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

Left ventricular (LV) output and function was investigated, using pulsed Doppler echocardiography in 52 patients with various localizations of accessory AV pathway (AP) in sinus rhythm and during paroxysm of AV reentrant tachycardia. In patients with sinus rhythm and ventricular preexcitation the most marked decrease in LV output and function (reduced aortic flow peak velocity [PV], mean acceleration [MA], stroke distance [SD], minute distance [MD], and lengthened time to peak velocity [TTP]) was noted in the presence of right parietal AP and less marked changes (decreased MA, lengthened TTP)--in the presence of posteroseptal AP, in comparison with the controls (P less than 0.005). During antidromic tachycardia the pronounced decrease in PV, MA, SD, and MD was noted, especially in patients with left parietal and posteroseptal AP, while in the case of right parietal AP changes in MA and MD were insignificant. During orthodromic tachycardia the decrease in LV function was less marked and no significant differences in the magnitude of LV output and function changes were found in various localizations of AP, except MA, which was more severely decreased in patients with posteroseptal AP. We conclude, that the alterations in Doppler indices of LV output and function are related to the localization of AP during AV reentrant tachycardia and regular sinus rhythm.
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PMID:Correlations between the localization of accessory atrioventricular pathway and Doppler indices of left ventricular output and function in patients with Wolff-Parkinson-White syndrome. 137 20

In an open pilot study, the authors tested whether the nonpeptide glycoprotein (GP) IIb/IIIa antagonist tirofiban, a highly effective and selective blocker of platelet aggregation, prevents the transition of ischemic brain tissue into the infarct proper as defined by MRI (perfusion-weighted/T2-weighted) in patients with acute ischemic stroke. The infarct volume (T2 lesion after 1 week) was smaller in treated patients (n = 10) compared with matched control subjects (n = 10; p = 0.029) with similar initial perfusion deficit (TTP-maps). The authors conclude that GP IIb/IIIa antagonists have therapeutic potential in acute stroke therapy.
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PMID:Ischemic brain tissue salvaged from infarction by the GP IIb/IIIa platelet antagonist tirofiban. 1183 55

Thrombotic thrombocytopenic purpura is a rare complication of ticlopidine treatment. This syndrome has been reported to occur typically within the first few weeks after the initiation of therapy. The authors describe a case of a 72-year-old woman in whom thrombotic thrombocytopenic purpura developed just 2 days after starting ticlopidine therapy for a new-onset ischemic stroke. The patient responded successfully to plasmapheresis. The authors are reporting this case to emphasize the unpredictable nature of the association between the drug and the disease, which necessitates careful hematologic monitoring.
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PMID:Ticlopidine-associated thrombotic thrombocytopenic purpura. 1197 97

Thrombotic thrombocytopenic purpura (TTP) is an uncommon but severe disorder that classically presents with microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and fluctuating neurological changes. Previously, it was impossible to make a diagnosis of TTP in the absence of thrombocytopenia or microangiopathic hemolysis (MAHA). We describe two cases of relapsing TTP that presented with acute cerebrovascular accident (CVA) without concurrent thrombocytopenia or MAHA after initial classical presentation of TTP. In both cases, the diagnosis of TTP as the cause of the CVA was attributed to severe deficiency of the von Willebrand factor cleaving protease, ADAMTS13 in plasma (11 and 12%, normal 79-127%). Each patient had a dramatic clinical improvement in response to therapeutic plasma exchange. The experience in these two cases suggests that TTP should be considered as a potential cause among patients presenting with a CVA, particularly if the patients have a history of TTP.
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PMID:Relapsed thrombotic thrombocytopenic purpura presenting as an acute cerebrovascular accident. 1527 97

Thrombotic thrombocytopenic purpura (TTP) is an autoimmune disorder characterised by thrombocytopenia, haemolytic anemia, fluctuating neurological deficits, fever, and renal impairment. This case report is about a young man who presented with acute onset right sided paralysis, dysarthria, and central facial paralysis, suggestive of cerebrovascular accident, but eventually diagnosed as TTP. In addition, the clinical presentation of TTP is discussed and some teaching points for the emergency physicians are emphasised.
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PMID:Thrombotic thrombocytopenic purpura mimicking acute ischemic stroke. 1692 Oct 72

The natural vitamin E tocotrienol (TCT) possesses biological properties not shared by tocopherols (TCP). Nanomolar alpha-TCT, not alpha-TCP, is potently neuroprotective (JBC 275:13049; 278:43508; Stroke 36:2258). The report that the affinity of TTP to bind (alpha-TCT is an order of magnitude lower than that for alpha-TCP questions the bioavailability of orally taken TCT to tissues. Oral supplementation of TCT for 3 years in nine generations of female and male rat was studied. Ten vital organs were examined. To gain insight into the turnover of alpha-TCT in tissues, a subset of supplemented rats was moved to vitamin E deficient diet for 7 weeks. Orally supplemented alpha-TCT was delivered to all vital organs including the brain and spinal cord in significant amounts. In organs such as the skin, adipose and gonads the maximum level of alpha-TCT achieved in response to supplementation was folds higher than baseline values of alpha-TCP in rats maintained on laboratory chow. Females had higher levels of alpha-TCT compared to matched tissues of corresponding males. To gain insight into how quickly alpha-TCT is metabolized in the tissues, washout of alpha-TCT from vital organs was examined. alpha-TCT accumulated in vital organs over more than 2 years was almost completely lost in less than 2 months when the supplementation was stopped. This is in sharp contrast with findings related to alpha-TCP retention. The ability of long-term oral supplementation to maintain and elevate alpha-TCT levels in vital organs together with the rapid elimination of the intact vitamin from all organs studied underscores the need for continuous oral supplementation of TCT.
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PMID:Natural vitamin E alpha-tocotrienol: retention in vital organs in response to long-term oral supplementation and withdrawal. 1698 3

Ischaemic stroke in thromboembolic mechanism may be a first sign of neoplastic disease, as in the presented case of a 56-year-old woman. Progressive trombocytopenia, anaemia with reticulocytosis and schistocytes in peripheral blood smear, elevated serum LDH activity as well as coexisting myocardial infarction initially suggested Moschcowitz syndrome. However, plasma exchange did not improve her neurological status and D-dimer values increase in subsequent evaluations indicated chronic DIC. At the same time, on transesophageal echocardiography, thrombotic endocarditis was diagnosed. Screening for cancer showed high CA 125 marker and chest computed tomography revealed lung tumor, not visible on earlier chest X-ray. In further treatment she underwent palliative radiotherapy and continued low molecular weight heparin. The neoplastic process had an unfavorable course and she died after four months. The authors point out that in case of multifocal ischaemic stroke and coexistent thrombocytopenia, neoplastic hypercoagulable state and thrombotic endocarditis should be considered.
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PMID:[Multifocal ischaemic stroke and myocardial infarction in a woman with occult lung cancer complicated with chronic DIC and thrombotic endocarditis]. 1719 80

Thrombotic thrombocytopenic purpura (TTP) has been recognised as an entity since 1924, and haemolytic uraemic syndrome (HUS) since 1955. The disease processes have generated new interest during the past two decades, and much progress has been made both in understanding and treating these diseases. They are best thought of as part of the same disease spectrum, characterised by thrombocytopenia and microangiopathic haemolytic anaemia on the blood film. We present a patient with HUS/ TTP who developed the macroangiopathic thrombotic complications of coronary occlusion causing myocardial infarction, and cerebral artery occlusion causing massive stroke. To our knowledge, this is the first published report of macroangiopathic complications of this condition.
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PMID:An unusual case of vascular catastrophe. 1722 73

Thrombotic microangiopathy (TMA) is a rare disorder characterized by microvascular thrombosis. TMA has been reported in patients with antiphospholipid antibodies and/or antiphospholipid syndrome but its pathogenesis is not clarified. We present two patients with TMA associated with IgG phosphatidylserine dependent antiprothrombin antibodies (aPS/PT). CASE 1: A 44-year-old Japanese female with systemic lupus erythematosus (SLE) and positive lupus anticoagulant (LA) was started on ticlopidine after having stroke. Four weeks later she developed TMA. IgG/M/A anticardiolipin antibodies (aCL) were negative, but strong positive IgG aPS/PT were detected. CASE 2: A 32-year-old Russian female with SLE was admitted because of hypertension, renal insufficiency and proteinuria at 14 weeks of pregnancy. She developed TMA after surgical abortion. IgG aPS/PT and LA were strongly positive but IgG/M/A aCL were negative. Neither case had von Willebrand factor cleaving protease (ADAMTS-13), suggesting that TMA in those patients was associated with thrombophilia rather than insufficient ADAMTS-13. Both patients were successfully treated with a series of plasma exchange.
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PMID:Thrombotic microangiopathy in patients with phosphatidylserine dependent antiprothrombin antibodies and antiphospholipid syndrome. 1832 60

Thrombotic thrombocytopenic purpura (TTP) has a varied clinical presentation with possibly rapid deterioration. Neurological involvement in TTP is common. A 75-year-old woman with TTP presented with diffuse ischemic stroke and fatal multi-organ damage following bacterial infections. Coexisting bacterial infection, cardiac dysfunction and diffuse cerebral infarction may be poor prognostic factors for TTP patients.
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PMID:Fatal thrombotic throbmocytopenic purpura coexisting with bacterial infection: a case report. 1856 27


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