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

Activated leukocytes are believed to be involved in the pathogenesis and progression of atherosclerotic vascular disease and its consequences. In a 4-year observational follow-up study, we investigated whether markers for systemic leukocyte activation (leukocyte-derived inflammatory mediators) were related to cardiovascular mortality after cerebrovascular ischemia. Using enzyme-linked immunosorbent assays, we measured the plasma levels of soluble tumor necrosis factor receptor protein-1 (sTNFR-1), neutrophil gelatinase-associated lipocalin (NGAL) and neutrophil protease-4 (NP4) in 144 patients (90 stroke, 54 transient ischemic attack) 1-3 days after cerebral ischemia. During the 4 years of follow-up, 42 (29%) of the 144 patients died; 38 of cardiovascular causes and 4 of other causes. Patients with evidence of higher leukocyte activation (n = 47) had a higher 4-year cardiovascular mortality rate than those without evidence of leukocyte activation (n = 97; p < 0.005). Logistic regression analysis with age, sex and other significant predictors as covariates showed higher plasma levels of sTNFR1 and NGAL both to be significant independent predictors of cardiovascular mortality, the respective odds ratio, 95% confidence intervals, and p values being 2.0, 1.2-3.4, p < 0.01, and 3.6, 1.2-10.5, p = 0.02, respectively. We concluded that in patients with acute cerebral ischemia, plasma markers of leukocyte activation were significant predictors of long-term cardiovascular mortality. This may indicate an important role of activated leukocytes in the progression of these diseases.
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PMID:Leukocyte activation: relation to cardiovascular mortality after cerebrovascular ischemia. 1068 47

The presence in the serum of antiphospholipid antibodies (aPL) is associated with venous and arterial thrombosis. This observation has led to the search for these antibodies in young patients with ischemic neurologic syndromes. However, 1% to 5% of healthy people may be found to have circulating aPL without necessarily being at increased risk of thromboembolism. Thus, the finding of APLA in a patient with cerebral ischemia does not necessarily provide an explanation for the etiology of the clinical syndrome. The aim of this study was to determine whether the presence of aPL in young patients with stroke or transient ischemic attacks represents a possible cause of hypercoagulability as defined by ongoing thrombin formation with resultant elevation of prothrombin fragment 1.2 (F1.2) levels. This was a retrospective, case-control study involving 57 subjects. Twenty-seven patients had a recent cerebrovascular ischemic event--either TIA or a stroke. Fifteen were positive for aPL, and 12 were aPL-negative. Thirty subjects, matched for age and sex with no history of cerebrovascular disease, served as controls. Of this group, 20 were aPL-positive and 10 were aPL-negative. Causes of hypercoagulability other than aPL were excluded by laboratory testing. A positive test for aPL was repeated after a 6-week interval and two positive tests were required for a patient to be regarded as being aPL-positive. Levels of F1.2 were measured by an ELISA technique. There was a significant difference (p < 0.05) in the mean F1.2 levels between the aPL-positive group with a history of cerebrovascular disease (mean F1.2 = 2.3733) and each of the other study groups. There was no statistically significant difference between any of the other study groups. Our findings suggest that F1.2 levels are elevated in young patients with cerebrovascular syndromes who have aPL and in whom other causes of hypercoagulability and atherosclerotic vascular disease are absent. Elevated F1.2 in these patients may be a potential marker of the hypercoagulable state associated with aPL.
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PMID:Value of prothrombin fragment 1.2 (F 1.2) in the diagnosis of stroke in young patients with antiphospholipid antibodies. 1077 22

Moyamoya disease is a rare cerebral vascular disease that results in narrowing of the vessels of the circle of Willis and the formation of a network of collateral vessels at the base of the brain for compensatory perfusion. Moyamoya disease has the highest incidence during the first decade of life, and children present most frequently with transient ischemic attacks. We present two cases of Moyamoya disease in children with associated hypothalamic-pituitary dysfunction. Both children presented to the endocrinologist for decreased growth velocity. One child had hypothyroidism and both had growth hormone deficiency. A review of the literature reveals a few isolated case reports of hypothalamic-pituitary dysfunction occurring with Moyamoya disease and with other states of cerebral vascular insufficiency. We suggest that children with compromise of cerebral vascular perfusion be monitored closely for clinical signs and symptoms of hypothalamic-pituitary dysfunction.
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PMID:Hypothalamic-pituitary dysfunction associated with Moyamoya disease in children. 1082 Dec 25

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

Vascular endothelial growth factor (VEGF) is most promising in therapeutic angiogenesis for ischemic vascular disease. This paper aimed to study VEGF gene therapy for the treatment of cerebral ischemia. The glial cell was chosen as the target cell for gene transfer, and the expression of VEGF was studied in vitro. VEGF plasmid/liposome complexes were constructed by mixing VEGF plasmid with liposome, and then cultured C6 glioma cells were transfected with these complexes by lipofectamine method. As control, the same kind of cells were exposed to liposome only. Immunohistochemistry was performed to both groups at 24, 48 and 72 hours after transfection. The transfected cells expressed VEGF significantly higher than the control. The present result demonstrated the feasibility of choosing the glial cell as the target cell for VEGF gene transfer, and found the rationale for the cerebral VEGF gene therapy.
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PMID:Gene transfer of vascular endothelial growth factor plasmid/liposome complexes in glioma cells in vitro: the implication for the treatment of cerebral ischemic diseases. 1132 55

Temperature management during cardiac surgery deserves considerable attention because it has broad effects, altering virtually every physiologic process, including oxygen demand, blood flow, cardiac output, and coagulation. Temperature is also important in cardiac surgery because virtually all patients undergo significant temperature change. These changes can be unique in mammalian physiology both with regard to their magnitude and rate of change. Furthermore, cardiac surgical patients may be uniquely vulnerable to the effects of temperature. Because of vascular disease and embolization, many patients are at risk for cerebral ischemia. Additionally, their cardiac, pulmonary, and renal reserve is typically limited; and there is risk for perioperative bleeding. Patient temperature can affect all of these processes and has its greatest effect on those who are physiologically most fragile. An appreciation for temperature management is also compelling because, unlike new technologies, procedures, or drugs; temperature management is simple, practical, applicable to every patient, and can be performed with very little cost. This article will show why cerebral hyperthermia should be avoided in cardiac surgery. Second, it will discuss why it occurs and the management steps that may prevent it. Finally, we will highlight recent discussion of postoperative hyperthermia and speculate as to its origin and relevance.
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PMID:Cerebral hyperthermia and cardiac surgery: consequences and prevention. 1149 9

Total occlusion of internal carotid artery in the cervical region is an end result of progressive occlusive vascular disease. A small proportion of these patients will have symptoms of cerebral ischemia due to cerebral hypoperfusion in a delayed fashion. Identification of those individuals who are at risk of developing symptoms and prophylactically treating with a revascularization procedure will prevent such catastrophic events. With the co-operative study for bypass not supporting the bypass procedure and trial being questioned for its design and conclusions, a new trial of extracranial-intracranial bypass, The Carotid Occlusion Surgery Study, using the currently available technology will be undertaken to verify that the bypass will decrease the future stroke rate by at least 40% in patients with total carotid occlusion. A subset of patients with skull base pathology including tumors and aneurysms who may have to undergo carotid sacrifice as part of the surgical procedure are at risk of peri-operative and delayed stroke. Identification of these patients at risk by pre-operative tests may allow performance of extracranial-intracranial bypass prior to undertaking complex skull base procedures. The new imaging technology will guide management of these patients at risk and help identify patients who may need a bypass procedure.
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PMID:Future of extracranial-intracranial bypass. 1207 43

We report of a woman with post-partum cerebral angiopathy (PCA), in whom we repetitively performed transcranial Doppler sonography (TCD), MR imaging (MRI), and MR angiography (MRA) to evaluate the underlying pathophysiology. A 31-year-old woman, Gemini pregnant, complained of severe throbbing frontal headache four days after an uneventful delivery by Cesarean section. Blurred vision occurred eight days after delivery, followed by three generalized tonic-clonic seizures. Neurological examination revealed a somnolent woman without focal neurological deficits. At the day of the seizures increased flow velocities and disturbed flow were observed in the right posterior and anterior cerebral artery on transcranial Doppler (TCD). MRI showed infra- and supratentorial patchy hyperintensities in T2-weighted images and in the FLAIR sequence. Diffusion-weighted imaging revealed corresponding multi-focal hyperintense areas indicating increased diffusion and MRA showed a diffuse multisegmental narrowing of all pial arteries. MRI at day 10 was completely normal, but MRA still revealed vascular narrowing in the right posterior cerebral artery. General slight flow accelerations in all basal arteries occurred after 10 days and lasted for three weeks. PCA is apparently associated with a vascular narrowing causing cerebral ischemia with increased diffusion. Later reactive cerebral hyperperfusion is observed. Vascular narrowing and cerebral hyperperfusion still persist after MRI has normalized.
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PMID:Post-partum cerebral angiopathy: repetitive TCD, MRI, MRA, and EEG examinations. 1223 22

The megadolichobasilar artery is a rare vascular disease, which usually becomes apparent either due to cerebral ischemia or due to compression of the brainstem or the cranial nerves, thereby leading to a large variety of neurological symptoms. We report on a patient who suffered a sudden right-sided deafness accompanied by vertigo and vomiting. Initially, an idiopathic sensorineural hearing loss was diagnosed and later on, after no improvement took place in spite of conservative therapy, a rupture of the round window membrane was suspected. Two weeks after the first symptoms had occurred the patient developed a hemiparesis on the left side.Radiology disclosed a dilated and partially thrombosed basilar artery as well as a paramedian pontine infarction. We therefore assumed that the patient's symptoms had been caused by thrombotic occlusion of the labyrinthine artery and several rami ad pontem. The article reviews the great variety of clinical symptoms caused by megadolichobasilar artery and discusses important therapeutic options.
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PMID:[The megadolichobasilar artery--a clinical chameleon]. 1259 19

Single-vessel cervical arterial dissections typically occur in young adults and are a common cause of cerebral ischemia and stroke. Although the pathogenesis of multivessel dissection is unclear, it is thought to be a consequence of underlying collagen vascular disease. We present a 34-year-old previously healthy man who developed bilateral internal carotid and vertebral artery dissection following chiropractic manipulation.
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PMID:Simultaneous bilateral internal carotid and vertebral artery dissection following chiropractic manipulation: case report and review of the literature. 1269 99


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