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

Stroke is the second most common cause of mortality and a major cause of long-term disability of adults in most countries. This study was performed to determine the level of knowledge and awareness regarding risk factors and warning signs of stroke in a selected sample. This cross-sectional study was carried out in Aydin between November and December 2005, utilizing a study sample of 920 people registered at urban health centers. The questionnaire, prepared by the investigators, was administered by 20 trained students utilizing face-to-face interviews at participants' homes. Two-thirds of the participants knew the organ effected by stroke. The participants reported that stroke was a consequence of occlusion (28.0%) or bleeding (18.0%) in brain arteries. Paralysis/weakness of one side of the body (37.1%), speech impairment (26.8%) and numbness of one side of the body (14.2%) were reported as three major stroke warning signs. Sixty-four percent of the participants knew at least one of these risk factors. Their primary sources of information were family and friends. Our study showed the great need for increasing awareness of risk factors and warning signs for stroke, perhaps utilizing community based education programs and the mass media.
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PMID:A population-based study on awareness of stroke in Turkey. 1743 10

Central pain is neuropathic pain resulting from a lesion of the CNS, such as a stroke [poststroke central pain (CPSP)]. Lesions involving the posterior thalamus lead to reduction or loss of sensation and to CPSP, although the responsible nuclei have not been identified. We now examine the hypotheses that thalamic lesions must extend posterior to the ventral caudal nucleus (Vc) and include ventral medial posterior nucleus (VMpo), to result in loss of cold sensibility and CPSP. Patients with small thalamic strokes associated with CPSP were evaluated by atlas-based mapping of magnetic resonance imaging scans, and by somatosensory testing. All lesions involved posterior Vc; two lesions also involved nuclei posterior to Vc, but not VMpo. All patients tested had alterations of cold pain sensation and tactile sensation, as measured by von Frey hairs. Three patients had altered cool sensation, and the patient with the least involvement of Vc had normal cool thresholds, suggesting that a critical volume of Vc must be involved before cool sensation is impaired. Perception of warm was impaired only in lesions involving nuclei posterior to Vc. Heat pain perception was never affected. In a subject with cold allodynia, a single-subject protocol PET study measured the responses to immersion of either hand in a 20 degrees C waterbath. The scan during stimulation of the affected hand was characterized by intense activation of contralateral sensorimotor cortex. Therefore, there are modality-specific subnuclear structures in the posterior thalamus, but lesions of Vc not involving VMpo are sufficient to impair cold sensibility and to produce CPSP.
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PMID:Lesions limited to the human thalamic principal somatosensory nucleus (ventral caudal) are associated with loss of cold sensations and central pain. 1747 8

Lead wire malposition is thought to be a rare complication of both permanent and temporary pacemaker implantation. The actual incidence and prevalence are unknown because of lack of reporting, which complicates consistency in treatment. Potential safeguards to prevent complications as a result of lead malposition are readily available, effective, and inexpensive, but underused. An 80-year-old white man presented to our institution with right-arm paresthesias and weakness, as well as facial numbness, 4 months after undergoing single-chamber pacemaker placement by an outside hospital because of tachybrady syndrome. Computed tomography scan of the head revealed a recent ischemic stroke. Electrocardiography revealed right bundle-branch block morphology of paced beats. Chest radiography raised the suspicion of lead malposition because of the posterior deflection of the lead wire on the lateral view. Transesophageal echocardiography conclusively demonstrated a pacemaker lead wire that transversed the aortic valve into the left ventricle without the presence of thrombus. The patient underwent successful removal of the device with a transcatheter approach, and a replacement pacemaker was placed for symptomatic bradycardia. It was recently suggested that echocardiography is not able to adequately detect thrombi on lead wires and that all patients with stroke should undergo open heart surgery for device extraction. We think that this does not adequately incorporate the significant comorbidities for some patients in the risk-benefit decision-making processes and that a transcutaneous approach is reasonable for patients without evidence of thrombi who are poor surgical candidates for an open heart procedure. A 12-lead electrocardiogram should be performed on every patient after pacemaker insertion. If right bundle-branch block morphology of paced beats is noted, chest radiography including a lateral view should be ordered. If there is any ambiguity regarding lead placement, echocardiography should be performed for determining lead malposition.
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PMID:A stroke of bad luck: left ventricular pacemaker malposition. 1760 Jun 76

Headache with neurological deficits and cerebrospinal fluid (CSF) lymphocytosis (HaNDL) is a benign condition with a transient ischemic attack (TIA)-like presentation. It is a disease of young adults that is characterized by headache, transient focal neurological symptoms, and lymphocytic pleocytosis. The onset of neurological symptoms after cerebral angiography in patients with this disease has occasionally been reported. The authors present the case of a 28-year-old man with episodes of left-sided numbness and weakness associated with headache. He underwent cerebral angiography as part of his evaluation, after which he experienced an episode of right hemiplegia and aphasia. A subsequent magnetic resonance image (MRI) revealed two small new infarcts in the left parietal cortex. A diagnosis of HaNDL was made based mainly on clinical symptoms and CSF analysis. The symptoms resolved with conservative therapy. HaNDL is a benign condition that can present with symptoms similar to a TIA. Although HaNDL remains a diagnosis of exclusion, caution is required when considering cerebral angiography in the evaluation of patients with a HaNDL-like syndrome, because these patients seem prone to developing neurological symptoms after angiography.
J Stroke Cerebrovasc Dis
PMID:Headache with neurological deficits and CSF lymphocytosis: A transient ischemic attack mimic. 1789 37

Secondary erythrocytosis of cyanotic congenital heart disease (CCHD) is pathologically different from primary erythrocytosis of polycythemia vera (PV). An association between elevated hematocrit and thrombosis has been established in PV patients, and treatment guidelines recommend maintaining hematocrit <45%. Although an association between elevated hematocrit and thrombosis has not been established in CCHD and secondary erythrocytosis, the current clinical practice is to phlebotomize these patients to hematocrit <65%. We report a 21-year-old woman with CCHD who presented with symptomatic erythrocytosis with numbness and tingling with hemoglobin 25.2 g/dl and hematocrit 75.8%. Her symptoms resolved with IV hydration. Other factors, including dehydration and iron deficiency, may precipitate hyperviscosity symptoms. The treatment is volume replacement and low-dose iron therapy, not phlebotomy. Repeated phlebotomy causes iron deficiency with microcytic erythrocytes, which increases the whole blood viscosity and, therefore, can potentially accentuate rather than decrease the risk for a cerebrovascular accident.
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PMID:Cyanotic congenital heart disease (CCHD) with symptomatic erythrocytosis. 1791 83

A 61-year-old patient with a sudden numbness of the right arm and hand and signs of amnestic aphasia is admitted to the stroke unit with the diagnosis of an acute ischemic stroke for systemic thrombolysis. Based on a case-report, drug-related problems are discussed according to the SOAP scheme. Aspects of pharmaceutical care such as counselling by a pharmacist about secondary prevention, discharge information and a pharmaceutical care plan in the community pharmacy are described.
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PMID:[Pharmaceutical care for a patient with ischemic stroke]. 1836 79

Rapid identification and treatment of ischemic stroke can lead to improved patient outcomes. We implemented a 20-week public education campaign to increase community awareness of warning signs for stroke and the need to call 911. Telephone surveys were conducted in adults aged 45 years and older before and after the intervention to evaluate its impact. There was a significant increase in awareness of two or more warning signs for stroke from baseline to follow-up (67% to 83%). Awareness increased significantly among both men and women and younger and older respondents. There was no significant change in the proportion of respondents indicating that they would call 911 if they witnessed someone having a stroke (74% to 76%). However, after the campaign, an increased proportion of respondents indicated that they would call 911 if they experienced sudden speech problems (51% to 58%), numbness or loss of sensation (41% to 51%), or paralysis (46% to 59%) that would not go away. Our findings suggest that a high-intensity public education campaign can increase community awareness of the warning signs for stroke and the need to call 911.
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PMID:Public education strategies to increase awareness of stroke warning signs and the need to call 911. 1840 40

Postpartum arterial dissection combined with subarachnoid hemorrhage (SAH) is rare and its mechanism is uncertain. A 32 year-old woman had a delivery by cesarean section 12 days prior to admission to our hospital. From the first day of delivery, she breast-fed her baby, sitting with her head always turned to the right. Each feeding lasted around 2 hours. A bilateral throbbing headache began two days after childbirth, and intermittent numbness of the right face, chest and hand as well as weakness of the right hand developed nine days after giving birth. A physical examination revealed transient mild hypertension and right hemiparesis. Her cholesterol ranged from 204 to 263 mg/dl. Computed tomography, magnetic resonance angiography and duplex ultrasound disclosed left fronto-parietal junction SAH and dissections of the right internal carotid (ICA) and vertebral arteries. Our patient demonstrated (1) that postpartum arterial dissection was not limited to natural delivery, (2) postpartum SAH could occur with dissections of the contralateral extracranial carotid and vertebral arteries, and (3) that turning one's head always to the same side during breast-feeding might be a risk factor for this unusual stroke pattern.
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PMID:Unilateral carotid and vertebral artery dissections and contralateral subarachnoid hemorrhage in a postpartum patient. 1868 48

A 48-year-old female presented to an emergency room with symptoms of episodic hemianopsia, dysphasia, and facial numbness. She had no obvious risk factors for cerebral vascular disease but was admitted into the hospital with a diagnosis of transient ischemic attack (TIA). A neurologist reviewed her history and discovered the additional history of bilateral head pressure accompanying her symptoms. The additional diagnosis of complex migraine with aura was added to the differential diagnosis. Migraine with aura is associated with many neurologic symptoms and can mimic stroke and TIA. Migraine-induced stroke is also described in the literature. The complex presentation of some episodes of migraine makes attention to a detailed history paramount for assessing the patient for diagnosis and for risk selection. Recent studies have demonstrated an association between migraine headaches and cardiovascular morbidity and mortality. The attributable mortality risk for migraine-induced stroke is very low.
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PMID:"TIA" or migraine in a woman with no risk factors for cerebral vascular disease. 1931 33

The disturbance of balance function is one of main etiology resulting in falling down in stroke patients. A number of studies report that acupuncture may improve the motor function of stroke patients. Therefore, the aim of the present study was to investigate the effect of acupuncture on balance function. We designed a single-blinded, controlled, randomized study. A total of 30 stroke patients were randomized into experimental and control groups. Experimental groups received acupuncture treatment accompanied by the manual twisting of needles and obtaining of qi (the subjects experienced sensations of soreness, numbness, swelling and heaviness, while the acupuncturist experienced a sensation of needle resistance), whereas the control group did not receive manual twisting of needles and without obtaining of qi. All of the subjects were first-time stroke patients; infarction location was limited to either the left or right hemisphere, and all subjects were able to walk for at least 6 meters. Acupuncture stimulation (AS) was applied to Baihui (GV 20) acupoint as well as to 4 spirit acupoints (1.5 cun anterior, posterior, left and right laterals from Baihui acupoint, respectively) for 20 min. Balance function outcome measures were: (1) the displacement area of the patient's center of gravity; (2) the time taken for a patient to stand vertically from a seated position; (3) the time taken for a patient to walk a distance of 6 meters; (4) muscle strength of both lower extremities. Results indicated that the displacement area from the center of gravity decreased in the experimental group, but not in the control group. There was greater reduction in the displacement area in the experimental group than in the control group. Following AS, the time taken to reach a standing position from a seated position, as well as the time taken to walk 6 meters was decreased equally in both the experimental and control groups. The muscle strength of the hip flexor and knee extensor were increased in the paralyzed and non-paralyzed sides of patients in the experimental group, but not in the control group. The results of the present study suggest that acupuncture stimulation may induce an immediate effect that improves balance function in stroke patients.
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PMID:Acupuncture stimulation improves balance function in stroke patients: a single-blinded controlled, randomized study. 1960 9


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