Cerebrovascular Diseases

Based on the results of the Prospective Investigation of Pulmonary Embolism Diagnosis II (PIOPED II), Stein and colleagues have made recommendations for the assessment of patients with suspected pulmonary embolism (PE). The clinical highlights are summarized as follows:

BOSTON -- In the critical three hours of an acute ischemic stroke, a little guidance by phone can help physicians in rural areas deliver tPA to patients safely.

SAN ANTONIO, Tex. -- Enoxaparin (Lovenox), a low-molecular-weight heparin, proved more effective than unfractionated heparin for preventing potentially fatal leg and lung clots after acute ischemic stroke, researchers reported.

ST. LOUIS -- A form of stroke damage called neglect has responded with mixed results to dopamine agonists. Now researchers here think they know why some patients with neglect aren't helped at all by these drugs.

DALLAS, April 3 -- Amphetamine and cocaine abuse appear to promote the risk of stroke among young adults, according to a large hospital database.

abstract: Low molecular weight heparins (LMWHs) have proved to be as safe and effective as unfractionated heparin for the treatment of venous thromboembolism. They have the advantage of not requiring frequent measurement of activated partial thromboplastin time and subsequent dosage adjustments. Patients who have deep venous thrombosis can be treated with once- or twice-daily subcutaneous doses. Hospital admission is necessary for patients with risk factors for major bleeding complications, for those with symptomatic pulmonary embolism, or when noncompliance is likely. Symptomatic proximal deep venous thrombosis and asymptomatic pulmonary embolism may be managed on an outpatient basis if there are no contraindications. Although heparin-induced thrombocytopenia occurs less frequently with LMWHs than with unfractionated heparin, the platelet count must still be monitored during therapy. (J Respir Dis. 2007;28(4):132-138)

A 57-year-old woman presents with swelling of the hands that began several weeks earlier and is now worsening. She denies joint pain, and she has no history of trauma or significant vascular disease. She has had pneumonia several times; each episode was successfully treated with antibiotics. She has smoked 2 packs of cigarettes a day for the past 20 years

Numerous randomized trials have evaluated antihypertensive regimens in various settings, including those complicated by at least one other vascular disorder. Among these trials are the Modification of Diet in Renal Disease (MDRD) Study in hypertensive patients with kidney disease; the Comparison of AMlodipine versus Enalapril to Limit Occurrences of Thrombosis (CAMELOT) Study and the INternational VErapamil-trandolapril STudy (INVEST) in patients with hypertension and coronary disease; and the Perindopril pROtection aGainst REcurrence of Stroke Study (PROGRESS) in hypertensive patients who have had a stroke.

PARIS -- Atherosclerotic arterial disease seems to predict relatively high rates of myocardial infarction, stroke, or cardiovascular death within a year, according to a large, international registry study.

ST. LOUIS -- Spatial neglect -- a common attention-deficit sequel to stroke -- appears to be caused by a lack of communication between two regions of the brain, according to researchers here.

NEW YORK -- Men given thrombolysis for acute ischemic stroke were three times more likely than women to have a good functional outcome, despite elevated mortality, researchers here reported.

LOS ANGELES -- The higher the body mass index, the lower the likelihood that patients hospitalized for ischemic stroke would be discharged directly home, found UCLA researchers.

CHICAGO -- Any abnormal electrocardiographic (ECG) finding was an independent predictor of myocardial infarction, stroke, and coronary heart disease death in asymptomatic postmenopausal women, researchers here reported.

TORONTO -- Stroke patients admitted to a hospital on a weekend had a 13% increased risk of death compared with those admitted on a weekday, researchers here reported.

SEATTLE -- Cardiac MRI used in tandem with echocardiography can enhance the likelihood of finding the cause of cardioembolic stroke, according to a small retrospective study.

In imaging studies in patients older than 55 yearswith suspected coronary artery disease or peripheralvascular disease, more than 80% of renal artery lesionsare associated with generalized atherosclerosis.

BOSTON -- Even healthy women with no history of heart disease or stroke need to keep their cholesterol down to help head off stroke risk, researchers here said.

BOSTON -- Two new risk factors added to the traditional risk model enhanced prediction of a woman's 10-year risk of cardiovascular disease or stroke, researchers reported.

SAN FRANCISCO -- The low-molecular-weight heparin Lovenox (enoxoparin) reduces the post-stroke relative risk of venous thrombosis by 43% compared with unfractionated heparin, researchers said here.

SAN FRANCISCO -- Women under age 35 who suffer migraine with aura should consider avoiding oral hormonal contraception because of their elevated risk of a stroke, a Canadian team suggested.

SAN FRANCISCO -- Tight glucose control during hospitalization for a stroke may not improve survival, British researchers said here.

SAN FRANCISCO -- A quarter of stroke patients given the thrombolytic Activase (tPA, Alteplase) in a six-hour intra-arterial window, twice the intravenous window, had a seemingly miraculous recovery within 24 hours, researchers said here.

SAN FRANCISCO -- A transcutaneous electrical nerve stimulation (TENS) device used in stroke rehabilitation clinics may be effective for home use as well, researchers said here.

SAN FRANCISCO -- A robot dubbed Howard may help stroke patients regain hand function and strength even when the therapy is begun after a delay of three months, researchers said here.

SAN FRANCISCO, Feb. 9 -- Getting selected patients out of bed and moving in the first 24 hours after a stroke appears to be safe, Australian researchers said here.

SAN FRANCISCO -- Activase (alteplase, tPA), the thrombolytic tissue plasminogen activator, is increasingly being used for childhood ischemic stroke even though it has only been evaluated for safety and efficacy in adults and there are no pediatric guidelines, researchers said here.

SAN FRANCISCO -- Women do not always show textbook examples of stroke symptoms to emergency department physicians, researchers said here.

SAN FRANCISCO -- Cognitive deficits caused by neonatal stroke may not emerge until early school years when children face needs to master higher level skills, researchers said here.

BEJING -- The degree of stenosis does not affect outcomes in elective stenting of intracranial arteries, but the procedure should probably be reserved for major lesions, researchers here reported.

SEATTLE -- Fine-particulate air pollution over time significantly increased the risk of a first heart attack or stroke, as well as cardiac mortality, in postmenopausal women, researchers here reported.