Cerebrovascular Diseases

Interruption of anticoagulation with rivaroxaban or warfarin should be bridged with an agent such as low-molecular weight heparin.

Depending on the specific type of event, stroke at age 50 years or younger increased mortality at least 3-fold.

Sleep apnea in adults aged 65 years or older posed an increased risk for silent cerebral infarction and lacunar infarction.

Typical interventions in persons without CKD are essential. SHARP and TNT have added to our knowledge. Aggressive cholesterol lowering (probably also affecting LDL particle number as well as traditional measures of LDL) seems to afford better outcomes by lessening residual risk in those with chronic kidney disease.

Suicidal ideation among stroke survivors (7.8%) was higher than among those with a history of MI (6.2%), diabetes (5.2%), and cancer (4.1%).

Two studies have demonstrated novel research directions for LDL-C and LDL-P. The first revealed that when LDL-C and LDL-P are concordant (that is either both high, normal, or low), either can serve as a good measure of CV risk. However, when they are discordant, cardiovascular events increase.

PFO can be detected in 10% to 15% of the population by transthoracic echocardiogram. Autopsy studies show a prevalence of PFO of approximately 26%.

Older patients with chronic obstructive pulmonary disease are at higher risk for plaque formation in the carotid artery, increasing their risk of stroke.

Stroke survivors who smoke cigarettes are at higher risk for additional strokes, heart attacks, and death than those who never smoked, according to research reported by the American Heart Association.

Autosomal dominant polycystic kidney disease (ADPKD) is common. Presenting symtpoms include hypertension, hematuria, proteinuria, and renal insufficiency.

The elderly patient has had type 2 diabetes for 15 years is now home bound after a stroke. Her HbA1c is 9.6 and she takes only metformin. Review the rest of her laboratory results and propose a management plan.

Would you treat the elevated A1C aggressively-and what would your target level be? Would you consider statins? Dr Shahady invites your insights.

A 54-year-old man presented to the ED with palpitations identified as atrial flutter and RVR. Medical history included stage IV renal-cell carcinoma, end-stage COPD, NYHA class IV heart failure, and recent pulmonary embolism. A CT scan of the thorax was ordered.

A 38-year-old man with a history of alcoholism, intravenous drug use, and cerebrovascular accident was referred for assessment of possible endocarditis, based on history, fever 39 °C (102.9 °F) and mildly elevated troponin level.

A 59-year-old woman had aphasia and right-sided weakness after a routine total knee replacement. CT and MRI scans revealed a large left middle cerebral artery infarct. A CT angiogram showed no significant disease of the cerebrovascular arteries. Test results for the lupus anticoagulant were positive. A venous study of the legs showed no deep venous thrombosis. She was treated with warfarin and aspirin and discharged. After speech and physical therapy, she had mild residual aphasia.

On December 18, 2005, Ariel Sharon, Prime Minister of Israel, experienced the sudden onset of aphasia. Despite being overweight, he had none of the traditional risk factors for cerebrovascular disease-hypertension, history of smoking, diabetes, or elevated cholesterol levels.

A 50-year-old man was brought to the emergency department (ED) after a witnessed syncopal event. He was awake but confused and unable to provide a history.

During an interval examination, a new pulsatile mass is detected slightly above the umbilicus of a 72-year-old man with chronic obstructive pulmonary disease (COPD). He has not noticed any abdominal pain or any other new symptoms.

Despite a lower prevalence of traditional risk factors-such as hypertension and diabetes-patients with inflammatory bowel disease (IBD) have a higher incidence of stroke, said researchers at the University of Miami.

Along with the release of revised guidelines, several pharmacological therapies have become available or are under investigation to help improve outcomes in patients with osteoporosis.

For the past 7 years, a 32-year-old African-American man had multiple nonpruritic scalp abscesses. He also reported intermittent fever and joint pain. The abscesses had been drained on many occasions, and he had received several antibiotics, although no organisms had been isolated. Collagen vascular disease, SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), discoid lupus, and cutaneous sarcoid had been ruled out. During the past 7 years, he had been treated with prednisone, methotrexate, and hydroxychloroquine without any response.

A 74-year-old man with a history of diabetes mellitus, atrial fibrillation, and stroke had a stable, skin-colored mass on his upper back for the past 10 years that had suddenly become swollen and red.

The Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2009) was held in Cape Town, South Africa, from July 19 to 22, 2009. More than 5500 delegates from more than 100 countries attended this annual event.

The risk of ischemic stroke may be twice as high in patients who experience migraine with aura as in those who have migraine without aura, according to results of a systematic review and meta-analysis.

The results of a meta-analysis indicate that intensive glycemic control significantly reduces the risk of coronary events in patients with type 2 diabetes mellitus. The meta-analysis, conducted by Ray and colleagues,1 included 5 randomized controlled trials that compared intensive with standard glucose-lowering regimens in more than 33,000 patients. The general treatment protocols are shown in the Table.

More than 5.5 million US adults, or nearly 2% of the adult population, have some type of paralysis,

The objective of this study was to estimate the annual cost burden of Parkinson disease (PD) in the United States. Resource use and cost profiles were developed using all-payer statewide hospital discharge data from 6 states; emergency department visit, long-term–care, and national survey data; fee schedules; and published study findings. (Average direct and indirect costs per patient were calculated in 2007 US dollars.) The annual cost per patient was $21,626 (direct cost: $12,491). When applied to the US PD population (N = 500,000), the annual average cost was approximately $10.78 billion (direct costs, $6.22 billion; indirect costs, $4.56 billion). PD has substantial economic consequences for patients and their families, insurers, and society. (Drug Benefit Trends. 2009;21:179-190)

Mortality rates from heart disease and stroke are falling in the United States, but cardiovascular disease remains the leading cause of death, according to a report by the American Heart Association (AHA). An estimated 869,724 persons died of heart disease in 2004 compared with 911,603 persons in 2003. When considered separately from other cardiovascular diseases, stroke was the third leading cause of death in 2004. The number of deaths attributable to stroke that year was estimated to be 150,074, a decrease from 157,689 deaths in 2003.