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

Transcranial Doppler sonography (TCD) is used to assess cerebral blood flow velocity in basal cerebral arteries and is a common tool for the diagnosis and follow-up of cerebrovascular disease. With more than 200 clinical studies using TCD published annually, indications for its use are expanding. The current article critically reviews standard and recent clinical applications for TCD including delayed vasospasm after subarachnoid hemorrhage, sickle cell disease, atherosclerosis of cranial vessels, ischemic stroke, brain trauma, brain death, carotid artery disease, cerebral venous thrombosis, intraoperative TCD monitoring, arteriovenous malformations, cardiac shunts and preeclampsia.
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PMID:Clinical applications of transcranial Doppler sonography. 1847 88

Stroke is a recognised complication of pregnancy, contributing to more than 12% of all maternal deaths. Estimated incidence rates vary considerably from 4.3 to 210 strokes per 100,000 deliveries. Atherosclerosis is rare in young adults, and so other causes of stroke become increasingly likely. Aetiological factors important in pregnancy include hypercoagulability due to maternal physiological changes, pre-eclampsia and eclampsia, cerebral venous thrombosis, paradoxical embolism, postpartum cerebral angiopathy and peripartum cardiomyopathy. Management of patients with pregnancy-related stroke should generally proceed as for non-pregnant patients, although there are a number of important areas specific to pregnancy which will be considered here.
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PMID:Stroke in pregnancy and the puerperium. 1850 80

Placental chorioangiomas are benign vascular tumors. Large chorioangiomas cause several obstetric complications, including premature labor, placental abruption, polyhydramnios, fetal hydrops, fetal growth restriction, fetal hepatosplenomegaly, cardiomegaly, congestive heart failure, and fetal death. The neonatal complications are hydrops fetalis, microangiopathic hemolytic anemia, and thrombocytopenia. The cause of perinatal cerebral arterial infarction remains unclear in the majority of cases. Investigators have reported a number of obstetric and neonatal complications in the setting of perinatal stroke, including birth asphyxia, preeclampsia, chorioamnionitis, cardiac anomalies, polycythemia, systemic infection, and genetic thrombophilias. We present a rare case of perinatal cerebral infarction associated with placental chorioangioma.
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PMID:Perinatal cerebral arterial infarction associated with a placental chorioangioma. 1852 77

A broad spectrum of global haemostatic assays has recently been developed and modified in an attempt to overcome the drawbacks of classical screening tests used for evaluation of coagulation and fibrinolysis. The Overall Haemostasis Potential (OHP) assay is one of such assays. The assay is based on repeated spectrophotometric registration of fibrin-aggregation in citrated plasma, to which small amounts of exogenous thrombin, tissue type plasminogen activator and calcium chloride have been added. The area under the fibrin aggregation curve which then develops is calculated and is the laboratory parameter used for OHP determination. The Overall Coagulation Potential (OCP) and Overall Fibrinolytic Potential (OFP) are supplementary parameters of OHP, providing details of underlying changes in coagulation and/or fibrinolysis. The sensitivity of the assay for detecting hypercoagulation in normal pregnancy, in preeclampsia, some thrombophilias, coronary heart disease, diabetes, stroke and vascular surgery has been evaluated. Since the assay can monitor haemostasis balance in the sample, it may serve as a laboratory tool to determine hypocoagulation, especially in patients with haemophilia A or B. Preliminary findings also indicate that the OHP assay may be useful in the monitoring of anticoagulant treatments. Larger controlled clinical studies are, however, mandatory before a definite conclusion about the usefulness of the method can be drawn.
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PMID:Screening haemostasis--looking for global assays: the Overall Haemostasis Potential (OHP) method--a possible tool for laboratory investigation of global haemostasis in both hypo- and hypercoagulable conditions. 1867 57

Homocysteine is a sulfur amino acid whose metabolism stands at the intersection of two pathways: remethylation, which requires folic acid and vitamin B12 coenzymes; and transsulfuration, which requires pyridoxal-5'-phosphate, the vitamin B6 coenzyme. Data from a number of laboratories suggest that mild elevations of homocysteine in plasma are a risk factor for occlusive vascular disease. In the Framingham studies, we have shown that plasma homocysteine concentration is inversely related to the intake and plasma levels of folate and vitamin B6 as well as vitamin B12 plasma levels. Almost two-thirds of the prevalence of high homocysteine is attributable to low vitamin status or intake. Elevated homocysteine concentrations in plasma are a risk factor for prevalence of extracranial carotid-artery stenosis > or = 25% in both men and women. Prospectively elevated plasma homocysteine is associated with increased total and cardiovascular mortality, increased incidence of stroke, increased incidence of dementia and Alzheimer's disease, increased incidence of bone fracture, and higher prevalence of chronic heart failure. It was also shown that elevated plasma homocysteine is a risk factor for preeclampsia and maybe neural tube defects (NTD). This multitude of relationships between elevated plasma homocysteine and diseases that afflict the elderly, pregnant women, and the embryo points to the existence ofa common denominator which may be responsible for these diseases. Whether this denominator is homocysteine itself or homocysteine is merely a marker, remains to be determined.
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PMID:Public health significance of elevated homocysteine. 1870 86

Postpartum stroke is rare, and because complaints are similar to preeclampsia, diagnostic confusion may delay the diagnostic workup that should include prompt computerized tomography of the brain. We describe a patient with postpartum stroke who died because of extensive ischemic damage throughout the brain with 3 simultaneous arterial occlusions. We stress the importance of raising this diagnosis in your workup because adequate measurements like angiography and intra-arterial thrombolysis could significantly improve the patient's outcome.
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PMID:Postpartum stroke, a diagnostic challenge. 1877 69

Women have a one in five chance of having a stroke during their lifetime. Although the majority of strokes occur in the oldest age groups, younger women have unique risks during their childbearing years because of pregnancy, preeclampsia, and the use of oral contraceptives. Fortunately, the absolute risk of stroke in these young women is low, but a history of preeclampsia during pregnancy or postpartum may be an indication of risk that carries over into later years after childbearing. In addition, menopause represents a risk because of the potential for increasing blood pressure, low-density lipoprotein cholesterol, abdominal obesity, insulin resistance, and decreasing high-density lipoprotein cholesterol. Early identification of stroke risk in women will help to minimize the effect of the stroke epidemic in older women.
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PMID:Stroke in women: risk and prevention throughout the lifespan. 1902 6

Evaluation of: Bellamy L, Casas JP, Hingorani AD, Williams DJ: Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. Br. Med. J. 335(7627), 974 (2007). Evidence has emerged over the years suggesting that women who develop hypertensive pregnancy disorders, most notably pre-eclampsia, are at an increased risk for cardiovascular disease later in life. In this study, a systematic review and meta-analysis were performed, assessing the future risks of cardiovascular disease, cancer and all-cause mortality in women with a history of pre-eclampsia and eclampsia. Women with a history of pre-eclampsia or eclampsia, compared with women without such a history, had an increased risk for cardiovascular disease, including a fourfold increased risk for hypertension, a twofold increased risk for ischemic heart disease, stroke and deep venous thrombosis, and a 1.5-times higher all-cause mortality. The study suggests that affected women may be eligible for preventive therapies at an earlier age, especially if future studies establish the role of pre-eclampsia as an independent cardiovascular risk factor.
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PMID:Pre-eclamptic pregnancies: an opportunity to identify women at risk for future cardiovascular disease. 1907 14

Blood pressure fluctuation early in the course of ischemic stroke is a proven independent predictor of morbidity and mortality. Both high and low systolic blood pressures have a detrimental effect on the neurologic outcome. Current guidelines support permissive hypertension in the early course of acute ischemic stroke. For patients with marked elevation in blood pressure, a reasonable goal would be to lower blood pressure by 15% during the first 24 hours after onset of stroke. The level of blood pressure that would mandate such treatment is not known, but consensus exists that medications should be withheld unless the systolic blood pressure is greater than 220 mm Hg or the diastolic blood pressure is greater than 120 mm Hg. For patients undergoing intravenous thrombolysis for acute ischemic stroke, it is recommended that the blood pressure be reduced and maintained below 185 mm Hg systolic for the first 24 hours. The first-line drugs for lowering of blood pressure remain labetalol, nicardipine, and sodium nitroprusside. These recommendations are based on consensus rather than evidence, however. Comorbid conditions such as myocardial infarction, left ventricular failure, aortic dissection, preeclampsia, or eclampsia would override the guidelines for permissive hypertension; a lower blood pressure would be preferred in these conditions. Children with acute strokes should be managed in the same way as adults, with extrapolated lowering of blood pressures, until further evidence emerges. Current research focuses on both hemodynamic augmentation of low blood pressures and the effects of further lowering the blood pressure after acute ischemic stroke. Until more definitive data are available, a cautious approach to the treatment of arterial hypertension is generally recommended.
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PMID:Treatment of hypertension in acute ischemic stroke. 1921 Sep 14

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by a sudden, severe headache at onset, vascular narrowing involving the circle of Willis and its immediate branches, and angiographic evidence of vasoconstriction reversibility within minutes to weeks of onset. RCVS is underrecognized and often misdiagnosed; it can defy clinical detection because it can mimic common conditions such as migraine and ischemic stroke. A lack of shared nosology has hampered awareness and understanding of the syndrome. Clinicians must consider primary angiitis of the central nervous system because of its high rates of morbidity and mortality if left untreated. RCVS has a number of primary and secondary associations (cerebral hemorrhage, vasoactive substances, the peripartum period, bathing, and physical exertion) but also occurs in isolation. RCVS can present in conjunction with hypertensive encephalopathy, preeclampsia, and reversible posterior leukoencephalopathy. This review provides an up-to-date account of RCVS.
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PMID:Reversible cerebral vasoconstriction syndrome: a thunderclap headache-associated condition. 1926 33


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