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

Contrary to a common view, ischemic stroke under the age of 45 is not rare. In the Lausanne Stroke Registry, more than 10% of the patients were within this age limit. Overall, in Occidental countries the causes of stroke in the young adult do not really differ from those in the older individual; it is only the relative frequency of stroke that is not the same. Cardiac embolism, arterial dissection, and migraine represent the most common etiologic factors, while atherosclerosis is much more unusual. The etiologic aspects and their therapeutic implications justify an active investigative attitude in young adults with recent ischemic stroke. After the acute phase of stroke, prognosis is reasonable.
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PMID:Ischemic stroke in patients under age 45. 155 98

Etiology, neuropsychological deficits, aphasia type, and recovery were retrospectively studied in 254 young adults with stroke. Cardiac embolism was the most common cause of stroke in patients younger than 40, while atherosclerosis was the most frequent etiology among those aged 41-50 years. In 166 aphasic patients, Broca's aphasia was the most common while Wernicke's and transcortical aphasias were rare. Compared with an older aphasic population, young patients had significantly more nonfluent aphasias and fewer comprehension deficits. These differences were related to stroke localization: the majority of infarcts localized by computed tomography in 37 patients involved either the entire middle cerebral artery territory or its superior or deep branches, explaining the preponderance of nonfluent aphasia. Prognosis of aphasia in our patients was better than has been reported for non-age-selected aphasia populations. Roughly one third of our patients recovered completely, one third improved, and one third had an unresolved language deficit. Complete recovery and significant improvement were observed even greater than 6 months after stroke. In some patients, recovery was much better than might have been predicted from lesion site and size depicted on computed tomograms.
Stroke 1988 Aug
PMID:Young adult stroke: neuropsychological dysfunction and recovery. 245 33

In 65 cases of ischemic cerebral infarction, CT scans and quantitative assessments of the neurological disturbances were undertaken at specific intervals during the 4 week period after stroke. Forty-three patients underwent lumbar puncture to determine the serum/CSF albumin ratio. The etiology of the infarction was evaluated on the basis of angiographic, ultrasonic and cardiologic findings. A hemorrhagic transformation of the infarction occurred in 28 patients, eleven within the first week, and 15 within the second. Risks of hemorrhage were correlated with a severe neurological deficit, disturbance of consciousness, large infarction with a mass effect, enhancement of contrast medium in CT (especially if occurring early), involvement of the cortex, and distinct blood/CSF barrier disturbances. Cardiac embolism was a frequent etiology in patients with secondary hemorrhagic infarction, especially when transformation occurred within the first week after stroke. In addition to a heterogeneous pattern of hemorrhage, frank hematoma predominated in those infarcts which underwent early transformation, while those transforming late often showed less hyperdense cortical hemorrhagic changes. Deterioration evident on clinical evaluation was caused by the hemorrhagic transformation in three cases, in each instance within the first week after stroke.
Stroke
PMID:Hemorrhagic cerebral infarction--a prospective study. 351 35

The cause of stroke in a young adult can usually be ascertained with proper workup. One of the most common causes is atherosclerotic cerebrovascular disease, and cigarette smoking is an important risk factor in young adults. Several types of nonatherosclerotic cerebral vasculopathy can also result in premature cerebral infarction; these include cervicocephalic arterial dissection, nonpenetrating traumatic arterial disease, moyamoya disease, fibromuscular dysplasia, vasculitis, and migraine. Cardiac embolism may play a more important role than was previously thought, and hematologic disorders (eg, sickle cell disease, polycythemia rubra vera, coagulation problems) are known to predispose patients to stroke. A careful history of risk factors and a thorough neurologic and cardiovascular examination followed by adequate testing, including angiography, are essential to diagnosis.
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PMID:Diagnosis of stroke in young adults. 356 68

We studied 34 consecutive patients with non-mass-producing cerebellar infarcts using a standard protocol of investigations including magnetic resonance imaging (MRI). We analyzed the topography of infarcts to determine the involved arterial territories and we correlated the findings with neurological dysfunction and potential causes of stroke. Sixteen patients had an infarct in the territory of the posterior inferior cerebellar artery (PICA); 2, in the territory of the anterior inferior cerebellar artery (AICA); 13, in the territory of the superior cerebellar artery (SCA); and 8 had junctional infarcts between the territories of the medial and lateral branches of the PICA or PICA/SCA territories. PICA or medial PICA territory infarcts were manifested by acute vertigo and truncal ataxia, while the patients with lateral PICA territory infarcts presented with unsteadiness, limb ataxia and dysmetria without dysarthria. Patients with infarcts in the AICA territory were characterized by limb and trunk ataxia associated with signs of lateropontine involvement. Patients with SCA territory infarcts presented with dysarthria, unsteadiness and/or vertigo, limb ataxia, and dysmetria. Cardiac embolism was the main cause of large infarcts in the territories of the PICA (8/16) or SCA (4/7). Multiple small infarcts were associated with vertebrobasilar atherosclerosis (8/12). These clinical-MRI correlations allow better definition of the topographic and etiological spectrum of cerebellar infarction, which was previously based on pathological studies in subjects with severe infarction.
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PMID:The clinical and topographic spectrum of cerebellar infarcts: a clinical-magnetic resonance imaging correlation study. 849 23

Cardiac embolism is often involved as a mechanism for embolic stroke, and may be implicated in many strokes that have traditionally been considered of unknown origin (cryptogenic strokes). In recent years, significant advancements have been made in understanding and reducing the risk of stroke from long-known cardioembolic sources (atrial fibrillation, intracardiac thrombus or tumor, infective endocarditis). Also, improved cardiac imaging, especially transesophageal echocardiography, has allowed the identification of newer embolic sources of stroke (aortic atheromas, patent foramen ovale, atrial septal aneurysm). This article reviews the current understanding of cardiac embolism as a mechanism for stroke, and the preventive options that are currently adopted to decrease the stroke risk.
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PMID:Mechanisms of cardioembolic stroke. 1182 38

Cardiac embolism accounts for a large proportion of ischemic stroke. Revascularization using systemic or intra-arterial thrombolysis is associated with increasing risks of cerebral hemorrhage as time passes from stroke onset. We report successful mechanical thrombectomy from a distal branch of the middle cerebral artery (MCA) using a novel technique. A 72-year old man suffered an acute ischemic stroke from an echocardiographically proven ventricular thrombus due to a recent myocardial infarction. Intraarterial administration of 4 mg rt-PA initiated at 5.7 hours post-ictus failed to recanalize an occluded superior division branch of the left MCA. At 6 hours, symptomatic embolic occlusion persisted. Mechanical extraction of the clot using an Attracter-18 device (Target Therapeutics, Freemont, CA) resulted in immediate recanalization of the MCA branch. Attracter-18 for acute occlusion of MCA branches may be considered in selected patients who fail conventional thrombolysis or are nearing closure of the therapeutic window for use of thrombolytic agents.
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PMID:Endovascular mechanical thrombectomy of an occluded superior division branch of the left MCA for acute cardioembolic stroke. 1456 85

Cardiac embolism has been thought to be one of the principal causes of posterior cerebral artery territory infarction. To determine stroke mechanisms and stroke risk factors in patients with posterior cerebral artery infarction, we studied 23 consecutive patients with recent infarcts in the posterior cerebral artery distribution (PCA infarcts) and compared these with a case-control group of 46 patients with recent infarcts in the middle cerebral artery distribution (MCA infarcts). All patients were similarly studied, including angiography and echocardiography. Case controls were age- and sex-matched and were randomly chosen from the most recent MCA infarcts seen at our institutions. All subjects were white. PCA infarcts had significantly more cardiac-source emboli (P=.01), less evident atherothrombosis (P=.003), multiplicity of infarctions (P=.05), and documented branch occlusions in the vessel involved (P=.05). MCA infarcts had more preinfarction transient ischemic attacks (P=.03) and evident occlusion of the appropriate extracranial vessel (P=.03). Different stroke mechanisms should lead to different diagnostic and therapeutic decisions.
J Stroke Cerebrovasc Dis
PMID:Differing mechanisms between posterior and middle cerebral artery infarctions. 1789 92

Atrial fibrillation (AF), as the most common cardiac rhythm disturbance, gains in importance not only for the persons affected, but also for health care and social economy due to thromboembolic events, of which stroke is the most serious, disabling, and life threatening one. Cardiac embolism is due to thrombus formation mainly in the left atrial appendage (LAA). The pathophysiology leading to increased thrombogenicity is complex and requires a remodelling of the LAA structure, decreased LAA blood flow, activation of inflammatory processes, deviations of the hemostatic/fibrinolytic system, and activation/dysfunction of endothelial/endocardial cells. Altogether, a prothrombotic state proposed by Virchow more than 150 years ago. The presence of a LAA thrombus, therefore, is a result of a dynamic process of clot formation and lysis. A comprehensive understanding of this pathophysiology is helpful to optimize the management of patients at high risk of cardioembolic stroke. Especially those with contraindications for oral anticoagulation are in a need of an alternative approach that is not associated with a long-term risk of hemorrhage and other attendant circumstances. The reasonable alternative may be the exclusion of the LAA cavity from circulation by either surgical or percutaneous catheter-based procedures.
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PMID:Rheological and hemostasiological aspects of thrombus formation in the left atrial appendage in atrial fibrillation? A new strategy for prevention of cardioembolic stroke. 2067 14

Cardiac embolism, primarily from atrial fibrillation (AF), is implicated in a quarter of all ischemic strokes. In the setting of AF, contraindications to traditional therapies can create a clinical dilemma when choosing an agent for secondary stroke prophylaxis. Newer horizons in the medical and surgical management of AF have helped us choose from a wide variety of available therapies, the best possible management. In this article, we review the current trends in AF management including newer oral anticoagulants as well as surgical devices from a neurologist's view.
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PMID:Trends in the management of atrial fibrillation: A neurologist's perspective. 2323 67


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