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

Stroke although rare in children, is an important cause of morbidity in the paediatric age group. Over a period of 8 years, 43 children (17 boys and 26 girls) in the age groups of 1-16 years (mean 8.02 yrs) presented with stroke which constituted 10% of all strokes in the young and 0.7% of all paediatric admissions. The chief clinical features were hemiplegia (86%), convulsions (27%), fever (23%), dysphasia (23%), headache (11%) and altered level of consciousness (11%). Routine laboratory tests were non-contributory. Cranial computerized tomography (CCT) on 21 patients was abnormal in 95% and was useful in revealing the extent of infarction. Infarction was confined to middle cerebral artery territory, often involving basal ganglionic structures and was associated with focal or diffuse atrophy. Angiograms were abnormal in 78% of the patients (18/23) and were complimentary to the CCT. Etiological factors identified were: Moya-moya disease 6, arteritis 5, fibromuscular dysplasia 2, scorpion sting 2, and venous sinus thrombosis and small vessel occlusion one each. Though 23% of the patients had fever at onset, no obvious evidence of systemic or CNS infection was noticed. Stroke in children continues to pose a diagnostic challenge.
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PMID:Cerebrovascular disease in children. 783 10

A case of a 39-year-old female with fibromuscular dysplasia (FMD) manifesting subcutaneous pulsatile nodules on the right side of her forehead and on her right wrist is reported here. These nodules proved to be FMD aneurysms of the frontal ramus of the right superficial temporal artery and the right radial artery. The patient had also suffered a stroke with subarachnoidal bleeding as a result of this disease. Angiographic examination showed aneurysms in the union and the bilateral vertebral arteries, a branch of the right renal artery, and one the right lumbar artery. A biopsy specimen taken from the frontal branch of the right superficial artery revealed segmental intimal thickening consistent with intimal fibroplasia type FMD upon histological examination. Electron-microscopic findings were also discussed in connection with the histogenesis of the disease. This appears to be the second case of FMD involving arteries in the skin to be reported in the dermatological literature.
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PMID:Cutaneous arterial fibromuscular dysplasia: a case report and electron-microscopic study. 801 76

The value of carotid artery surgery for symptomatic lesions causing TIA, stroke, or amaurosis fugax has been well documented. The role of prophylactic carotid endarterectomy in the treatment of asymptomatic stenosis remains controversial. Since a completed stroke with cerebral infarction is often the first clinical manifestation of a stenotic carotid artery lesion, an accurate estimate of the relative risk of medical or operative therapy is needed. Current data suggest that severe internal carotid stenosis of > 75% diameter reduction, deep or complex ulcerations, bilateral stenoses, and stenosis with contralateral occlusion represent a cumulative risk of stroke of 5% to 10% per year, often without antecedent TIA. Conversely, mild or moderate stenosis, small ulcers, fibromuscular dysplasia, and congenital kinking or coiling of the internal carotid carry a very low risk of stroke. The combined risk of stroke and death following prophylactic endarterectomy varies widely, with published rates from less than 1% to nearly 10%. The author suggests that carotid endarterectomy is warranted in good-risk patients with the most severe categories of asymptomatic lesions, when the surgeon's combined rates of stroke and death fall with the 1% to 2% range.
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PMID:Asymptomatic carotid stenosis: appropriateness of operative intervention. 802 35

Renal artery stenotic disease is the most common form of surgically correctable hypertension. Occlusive lesions of the renal artery are categorized as: arteriosclerotic, fibrodysplastic (intimal fibroplasia, medial fibrodysplasia, perimedial dysplasia) and developmental. The incidence of stroke, heart disease and renal failure has been reduced with contemporary drug management of hypertensive vascular disease, but similar salutary outcomes have not accompanied the medical treatment of renin-mediated renovascular hypertension. Selection of patients for operation implies documentation that a renal artery stenosis is of functional importance. Advances in the surgical management of renovascular hypertension have evolved over the past 50 years, such that carefully performed reconstructions benefit 85-95% of properly selected patients.
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PMID:The evolution of surgery for renovascular occlusive disease. 804 46

A few days after a judo session, an 11-year-old boy presented with an ischemic stroke with dizziness, aphasia and ataxia. CCT scan revealed a left thalamic infarct. Angiography showed a fibromuscular dysplasia (FMD) of the left vertebral artery probably complicated by dissection. Subsequent evolution was favorable. This observation points out the fact that the association of a cervical pain with neurological signs of vertebrobasilar stroke, especially occurring after a cervical trauma or rotatory motion, should alert to the possibility of vertebral-artery dissection. The diagnosis is mainly based on angiographic criteria. Accurate diagnosis has implications for prognosis and probably for acute medical treatment.
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PMID:Vertebral-artery dissection following a judo session: a case report. 807 74

Between January 1979 and December 1991, 174 of a total of 2304 carotid reconstructions (7.5%) were performed in 166 patients for stenotic coiling or kinking of the internal carotid artery. There was a 1.4 male predominance and the mean age of the patients was 66.3 +/- 9.6 years (range 38 to 91 years). Seventeen patients (9.8%) were asymptomatic, 54 (31%) were symptomatic because of a previous stroke, and 103 (59.2%) had had transient ischemic attacks. The symptoms were hemispheric in 108 (62.1%) cases, ocular in 19 (10.9%), and vertebrobasilar in 30 (17.2%). The stenotic coiling or kinking was isolated in 35 (20.1%) cases and associated with other lesions of the internal carotid artery in 139 (79.9%). These included 119 atherosclerotic stenoses, 14 aneurysms, and six stenotic lesions due to fibromuscular dysplasia. Angioplasty of the carotid bifurcation was performed in 102 (58.6%) patients, associated with endarterectomy in 84 (48.3%) cases and with dilatation of dysplastic lesions in six (3.5%) cases. A bypass graft and resection and anastomosis of the carotid artery were performed in 36 (20.7%) patients each. There were four postoperative deaths (2.3%): two were due to neurologic causes, one to heart disease, and one to complications of an associated surgical procedure. Five patients (2.9%) had postoperative strokes and eight (4.6%) had transient ischemic attacks. At postoperative follow-up investigations four (2.3%) patients had carotid occlusions and 10 (5.7%) had morphologic abnormalities. At 5 years, actuarial survival was 80.97 +/- 8.8%, patency was 96.12 +/- 2.95%, and the ipsilateral stroke-free rate was 93.12 +/- 4.49%. Treatment of stenotic coiling or kinking of the internal carotid artery yields satisfactory results, comparable to those of endarterectomy, for isolated atherosclerotic carotid stenoses and is effective in the prevention of ipsilateral ischemic stroke.
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PMID:Stenotic coiling and kinking of the internal carotid artery. 812 55

We systematically investigated clinical, laboratory, radiologic, and pathologic features, including treatment and prognosis, of stroke syndromes in 30 patients, six from our institution and 24 from the literature, with systemic lupus erythematosus (SLE) and symptomatic large cerebral vessel occlusive disease, documented by angiography or autopsy. The average age at stroke onset was 35 years, and the diagnosis of SLE was made on average 4.4 years prior to that. At least 86% had active SLE at the time of their stroke. Headache was common at onset. We found major intracranial or extracranial vessel occlusive process by (1) thrombus, (2) dissection, (3) fibromuscular dysplasia or vasculitis, and (4) atherosclerosis. The presumed mechanisms were coagulopathy, cardiogenic embolism, large cerebral vessel vasculitis or occlusive vasculopathy, cervical arterial dissection, and premature atherosclerosis. The short-term death rate was 40% and the recurrent stroke rate was 13%. We conclude that symptomatic large cerebral vessel occlusive disease in SLE generally occurs several years after the diagnosis of SLE, usually during the active phase of the disease, is related to heterogeneous mechanisms, and carries a relatively poor short-term outcome.
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PMID:Large cerebral vessel occlusive disease in systemic lupus erythematosus. 814 3

A 44-year-old patient, without remarkable medical history, was admitted with a head trauma with initial loss of consciousness and a thoracic trauma. The initial treatment included the insertion of a chest drain for evacuation of a pneumothorax and intrapleural analgesia with bupivacaine. The day after admission, the patient experienced a generalized epileptic crisis, without prodomes. Later, a left proportional hemiplegia with aphasia was recognized. The CT scan obtained immediately after the crisis, as well as the carotid Doppler ultrasonography and echocardiography were normal. The bilateral carotid angiography showed an image of fibromuscular dysplasia of the extracranial segment of the right internal carotid artery. The migration of a carotid thrombus initiated by the trauma was hypothetized. A treatment with a platelet aggregation inhibiting drug was started and associated 20 days later with low molecular weight heparin. The patient recovered a normal motility within 10 days; only the aphasia remained. Trauma of the carotid artery is not a frequent cause of cerebrovascular accident. The occurrence of the latter is favoured by a pre-existing lesion of this artery. This case demonstrates that in a trauma patient not all central nervous system manifestations are initiated by a head trauma.
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PMID:[Post-traumatic hemiplegia in a patient with fibromuscular dysplasia of the carotid artery]. 831 57

A case of fibromuscular dysplasia at the internal carotid origin is reported. A 45-year-old, right-handed woman who was in good health, experienced 5-6 second episodes of numbness and tingling in her right hand and lip. She had no history of medical illness or trauma. The patient suffered the same sort of attack almost seven years after her first episode. General examination was unremarkable. There was no sign of residual neurologic deficit. Cerebral angiography demonstrated a discrete filling defect at the internal carotid origin. There was no evidence of atherosclerosis in the intracranial or extracranial vessels. The lesion occluded approximately 58% of the lumen. A carotid endarterectomy was performed and a "web shaped" tissue was removed from the posterior aspect of the right internal carotid artery. Microscopic examination of the surgical specimen demonstrated intimal fibrosis, consistent with the diagnosis of fibromuscular dysplasia. In addition to our patients, eight other cases of cephalic fibromuscular dysplasia have been reported in the form of an internal carotid web. This type of lesion is unique because the changes involve only the intima of the vessels without involvement of the medial structure as is seen in the usual form of fibromuscular dysplasia. Moreover, 5 out of 9 patients reported had the repeated episodes of the ischemic symptom, suggesting patients with this particular lesion have higher risk for stroke than those with the usual "string of beads" lesion. In these patients, surgical treatment should be considered, especially if medical therapy is unsuccessful.
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PMID:[Fibromuscular dysplasia at the internal carotid origin: a case of carotid web]. 832 4

The perioperative care, morbidity, and mortality in 30 patients with mucopolysaccharidosis (MPS) are presented. They underwent a detailed preoperative assessment and were anesthetized 141 times. An intravenous induction technique was used in most patients. It was easier to see the vocal cords, during laryngoscopy, in children with Hurler syndrome (HS) when they were younger (23 v 41 months, P < or = .01) and smaller (12 v 15 kg, P < or = .05). Preoperative obstructive breathing was associated with a significantly higher incidence of postextubation obstruction (P < or = .05). A total of 28 children underwent bone marrow transplantation (BMT); this reversed upper airway obstruction and also reversed intracranial hypertension. In children with HS, the incidence of odontoid dysplasia was 94%; 38% demonstrated anterior C1-C2 subluxation. Head and neck manipulation was limited in children with cervical spine defects. None of the 30 patients experienced spinal cord morbidity. One child suffered an intraoperative stroke; another, pulmonary edema. Severe and extensive coronary obstruction was responsible for 2 intraoperative deaths. Coronary angiography underestimated coronary artery disease.
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PMID:Children with mucopolysaccharidosis: perioperative care, morbidity, mortality, and new findings. 846 55


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