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

The indications for anticoagulant treatment to prevent cerebral infarction or progression of cerebral infarction are now clear. The indications are: (1) Prevention of recurrent embolization from a cardiac source (long-term anticoaguland treatment). (2) Transient ischemic attacks (particularly vertebrobasilar system) if a surgically accessible causative lesion, polycythemia, and thrombocytosis are not present (anticoagulants for a few months.) (3) Progressing stroke in either systme assuming that the neurological defect is partial and CT scan shows no evidence of bleeding (anticoagulants for a few months.) (4) Rarely, completed stroke (long-term).
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PMID:Anticoagulant treatment to prevent cerebral infarction. 38 11

No permanent neurologic deficit results from a transient ischemic attack, but patients with these episodes are at risk of stroke. Successful treatment depends on identifying the source of the problem--the heart, blood, or vessel wall. However, anticoagulants and antiplatelet agglutinating agents will reduce only the incidence of TIA's, not the incidence of stroke. Prompt vigorous treatment of progressive stroke may avert completed stroke. Heparin is recommended, unless a specific etiologic factor, such as polycythemia or hypertension, is identified.
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PMID:Current concepts in managing TIAs and stroke. 44 70

Data regarding the etiology and subsequent course of 54 patients with an occlusion of the central retinal artery included the following: of 44 patients over 40 years of age at the time of the central retinal artery occlusion, eight (18%) had cerebrovascular accidents, but only two patients (5%) had a stroke clearly related to the vessels involving the affected central retinal artery. Five patients (11%) had occlusive disease of the ipsilateral internal carotid artery; two of these had cerebral involvement later or simultaneously. Ten of the older patients had cardiac valvular disease and presumed embolic occlusion of the central retinal artery. Associated medical disorders were common. Of the ten patients under 40 years of age, six occlusions were secondary to atrial myxoma, mitral insufficiency with Marfan's syndrome, polycythemia, hypercoagluopathy, hypertension, and orbital compression. Four had no apparent etiology at onset and were in good health many years later.
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PMID:Central retinal artery occlusion. 112 94

The hemorheologic properties are obviously abnormal in patients with cor pulmonale (CP), presenting as high hematocrit (HCT), hyperviscosity and hyper-viscoelasticity. Twenty patients suffering from CP with polycythemia were randomized into either an isovolemic hemodilution (IHD) group or control group. In the IHD group, 10 patients were treated by routine therapy combined with IHD. The other 10 patients in the control group were treated by routine therapy only. The results demonstrated that after treatment in IHD group, all viscoelasticity property parameters except eta p were decreased significantly. Oxygen delivery, oxygen transport capacity, and stroke volume and cardiac output were increased. Mean pulmonary artery pressure and total pulmonary resistance were decreased. However, in the control group only HCT and eta 0.512 were decreased after treatment. The viscosity and eta' of the whole blood in IHD group were decreased more markedly than those in the control group. IHD was well tolerated in most of the patients. There were no complications or side effects. Thus, IHD is a safe, effective and acceptable therapy, and it may play a role in the treatment of cor pulmonale.
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PMID:[A randomized control trial of isovolemic hemodilution therapy in cor pulmonale]. 128 45

Maximal exercise performance was evaluated in four adult foxhounds after right pneumonectomy (removal of 58% of lung) and compared with that in seven sham-operated control dogs 6 mo after surgery. Maximal O2 uptake (ml O2.min-1.kg-1) was 142.9 +/- 1.9 in the sham group and 123.0 +/- 3.8 in the pneumonectomy group, a reduction of 14% (P less than 0.001). Maximal stroke volume (ml/kg) was 2.59 +/- 0.10 in the sham group and 1.99 +/- 0.05 in the pneumonectomy group, a reduction of 23% (P less than 0.005). Lung diffusing capacity (DL(CO)) (ml.min-1.Torr-1.kg-1) reached 2.27 +/- 0.08 in the combined lungs of the sham group and 1.67 +/- 0.07 in the remaining lung of the pneumonectomy group (P less than 0.001). In the pneumonectomy group, DL(CO) of the left lung was 76% greater than that in the left lung of controls. Blood lactate concentration and hematocrit were significantly higher at exercise in the pneumonectomy group. We conclude that, in dogs after resection of 58% of lung, O2 uptake, cardiac output, stroke volume, and DL(CO) at maximal exercise were restricted. However, the magnitude of overall impairment was surprisingly small, indicating a remarkable ability to compensate for the loss of one lung. This compensation was achieved through the recruitment of reserves in DL(CO) in the remaining lung, the development of exercise-induced polycythemia, and the maintenance of a relatively large stroke volume in the face of an increased pulmonary vascular resistance.
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PMID:Cardiopulmonary adaptations to pneumonectomy in dogs. I. Maximal exercise performance. 150 92

Polycythemia in CAPD patients has been rarely described. Over an eight year period, 4 out of 123 CAPD patients (3%) were identified as having Hct values exceeding 50% for 1 month or longer. All of the 4 patients were insulin dependent diabetics (4/47 diabetic patients, 8.5%). Charts were reviewed on 3 of these 4 patients. Polycythemia developed after a mean of 21 +/- 7 months on peritoneal dialysis. Prior to the development of polycythemia, ferritin levels were low and ferrous sulfate therapy was begun at a time the Hct values were 36 to 40%. Erythropoietin levels were obtained in 2 patients, and were 22 U/L (Hct 51%) and less than 5 U/L (Hct 55%). Renal ultrasound failed to show renal masses or cysts. One patient had a plasma volume of 2.1 L (normal 2.4-3.2 L); another patient was clinically volume depleted. Complications during the period of polycythemia included gangrenous feet requiring amputation in 2 patients, CVA in 2 patients, and splenic infarct in 1 patient. One patient died of cerebral thrombosis. We conclude that polycythemia is uncommon in CAPD patients and occurs most often in diabetic patients. Volume depletion and iron therapy may play a role in its etiology. In this high risk group of patients polycythemia may contribute to vascular complications and should be avoided.
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PMID:Polycythemia in diabetic patients on CAPD. 168 Apr 62

The prevention of stroke has undenied merit. Recognition of stroke-inducing conditions (eg, cardiac diseases associated with embolism, polycythemia) provides opportunities for specific prevention strategies. For a larger number of patients, however, risk factors for degenerative vascular disease should be addressed. The evidence for efficacy is strongest for treatment of hypertension, and smoking cessation also reduces the risk of stroke. The value of treatment of hyperlipidemia in reducing the incidence of a first stroke remains to be demonstrated. Optimal management of carotid bruit and asymptomatic stenosis will be clarified by results of ongoing clinical trials. On the basis of available data, use of aspirin by healthy persons without risk factors cannot be recommended as a method for preventing a first ischemic stroke.
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PMID:Ischemic stroke. How to keep the first one from happening. 174 39

An overview is given over etiology and prognosis of cerebral ischemias until the age of 40. In a time period of 19 years, 168 patients were diagnosed with cerebral ischemia until the age of 40 (91 females, 77 males). The most frequent etiology is premature atherosclerosis in patients with vascular risk factors (up to 50%). Cardiogenic embolism is responsible for 1 to 34% of the cases: cardiac valve diseases and endocarditis being the most frequent sources. In 2 to 19% a vasculitis is diagnosed. While infectious arteritis is especially frequent in countries of the third world, immunovasculitides are common in Europe and the USA. Noninflammatory vasculopathies include spontaneous or traumatic dissection, fibromuscular dysplasia and vascular malformations. A migrainous stroke is especially frequent in female smokers with intake of oral contraceptives. During pregnancy both sinus thrombosis and arterial ischemia occur. Hematologic causes for ischemia are polycythemia, thrombocytosis and genetic diseases (sickle cell anemia, AT3-deficiency). Cerebral ischemia may occur in connection with the ingestion of ergot-derivates. The prognosis of cerebral ischemia in young adults is better than in older stroke-patients.
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PMID:[Cerebral ischemia in young adults]. 193 40

A hospital-based study of the relationship between the hematocrit and thrombotic stroke was carried out among 117 patients admitted to Ramathibodi hospital. There was no significant difference in the age of patients with and without CT scan. Six patients, three males and one female with CT scan and one male and one female who did not have CT scan were found to have polycythemia vera. Ten patients had relative polycythemia (five had CT scan and five without CT scan). The mean age of patients with PV and relative polycythemia was not significantly different from those without polycythemia. The mean Hct in those with PV and relative polycythemia was generally higher than those without polycythemia. We recommended that Hct should be determined in every thrombotic stroke and a high Hct should be further studied for evidence of polycythemia vera or relative polycythemia.
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PMID:Hematocrit in thrombotic stroke at Ramathibodi Hospital. 273 92

To examine right ventricular function during long-term hypoxemia, we instrumented 12 fetal sheep with intravascular catheters and an electromagnetic flow probe on the pulmonary artery. In six cases, hypoxemia was induced by infusing N2 gas into the maternal trachea for 2 wk. Maternal arterial PO2 was less than 60 Torr, and fetal arterial PO2 was reduced from approximately 26 to approximately 19 Torr. Six cases served as nonhypoxic controls. We studied fetal cardiac function by increasing either preload with a volume infusion of 5% (wt/vol) dextrose or afterload by administering methoxamine (alpha-adrenergic agonist). In hypoxic animals, right ventricular output (QRV) and stroke volume (SV) were not affected on the first 2 days but fell 30% on day 3. Fetal arterial pressure (Pfa) increased 20%, hemoglobin concentration increased approximately 30%, and fetal heart rate (FHR) showed minimal changes. Within 2 wk, QRV recovered to normal values, whereas ventricular sensitivity to arterial pressure was reduced. We observed no change in plasma concentration of "cardiac enzymes" or differences in fetal growth between groups. In conclusion, during prolonged hypoxemia, right ventricular function showed a triphasic response (primary maintenance, secondary depression, and subsequent recovery), achieving a new steady state 2 wk after the start of hypoxia, characterized by decreased sensitivity to afterload, associated with polycythemia and hypertension.
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PMID:Cardiac function during long-term hypoxemia in fetal sheep. 276 38


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