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

The occurrence of a neurologic deficit at the time of an acute obstruction of the internal carotid does not equate with neurons death. The size of the residual infarct depend on the duration and the depth of ischemia. The goal of fibrinolytic therapy is to obtain a fast reperfusin of the ischemic areas to limit the size of the residual infarct. The risk of reperfusion depend on the depth of the blood-brain barrier ischemia. The indications of reperfusion in emergency settings are based on pretherapeutic CTscan and angiographic assessment with cerebral digitalized parenchymography. Between 1984 and 1994, 100 ischemic strokes have been treated on emergency by local intra-arterial thrombolysis. The results depend on the condition of lenticulostriate arteries: --when the lenticulostriate arteries are not involved in the occlusion, arterial thrombolysis is very efficient (75% good results; 0% bad results) and has been performed up to the 12th hour. --when the lenticulostriate arteries are involved, the results are not as good (58% good results; 23% bad results); the hemorrhagic risk has dramatically dropped in this group when the decision was taken to do not treat the patients after the 5th hour (16.7% to 2.3%). There has been 7 deaths, 6 were due to non efficient revascularization of the parenchyma with vasogenic oedema. In conclusion, we think that ischemic stroke is an emergency; the cerebral digitalized parenchymography appears to be a major diagnostic and prognostic tool; intra-arterial thrombolysis is a very efficient technique when used at the right site and time.
J Mal Vasc 1996
PMID:[Acute carotid occlusion: thrombolytic treatment]. 871 76

In patients with an acute arterial occlusion, identification of the type of mechanism is important, because both prognosis and treatment differ for each type. The aorta is the most frequent source of arterial atheromatous emboli. Aortic arch plaques are therefore recognized as an independent risk factor for stroke, and plaques located on the thoracoabdominal aorta embolize in the visceral arteries or limb circulation. The treatment of risk factors seems the most effective preventive treatment. When atherosclerosis is patent, an anti-platelet drug such as aspirin or ticlopidine is useful. When the embolus actually occurs, heparin avoids extension of thrombus and prevents its recurrence. Surgical treatment is logical but has not been supported by any randomized trial. Cholesterol cristal embolization evolves in 3 clinical forms: 1-the paucisymptomatic form, not diagnosed during subject's lifetime and only recognized in autopsy studies; 2-a benign form such as the blue toe syndrome or cutaneous livedo, with a spontaneous mild prognosis, and 3-a diffuse multisystemic form with a very poor prognosis. More than 80% of patients with the diffuse form die. When there is renal involvement, only 25% are still alive, with renal function after 6 months of follow up. Vascular surgery is limited to patients with aneurysms, which in themselves constitute a surgical indication. For all other patients, surgery is rarely indicated because 1-the source of cholesterol cristal embolization is not certain, 2-patients are usually too weak for a major surgical intervention, and 3-the necessary aortic clamping during surgery would induce a major risk of recurrence. Prevention is the most effective treatment because in 30% of patients, embolization is due to one of the following: anticoagulant drug, recent fibrinolysis, percutaneous angioplasty, vascular surgery, diagnosis angiography and/or coronarography. The medical treatment is mostly symptomatic: rest, warm conditions, appropriate dressing, antiplatelet drugs, hydration, and organ supply when necessary, principally to ensure renal function. In diffuse and multi-visceral embolization, either colchicine or corticosteroids adjuvant therapy might be useful Prostanoid drugs are also a possible adjuvant treatment.
J Mal Vasc 1996
PMID:[Atheromatous embolisms and cholesterol embolisms: medical treatment]. 871 78

The authors report the case of a 84-year old patient admitted to hospital for pulmonary embolism. The diagnosis was made by ventilation and perfusion pulmonary scintigraphy. Transthoracic echocardiography was performed routinely and showed a thrombus wedged across a patient foramen ovale, confirmed at transoesophageal echocardiography. Spiral thoracic computerised tomography showed thrombus in the two main pulmonary arteries and the inferior vena cava. Thrombolysis or thrombectomy under cardiopulmonary bypass, was thought to carry an excessive risk at that age and with the left-sided position of the thrombus. The alternative was therefore anticoagulation which led to dissolution of the thrombus without recurrence of pulmonary embolism or cerebrovascular accident.
Arch Mal Coeur Vaiss 1996 Mar
PMID:[Pulmonary embolism and thrombus trapped in a patent foramen ovale. Cure by heparin therapy]. 873 92

The long-term physiopathological consequences of atrial surgery (Senning or Mustard procedures) for transposition of the great vessels with respect to exercise capacity are not well known. We measured the cardiac index by the technique of CO2 rebreathing at two submaximal levels of exercise corresponding to a stable oxygen consumption of 20 (E20) and 30 (E30) ml/min/kg in 7 patients successfully operated for transposition of the great vessels and in 7 control children paired for age, gender and body surface area. Despite an identical chronotropic response to exercise in the two groups, the increase in cardiac index was not as great in the children operated for transposition (from 6.86 +/- 0.51 to 7.71 +/- 0.78 l/min/m2) as in the control population (from 7.71 +/- 0.78 to 10.2 +/- 0.51 l/min/m2; p < 0.02). The stroke volume index was therefore significantly lower in the transposition group at both levels of exercise (52 +/- 3.2 vs 63 +/- 4.1 ml/m2; p < 0.04 at E20; and 46.4 +/- 4.3 vs 66 +/- 5.1 ml/m2 at E30). The main cause of this reduction of the stroke volume index is probably a lack of adaptation of right ventricular systolic function on exercise but it is not possible to exclude diastolic dysfunction due to reduce compliance secondary to the intraatrial patch. The conditions of preload are in fact instrumental in increasing stroke volume index at submaximal exercise levels.
Arch Mal Coeur Vaiss 1996 May
PMID:[Cardiac output evaluation during exercise in children treated with atrial surgery for transposition of great vessels]. 875 68

More than 10 epidemiologic studies have established that a high fibrinogen level is a thrombotic risk factor. The role of fibrinogen in arterial occlusion is multiple : the atheroma plaque involvement in formation thrombus, erythrocyte aggregation, whole blood and plasma viscosity. Fibrinogen level is high during inflammation and increases with ageing and in tobacco addicts. In coronary disease, it is an independent risk factor of prognosis value. In arterial peripheral disease, it is a risk factor of postsurgical reocclusion. After a stroke, a high level of fibrinogen is a sign of severe disease. The dosage of fibrinogen is quite easy but requires a precise calibration. The determination of genetic polymorphism associated with high fibrinogen level is promising. Many circumstances can modify fibrinogen level and are targets for prophylaxis treatments. The influence of genetic factors is still discussed.
J Mal Vasc 1996
PMID:[Fibrinogen: a risk factor]. 896 39

Vertebrobasilar-distribution stroke is a rare but sometimes severe complication of chiropractic neck manipulation. We report two patients with dissections of the vertebral arteries authenticated two and six days after the cervical manipulation. In the first case, a Wallenberg's syndrome occurred due to a dissection of the right intracranial vertebral artery; the patient was treated with anticoagulant therapy but little improvement of the disorder was noted. The second patient had transitory neurologic manifestations which led to the discovery of an intimal tear of the ostium of the right vertebral artery with a floating clot. Further embolic complications were avoided by performing a venous bypass between the right common carotid and the vertebral artery at the base of the skull. Therapists should be aware of vertebrobasilar complications after spinal manipulations and should ask for early explorations (brain CT, cerebral angiography) to institute rapidly the most appropriate treatment.
J Mal Vasc 1996
PMID:[Manipulations of cervical vertebrae and trauma of the vertebral artery. Report of two cases]. 902 51

This study searched for abnormalities of the atrial electrophysiological substrate in young subjects with unexplained ischaemic cerebrovascular accidents. Thirty-seven patients (18 to 45 years) underwent programmed atrial stimulation at 2 sites in the right atrium after an unexplained ischaemic cerebrovascular accident. Seventeen of them underwent repeat study at 6 months. The following parameters were analysed: indices of atrioventricular conduction and sinus node automaticity; indices related to atrial hyperexcitability: effective refractory period; adaptation of the refractory periods to heart rate, intraatrial conduction and the index of latent vulnerability; the inducibility test by the extrastimulus technique. The following results were obtained: 54% of patients had an inducible atrial arrhythmia; the effective refractory periods and index of latent vulnerability were lower (204 +/- 21 ms and 2.25 +/- 0.7) in the inducible patients than in the non-inducible patients (232 +/- 28 ms and 3.4 +/- 1.1) (p < 0.001 and p < 0.002 respectively); 76% of patients had latent atrial vulnerability indicating and underlying arrhythmogenic substrate; this substrate was still present 6 months later in 80% of these cases; in patients with an abnormality of the interatrial septum, there was an abnormality of the electrophysiological investigation in 85% of cases compared with 65% in those with normal transoesophageal echocardiography. These results confirm the presence of an arrhythmogenic substrate similar to that of patients with paroxysmal atrial fibrillation in over two thirds of cases. Programmed atrial stimulation is a reproducible technique. The relationship between latent atrial vulnerability and abnormalities of the interatrial septum requires confirmation in a series with a larger numbers of patients.
Arch Mal Coeur Vaiss 1996 Nov
PMID:[Value of the study of latent atrial vulnerability in unexplained ischemic cerebrovascular accident of young subjects]. 909 94

In comparison with the incidence of cerebrovascular accident in the general population, atrial fibrillation increases the risk by a factor of five. Although age is without doubt the main risk factor for cerebrovascular accidents in patients with permanent of paroxysmal non-valvular atrial fibrillation, other independent risk factors have been identified: a previous history of hypertension, cerebrovascular accident, heart failure or diabetes. These factors enable identification of a population at risk in which oral anticoagulation may be recommended with an excellent efficacy/risk ratio. Six large scale randomised controlled multicenter trials of primary prevention have been published with a total of over 2,800 patients with non-valvular atrial fibrillation. The combined results of these trials show that treatment with vitamin K antagonist (INR 2-3) leads to a significant reduction in the risk of an ischaemic cerebrovascular accident of 64% (95% CI [51-74]; p < 0.001) and in the risk of death from all causes of 28% (95% CI [12-47]; p = 0.038) with a slight increase in the risk of cerebral haemorrhage (+ 2.7% NS). Although the benefits of aspirin therapy are not as impressive (reduction of the risk of an ischaemic cerebrovascular accident of 22%; 95% CI [0-39]; p = 0.053), this alternative may be proposed in patients under 75 years of age without the previously mentioned risk factors. The value of combined aspirin-oral anticoagulant therapy, especially in high risk patients, has not yet been established and is under evaluation.
Arch Mal Coeur Vaiss 1996 Nov
PMID:[Antithrombotic therapy of atrial fibrillation]. 909 15

The postoperative follow-up of 8 patients on the waiting list for cardiac transplantation, with implanted left ventricular assist devices of the Novacor type, was marked by right ventricular failure in the first week, controlled by positive inotropic agents and the maintenance of high right ventricular preload. The outcome later on showed that an ambulatory life was possible for 6 of the 8 patients, allowing the wait for cardiac transplantation under excellent conditions. Three major complications were observed: a case of aspergillosis endocarditis, one vertebrobasilar cerebrovascular accident and one low output state by progressive degradation of right ventricular function: after a period of circulatory assistance of 52 to 201 days. 6 out of the 8 patients underwent cardiac transplantation, 5 of which were successful.
Arch Mal Coeur Vaiss 1996 Nov
PMID:[Mechanical circulatory assistance using the Novacor implanted device. A postoperative follow-up]. 909 32

After 6 years of experience, Spencer and colleagues described the detection of embolus signals as height intensity transient signals (HITS) within Doppler flow spectrum from intracranial vessels. These signals (gaseous or materials) are recorded in many situations such as cardiac prosthetic valves, atrial fibrillation, carotid stenosis, carotid surgery or angioplasty. The clinical value is not well known: neurological impairment associated with brain lesions is described in case of cardiac prosthetic valves. The observation of HITS in carotid stenosis is associated with an increased risk of stroke. The detection of HITS offers a new orientation in studying stroke but some technical and/or clinical difficulties have to be solved.
J Mal Vasc 1997 Mar
PMID:[Cerebral HITS: diagnosis, clinical relevance, outlook]. 912 Mar 64


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