm of the vertebral artery--report of two cases and review of the literature]. 306 7

Infarction in the vertebrobasilar system presenting as a posterior fossa mass lesion is extremely rare in children. We recently studied and treated a 9-year-old boy with cerebellar infarct produced by angiographically confirmed Type I fibromuscular dysplasia of the vertebral artery, complicated by a dissecting aneurysm. This case appears to be the first reported in the literature.
Stroke 1988 Apr
PMID:Cerebellar infarction from fibromuscular dysplasia and dissecting aneurysm of the vertebral artery. Report of a child. 336 81


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