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

The course of the extracranially conditioned cerebrovascular disease is characterized by a worse prognosis in comparison with the average population of the GDR (11 years older) and by increased cardiovascular complication rate (every fifth patient suffered a myocardial infarction, every fourth patient suffered an apoplexy). Younger age of manifestation and increasing number of concomitant diseases form the basis of a course which is altogether endangered by complications, which, however, compared with peripheral and coronary arteriosclerosis, is more favourable. Operative reconstruction of the path of a vessel leads to an enduring improvement of the picture of the complaint. The total prognosis corresponds to the so-called spontaneous course. Under permanent treatment with anticoagulants a retardation of the general progressing of arteriosclerosis and improvement of the survival rates is to be proved.
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PMID:[Long-term course of aortic arch syndrome caused by arteriosclerosis]. 38 91

Regional cerebral blood flow (rCBF) was measured by 133Xe inhalation in 46 normal volunteers, aged 21 to 63 years, and 14 neurologically asymptomatic subjects above age 40 with risk factors for atherothrombotic stroke, including hypertension, diabetes mellitus, and hyperlipidemia. In normal volunteers, there was diffuse and progresive reduction of gray matter flow and weight as well as increases of cerebrovascular resistance (CVR) with advancing age. Reduction of gray matter flow with advancing age appears to be attributed in part to neuronal atrophy and in part to cerebral arteriosclerosis. Regional increases of CVR and reduction of gray matter flow with advancing age were most evident in the middle cerebral arterial (MCA) distribution and were enhanced by the association of risk factors. Development of cerebral arteriosclerosis with age and/or risk factors appears to be most evident in MCA distribution.
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PMID:Effects of advancing age on regional cerebral blood flow. Studies in normal subjects and subjects with risk factors for atherothrombotic stroke. 45 46

The handling of patients with cerebral ischemia is reviewed, taking into consideration recent concepts regarding etiopathogenesis along with new diagnostic and therapeutic methods. A particularly important new diagnostic method is computerized axial tomography. The subject is divided into four sections in order to present a practical outline. The first section deals with the arterial circulatory system. Evaluation of patients with arteriosclerosis of the vessels in the neck and/or intracranial are reviewed in some detail, according to whether the clinical manifestation was transitory ischemia, progressive cerebral infarction, or complete cerebral infarction. Emphasis is placed on the proper selection of diagnostic tests and application of therapy in each case. The second part is a discussion of the changes in arterial blood pressure in the etipathogenesis of stroke. Arterial hypertension is an important factor in production of small infarctions. In the third section a review is made of the role of the heart in transitory ischemia and as a cause of cerebral infarctions. Lastly, the hematologic factors which might contribute to the development of cerebral ischemia, along with the other causes, are mentioned.
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PMID:[Practical considerations in dealing with cerebral ischemia (author's transl)]. 47 Apr 90

A trial by any means that can possibly prevent or retard the development of arteriosclerosis is to be recommended. Arteriosclerosis is the chief cause of strokes and heart attacks. The heavy evening meal now in vogue is characteristically rich in animal fats. Normal digestion is at its peak at about the seventh hour, usually during sleep, when the body economy is at its lowest ebb. A large amount of digested material with a high content of lipids is dumped into the slow-moving circulation. As this material, full of saturated fats, moves slowly through the arteries, the situation is ideal for clot formation, possibly resulting in a stroke, a heart attack, or sudden death. Such a catastrophe can occur in almost anyone, but is more apt to strike the high-powered executive or the apparently healthy man past 45 who has a voracious appetite. It seems logical to postulate that a light, rather than a heavy evening meal would result in less arteriosclerosis with complications such as heart attacks and strokes.
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PMID:The evening meal and atherosclerosis. 65 70

Theories on the nature of cancer may be classified into two categories. One regards cancer strictly as a local phenomenon while the second looks at cancer as a local manifestation of a systemic process or disease. Although the first dominates current medical thought, the theories of immunological surveillance and of protovirus-oncogene implicitly assume cancer to represent a local manifestation of a systemic process or disease. This is supported also by epidemiological data forwarded in the present paper. In order to clarify the exact meaning of a systemic disease, cancer and its manifestation are compared with arteriosclerosis and its sequelae. Arteriosclerosis could be regarded as a prototype of a systemic disease. It presents itself clinically solely by its local manifestations, like myocardial infarction or stroke. These local manifestations may be followed by secondary systemic sequelae like congestive heart failure. In the same context, it is proposed to regard cancer as one systemic disease which presents itself clinically by local phenomena like carcinoma, lymphoma and sarcoma. These local manifestations may lead further to secondary systemic sequelae like metastasis.
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PMID:Cancer as a systemic disease. 67 9

Fifty-seven cases admitted to the Karolinska Hospital 1973-1976 with the diagnosis transient cerebral ischemia were reviewed. Seventeen cases were excluded as not fulfilling the strict TIA definition. An analysis of the records and the supplementary questionnaire of the remaining cases showed considerable sex differences in the stroke-prone profile. In the male group arteriosclerosis in the extracranial cerebral arteries was demonstrated in 90% of these examined by angiography. In the female group factors recognized as interfering with the coagulation system were obvious in more than 70% and two women had fibromuscular dysplasia. These differences may have therapeutic and prognostic implications. In the total material only 35% had hypertension. Diabetes was not present in any of the patients. Of the men 46.6% had abnormal blood lipids against 15.4% of the women. Seventy-five percent of the patients with verified arteriosclerosis were regular smokers. At a mean follow-up time of 18.7 months only one patient, in the untreated group, developed completed stroke.
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PMID:Pathogenetic profile of TIA before 55. A three-year investigation. 68 66

The hypertensive encephalopathy is a syndrome consisting of a sudden elevation of arterial pressure usually preceded by severe headache and followed by convulsions, coma or a variety of transitory cerebral phenomena. The syndrome may complicate acute glomerulonephritis, toxemia of pregnancy and essential or malignant hypertension. Two syndromes must be differentiated from true hypertensive encephalopathy: 1. acute anxiety state with labile hypertension and 2. acute pulmonary edema due to hypertensive heart disease. At least in patients with acute anxiety states, the use of antihypertensive agents is usually not indicated. Since encephalopathy is always accompanied by increased vascular resistance and since clinical experience has demonstrated clearing of the sensorium, cessation of convulsions and release of vasoconstriction following reduction of blood pressure, the primary aim of therapy should be prompt lowering of arterial pressure. The two agents of choice are diazoxide and sodium nitroprusside. Stroke is differentiated from encephalopathy by the persistence of lateralizing signs. The aggressiveness of antihypertensive therapy in this situation depends on the severity of the hypertensive process. Rapid reduction of blood pressure is indicated in patients found to have accelerated hypertension while a more gradual lowering of pressure appears warranted for patients with chronic arterial hypertension and evidence of generalized arteriosclerosis.
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PMID:Management of hypertensive encephalopathy. 72 Oct 56

Predictors of functional outcome were developed in a group of 114 stroke patients consecutively admitted to a tertiary rehabilitation center. These predictors included a pool of medical data, the age of the patient, psychological tests and the patient's educational level. None of these predictor items showed a correlation with outcome high enough to allow precise prediction of individual outcome. They did, however, provide general indicators for those patients with severe functional impairment who are more likely to gain from a rehabilitation program. The group of medical predictors indicated that a patient with a more extensive, severe lesion, with signs of congestive heart failure, generalized arteriosclerosis, gross perceptual deficit, a lower level of education, and who is older, is less likely to improve in the rehabilitation program. Since a prediction on an individual basis was not possible, it was concluded that even the most severely involved patient should be provided with a therapeutic rehabilitation trial. There was no correlation between severity of the functional impairment at admission and the gains obtained in the rehabilitation program. The same predictors were used to predict whether the patient went home or to an institution. It was found that family income and involvement in support of the patient predicted this outcome, whereas medical data did not. Since family involvement can sometimes be changed by a therapeutic team, this predictor may also present a major target for therapeutic intervention.
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PMID:Stroke rehabilitation: Outcome and prediction. 80 23

One hundred thirty consecutive patients in whom the initial diagnosis of cerebrovascular disease was made on clinical basis were evaluated by cerebral computed tomographic (CCT) scan. Three of 20 patients with transient ischemic attacks were found to have an abnormality on CCT scan. Of 30 patients with an initial diagnosis of stroke-in-evolution, 13 were found to have a clinically unsuspected lesion by CCT scan. Of 60 patients with completed stroke, CCT scan made possible differentiation of intracerebral hematoma, hemorrhagic and nonhemorrhagic infarction, and excluded intracranial tumors. Of 20 patients believed to have symptoms of cerebral arteriosclerosis, six had nonvascular lesions and eight had a cerebral atrophic process. This study demonstrates the efficacy of this safe and noninvasive procedure in evaluating patients with cerebrovascular disease.
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PMID:Intracranial tumors simulating the presentation of cerebrovascular syndromes. Early detection with cerebral computed tomography (CCT). 91 Aug 5

Cerebrovascular reactivity to CO2 inhalation and voluntary hyperventilation was studied in seven normotensive subjects and nine hypertensive patients without clinical or angiographical signs of arteriosclerosis. Cerebral blood flow (CBF) was measured by the intracarotid 133Xe clearance method and calculated as the initial slope index. Three to five CBF measurements were made in each patient in the PaCO2 range of 20 to 55 mm Hg. No difference was observed in reactivity between hypertensive and normotensive patients, either during CO2 inhalation or during hyperventilation. The shape of the CBF:PaCO2 curve suggested a decrease in reactivity below a PaCO2 of 30 to 35 mm Hg in both groups. Above a PaCO2 of 35 mm Hg, exponential regression analysis yielded a mean reactivity of 6 +/- 2%, whereas below a PaCO2 of 30 mm Hg it was about 2%. The rise in CBF during CO2 inhalation was not influenced by the intravenous infusion of a small dose of trimethaphan which blocked the concomitant rise in blood pressure.
Stroke
PMID:Cerebrovascular CO2 reactivity in normotensive and hypertensive man. 96 Jan 76


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