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

Ischaemic stroke occurs in over 500,000 US residents each year. Most strokes are due to embolic or thrombotic occlusion of an artery to the brain. Strategies to reduce thrombus formation and to improve blood flow in the compromised arterial bed have been have been a major focus of management with the goal of improving the outcome of ischaemic stroke. Ancrod is a biological agent extracted from the venom of the Malayan pit viper that reduces blood fibrinogen levels. This action prolongs blood clot formation and lowers blood viscosity. Ancrod has been studied in a variety of ischaemic conditions including stroke. The clinical studies of ancrod in patients with stroke have shown a benefit with ancrod treatment in neurological outcome with only a modest increase in bleeding risk.
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PMID:Ancrod. 1236 29

The diagnosis of acute stroke remains a clinical diagnosis in the initial phases of patient evaluation. There is a differential diagnostic process to the abrupt onset of focal neurologic deficit that characterizes an acute stroke. "Is this a CNS event?" might be the initial question posed by the clinician. The stroke mimics of systemic problems such as hypoglycemia, hyperglycemia, and other encephalopathies are considered. Certainly consideration of hypoglycemia, which is common, easily detectable, and correctable, should occur in every stroke patient encounter. Any witnesses that suggest a convulsive episode should raise suspicion of the presence of an ictal or postictal phenomena. Next, if a CNS event is believed to exist, the different stroke subtypes are considered along with other CNS events that may simulate stroke. The standard acute neuroimaging with noncontrast CT scanning uncovers some mass lesions mimicking stroke and confirm a stroke subtype in other patients. Ischemic stroke, like other common diseases, does have uncommon manifestations. Acute stroke is considered in neurologic syndromes in which abrupt onset of symptoms figure prominently, particularly in patients with cerebrovascular risk factors.
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PMID:Stroke mimics and chameleons. 1237 62

This study reports the characteristics of stroke patients admitted to our hospital in the period Jan 1st, 1998-Dec 31st 1999. Seven hundred and ninety seven consecutive subjects (412 males; mean age 71 +/- 13 years) with a first-ever stroke were registered. Two-thirds of patients (65%) were admitted to the Stroke Unit (SU). The remaining part was managed in six general medicine wards (GM) or other services [neurosurgery and intensive care units (ICU+ NS)]. Ischemic stroke occurred in 534 subjects (67%). The high prevalence (30.1%) of haemorrhages can be partly explained by the presence of specialized neurosurgical services. Athero-thrombotic infarctions occurred in 21.7% of patients, lacunar in 24.7%, cardioembolic in 18.1%, other determined in 6.1%, and other undetermined in 27.5%. Overall hospital mortality was 10%. In cerebral hemorrhage mortality was 18% (44/240) vs. 6.3% (32/534) in ischemic stroke (p < 0.05). The distribution of stroke types and mortality was similar to other previous reports.
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PMID:The Perugia hospital-based Stroke Registry: report of the 2nd year. 1245 Feb 23

Ischemic stroke produces cell death and disability, and a process of repair and partial recovery. Plasticity within cortical connections after stroke leads to partial recovery of function after the initial injury. Physiologically, cortical connections after stroke become hyperexcitable and more susceptible to the induction of LTP Stroke produces changes in the distribution and laterality of sensory, motor, and language representations within the brain that correlate with functional recovery. Anatomically, ischemic lesions induce axonal sprouting within local, intracortical projections and long distance, interhemispheric projections. This postischemic axonal sprouting establishes substantially new patterns of cortical connections with de-afferented or partially damaged brain areas. Axonal sprouting after ischemic lesions is induced by a transient pattern of synchronous, low-frequency neuronal activity in a network of cortical areas connected to the infarct. This pattern of neuronal activity that induces axonal sprouting in the adult after ischemic lesions resembles that seen in the developing brain during axonal elongation and synaptogenesis. Thus, stroke induces a process of remapping and reconnection within the adult brain through changes in neuronal activity that may involve a reactivation of developmental programs in areas connected to the infarct.
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PMID:Plasticity of cortical projections after stroke. 1258 Mar 41

Ischemic stroke remains a complex neurobiological and clinical disease, and stroke drug development remains time consuming and costly. In addressing these challenges, the pharmaceutical industry has a principal responsibility to ensure that the acute stroke trials it sponsors are ethically conducted, scientifically sound and satisfy global regulatory requirements. The industry must also be a leader in promoting the innovative and effective partnerships between the public, private and academic sectors that are necessary if new therapies for patients with acute stroke are to be developed.
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PMID:He who pays the piper calls the tune: the role of the industry sponsor in acute stroke trials. 1258 25

Atrial fibrillation (AF) is a common risk factor for disabling ischemic stroke in the elderly, but it is not clear that its severity is generally worse than that of ischemic stroke due to other etiologies. We reviewed the clinical presentations of patients with acute ischemic stroke admitted between 1990 and 2001. The etiologies of these strokes were also classified using well-established criteria. Of 1,061 patients with acute ischemic stroke, 216 (20.3%) had AF. The frequency of bedridden state was 41.2% in patients with AF, compared to 23.7% in patients without AF (p < 0.0005). Other measures of clinical stroke severity showed similar disparities between these groups. The odds ratio for bedridden state following ischemic stroke due to AF was 2.23 (95% CI = 1.87-2.59, p < 0.0005) by multivariate logistic regression. Ischemic stroke associated with AF is typically more severe than ischemic stroke due to other etiologies, and this increased severity is independent of advanced age and other stroke risk factors.
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PMID:Atrial fibrillation is associated with severe acute ischemic stroke. 1262 77

Ischaemic stroke subtypes in children and adults were compared to determine the similarity in aetiologies. Thirty-six children (22 females, 14 males; median age 5 years 7 months, range 6 weeks to 15 years 10 months) and 50 adults (35 males, 15 females; median age 44 years, range 17 years 2 months to 49 years 11 months) who had presented with ischaemic stroke between 1995 and 2000, were categorized using a modified version of the Trial of Org 10172 in Acute Stroke Therapy (TOAST) classification. Proportions of patients in the subtypes of the TOAST classification system were significantly different in the two groups (chi2 test, p<0.01). The first three subtypes (large artery atherosclerosis, cardioembolic, and small vessel disease) accounted for the majority of adult strokes (27 of 50). In contrast, only three of 36 children were accounted for within these three subtypes. The majority of children (29 of 36) were classified within the 'other determined aetiology' subtype. Aetiology was undetermined in 12 of 50 adults compared with three of 36 children. Causes of ischaemic stroke in children and adults are distinct. A classification system for ischaemic stroke in children would be useful for collaborative studies.
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PMID:Ischaemic stroke subtypes in children and adults. 1264 23

Ischemic stroke is a uniquely human disease syndrome. Models of focal cerebral ischemia developed in nonhuman primates provide clinically relevant platforms for investigating pathophysiological alterations associated with ischemic brain injury, microvascular responses, treatment responses, and clinically relevant outcomes that may be appropriate for ischemic stroke patients. A considerable number of advantages attend the use of nonhuman primate models in cerebral vascular research. Appropriate development of such models requires neurosurgical expertise to produce single or multiple vascular occlusions. A number of experimentally and clinically accessible outcomes can be measured, including neurological deficits, neuron injury, evidence of non-neuronal cell injury, infarction volume, real-time imaging of injury development, vascular responses, regional cerebral blood flow, microvascular events, the relation between neuron and vascular events, and behavioral outcomes. Nonhuman primate models of focal cerebral ischemia provide excellent opportunities for understanding the vascular and cellular pathophysiology of cerebral ischemic injury, which resembles human ischemic stroke, and the appropriate study of pharmacological interventions in a human relevant setting.
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PMID:Models of focal cerebral ischemia in the nonhuman primate. 1265 4

Ischemic stroke represents the leading cause of death and disability among elderly people. Most stroke survivors are left with lifelong disability. With the exception of tissue-type plasminogen activator (t-PA), no effective therapy exists for the management of acute stroke. Understanding the role of various extrinsic and intrinsic pathogenic factors of ischemic damage represents a prime objective of ongoing stroke research. An important variable affecting stroke outcome is the presence or absence of reperfusion (recanalization of the occluded vessel) following an ischemic event. It appears that early reperfusion after a stroke is beneficial and capable of reversing the majority of ischemic dysfunctions. However, in some instances, late reperfusion may contrarily trigger deleterious processes and lead to more ischemic damage. Examples of ischemia/reperfusion damage using an experimental model of focal ischemia in rodents are provided, along with evidence that the brain-enriched gamma-isoform of protein kinase C may represent an important mediator of reperfusion-induced brain injury in mutant mice.
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PMID:Perspectives on reperfusion-induced damage in rodent models of experimental focal ischemia and role of gamma-protein kinase C. 1265 5

Ischemic stroke is usually a manifestation of arteriosclerosis in the elderly patient. The major risk factors are age and high blood pressure; prevention is particularly successful in hypertensives. All known antihypertensive agents can be applied, and ACE inhibitors and the lipid-lowering agents, in particular the statins are now well established. That said, under certain circumstances it might be of importance to pay greater attention to the other lipid fractions. It is currently estimated that only one-third of patients with a disturbance of lipid metabolism actually receives treatment. Results of treatment in the acute phase of apoplexy have been improved by the establishment of stroke units that provide the facilities for intensive and comprehensive management of stroke victims. Inhibitors of platelet aggregation, in particular aspirin, now have a permanent role in the acute and follow-up phase. For specific risk factors such as stenosis of the carotid artery or atrial flutter, special therapeutic guidelines apply.
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PMID:[Drug therapy of stroke in the stroke unit. A race against time]. 1265 24


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