Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aquaporin-4 (AQP4) is a water-channel protein expressed strongly in the brain, predominantly in astrocyte foot processes at the borders between the brain parenchyma and major fluid compartments, including cerebrospinal fluid (CSF) and blood. This distribution suggests that AQP4 controls water fluxes into and out of the brain parenchyma. Experiments using AQP4-null mice provide strong evidence for AQP4 involvement in cerebral water balance. AQP4-null mice are protected from cellular (cytotoxic) brain edema produced by water intoxication, brain ischemia, or meningitis. However, AQP4 deletion aggravates vasogenic (fluid leak) brain edema produced by tumor, cortical freeze, intraparenchymal fluid infusion, or brain abscess. In cytotoxic edema, AQP4 deletion slows the rate of water entry into brain, whereas in vasogenic edema, AQP4 deletion reduces the rate of water outflow from brain parenchyma. AQP4 deletion also worsens obstructive hydrocephalus. Recently, AQP4 was also found to play a major role in processes unrelated to brain edema, including astrocyte migration and neuronal excitability. These findings suggest that modulation of AQP4 expression or function may be beneficial in several cerebral disorders, including hyponatremic brain edema, hydrocephalus, stroke, tumor, infection, epilepsy, and traumatic brain injury.
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PMID:Aquaporin-4 and brain edema. 1734 37

Ischemic stroke and brain abscess are life threatening, severe medical conditions requiring urgent and comprehensive evaluation. Brain abscess is a very rare and dangerous complication of ischemic stroke that can be treated successfully when diagnosed. Association of these two life threatening condition may cause catastrophic results. In this report, we present our experience with an ischemic stroke case complicated by a brain abscess under the light of previous literature. A 64-year-old patient with a cerebral infarction complicated by a cerebral abscess is reported with its clinical and radiological features. Because of their insidious and opportunistic nature, brain abscess complicating cerebral infarcts are pathologies requiring a high index of suspicion for proper treatment and favorable results.
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PMID:Ischemic stroke complicated by a brain abscess: a case report and review of the literature. 1791 80

Hereditary hemorrhagic telangectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant vascular dysplasia with high penetrance and variable expressivity. A wide variety of neurological complications have been reported in association with this condition. We report the first case of spinal cord infarction likely due to paradoxical embolization with HHT and review the literature on the neurological complications of this disorder. MEDLINE was employed to identify all published reports of HHT with neurological complications. We identified 44 references with a total of 436 cases of neurological complications of HHT. The most common complication was ischemic stroke and the main etiology for the vascular neurological complications in patients with HHT was pulmonary arteriovenous malformation. HHT should be considered in the differential diagnosis of any patient with cutaneous or mucosal telangiectasia or a history of unexplained epistaxis. HHT is associated with a diverse array of neurological disorders; most commonly ischemic and hemorrhagic stroke, transient ischemic attack, and brain abscess. While myelopathy secondary to arteriovenous malformation with HHT has been previously reported, this is the first instance of spinal cord infarction due to paradoxical embolization in this disorder.
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PMID:Hereditary hemorrhagic telangectasia and spinal cord infarct: case report with a review of the neurological complications of HHT. 1830 27

Rendu-Osler-Weber syndrome is an autosomal dominant disorder characterized by multiple skin and mucosal telangiectasis and multiorgan arteriovenous malformations. Neurological manifestations may occur because of cerebral arteriovenous malformations, intracranial hemorrhage, and most commonly by ischemic stroke and brain abscess secondary to paradoxical embolization in patients with pulmonary arteriovenous malformations. Intramedullary abscess is a rare, unusual condition, in Rendu-Osler-Weber syndrome. We report the case of a 56 years old woman, with a familial history of Rendu-Osler-Weber syndrome, admitted to intensive care with acute quadriplegia and hypoxemia. Our diagnosis was pulmonary arteriovenous malformations and intramedullary abscess.
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PMID:[Spinal abscess in a patient with hereditary hemorrhagic telangiectasia]. 1842 64

Brain abscess is a rare but very dangerous neurosurgical lesion. Prompt diagnosis and emergency surgical evacuation are the hallmarks of therapy. Brain abscess following ischemic and hemorrhagic stroke is a rare entity. These cases are often preceded by episodes of bacteremia, sepsis, and local infection. The authors report the case of a 30-year-old woman who presented with a cerebral abscess at the site of a recent intraparenchymal hemorrhage.
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PMID:Brain abscess formation at the site of intracerebral hemorrhage secondary to central nervous system vasculitis. 1851 42

Pulmonary arteriovenous malformations (PAVM) are high-flow, low-pressure shunts, consisting of a single feeding artery connecting via an aneurysmal sac to a draining vein. The aneurysmal connection is referred to as an aneurysmal sac. The "filter capacity" of the pulmonary capillaries is lost and results in predisposition to brain abscess, stroke, and transient ischemic attack and, when multiple, dyspnea, because of right-to-left shunting and hypoxemia. PAVM are markers of hereditary hemorrhagic telangiectasia (HHT). Up to 30% of patients with HHT have PAVM complicating their disorder. Left untreated, 50% of patients with PAVM will develop disabling or fatal complications. In addition to stroke and transient ischemic attack syndromes due to passage of paradoxical emboli through the PAVM, rupture of the aneurysmal sac, particularly in the third trimester of pregnancy, can lead to fatal hemoptysis or hemothorax. Finally, brain abscess or more obscure musculoskeletal or spinal infections may be secondary to PAVM. Since detachable silicone balloons are no longer available, we have developed precise techniques for closing pulmonary malformations using pushable fibered coils. It is not the coil that is so important, but it is the use of coaxial or triaxial catheters that allow for precise placement of the coil. Cross-sectional occlusion is essential for embolization of PAVM and this is achieved using the "anchor" or "scaffold" technique. Our recent results indicate permanent involution of treated malformations with a 3% recurrence rate. All patients should be assessed for other manifestations of HHT before treatment and they are best followed in one of the 20 HHT Centers worldwide (www.hht.org).
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PMID:Pulmonary arteriovenous malformations: how do I embolize? 1857 43

Amatus Lusitanus, a Portuguese Jew who gained notoriety as one of the most famous physician-scientists in XVI century Europe published collections of case histories--Centuriae--describing his most interesting patients. The Renaissance was a transitional period for medicine and the neurological sciences, which if still dominated by the humoral and ventricular-pneumatic doctrines, were taking the first steps away from them. We analysed the Centuriae for neurological and psychiatric cases in order to appreciate neurological practice in this period and selected one hundred which fit those diagnostic categories. The Centuriae contain cases of CNS infection and trauma, epilepsy, apoplexy and depressed states of consciousness (including coma, carus, lethargy and cataphora), headache and vertigo, tumours, cranial nerve paralysis, melancholy, anatomical and physiological observations, as well as a short treatise on cranial traumatology. The most relevant observations point to the importance of the brain parenchyma in cognition, provide original observations of epidemic lethargic encephalitis, describe the neurological consequences of syphilis, including the first description of tertiary syphilis, attempt to distinguish mania from melancholy, extensively describe medical and surgical treatment of cranial trauma, document the first use of anatomical dissection to study a case of brain abscess, negate Galen's view of the optic nerves as hollow, and describe the use of new drugs such as guaiac wood for the treatment of headache. The Centuriae not only provide insight into neurological clinical practice in the XVI century, but also emphasize the role of Amatus Lusitanus as an important precursor of this discipline, given his numerous original observations.
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PMID:Neurological practice in the Centuriae of Amatus Lusitanus. 1915 48

Brain oedema is a major clinical problem produced by CNS diseases (e.g. stroke, brain tumour, brain abscess) and systemic diseases that secondarily affect the CNS (e.g. hyponatraemia, liver failure). The swollen brain is compressed against the surrounding dura and skull, which causes the intracranial pressure to rise, leading to brain ischaemia, herniation, and ultimately death. A water channel protein, aquaporin-4 (AQP4), is found in astrocyte foot processes (blood-brain border), the glia limitans (subarachnoid cerebrospinal fluid-brain border) and ependyma (ventricular cerebrospinal fluid-brain border). Experiments using mice lacking AQP4 or alpha syntrophin (which secondarily downregulate AQP4) showed that AQP4 facilitates oedema formation in diseases causing cytotoxic (cell swelling) oedema such as cerebral ischaemia, hyponatraemia and meningitis. In contrast, AQP4 facilitates oedema elimination in diseases causing vasogenic (vessel leak) oedema and therefore AQP4 deletion aggravates brain oedema produced by brain tumour and brain abscess. AQP4 is also important in spinal cord oedema. AQP4 deletion was associated with less cord oedema and improved outcome after compression spinal cord injury in mice. Here we consider the possible routes of oedema formation and elimination in the injured cord and speculate about the role of AQP4. Finally we discuss the role of AQP4 in neuromyelitis optica (NMO), an inflammatory demyelinating disease that produces oedema in the spinal cord and optic nerves. NMO patients have circulating AQP4 IgG autoantibody, which is now used for diagnosing NMO. We speculate how NMO-IgG might produce CNS inflammation, demyelination and oedema. Since AQP4 plays a key role in the pathogenesis of CNS oedema, we conclude that AQP4 inhibitors and activators may reduce CNS oedema in many diseases.
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PMID:Aquaporin-4 in brain and spinal cord oedema. 1968 55

Isolated PAVM is rare condition and only a few cases of VATS (Video-Assisted Thoracoscopic Surgery) resection have been reported so far. Since the clinical course of PAVM is not entirely benign due to its possible progression and serious complications (paradoxical emboli, stroke, brain abscess, etc.), the most radical least invasive treatment should be chosen in all cases nowadays. Embolization may be incomplete and carries a risk of accidental systemic embolization, therefore surgical excision is the preferred method of choice. In cases of surgical resections, pulmonary parenchyma sparing techniques such as wedge resection and local excision by VATS is desirable, if possible. We present three patients who were admitted with asymptomatic pulmonary round shadow (umbra rotunda) for further investigation and treatment. We have performed two wedge resections by VATS and one segmentectomy via axillary thoracotomy. We wish to emphasize the importance of this disease to consider in differential diagnosis to avoid complications.
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PMID:[Isolated pulmonary arteriovenous malformation (PAVM)--report of three cases]. 2040 Mar 98

Pulmonary arteriovenous malformations (PAVMs) can cause stroke, brain abscess or life-threatening haemorrhage. Most PAVMs are associated with hereditary haemorrhagic telangiectasia (HHT). The aim of the present study was to describe the clinical presentation and treatment outcomes of those with idiopathic PAVMs, which has not previously been described in the literature. Patients with idiopathic PAVMs were identified at our HHT centre. Retrospective review of charts and imaging were performed. 20 patients were identified with idiopathic PAVMs. The most common symptoms reported were dyspnoea and migraines (50 and 30% of patients, respectively). Previous complications of PAVMs included haemoptysis (20%), stroke (20%) and brain abscess (5%). A total of 28 focal PAVMs were identified. Most patients (80%) had a solitary PAVM. 13 out of 28 PAVMs (46%) were located in the lower lobes. Most were simple and fistulous rather than complex and plexiform. Transcatheter embolotherapy was performed in 17 patients and was successful in improving oxygenation in all cases. The clinical manifestations and complications of idiopathic PAVMs are similar to those associated with HHT. Idiopathic PAVMs are anatomically similar to HHT-related PAVMs except for a greater number of solitary PAVMs and a lack of lower lobe predominance. Transcatheter embolotherapy is a safe and effective method for treating idiopathic PAVMs.
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PMID:Idiopathic pulmonary arteriovenous malformations: clinical and imaging characteristics. 2117 36


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