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

The long-term outcome following carotid endarterectomy for neurological symptoms was analyzed using a retrospective life-table approach in 212 patients who had undergone 243 endarterectomy procedures. The postoperative follow-up period averaged 38.9 +/- 2.1 months (mean +/- standard error of the mean). The endpoints of stroke and death were evaluated in these patients. Patient groups with the preoperative symptoms of amaurosis fugax, transient ischemic attack, and prior recovered stroke were similar in terms of life-table outcome over the follow-up period. Sixty-two percent of symptomatic patients were alive and free of stroke at 5 years. The late risk of stroke (after 30 days postoperatively) averaged 1.7% per year based on a linear approximation to the hazard at each life-table interval (1.3% per year for ipsilateral stroke). The trend of late stroke risk was clearly downward, however, and could be fitted more accurately by an exponential decay function with a half-life of 33 months. Thus, the risk of stroke following carotid endarterectomy for neurological symptoms was highest in the perioperative period, slowly declined with time, and occurred predominantly ipsilateral to the procedure. The definition of a prospective medical control group remains crucial for a critical analysis of treatment modalities following the onset of premonitory neurological symptoms. In the absence of an adequate control group for this series, the calculated perioperative and postoperative stroke risk from this study was compared to data obtained from the literature on stroke risk in medically treated symptomatic patients. This uncontrolled comparison of treatment modalities suggests the combined perioperative and postoperative stroke risk associated with carotid endarterectomy to be modestly improved over medical treatment alone.
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PMID:Risk of late stroke and survival following carotid endarterectomy procedures for symptomatic patients. 236 76

One hundred carotid endarterectomy (CEA) procedures were performed in this teaching institution from August, 1984 to January, 1989 under the direction of the author. Presenting symptoms were TIA (36), CVA (25), amaurosis fugax (17), and asymptomatic carotid stenosis greater than 80 per cent (22). The average age was 61.8 years and 68 per cent were male. The operation was performed through a transverse neck incision with the use of flaps, a shunt was used (96%) and the artery closed primarily (95%). The heparin given was not reversed. There was no operative mortality and the stroke morbidity consisted of one permanent (1%) and one temporary (1%) deficit. Hematoma evacuations were required in four cases; one had a demonstrable bleeding point. The long-term stroke rate was 1.62 per cent, with overall survival of 94 per cent at 42 months. Restenosis following repair was noted in only 5.5 per cent of the cases at one year. When carotid endarterectomy is performed in a teaching institution, excellent early results (2% combined stroke/mortality rate) are maintained long-term. Furthermore, a 50-plus per cent decrease in the risk of stroke at 42 months is demonstrated when this study's results are compared to estimates of the natural history of significant carotid disease.
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PMID:The training of carotid endarterectomy during an era of controversy. A personal experience. 237 47

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 a prospective community-based study, 184 patients with transient ischaemic attacks (TIAs) were identified from a study population of about 105,000 between 1981 and 1986. Computed tomography (CT) was attempted in all those with cerebral ischaemic attacks (n = 152, 83%); patients with amaurosis fugax only (n = 32, 27%) were not scanned routinely. Scans were obtained in 120 (79%) of those with cerebral attacks and 12 (38%) of those with amaurosis fugax. The scans were reported by a neuroradiologist who was blinded to the patients' clinical features. Of 120 (27%:95% confidence interval 19-35) scans in patients with cerebral attacks, 32 showed a focal area of hypodensity or cortical loss, but in only 14 (12%:95% confidence interval 6-18) was this in an area of the brain appropriate to the patients' symptoms. There were no significant differences in the clinical features, the duration of attacks or the prognosis (i.e., risk of death, stroke or myocardial infarction) of patients with and without ischaemic lesions on CT. It is concluded that patients with clinically definite TIAs who have a presumed ischaemic and appropriately sited lesion on CT should not be re-classified as having had a stroke.
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PMID:Computed tomography in patients with transient ischaemic attacks: when is a transient ischaemic attack not a transient ischaemic attack but a stroke? 203 Mar 77

We present a consensus on the pathophysiology, etiology, diagnosis, and treatment of amaurosis fugax. The phenomenon is defined and described, and the roles that extracranial and ocular vascular diseases play are discussed. Nonvascular ophthalmic and neurologic disorders that can be confused with amaurosis fugax are listed, and an algorithm for evaluation (which includes ophthalmic examination, laboratory studies, and noninvasive carotid artery studies) is given. Treatment of atherosclerosis, carotid artery disease, and other causes of amaurosis fugax are also discussed.
Stroke 1990 Feb
PMID:Current management of amaurosis fugax. The Amaurosis Fugax Study Group. 240 92

We identified 60 patients (42 men and 18 women with an average age of 62.6 years) with angiographically documented carotid stenoses of greater than or equal to 95%; a string sign was demonstrated in 28. Twenty of the 60 patients (33%) were asymptomatic on presentation, 26 (43%) had hemispheric transient ischemic attacks, 21 (35%) had amaurosis fugax, and nine (15%) had previous ipsilateral infarctions. Demographics, mode of presentation, and prevalence of atherosclerotic risk factors were not significantly different between patients with and without a string sign. Doppler frequencies recorded in patients with a string sign were less than 6 or greater than 16 KHz. Real-time ultrasonography imaged a patent lumen in all but three cases with a string sign. Surgery was performed in 26 patients with a string sign and in 21 patients without a string sign. The rate of major perioperative complications was not influenced by the presence of a string sign, contralateral extracranial stenosis, or ipsilateral siphon stenosis. Average lumen size of the endarterectomy specimens was 0.94 mm in those with and 1.7 mm in those without a string sign. We conclude that combined noninvasive testing has a sensitivity of 83% for demonstrating a residual lumen in patients with greater than or equal to 95% carotid stenosis and that the angiographic string sign does not affect the mode of presentation or surgical outcome of these patients.
Stroke 1990 Mar
PMID:Implications of the angiographic string sign in carotid atherosclerosis. 240 99

Acute enlargement of pituitary adenomas due to haemorrhage or ischaemic necrosis in the tumour was described as "pituitary apoplexy" by Brougham et al. in 1950. Since then, more than 200 cases have been reported, but--especially in the German literature--the syndrome has caught only little attention. Therefore, in a series of 12 own patients, typical findings and clinical characteristics are demonstrated and the literature is discussed. 9 patients had a haemorrhage into the tumour, 3 an acute ischaemic necrosis. The guiding symptom was the acute onset with ophthalmoplegia (11 of 12 patients). Only in one case the adenoma was known before the apoplexy. Other symptoms were headache, blurred vision, drowsiness and, in severe cases, hemiparesis, coma, and hypothalamic disorder. Most important is the acute endocrinological substitution with hydrocortisone; this may be life-saving. Neuroophthalmological recovery depends on early operation: cases of oculomotor palsy require an operation within the first 2 weeks after the acute event. An emergency operation is required only by an acute amaurosis. In general there will be enough time for careful clinical endocrinological and radiological investigations.
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PMID:[Acute hemorrhage and ischemic necroses in hypophyseal tumors: hypophyseal apoplexy]. 259 99

A proportion of patients with apparently classical transient ischaemic attacks (TIA), will have no cause for their symptoms discovered when investigated. We have reviewed 74 patients with TIA and a further 28 with amaurosis fugax whose symptoms remained unexplained following non-invasive carotid evaluation using pulsed Doppler imaging with spectrum analysis. After a mean follow-up of 31.7 months, 48.6% of TIA patients were symptom free, 36.5% had experienced recurrent symptoms and 8.1% had suffered a stroke. Among the patients with amaurosis fugax the equivalent figures were 32.1% symptom free, 42.7% recurrent symptoms, and 10.7% stroke. These figures suggest that unexplained TIAs do not necessarily have a benign prognosis and more extensive or repeated investigation of these patients is warranted.
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PMID:Outcome of TIAs of unknown aetiology following non-invasive evaluation. 265 73

This report summarizes the study design and organization of a multicenter, randomized trial of carotid endarterectomy for the treatment of asymptomatic carotid stenosis. The Asymptomatic Carotid Atherosclerosis Study will determine whether the addition of carotid endarterectomy to aspirin plus risk factor modifications affects the incidence of ipsilateral transient ischemic attack, amaurosis fugax, and retinal and cerebral infarction in patients with asymptomatic hemodynamically significant carotid stenosis in at least one artery. Power calculations are based on assumptions of alpha = 0.05 (two-sided test) with annual event rate 3% transient ischemic attack and 1% cerebral infarction per year. The study has 90% power for detection of a 25% difference in events in a 5-year study. Two continuous validation programs are in use: a Doppler/angiogram correlation study for each Doppler instrument used in screening potential candidates and a transient ischemic attack/stroke questionnaire/validation study for verification of end points. Quality assurance is a major component in study design.
Stroke 1989 Jul
PMID:Study design for randomized prospective trial of carotid endarterectomy for asymptomatic atherosclerosis. The Asymptomatic Carotid Atherosclerosis Study Group. 266 5

Neurological examination and Doppler sonography of a 50-year-old patient were suggestive of a spontaneous dissection of the left internal carotid artery (left-sided headaches, amaurosis fugax, Horner's syndrome and hemispheric stroke). Four-vessel angiogram performed several days after the onset of the symptoms showed dissection of both extracranial carotid arteries, more pronounced on right side where the dissection was clinically asymptomatic. Angiogram follow-up demonstrated a recanalization of both carotid arteries. A review of 15 other documented reports indicates that bilateral internal carotid dissection is usually associated with fibromuscular dysplasia. A large majority of cases does not clinically differ from unilateral carotid artery dissection.
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PMID:Spontaneous dissection of both extracranial internal carotid arteries. 268 19


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