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

The present contribution discusses the clinical use of functional MRI (fMRI) and its role in the most common neurological diseases. FMRI was found a reliable and reproducible examination tool resulting in a wide distribution of fMRI methods in presurgical evaluation of epilepsy in determining the relationship of eloquent areas and the epileptic focus. Preliminary data suggest that fMRI using memory paradigms can predict the postoperative memory decline in epilepsy surgery by determining whether a reorganization of memory functions took place. Speech-activated fMRI became the most used tool in determining hemispheric dominance. Visual and sensory-motor cortex can also be routinely investigated by fMRI which helps in decision on epilepsy surgery. FMRI combined with EEG is a new diagnostic tool in epilepsy and sleep disorders. FMRI can identify the penumbra after stroke and can provide an additional information on metabolic state of the threatened brain tissue. FMRI has a predictive role in post-stroke recovery. In relapsing-remitting MS an adaptive reorganization can be demonstrated by fMRI affecting the visual, motor, and memory systems, despite preserved functional performance. Much more extensive reorganization can be demonstrated in secondary progressive MS. These findings suggest that the different stages of MS are related to different stages of the reorganization and MS becomes progressive when there is no more reserve capacity in the brain for reorganization. FMRI offers the capability of detecting early functional hemodynamic alterations in Alzheimer's disease before morphological changes. FMRI can be a valuable tool to test and monitor treatment efficacy in AD. FMRI can also provide information about the mechanisms of different therapeutic approaches in Parkinson disorder including drug treatment and deep brain stimulation.
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PMID:Functional magnetic resonance imaging in neurology. 1837 71

Several conditions commonly seen in the primary care setting are known to be associated with obstructive sleep apnea (OSA), including hypertension, obesity, coronary artery disease, and type 2 diabetes, and should alert the physician to the possibility of this sleep disorder. The pathophysiology of OSA increases the risk of ischemic heart disease, decreases cardiac function, and elevates the risk of stroke. Treatment of OSA along with appropriate therapy for associated comorbidities presents an opportunity to simultaneously improve both conditions. Up to 56% of patients with OSA have hypertension. Addressing OSA can help improve this condition. More than 50% of patients with OSA experience depression. Treatment of OSA can lessen depressive symptoms associated with this sleeping disorder.
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PMID:The clinical consequences of obstructive sleep apnea and associated excessive sleepiness. 1868 38

Obstructive sleep apnea is the most frequent sleep disorder. The prevalence of sleep apnea in the general population is 2-4% and the main characteristic of the disease is the intermittent cessation or substantial reduction of airflow during sleep, caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. The clinical presentation of the disorder is complex. Loud snoring with breathing pauses and daytime sleepiness should raise the suspicion of sleep apnea, but we have to consider this disease if the patient has therapy resistant hypertension, heart failure, arrhythmias, stroke, depression or memory problems. Family physicians have an important role in recognizing sleep apnea. High risk patients can easily be identified by the main symptoms and using the Berlin sleep apnea questionnaire. These patients should be referred to a sleep laboratory for polysomnographic assessment and, if necessary, for further treatment.
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PMID:[The role of family physicians in the recognition and screening of obstructive sleep apnea]. 1902 51

Rapid eye movement (REM) sleep behavior disorder (RBD), which is characterized by dream-enacted, sometimes violent and aggressive, behaviors was firstly reported by Schenck and his colleagues in 1986; thereafter, it was incorporated as parasomnia in the International Classification of Sleep Disorders 1st edition (ICSD-1). The polysomnographical hallmarks of RBD include intermittent/sustained loss of the skeletal muscle atonia of REM sleep (REM sleep without atonia [RWA]); further, this finding has been mandatory in the diagnostic criterion (requiring polysomnographic [PSG] monitoring) in the ICSD-2 in 2005. The animal equivalent of RBD was previously described by Jouvet's and Morrison's groups, dated back to 1965, when Jouvet's group firstly created experimentally lesioned cats (in the bilateral pontine tegmentum areas) presenting with "oneiric behaviors". In 1970s Hishikawa's group had also described peculiar sleep state in alcoholics and other subjects of drug withdrawal with rapid eye movements and tonically increased chin muscle activity (reffered to as "Stage 1-REM with tonic EMG" [Stage 1-REM]). It was difficult to determine from the polysomnographical features whether Stage 1-REM was REM sleep or not, as this state did not preserve proper cyclic appearance of REM sleep. They also reported Stage 1-REM in patients with Shy-Drager syndrome in 1981. The latter finding of Hishikawa's group, together with RBD observed in multiple system atrophy (MSA) reported by other groups, could be best explained by the experimental cat model because of its presumed extensive brainstem pathology. However, neurophysiology of withdrawal states has not been well understood; therefore, Stage 1-REM should be reappraised from new perspectives. After 1990, more extensive studies on RBD revealed that about half of RBD cases were associated with neurological disorders, especially neurodegenerative diseases pathologically known as syncleiopathies (Parkinson disease [PD], dementia with Lewy bodies, and MSA). In addition, it has been shown that a substantial number of idiopathic RBD (iRBD) patients eventually developed Parkinsonian diseases. In accordance with accumulative data indicating that various non-parkinsonian features can precede the onset of motor symptoms of PD (or pathologically Lewy body diseases), a search of early PD markers in patients with iRBD has been performed. The results of the studies support the hypothesis of RBD as an early sign of a neurodegenerative disorder. More recently, it was reported that RBD is frequently symptomatic of narcolepsy, although the pathophysiological mechanism of this state was still unknown. RBD in stroke patients have been anecdotal; however, under such conditions, specific lesion studies can be possible, as data in the experimental RBD rats have been accumulated during these few years. In conclusion, RBD is observed in a wide range of neurological disorders, and the causative mechanism of RWA and behavioral manifestations may not only be attributable to brainstem lesions. RBD is not a homogeneous clinical entity, and further refinement of its diagnostic classification is warranted to avoid diagnostic confusion.
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PMID:[Historical overview of REM sleep behavior disorder in relation to its pathophysiology]. 1951 16

Renal diseases-related metabolic abnormalities cause diverse CNS disturbances, namely uremic encephalopathy, seizures, stroke, movement disorders, sleep alterations, and peripheral nervous system involvement comprising polyneuropathy, mononeuropathies, and myopathy. Some inherited and acquired renal diseases present with concomitant or precedent neurologic syndromes. Several mechanisms involved include toxic metabolic accumulation, hyperkalemia, hypercoagulability, immunologic disturbances, and tubular acido-basic disequilibrium. Clinical symptoms usually indicate severe renal dysfunction, but subtle abnormalities may occur. Judiciously tailored renal replacement therapy may avoid these complications, whereas others may emerge from these very therapies with overlapping clinical pictures. This makes an already complex management of renal patients even more difficult and asks for tight collaboration between nephrologists and neurologists.
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PMID:Neurologic presentations of renal diseases. 1993 75

Reports from a large number of studies document significant associations between sleep duration and various health problems such as cardiovascular events, risk of stroke, incident artery calcification, changes in inflammatory markers and many more. Furthermore, some sleep duration studies have shown that shorter sleep precedes some adverse health outcomes, although a causal relationship has yet to be demonstrated. Whilst clinical studies have shown that de-fragmenting (reducing awakenings and improving sleep continuity) sleep can reverse the harmful consequences of sleep apnea, and other studies have demonstrated that adjunctive treatment of insomnia improves depression, evidence that treatment of insomnia results in health benefit is more controversial. This article documents the debate session from the 6th International Sleep Disorders Forum -The Art of Good Sleep, held in Toronto, Canada in September 2008; the topic of which was "Does an improvement in sleep positively impact on health?"
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PMID:Can an improvement in sleep positively impact on health? 2042 12

Obstructive sleep apnoea (OSA) is a sleep disorder characterized by recurrent episodes of oxygen desaturation during sleep, representing an independent risk factor for cardiovascular disease, such as myocardial infarction, stroke, congestive heart failure and resistant hypertension. Several neurohormonal mechanisms have been suggested to account for blood pressure increases, such as sympathetic nervous system hyperactivity, oxidative stress, renin-angiotensin-aldosterone system (RAAS) activation, endothelin system activation, and endothelial dysfunction. The aim of this study was to evaluate the behaviour of RAAS and the presence of primary aldosteronism (PA) in these patients and possible correlations between RAAS and the severity of OSA. From October 2007 to November 2008 we studied 325 consecutive newly diagnosed hypertensive patients; 71 patients (21.8%) presented with clinical signs of sleep disorders, evaluated also through a specific questionnaire (Epworth Sleepiness Scale). In hypertensive patients with sleep disorders, 53 patients were affected by OSA; in this group 18 patients were affected by PA (five with aldosterone-producing adenoma (APA) and 13 with bilateral hyperplasia (IHA)); obesity was also demonstrated (BMI > 30 kg/m(2)). Overall, in patients with OSA PRA levels correlated positively with apnoea/hypopnoea index (AHI; r = 0.35; p<0.01), and in all groups the waist circumference and the neck circumference were correlated positively with AHI (r = 0.3 p<0.02 and r = 0.3 p<0.03, respectively). We revealed a high prevalence of PA in patients with OSA, and we can conclude that patients with hypertension and OSA, especially those who are newly diagnosed, must be evaluated for PA.
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PMID:Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism. 2048 24

Obstructive sleep apnea (OSA) is a common sleep disorder, and research on the effects of sleep apnea is important to gain insight into how sleep affects health. Untreated OSA has been associated with important health consequences, such as an increased risk for hypertension, cardiovascular disease and diabetes. Previous studies have shown that OSA also represents a risk factor for stroke. The relationship between OSA and stroke is particularly relevant, as stroke is the second leading cause of death globally. The reviewed article presents new data from the Sleep Heart Health Study, a longitudinal cohort study, which shows an association between incident stroke and untreated OSA of varying severity for men and possibly more severe OSA for women. The study is discussed in the context of the current state of knowledge about OSA, in particular its health consequences, and the general limitations in conducting research with OSA patients.
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PMID:Risk of stroke from sleep apnea in men and women. 2033 44

Carotid artery redundancy with kinking and coiling can be the cause for acute, ischaemic transitory or even permanent, brain damage and cerebrovascular symptoms. The cerebral ischaemia typically associated to kinking of carotid artery is positional and can be provoked by some (extreme) movenets of the head. The awake patient is coscious of those typical head positions, and capable to avoid them. Prolonged uncontrolled turning of the head during sleep has been reported to cause a stroke in sleep or unpleasant phenomena during sleep. The parasomnias and central sleep apnea syndrome caused by ischaemia on the basis of haemodynamically significant reduction of blood flow to the brain bacause of kinking of carotid artery, are not properly analised, investigated, described and classified. Only one case, as far as we know, of obstructive sleep apnea syndrome caused by tortuous internal carotid artery has been published until now. The surgical treatment with resection of proximal redundant segment of internal carotid artery and reimplantation in its anatomical position resolved transient ishaemic attacks and paroxysmal sleep disorders in children. Sleep disorders in patients with kinking of carotid artery could adress the question about the nature of the link between stroke and sleep disorders, which has been found in a significant proportion of patients with paroxysmal cerebral ischaemia caused by kinks and coils. The sleep disorders may be both a risk factor for stroke but also a direct consequence of acute ischaemic transitory or even permanent brain damage. There are some data supporting the hypothesis of a cause-effect relationship between sleeping disorders and brain ischaemia. Comparation between sleep disorders symptoms and signs in patiens with kinking of carotid artery pre and postoperatively (resolved symptoms) could be sutable model for design of investigation of the relationship between brain ischaemia and sleep disorders.
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PMID:[Observation of sleep disorders in patients with kinking of carotid artery]. 2066 20

Although sleep appears to be a quiescent, passive state externally, there are a multitude of physiological changes occurring during sleep that can affect cerebral homeostasis and predispose individuals to cerebrovascular disorders. Therefore, it is not surprising that sleep-disordered breathing causes significant nocturnal perturbations, such as obstructive sleep apnea (OSA), that can lead to cerebrovascular disorders. There is evidence to suggest that OSA is a risk factor for stroke, although studies have not been able to clearly discern the absence or presence of OSA before the stroke event. Sleep-disordered breathing, such as OSA and central sleep apnea, can occur as a consequence of stroke. Fortunately, treating OSA appears to decrease morbidity and possibly mortality. Unfortunately, continuous positive airway pressure compliance in this population group is low, and significant efforts and resources may be needed to improve compliance and adherence. Various other sleep disorders, such as insomnia, fatigue, hypersomnia, and parasomnia, can occur following a stroke, and physicians treating patients following a stroke need to be aware of these disorders in order to effectively treat such patients.
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PMID:The relationship between sleep disorders and stroke. 2108 91


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