Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardioembolic stroke represents a major healthcare challenge in the United States, accounting for significant morbidity and mortality, as well as economic and social costs. Determining the cause of ischemic stroke is often difficult because multiple potential etiologies are often present and available diagnostic tools are relatively insensitive. The diagnosis of cardioembolic stroke is based on a variety of clinical and laboratory clues that are significant, although not invariable, predictors of stroke etiology. Computed tomography scans help suggest etiology, and scans performed at 48 hours after stroke onset are essential to identify hemorrhagic infarctions. Cerebral angiograms may be helpful if performed early. Echocardiography is indicated only for selected patients who are more likely to demonstrate cardiac abnormalities on an echocardiogram. The management of acute cardioembolic stroke involves weighing the benefits of reducing stroke recurrence by anticoagulation against the risk of symptomatic brain hemorrhage. A management algorithm is provided that can help reduce both the risk of symptomatic brain hemorrhage and the incidence of potentially disabling stroke recurrence.
 ...
PMID:Cardiac embolism: the neurologist's perspective. 240 25

Cardioembolic stroke accounts for 1 out of every 5 to 6 ischemic strokes. A potential cardiac source should be considered in all patients presenting with ischemic neurologic deficits. a clear understanding of the various types of cardiac conditions associated with cardioembolic stroke is important. This article reviews potential cardiac sources of emboli and discusses the role of anticoagulation in both primary and secondary prevention of cardioembolic stroke. The role of echocardiography in evaluating patients with possible cardioembolic stroke is also addressed, and an algorithm is proposed for the use of echocardiography in evaluating patients with ischemic neurologic deficits.
 ...
PMID:Cardioembolic stroke. 861 Jul 36

Thrombogenesis in the left atrial appendage (LAA) has been related to the special morphology of this cavity and to its size and degree of dysfunction. However, no study has focused on LAA function in conjunction with left atrial (LA) function in both sinus rhythm (SR) and nonrheumatic idiopathic atrial fibrillation (AF) in relation to clinical status (cardioembolic stroke). Forty-three patients in SR (14 patients with stroke, 29 control subjects) and 45 patients in AF (27 patients with stroke, 18 control subjects) were examined by transthoracic and transesophageal echocardiography. Baseline clinical characteristics and standard transthoracic and transesophageal measurements of the LA and LAA (size, fractional area change, flow measurements, spontaneous echo contrast, and thrombus) were recorded and compared in relation to cardiac rhythm. Patients in the stroke-SR group showed a significant decrease of fractional area change in the LA (32%+/-15%) and LAA (34%+/-15%) in relation to control subjects (43%+/-10%, p = 0.035, 49%+/-13%, p = 0.006, respectively). Patients in the stroke-AF group showed significant reduction of appendage flow measurements (outward velocity = 22+/-13 vs 33+/-19 cm/sec, p = 0.036), whereas no differences were detected in the center of the LA. In multiple regression analysis, the presence of cardioembolic stroke was positively associated with the presence of spontaneous echo contrast (p = 0.0253) and spontaneous echo contrast negatively associated with appendage inward flow velocity (p<0.001). Cardioembolic stroke in patients in SR is associated with a global decrease of shortening in both cavities and in patients with AF, with a reduction of LAA flow parameters. Patients with spontaneous echo contrast, thrombus, or both showed further reduction of shortening and flow velocities in both cavities, indicating a more advanced stage of dysfunction.
 ...
PMID:Left atrial and left atrial appendage functional abnormalities in patients with cardioembolic stroke in sinus rhythm and idiopathic atrial fibrillation. 969 28

To elucidate the pathophysiologic mechanism of cardioembolic stroke in elderly people and to devise therapeutic strategies for it, was analyzed 120 consecutive patients (77 men and 43 women aged 65 +/- 13 years) with acute cardioembolic stroke who were admitted within 7 days of the stroke onset. We compared underlying heart diseases. NIH stroke scale on admission, lesion size on computed tomography (CT), the relation between anticoagulant therapy and recurrence, complications during admission. ADL at discharge, recurrence, and death during the follow up period in three groups: patients aged less than 65 years (the young group), those aged from 65 to 74 years (the "non-old" group), and those aged more than 75 years (the "old old" group). In the "old old" group, non valvular atrial fibrillation (75.8%) was the most common underlying heart disease and so was rheumatic heart disease (33.3%) in the "non-old" group. NIH stroke scale score (median, 11) and the proportion of patients with a large lesion (> 3 cm) of CT were higher in the "old old" group than in the other two groups. Immediate anticoagulation (A/C) within 14 days of onset was performed in more than 70% of the "non-old" and the "young old" groups but in only 57.6% of the "old old" group. Stroke recurred more often in 34 patients who did not receive immediate A/C than in the 86 who did (11.8% v.s. 2.3%. Chi square test, p = 0.053). Hemorrhage during immediate A/C and other complications (infection and pulmonary embolism) were seen in 2 and 14 patients, respectively, in both the "young old" groups, but not in the "non-old" group. Good outcomes (able to walk with or without cane) were more common in the "non-old" group (78.9%) than the other groups (57.1%, Chi square test, p < (0.01). A/C after the acute stage was done in more than 80% of those in the "non-old" and the "young old" groups, but in less than 30% of those in the "old old" group (Chi square test, p = 0.0514). Survival without recurrence during the observation period (605 +/- 550 days) was significantly lower in the "old old" group than in the other two groups (log-rank test, p = 0.0091). Cardioembolic stroke in the elderly may be characterized as follows: (1) non valvular atrial fibrillation is the most common, (2) severe neurologic deficits on admission and large lesions on CT are noted, (3) complications (infection and pulmonary embolism) often occur, (4) A/C in both acute and chronic stages are done infrequently. Therefore, the indication and intensity of A/C for primary and secondary prevention and prevention of complications are important in management of cardioembolic stroke in the elderly.
 ...
PMID:[Pathophysiology and treatment of cardioembolic stroke]. 989 77

A seasonal variation with an incidence peak during the colder period of the year, as well as a circadian distribution with a single peak of stroke onset in the morning hours are described in various countries. Cardioembolic stroke seems to be the most frequent stroke subtype among Greek patients. Atrial fibrillation is identified as the most frequent cause of stroke. Analysis of the temporal pattern of symptom onset in a series of over 300 Greek patients with first-ever cardioembolic acute stroke due to atrial fibrillation revealed a circannual distribution with a peak during winter and a decline of stroke occurrence during summer. Analysis of the diurnal variation of symptom onset in this stroke subgroup showed a distribution with 2 incidence peaks between 08:00-10:00 and 16:00-18:00. A relation between the second, however lower, frequency peak and the traditional Greek habit of afternoon sleep (siesta) could be assumed. Possible clustering of cardiologic events in patients with atrial fibrillation, especially during the time interval after awakening from night and afternoon sleep, could be a plausible explanation, which certainly deserves to be further investigated.
 ...
PMID:Diurnal and seasonal variation of stroke incidence in patients with cardioembolic stroke due to atrial fibrillation. 1271 53

The aim of this article was to study mortality following a first-ever cerebral infarct, accounting for ischemic stroke subtypes (lacunar, cardioembolic, atherothrombotic) and relevant prognostic variables. This study was done from s a hospital-based prospective registry of all patients with a first cerebral infarct, with a high case ascertainment of first and recurrent stroke by CT. We used a cross-sectional follow-up, using standardized methods. Analyses were performed using crude comparison of mortality data and death causes between stroke subtypes. We analyzed 30-day case fatality and 1-year mortality in 30-day survivors by means of logistic regression analysis, and mortality in 1-year survivors by means of Cox proportional hazard modeling. We also constructed Kaplan-Meier survival curves, and used log-rank testing for differences between stroke subtypes. Thirty-day case fatality was 10%, 1-year mortality 15%, and after 1-year mortality 16%. Mean follow-up was 691, SD 521 days. At the end of follow-up 36% of all patients had died. Mortality was at all three time points lowest in lacunar stroke (2, 12, and 14%, respectively), intermediate in atherothrombotic stroke (10, 16, and 15%, respectively), and highest in cardioembolic stroke (23, 22, and 21%, respectively). Death related to recurrent stroke was similar in all three stroke subtypes (13-16%). Although 30-day case fatality rate was low in lacunar stroke, a quarter of lacunar stroke patients had died at the end of follow-up. Diabetes mellitus, age, stroke subtype, and initial stroke severity were independent predictors of 30-day case fatality, but only diabetes and age were consistent independent predictors for later mortality. Recurrent stroke and heart failure were important death causes. Prognosis for (future) death following a first cerebral infarct differs between stroke subtypes; lacunar stroke patients have the lowest mortality. However, lacunar stroke cannot be regarded as a mild stroke type, as after 2 years more than a quarter of such stroke patients had died. Cardioembolic stroke patients have the grimmest prognosis: more than half of them had died within 1.5 years. Better prognosis for long-term survival following stroke may be achieved by therapies which lower the risk of stroke recurrence, provide better treatment of heart failure, or both.
 ...
PMID:Stroke subtype and mortality. a follow-up study in 998 patients with a first cerebral infarct. 1272 81

Cardioembolic stroke accounts for approximately 15% of all strokes and is thought to be one of the more preventable types of strokes. Features that have been reported to support cardioembolism as a mechanism for ischemic stroke have included documented cardiac source of embolism, maximal neurologic deficit at onset, multiple cerebrovascular territories involved, enhanced tendency toward hemorrhagic transformation, enhanced risk of syncope or seizure associated with presentation, and lower likelihood of premonitory transient ischemic attacks. Features that tend to make cardioembolic stroke less likely include significant cerebral atherosclerosis, step-wise progression of the neurologic deficit within a finite period of time, vascular distribution such as entire internal carotid artery territory with combined middle cerebral artery and anterior cerebral artery involvement or watershed distribution, and premonitory transient ischemic attacks. A number of cardiac conditions can promote thromboembolism, and there is risk stratification reflective of the specific condition or coexistent conditions. Anticoagulant therapy generally has been found to be the most effective means of preventing cardiogenic brain embolism, but the intensity of anticoagulation needs to be optimized to reflect the risk-to-benefit ratio for the particular patient.
 ...
PMID:Cardioembolic stroke: an update. 1291 51

Cardioembolic stroke is quite common (15% of all ischemic strokes) not only in younger patients but also in the elderly. Clinical diagnosis is often difficult. Transthoracic echocardiography (TTE) seems to be the most reliable non-invasive method of examination. Because of the close topographical relationship between heart and esophagus, transesophageal echocardiography (TEE) is particularly suitable to evaluate those cardiac structures (left atrium and appendage) where the embolus can most likely be found. Using TTE and TEE, we studied 62 patients older than 65 years of age (mean age 76 +/- 6), having been affected by ischemic stroke. TEE proved to be clearly superior to TTE in the diagnosis of cardioembolic stroke, without any major complication during the execution of this diagnostic method.
 ...
PMID:The role of transesophageal echocardiography in the diagnosis of ischemic stroke in the elderly. 1537 54

Management of acute ischemic stroke with IV unfractionated heparin is subject to debate. The authors evaluated patient-related and institutional factors influencing its use in 42 hospitals. Cardioembolic stroke type, carotid stenosis, atrial fibrillation, and treatment in stroke units or intensive care units significantly increased the probability of use. However, there are large unexplained variations in IV heparin use among hospitals.
 ...
PMID:Determinants of IV heparin treatment in patients with ischemic stroke. 1562 14

We reported two patients of cardioembolic stroke with stepwise progression. Magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) showed narrowing of the middle cerebral artery (MCA) in both patients at the acute phase of onset. Case 1 was classified as "undetermined" based on the TOAST classification although his electrocardiogram revealed atrial fibrillation. Case 2 was classified as "large artery atherosclerosis" with no evidence of cardioembolic source at the acute phase of onset. Follow-up MRA was performed at seventeen days after the onset in case 1 and ten days after the onset in case 2 respectively, which showed complete recanalization of the MCA in each case. The presence of cardioembolic source was also detected in both patients at that time, resulting in the final diagnosis of cardioembolic stroke. Cardioembolic stroke may occasionally present in a stepwise manner suggesting a thrombotic process. When MRA shows stenosis or occlusion of the arteries supplying the cortical areas at the acute phase of onset, it is advisable to examine recanalization of these arteries by follow-up MRA with simultaneous efforts to find out the possible embolic source.
 ...
PMID:[Two cases of cardioembolic stroke with stepwise progression]. 1904 49


1 2 3 4 Next >>