PHOTOCLINIC

Cryptogenic Stroke
May 9, 2011

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.

Carotid Dissection From Weight Lifting
June 4, 2009

A 37-year-old man was brought to the emergency department (ED) after he had 2 near-syncopal events. The first occurred in the morning and rapidly resolved; the second occurred later in the day at work. The night before he had a headache and neck pain. In the ED, he reported left arm and leg weakness and was noted to have left facial droop.

Aortic Atheroma
April 1, 2009

A 68-year-old woman with a history of hypertension, hyperlipidemia, and tobacco use presented with her third stroke in the past 7 years. Neurological deficits included dysarthria and left-sided motor and sensory loss. A previous transthoracic echocardiogram with a bubble study did not reveal any cardiac source of embolism. Axial MRI of the brain on admission showed an abnormal signal in the bilateral hemispheres representative of multiple subacute infarcts

CLINICAL TRIALS

Safety of Donepezil in Patients With Dementia Associated With Cerebrovascular Disease

www.clinicaltrials.gov -

Cerebrovascular Involvement in Sickle Cell Disease

www.clinicaltrials.gov -

Donepezil Hydrochloride (E2020) in Dementia Associated With Cerebrovascular Disease

www.clinicaltrials.gov -

NEWS

www.medpagetoday.com/upload/2009/2/17/b462.pdf

www.medpagetoday.com -

Medical News: ICAD: Vascular Defects Predate Cognitive Decline

www.medpagetoday.com -

Medical News: ASA: Guidelines Urge Same Urgency for TIAs as Stroke

www.medpagetoday.com -

PATIENT RESOURCES

Stroke: MedlinePlus

www.nlm.nih.gov - 3/21/13

Hereditary cerebral amyloid angiopathy

ghr.nlm.nih.gov - 3/18/13

FIBGC

ghr.nlm.nih.gov - 3/11/13

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Cerebrovascular Diseases

FEATURED CONTENT

May 16, 2013

Filling Gaps in Hypertension Rx: Sleep Disorders and Stroke

ASH 2013 has uncovered 2 glaring gaps in the management of people with sleep disorders (OSA as well as others) and appropriate care after a stroke. Both cohorts frequent primary care practice. More »

April 11, 2013

Predict Midlife Cognitive Decline With Heart Disease Risk Scores

Heart disease and stroke risk prediction tools may be more useful in predicting cognitive decline in middle-aged patients than a dementia risk test, according to a new study. More »

April 10, 2013

First Stroke Risk Reduced With High Fiber Intake

Persons who eat a high-fiber diet experience a lower risk of first-time stroke, according to a new meta-analysis that supports current guidelines to increase fiber consumption. More »

April 9, 2013

Dementia Care Costs Comparable to Heart Disease, Cancer

Adding informal, unpaid care to the equation as much as doubled the estimated total national costs. More »

April 5, 2013

Women and Heart Disease: Incidence, Prevalence, Progress, and the Future

Female CV mortality lags behind male mortality; lifetime risk assessment, not 10-year risk, is a better estimation tool for women More »

March 22, 2013

Stroke at Young Age Ups Risk for Death

Depending on the specific type of event, stroke at age 50 years or younger increased mortality at least threefold. More »

March 15, 2013

Sleep Apnea Doubles Risk for Stroke Precursor in Elderly

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

March 13, 2013

Heart Disease and HIV: Updates from the Conference on Retroviruses and Opportunistic Infections

Cardiovascular disease is now the cause of death for 10% of HIV-positive patients. Why this happens and how to prevent or treat it remain unclear, but research presented at the CROI conference offers insights into potential solutions. More »

February 28, 2013

Residual Cardiovascular Risks: Don’t Forget Kidney and Vascular Disease

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... More »

February 11, 2013

Suicidal Ideation Higher Among Stroke Survivors Than Among Those With History of Cancer

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%). More »

Showing 1 - 10 of 174 results.

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JOURNAL SCAN

Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis.

pubmed.gov - 9/1/12

The aim of this study was to estimate the relative risk of cardiovascular disease (CVD) among people living with HIV (PLHIV) compared with the HIV-uninfected population.|We conducted a systematic review and meta-analysis of studies from the peer-reviewed literature. We searched the Medline database for relevant journal articles published before August 2010. Eligible studies were observational and randomized controlled trials, reporting CVD, defined as myocardial infarction (MI), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among HIV-positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy (ART).|The relative risk of CVD was 1.61 [95% confidence interval (CI) 1.43-1.81] among PLHIV without ART compared with HIV-uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70-2.37) among PLHIV on ART compared with HIV-uninfected people and 1.52 (95% CI 1.35-1.70)

Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies.

pubmed.gov - 9/1/12

To determine the magnitude of the risk of incident cardiovascular disease (CVD; fatal and non-fatal), including acute myocardial infarction (MI), cerebrovascular accidents (CVA) and congestive heart failure (CHF), in patients with rheumatoid arthritis (RA) compared to the general population through a meta-analysis of controlled observational studies.|The authors searched the Medline, Embase, LILACS and Cochrane databases from their inception to June 2011. Observational studies meeting the following criteria were included: (1) prespecified RA criteria; (2) predefined CVD criteria for incident CVD (MI, CVA or CHF); (3) a comparison group; and (4) RR estimates, 95% CI or data for calculating them. The authors calculated the pooled RR using the random-effects model and tested for heterogeneity using the bootstrap version of the Q statistic.|Fourteen studies comprising 41 490 patients met the inclusion criteria. Overall, there was a 48% increased risk of incident CVD in patients with RA

Benefits and risks of using erythropoiesis-stimulating agents (ESAs) in lung cancer patients: study-level and patient-level meta-analyses.

pubmed.gov - 6/1/12

In anemic patients receiving myelosuppressive chemotherapy, erythropoiesis-stimulating agents (ESAs) raise hemoglobin levels and reduce transfusion requirements, but ESA-related safety concerns exist. To evaluate ESA benefits and risks in lung cancer, we conducted meta-analyses of data from controlled ESA trials conducted in lung cancer patients. Study-level analyses included controlled ESA trials reporting lung cancer mortality, identified from the 2006 Cochrane ESA report and from a systematic search for studies published through December 2010. Patient-level analyses included data from lung cancer patients receiving chemotherapy in Amgen studies evaluating darbepoetin alfa (DA) vs placebo. Study-level and patient-level analyses examined deaths, progression, and transfusion incidence. Patient-level analyses also examined adverse events (AEs) and fatigue. In a study-level meta-analysis of nine ESA studies of 2342 patients receiving chemotherapy, the ESA odds ratio (OR) was 0.87 (95%

Cerebrovascular hemodynamics in Alzheimer's disease and vascular dementia: a meta-analysis of transcranial Doppler studies.

pubmed.gov - 4/2/12

Alteration in cerebrovascular hemodynamics has reported in both ageing and dementia. However, it is still unclear whether this alteration follows similar pattern in ageing and in different dementia pathologies. The aim of this meta-analysis was to investigate changes in cerebral blood flow velocity and pulsatility index in two most common forms of dementia; Alzheimer's disease and vascular dementia, using transcranial Doppler studies.|A literature search was conducted in Pubmed, EMBASE and Web of Science. After initial screening of 304 articles and removing duplicates, a total of 53 articles, published between 1980 and 2010, were reviewed. Finally 12 articles were included in the meta-analysis. For each study, effect sizes (ES) indicating the standardized mean differences of the hemodynamic measures between two groups were calculated. Using random effect models, pooled estimates of ES were measured.|Patients with Alzheimer's disease (ES=-1.09, 95% CI -1.77 to -0.44, p=0.004) and

Association between periodontal disease and stroke.

pubmed.gov - 4/2/12

Periodontitis is a very common human infection. There is evidence that periodontitis is associated with cerebrovascular disease (CVD) and stroke. The aim of this study is to examine the relationship between periodontal disease and CVD in observational studies.|An electronic search of the English literature using PubMed was conducted. A meta-analysis of the studies reporting on the risk of stroke in patients with periodontitis was performed.|Six prospective and seven retrospective studies met the inclusion criteria. Patients with both hemorrhagic and ischemic cerebrovascular events, fatal and nonfatal, were included. Definition of periodontitis was taken directly from included studies. Most studies have been adjusted for common cardiovascular risk factors. Separate statistical analysis was performed for prospective and retrospective studies. Overall adjusted risk of stroke in subjects with periodontitis was 1.47 times higher than in subjects without (95% confidence interval,

MEDLINE

Impaired cerebral haemodynamic function associated with chronic traumatic brain injury in professional boxers.

pubmed.gov - 1/31/13

The present study examined to what extent professional boxing compromises cerebral haemodynamic function and its association with CTBI (chronic traumatic brain injury). A total of 12 male professional boxers were compared with 12 age-, gender- and physical fitness-matched non-boxing controls. We assessed dCA (dynamic cerebral autoregulation; thigh-cuff technique and transfer function analysis), CVRCO (cerebrovascular reactivity to changes in CO: 5% CO and controlled hyperventilation), orthostatic tolerance (supine to standing) and neurocognitive function (psychometric tests). Blood flow velocity in the middle cerebral artery (transcranial Doppler ultrasound), mean arterial blood pressure (finger photoplethysmography), end-tidal CO (capnography) and cortical oxyhaemoglobin concentration (near-IR spectroscopy) were continuously measured. Boxers were characterized by fronto-temporal neurocognitive dysfunction and impaired dCA as indicated by a lower rate of regulation and

Physical activity and risk of cerebrovascular disease in the European Prospective Investigation into Cancer and Nutrition-Spain study.

pubmed.gov - 12/31/12

Large-scale prospective epidemiological data testing the association between physical activity (PA) and cerebrovascular diseases (CVDs) are scarce, particularly in Europe. The objective was to assess the risk of CVD according to PA levels in adults.|We included a total of 13 576 men and 19 416 women aged 29 to 69 years and participating in the European Prospective Investigation into Cancer and Nutrition cohort in Spain, recruited between 1992 and 1996 and followed-up until 2006 to ascertain incident CVD events. The validated European Prospective Investigation into Cancer and Nutrition PA questionnaire was used to assess metabolic equivalent hours per week dedicated to different types of PA. Hazard ratios of CVD by PA levels were estimated using multivariate Cox regression. Extensive baseline data collected on diet, lifestyle habits, medical history, and anthropometry were available to adjust for.|A total of 210 transient ischemic attacks and 442 stroke cases (80% ischemic, 10%

Skin autofluorescence as a measure of advanced glycation end products deposition is elevated in peripheral artery disease.

pubmed.gov - 12/31/12

Evidence for an important role of advanced glycation end products (AGEs) in the development of atherosclerosis and cardiovascular disease beyond diabetes mellitus and renal disease is growing. Skin autofluorescence (SAF) is a validated noninvasive measure of tissue AGEs. We hypothesized that SAF is elevated in peripheral artery disease (PAD).|A case-control study was performed in 492 patients with PAD and 164 controls, matched for age (mean 66 10 years) and presence of diabetes mellitus. Cardiovascular risk factors and comorbidity (coronary artery disease, cerebrovascular disease, abdominal aortic aneurysm) were assessed. SAF was measured with the AGE Reader. SAF was higher in patients compared with controls: geometric mean 2.77 (95% confidence interval [CI], 2.71-2.83) versus 2.44 (95% CI, 2.35-2.53) arbitrary units, P=0.410(-8). In logistic regression, the adjusted odds ratio for the presence of PAD was 2.47 (95% CI, 1.66-3.69) per 1 unit increase of SAF. PAD patients with

Immunologic privilege in the central nervous system and the blood-brain barrier.

pubmed.gov - 12/31/12

The brain is in many ways an immunologically and pharmacologically privileged site. The blood-brain barrier (BBB) of the cerebrovascular endothelium and its participation in the complex structure of the neurovascular unit (NVU) restrict access of immune cells and immune mediators to the central nervous system (CNS). In pathologic conditions, very well-organized immunologic responses can develop within the CNS, raising important questions about the real nature and the intrinsic and extrinsic regulation of this immune privilege. We assess the interactions of immune cells and immune mediators with the BBB and NVU in neurologic disease, cerebrovascular disease, and intracerebral tumors. The goals of this review are to outline key scientific advances and the status of the science central to both the neuroinflammation and CNS barriers fields, and highlight the opportunities and priorities in advancing brain barriers research in the context of the larger immunology and neuroscience

Transcranial Doppler ultrasonography in sickle cell disease: a study in Omani patients.

pubmed.gov - 12/31/12

Changes on Transcranial Doppler (TCD) ultrasonography have been proposed as significant predictors of cerebrovascular complications in sickle cell disease (SCD). However, consensus with regards to the TCD criteria to recognize abnormalities in cerebral vasculature is lacking. We studied the TCD characteristics of cerebral arteries among Omani patients with SCD and correlated them with cerebrovascular events. TCD was performed through the temporal and suboccipital windows using a 2 MHz probe (DWL). Thirty-three of 59 patients (56%) with SCD had neurological symptoms including stroke--12 (20%) and epilepsy--7. Fifteen patients (25%) had significant TCD abnormalities including: markedly increased velocities--11 (3 with stroke); turbulent flow--2; and reversal of flow--2. No patient had a time averaged maximum mean velocity of >200 cm/s in anterior circulation. On applying a modified definition of "abnormal TCD" to anterior and posterior circulation studies, increased TCD velocities in

PRACTICE GUIDELINES

National Guideline Clearinghouse | Use of imaging in cerebrovascular disease.

www.guidelines.gov -

Use of imaging in cerebrovascular disease.

National Guideline Clearinghouse | ACR Appropriateness Criteria cerebrovascular disease.

www.guidelines.gov -

ACR Appropriateness Criteria cerebrovascular disease.

Microsoft Word

www.acr.org -

Date of origin: 1996 Last review date: 2011 ACR Appropriateness Criteria 1 Cerebrovascular Disease American College of Radiology ACR Appropriateness Criteria Clinical Condition: Cerebrovascular Disease Variant 1: Asymptomatic. ... .