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

Approximately 15% of ischemic strokes are the result of an embolism from a cardiac source. Patients with nonvalvular atrial fibrillation, acute myocardial infarction, ventricular aneurysm, rheumatic heart disease, prosthetic heart valves and other less common cardiac disorders are at an increased risk for cardioembolic stroke. Clinicians must distinguish cardioembolic from atherosclerotic strokes to provide unique management for each patient. The nurse plays a dynamic role in diagnosis, education and treatment of patients at risk or who have had a stroke from a cardiac source. Knowledge of the pathophysiologic mechanisms and treatment options is essential for the nurse to adequately manage patient care.
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PMID:Cardioembolic stroke. 160 74

Appreciation of metaphoric and nonmetaphoric alternative word meanings was assessed in 19 aphasic, left (LHD) and 15 non-aphasic, right (RHD) hemisphere brain-damaged stroke patients. With the one exception in the aphasic group, all patients were male. In an unspeeded sorting task, subjects responded on the basis of less frequent, alternative meanings of polysemous target words. Targets were either polysemous adjectives (e.g. "warm") having metaphoric alternative meanings (loving) or polysemous nouns (e.g., "pen") having non-metaphoric alternative meanings (writing implement, cage). Both patient groups performed worse overall than a group of nonbrain-damaged control subjects. Relative to the RHD patients, LHD patients showed a spared appreciation of metaphoric alternative meanings. In addition, LHD, but not RHD, patients performed better on metaphoric adjective trials when there was high similarity between a word's dominant and (metaphoric) alternative meaning. The results suggest a pervasive insensitivity of RHD patients to alternative interpretations of linguistic units, and a special role for the intact right hemisphere in lexical-semantic processes related to metaphor comprehension.
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PMID:Appreciation of metaphoric alternative word meanings by left and right brain-damaged patients. 169 80

We studied the pattern and outcome of strokes in 200 Saudi patients. Cerebral infarction constituted 87% of strokes, subarachnoid hemorrhage 4.5%, cerebral hemorrhage 6.5%, and venous infarction 2%. The vessel most commonly involved was part or all of the middle cerebral artery, constituting 52% (90) of the 174 arterial infarcts. Lacunar infarcts were seen in 21% (37) of the patients with arterial infarcts. Among all 200 patients, 8% died and 8% had secondary generalized seizures. Hypertension occurred in 41% of the 174 patients with arterial infarcts and 62% of the 13 with cerebral hemorrhages. The highest incidence of hypertension as a risk factor was among those with lacunar infarcts (81%), ganglionic cerebral hemorrhages (80%), and infarcts of deep branches of the middle cerebral artery (57%). Embolic infarcts due to rheumatic heart disease constituted 11% of all arterial infarcts. We conclude that our pattern of strokes is similar to that of the west rather than that of the Japanese, but with less frequent arteriovenous malformations and aneurysms.
Stroke 1991 Sep
PMID:Cerebrovascular disease in Saudi Arabia. 192 60

In addition to a working knowledge of general complications such as thromboembolism and infective endocarditis, optimal care of the patient with a prosthetic valve requires specific knowledge concerning the characteristics of a given patient's prosthesis. This may need to include the ability to identify the valve roentgenographically when history and records are unavailable. A 53-year-old woman with mitral stenosis secondary to rheumatic heart disease and status post a reported Bjork-Shiley mitral valve (MV) replacement 17 years prior to hospital admission was referred for evaluation of severe hemolytic anemia. Previous cinefluoroscopy in 1986 at the time of a cerebrovascular accident revealed a normally functioning caged disc prosthesis and not the tilting disc of a Bjork-Shiley prosthetic valve. The valve was not further characterized and she continued receiving warfarin therapy until May 1989 when she presented with laboratory findings showing a marked hemolytic anemia with a hemoglobin of 6.5 mg/dl and lactate dehydrogenase (LDH) value of 2100 IU. Echocardiography revealed normal valvular function without evidence of perivalvular leak. The patient was referred for further evaluation with chest roentgenogram at the time of hospital admission revealing a valve configuration characteristic of the Beall model 103/104 series that has been found to manifest progressive disc variance with a high degree of hemolytic anemia (despite normal noninvasive evaluation of MV function), disc tilting with intermittent regurgitation, and catastrophic disc embolization in extreme cases. The precise identification of valvular prosthesis in patients after valve replacement is crucial for optimal management. As in our case, the mere identification of a particular valve may necessitate certain management and therapy based on the natural history of that valve. In the absence of reliable history and/or records, the roentgenographic examination should lead to the precise identification.
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PMID:Progressive hemolytic anemia due to delayed recognition of a Beall mitral valve prosthesis. 198 16

Fifty-two patients with a mean age of 67.6 years underwent coronary artery bypass plus mitral valve replacement from 2 April 1984, through 6 February 1989. All but four of these 25 males and 27 females were in the New York Heart Association Functional Classes III and IV, with presenting symptoms of angina and/or dyspnea. Twenty-four patients (44.2%) presented with acute myocardial infarctions, and eleven patients (21.2%) had a past history of rheumatic fever or rheumatic heart disease. Forty-five patients (86.5%) had a diagnosis of coronary artery disease plus mitral regurgitation. Treatment included a mean of 2.3 bypass grafts per patient plus mitral valve replacement with Carpentier-Edwards (41), St. Jude (10), and Bjork-Shiley (1) prostheses. The four operative deaths (7.7%) were attributed to congestive heart failure (1), mediastinal bleeding (1), mediastinitis (1), and stroke (1). There were eight late cardiac deaths (16.7%) and six late noncardiac deaths (12.5%), a mean of 16.6 and 18.9 months postoperatively, respectively. Thirty-four patients have survived from 10 to 65 (mean 33.7) months postoperatively with a mean New York Heart Association Functional Class 1.6. Follow-up determination of patients' attitudes toward their surgery was ascertained in 28 of the 34 survivors, and 26 (92.8%) patients indicated that they were pleased with their surgery. These results compare favorably with data reported in the recent literature. In addition, the study shows that patients requiring supportive treatment in a critical care unit preoperatively had the same operative mortality but more postoperative complications and a longer mean hospital stay than the equal number of patients who were not in a critical care unit preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Coronary artery bypass plus mitral valve replacement. A five-year study. 228 98

Average heights of adults and children in the counties of England and Wales were examined using national samples of people born between 1920 and 1970. Although height increased over this 50-year period the differences between counties persisted. Average height in a county is closely related to its pattern of death rates, which were derived from all deaths during 1968-78. Counties with taller populations have lower mortality from chronic bronchitis, rheumatic heart disease, ischaemic heart disease and stroke, and higher mortality from three hormone-related cancers, of the breast, prostate and ovary. The inverse relation of height with bronchitis and cardiovascular disease is further evidence of risk factors acting in early childhood. The positive relation between height and cancers of the breast, ovary and prostate could suggest that promotion of child growth has disadvantages as well as benefits.
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PMID:Height and mortality in the counties of England and Wales. 884 13

Chronically elevated blood pressure predisposes to stroke through effects on the extracranial and intracranial cerebral vessels. Hypertension-associated disease of small-diameter penetrating cerebral arteries may produce either lacunar infarction or intracerebral hemorrhage. The role of hypertension in the pathogenesis of atherothromboembolic cerebral infarction must be questioned in view of the evidence that antihypertensive therapy does not prevent myocardial infarction. Hypertension, in the absence of rheumatic heart disease, is frequently associated with atrial fibrillation. The incidence of stroke due to embolization of thrombus from the fibrillating left atrium of the nonrheumatic heart may have been overestimated in the past. Ideally, investigation of the patient who has had a stroke should include a brain-imaging study and a cerebral arteriogram. In practice, however, arteriography cannot always be justified. Treatment of the completed stroke is unsatisfactory but tissue plaminogen activator and calcium-channel blockers hold promise for cerebral infarction. Surgical decompression of the posterior fossa can be life-saving in cases of cerebellar infarction or hemorrhage. In patients with cerebral infarction, aspirin has been shown to reduce the incidence of stroke recurrence.
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PMID:Pathogenesis, diagnosis, and treatment of hypertension-associated stroke. 266 72

The cardiac status of 102 consecutive black stroke patients entered to the Medunsa Stroke Databank was determined. Cardiological examination, echocardiography and a gated blood pool scan revealed structural and/or functional cardiac abnormalities in 73.6% of patients. Rheumatic heart disease was diagnosed in 15.6%, mitral valve prolapse in 5.8% and mitral annulus calcification in 4.9% of cases. 'Possible' cardiac sources of cerebral embolism were detected in 22.5% and 'definite' sources in 23.5% of patients. Hypertensive heart disease was diagnosed in 35.2% and cardiomyopathy in 13.7% of the study population. Ischaemic heart disease was present in 6.86%. Ultrasonography revealed ventricular bands in 29.4% of patients. The high incidence of structural cardiac abnormalities detected by non-invasive means is in keeping with recent studies in white stroke patients.
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PMID:The cardiovascular status of the black stroke patient. 268 43

The pattern of cerebrovascular disease in North-West India has been studied in a necropsy series of 362 cases over a 14 year period. One hundred and thirty eight cases of intracranial haemorrhage were found, 89 of cerebral embolism, 101 of cerebral arterial thrombosis and 34 of cerebral venous thrombosis. Nearly 37% of the affected patients were below 40 years of age. Cerebral embolism and cerebrovenous thrombosis were important causes of stroke in the young. Rheumatic heart disease and infective endocarditis formed the major causes of cerebral embolism. Cerebral venous thrombosis associated with pregnancy and puerperium was relatively more common in our series than has been reported in the West.
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PMID:Cerebrovascular disease in north-west India: a study of necropsy material. 273 94

Atrial fibrillation is associated with an increased risk of stroke. Different risk factors may be of importance regarding stroke incidence and mortality in atrial fibrillation. Retrospectively, we studied 786 patients with chronic atrial fibrillation, 229 with rheumatic heart disease and 557 without. In all, 127 patients had stroke (16%). Using Cox's proportional hazard model for failure-time data with age, gender, etiology, degree of heart failure and cardiac enlargement as explanatory (independent) variables, only etiology (rheumatic heart disease) was a significant risk factor for stroke (P less than 0.006). Significant risk factors for death in 653 patients without stroke were age (P = 0.000) and congestive heart failure at the onset of atrial fibrillation (P = 0.000). The need to identify other risk factors for stroke in patients with atrial fibrillation is emphasized, for selecting patients at high risk for prophylactic treatment with anticoagulants or aspirin.
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PMID:Risk factors for stroke in chronic atrial fibrillation. 296 47


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