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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cerebral infarction before the age of 45 years accounts for 4-6% of all strokes. The etiology remains unexplained in a significant proportion of patients even after extensive investigations. The reported risk factors of this age group are cardiopathies, hypertension, smoking, hypercholesterolemia, reduction of anticoagulant proteins, hypercoagulable states, antiphospholipid antibodies primary syndrome, antiphospholipid antibodies secondary syndrome, some hemoglobinopathies, hyperviscosity syndromes, vasculitis, collagen vascular diseases, fibromuscular dysplasia, arterial dissections, migraine, myopathy encephalopathy lactic acidosis stroke like episodes, homocystinuria, familial amyloid angiopathy, microangiopathy with retinopathy encephalopathy and deafness, systemic lupus erythematosus, use of cocaine, traumas or manipulations of neck, AIDS. From 1/1/94 to 04/30/95 we observed 19 patients with cerebral infarctions and 9 patients with transitory ischemic attacks in young people. The aim of our study was to apply a diagnostic protocol by sequential tests of first level and second level. According to this protocol we found that the more common risk factors were ischemic cardiopathy, hypertension, smoking and hypercholesterolemia. Moreover we observed other independent risk factors, although less frequent, like the antiphospholipid antibodies, neurolupus, AIDS, deficit of protein S.
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PMID:[The application of a new diagnostic protocol for stroke in the young]. 876 46

To define the causal relationship of ischemic cerebral infarction to automobile accidents in hospitalized patients a computerized hospital record search with ICD-9 diagnostic codes 433 and 434 for occlusive cerebrovascular disease, and E810 and E819 for motor vehicle traffic accidents was conducted over a three-year period. Inclusion criteria required patients be identified as the driver of the vehicle and demonstrate computed tomographic (CT) evidence of an evolving cerebral infarction on serial scans. Of 2,844 ischemic cerebral infarctions admitted to the hospital during the study period, four met the selection criteria. In three, stroke was the cause and in one, the result of the accident. When stroke preceded the accident, visual field defect impaired consciousness, and/or loss of motor control were major contributing factors. Head CT, detailed accident scene history, and vascular disease risk factors were most important in determining a cause-and-effect relationship of stroke to the accident.
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PMID:Stroke and automobile accidents. 877 36

The prevention of dementia is of critical importance. The increasing population of high-risk older individuals will result in an increasing prevalence of dementia. Primary prevention of dementia and Alzheimer disease can take either a public health or high-risk preventive medicine approach. At the present time, there is little evidence to support a specific primary public health approach such as a specific nutrient. The possible association of vascular disease with dementia may offer the best preventive high-risk approach. The identification of individuals with clinical and subclinical vascular disease is possible. There is a very high prevalence of subclinical cerebral infarction in older individuals. Specific treatments can prevent clinical disease such as stroke and coronary heart disease. Whether therapies will prevent some dementia can be determined.
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PMID:Potential prevention of Alzheimer disease and dementia. 887 82

We determined plasma activity of the isoenzymes of beta-hexosaminidase (Hex) in 151 patients with cerebral infarction, since earlier findings have shown a relation between Hex isoenzymes and risk factors for vascular disease in normal subjects. Compared with 206 control subjects, an elevated level of plasma Hex isoenzymes was found in patients with cerebral infarction, particularly females. However, there was no relation to the clinical subtypes of diagnosis or to the presence of any risk factors for vascular disease, such as carotid artery stenosis, major potential cardio-embolic risk factors on echocardiography, hypertension, heart disease, diabetes mellitus or tobacco smoking. Instead, our findings indicate that Hex isoenzymes in patients with cerebral infarction are more influenced by the level of serum aspartate aminotransferase and blood glucose. The main conclusion is that the liver function as reflected by the level of liver enzymes and glucose metabolism are the major determinants of Hex isoenzymes in plasma.
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PMID:Plasma beta-hexosaminidase isoenzymes A and B in patients with cerebral infarction. 891

The incidence, prognosis and causes of strokes associated with pregnancy or puerperium are poorly known, and we do not know whether and to what extent they differ from those of the general female population of childbearing age. Based on early and mostly hospital-based studies, it has been claimed that pregnancy increases the likelihood of cerebral infarction to about 13 times the rate expected outside of pregnancy. However, because of methodological weaknesses, these estimates must be regarded with caution. In a recent study in Ile de France, the incidence of arterial ischemic strokes associated with pregnancy or early puerperium was 4.3 per 100,000 deliveries (95% confidence interval, 2.4 to 7.1), a rate not much different from that for all women of childbearing age. Ischemic strokes related to various etiologies have been reported in pregnancy and the puerperium. Their relative frequency is poorly known because there are no recent large series of pregnancy-related ischemic strokes benefiting from detailed investigation with modern imaging techniques. Most of the known causes of ischemic stroke in the young been reported during pregnancy. In most of these conditions, it is uncertain whether pregnancy is coincidental or plays a role in the occurrence of stroke. Among pregnancy-specific causes, eclampsia may be associated with focal neurological deficits of sudden onset, consistent with a clinical diagnosis of stroke. However, the precise pathogenesis of these stroke-like focal deficits remains poorly understood. Except for some women who have persisting neurological deficits and neuroradiological abnormalities suggesting brain infarction, the reversibility of the neurological clinical signs and neuroradiological lesions within a few days or weeks in most cases argues against the existence of true cerebral ischemic necrosis. The two other pregnancy-specific causes-choriocarcinoma and amniotic fluid embolism-are rarely responsible for focal cerebral ischemia. Other diseases such as peripartum cardiomyopathy and postpartum cerebral angiopathy were initially considered as pregnancy-specific causes but subsequently reported outside of pregnancy. In a significant number of patients, the cause of the stroke remains undetermined, despite an extensive etiological workup. Whether hypercoagulable state and vessel wall changes associated with pregnancy may play a role in the occurrence of these otherwise unexplained ischemic strokes remains unknown. Too frequently, the stroke is considered at the first attempt as a complication of pregnancy and another underlying etiology may be missed. Therefore, evaluation of arterial ischemic stroke in pregnancy should proceed as in the non-pregnant state. There are no follow-up studies that consider the risk of recurrent stroke in future pregnancies. No data are available on the risk associated with use of oral contraception in a woman who had ischemic stroke during pregnancy. The frequency of cerebral venous thrombosis associated with pregnancy and the puerperium is not precisely known. Indeed, epidemiologic studies have been difficult to perform because cerebral venous thrombosis may have a misleading presentation and a definite diagnosis requires angiography, MRI or autopsy. The incidence of cerebral venous thrombosis has been estimated at 10 to 20 per 100000 deliveries in occidental countries, whereas rates of 200 to 500 per 100,000 deliveries have been reported in India. The pregnant and puerperal state accounts for 5 to 20% of all cerebral venous thrombosis in occidental countries; this proportion may reach 60% in developing countries. Labor and delivery are characteristically normal in occidental countries. The occurrence of cerebral venous thrombosis is clearly linked to the puerperial state, suggesting a direct role of the puerperial state.(ABSTRACT TRUNCATED)
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PMID:[Cerebrovascular diseases in pregnancy and puerperium]. 894 39

The authors report on a series of patients with idiopathic Parkinson's disease (IPD) who underwent stereotactic radiofrequency (RF) pallidotomies, three of whom suffered delayed postoperative strokes. These three belonged to a group consisting of 42 patients with medically intractable IPD in whom 50 pallidotomies were performed. All three patients had significant previous vascular disease and were in a high-risk group for cerebral infarction. A postoperative magnetic resonance (MR) image was obtained immediately after the pallidotomy was performed to document the placement of the RF lesion and to rule out any hematoma. The delayed strokes occurred on postoperative Days 10, 51, and 117 in patients with previous vascular disease (Group 1, 11 patients). No strokes occurred in the group with the vascular disease risk factor (Group 2, 11 patients) or in the group with no risk factors for vascular disease (Group 3, 20 patients). This observation is statistically significant (p < 0.05). The T2-weighted MR images showed the lesions as high-intensity signals extending to the posterior limb of the internal capsule ipsilateral to the pallidotomy site. The poststroke T1-weighted images obtained in two patients showed persistent contrast enhancement of the RF lesion and no enhancement around the stroke lesion. Clinically and radiographically, these discrete new lesions represent delayed infarctions, suggesting that RF lesioning can induce delayed injury in adjacent tissue. Patients with previously identified vasculopathy may be at risk for delayed capsular infarction following RF pallidotomy.
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PMID:Delayed internal capsule infarctions following radiofrequency pallidotomy. Report of three cases. 938 11

Cerebral amyloid angiopathy affects the cerebral vasculature selectively, and there is no systemic amyloidosis. Amyloid is deposited in small and medium-sized vessels of the cortex and leptomeninges. Cerebral amyloid angiopathy is a common cause of spontaneous lobar haemorrhage in elderly patients. However, cerebral amyloid angiopathy may have atypical clinical and radiological presentations. We report on five patients (three males and two females, aged 43-77 years) with histologically verified cerebral amyloid angiopathy. One patient experienced an acute headache attack and classical lobar haemorrhage. The other patients had various neurological symptoms and signs, such as seizure, disturbed vision, pareses, aphasia, and dementia that were initially diagnosed as cerebral infarction or tumour. Two patients with cerebral amyloid angiopathy and granulomatous angiitis responded to immunosuppressive treatment.
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PMID:[Cerebral amyloid angiopathy]. 976 Aug 54

Cerebral vascular disease is a common and serious complication of sickle cell disease that mainly involves the large blood vessels of the skull base. Because recurrences are common and residual deficits severe, attention has turned to detection of preclinical cerebral involvement with the goal of preventing clinical damage. Magnetic resonance imaging (MRI), an extremely sensitive tool for detecting cerebral infarction/ischemia, has shown that 10% of asymptomatic patients exhibit white matter lesions that seem to be associated with impaired cognitive function and may be predictive of stroke; magnetic resonance angiography demonstrates occlusions of skull base arteries but is not reliable for the diagnosis of stenosis because of artifacts generated by rapid turbulent flow. Transcranial Doppler is sensitive and specific for the detection of arterial stenosis and occlusion, even in asymptomatic patients. Digitized cerebral angiography remains the gold standard investigation for pretreatment confirmation of lesions detected by Doppler and/or MRI.
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PMID:[Imaging of cerebrovascular disease in sickle cell anemia]. 1008 77

The Alzheimer type of dementia and stroke are known to increase at comparable rates with age. Recent advances suggest that vascular risk factors linked to cerebrovascular disease and stroke in the elderly significantly increase the risk of developing Alzheimer's disease (AD). These include atherosclerosis, atrial fibrillation, coronary artery disease, hypertension, and diabetes mellitus. Moreover, review of various autopsy series shows that 60-90% of AD cases exhibit variable cerebrovascular pathology. Although some vascular lesions such as cerebral amyloid angiopathy, endothelial degeneration, and periventricular white matter lesions are evident in most cases of AD, a third will exhibit cerebral infarction. Despite the interpretation of pathological evidence, longitudinal clinical studies suggest that the co-existence of stroke and AD occurs more than by chance alone. Strokes known to occur in patients with Alzheimer syndrome and most frequently in the oldest old substantially worsen cognitive decline and outcome, implicating some interaction between the disorders. Nevertheless, the nature of a true relationship between the two disorders seems little explored. What predisposes to strokes in underlying cognitive decline or AD? Is it possible that cerebral ischemia is a causal factor for AD? I examined several vascular factors and the vascular pathophysiology implicated in stroke and AD, and propose that cerebral ischemia or oligemia may promote Alzheimer type of changes in the aging brain. Irrespective of the ultimate pathogenetic mechanism, these approaches implicate that management of peripheral vascular disease is important in the treatment or prevention of Alzheimer's disease or mixed dementia.
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PMID:The role of cerebral ischemia in Alzheimer's disease. 1086 17

A mail survey was conducted to elucidate the influential factors on heath-related quality of life (HRQOL) after cerebral vascular disease. Questionnaires for clinicians and their patients were mailed to 2,587 hospitals with more than 100 beds, which have at least one of the following departments: neurosurgery, neurology, psychiatry or rehabilitation. Each mailing contained a request to the clinician and questionnaires for 5 cases. 378 effective questionnaires could be collected, meaning the collection rate was 2.9%. The questions for the physicians concerned diagnosis (cerebral infarction or hemorrhage), duration of illness, activities of daily living(ADL), manifestation of paralysis and psychiatric symptoms and so forth. The questionnaire for the patients was composed of items from the EuroQol clinical version (EuroQol). Geriatric Depression Scale short form (GDS) and inquiries concerning family living with the patients, their housekeeping and so on. A visual analogue scale (VAS) concerning health state of the EuroQol was used as a measure of HRQOL. Coefficients of determination between VAS and other inquiries were calculated by regression analysis or ANOVA, revealing that "anxiety/depression", "GDS" and 16 other items were statistically significant on VAS (p < 0.05). General linear model (GLM) analysis using VAS as a criterion variable and these 18 items as predictor variables showed that "sleep disturbance" and GDS score were most influential on VAS according to the F value of the type 3 sum of squares. "Health state today compared to that during the past one year", "shopping as housekeeping", "ADL" and "pain/discomfort" also have some influence on VAS. In conclusion, sleep disturbance and depression had the most deleterious effect on HRQOL.
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PMID:[Influential factors on health-related quality of life after cerebral vascular disease]. 1103 29


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