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

Neuropeptides are the most abundant chemical messengers in the brain and their major role seems to be the modulation of amine and amino acid neurotransmission. This appears to be achieved at many sites by the co-release of peptide with the primary transmitter. The presynaptic biochemistry and physiology of neuropeptides ensure that neuromodulation is highly plastic with almost infinite adaptive potential. The recent development of novel drugs (termed peptoids) that mimic or block neuropeptide function have opened up new clinical approaches to a number of conditions. Thus high efficacy kappa opioid-receptor agonists such as CI-977 (enadoline) have potential for the treatment of pain and stroke whilst the development of highly selective and bioavailable cholecystokinin B (CCK-B) antagonists such as CI-988 ([R-(R*,R*)]-4-[[2-[[3-(1H-indol-3-yl)-2-methyl-1-ox6-2- [[tricyclo[3.3.1.1.3.1]dec-2-yloxy)carbonyl]amino]propyl]ami no]-1-phenethyl]amino-4-oxobutanoic acid) have offered new insights into the mechanisms underlying and the treatment of anxiety disorders and drug abuse. In general it appears that peptoids may offer a greater selectivity of drug action when compared to amino acid/amine based compounds. Peptoid antagonists appear to be relatively free of side effects possibly because neuropeptide systems are only activated under very selective conditions. Peptoid agonists on the other hand can exert extremely powerful actions on brain function and this may be related to the key position neuropeptide receptors occupy in the hierarchy of chemical communication in the brain.
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PMID:Neuropeptides. Function and clinical applications. 131 55

Drugs of many classes have been implicated in hemorrhagic and ischemic stroke. Alcohol in moderation may have a protective effect although in greater doses may predispose to stroke. Drugs such as cocaine, amphetamines and heroin have been associated with stroke by a number of mechanisms. Antiplatelet, anticoagulant and thrombolytic therapy carry risk of hemorrhagic complications. Oral contraceptives appear to slightly increase stroke risk whereas estrogen replacement therapy may decrease it. Anabolic steroid use in athletes has been linked to stroke. The antineoplastic agent L-asparaginase has been associated with cerebral hemorrhage, ischemic infarction and venous sinus thrombosis. Infarction has been reported in association with cisplatin-based combination chemotherapy. Stroke is an infrequent but recognized complication of some forms of drug therapy and drug abuse.
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PMID:The role of drugs in the etiology of stroke. 151 72

Stroke is a frequently reported, though uncommon, complication of drug abuse, primarily cocaine. The pathogenesis is uncertain, although such cerebrovascular events may result from sympathetically mediated vasoconstriction of cerebral vessels. Amphetamine, another sympathomimetic amine that is commonly abused, may also cause strokes by producing cerebral vasospasm and/or vasculitis. Amphetamine and its derivatives are frequent adulterants of illegally obtained cocaine and may also be used concurrently; the effect(s) of this combination of drugs upon the cerebral vasculature is not known. Our aim was to develop an animal model that would enable us to study the ability of these drugs to produce acute cerebral vasospasm and to observe the response to IV administration of amphetamine and cocaine, either alone or together. Magnified basilar artery arteriograms were obtained in 12 New Zealand white rabbits before and after IV administration of cocaine, methamphetamine, or both, at various dosages. Low doses produced mild vasodilatation. At higher doses, the animals who received cocaine and methamphetamine alone showed little or no basilar artery spasm, but coadministration produced definite basilar artery vasospasm, reflecting a synergistic vasoconstrictive effect. If a similar response exists in the human cerebral vasculature, then this could help explain the cause of strokes associated with drug abuse.
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PMID:Cocaine- and methamphetamine-induced acute cerebral vasospasm: an angiographic study in rabbits. 212 40

Alcohol and drug abuse should be among the possible causes considered in cases of stroke, especially in young adults. As both are potentially remediable factors, primary care physicians may play an important role in the reduction of stroke by implementing educational and preventive measures among their young patients.
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PMID:Stroke from alcohol and drug abuse. A current social peril. 219 55

Drug abuse has become a social and medical problem. Amphetamine and cocaine have a potent sympathicomimetic action, so they have important effects on the Central Nervous and Cardiovascular Systems. Their neurological complications are principally: psychic alterations, seizures and stroke (hemorrhagic and ischemic). The latter are the most important in the clinical practice. Their capacity to produce transit arterial hypertension and cerebral vascular constriction could be the physiopathological substrate of such alterations. Angiographic studies have shown lesions suggesting vasculopathy. In the last ten years cocaine abuse has become an authentic epidemic. We have reviewed its neurological complications, particularly the vascular ones--42 hemorrhagic and 24 ischemic--and the following conclusions were drawn: it should be considered as a risk factor in the younger age group; a short period of time between the last drug dose and the clinical picture is frequently seen; clinical features may appear with the first drug administration; no characteristic lesion in relation to the way of administration or consumption time was elicited.
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PMID:[Neurologic complications caused by use of cocaine, amphetamines and sympathomimetics]. 270 Feb 92

A 54 year-old female expired at her residence. Her husband, a physician, signed a certificate stating that her death was due to cerebrovascular accident (CVA) and released her body to a funeral home, where she was embalmed. Since the deceased had a long history of medical problems and drug abuse, an autopsy was performed and no evidence of CVA was found. Toxicological analyses of body fluids and tissues revealed the presence of ethchlorvynol in high concentration in the bile (112 mg/l). The bloody fluid collected from the heart contained a concentration of ethchlorvynol below the limit for quantitation. Other findings included phenobarbital (32.8 mg/l) in heart bloody fluid and methanol (an ingredient of embalming fluid). The significance of the findings is discussed in relation to embalmment prior to autopsy and toxicological analyses. Ethchlorvynol concentration in the bile is compared to other fatal cases due to ethchlorvynol overdose.
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PMID:Determination of ethchlorvynol in body tissues and fluids after embalmment. 340 56

Six hundred and sixty-one patients with stroke, confirmed by CT scan or at autopsy, were reviewed in order to evaluate the frequency of presentation with altered mental state. Nineteen patients (3%) had presented with delirium, an organic delusional state, the acute onset of dementia, or mania, mimicking psychiatric illness. All had focal cerebrovascular lesions which were usually, but not invariably, right sided. None had a previous history of cognitive impairment, psychiatric disease, drug abuse, or alcohol excess. Neurological signs were absent or mild and transient, and therefore easily missed. Post-mortem examinations in four patients showed localised cerebral infarctions with no evidence of multiple lesions, Alzheimer's disease, or metabolic encephalopathies. The possible causative factors are discussed and the evidence of asymmetrical cerebral representation of emotion, and for a relationship with epilepsy, is reviewed.
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PMID:Inobvious stroke: a cause of delirium and dementia. 347 Nov 94

In the United States, stroke accounts for 160,000 annual deaths; only 16% of the 1.8 million stroke survivors are fully independent. The incidence of stroke increases with age. Hemorrhagic strokes outnumber ischemic strokes before age 15. Japanese men in this country have a lower stroke mortality than their age peers in Japan. Excessive stroke mortality for US nonwhites may not be entirely due to the greater prevalence of hypertension among blacks. Hypertension emerges as the single most powerful and reversible risk factor in stroke and for survival after stroke. Impaired cardiac function is the second most important precursor of stroke. The recurrence of stroke in survivors is high. The frequency of completed stroke is high in persons with transient ischemic attacks, but not in those with asymptomatic carotid bruits. Other reversible risk factors are smoking, the use of oral contraceptives, alcoholic excess, a low level of physical activity, blood hyperviscosity and drug abuse.
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PMID:Risk factors in stroke. 389 97

Transcutaneous stimulation is a proven effective way to relieve pain. Its optimal use requires an accurate patient diagnosis. Treatment of pain as a symptom only is likely to fail. There must be a careful psychosocial evaluation, for the majority of patients who come to the doctor complaining of pain have major psychological, social, or behavioral factors that are most important in the genesis of the complaint. Drug abuse must be corrected. Related symptoms, such as anxiety and depression, must be treated. Then, a thorough trail of transcutaneous stimulation is mandatory. A desultory use will undoubtedly lead to failure. This trial must begin with patient education by experienced personnel. Then the electrodes must be properly applied, and there must be a regular follow-up of stimulation to be certain the patient is utilizing it correctly. The patient must be supported through an adequate trial which should extend over 2-4 weeks before purchase of the device is contemplated. Furthermore, all related nursing and physician personnel must be educated in the proper use of the technique. The uninformed professional who denigrates the therapy is a very effective deterrent to appropriate use. In this situation, transcutaneous electrical stimulation will be of great value in the treatment of acute musculoskeletal injury and acute postoperative pain. It will be effective in the treatment of peripheral nerve injury pain, chronic musculoskeletal abnormalities, chronic pain in the patient who has undergone multiple operations upon the low back and neck, visceral pain, some of the reflex sympathetic dystrophies, and postherpetic neuralgia. Stimulation will not help a complaint which is psychosomatic in origin. It will not influence drug addiction. It is not likely to be useful in any situation where secondary gain is important. The metabolic neuropathies, pain of spinal cord injury, and pain from cerebrovascular accident will not respond frequently enough to warrant more than hopeful trials. The technique is inexpensive, places the patient in control of his own pain, and has no known serious side effects. Its widespread application awaits the development of reasonable systems to provide this service to physicians and patients. Stimulation-induced analgesia deserves a place in the armamentarium of every physician dealing with the complaint of pain.
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PMID:Stimulation of the peripheral nervous system for pain control. 623 44

This discussion addresses the questions of the parinatal, neonatal, and infant health and development of children born to adolescent mothers as related to other biologic and social factors. Medical and legislative plans for adolescent mothers and their infants must be based on assessment of both mortality and morbidity of the infants born to adolescent mothers. Focus here is on neonatal data on 55,711 pregnancies collected by the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke; neonatal data from the University of Kansas Medical Center covering 4000 pregnancies, 770 of which were gestations in teenage mothers; and obstetric, perinatal, and neonatal data concerning 6087 pregnancies in 1976, 1977, and 1978 at the Regional Perinatal Center at the University of Rochester. Ample evidence suggests a strong association between maternal age and birth weight. In particular, Hardy and Mellits found a higher frequency of low birth weight infants born to young black women. Interactions with other variables, including parity, clearly illustrate that firstborn infants are lighter than subsequent infants up to a maternal age of 35. Hoffman et al. have demonstrated that American women 18 years and under show a tendency to have infants of shorter gestational age than women 19-24 years of age. Cigarette smoking, alcohol and drug abuse, prolonged rupture of membranes, seizure disorders, and gonorrhea were significantly more frequently diagnosed in teenage mothers. The studies showed that behavioral and medical complications in the mothers were more powerful determinants of infants born with weight of less than 2500 gm than maternal age alone. In sum, when maternal and fetal growth retarding factors are taken into account among mothers of specific age categories, no biologic disadvantage appears unique to adolescent mothers. Findings fail to support the often expressed view that the mother's biologic immaturity is the main factor responsible for excessive fetal and neonatal deaths in infants born to very young mothers. Proportionately more infants born to adolescent mothers required admission to the intensive care or special care nurseries at the University of Rochester hospital than did infants born to mothers in their 20s (15.77% versus 13.9%). The data suggest that the mothering skills and child rearing practices of adolescent childbearing women have yet to be evaluated adequately.
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PMID:The infants of adolescent mothers. 736 May 10


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