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

An investigation limited to patients under 70 years of age was undertaken to study the incidence of new cerebrovascular strokes (cerebral hemorrhage, cerebral infarction, and cerebral embolism) in all cases from Uppsala county between 1967-1971. The total incidence of stroke is 36/1000,000 in this age category; the mean age was 59.9 years for men and 60.8 years for women. Of the total number, 25% were recurrences. The occurrence of a moderate but significant decrease during the period of study has been attributed to an extended and improved treatment of hypertension. All of the 6 females who had suffered strokes below 40 years of age had been on oral contraceptives at the time. A high incidence of diabetes and symptoms of cardiovascula r impairment (hypertension, transient ischemic attack, cardiosclerotic disease) was found. A high incidence of myocardial infarction and of strokes was found among parents of those suffering cerebral hemorrhage and cerebral infarctions, respectively.
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PMID:Studies on cerebrovascular stroke. I. Epidemiology of first-time strokes in persons under 70 years of age. 120 87

The treatment of TIA must be individualized. TIA is one of several manifestations of generalized atherosclerosis. While one-third of patients with TIA will suffer a stroke in five years, one-half of the same group will die of myocardial infarction. The risk of stroke is greater in carotid rather than vertebral-basilar TIA, in older patients, and in those with a cluster of TIAS, an is highest in the first month after the TIA. Treatment should reflect this knowledge.
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PMID:Transient ischemic attacks. 122 59

There is substantial evidence to support the concept that most transient ischemic attacks (TIAs) are caused by microemboli that originate in areas of atherosclerosis in the blood vessels of the neck. TIA's are important risk factors in the development of stroke. The most common clinical features of TIAs caused by carotid insufficiency are hemianesthesia and hemiparesis; other symptoms in these cases include headache, dysphasia, and visual field distrubance. By far the most common clinical manifestation of vertebrobasilar insufficiency is vertigo.
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PMID:Transient ischemic attacks: Pathophysiology and medical management. 126 82

A case-control study to investigate the risk factors of cerebral hemorrhage was conducted in 162 hospitalized patients diagnosed by head CT scan in Tianjin, 1988-89. Each patient was matched at the same time by one hospital control and one community control. Multivariable conditional logistic regression analysis showed that history of hypertension or TIA, stroke history of parents and snoring were found to be the risk factors of cerebral hemorrhage, without involvement of smoking.
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PMID:[A case-control study on risk factors of cerebral hemorrhage]. 130 13

We reviewed 538 charts of patients hospitalized with acute ischemic strokes between 1983 and 1991. The inclusion criteria for cardioembolism were: 1) sudden onset and maximal neurological focal deficit from the beginning, 2) brain CT showing an ischemic infarct, hemorrhagic infarct, or multiple infarcts, 3) cardioembolic sources demonstrated by echocardiography or heart catheterization, and 4) absence of stenotic-occlusive cerebrovascular disease. Sixty-nine patients (12.8%) filled the criteria for cardiogenic brain embolism. Cardiac sources were: 1) nonvalvular atrial fibrillation in 20 patients (29.0%), 2) rheumatic heart disease in 14 (20.3%), 3) nonischemic dilated cardiomyopathy in 13 (18.8%). Nine of these (69%) had cardiac involvement due to Chagas' disease, 4) ischemic heart disease in 11 (15.9%), and 5) other less common conditions such as bacterial endocarditis, mitral valve, and congenital heart malformation in 11 (15.9). Transient ischemic attacks preceding stroke occurred in 11 patients (15.9%), six patients had previous strokes, and 14 patients (20.3%) had silent infarcts. Early recurrence of embolism (three initial weeks) occurred in 5 patients (7.2%), and 28.6% of the patients had hemorrhagic transformation within this period. Taken together, our figures show that, although they are well in line with the current literature, nonischemic dilated cardiomyopathy is one of the main causes of cerebral embolism in our community. This reflects the presence of a regional factor, namely Chagas' disease.
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PMID:[Cerebral embolism of cardiac origin]. 134 85

Proposed guidelines for the diagnosis of transient ischaemic attack (TIA) involve interpretation of symptoms, so it can be very difficult to distinguish a TIA from other disorders, such as migraine, epilepsy, syncope, or neurosis. Atypical cerebral and visual events may be classified as TIA. To see whether TIA or stroke patients with atypical cerebral or visual symptoms are at high or low risk of cardiac complications, we prospectively followed 572 patients (entered into the Dutch multicentre TIA trial) with a diagnosis of TIA or minor ischaemic stroke, but whose symptoms did not fully accord with internationally accepted criteria. We compared their outcome with that of 2555 other TIA or stroke patients in the trial, who had unequivocal symptoms; all patients were treated with aspirin. During mean follow-up of 2.6 years the risk of a major vascular event did not differ between the groups (14.5% in patients with atypical symptoms vs 15.1% of patients with typical attacks). Patients with atypical attacks had a lower risk of stroke (5.6% vs 9.4%, hazard ratio 0.6, 95% confidence interval 0.4-0.9) and a higher risk of a major cardiac event (8.4% vs 5.9%, 1.4, 1.0-2.0) than did patients with typical attacks. These differences could not be explained by differences in cardiac risk factors, and were independent of minor discrepancies in baseline characteristics between the groups. A heavy or tired feeling in one or two limbs was the only atypical symptom associated with cerebral rather than cardiac events (ratio cardiac/cerebral events 0.8). For all other atypical symptoms cardiac events were about twice as common as cerebral events (range 1.3-2.5). Our findings suggest that TIA or minor stroke patients with atypical symptoms may have symptomatic heart disease, especially cardiac arrhythmia.
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PMID:Risk of cardiac events in atypical transient ischaemic attack or minor stroke. The Dutch TIA Study Group. 135 13

It has been previously shown that boundary layer or flow separation occurring in the carotid bulb and detected by duplex scanning denotes minimal or no carotid atherosclerotic disease as demonstrated by angiography and reliably predicts aetiology other than carotid artery disease in symptomatic patients. To evaluate outcome at long-term follow-up we prospectively studied 94 patients (48 males, 46 females) who demonstrated bilateral flow separation. Mean age was 61.2 years (27 to 86 years). Mean follow-up was 57 months (5 to 113 months). There was one death during follow-up at 69 months. It was stroke related. Using age and sex specific death rates for the general population 14.3 deaths would be expected for the same average period. By life table analysis, survival was 98.7% at five years compared to a general population expected 5 year survival of 85.9%. There were no strokes at 5 years of follow-up. (Age and sex specific stroke-free survival for Rochester, MN 1970-1974 is 98% at 5 years). TIA-free survival was 99% at one year (n = 87) and 96% at five years (n = 46). It is concluded that the presence of boundary layer separation in the carotid bulb not only indicates absent or minimal atherosclerotic disease, but is predictive of a favourable long-term outcome with respect to mortality and neurological events.
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PMID:Flow separation in the carotid bulb: prognostic significance. 135 96

Transient ischaemic attack (TIA) represents a neurological deficit during less than 24 hours, without any abnormality on CT scan. This symptom may have 2 risks: it may give place to a severe stroke, and it is not always linked to an ischaemic mechanism. This work rests on a population-based registry existing in Dijon since 1985 with a specific and exhaustive registration. CT scan allows the mechanisms of stroke to be identified: cortical infarct, lacunar infarct, cerebral haemorrhage, and TIA. TIA represent 15% of stroke. Survival rate of 80% is better than other strokes. A TIA may appear before a cerebral infarct in 48% of the cases, a lacunar infarct in 18% of the cases, another TIA in 28% of the cases, and a haematoma in 8% of the cases. Therefore TIA is an important symptom appearing before severe stroke, that may let place to a preventative action.
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PMID:Frequency of transient ischaemic attacks in strokes: place for a preventive treatment. 135 97

In a case-controlled study into the risk factors for admission to hospital with stroke, 400 subjects and 400 age and sex-matched controls were recruited. All bar two subjects were followed until death or 6 months. Previous stroke and regular snoring (p = 0.0013 and p less than 0.0001 respectively) were the only two risk factors adversely to effect mortality. Transient ischaemic attack, ischaemic heart disease, hypertension, atrial fibrillation, diabetes mellitus did not significantly effect prognosis. An apparent beneficial effect of drinking alcohol and smoking became insignificant when the confounding influence of age was taken into account.
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PMID:Effect of the risk factors for stroke on survival. 135 99

Blood pressure and clinical status of 1,736 patients with cerebrovascular disease were observed during 12 months of treatment with nicardipine. The most common diagnoses were chronic cerebral ischemia (53.2%), transient ischemic attacks (TIA; 25.1%), and cerebral infarct (8.7%); 50.1% of patients were classed as hypertensive [systolic blood pressure (SBP) > or = 160 mm Hg or diastolic blood pressure (DBP) > or = 90 mm Hg]. Most patients (91.2%) received a daily dose of 60 mg nicardipine. Additional treatments included diuretics (37%), beta-blockers (11.5%), other antihypertensive drugs (15.8%), platelet antiaggregants (25.1%), and cardiotonic drugs (15.1%). A total of 282 patients (16.2%) were lost to follow-up, 21 (1.2%) patients withdrew due to side effects, 32 (1.8%) died, and 9 (0.5%) patients had treatment interrupted due to concomitant illness. In the hypertensive subgroup, blood pressure (SBP/DBP) was reduced from a mean baseline value of 175 +/- 22/97 +/- 14 mm Hg to 152 +/- 17/85 +/- 11 mm Hg at 3 months and 149 +/- 23/81 +/- 11 mm Hg after 12 months of treatment. The incidence of TIA or stroke among these patients was reduced from 29 cases (3.5%) during the first 3 months to 11 cases (1.54%) during months 4-12 (p < 0.01). In normotensive patients there were 18 (2.15%) cases during months 1-3 and 13 (1.55%) cases during months 4-12 (difference not significant). In the 280 patients treated with nicardipine alone, the most frequent side effects during the first month were facial flushing (6.8%), gastrointestinal problems (5%), dizziness (3.2%), headache (3.2%), drowsiness (3.2%), and hypotension (1.1%). Most of these side effects were transient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The influence of nicardipine in patients with high risk of stroke. 136 3


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