Cerebrovascular Diseases

BIRMINGHAM, Ala. -- Patients who have a stroke at a relatively young age are less likely to have access to a doctor's care than older patients and to be able to afford prescription medications, according to researchers here.

NEW YORK -- Uncomplicated diabetes does not affect 10-year heart transplant survival, but patients with diabetes-related renal disease or stroke do not do as well, reported surgeons here.

STANFORD, Calif. -- For patients with an acute ischemic stroke who arrive at emergency department too late for thrombolysis, an MRI scan may show whether they could still benefit even though the three-hour therapy window has shut.

ABSTRACT: Establishing the time of symptom onset is essential to selecting the appropriate therapy. Intravenous tissue-type plasminogen activator (t-PA), administered within 3 hours of symptom onset, is the only FDA-approved treatment for acute ischemic stroke. Intra-arterial and combined intra-arterial-intravenous thrombolytic therapy may be considered for patients whose condition does not improve or who present within 3 to 6 hours of symptom onset. Other options for treating acute ischemic stroke are balloon angioplasty with or without stenting (for symptomatic patients with more than 50% intracranial stenosis in whom medical therapy has failed) and mechanical clot retrieval (for those with an NIH Stroke Scale score greater than 10 who present after the 3-hour window for intravenous t-PA and can be treated within 8 hours of symptom onset or who present within 3 hours of symptom onset but in whom intravenous thrombolysis is contraindicated).

ABSTRACT: Establishing the time of symptom onset is essential to selecting the appropriate therapy. Intravenous tissue-type plasminogen activator (t-PA), administered within 3 hours of symptom onset, is the only FDA-approved treatment for acute ischemic stroke. Intra-arterial and combined intra-arterial-intravenous thrombolytic therapy may be considered for patients whose condition does not improve or who present within 3 to 6 hours of symptom onset. Other options for treating acute ischemic stroke are balloon angioplasty with or without stenting (for symptomatic patients with more than 50% intracranial stenosis in whom medical therapy has failed) and mechanical clot retrieval (for those with an NIH Stroke Scale score greater than 10 who present after the 3-hour window for intravenous t-PA and can be treated within 8 hours of symptom onset or who present within 3 hours of symptom onset but in whom intravenous thrombolysis is contraindicated).

MONTREAL -- Induced labor is associated with a doubling in risk of amniotic-fluid embolism, a serious but rare complication of pregnancy, according to researchers here.

NEW ORLEANS -- Stroke patients are likely to be unaware of what is happening to them and that it is an urgent medical matter, reported researchers here.

NEW ORLEANS -- In acute ischemic stroke patients, mechanical snares and other devices that remove clots can improve survival and functional outcomes, investigators reported here.

BIRMINGHAM, Ala. -- In a national sample of the general population, although weighted in favor of African Americans and the so-called stroke belt, about one in five individuals 45 or older has had undiagnosed cerebrovascular symptoms, investigators reported.

When a patient with chronic obstructive pulmonary disease (COPD) presents with what appears to be an acute exacerbation, you should consider the possibility of pulmonary embolism (PE). This is the message conveyed by a prospective cohort study in France.

KYOTO, Japan -- Short term exposure to high levels of air pollution in warm weather more than doubles the risk of hemorrhagic stroke among older patients, found researchers here.

MONTREAL -- A coronary artery calcium score, obtained via CT, can accurately predict the development of atherosclerotic and ischemic disease in asymptomatic patients with type 2 diabetes, according to a report at the American Society of Nuclear cardiology meeting here.

Acute infection has been known to increase the risk of arterial cardiovascular events, but the effects of acute infections on venous thromboembolic disease have not been well established. Using the self- controlled case-series method, British researchers studied data obtained from general practitioners between 1987 and 2004 to investigate whether acute respiratory and urinary tract infections transiently increased the risk of initial incidents of deep venous thrombosis (DVT) in 7278 persons and pulmonary embolism (PE) in 3755.

IWATE, Japan -- Ischemic strokes are more likely to occur in the morning and hemorrhagic strokes in the early evening, according to investigators here.

ANN ARBOR, Mich. -- When the cumulative bill for ischemic stroke comes due in 2050 it is likely to total .2 trillion, and that's a conservative estimate, calculated University of Michigan researchers.

PAMPLONA, Spain -- Severe obstructive sleep apnea more than doubled the risk of a first ischemic stroke in persons over age 70, researchers here reported.

NEW YORK -- Stroke risk trumps age, gender or other history of heart disease in determining which atrial fibrillation patients benefit from anticoagulation, according to revised guidelines issued today by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology.

TORONTO -- Perhaps patients in their 70s should be advised to play it cool on their birthdays. The excitement surrounding the event increases the risk of stroke and heart attacks, according to researchers here.

How best to prevent future vascular events in a patient who has a history of stroke and an acute coronary syndrome?

We describe a case in which a patient received thrombolytic therapy after he presented with a clinical picture consistent with submassive pulmonary embolism (PE). Two months later, a malignant peripheral nerve sheath tumor was diagnosed, and the patient died with metastatic disease. The filling defect in the left main pulmonary artery originally interpreted as PE was in fact a tumor. This case describes an unusual presentation of a rare disease (malignant peripheral nerve sheath tumor) mimicking a submassive PE.

Pregnancy, childbirth, and the puerperium are the times when women are at greatest risk for stroke. Women in their childbearing years are at a greater risk for stroke than men of the same age.

ROCHESTER, Minn. - Patients with wide swings in blood pressure during the early hours of an ischemic stroke have a higher likelihood of death within three months, said researchers here.

NEW HAVEN, Conn. - The stress of losing a job after age 50 can double the risk of a heart attack or stroke, researchers here reported.

HAMILTON, Ontario ? Antiplatelet therapy is a poor alternative to oral anticoagulation for preventing stroke in patients with atrial fibrillation, according to researchers here.

Abstract: Failure to recognize heparin-induced thrombocytopenia (HIT) can lead to devastating thrombotic events, including pulmonary embolism and stroke. In most cases, the problem develops within 5 to 14 days after a first-time exposure to heparin. HIT can occur with either unfractionated heparin or low molecular weight heparin (LMWH), but the incidence is much lower with LMWH. When HIT is suspected clinically, a functional assay and immunoassay should be performed. However, treatment should not be delayed while waiting for laboratory confirmation. All forms of heparin should be eliminated, and treatment with an alternative anticoagulant should be initiated to prevent new thromboembolic events. Argatroban and lepirudin are the direct thrombin inhibitors that have been approved for the treatment of HIT. Because of the risk of warfarin-induced venous limb gangrene or skin necrosis, warfarin should be avoided in patients with acute HIT until their platelet counts have recovered and they are improving clinically. (J Respir Dis. 2006;27(6):248-259)

Cerebrovascular accidents occur in a small but significant number of young persons, many of whom do not have traditional risk factors for vascular disease.

Lower back pain of 7 days' duration prompted a 79-year-old man to seek medical attention. The pain was localized to the left side of the back. Vital signs were stable. During the abdominal examination, a pulsatile mass was noted in the periumbilical region. The patient was admitted to the hospital.

One of the keys to successfully managing acute pulmonary embolism (PE) is to quickly and reliably identify which patients require anticoagulant therapy. A diagnostic algorithm that combines clinical probability, D-dimer results, and CT findings appears to be quite effective in achieving this, according to a multicenter study conducted in the Netherlands.

Excess weight increases the risk of having a heart attack, stroke, high blood pressure, arthritis, diabetes, depression, fatigue, and certain types of cancer. Losing weight and keeping it off are very difficult for most persons who are overweight. Here are some suggestions to help you lose pounds and keep your weight down.

n the first 7 days after a transient ischemic attack (TIA), the risk of a stroke is 10%.1 If half the patients who presented with TIAs were admitted and received an immediate workup within that 7-day window, only 5% of them would have a stroke.1 Thus, many patients would undergo unnecessary tests. Some would have complications, and the costs would be prohibitive. What is needed is a way to identify patients who are at high risk for a stroke in the immediate future--and who require emergent assessment.