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

Lupus anticoagulants (LA) are antiphospholipid serum immunoglobulins generally associated with autoimmune conditions, especially systemic lupus erythematosus (SLE). They have recently been linked to thrombotic events, including stroke. A possible association of migraine with LA is now forwarded with the presentation of two cases and a literature review. Our two patients, both in their forties, had migrainous phenomena without SLE or thrombotic events. Eight other cases were found in the literature, suggesting more than a chance association. Relevance to migraine pathophysiology is discussed and may come from the ability of the LA to alter prostaglandins and platelet activity and to interact with neuronal phospholipids. Further, larger studies are needed to support this association.
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PMID:Migraine and the lupus anticoagulant. Case reports and review of the literature. 311 15

Four patients with recurrent stroke and multi-infarct dementia are presented in whom the dementia was progressive and severe. Three of the patients developed the dementia during the course of an illness which was punctuated by repeated episodes of cerebral infarction demonstrated by computed tomographic (CT) scans. The fourth patient presented with an illness dominated by progressive and deteriorating higher mental functions, which culminated in a major stroke 18 months later. Three patients fulfilled the American Rheumatism Association (ARA) criteria for the classification of systemic lupus erythematosus, the fourth had a 'lupus-like' disease. All had livedo reticularis, severe migraines, and also demonstrated antibodies to phospholipids. All four patients suffered deep vein thromboses.
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PMID:Recurrent stroke and multi-infarct dementia in systemic lupus erythematosus: association with antiphospholipid antibodies. 311 54

A six year randomised trial was conducted among 5139 apparently healthy male doctors to see whether 500 mg aspirin daily would reduce the incidence of and mortality from stroke, myocardial infarction, or other vascular conditions. Though total mortality was 10% lower in the treated than control group, this difference was not statistically significant and chiefly involved diseases other than stroke or myocardial infarction. Likewise, there was no significant difference in the incidence of non-fatal myocardial infarction or stroke--indeed, disabling strokes were somewhat commoner among those allocated aspirin. The lower confidence limit for the effect of aspirin on non-fatal stroke or myocardial infarction, however, was a substantial 25% reduction. Migraine and certain types of musculoskeletal pain were reported significantly less often in the treated than control group, but as the control group was not given a placebo the relevance of these findings was difficult to assess. There was no apparent reduction in the incidence of cataract in the treated group. The lack of any apparent reduction in disabling stroke or vascular death contrasts with the established value of antiplatelet treatment after occlusive vascular disease.
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PMID:Randomised trial of prophylactic daily aspirin in British male doctors. 312 82

Somatosensory evoked potentials (SEP) were investigated in 140 patients suffering from cerebro-vascular ischemic disease (CVD). Data were compared to age-correlated normal persons (n = 26; male 16, mean age 55.6 years SD 10.9). Patients with asymptomatic vascular diseases (n = 10; male 7, mean age 63.8 years SD 10.4) showed bilateral prolonged CCT (left side p less than 0.05). Patients with TIA (n = 44; male 21, 58.3 years SD 12.3), complicated migraine (n = 3, all female, 24, 40, 63 years) and RIND (n = 17; male 10, 56.5 years SD 16.8) showed no abnormalities of CCT and AR as compared to normals. Abnormalities of PHAS were only seen in patients with RIND of the right carotic supply. In patients suffering from completed stroke (n = 40; male 29, mean age 56.9 years SD 14.4) bilateral prolongation of CCT was seen in those with ischemia of the right carotic supply; those with ischemia of the left carotic supply showed a significant asymmetry of CCT and deviation of AR l/r. In two patients with infarction of the pons an increase of CCT and decrease of AR at the side of the lesion was found. Patients with MID (n = 27; male 20, 69.7 years SD 10.3) showed significant bilateral prolongation of CCT, increase of AR (at the side of stimulation) and deviation of AR l/r (1.63).
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PMID:[Early somatosensory evoked potentials in ischemic diseases--II: Normal values and findings in asymptomatic vascular stenoses/occlusions, complicated migraine, transitory ischemic attacks, reversible ischemic neurologic deficit, complete stroke and multi-infarct dementia]. 313 Nov 9

The records of fifteen patients referred for neurological assessment and found to have lupus anticoagulant or elevated anticardiolipin antibodies were reviewed. The mean age for females in the group was 29.4 years and for males was 35. A diagnosis of migraine, either as an acute or chronic problem, was made in 10 (66%) of these patients. Seven of the 15 patients had ischemic stroke and two patients had other thrombotic complications associated with lupus anticoagulant. Three of the nine female patients with migraine had histories of spontaneous abortions. All migraine patients experienced transient or more prolonged neurological deficits with their headaches. An association between lupus anticoagulant and migraine can only be suggested. Data on the incidence of migraine in patients with lupus anticoagulant in the general medical population does not exist. Furthermore the prevalence of lupus anticoagulant in migraine sufferers is unknown. Therefore further studies are required to investigate this possible association.
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PMID:Lupus anticoagulant, antiphospholipid antibodies and migraine. 314 36

To determine the outcome of patients with carotid transient ischemic attacks (TIAs) and normal cerebral angiograms, we assessed 68 patients (40 men, 28 women) aged 24-72 (mean 53.5) years for recurrent TIAs and strokes and for the development of cardiac disease over 2-6 (mean 4.4) years. All but one patient had a follow-up interview in early 1987; that patient had died of an unrelated cause (lung cancer) 18 months after the presenting TIA. The diagnosis was changed at the follow-up interview in three patients (multiple sclerosis, meningioma, migraine). Among the 64 remaining patients, at admission cranial computed tomography had shown cerebral infarction in 11 of 64, two-dimensional echocardiography had been abnormal in nine of 61, Holter monitoring had been abnormal in eight of 45, and twelve-lead electrocardiography had been abnormal in three of 64. Two patients had abnormalities on both echocardiography and Holter monitoring. At the follow-up interview of the 64 remaining patients, TIAs had recurred in nine and three had developed a completed stroke; cardiac disease (angina in seven, myocardial infarction in four) was noted in 11 patients. Findings from cardiac investigations on admission in the nine patients with recurrent TIAs had been abnormal in six and normal in three; all three patients who developed a stroke had had abnormal cardiac findings. Overall, further neurologic or cardiac events occurred in 12 of 46 patients (26%) with normal and in 10 of 18 patients (55.5%) with abnormal findings on admission (p less than 0.01). In the presence of normal angiograms, extensive cardiac investigations may help predict the outcome of patients with TIAs.
Stroke 1988 Oct
PMID:Transient ischemic attacks and normal cerebral angiograms: a follow-up study. 317 81

One characteristic of the Limousin district is the raised average age of its population. Given the growing average age found in France and the ensuing potential problems, it was thought useful to undertake a neuro-epidemiological study of the distribution of neurological diseases in this region. The initial step involved checking the techniques to be used and the form of questionnaire relevant to this type of study. Following W.H.O. recommendations, the total population of one small town was surveyed, and the distribution of various neurological ailments was thus measured (headaches, migraine, cluster headaches: 12.73 p. 100, transient ischemic attack: 1.89 p. 100, stroke: 1.36 p. 100, epilepsy: 1.68 p. 100. Parkinson's disease 1.47 p. 100, dementia: 0.31 p. 100, misc: 0.84 p. 100). These figures were compared with the results from similar pilot projects carried out elsewhere around the world. The results obtained in this preliminary study enabled us to perfect the methods, and to perform a more extensive survey of a representative cross section of the Limousin population. This larger study will be published later.
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PMID:[A neuro-epidemiologic survey in a Limousin town]. 326 31

One hundred and twenty-nine patients notified to the Perth Community Stroke Study in whom the final diagnosis was cerebrovascular disease were matched with controls of the same sex and 5-year age group drawn from the records of the usual general practitioner of each index case. The control subjects were interviewed and examined briefly at home, following the same protocol as that used for assessment of cases. The significant risk factors for cerebrovascular disease to emerge in the case-control comparison were previous stroke (estimated relative risk 6.6), signs of peripheral vascular disease (3.6) and current smoking (2.6). Being married (0.6) and history of migraine (0.4) were significant protective factors. There was no association between a history of hypertension and cerebrovascular disease in this series.
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PMID:A case-control study of cerebrovascular disease in Western Australia. 326 50

In this article we review the most recent literature that concerns the various neurotransmitters that are known to innervate the cerebral circulation. The best characterized of these systems (the adrenergic and serotonergic pathways) are discussed extensively, but other putative neurovascular pathways (cholinergic and peptidergic nerves) was covered. The review will be divided into five major sections: the origin and nature of the perivascular nerve fibers in the cerebrovascular bed (this section encompasses both morphological and biochemical investigations); the response of isolated cerebral vessels to neurotransmitters and transmural nerve stimulation (covering the uptake and release of transmitters by brain vessels as well as the pre- and postsynaptic effects of these agents on cerebrovascular smooth muscle); the effects of neurotransmitter and other vasoactive agents on cerebral perfusion and metabolism in vivo. This section includes the effects of perivascular nerve stimulation or ablation on cerebral blood flow as well as on capillary (i.e., blood-brain barrier) properties. The regional metabolic effects of neurotransmitters are compared to their known effects on neuronal function; the involvement of various neurotransmitters in a number of cerebrovascular diseases (in particular, migraine, cerebral vasospasm following subarachnoid hemorrhage and cerebral ischemia, or stroke); and we attempt to synthesize the ever-increasing literature on the origin and function of the multiple innervation of two other noncerebral, intracranial tissues: the choroid plexus and the dura mater.
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PMID:Cerebral circulatory and metabolic effects of perivascular neurotransmitters. 329 95

The newer dihydropyridine calcium antagonists are structurally related to nifedipine, but may provide greater vascular selectivity and wider clinical utility. Five new dihydropyridines-nisoldipine, nicardipine, nimodipine, felodipine and nitrendipine-are reviewed with regard to their preclinical pharmacology, haemodynamic effects and clinical indications. Nisoldipine is a potent arterial vasodilator with minimal electrophysiological and negative inotropic effects. Although data are still preliminary, the drug has shown some efficacy in both exertional angina and essential hypertension. The dosing interval is not yet clearly established, but may be twice daily. Utility in congestive heart failure awaits confirmation, but preliminary studies are promising. Nicardipine is an especially potent peripheral, cerebral and coronary arterial vasodilator that causes 10-fold less myocardial depression in animals than nifedipine, and may provide important cardioprotective effects during ischaemia. Human haemodynamic studies have confirmed nicardipine's lack of negative inotropism, its ability to reduce coronary and peripheral vascular resistance, and its lack of effect on cardiac conduction. Several controlled trials have documented its efficacy in exertional angina, vasospastic angina, and essential hypertension. Nicardipine's potential as an antiatherosclerotic agent is currently under investigation. Nimodipine is undergoing a unique clinical development programme aimed at cerebrovascular disorders. In almost all species, nimodipine selectively increases cerebral blood flow and reverses cerebral artery spasm without altering cerebral oxidative metabolism or systemic blood pressure. In humans, a large, double-blind, placebo-controlled trial in subarachnoid haemorrhage showed that nimodipine significantly reduced the severity of neurological deficits associated with delayed cerebral vasospasm. Several uncontrolled trials with larger numbers of patients support these results. Nimodipine has also proved useful in reducing cerebral artery spasm during intracranial surgery, and in the prophylactic treatment of migraine headaches. A preliminary study of nimodipine in acute stroke showed promising results in limiting neurological disability. Felodipine is a very potent systemic arterial vasodilator with negligible myocardial depressant activity. It is also a renal artery vasodilator. Unlike the other new dihydropyridines, felodipine prolongs the A-H interval on electrophysiological testing, but only to about 50% of that observed with verapamil. Felodipine is undergoing clinical trials in essential hypertension.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:'Second generation' dihydropyridine calcium antagonists. Greater vascular selectivity and some unique applications. 331 91


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