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

Highly elevated concentrations of homocysteine measured as homocysteine or cysteine-homocysteine mixed disulfide (MDS) are found in plasma and urine in subjects with inherited abnormalities of the methionine metabolism. These subjects have a high incidence of arteriosclerotic vascular complications during childhood. Homocysteine causes endothelial cell injury and cell detachment that initiates the development of arteriosclerosis. The present study demonstrates a significantly elevated mean plasma MDS concentration in 19 patients with arteriosclerotic cerebrovascular disease compared to 17 controls. Our findings suggest that moderate homocysteinemia might be a risk factor for arteriosclerotic cerebrovascular disease.
Stroke
PMID:Moderate homocysteinemia--a possible risk factor for arteriosclerotic cerebrovascular disease. 650 11

Prospective data from Western populations show a fairly steady increase in the incidence of total mortality as well as of myocardial infarction (MI) and sudden coronary death (SD) with increasing blood pressure levels. In the age groups up to 70 years, stroke is much less common than MI and SD at virtually all blood pressure levels, but for older men and also for somewhat younger women, stroke is as common as MI and SD at the highest blood pressure levels. The incidence of MI and SD is strongly dependent on serum lipid abnormalities and smoking habits, whereas stroke appears to depend very little on lipid levels and in only a few studies appears related to smoking habits. Thus, the effect of blood pressure is appreciably modified by the presence of some other abnormalities that are believed to enhance coronary arteriosclerosis. There are major differences between populations with respect to the incidence of MI, SD, and stroke. MI mortality and SD have, for example, been very high in the United States, whereas stroke mortality has been low. In Japan, on the other hand, stroke mortality has been high and MI mortality and SD have been low. Sweden has occupied an intermediate position with respect to MI mortality and SD, which have been increasing slightly while they have been decreasing in the United States, whereas stroke mortality in Sweden and in the other Scandinavian countries has been very low and is even showing a slight decrease. Both prospective epidemiologic studies and intervention trials indicate some influence of blood pressure on noncardiovascular mortality, such as that from cancer.
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PMID:The main end points in human hypertension. 651 57

Effects of chronic cigarette smoking on cerebral blood flow were investigated by measuring gray matter blood flow (Fg) using xenon 133 inhalation among 192 volunteers without cerebrovascular symptoms. There were 108 normal, healthy volunteers; 84 had risk factors for stroke (hypertension, hyperlipidemia, diabetes mellitus, and/or heart disease). Of both risk and nonrisk groups, 75 were habitual smokers (0.5 to 3.5 packs per day for 25 years). Comparisons of mean Fg values for both hemispheres showed significant reductions related to tobacco consumption and risk factors for stroke. Multiple-regression equations using smoking, age, risk, and alcohol consumption indicated a combined R2 value of 0.22. Smoking seems to be a potent risk factor decreasing cerebral blood flow probably by enhancing cerebral arteriosclerosis. Chronic cigarette smoking in persons with other risk factors further reduced Fg values in an additive manner when compared with subjects who had corresponding risk factors who did not smoke.
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PMID:Cigarette smoking decreases cerebral blood flow suggesting increased risk for stroke. 664 57

Arteriosclerosis causes damage by strokes. No evidence exists for continuous ischemia in the brain. Decreased cerebral blood flow and metabolism are the result not the cause of dementia so the use of cerebral vasodilators and "activators" lacks a scientific basis. Instead, the treatment and prevention of multi-infarct dementia consist in the treatment and prevention of stroke.
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PMID:Multi-infarct dementia. 668 Jan 61

Eleven freshly removed brains and 20 lenticulostriate arteries (collected at emergency surgery for intracerebral hemorrhage) were examined by electron microscopy in a search for the mechanism of arterial rupture in hypertensive intracerebral hemorrhage. Forty-six of 48 ruptured arteries examined showed severe arteriosclerosis including degenerative changes of the media at or near bifurcations. Atrophy and fragmentation of smooth muscle cells gave them a moth-eaten appearance. Material resembling basement membrane and cell debris was also present in the arterial walls. The above findings were restricted to the middle and distal portions of the perforating arteries. Rupture from a miliary aneurysm was observed in only 2 of the 48 specimens examined. These resembled saccular aneurysms, ultrastructurally. They seemingly formed at a cavity which we strongly felt may have been formed by complete or incomplete subclinical hemorrhages; reabsorption of the hemorrhage from the dissection resulted in the aneurysms seen. Degeneration of smooth muscle cells may be the result of prolonged tension or spasm of the arterial wall as a result of longstanding hypertension.
Stroke
PMID:Electron microscopic studies of ruptured arteries in hypertensive intracerebral hemorrhage. 682 83

Cerebral vasoconstrictor responsiveness to 100% oxygen inhalation was measured in 149 subjects, including normal healthy volunteers and those with risk factors for cerebral arteriosclerosis (N = 87). Test results were compared among patients with hemispheric stroke and vertebrobasilar insufficiency (N = 62) with the 133Xe inhalation method. Normal volunteers without risk factors (N = 49), aged 25 to 86 years, showed symmetrical vasoconstriction. Asymptomatic subjects with risk factors (N = 38) and those with vertebrobasilar insufficiency (N = 25) had decreased hemispheric gray matter flow (Fg) values during rest, but vasoconstrictor responsiveness to 100% oxygen inhalation was not significantly reduced. In patients with acute hemispheric infarction, regional vasoconstrictor responsiveness to 100% oxygen inhalation was lost and/or paradoxically reversed; in patients with chronic hemispheric infarction, it was decreased. Testing vasomotor responses during hyperoxia is safe, clinically helpful, and demonstrates impaired vasomotor reactivity in infarcted regions.
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PMID:Cerebral vasomotor responsiveness during 100% oxygen inhalation in cerebral ischemia. 684 19

The role of serum triglyceride as a risk factor for coronary heart disease (CHD), stroke, and total mortality was examined in men of Japanese ancestry who were 45 to 78 years old. During the first 10 years following a baseline nonfasting triglyceride determination, there were 490 incidence cases of CHD in 7615 men at risk. Average annual incidence rates were 2.1 times higher in men with nonfasting values above the 75th percentile (279 mg/dl) than in those under the 25th percentile (129 mg/dl, p less than 0.001). This association largely disappeared when associations of triglyceride with other CHD risk factors were accounted for. Fasting triglycerides were measured in a representative sample of 1729 men part-way through the study. With an average follow-up of 5.7 years there were 72 new CHD cases in this group with the risk for men in the top quartile (above 195 mg/dl) being 1.9 times higher than for those in the bottom quartile (below 94 mg/dl). This gradient was of borderline significance (p less than 0.10) and completely disappeared in a multivariate analysis which included HDL and other factors. It appears that the association of triglyceride with CHD in this cohort is of a noncausal nature. Triglycerides were not predictive of stroke or of total mortality in these men.
Arteriosclerosis
PMID:Serum triglyceride and risk of coronary heart disease, stroke, and total mortality in Japanese-American men. 688 86

Transient cerebral ischemia and stroke may occur despite previous occlusion of the artery supplying the appropriate part of the brain. After occlusion of the internal carotid artery, emboli may pass from the "stump" of the occluded artery to later produce transient cerebral ischemia or a stroke. Transient cerebral ischemia and stroke are due to a variety of conditions, some of which are strongly correlated with platelet thromboembolism, while others have little primary relation to thrombosis. The impact of this on therapeutic considerations is obvious. Thromboembolism related to myxomatous degeneration of the mitral valve (mitral valve prolapse) is a factor to consider in determining the cause of a stroke in a younger person. The prognosis for the different varieties of threatened stroke is incompletely known. When due to arteriosclerosis of the large cerebral arteries, transient cerebral ischemia and minor strokes pose a cumulative threat for a major stroke or death of 13% in the first year, 22% in the second year and 30% in the third year.
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PMID:Randomized trial of therapy with platelet antiaggregants for threatened stroke. 2: Observations on the pathogenesis and natural history of threatened stroke. 698 64

Since 1968, there has been a dramatic, unprecedented decline in mortality from cardiovascular disease in the United States, especially from coronary heart disease and stroke. The decline has now been confirmed as real and has been observed in all age, sex, and race groups. Possible causes of the decline in coronary heart disease mortality include the development of the concept of acute coronary care, new drugs, sophisticated surgical techniques such as coronary artery bypass, noninvasive diagnostic methods for earlier disease detection, and the identification of specific cardiovascular risk factors. The decline has been temporally related to risk factor awareness and modification (cigarette smoking cessation, hypertension control, diet change and reduction in cholesterol). Thus, both primary prevention through lifestyle changes and improved treatment regimes have played a role in the decline.
Arteriosclerosis
PMID:Declining mortality in coronary heart disease. 705 33

The aim of this report is to describe the intracranial cerebrovascular abnormalities and clinical status of 8 children who had familial lipoprotein disorders and evidence of thromboembolic cerebrovascular disease. Six of the 8 children had low levels of plasma high density lipoprotein cholesterol, two had high triglyceride levels, and all came from kindreds characterized by familial lipoprotein abnormalities and premature cardio- and/or cerebrovascular atherosclerosis. Vascular occlusion, irregularities of the arterial lumen, beading, tortuosity, and evidence of collateralization were consistently noted. We speculate that cerebrovascular arteriosclerosis in pediatric ischemic stroke victims who have familial lipoprotein abnormalities may be related to lipoprotein-mediated endothelial damage and thrombosis formation, or to the failure to restore endothelial cells' integrity following damage. The apparent association of lipoproteins and strokes in children and their families merits further exploration, particularly when assessing cerebral angiograms in pediatric ischemic stroke victims. In children with unexplained ischemic cerebrovascular accidents, the diagnostic possibility of occlusive arteriosclerosis with thrombosis must be entertained.
Stroke
PMID:Cerebrovascular arteriopathy (arteriosclerosis) and ischemic childhood stroke. 708 Jan 31


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