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

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception, (II) spatial attention, (III) visuospatial processing, and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.
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PMID:To drive or not to drive: neuropsychological assessment for driver's license among stroke patients. 772 76

The comparative study of the efficacy of coumadin and aspirin in primary cardioembolic stroke prevention of chronic rheumatic heart disease (mitral stenosis) with atrial fibrillation was conducted at Siriraj Hospital, Mahidol University, Bangkok, Thailand. Seventy-nine patients were enrolled in the trial. Allocation of patients into coumadin or aspirin groups depended upon the patients' choice. Nineteen patients were given coumadin at the adjusted dosage to maintain the therapeutic range of International Normalised Ratio between 1.5-3. Sixty patients were given aspirin at the fixed dosage of 75 mg per day. Six patients were lost to follow-up over the 3 yr period; four in the aspirin group and 2 in the coumadin group. There were three patients with nonfatal cardioembolic stroke in the aspirin group but none in the coumadin group after three years of follow-up. Six patients had mitral valve replacement during the study (i.e. three patients in each group). There were complications in 12 patients, 10 in the aspirin (16.6 per cent) and 2 in the coumadin (10.5 per cent) group. The complications in coumadin group were minor bleeding over the thigh in one patient and generalised ecchymosis over the whole body in one other. In the aspirin group, the complication was gastrointestional symptoms, mainly epigastric pain, but no frank bleeding was observed. Primary prevention of cardioembolic stroke in chronic rheumatic heart disease was found to be more effective with coumadin than aspirin. Our study does not support the use of aspirin in primary prevention of cardiac embolism in chronic rheumatic heart disease.
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PMID:A comparative study of coumadin and aspirin for primary cardioembolic stroke and thromboembolic preventions of chronic rheumatic mitral stenosis with atrial fibrillation. 779 24

Atrial fibrillation is the most common sustained cardiac arrhythmia encountered in clinical practice. Atrial fibrillation increases with age and is relatively common (> 5%) in patients > 69 years old. Despite this, our understanding of the underlying electrophysiologic mechanisms and the optimal management remains incomplete. This arrhythmia is seen most frequently in association with coronary disease or hypertension, but it is also frequently a consequence of rheumatic heart disease. The mechanism of atrial fibrillation requires further elucidation, but the most widely accepted hypothesis is a multiple reentrant wavelet mechanism. The treatment of atrial fibrillation is undertaken to reduce the risk of stroke or systemic embolus, to control palpitation or other symptoms or to improve exercise tolerance or treat pulmonary congestion. This report is a discussion of the epidemiology of atrial fibrillation and of the etiology, mechanism, management and future research directions in the study of this arrhythmia.
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PMID:Atrial fibrillation: current understandings and research imperatives. The National Heart, Lung, and Blood Institute Working Group on Atrial Fibrillation. 790 70

When atrial fibrillation (AF) complicates rheumatic heart disease, the risk of stroke is 17 times that of patients in sinus rhythm and full anticoagulation is mandatory. Non-rheumatic AF carries a lower risk--5% per annum, a 5-fold increase. Four major trials (SPAF, AFASAK, BAATAF, CAFA) have lately examined thromboembolic prophylaxis in this group of patients. These randomized prospective open studies showed a 56-86% reduction in stroke and systemic embolism in patients receiving full anticoagulation compared with placebo. In older people, the BAATAF trial of low-dose warfarin (INR = 1.5-2.7) showed an 86% reduction in stroke and a significant reduction in mortality. In all 4 studies the incidence of hemorrhagic complication was very low (0.5%). In SPAF trial, aspirin, 325 mg/day was found to be effective, but this was not the case in AFASAK, which used 75 mg/day and had an older population. In a double-blind randomized trial indobufene, 100 mg bid, was found effective in the 67% reduction of stroke, systemic and pulmonary embolism in patients with various cardiac diseases in AF or in sinus rhythm. Consequently, a reasonable policy would be to give full or low-dose anticoagulation to those patients with chronic AF who have structural heart disease or are over 65 years old; to consider low-dose anticoagulation or aspirin or indobufene in younger patients with chronic lone AF; and to give indobufene or aspirin or nothing to those with episodes of paroxysmal AF lasting hours only. In borderline cases, the use of transesophageal echocardiography to exclude left atrial thrombus and spontaneous echo contrast may aid decision-making.
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PMID:[Atrial fibrillation: embolic risk and prevention]. 802 31

Atrial fibrillation is the second most common arrhythmia after ventricular premature beats. For years, prophylactic anticoagulation has been recommended in patients with atrial fibrillation in underlying rheumatic heart disease. With the aim of establishing the risk of embolism in non-rheumatic atrial fibrillation, and the justification for prophylactic anticoagulation therapy, five prospective studies were carried out. The results obtained indicate that all patients with chronic atrial fibrillation should receive anticoagulation therapy wherever possible (INR 2.0 to 3.0). The sole exception are patients aged under 55 years with no other organic heart disease. For this group, the risk of a stroke is appreciably reduced, so that treatment with ASA suffices.
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PMID:[Anticoagulation in non-rheumatic atrial fibrillation. Recommendations based on five prospective studies]. 814 16

While in the past, rheumatic heart disease accounted for the largest number of pregnant women with heart disease, the incidence has declined over the years. On the other hand, because of advances in medical treatment and surgical management, the ratio of adolescent females with congenital heart disease increased significantly during the last decade. Pregnancy is associated with many physiologic adjustments such as changes in blood volume, stroke volume, and cardiac output, and may result in deleterious clinical effects in patients with congenital heart disease. Although a good outcome for these women can often be expected, congenital heart disease still presents a high-risk pregnancy involving both mother and infant. The actual risk depends on the type of malformation and functional impairment of the mother. To bring these women safely through pregnancy, a strong cooperation between pediatric and adult cardiologists, obstetrician, and other physicians is necessary.
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PMID:[Pregnancy and congenital heart failure]. 817 44

Proportion and causes of brain infarction among young persons may differ between Western world and developing countries, which may require different diagnostic and treatment strategies. We compared a Thai series of 56 hospitalized brain infarct patients younger than 50 years (16% of 357 similar patients from all ages) with a series of 55 Dutch patients (8% of 694 patients). The Thai patients had 12% (95% confidence interval: 3-21) more often a cardioembolic stroke cause, due to a higher frequency of rheumatic heart disease in the Thai series. The percentage of patients with atherothrombotic stroke cause was higher in the Dutch series, whereas the percentage of those with hematologic abnormalities, or those with vasculopathies did not differ. Patients in the Thai series had 17% (95% confidence interval: 7-27) more often an unidentified stroke cause, which was probably related to less extensive ancillary investigations compared with the Dutch series. We conclude that especially centers in developing countries that treat young stroke patients should be supplied with ancillary testing facilities, such as cardiac echo, carotid ultrasound, and some laboratory facilities. Early treatment of infections, especially acute rheumatic fever, could lower the incidence of stroke in the young.
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PMID:Brain infarct causes under the age of fifty: a comparison between an east-Asian (Thai) and a western (Dutch) hospital series. 824 62

Few papers on alteration of whole blood viscoelastic properties in patients with congestive heart failure (CHF) have been reported. In this study viscoelastic property parameters were measured in 63 consecutive patients with rheumatic heart disease and CHF. All subjects were divided into four groups according to NYHA classification of heart function. There were 14 class I, 16 class II 20 class III and 13 class IV. Contraves low-shear-30 rheometer was used for measuring the viscoelastic parameters. The results demonstrated that there was no significant difference of these parameters between class I and class II, that the apparent viscosity, AI and eta' in class III were higher than those in class I, and that eta 0.512, eta 5.96 AI, eta', eta" and G' in class III were higher than those in class II. All viscoelastic parameters but eta p in class IV were markedly higher than those in other groups. However, there were no statistically significant difference of eta p among all subjects and nor significant difference of these parameters between male and female were noted. There was a negative correlation between viscoelastic parameters and heart function parameters by pulse Doppler echocardiography (peak flow velocity, stroke volume and cardiac output). The results also showed a significant direct correlation between eta 0.512 AI, and eta" and the heart function parameters mentioned above.
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PMID:[Viscoelastic property alterations in patients with rheumatic heart disease and congestive heart failure]. 828 95

Oral anticoagulation in patients with rheumatic heart disease for prevention of systemic thromboembolism is accepted clinical practice. The incidence of stroke in patients with nonrheumatic atrial fibrillation is about five times the rate of patients in sinus rhythm. However, contradictory findings in several small retrospective studies have precluded determination of a gold standard for patients with nonrheumatic atrial fibrillation so far. Recently, the results of five prospective, placebo-controlled studies in patients with nonrheumatic atrial fibrillation treated with anticoagulation have been published. A consistent risk reduction of thromboembolism ranging from 37 to 87% in patients treated with warfarin was reported. This risk reduction occurred in excess of a relatively low incidence of intracerebral and/or fatal bleeding complications. The efficacy of prevention of thromboembolism was comparable for high intensity anticoagulation (International Normalized Ratio (INR) 2.8-4.2) and low dose anticoagulation (INR 1.5-2.7). However, fatal and/or intracerebral bleedings only occurred with INR > or = 2.6. In subgroup analysis, recent congestive heart failure, arterial hypertension, and previous apoplex or arterial thromboembolism were independent clinical predictors of increased risk for thromboembolism, whereas results in patients with chronic and intermittent atrial fibrillation were comparable. In 69 patients with lone atrial fibrillation, no single event occurred in the follow-up period. Thus, lone atrial fibrillation does not seem to carry an increased risk for stroke when strict criteria for diagnosis of lone atrial fibrillation are applied. In two of the five studies, aspirin was additionally randomized. Since contradictory findings resulted, the role of aspirin for prophylaxis of stroke still needs to be determined.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Oral anticoagulation for prevention of thromboembolism in non-rheumatic atrial fibrillation: indications, effectiveness and risk]. 829 Dec 87

The availability of basic and reliable data on cardiovascular problems in Africans is limited and this hinders the presentation of a comprehensive review of the subject. Nevertheless, there is a strong suggestion that the spectrum and pattern of cardiovascular disorders in Africa is rapidly becoming indistinguishable from that observed in developed countries. The classic risk factors appear to be on the rise and smoking may attain levels equal to or exceeding those in many developed countries. Infectious and inflammatory cardiovascular conditions may still be the most common, although limitations in the technology available for accurate diagnosis make this difficult to verify. Rheumatic fever and rheumatic heart disease remain common, and the potential for educational and other preventive strategies is being realized in many countries. Hypertension at frequencies exceeding 5-10% in most rural areas and 12% in most urban areas, together with complications such as stroke, heart failure and renal failure, are leading causes of morbidity and mortality. Hypertension is the major public health problem in most African countries. The cardiomyopathies are a common problem, and the limited availability of specific diagnostic procedures is matched by limited therapeutic options for most Africans. The prevalence of atherosclerosis and coronary artery disease and its complications, such as myocardial infarction and other degenerative disorders, remains low, but the situation is rapidly changing, especially in urban areas where appropriate diagnostic capabilities exist. It is thought that changes or modifications in lifestyle, risk-prone behaviour, diet, cultural attitudes and certain other consequences of rapid urbanization and demographic tendencies largely explain the observed trends.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiovascular disorders in Africa. 830 7


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