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

Many ophthalmological disorders are due to poor local microcirculation, examples being central retinal vein occlusion, acute retinal artery occlusion, and ischaemic eye disease. Generalized changes have been found in arterial hypertension, diabetes mellitus, and arteriosclerosis. It is only at a few places that the microcirculation can be investigated non-invasively in man, and in this connection the retina is of particular interest because it is one of the regions supplied by the intracranial part of the internal carotid. The retinal blood supply is divided into four clearly separate quadrants, normally not communicating via anastomoses. The time of the arteriovenous passage (AVP) can therefore serve as a good indicator of retinal microcirculation. This parameter was measured before and after treatment in patients with diabetic retinopathy, angiosclerosis of the fundus, and lacunar stroke. Video fluorescence angiography reveals the abnormalities of the microcirculation in the area supplied by the carotid artery and can be used to check on therapeutic effects.
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PMID:Measurement of retinal blood flow in various pathological conditions by video fluorescence angiography. 378 45

Venous stasis retinopathy and ischemic oculopathy are ocular manifestations of ischemia in the distribution of the carotid artery. While not as common as transient monocular blindness or retinal arterial emboli, they are readily recognizable and indicate the presence of severe, often bilateral, carotid occlusive disease. Patterns of occlusion vary but usually include complete occlusion of at least one common or internal carotid artery, often accompanied by occlusion or narrowing in the opposite carotid system. The ocular findings in venous stasis retinopathy and ischemic oculopathy indicate ongoing ocular ischemia and may progress to intractable neovascular glaucoma. Therapy, individualized for the specific pattern of occlusive changes, may be directed toward prevention of stroke or may be indicated primarily for the reversal of ocular ischemia and prevention of blindness secondary to neovascular glaucoma.
Stroke
PMID:Chronic ocular ischemia and carotid vascular disease. 402 85

Diabetes mellitus is associated with severe microvascular complications (e.g., kidney disease and eye disease) and macrovascular complications (e.g., stroke and ischemic heart disease). These complications can result in severe long-term complications (e.g., amputation, disability, and blindness) and account for a substantial economic burden. This report uses data from CDC's National Health Interview Survey (NHIS) to examine trends in the incidence and prevalence of self-reported diabetes in the United States during 1980-1994. The findings document increases in both the incidence and prevalence of diabetes during this period and suggest that most of the increase was attributable to factors other than the aging of the U.S. population.
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PMID:Trends in the prevalence and incidence of self-reported diabetes mellitus -- United States, 1980-1994. 936 35

The attributes of Release 3.0 of the user friendly version (UFV) of the global diabetes model (GDM) are described and documented in detail. The GDM is a continuous, stochastic microsimulation model of type 2 diabetes. Suitable for predicting the medical futures of both individuals with diabetes and representative diabetic populations, the GDM predicts medical events (complications of diabetes), survival, utilities, and medical care costs. Incidence rate functions for microvascular and macrovascular complications are based on a combination of published studies and analyses of data describing diabetic members of Kaiser Permanente Northwest Region, a non-profit group-model health maintenance organization. Active risk factors include average blood glucose (HbAlc), systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides, smoking status, and use of prophylactic aspirin. Events predicted include diabetic eye disease, diabetic nephropathy, peripheral neuropathy amputation, myocardial infarction, stroke, peripheral artery disease, congestive heart failure, coronary artery surgery, coronary angioplasty, and death.
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PMID:The global diabetes model: user friendly version 3.0. 1108 May 61

The burden of Type II diabetes is growing rapidly worldwide, across high-, middle- and low-income countries. This burden is associated primarily with increased risks of macrovascular and microvascular diseases, and it is agreed that multifactorial treatment regimens are required to reduce it. ADVANCE (Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation) is a large-scale, 2 x 2 factorial, randomised clinical trial. It will investigate the potential benefits of blood pressure lowering, using a fixed low-dose combination of perindopril and indapamide vs placebo, and of tighter glucose control, using an intensive gliclazide-MR-based glucose control regimen vs a standard guidelines-based regimen, separately and together. The two primary outcomes are a composite macrovascular end point of nonfatal stroke, nonfatal myocardial infarction and cardiovascular death; and a composite microvascular end point of new or worsening nephropathy or microvascular eye disease. Following successful recruitment and randomisation of 11,140 participants by March 2003, the study is currently half way through its planned follow-up of 4.5 years. Adherence to randomised study treatment is good; and loss to follow-up is minimal. It is hoped that the study will answer a number of unresolved issues. The blood pressure lowering arm will investigate the possible reduction in major vascular disease in patients with Type II diabetes whether or not they have hypertension, and the possible benefits of blood pressure lowering in such patients already receiving background therapy with the ACE inhibitor perindopril. The glucose control arm will investigate the possible reduction in both macrovascular and microvascular disease achieved with tighter glucose control, targeting an HbA1c of 6.5% and a fasting blood glucose of 6.0 mmol/l. Finally, the factorial design will enable investigation of the combined effects of more intensive glucose control and tighter control of blood pressure.
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PMID:ADVANCE: action in diabetes and vascular disease. 1607 30

In 2001, the incidence of primary and secondary syphilis increased in the United States for the first time in a decade. Increasing rates of early syphilis among men who have sex with men have been reported in many American cities, with similar outbreaks noted in Canada and Europe. In San Francisco, the increase has been particularly sharp and accompanied by an increase in the incidence of neurosyphilis. Early neurosyphilis develops within weeks to years of primary infection and primarily involves the meninges. Syndromes include syphilitic meningitis (often accompanied by cranial neuropathies), meningovascular syphilis (with associated ischemic stroke), or asymptomatic neurosyphilis. Late neurosyphilis occurs years to decades after exposure as cerebral or spinal gummatous disease or the classic parenchymal forms affecting the brain (general paresis or syphilitic encephalitis) or spinal cord and nerve roots (tabes dorsalis). Treponema pallidum, the causative agent, cannot be cultured in vitro, and microscopic techniques are laborious. Thus, diagnosis depends on serologic tests and cerebrospinal fluid (CSF) examination. The suboptimal sensitivity and specificity of these tests complicate diagnosis, particularly among patients coinfected with HIV. CSF examination should be performed to evaluate for neurosyphilis in all patients with positive serum syphilis serology and neurologic, ophthalmic, or tertiary disease, or in those who have failed therapy, and in HIV-infected patients with late latent syphilis or syphilis of unknown duration. Intravenous penicillin G is the recommended treatment for all forms of neurosyphilis and for syphilitic eye disease. An outpatient alternative, if adherence can be assured, is intramuscular benzathine penicillin with oral probenecid. Newer drugs that penetrate CSF, such as ceftriaxone or azithromycin, have not yet been adequately tested for neurosyphilis. Syphilis facilitates transmission of HIV (and vice versa), and thus all patients diagnosed with syphilis should be offered HIV testing.
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PMID:Treatment of neurosyphilis. 1656 77

The advent of ambulatory blood pressure monitoring has led to an improved reliability of blood pressure measurement. A consensus has emerged that such monitoring of blood pressure more closely identifies hypertensive organ damage than does office blood pressure. The application of this technology to various aspects of vascular disease is increasing and cerebrovascular disease is no exception. There is preliminary evidence that patients whose blood pressure does not drop at night are at added risk for cerebrovascular disease. To complicate matters, patients with an exaggerated drop of blood pressure during sleep may also be at increased risk. Finally, valid concern has been raised that nocturnal hypotension may accelerate visual loss in certain subgroups of subjects with eye disease. These preliminary findings will stimulate further work in this promising and important area.
J Stroke Cerebrovasc Dis
PMID:Ambulatory blood pressure monitoring in cerebrovascular and retinal vascular disease. 1789 21

Acute decrease of mono or binocular vision although it is not a common clinical symptom, is of major importance, with serious implications for the patient and physician, requiring a comprehensive approach in terms of clinical, laboratory and therapeutic. It is an attempt that often proves difficulty by lack of access to specific investigations and the lack of neuroophthalmology specialists. In most cases, the sudden decrease of vision occurs in the stroke of the eye by occlusion of central retinal artery or one of its branch, occlusion of vein, occlusion of optic nerve vessels or by demyelinating processes of the optic nerve. Rapid diagnosis of eye disease by appropriate clinical or paraclinical investigations, leads to prompt treatment with decreased risk of complications, but in many cases it requires preventive measures.
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PMID:[Transient visual loss due to neurological cause]. 2177 80

Even in the new millennium, arterial hypertension remains a serious condition, with considerable morbidity and mortality worldwide. Crucial in managing the disease is not only lowering arterial blood pressure but also preventing or treating the typical end-organ damage caused by long-lasting and inadequately treated hypertension. In the past decade, it has been shown that microRNAs (miRs) are involved in several hypertension-related pathologies, such as cardiac hypertrophy and fibrosis, hypertensive heart failure, renal fibrosis, kidney failure, and, to a lesser extent, eye disease and hemorrhagic stroke. Whereas others extensively reviewed the role of miRs in atherosclerosis and vascular disease, this review focuses on their role in target organ damage during arterial hypertension. We emphasize the involvement of miRs in pathological end-organ remodeling processes and try to demonstrate some common miR signatures in distinct end organs. Hence, we aimed to provide proof of arterial hypertension being a systemic disease, similar to diabetes mellitus or metabolic syndrome. Furthermore, miRs that act on one particular process in different end organs are interesting therapeutic targets. Some future perspectives in miR research are highlighted with respect to novel therapeutic strategies in the cardiovascular field.
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PMID:MicroRNAs are involved in end-organ damage during hypertension. 2298 22

Prevention of target organ damage represents the El Dorado for clinicians who treat hypertension. Although many of the cardiovascular sequelae of chronic hypertension are due to large artery atherosclerosis, an equal number are due to small artery dysfunction. These microvascular complications include eye disease (retinopathy), kidney failure, diastolic dysfunction of the heart and small vessel brain disease leading to stroke syndromes, dementia and even depression. Examination of the retinal vasculature represents the only way to reliably derive information regarding small arteries responsible for these diverse pathologies. This review aims to summarise the rapidly accruing evidence indicating that easily observable abnormalities of retinal arteries reflect target organ damage elsewhere in the body of hypertensive patients. In tandem, we also present putative mechanisms by which hypertension and diabetes fundamentally change small artery structure and function and how these processes may lead to target organ damage.
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PMID:Retinal arterial hypertrophy: the new LVH? 2357 36


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