Spontaneous Cerebellar Hemorrhage/Infarct in 34-Year-Old Female Freeland LeClair, Bethany; Rasmussen, Sarah; Kemp, Walter L
The American journal of forensic medicine and pathology,
2022-Mar-01, 2022-3-00, 20220301, Letnik:
43, Številka:
1
Journal Article
Highlights • Treatment of persistent central sleep apnea post ischemic stroke is evaluated. • Adaptive servo ventilation suppresses central sleep apnea post ischemic stroke. • Adaptive servo ...ventilation improves ESS in these patients. • Adherence to therapy of these patients is good.
The effects of thrombin, a blood coagulation serine protease, were studied in rat hippocampal slices, in an attempt to comprehend its devastating effects when released into the brain after stroke and ...head trauma. Thrombin acting through its receptor, protease-activated receptor 1 (PAR1), produced a long-lasting enhancement of the reactivity of CA1 neurons to afferent stimulation, an effect that saturated the ability of the tissue to undergo tetanus-induced long-term potentiation. This effect was mediated by activation of a PAR1 receptor, because it was shared by a PAR1 agonist, and was blocked by its selective antagonist. An independent effect of thrombin involved the lowering of the threshold for generating epileptic seizures in CA3 region of the hippocampus. Thus, the experiments in a slice mimicked epileptic and cognitive dysfunction induced by thrombin in the brain, and suggest that these effects are mediated by activation of the PAR1 receptor.
Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine.
Our goal was to present our ...experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO.
Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure.
During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001).
Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms.
Background: Remarkable advancements in the understanding of etiological risk factors and pathophysiology of cerebrovascular diseases have led to the refining of definitions and terminologies in ...stroke medicine periodically. We aim to analyze the utility and meaning of different eponyms in the stroke medicine literature during the last 20 years.
Materials and Methods: A systematic search was performed in Google Scholar for the words "stroke," "TIA," "cerebrovascular accident (CVA)," "cerebrovascular insult," "cerebrovascular event," "cerebral ischemia," and "cerebrovascular disease." Each of the words were searched yearwise from 1996 to 2015, and the numbers of articles using these words were collected and analyzed.
Results: " Stroke" has been the most common terminology used in literature, which showed a progressive increase in its usage until 2010, after which its use drastically reduced. "Cerebrovascular events" and "cerebral ischemia" are the second most commonly used terminologies with variable definitions; there was a steep increase in the use of these words until 2012.
Conclusions: The most imprecise term that continues to be used is "CVA". The precisely defined entity like "cerebrovascular disease," which is a group of diseases, continues to be used inappropriately. All the terms are not defined uniformly across the globe, whereas most continue to use the World Health Organisation definition of stroke, defined in the 1970s. It is essential to condemn the use of imprecise terminologies and promote the use of recently defined precise terms "stroke" and "transient ischemic attack (TIA)". Unless the same terms with precise definitions are used in clinical practice or literature, the progress of stroke medicine will continue to be hampered.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Summary
Obsessive–compulsive disorder (OCD) is characterized by repetitive, persistent and unwanted thoughts and ritualistic, repetitive behaviors. The pathophysiology of OCD involves many distinct ...cortical and subcortical regions and it has been reported that OCD may occur as a consequence of traumatic brain injury, infections and tumors as well as cerebrovascular insult such as cerebral venous sinus thrombosis (CVST). We here describe the case of a 36-year-old woman who developed OCD at the age of 13 with almost complete remission of the symptoms after a 1 year-long treatment. Interestingly, after suffering CVST at the superior sagittal sinus at the age of 33, she experienced a relapse of OCD. The patient was successfully treated with Sertraline and Clomipramine. Previous studies revealed cases of OCD following different cerebrovascular accidents, i.e. predominantly arterial stroke. However, the present case is the first to describe OCD after venous thrombosis. Based on our clinical experience, the most effective treatment of OCD after CVST represents the combination of the selective serotonin reuptake inhibitor Sertraline and the tricyclic antidepressant Clomipramine.
Background The angiotensin II type 2 receptor ( AT2R ) −1332 A/G polymorphism has been denoted as functional and associated with certain cardiovascular disease phenotypes. However, there are no ...studies considering the association of this gene polymorphism with carotid atherosclerosis (CA) and cerebrovascular events. Therefore, the aim of our study was to investigate a possible association of the AT2R −1332 A/G polymorphism with the occurrence of carotid plaques (CPs) and history of cerebrovascular insult (CVI) in advanced CA. Methods The study group included 381 controls and 509 patients with CA consecutively admitted for endarterectomy. Genotyping was determined by polymerase chain reaction–restriction fragment length polymorphism method. The association was analyzed separately for males and females because the AT2R gene is located on the X chromosome. Results The AT2R −1332 GG genotype was associated with the advanced CA in the female study group (recessive model of inheritance, AA+AG versus GG; adjusted odds ratio OR = 2.25; 95% confidence interval CI 1.17-4.33; P = .01). In the male subgroup of patients with CA, the significant overrepresentation of G/− hemizygote was detected in patients with CVI compared to male patients without this event (crude OR = 2.05, 95% CI 1.20-3.50, P = .008). Conclusions This study suggests a gender-specific association between the AT2R −1332 A/G polymorphism and the occurrence of CP and the history of CVI in advanced CA, but further replication studies are needed.
Cerebrovascular insult (CVI) is one of leading causes of mortality and morbidity worldwide, with significant influence of lifestyle on its development.The aim of this study was to investigate the ...different risk factors and their impact on hyperlipidaemia in two ethnic groups of patients who were hospitalized after CVI during two years.The total of 230 patients, 35-65 years old, with the ischemic CVI who had been hospitalized and treated at the Clinical Center Priština were included in our study. The patients were divided into two groups: group A (n=130)- Muslim patients, and group S (n=100) – Orthodox patients. Their antropometric and serum lipid parameters were measured and nutritional habits were assessed by food frequency questionnaire (FFQ).The patients from both groups were classified as adipose, with BMI in males around 33, and in females 28-30. Percentage of body fat was also high in both groups, especially in women (p<0.001), without significant difference between groups A and S. Physical activity was very low in both studied groups. In the group A, 86.92% patients with CVI were physically inactive, while in the group S the percentage amounted to 92% (p<0.001). The number of smokers was rather high in both groups, particularly in group S (89%) and more than a half (53%) of examinees had been smoking for more than 10 years. Almost all smokers consumed more than 20 cigarettes per day (83%). In group A, there were 35% of non-smokers (p<0.001).The average diastolic blood pressure value in the groups A and S (Table 6,7) was 97.97±4.75 mmHg and 100.82±6.71 mmHg, respectively, while systolic pressure was 174.27±3.18 mmHg in group A and 183.73±11.39 mmHg in group S. In spite of different lifestyles in both groups, the studied risk factors were proved to have significant influence on the onset of hyperlipidemia. The S group patients whose diet was predominantly based on animal fats had significantly higher risk in comparison to the group whose diet was based on vegetable fats. Smoking habits and physical inactivity were widely present in both groups. Our results suggest the need for target nutrition messages and behavioral interventions in developing prevention strategies for reduction of cerebrovascular risk factors.
Introduction: Cerebrovascular insult (CVI) is acute or sub-acute occurrence of symptoms which signal death of cerebral cells caused by localized disruption of arterial circulation in the brain. The ...goal of this study is to
investigate whether ischemic or hemorrhagic CVI can be used as predictor of rehabilitation.
Methods: A retrospective study was conducted in the period from January 2009 to the December 2009 and as a source of data we used medical records. The study included 89 patients who had CVI and who were
hospitalized at the Clinic for Physical medicine and rehabilitation, Clinical Center University of Sarajevo (CCUS). We analyzed socio-demographic variables such as gender and age and clinical variables: the diagnosis,
the length of stay in hospital (LOH), and Barthel index (BI) at admission and discharge from hospital.
Results: Out of 89 patients, 78/89 (87.6%) were patients with ischemic CVI (group A), and 11/89 (12.4%) with hemorrhagic CVI (group B). There was not a signifi cant association between the gender and type of CVI
(χ2(1)= .041, P> .05. There was a statistically signifi cant difference in median of length of hospitalization (LOH) between two groups (U=186.5; z=-3,025; P= .002). There was not a statistically signifi cant difference
in median of BI at admission (U=317.0; z=-1,399; P= .162) and discharge (U=319.0; z=-1.374; P= .169) between two groups.
Conclusion: Patients with hemorrhagic CVI have a longer stay in hospital and consequently more expensive cost of treatment.
Zusammenfassung
Hintergrund
Die Migräne ist eine komplexe, invalidisierende Erkrankung, die überwiegend Frauen im reproduktiven Alter betrifft. Ziel bei betroffenen Frauen muss es sein, eine ...Verhütungsmethode zu finden, die weder mit einem erhöhten Insultrisiko assoziiert ist noch den Migräneverlauf negativ beeinflusst. Um dies zu erreichen, ist eine sorgfältige Anamnese zum Ausschluss weiterer kardiovaskulärer Risiken erforderlich.
Kontrazeption mit Gestagenen
Unter den hormonellen Methoden stehen die Gestagenmethoden an erster Stelle. Sie erhöhen das Risiko für einen Insult nicht. Für Desogestrel 75 μg gibt es zudem immer mehr Hinweise, dass es den Verlauf hormonabhängiger und -unabhängiger Migränen bei der Mehrzahl der Frauen positiv beeinflussen kann.
Weitere Verfahren
Kombinierte hormonelle Kontrazeptiva (KHK) sollten nur ausnahmsweise verordnet werden. Die Migräne mit Aura ist eine absolute Kontraindikation. Kupferfreisetzende Intrauterinpessare beeinflussen den Verlauf der Migräne nicht. Hormonentzugsmigränen unter KHK kann man mit dem Langzyklus positiv beeinflussen. Es bleibt aber unklar, was dies für das individuelle Risiko eines zerebralen Insults bedeutet. Daher sind Gestagene vorzuziehen.
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