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

Fifty six patients aged 17 to 45 years who had Ischemic Cerebral Infarction (I.C.I.) were studied. The following etiologies were established: 1. Juvenile atherosclerosis (21 patients); 2. Cerebral embolism either from cardiac (10 patients) and from unknown source (3 patients); 3. Secondary coagulopathies (4 patients); 4. Non atherosclerotic vasculopathies (6 patients); 5. Traumas of skull and neck (3 patients); 6. Migraine (2 patients); 7. Oral contraceptives use (1 patient). In 6 cases the etiology remained unknown. Young subjects with I.C.I. are a heterogeneous group: however in most of them a reasonable cause can be found. The occurrence of acute death (14%) was high, while recurrent stroke (5%) and non acute death (3%) were rare when compared to older patients. At the follow-up 80% had a very little residual motor deficit but only 43% were able to return to previous work.
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PMID:Ischaemic cerebral infarction in young adults. 236 Apr 74

The association between migraine and stroke is well known. It is assumed that 15% of strokes in patients below 45 years are due to migraine. To evaluate the features of this association, we have reviewed seven cases of patients with migraine and established neurological deficits. All patients fulfilled the following criteria: 1) past history of migraine, defined on the basis of the classification by the International Committee for the Classification of Headache; 2) temporal association between a migraine episode, similar to previous ones, and the ischemic episode, and 3) absence of other concomitant diseases that might result in stroke. We evaluated the age at the onset of migraine, its type, familial history of migraine (particularly of migrainous accompaniments), vascular risk factors, mode of onset, and type and duration of neurological deficit. In all cases, cranial CT, EEG, echocardiogram, serologic tests for syphilis, autoantibody investigation, routine laboratory tests and nuclear magnetic resonance (in four patients). In five cases cerebral arteriography was carried out, and arterial occlusion was demonstrated in one. We conclude that, in spite of its low frequency, migraine may result in cerebral ischemic episodes, although the relevant pathogenetic mechanisms are not yet well understood.
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PMID:[Complicated migraine: a study of 7 cases]. 236 Oct 51

Lupus anticoagulants and anticardiolipin antibodies are antiphospholipid antibodies (APLAb) with related antigenic specificities and are newly recognized markers for an increased risk of thrombosis. We studied 48 patients who presented with cerebral or visual dysfunction associated with APLAb to help clarify the diagnostic, clinical, laboratory, radiologic, and pathologic features in these patients. Most patients presented with transient cerebral ischemia or cerebral infarction. Recurrent and stereotypic events were frequent. Visual disturbances resulted from amaurosis fugax, retinal arterial or venous occlusion, occipital ischemia, diplopia, and migraine-like disturbances. Three patients presented with severe atypical classic migraine. Recurrent infarcts of brain and eye were significantly associated with the presence of cigarette smoking, hyperlipidemia, and a positive antinuclear antibody. During 44.4 patient-years of prospective follow-up, the combined stroke and systemic thrombotic event rate was 0.27 events per patient-year and was 0.54 events per patient-year if TIA and death were included. Forty (83%) of the patients did not have systemic lupus erythematosus (SLE). Thrombocytopenia was present in 15 (31%) and a false-positive VDRL in 11 (23%) of the patients. Cerebral angiography was normal or revealed large-vessel occlusion or stenosis without changes suggestive of vasculitis. Patients with only transient dysfunction generally had normal radiologic studies, including angiography. Organs and arterial vessels studied pathologically revealed thrombotic occlusive disease without vasculitis. APLAb are strongly associated with an immune-mediated thrombotic tendency, generally in the absence of SLE. Other stroke risk factors may add to the risk of recurrent ischemic events in patients with APLAb.
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PMID:Cerebrovascular and neurologic disease associated with antiphospholipid antibodies: 48 cases. 238 25

In some forms of cerebrovascular disease, such as intracranial hemorrhage, headaches are well known as a prominent symptom and often are a valuable clue to diagnosis. There are difficulties, sometimes, in distinguishing between a small subarachnoid hemorrhage and a severe migraine headache, but these can be resolved using clinical observations, CT scan, and lumbar puncture. It seems less well known that headaches may accompany or precede cerebral thrombosis and embolism. When these headaches are recognized as a forerunner to stroke, they may allow an opportunity for preventive treatment.
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PMID:Headache as a symptom of cerebrovascular disease. 252 Mar 91

Sixty-one consecutive patients, less than or equal to 40 years old, were hospitalized for cerebral infarction between 1977 and 1985. Evaluation included computed tomographic brain scan, arteriography, echocardiography, and blood tests. A probable migrainous infarction was diagnosed in six patients (10%) (all women with a history of migraine) who survived the initial stroke and were followed-up for an average of four years. In five patients the stroke occurred during a common migraine attack and in one patient during a classic migraine attack. The site of infarction was invariably the occipital lobe. During the follow-up, no subject had a further stroke. All six women had a permanent hemianopic deficit.
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PMID:Ischemic stroke in young adults: the relevance of migrainous infarction. 261 82

A 50-year-old woman with migraine was admitted to hospital shortly after having abruptly developed hemiparesis. CT scan revealed infarction in the territory of the right middle cerebral artery. Death ensued after three days due to cerebral edema with herniation. Autopsy revealed no pathologic findings in the heart or in the extra- or intracranial arteries. It is suggested that the fatal stroke may have resulted from arterial spasm caused by ergotamine overdosage and possibly complicated by thrombosis.
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PMID:Fatal stroke in migraine: a case report with autopsy findings. 261 86

The case of a "young stroke" affecting a 22 years old man is reported. Essential clinical features were drowsiness, headache, motor aphasia, right hemiparesis and Claude-Bernard-Horner in the left eye. An extensive investigative protocol was carried out which revealed an occlusion of the intracranial left ICA with subsequent recanalization. The possible causes of the stroke (migraine, dissection or combination of both) are discussed and the importance of a complete evaluation of patients of this kind is stressed.
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PMID:A case of "young stroke" with ICA intracranial occlusion: pathogenetic implication for dissection in migraine. 263 67

Pulsatile blood flow within the normal carotid sinus involves at least two distinct components. That near the flow divider is laminar and antegrade, whereas a boundary layer separation zone in the posterolateral aspect exhibits transient blood flow reversal. It is now possible to document these flow velocity components using pulsed Doppler ultrasound methods. When atherosclerosis develops, it preferentially involves the posterolateral bulb region, obliterating the normal configuration of the sinus with consequent loss of the flow separation zone. It was therefore hypothesized that if flow separation could be detected, it should be predictive of a normal angiogram. To assess this, we evaluated 20 symptomatic patients and two with only bruits found by duplex scanning to have flow separation in either one or both carotid bulbs and who also underwent cerebral angiography. Initial diagnoses were stroke in seven, reversible ischemic neurologic deficit in one, transient ischemic attack in 12, and bruit in two. Flow separation was bilateral in 13 patients (59%). There were 15 patients with symptoms in the territory of a carotid bulb exhibiting flow separation. By angiography, of the 35 bulbs with boundary layer separation, 27 (77%) were normal, with the remainder showing lesions that reduced the diameter of the vessel by 20% or less. Final diagnoses of the 15 patients with symptoms ipsilateral to a carotid sinus exhibiting flow separation were fibromuscular disease in two, lacunar stroke in three, dissection in two, subclavian steal in one, cardiogenic embolus in three, migraine in one, hyperventilation syndrome in one, kink of the mid-internal carotid artery in one, and no diagnosis in one.(ABSTRACT TRUNCATED AT 250 WORDS)
Stroke 1989 Feb
PMID:Diagnostic significance of flow separation in the carotid bulb. 264 91

Vascular headaches are among the most prevalent yet poorly understood problems in clinical neurology. Headaches may develop in association with hypertension, seizures, stroke or without a recognizable pathophysiology such as during migraine and cluster headaches. Cephalic blood vessels (pial and dural vessels) are implicated as the most important source for all headaches and are innervated by sensory fibers which arise from ganglia innervating the forehead, scalp and neck. Sensory fibers contain vasoactive neuropeptides which become released from peripheral (perivascular) and central terminations to mediate vasodilation and pain, respectively. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The presence of vascular headache implies activation of this final common pain pathway which we have termed the trigeminovascular system. The existence of such a system a) clarifies certain pain patterns which develop following stimulation of cephalic blood vessels, b) suggests a mechanism to explain the referral of pain to the forehead, c) provides a mechanism to explain the action of certain antimigraine drugs, d) suggests a local mechanism which enhances blood flow under certain pathological conditions. Hence, this review will update existing knowledge about the trigeminovascular system and its role in headache pathophysiology.
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PMID:Pain mechanisms underlying vascular headaches. Progress Report 1989. 266 74

Mitral valve prolapse (MVP), the most frequently encountered valvular condition in the population, has been reported in an increasing variety of neurologic, muscular, and psychiatric disorders during the last twelve years. Extensive review of reports indicates this has resulted from observations of either (1) inordinate incidence of MVP in well-defined neurologic entities or (2) development of neurologic or ophthalmologic complications attributed to MVP. In the review presented, basis is found for categorizing MVP by its association with (1) well-defined, genetically determined neurologic disorders; (2) disorders characterized by structural abnormalities, many genetically determined, or inflammatory processes of connective tissues; (3) "mechanical" prolapse resulting from disproportion of mitral valve annulus and left ventricular size, which is, at times, reversible; and (4) a generally asymptomatic state that, at times, is associated with ischemic, thrombotic, embolic, and infectious disorders of the brain and eye. The paradox between the large number of persons with MVP in the general population who remain healthy and a subpopulation of patients with complications of MVP (eg, stroke) or other entities has been identified. A second paradox is found between the well-known increased incidence of MVP, especially in young patients with stroke, and the apparent rarity of stroke among patients with both common (eg, migraine) and unusual (eg, myotonic dystrophy) neurologic entities in which an extraordinary high prevalence of MVP is known to exist.
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PMID:Neurologic aspects of mitral valve prolapse. 266 5


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