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Ischaemic Attack (ischaemic + attack)
Kinds of Ischaemic Attack Selected AbstractsThe causes and consequences of maxillofacial injuries in elderly peopleGERODONTOLOGY, Issue 1 2002K. Rehman Abstract Objective: The occurrence of trauma in older people is well-documented; however the incidence of maxillofacial trauma is scarcely reported. Therefore, the objective of this study is to determine the causes and consequences of maxillofacial trauma in older people. Design: A five-year (March 95 - March 2000) retrospective study was earned out of all patients over the age of 65 years with facial trauma presenting to Accident and Emergency Department (A&E). The information was collected using the medical notes and discharge summaries. Setting: The Departments of A&E and Maxillofacial Surgery. Subjects: A total of 42 patients' records were examined for study related data. Results: A total of 42 patients were seen during the study period. Thirty-six gave a history of a fall, of which 15 had tripped, 5 had slipped, 3 resulted from a Transient Ischaemic Attack (TIA), 1 as a result of alcohol abuse, in 1 a prosthetic knee gave way and 11 gave no cause for the fall. Of the remaining 6 patients. 5 were assaulted and 1 had a wardrobe fall on top of him. The majority of the falls occurred during the winter months. Maxillofacial injuries were noted in 27 of the 42 patients. Sixteen patients had cheekbone fractures, 8 mandibular fractures, 2 midface and 1 orbital complex fracture. Twenty-five percent of cheekbone fractures and 50% of mandibular fractures were treated surgically. Medical history was noted in 27 patients. Conclusions: This study clearly demonstrates the majority of the facial trauma in the older people can be treated conservatively unless the patients complain of functional problems. [source] Homozygous thermolabile variant of the methylenetetrahy-drofolate reductase gene: a potential risk factor for hyperhomo-cysteinaemia, CVD, and stroke in childhoodDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2001Mara Prengler In this study of 118 children (median age 5.1 years; range 6 months to 17 years) with ischaemic stroke or transient ischaemic attack (TIA), 22 children (19%) were homozygous for the thermolabile variant of the methylenetetrahydrofolate reductase allele (t-MTHFR), compared with nine of 78 (12%) of a reference population (p=0.18, OR 1.76, 95% CI 0.76 to 4.04). Of those with cerebrovascular disease (CVD), 17 of 84 were homozygous for the t-MTHFR allele (p=0.13 compared with the reference population (OR 1.95, 95% CI 0.81 to 4.65). There was a significant (p<0.025) increment of plasma total homocysteine concentration in homozygotes for the t-MTHFR allele compared with heterozygotes, negatives for the t-MTHFR allele, and control children with no history of stroke. In four of 12 homozygotes for the t-MTHFR allele, plasma homocysteine levels were raised, compared with three of 38 of those who were negative or heterozygous (p=0.047; OR 5.8, 95% CI 1.1 to 31.2). Homozygotes for the t-MTHFR allele were significantly more likely to have a recurrent event than those who were negative or heterozygous (Cox regression p=0.031, hazard ratio 2.18, 95% CI 1.08 to 4.42). These data suggest that homozygosity for the t-MTHFR allele is associated with raised homocysteine levels in children and is a risk factor for primary and secondary stroke and TIA. [source] Genetic variation and decreased risk for obesity in the Atherosclerosis Risk in Communities StudyDIABETES OBESITY & METABOLISM, Issue 4 2007M. L. Hart Sailors Aim:, To investigate the effects of variation in the leptin [LEP (19A>G)] and melanocortin-4 receptor [MC4R (V103I)] genes on obesity-related traits in 13,405 African-American (AA) and white participants from the Atherosclerosis Risk in Communities (ARIC) Study. Methods:, We tested the association between the single-locus and multilocus genotypes and obesity-related measures [body mass index (BMI), body weight (BW), waist,hip ratio, waist circumference and leptin levels], adjusted for age, physical activity level, smoking status, diabetic status, prevalence of coronary heart disease, hypertension, stroke or transient ischaemic attack. Results:, AA and white female carriers of the MC4R I103 allele exhibited significantly lower BW than non-carriers of this allele (p < 0.05 and p < 0.01 respectively). AA female carriers of both the LEP A19 allele and the MC4R I103 allele were 63% [odds ratio (OR) = 0.37, 95% confidence interval (CI) (0.18,0.78)] less likely to be obese, and white female carriers of the same two alleles were 46% [OR = 0.54, 95% CI (0.32,0.91)] less likely to be obese, than non-carriers of the variant alleles. Female carriers of both the LEP A19 and MC4R I103 alleles had significantly lower BW (p < 0.05), BMI (p < 0.05) and plasma leptin (p < 0.01) than the non-carriers of both the alleles. Carriers of the two variant alleles had lower BMI over the 9-year course of the ARIC study and significantly lower weight gain from age 25 years. No significant joint effect of these two variants was observed in males. Conclusion:, These results suggest that variation within the LEP and MC4R genes is associated with reduced risk for obesity in females. [source] Neurological manifestations of antiphospholipid syndromeEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 4 2010Carlos E. M. Rodrigues Eur J Clin Invest 2010; 40 (4): 350,359 Abstract Background, Neurologic disorders are among the most common and important clinical manifestations associated with the antiphospholipid syndrome (APS). It is characterized by diverse neurological manifestations. These include stroke, transient ischaemic attack, Sneddon's syndrome, convulsions/epilepsy, dementia, cognitive deficits, headaches/migraine, chorea, multiple sclerosis-like, transverse myelitis, ocular symptoms and Guillain,Barré syndrome. Material and methods, We review the latest data about neurologic disorders and APS. Results, In patients under 45 years of age, 20% of strokes are potentially associated with APS. Our study group recently reported a correlation between primary APS and peripheral neuropathy. Only one study investigated the occurrence of peripheral neuropathy in patients diagnosed with PAPS through electrophysiological study and showed alterations in 35% of patients. The mechanism of nervous system involvement in APS is considered to be primarily thrombotic. However, other mechanisms have been described, such as antiphospholipid antibodies that bind to the neural tissue, deregulating their functions and having an immediate pathogenic effect. Conclusions, This review summarizes the latest data regarding the clinical aspects, radiological and therapeutic of major neurologic manifestations associated with antiphospholipid antibodies. [source] Long-term follow-up of patients with asymptomatic occlusion of the internal carotid artery with good and impaired cerebral vasomotor reactivityEUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2010I. Kimiagar Background:, Cerebral hemodynamic status might be prognostic for either the symptomatic or asymptomatic course of carotid occlusive disease. It is determined by evaluating cerebral vasomotor reactivity (VMR). We assessed VMR in asymptomatic patients with total occlusion of the internal carotid artery (ICA) and followed them to evaluate the role of impaired VMR in predicting ischaemic stroke (IS). Methods:, Thirty-five patients (21 men, mean age ± SD 68 ± 7.5 years) with unilateral asymptomatic ICA occlusion were studied by transcranial Doppler and the Diamox test (intravenous 1.0 g acetazolamide) and followed for 48 months or until reaching the end-points of IS, transient ischaemic attack, or vascular death. VMR% was evaluated by recording the percent differences in peak systolic blood flow velocities in each middle cerebral artery at baseline and after Diamox administration. Results:, Based on VMR% calculations, 14 (40%) patients had good VMRs and 21 (60%) had impaired VMRs. The global annual risk of ipsilateral ischaemic events was 5.7%. The annual ipsilateral ischaemic event risk was 1.8% in patients with good VMRs, whilst it was 7.1% in patients with impaired VMRs. An impaired VMR was significantly correlated with ipsilateral IS (Kaplan,Meier log rank statistic, P = 0.04). Conclusions:, Our results support the value of VMR assessment for identifying asymptomatic patients with carotid occlusion who belong to a high-risk subgroup for IS. New trials using extracranial-to-intracranial bypass surgery in patients with asymptomatic ICA occlusion and impaired VMRs are warranted. [source] Clinical features associated with medically unexplained stroke-like symptoms presenting to an acute stroke unitEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2005F. S. Nazir In many areas of secondary care, symptoms unexplained by disease account for around one-third of all patients seen. We sought to investigate patients presenting with medically unexplained stroke-like symptoms to identify distinguishing features which may help to identify a non-organic aetiology. Patients given a discharge diagnosis of medically unexplained stroke-like symptoms over the preceding 11 years were identified retrospectively from a prospectively completed stroke unit database. Age- and sex-matched controls with ischaemic or haemorrhagic stroke or transient ischaemic attack were also identified. Clinical features on presentation, ischaemic risk factors, alcohol history, marital status and history of depression or anxiety were examined. Previous or subsequent admissions with medically unexplained syndromes were also examined via record linkage with hospital discharge records. A medically unexplained syndrome was assumed to be present if an International Classification of Diseases 9 discharge code for one or more of the thirteen conditions forming recognized functional syndromes was given. Logistic regression was applied to determine predictors of non-organicity. One hundred and five patients and controls, 1.6% of all stroke unit admissions were identified, 62% (65 patients) were females. Mean age was 50.3 ± 14.9. Compared with age- and sex-matched controls patients with medically unexplained stroke-like symptoms were significantly more probable to have a headache at presentation (47% vs. 26%, P = 0.0004), have a diagnosis of one or more additional medically unexplained syndromes (24% vs. 11%, P = 0.007) but significantly less probable to present with symptoms of vertebrobasilar dysfunction (32% vs. 61%, P < 0.0001). A history of anxiety or depression, as recorded in the notes, was not found to be associated with a medically unexplained presentation. Medically unexplained stroke-like presentations are common (1.6% of all stroke presentations), they are most strongly predicted by the presence of other functional somatic syndromes, headache and the absence of symptoms of vertebrobasilar dysfunction. [source] Stroke secondary prevention and blood pressure reduction: an observational study of the use of PROGRESS therapyFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2008Jean-Marc Bugnicourt Abstract The Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) showed the efficacy of blood pressure reduction in secondary stroke prevention. This anti-hypertensive treatment (perindopril 4 mg daily plus indapamide 1.5 mg daily) is now routinely proposed to patients referred to our department for stroke or transient ischaemic attack (TIA). The aim of this study was to evaluate the prescription of PROGRESS therapy during hospitalization and to identify the predictors of therapy discontinuation after discharge. Eligible patients admitted to the Amiens University hospital for acute stroke or TIA from January to April 2003 were included (n = 101). At 1 year, the use of PROGRESS therapy was evaluated by structured phone interviews. In addition, each patient's general practitioner (GP) was also contacted to provide information. PROGRESS therapy was mentioned on the hospital discharge summary significantly less frequently after cardioembolic stroke (OR: 0.15; 95% CI: 0.05,0.5; P = 0.001) and TIA (OR: 0.12; 95% CI: 0.02,0.7; P = 0.02). At 1 year, only 25.7% of patients were treated with optimal PROGRESS therapy (perindopril 4 mg daily plus indapamide 1.5 mg daily). Mention of PROGRESS therapy in the discharge summary was the main predictor of optimal PROGRESS therapy at 1 year (OR: 10.8; 95% CI: 1.3,88.3; P = 0.03). This study shows that mention of PROGRESS therapy in the discharge summary must be improved as it is associated with a higher use of these anti-hypertensive agents 1 year after stroke/TIA. [source] Acute stroke and transient ischaemic attack management , time to act fastINTERNAL MEDICINE JOURNAL, Issue 5 2009D. S. Crimmins Abstract Stroke is Australia's second single greatest killer with 53 000 new events each year at a rate of 1 every 10 min. Stroke services should be organized to enable people to access proven therapies, such as stroke unit care and thrombolysis, to reduce the impact of stroke. Timely, efficient and coordinated care from ambulance services, emergency services and stroke services will maximize recovery and prevent costly complications and subsequent strokes. Efficient management of patients with transient ischaemic attack can produce significant reductions in subsequent stroke events and risk stratification using the ABCD2 tool can aid management decisions. Evidence for acute stroke care continues to evolve and it is crucial that health professionals are aware of, and implement, best practice clinical guidelines for stroke care. [source] Prevention of secondary stroke and transient ischaemic attack with antiplatelet therapy: the role of the primary care physician roleINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2007H. S. Kirshner Summary Background:, Stroke risk is heightened among patients who have had a primary stroke or transient ischaemic attack (TIA). The primary care physician is in the best position to monitor these patients for stroke recurrence. Because stroke recurrence can occur shortly after the primary event, guidelines recommend initiating antiplatelet therapy as soon as possible. Aspirin, with or without extended-release dipyridamole (ER-DP), and clopidogrel are options for such patients. Low-dose aspirin (75,150 mg/day) has the same efficacy as higher doses but with less gastrointestinal bleeding. Clopidogrel remains an option for prevention of secondary events and may benefit patients with symptomatic atherothrombosis, but its combined use with aspirin can harm patients with multiple risk factors and no history of symptomatic cerebrovascular, cardiovascular or peripheral vascular disease. Results:, Low dose aspirin is effective in secondary stroke prevention. Trials assessing aspirin plus ER-DP have shown that the combination is more effective than aspirin monotherapy in preventing stroke, with efficacy increasing among higher risk patients, notably those with prior stroke/TIA. Clopidogrel does not appear to have as much advantage over aspirin in secondary stroke prevention as aspirin plus ER-DP. Smoking cessation and cholesterol, blood glucose and blood pressure control are also important concerns in preventing recurrent stroke. In choosing pharmacological therapy, the physician must consider the individual patient's risk factors and tolerance, as well as other issues, such as use of aspirin among patients with ulcers. Conclusion:, Antiplatelet therapy is effective in secondary stroke prevention. Low dose aspirin can be used first-line, but aspirin plus ER-DP improves efficacy. Clopidogrel is another option in secondary stroke prevention, especially for aspirin-intolerant patients, but it appears to have less advantage over aspirin than aspirin plus ER-DP, and its combined use with aspirin has only marginally better efficacy and increased bleeding risk. [source] The burden of paediatric stroke and cerebrovascular disorders in CroatiaINTERNATIONAL JOURNAL OF STROKE, Issue 5 2009J. Lenicek Krleza Pediatric stroke is significantly less common than stroke in adults, but represents a major challenge to public health authorities. The aim of this retrospective study was to identify the total and annual number of children younger than 18 years with arterial ischaemic stroke and transient ischaemic attack referred to the Children's Hospital Zagreb, which is a major national centre specialised for the treatment and prevention of stroke in children. We reviewed the medical records of the Department of Neuropediatrics database at the Children's Hospital Zagreb between 1998,2005 in order to provide demographic and clinical characteristics and neuroimaging findings in children with arterial ischaemic stroke. In the 7-year period, we identified a total of 124 children from different geographic areas of Croatia with a confirmed diagnosis of transient ischaemic attack (N=77), and arterial ischaemic stroke (N=47). Perinatal and childhood arterial ischaemic stroke were equally represented (23 and 24 children, respectively). The average number of new cases identified each year was 18 cases (range: 12,21), seven arterial ischaemic stroke and 11 transient ischaemic attack cases. Male predominance was found in children with arterial ischaemic stroke with a male : female ratio of 1·76 : 1, and was slightly higher in childhood arterial ischaemic stroke compared with perinatal arterial ischaemic stroke (2 : 1 and 1·56 : 1, respectively). In contrast, transient ischaemic attack was more frequently found in girls, and more likely identified in older children compared with younger children with arterial ischaemic stroke. Obtained data will contribute to better understanding of paediatric stroke in Croatia and will provide a base for the establishment of the national referral center and national pediatric stroke registry. [source] Evidence for prolonged prescribing of aspirin,clopidogrel combination in Scottish primary care,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008Colin R. Simpson PhD Abstract Purpose To identify whether patients were prescribed the combination of aspirin,clopidogrel in primary care after the generally recommended 12-month period. Methods A population based cross-sectional study using data from 61 general practices (1st April 2003,31st March 2004). Results 691 patients (0.18% of total population) were prescribed aspirin,clopidogrel in combination. 27.78% of these patients had undergone coronary stenting or angioplasty and 34.30% were prescribed this combination for more than 1,year. 96 (13.9%) patients had a previous history of ischaemic stroke or transient ischaemic attack. Conclusions Patients were prescribed the combination of aspirin,clopidogrel beyond the generally accepted 12-month period, which may lead to increased safety and cost concerns. Copyright © 2008 John Wiley & Sons, Ltd. [source] Patient flow to carotid endarterectomy: hastening the patient journeyANZ JOURNAL OF SURGERY, Issue 6 2010Manar Khashram Abstract Background:, Early carotid endarterectomy (CEA) after stroke or transient ischaemic attack is the proposed standard of care to prevent recurrent ischaemic events in selected patients. The aim of this study was to investigate if this standard is achieved in a tertiary vascular unit. Methods:, This was a clinical audit. CEAs performed from 1 January 2006 to 31 December 2008 at Christchurch hospital were identified. The value stream from initial presentation to surgery was mapped in two phases (phase 1; 2006,2007 and phase 2; 2008). Patients who had carotid intervention for asymptomatic carotid lesions were excluded. Results:, The relevant patient journey was documented in 81 patients (55 phase 1; 26 phase 2). Median time from initial presentation to carotid ultrasound was 5 days in phase 1 and 6 days in phase 2. Time from presentation to vascular surgery review was 22 days in phase 1 and 13 days in phase 2. Time from presentation to CEA significantly reduced from 83 to 32 days between phases (P < 0.005). Conclusions:, There has been a significant decrease in time from presentation to operation between phase 1 and 2. The most significant change is reduced delay between vascular surgery review and CEA. There has been no improvement in urgency of referral for imaging or surgical review. This part of the patient journey is a target for improvement. [source] Why do some patients with > 80% stenosis of the internal carotid artery not undergo surgery?ANZ JOURNAL OF SURGERY, Issue 11 2001A retrospective review Background: Carotid endarterectomy is known to benefit both symptomatic and asymptomatic patients with high-grade internal carotid artery stenosis. Duplex scanning is the ,gold standard' for non-invasive preoperative investigation of carotid artery stenosis. The aim of the present study was to analyse the indications for duplex scanning and to identify other factors that influenced the management of patients with high-grade stenosis who did not undergo carotid endarterectomy. Methods: A total of 271 patients was observed to have > 80% stenosis of the internal carotid artery on duplex scanning during the period of review. Of these patients, 85 did not undergo carotid endarterectomy. The vascular laboratory database and hospital records of these patients were retrospectively reviewed. Results: The indications for requesting a carotid duplex scan in the 85 patients were transient ischaemic attack (22%), stroke (25%), symptomatic bruit (7%), asymptomatic bruit (12%), and stroke and symptomatic bruit combined (7%). Falls and preoperative carotid assessment prior to coronary surgery were the commonest indications in the remaining patients. The main risk factors were cardiac (68%), hypertension (60%), respiratory (21%), diabetes (25%), peripheral vascular disease (19%), neoplasm (16%) and renal disease (16%). Twenty-five per cent of the patients were over 80 years of age. Conclusion: In the present study risk factors associated with increased perioperative morbidity and mortality were the commonest explanation for patients with high-grade stenosis of the internal carotid artery not undergoing surgery. These patients would generally not meet the inclusion criteria for the major carotid endarterectomy trials. [source] Psoriasis and risk of incident myocardial infarction, stroke or transient ischaemic attack: an inception cohort study with a nested case,control analysisBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2009Y.B. Brauchli Summary Background, Systemic inflammation may increase the risk for cardiovascular diseases in patients with psoriasis, but data on this risk in patients with early psoriasis are scarce. Objectives, To assess and compare the risk of developing incident myocardial infarction (MI), stroke or transient ischaemic attack (TIA) between an inception cohort of patients with psoriasis and a psoriasis-free population. Methods, We conducted an inception cohort study with a nested case,control analysis within the U.K.-based General Practice Research Database. The study population encompassed 36 702 patients with a first-time recorded diagnosis of psoriasis 1994,2005, matched 1 : 1 to psoriasis-free patients. We assessed crude incidence rates (IRs) and applied conditional logistic regression to obtain odds ratios (ORs) with 95% confidence intervals (CIs). Results, Overall, the IRs of MI (n = 449), stroke (n = 535) and TIA (n = 402) were similar among patients with or without psoriasis. However, the adjusted OR of developing MI for patients with psoriasis aged < 60 years was 1·66 (95% CI 1·03,2·66) compared with patients without psoriasis, while the OR for patients aged , 60 years was 0·99 (95% CI 0·77,1·26). The adjusted ORs of developing MI for patients of all ages with , 2 or > 2 prescriptions/year for oral psoriasis treatment were 2·48 (95% CI 0·69,8·91) and 1·39 (95% CI 0·43,4·53), with a similar finding for stroke and TIA. Conclusions, The risk of developing a cardiovascular outcome was not materially elevated for patients with early psoriasis overall. In subanalyses, however, there was a suggestion of an increased (but low absolute) MI risk for patients with psoriasis aged < 60 years, mainly with severe disease. [source] Sequential cohort study of Dacron® patch closure following carotid endarterectomyBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2005T. Ali Background: Carotid endarterectomy reduces the risk of stroke and death in patients with severe carotid artery stenosis. This study examined whether the technique used to close the arteriotomy influenced the rate of perioperative transient ischaemic attack (TIA), stroke or death. Methods: A cohort of 236 patients undergoing carotid endarterectomy at a single centre was studied; 117 patients had primary closure of the arteriotomy and 119 patients in a sequential series had closure with a Dacron® patch. A standard endarterectomy with completion intraoperative duplex imaging and digital subtraction angiography was used throughout. Results: Patch closure was associated with a significant reduction in the 30-day combined death, stroke and TIA rate: 10·3 per cent for primary closure versus 2·5 per cent for patch closure (P = 0·017). The risk of any cerebral event (stroke or TIA) was also significantly reduced (7·7 versus 1·7 per cent; P = 0·033). Residual stenosis on completion angiography was more common after primary closure (24·6 versus 7·4 per cent; P = 0·003). Conclusion: Dacron® patch closure had a higher technical success rate on completion imaging and was associated with a significant reduction in the risk of perioperative stroke, TIA and death. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Initial management of cerebrovascular disease by general practitionersBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000R. G. J. Gibbs Background: The aim of this study was to determine the primary management of patients presenting with a new diagnosis of transient ischaemic attack (TIA) or stroke by general practitioners and to establish whether practice was uniform across the UK, and to determine whether initial management influenced the performance of carotid endarterectomy (CEA) across the health regions of the UK. Methods: Information on regional reporting of new cases of TIA and stroke between 1992 and 1996 was obtained from the General Practice Research Database, a database of six million patients from 450 practices. Analysis of data from the primary care database and routine data sources was undertaken. Main outcome measures were incidence of TIA and stroke, rates of referral for specialist opinion, prescription of antiplatelet agents and rates of CEA. Results: There were twofold differences (P < 0·00005, ,2 test) in the incidence of cerebrovascular disease between Regional Health Authorities (RHAs) between the years 1992 and 1996 and also for each year. Mean stroke incidence per annum was 143 per 100 000 and TIA incidence 183 per 100 000. Yorkshire had the highest incidence at 170 (stroke) and 206 (TIA) per 100 000 of the population compared with 95 and 98 per 100 000 for Oxford. Some 37 per cent of new patients with stroke and 19 per cent of patients with TIA were referred for specialist opinion following initial diagnosis. These rates did not change over time. There was no positive correlation between disease incidence and referral rate; Yorkshire referred the least (14 per cent) and Oxford the most (26 per cent). The majority of referrals for TIA were made to general medicine (39 per cent); 6 per cent of patients were referred directly for surgical opinion. Mean prescription rate of antiplatelet medication over the time period was 17 per cent for patients with stroke and 35 per cent for those with TIA. Mean CEA rate for English RHAs for the time interval was 15·5 per 100 000. There was a positive correlation between the incidence of disease and rate of CEA, with the regions with the highest incidence of disease tending to perform the most CEAs. Conclusion: The incidence of cerebrovascular disease varies significantly across health regions in the UK. There was no correlation between the regional incidence of disease and the number of patients referred for specialist opinion, but CEA rates were generally correlated with the regional difference in incidence of disease. The low referral rate may be a factor in the perceived underperformance of CEA in the UK and the low usage of antiplatelet medication is surprising. © 2000 British Journal of Surgery Society Ltd [source] Antithrombotic management of ischaemic stroke and transient ischaemic attack in China: A consecutive cross-sectional surveyCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 8 2010Yi-Long Wang Summary 1.,Little is known about the prevention of secondary stroke in China. In the present study, we assessed the status of antithrombotic management of stroke patients in clinics across China. 2.,A cross-sectional survey was conducted in 19 urban neurological clinics. All subjects diagnosed with ischaemic stroke (IS) or transient ischaemic attack (TIA) were enrolled consecutively in the study. Face-to-face interviews were conducted by research assistants using questionnaires on the day of enrolment. The data recorded included demographic and clinical characteristics, medication and reasons for not using medication. Independent predictors for the prescription of antiplatelet drugs were determined using multivariate logistic regression models. 3.,Of the 2283 patients with IS or TIA enrolled in the study (34.7% women; mean ( ± SD) age 65.8 ± 11.6 years), 1719 (75.3%) had a prescription for antiplatelet therapy. Of the 108 patients with atrial fibrillation, only 14 (13.0%) were receiving warfarin therapy. The main independent factors significantly associated with being on antiplatelet therapy were having basic health insurance (odds ratio (OR) 1.47; 95% confidence interval (CI) 1.09,1.99), government insurance and labour insurance (OR 1.63; 95% CI 1.03,2.59) and a monthly income of > 500 yuan (US$66.70; OR 2.14; 95% CI 1.51,3.03). Being older (OR 0.70; 95% CI 0.50,0.99) and having a severe disability (OR 0.68; 95% CI 0.49,0.97) were associated with lower odds of receiving antiplatelet therapy. 4.,Based on the survey results, adherence to guidelines for antithrombotic management in neurological clinics in China is poor. The main reasons contributing to the less than optimal management of stroke patients include negative attitudes among neurologists, a lack of medical insurance, a lower income and being elderly and/or severely disabled. [source] EFFECTS OF A SINGLE, SHORT INTRAVENOUS DOSE OF ACETYL- l -CARNITINE ON PATTERN-REVERSAL VISUAL-EVOKED POTENTIALS IN CIRRHOTIC PATIENTS WITH HEPATIC ENCEPHALOPATHYCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 1-2 2006Massimo Siciliano SUMMARY 1In animals and in cultured neurons, l -carnitine and acetyl- l -carnitine (ALCAR) have been shown to counteract some of the toxic effects of ammonia. In order to detect similar properties in humans, we studied neuronal function after ALCAR administration in cirrhotics with hepatic encephalopathy (HE). 2Eighteen cirrhotic patients with persistent HE and hyperammonaemia were investigated in the present study and six subjects with a prior transient ischaemic attack were used as controls. 3The prominent positive component that occurs approximately 100 msec after the pattern reversal (P100) latencies of visual-evoked potentials were used to evaluate neuronal function. At first, the P100 latency was measured in six cirrhotic patients with HE and in the six controls before the administration of 0.5 g ALCAR in 50 mL isotonic saline (infusion rate 10 mL/min) and 15, 30, 60 and 90 min later. 4A significant reduction in P100 latencies was identified 30 min after ALCAR infusion in HE patients, whereas no differences were observed in controls. 5Thereafter, the P100 latency was evaluated in the 12 other cirrhotic patients with HE only before and 30 min after ALCAR infusion. The mean of the P100 latencies measured in these subjects was significantly shorter after ALCAR infusion compared with values obtained before ALCAR administration (mean (SD) 130.78 5.50 vs 136.08 6.45 msec, respectively; P = 0.0013). 6The present study suggests that a single intravenous dose of ALCAR may transiently improve neuronal function in cirrhotic patients with persistent HE and hyperammonaemia. [source] Sturge,Weber syndrome and paroxysmal hemiparesis: epilepsy or ischaemia?DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2004Floor E Jansen MD Transient neurological deficits experienced by patients with Sturge,Weber syndrome can be caused by epilepsy, or may result from temporary ischaemia of the cortex underlying the vascular malformation. To show the difficulty in distinguishing seizures from ischaemic symptoms, two male children with episodes of acute unilateral weakness are presented here as well as a review of the literature. The first child presented at 2 years of age with a sudden increase in his pre-existing right hemiparesis accompanied by screaming. Ictal epileptiform activity was recorded at the moment of the attack, and subsequent seizures were controlled by adjustment of antiepileptic drug treatment. The second child presented at 4 years of age with attacks of vomiting and a coinciding increase in the pre-existing paresis of the left leg. Electroencephalogram (EEG) recording did not show ictal epileptiform activity. The origin was presumed to be vascular. Treatment with aspirin led to control of these transient ischaemic attacks. Ictal EEG is needed to differentiate between an epileptic and an ischaemic origin of transient focal deficit. Treatment with aspirin should be considered if an ischaemic origin cannot be excluded. [source] Symptomatic stenosis of the vertebrobasilar arteries: results of extra- and intracranial stent-PTAEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2009T. Seifert Background and purpose:, About half of all transient ischaemic attacks (TIAs) or strokes in the posterior circulation are caused by the arterial stenosis. The purposes of this study were to determine the safety of stent-assisted percutaneous transluminal angioplasty (stent-PTA) and its efficacy for the prevention of recurrent stroke in patients with symptomatic artery stenosis in the extra- and intracranial posterior circulation. Methods:, Forty-six patients with a previous stroke or TIA who received balloon-mounted coronary stents for vertebral artery origin stenosis (VAOS; 29 patients) or self-expanding nitinol stents for vertebrobasilar intracranial stenosis (VBIS; 17 patients) were followed-up for a mean of 24.1 (VAOS) and 12.7 (VBIS) months. Results:, When all cause morbidity/mortality within 30 days from stent-PTA and stroke or death from stroke in the treated vascular territory during the first 12 months of follow-up are combined, the incidence of periprocedural complications and disease progression for the first year is 10.3% in VAOS patients and 17.6% in the VBIS group. Vessel restenosis ,50% was found in 52.0% of VAOS and in 32.1% of VBIS patients who completed 6 months follow-up. Conclusions:, We observed a higher periprocedural complication rate for patients with VBIS and a higher rate of restenosis in VAOS patients after stent-PTA for symptomatic artery stenosis. [source] Wagging the dog-moving closer to features defined by basic scientists, the protection of prodromal transient ischaemic attacks reveals itselfEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2008B. A. McLaughlin No abstract is available for this article. [source] Who is at high risk of stroke following transient ischaemic attacks?INTERNAL MEDICINE JOURNAL, Issue 4 2006R. P. Gerraty No abstract is available for this article. [source] Effects of low-dose warfarin and aspirin versus no treatment on stroke in a medium-risk patient population with atrial fibrillationJOURNAL OF INTERNAL MEDICINE, Issue 1 2003N. Edvardsson Abstract. Edvardsson N, Juul-Möller S, Ömblus R, Pehrsson K (Sahlgrenska University Hospital, Malmö University Hospital, Bristol-Myers Squibb Bromma; and Karolinska University Hospital; Stockholm, Sweden). Effects of low-dose warfarin and aspirin versus no treatment on stroke in a medium-risk patient population with atrial fibrillation. J Intern Med 2003; 254: 95,101. Objectives. To assess the optimal stroke prevention treatment for patients with atrial fibrillation (AF) and a low,medium risk (,4%) of stroke. Design. A total of 668 patients with persistent or permanent AF, without an indication for full dose and with adequate rate control on sotalol, were randomized to warfarin 1.25 mg + aspirin 75 mg daily (W/A, 334 patients) or no anticoagulation (C, 334 patients). The mean follow-up period was 33 months. The protocol intended to verify a 37% relative risk reduction provided a 4% stroke incidence in the C group. Results. The stroke incidence was less in the W/A group, although the reduction was not statistically significant (W/A 9.6% versus C 12.3%). Four haemorrhagic strokes were identified, two in each group. Secondary end-points were transient ischaemic attacks (TIA) (W/A 3.3% versus C 4.5%), all cause mortality (W/A 9.3% versus C 10.8%), cardiovascular morbidity (W/A 17.7% versus C 22.2%) and the combination of stroke + TIA (W/A 11.7% versus C 16.5%). Bleedings were documented in 19 versus four patients (W/A 5.7% versus C 1.2%) (P = 0.003), although none fatal. Sinus rhythm (SR) was recorded occasionally in 68 patients (W/A 9.6% versus C 10.8%). The stroke incidence tended to be higher in those with SR than without, 16.2% versus 10.4%. Conclusions. Our results were inconclusive, but consistent with a small beneficial effect of W/A for reduction of stroke and major vascular events in AF patients at moderate risk. The low-dose regiment produced, however, a significantly increased risk of bleedings. Documented SR occasionally recorded may represent a subpopulation that warrants full dose warfarin. [source] CADASIL,an unusual manifestation with prominent cutaneous involvementBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2005G. Ratzinger Summary Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucencephalopathy (CADASIL) is a rare vascular disorder affecting mainly the central nervous system with transient ischaemic attacks, strokes, psychiatric symptoms and dementia. It is a progressive familial disease owing to mutations in the Notch3 gene. Clinically apparent skin involvement is usually absent. Electron microscopy of seemingly uninvolved skin reveals characteristic granular deposits in the basal lamina of vessels and adnexals. We report on a case of CADASIL with generalized haemorrhagic macules and patches. Typical neurological symptoms as well as classical findings in histopathology and electron microscopy confirmed the diagnosis. Immunofluorescence showed an increased number of vessels with walls markedly thickened by deposits of fibrin, complement and immunoglobulins. This method could serve as an additional method for accurate diagnosis of CADASIL. [source] Transcranial Doppler ultrasonography-directed intravenous glycoprotein IIb/IIIa receptor antagonist therapy to control transient cerebral microemboli before and after carotid endarterectomy,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2008D. van Dellen Background: Patients with a transient focal neurological deficit, critical carotid stenosis and/or microemboli detected by transcranial Doppler ultrasonography (TCD) have a significant risk of stroke. The effect of tirofiban, a selective glycoprotein IIb/IIIa inhibitor, was assessed in patients with microembolic signals on TCD after transient ischaemic attacks or carotid endarterectomy (CEA). Methods: Thirty-three patients with microemboli on TCD (13 symptomatic preoperative, 19 postoperative, one both) were treated with tirofiban between 2002 and 2007. All patients had carotid stenosis greater than 70 per cent. TCD monitoring was used during and after tirofiban therapy. Results: The median (range) rate of microemboli decreased from 22 (4,260) per h before surgery and 81 (44,216) per h after surgery to 0 (0,9) per h in both groups (P < 0·001, Mann,Whitney U test). This occurred rapidly (preoperative median 30 min; postoperative median 45 min) and was well tolerated in all patients, with no serious adverse effects. Conclusion: Cerebral microemboli were controlled by tirofiban both before and after CEA. Further study is required to compare the relative efficacy of tirofiban and dextran. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||