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Query: UMLS:C0917798 (cerebral ischemia)
 17,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred and seventy eight patients admitted to hospital with acute cerebral infarction or transient ischaemic attack were studied to determine if their treatment had been changed during the previous three weeks and to compare their blood pressure after the stroke with premorbid values. Blood pressure measurements taken within one year before the stroke were available for 100 patients; seven of these had had a recent change in antihypertensive or diuretic treatment. Of these, three patients who had started taking frusemide because of hypertension and one whose dosage of a reserpine combination drug had been increased experienced an appreciable decrease in blood pressure immediately after the stroke; they also showed signs of haemoconcentration. The change in treatment probably contributed to the stroke in these four patients. The other three showed a smaller decrease or even an increase in blood pressure and no signs of haemoconcentration; the relation between the change in treatment and stroke is less likely in these patients. The use of high ceiling diuretics such as frusemide in the treatment of hypertension may induce hypovolaemia and hypotension, resulting in cerebral ischaemia, and are therefore best avoided in such treatment.
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PMID:Contribution of inappropriate treatment for hypertension to pathogenesis of stroke in the elderly. 309 13

A 16-year-old girl developed right middle cerebral artery infarction and deep venous thrombosis of the lower extremities in association with circulating lupus-like anticoagulant. Currently, she is functionally independent with no further vascular insults and is being treated with sodium warfarin. This patient illustrates that cerebral ischemia can occur in association with lupus anticoagulant in the pediatric population. This entity should be considered and appropriate screening tests performed in young patients with unexplained ischemic stroke or transient ischemic attack.
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PMID:Ischemic stroke in a girl with lupus anticoagulant. 314 70

This study presents the results of surgery in 19 patients with cerebral ischaemia caused by an elongated internal carotid artery. Nine of them had a history of transient ischaemic attacks, eight-reversible stroke, and two-completed stroke. Angiography revealed a kink in 10 cases and a loop in 9. An aneurysm was also found in 2 cases. 8 re-implantations, 5 arterioplasties, 4 re-insertions and 2 aneurysmectomies were performed. Re-insertion was a supplementary procedure in 3 patients. There were no neurological complications, save one case of TIA. Follow-up studies during a period of 1 to 6 years revealed no recurrence of cerebral ischaemia.
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PMID:Surgical treatment of cerebrovascular insufficiency in patients with pathological elongation of the internal carotid artery. 316 69

94 subjects, 64 with cerebral ischemia of varying severity and outcome, and 30 controls were studied with technetium-99m hexamethyl propylenamino oxime single photon emission computed tomography in order to evaluate the suitability of this technique in the assessment of cerebral ischemia. Decreased uptake corresponding to the side of clinical symptomatology and/or to CT lesion was found in 93% of the patients with complete stroke and in 28% of the patients with transient ischemic attack. This procedure can be a useful tool in the routine examination of ischemic patients, although the mechanism underlying brain uptake is far from being completely understood and the possible quantitative evaluation of regional cerebral blood flow is worthy of further assessment.
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PMID:Single photon emission computed tomography with technetium-99m hexamethyl propylenamino oxime in the clinical assessment of cerebral ischemia. A preliminary evaluation. 326 61

Cerebral rCBF, rOEF, rCMRO2, and rCBV in moyamoya disease were studied by means of positron emmission tomography (PET), using 15O as a tracer. Steady-state methods with C15O2 and 15O2 were used to obtain the functional images of rCBF, rCMRO2, and rOEF. The 15O single-inhalation method was used to obtain the rCBV image. Five children (two boys and three girls) with mean age of 11 years and eight normal volunteers with mean age of 31 years were included in the study. The symptoms of moyamoya disease were due to cerebral ischemia, such as transient ischemic attack (TIA), reversible ischemic neurological deficit (RIND), and minor stroke. The interval between the latest ictus and PET scan ranged from 3 days to 3 years 6 months. Physiological parameters (rCBF, rCMRO2 etc.) in cerebral gray matter, cerebral white matter and basal ganglia were calculated from the single functional images. Any, low density areas appearing in X-ray-CT performed just prior to the PET study were carefully excluded from the analysis. The parameters of moyamoya disease were statistically compared with normal control parameters. Though the value of rCBF was slightly higher in moyamoya disease, this difference was not statistically significant. On the other hand, in moyamoya disease rCBV increased significantly in gray matter, white matter, and basal ganglia. The ratio of CBF to CBV is considered to be the index of perfusion pressure and reciprocal of cerebral mean transit time under the normal autoregulation of CBF. This ratio was calculated and compared with the normal value for each tissue.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cerebral circulation and oxygen metabolism in moyamoya disease of ischemic type in children. 326 63

In a prospective study of 87 patients with TIA or minor stroke (48 men and 39 women, average age 65 years) a history of ischaemic heart disease (IHD) was present in 30 (angina in 25 and myocardial infarction (MI) in 19, 14 having both). The London School of Hygiene Questionnaire did not confirm the diagnosis of IHD in 7 patients, but did detect a further 5 patients with angina and/or MI. The Minnesota coding of the ECG revealed 5 patients with asymptomatic suspect IHD and 15 with probable IHD (a total of 23%). Cardiomegaly (cardiothoracic ratio greater than 0.5) was present in 28 patients, 9 with a history of MI and 8 with a history of angina. These findings indicate that IHD is common in patients with cerebral vascular disease. As both probable IHD on Minnesota coding of the ECG and the presence of cardiomegaly are highly predictive of a poorer outcome, the findings add further weight to the argument that, amongst patients with minor cerebral ischaemia, a sub-group at high risk of death due to IHD can be detected by using simple methods rather than by performing routine coronary angiography on all patients as has been suggested in recent times.
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PMID:Unreported symptomatic and asymptomatic ischaemic heart disease in patients presenting with TIA or minor stroke detected by the London School of Hygiene Cardiovascular Questionnaire and Minnesota coding of a routine ECG. 326 47

The classification, epidemiology, pathophysiology, diagnosis, and treatment of ischemic cerebrovascular disease (ischemic stroke) are reviewed, and the major drugs used in the prevention of this disease are discussed. Ischemic stroke is a major problem in terms of morbidity and mortality because of the high prevalence of atherosclerosis in the United States population. The pathogenesis of cerebral ischemia is multifactorial, beginning with an atherosclerotic plaque on the arterial wall that may result in stenosis or ulceration with subsequent thrombosis or embolization. Platelets may adhere to the exposed arterial wall endothelium, stimulating further platelet aggregation and accumulation of leukocytes and fibrin. Consequences of cerebral ischemia include transient ischemic attacks and brain infarcts. Diagnosis is based mainly on patient history and ancillary radiologic studies. Treatment of ischemic cerebrovascular disease is primarily preventive, since the brain has limited capacity to recover neurologic function after an infarction. Transient ischemic attacks are treated with either antiplatelet agents, anticoagulants, or surgery. Treatment of stroke is also preventive, although anticoagulation is sometimes used to prevent stroke progression. Agents that may reverse neurologic impairment following an acute stroke, such as prostacyclin, calcium-channel blockers, and opiate antagonists, are being investigated. Antiplatelet therapy is indicated in subsets of patients with cerebral vascular insufficiency. Anticoagulation therapy, if needed, should be given for only three to four months.
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PMID:Current concepts in clinical therapeutics: ischemic cerebrovascular disease. 331 77

Twenty five carotid endarterectomies were performed in 24 patients with cerebral ischemia due to atherosclerosis. Four of these patients were asymptomatic, 7 suffered from hemispheric TIA (hemispheric attack group), 7 suffered from nonhemispheric TIA (nonhemispheric attack group) and other 6 had previous completed stroke (completed stroke group). The average length of follow-up study was two and half years with a range of 2 months to 6 years. Completed strokes occurred in 1 patient following the operation and in 3 patients during the follow-up period (16.7%). Two patients were reoperated upon because of recurrent carotid stenosis (8.3%). Four patients continued to have neurologic symptoms postoperatively. Ultimately 10 of 24 patients had some neurologic complications even following carotid endarterectomies (41.7%). The first postoperative year was the worst period because almost all late neurologic complications occurred in that time. Kaplan-Meier's analysis demonstrated a relatively favorable result in the hemispheric attack group among these 3 groups. The completed stroke group was followed by that and the nonhemispheric attack group was proved to be the worst, although there was no statistical significance.
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PMID:[Carotid endarterectomies for cerebral ischemia: a follow up study of surgical results and late neurologic complications]. 339 33

Transient ischemic attack (TIA) is a common but poorly understood disorder. Although it rightfully has been classified as a major risk factor for stroke, the majority of patients with TIAs do not suffer subsequent stroke, and it is unclear whether aggressive evaluation and treatment of TIA will significantly lower stroke risk. To effectively treat this disorder, the implications of transient cerebral ischemia and the basic pathophysiologic process underlying this condition must be understood, as well as the myriad of specific clinical causes that must be considered in any patient. Any less sophisticated approach will only propagate the confusion that already exists and lead to the use of therapies that may be useless or even harmful.
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PMID:Clinical evaluation and management of transient ischemic attacks. 355 62

TIA has been accepted as a concept of transient cerebral ischemia. There is an ever enlarging body of literature sparking controversies considering its natural history, prognosis, outcomes of clinical trials and usefulness of the concept. Much of the controversy is related to the diverse pathophysiology of TIAs, the selection of patients for clinical trials and the associated risk factor in the studied population. The advantages of the concept are a warning of the possibility of future irreversible pathology an opportunity to treat and/or remove risk factors an opportunity to establish a basis for monitoring the patient and making interim decisions concerning intervention. The risks of the concept are: administering a specific therapy to all patients, failure to fully evaluate the patient once the diagnosis is made, tendency to rely on "experts" for guidance. TIA is a useful concept if one recognizes: the pathophysiology is polymorphous and multiplex, the concept is a signal for diligent search for the underlying cause or causes, it is more important to treat the risk factors than to give a specific therapy.
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PMID:T.I.A. revisited: new wine--old bottle. 371 1


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