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

The authors report 22 cases of transient ischemic attacks (TIA's) manifested by amaurosis fugax or hemiparesis or paresthesia of less than 24 hours' duration. None of the patients demonstrated 1) evidence of atherosclerotic cerebral vascular disease on angiography, 2) evidence of intracranial lesion on brain scan, 3) cardiac source of emboli, 4) arteritis or collagen disease, or 5) history of migraine. The only abnormalities found to explain the TIA's were abnormally increased platelet adhesiveness and/or aggregation. All of these patients were followed from 1 to 5 years, and had repeated coagulation studies. Treatment with antiplatelet drugs showed an excellent clinical response with associated decrease in platelet adhesiveness and aggregation. Discontinuance of the antiplatelet drug resulted in a recurrence of the TIA's which coincided with an increase in aggregation and adhesiveness. In two cases the platelet morphology was studied by transmission and scanning electron microscopy. It appears that there is a specific group of patients with TIA's in whom the sole cause of the attack is an abnormality of platelet function. For these people there is a specific therapy and a method monitoring the treatment.
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PMID:Transient ischemic attacks due to increased platelet aggregation and adhesiveness. Ultrastructural and functional correlation. 42 99

Transient ischemic attacks (TIA) are episodes of abrupt beginning, consisting of subjective or objective neurological dysfunction of short duration, with complete recovery of neurological function in the course of 24 hours. With this definition, the authors carried out a retrospective study of 150 patients suffering from ischemic infarct in the brain in the territory of the middle cerebral artery. Thirty-eight percent of the patients had had TIAs before their cerebral infarct. The symptoms, in order of frequency, were motor, sensory deficits, alterations of speech and vision. Most of the patients had a definite cerebral infarct, occurring one month after the last TIA; the symptoms of both processes were remarkably similar. The authors studied the angiographic characteristics, pharmacological and toxic antecedents, and associated diseases in these patients. The study indicates that TIA may be the first manifestation of cerebral vascular disease.
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PMID:Transient ischemic attacks. Retrospective study of 150 cases of ischemic infarct in the territory of the middle cerebral artery. 46 11

Twelve patients who had no evidence of arteriosclerotic cerebral vascular disease, lacked hypertension or coagulation defect, and had not been receiving contraceptive therapy had recurrent transient cerebral ischemic attacks (TIAs) and partial nonprogressive strokes. All had prolapsing mitral valve proved by angiocardiography. The average age was 38 years, compared with 62 years in a larger series of patients with TIA associated with arteriosclerosis. We propose that the ischemic events are related to emboli emanating from the abnormal mitral valve with or without an associated paroxysmal cardiac arrhythmia.
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PMID:Cerebral ischemic events associated with prolapsing mitral valve. 98 56

Recent studies concerning secular trends in stroke incidence and mortality and identification of independent risk factors for stroke are reviewed. Stroke mortality has declined in many industrialized countries in recent decades. In France, it has been declining by more than 30% between 1968 and 1982 in all age groups and in both sexes except for women under 40 years. The decline in stroke mortality seems to be partly real and partly apparent. In the community-based study of Rochester, Minnesota, stroke incidence decreased by 54% between 1945-49 and 1975-79. Recent data from Rochester, however, suggest that the incidence of stroke may no longer be declining. Survival after stroke has also apparently been improving but several sources of potential bias may also have influenced the decrease in reported survival rates. Hypertension is a major risk factor for stroke. Prolonged differences in "usual" diastolic blood pressure of 5 to 10 mmHg are associated with about 40% difference in stroke incidence. Recent analysis suggests that stroke incidence reduction could arise rapidly after hypertension control and that a lower blood pressure should confer a lower risk of vascular disease, even in individuals conventionally considered as "normotensive". There is evidence that cigarette smoking is an important risk factor for stroke with an overall relative risk of 1.5 and that the risk of stroke declines rapidly after the cessation of smoking. A cardiac condition may be a marker for another risk factor or the primary substrate for cerebral embolism. In patients with atrial fibrillation, the risk of stroke is increased through both of these mechanisms. Diabetes mellitus, chronic alcohol consumption (> 3 drinks/day), and high fibrinogen levels are other independent risk factors for stroke. While high levels of cholesterol may be associated with ischemic stroke, an inverse association of the serum cholesterol with the occurrence of intracerebral hemorrhage in men has been reported. In patients with asymptomatic internal carotid stenosis, higher degrees of stenosis convey a higher risk of stroke. However, far from all these strokes are due to thromboembolism from an atheromatous plaque in the ipsilateral internal carotid artery. The relative risk of stroke during the first 5 years following a transient ischemic attack is 7 times that in persons without transient ischemic attack. More than a third of the subsequent strokes occur in a vascular territory different from that of the incident TIA. While the use of oral contraceptives may increase the relative risk of stroke, postmenopausal estrogen treatment may have a protective effect on the risk of vascular diseases.
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PMID:[Epidemiology of cerebrovascular accidents]. 143 51

Subdural hematomas many sometimes clinically resemble Transient Ischemic Attacks (TIA's). We present three cases which were initially evaluated for, diagnosed as having and were treated for TIA's, but later were found to have subdural hematomas. As in case one, patients with subdurals may have antecedent head trauma which they may or may not recall. Patients presenting with symptoms resembling TIA's need a complete neurologic evaluation. The differential diagnosis for TIA's includes arteriosclerotic extracranial vascular disease, cardiac emboli, migraine, seizure disorder, and mass lesions. Since the prognosis and treatment differs one needs to determine the etiology of the symptoms before treatment is initiated. Specifically, other diagnoses must be excluded prior to anticoagulation therapy, as evidenced by case 2.
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PMID:Transient ischemic attack (TIA) secondary to subdural hematoma. 145 13

The common signs of hypoglycemia include: tachycardia, diaphoresis and vertigo which may be associated to disturbances of the consciousness. Occasionally, focal neurological signs occur with conservation of consciousness which are erroneously interpreted as cerebral vascular disease. An insulin dependent diabetic patient is presented with an initial diagnosis of transient ischemic attack (TIA) with right hemiparesis and dysarthria associated to hypoglycemia (35 mg %) whose remission occurred following the correction of glycemia. The different physiopathogenic mechanisms were also revised postulating (selective neuronal vulnerability, vasospasms and subjacent vascular disease) and the need for considering this diagnosis must be emphasized in those diabetic patients with focal neurological symptoms.
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PMID:[Hypoglycemic hemiparesis]. 161 Jun 4

Fibromuscular dysplasia (FMD) is a non-atheromatous, non-inflammatory, segmental arteriopathy of unknown etiology. Fibroplasia of the tunica media is most common. After the renal arteries, the carotid arteries are most frequently affected. Angiographically beaded and tubular stenoses are seen. Complete occlusions and spontaneous dissection of the carotid arteries occur. The angiopathy causes general symptoms such as headache and vertigo, but also recurrent TIA and ischemic cerebral infarction. We examined 15 patients (12 female) suffering from FMD and stroke. The diagnosis of FMD was based on angiographic findings in all cases. 13 patients made a good recovery and seven of them could be discharged from hospital without any neurological deficit. Apart from conservative treatment, primary percutaneous or operative angioplasty may be necessary in some cases in spite of the mostly benign outcome of the disease. Acetylsalicylic acid should be given in all cases.
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PMID:[Fibromuscular dysplasia as a cause of cerebral infarct]. 163 15

Clinical, radiological, and immunohistochemical findings in brain biopsy specimens from six patients with cerebral amyloid angiopathy-associated intracerebral hemorrhage were reviewed. Acute clinical presentations included headache, nausea and vomiting, loss of consciousness, and focal neurological deficits such as hemiplegia and blindness. Transient ischemic attacks experienced by one patient and referable to one hemisphere did not indicate impending hemorrhage in that region. Computed tomographic scans revealed acute, irregular, superficial, lobar hemorrhage with occasional ring enhancement. Immunohistochemical studies were performed on biopsy specimens using primary antibodies against portions of the Alzheimer A4 (beta-) peptide or gamma-trace peptide (the vascular amyloid protein in patients with hereditary cerebral hemorrhage with amyloidosis-Icelandic type). In all patients, anti-A4 and anti-gamma-trace labeled cerebral microvessels. Immunoreactive senile plaques were few compared with the numbers of stained microvessels. Reactive astrocytes in some patients were labeled by both antiserum samples, suggesting uptake or production of these proteins by the astrocytes. This study demonstrates the heterogeneous clinical and radiological features of cerebral amyloid angiopathy-related brain hemorrhage and the value of anti-A4 and anti-gamma-trace immunohistochemical study of biopsy material from patients with suspected cerebral amyloid angiopathy-related intraparenchymal bleeding.
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PMID:Cerebral hemorrhage with biopsy-proved amyloid angiopathy. 172 64

To determine the influence of family history on vascular disease, we surveyed hospital patients discharged with a diagnosis of transient ischemic attack. Of 117 respondents, 81 knew their family history for myocardial infarction and 81 knew their family history for stroke. Of 83 responding 43 reported a personal history of myocardial infarction, and of 85 responding 66 reported a personal history of stroke. As expected, there was an association between positive family and personal histories of myocardial infarction in younger (aged less than 70 years) patients (Fisher's two-tailed exact test, p = 0.014). This association was reversed for stroke (Fisher's two-tailed exact test, p = 0.017). Older (aged greater than or equal to 70 years) patients had a stronger association between positive family and personal histories of stroke; 14 (74%) of 19 older patients with a positive personal history of stroke had a positive family history of stroke. The reason for this reversal in the relation between family and personal histories of stroke compared with myocardial infarction may relate to the older age at onset of most strokes, differing stroke subtypes in older age groups, or lower rates of fatal myocardial infarction. This study suggests that familial factors may be important in some subtypes of cerebrovascular disease. Familial effects may be different in vascular diseases of the heart and brain.
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PMID:Family history in patients with transient ischemic attacks. 185 2

The important differential diagnosis between epileptogenic versus non-epileptogenic attacks becomes increasingly difficult with elderly patients: 1) Vasovagal syncopes may occur abruptly, not infrequently with injuries caused by the sudden fall ("Blitz-Synkope"). Other generalized non-epileptic seizures include drop-attacks, amnesic episodes, prolonged syncopes, and seizures caused by faulty metabolism. 2) Focal non-epileptic seizures in advanced age are mainly TIA and prolonged TIA (PRIND). Complicated migraine is more typical for the younger age group. In this connection it must be kept in mind that 10% of TIA are caused by brain tumor, 20% can be traced to cardiac origin. 3) In connection with the non-epileptic seizures mentioned above there may appear singular irregular cloni without any rhythmical sequence. We have come to call this type of attacks "incidental convulsions". Especially in these cases differential diagnosis is of great importance with respect to basically different therapeutic measures. 4) First manifestations of epilepsy in advanced age are--regarding etiology--in the first rank symptoms of cerebral vascular disease or of intracranial tumors. 5) In the diagnostic approach it is necessary to keep in mind all the above-mentioned possibilities and to exploit every possible access to anamnestic exploration, with the patient as well as with his family, friends and colleagues. Essential auxiliary diagnostic methods include EEG, computed tomography, Doppler-sonography, occasionally long-time EEG or ECG, in some cases NMR.
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PMID:[Seizures in old age]. 189 17


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