Cerebrovascular Diseases

Ischemic infarcts of the brain are usually caused by vascular disease, but 1 in 5 results from emboli that arise in the heart. The largest contributor to cardioembolic stroke is non-valvular atrial fibrillation, which is associated with a 5-fold increased risk of cerebral infarction.

AMSTERDAM -- Mixed results from trials investigating the clinical efficacy of idraparinux, an investigational long-acting factor X inhibitor, suggest the drug is not as effective as standard therapy for treatment of pulmonary embolism.

VIENNA, Sept. 4 -- Even normotensive patients with diabetes can reduce their risk of heart attack, stroke, and renal failure by lowering of blood pressure, researchers reported here.

ROME -- Stroke survivors who discontinued statin therapy within a year of hospital discharge almost tripled their mortality risk, investigators here reported.

SANTIAGO DE COMPOSTELA, Spain -- Ischemic stroke patients already taking statins should be continued on the drugs during the acute phase, clinicians here recommended.

BOSTON -- Antioxidant vitamins C and E and beta carotene did not reduce the risk of cardiovascular events in more than 8,000 high-risk women, reported researchers here.

NEW YORK -- Increasing brain activity is the key to improving eyesight by visual training for stroke patients with hemianopia, researchers here found.

BALTIMORE --Women who have migraine with visual symptoms have a 50% greater risk of ischemic stroke than women without the headaches, researchers reported.

BIRMINGHAM, England -- Warfarin's stroke prevention benefits extend to the elderly -- without increasing the risk of major bleeds.

BIRMINGHAM, England -- When seeking to reduce the risk of stroke in older patients by screening for atrial fibrillation, a pulse-based system is an effective approach, found researchers here.

The authors describe a case of air embolism that developed during a plane flight in a woman who had a congenital cystic adenomatoid malformation. They review the pathophysiological mechanisms, risk factors, clinical features, and treatment of air embolism.

DUISBURG, Germany -- Multidetector CT angiography can diagnose and assess intracranial aneurysms with equivalent accuracy to digital subtraction angiography, investigators here reported.

ROCHESTER, Minn. -- Patients with nonvalvular atrial fibrillation have about a 33% lower risk of stroke and major vascular events when treated with oral anticoagulants rather than antiplatelet therapy, findings from a systematic review of clinical trials suggest.

SAN ANTONIO -- Patients who had post-stroke urinary incontinence and were unaware of the urge to void had a significantly higher risk of mortality and nursing-home placement.

SAN ANTONIO -- Drugs that lower angiotensin II may increase the risk of stroke, contrary to conventional wisdom, an investigator asserted here.

SAN ANTONIO -- Years before carotid artery disease poses a stroke risk, arterial thickening and early-stage atherosclerosis may cause deterioration in cognitive performance.

SAN ANTONIO -- Mild impairment of the executive function domain of cognition may represent an early marker of an increased stroke risk, according to data from the Framingham Study.

BOSTON -- The FDA has okayed use of a strap-on robotic arm to help restore function to an upper-extremity disabled by a stroke, according to the manufacturer.

MORGANTOWN, W.Va. -- Operators who staff hospital healthlines are often unable to recognize the symptoms of a stroke, investigators here found.

abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown etiology that leads to progressive fibrosis and respiratory failure. Patients with IPF typically present in their sixth to seventh decade of life with the insidious onset of progressive dyspnea and cough. Lung histopathology reveals the distinct lesion of usual interstitial pneumonia (UIP), and other causes of UIP, such as collagen-vascular disease, drug exposure, or occupational exposures, must be excluded. A confident clinical diagnosis of IPF can often be made without resorting to surgical lung biopsy if certain clinical features are present and a typical pattern is identified on high-resolution CT (HRCT) scanning of the thorax. Changes on HRCT scans that are typical for UIP include a predilection for peripheral and basilar lung zones with patchy involvement and sparing of more central areas, especially in upper lung zones. (J Respir Dis. 2007;28(7):283-292)

* Vena caval interruption has been used in the treatment of deep venous thrombosis (DVT) to prevent PE since the early 1970s. Filter placement has been increasing in the past decade. We estimate that filters are placed in more than 0.2% of all Medicare recipients annually.

Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).

CHICAGO -- Folic acid supplementation reduced the risk of a stroke by 18% to 25%, found a meta-analysis, but its possible benefit of for other cardiovascular conditions was not clarified.

The prevalence of onychomycosis increases with age; it is less than 1% in persons younger than 19 years and rises to about 18% in those who are 60 to 79 years. The infection is more common in men than in women. Among the predisposing factors are diabetes mellitus, psoriasis, a family history of onychomycosis, use of immunosuppressive drugs, and peripheral vascular disease.

ATLANTA -- Ischemic stroke patients who arrive at the hospital in an ambulance are more likely to meet the deadline for the use of tPA-three hours from symptom onset.

CHICAGO -- Simple clinical criteria to rule out a pulmonary embolism can substitute for blood tests and ultrafast CT scanning, according to researchers here.

WASHINGTON -- When the stroke is hemorrhagic, secondary prevention measures are significantly less likely to be initiated than when the event is ischemic, researchers said here.

BOSTON -- Siblings of middle-age stroke patients have nearly twice the risk of strokes themselves compared with the average American.

BOSTON -- The risk of a second stroke declined significantly among patients who had a large reduction in LDLs within a month of starting on a statin, investigators reported here.

EDINBURGH, Scotland -- When acute coronary syndrome guidelines get used, patients have had significant reductions in rates of heart failure, myocardial infarction, stroke, and death according to the multinational GRACE study.