Journal articles on the topic 'Cerebrovascular disease – Patients – Care'
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Passavanti, MB, MA Tedesco, F. Massimo, G. Ratti, G. Di Salvo, F. Argenzio, G. Limongelli, C. Aurilio, and M. Chiefari. "Electrocardiographic abnormalities in patients with cerebrovascular disease." Critical Care 2, Suppl 1 (1998): P060. http://dx.doi.org/10.1186/cc190.
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Han, Dae Hee. "ICU care of Patients with Cerebrovascular disease in SNUH." Nosotchu 22, no. 4 (2000): 564. http://dx.doi.org/10.3995/jstroke.22.564.
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Chang, Chia-Ming, Tzu-Yuan Stessa Chao, Yi-Ting Huang, Yi-Fang Tu, Tzu-Ching Sung, Jung-Der Wang, and Hsin-I. Shih. "Maintaining Quality of Care among Dialysis Patients in Affected Areas after Typhoon Morakot." International Journal of Environmental Research and Public Health 18, no. 14 (July 11, 2021): 7400. http://dx.doi.org/10.3390/ijerph18147400.
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Natural disasters have negative health impacts on patients who need dialysis in affected areas. Severely affected areas are usually rural, with limited basic infrastructure and a population without optimal dialysis-specific care after a disaster. A population-based longitudinal case–cohort study enrolled 715,244 adults from the National Health Insurance Registry who lived in areas affected by a major natural disaster, Typhoon Morakot, in 2009. The observation period was from 2008 to 2011. A total of 13,268 patients (1.85%) had a history of end-stage renal disease (ESRD). Of the ESRD patients, 1264 patients (9.5%) received regular dialysis. Only eight patients missed dialysis sessions in the first month after the disaster. Compared to the moderately affected areas, the incidences of acute cerebrovascular and cardiovascular diseases were higher in patients in severely affected areas. Male dialysis patients aged 45–75 years had a higher mortality rate than that of the general population. Among the affected adults receiving regular dialysis, patients with diabetes (adjusted hazard ratio (aHR): 1.58, 95% confidence interval (CI): 1.20–2.08) or a history of cerebrovascular disease (aHR: 1.58, 95% CI: 1.12–2.21), chronic obstructive pulmonary disease (COPD) or asthma (aHR: 1.99, 95% CI: 1.24–3.17) in moderately affected areas had significantly elevated mortality rates. Additionally, among dialysis patients living in severely affected areas, those with a history of cerebrovascular disease (aHR: 4.52 95% CI: 2.28–8.79) had an elevated mortality rate. Early evacuation plans and high-quality, accessible care for cardiovascular and cerebrovascular diseases are essential to support affected populations before and after disasters to improve dialysis patients’ health outcomes.
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Siegler, James E., Savanna Dasgupta, Mohamad Abdalkader, Mary Penckofer, Shadi Yaghi, and Thanh N. Nguyen. "Cerebrovascular Disease in COVID-19." Viruses 15, no. 7 (July 21, 2023): 1598. http://dx.doi.org/10.3390/v15071598.
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Not in the history of transmissible illnesses has there been an infection as strongly associated with acute cerebrovascular disease as the novel human coronavirus SARS-CoV-2. While the risk of stroke has known associations with other viral infections, such as influenza and human immunodeficiency virus, the risk of ischemic and hemorrhagic stroke related to SARS-CoV-2 is unprecedented. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has so profoundly impacted psychosocial behaviors and modern medical care that we have witnessed shifts in epidemiology and have adapted our treatment practices to reduce transmission, address delayed diagnoses, and mitigate gaps in healthcare. In this narrative review, we summarize the history and impact of the COVID-19 pandemic on cerebrovascular disease, and lessons learned regarding the management of patients as we endure this period of human history.
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Hauer, Eva-Maria, David Stark, Dimitre Staykov, Tobias Steigleder, Stefan Schwab, and Juergen Bardutzky. "Early continuous hypertonic saline infusion in patients with severe cerebrovascular disease." Critical Care Medicine 39, no. 7 (July 2011): 1766–72. http://dx.doi.org/10.1097/ccm.0b013e318218a390.
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Fernandes, Darci Ramos, Edenilde Alves dos Santos, Rosilda Silva Dias, Silvia Raimunda Costa Leite, Dayse Eveline Santos Sousa, and Jedaías Silas da Silva. "CARACTERIZAÇÃO DE PACIENTES COM DOENÇA CEREBROVASCULAR: uma avaliação retrospectiva." Cadernos de Pesquisa 20, no. 1 (March 8, 2013): 50. http://dx.doi.org/10.18764/2178-2229.v20.n1.p.50-57.
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O presente estudo teve como objetivo descrever características demográficas e clínicas dos pacientes com doença cerebrovascular e caracterizar os fatores de risco para o desenvolvimento da doença. Trata-se de estudo descritivo , observacional e retrospectivo que fez uma revisão de todos os prontuários médicos dos pacientes com doença cerebrovascular que estiveram internados em um Hospital Universitário em São Luís-Maran hão no período de 1992 a 2010, totalizando 346 pacientes. Os resultados evidenciaram que a maioria dos pacientes com DCV são homens, na faixa etária de 51 a 80 anos. Os principais fatores de risco para o desenvolvimento das DVC são hipertensão arterial, dislipidemias, diabetes, tabagismo e etilismo, independentemente do sexo e faixa etária. Os dados descritos neste estudo serão importantes para despertar um maior interesse para as doenças cerebrovasculares na cidade de São Luís e auxiliar outros pesquisadores desta instituição no planejamento de condutas, implantação de melhorias nos atendimentos e criação de programas e estrat égias de preven ção mais específica. A elabora ção de um protocolo de intervenção clínica para atendimento de pacientes acometidos por doença cerebrovascular foi a contribuição para a equipe.Palavras-chave: Doença cerebrovascular. Prontuários. Fatores de risco.CHARACTERIZATION OF PATIENTS WITH CEREBROVASCULAR DISEASE: a retrospective reviewAbstract: This study aimed to describe demograp hic and clinical characteristics of patients with cerebrovascular disease and characteri ze the risk factors for developing the disease. It is a descriptive , observational and retrospective study that did a review of all medical records of patients with cerebrovascular disease who were admitted to a universit y hospital in São Luís, Maran hão from 1992 to 2010, totaling 346 patients. The results showed that most patients with CVD are men, aged 51-80 years, the main risk factors for the development of CVD were hypertension, dyslipidemia, diabetes, smoking, and alcoholism regardless of gender and age. The data described in this study will be important to awaken a greater interest for cerebrovascular disease in the city of São Luís-MA, and help other researchers at this institution conducts planning, implementing improvements in the care and creation of programs and prevention strategies more specific. The development of a protocol for clinical intervention for treating patients suffering from cerebrovascular disease was the contribution to the team.Keywords: Cerebrovascular disease. Medical Records. Risk factorsCARACTERIZACIÓN DE LOS PACIENTES CON ENFERMEDAD CEREBROVASCULAR: una evaluación retrospectiva Resumen: Este estudio tuvo como objetivo describir las características demográficas y clínicas de los pacientes con enfermedad cerebrovascular y caracteri zar los factores de riesgo para desarrollar la enfermedad. Se trata de un estudio descriptivo , observacional y retrospectivo producto de una revisión de los registros médicos de los pacientes con enfermedad cerebrovascular ingresados en un hospital universitario de São Luís, Maran hão desde 1992 hasta 2010, un total de 346 pacientes. Los resultados mostraron que la mayoría de los pacientes con ECV son hombres, con edades entre 51-80 años. Los principales factores de riesgo para el desarrollo de las enfermedades cerebrovasculares son la hipertensión, la dislipidemia , la diabetes, el tabaquismo, independientemente del sexo y edad. Los datos que se describen en este estudio serán importantes para despertar un mayor interés para la enfermedad cerebrovascular en la ciudad de São Luis, y ayudar a otros investigadores de esta institución para llevar a cabo la planificación, la implementación de mejoras en el cuidado y la creación de programas y estrategias de prevenci ón más específicas. El desarrollo de un protocolo de intervenci ón clínica para el tratamiento de pacientes que sufren de enfermedad cerebrovascular fue la contribución para el equipo.Palabras clave: Enfermedad Cerebrovascular. Registros Médicos. Factores de Riesgo.
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YILMAZ, Ayşe, Veysel Garani SOYLU, Ufuk DEMİR, Öztürk TAŞKIN, and Zahide DOĞANAY. "Neurologic symptoms and signs observed in critical COVID-19 patients may be precursors of existing cerebrovascular disease." Journal of Health Sciences and Medicine 5, no. 6 (October 25, 2022): 1644–49. http://dx.doi.org/10.32322/jhsm.1180623.
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Introduction: Although COVID-19 disease often includes respiratory system findings, that affects the gastrointestinal system, circulatory system, coagulation system and neurological system. In this study, we identified the neurological signs and symptoms observed in critical COVID-19 patients.
Material and Method: This retrospective study reviewed 595 COVID-19 patients admitted to our intensive care unit (ICU) between January to June 2020. Patients with neurologic symptoms that were divided into two groups were diagnosed neurological disease (group ND) and non-neurological disease (group non-ND). Clinical signs and symptoms, radiological findings, demographic data (age, gender, presence of comorbidities), white blood cell (WBC), lymphocyte, platelet, lactic acid, glucose, and D-dimer levels, length of hospitalization, requirement of mechanical ventilation, and mortality were recorded for each patient.
Results: Neurologic symptoms were observed in 148 (24.8%) patients. Of these, 44 patients were diagnosed neurological disease and 104 patients were non- neurological disease. The prevalence of neurologic symptoms was significantly higher in group ND. The rate of acute ischemic cerebrovascular disease in 595 critical COVID-19 patients was 6.2%.
Conclusion: Presence of cerebrovascular diseases should be suspected in COVID-19patients with paresis, altered consciousness, numbness, taste/smell disorders, and plegia. The rate of ischemic cerebrovascular disease was approximately seven times higher than the rate of hemorrhagic cerebrovascular disease in critically COVID-19 patients.
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Petersen, Nils H., Kevin N. Sheth, and Ruchira M. Jha. "Precision Medicine in Neurocritical Care for Cerebrovascular Disease Cases." Stroke 54, no. 5 (May 2023): 1392–402. http://dx.doi.org/10.1161/strokeaha.122.036402.
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Scientific advances have informed many aspects of acute stroke care but have also highlighted the complexity and heterogeneity of cerebrovascular diseases. While practice guidelines are essential in supporting the clinical decision-making process, they may not capture the nuances of individual cases. Personalized stroke care in ICU has traditionally relied on integrating clinical examinations, neuroimaging studies, and physiologic monitoring to develop a treatment plan tailored to the individual patient. However, to realize the potential of precision medicine in stroke, we need advances and evidence in several critical areas, including data capture, clinical phenotyping, serum biomarker development, neuromonitoring, and physiology-based treatment targets. Mathematical tools are being developed to analyze the multitude of data and provide clinicians with real-time information and personalized treatment targets for the critical care management of patients with cerebrovascular diseases. This review summarizes research advances in these areas and outlines principles for translating precision medicine into clinical practice.
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Drigant, M. "Relevance of restorativ treatment and rehabilitation of patients with cerebrovascular disease." Likarska sprava, no. 7 (November 19, 2012): 74–75. http://dx.doi.org/10.31640/ls-2012-7-04.
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Reducing treatment and rehabilitation of patients with cerebrovascular disease (TSVB) for many years has been one of the priorities of the national health care, which is largely due to a significant increase in the incidence and severity of medical, economic and social consequences of the disease for patients and their relatives, and for society as a whole. The objectives of rehabilitation include: restoring consumer opportunities patient, ie, mobility, self-care and the implementation of simple homework, rehabilitation, ie lost disability skills through the use and development of the skeletal system functionality, preventing the development of pathological processes that lead to temporary or permanent disability, that is, implementation of secondary prevention.
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Prasolov, N. V., E. M. Shulutko, A. E. Vasiliev, and D. G. Gitelson. "The role of sugammadex in endovascular interventions on cerebral vessels." Complex Issues of Cardiovascular Diseases 11, no. 3 (October 12, 2022): 134–42. http://dx.doi.org/10.17802/2306-1278-2022-11-3-134-142.
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Highlights. The article discusses the features of general anesthesia in patients with cerebrovascular diseases using the relaxant binding agent sugammadex.Aim. To evaluate the effectiveness of sugammadex in endovascular management of cerebrovascular diseases.Methods. The study included 57 patients who underwent endovascular treatment of cerebrovascular disease under general anesthesia. The experimental group included 29 patients who were injected with sugammadex - a selective relaxant binding agent for reversal of neuromuscular block induced by rocuronium. The comparison group included 28 patients who did not undergo decurarization (n = 13), or it was performed with neostigmine (n = 15). Acceleromyography was used to monitor the state of neuromuscular function.Result. Onset of action and duration of action of rocuronium at a dose of 0.9 mg/kg did not differ between the groups. The neuromuscular recovery time was 2.14 [1.67; 2.59] minutes after administration of sugammadex, compared with spontaneous 35.8 [31.5; 40.4] minutes and neostigmine-induced 22.1 [16.8; 27.3] minutes (p<0.001). No adverse or allergic reactions were noted after administration of the relaxant binding agent.Conclusion. Using a specific antidote sugammadex to eliminate the effect of rocuronium helps to restore neuromuscular function within 2–3 minutes and assess the neurological status of patients immediately after the endovascular treatment of cerebrovascular disease.
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Kaul, Tej K., Barry L. Fields, David A. Wyatt, Christopher R. Jones, and Donald R. Kahn. "Surgical Management in Patients With Coexistent Coronary and Cerebrovascular Disease." Chest 106, no. 5 (November 1994): 1349–57. http://dx.doi.org/10.1378/chest.106.5.1349.
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Kamenova, S. U., A. M. Kondybayeva, O. A. Ostapenko, and E. Belaya. "THE ORGANIZATION OF CARE FOR PATIENTS WITH STROKE." National Journal of Neurology 2, no. 04 (November 30, 2013): 71–76. http://dx.doi.org/10.61788/njn.v2i13.12.
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The analysis of the problem of the vascular diseases of the brain needs the estimation of the organization of help to sick people in early stages. The medical correction of the earliest vascular syndromes can be very effective and capable for the reducing of the cerebrovascular accidents, that’s why we must have well-timed diagnostics and to render the skilled help. In this article were presented epidemiological dates of the cerebrovascular accident in Almaty and Atirau region.
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Kietaibl, Clemens, Klaus Markstaller, and Klaus U. Klein. "Perioperative Evaluation and Care of Patients With Mild to Moderate Cerebrovascular Disease." Journal of Neurosurgical Anesthesiology 29, no. 2 (April 2017): 189–90. http://dx.doi.org/10.1097/ana.0000000000000279.
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Sato, Nobuhiro, Reo Takaku, Hidenori Higashi, Alan Kawarai Lefor, and Takashi Shiga. "Factors associated with difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases: A nationwide population-based observational study." PLOS ONE 16, no. 1 (January 12, 2021): e0245318. http://dx.doi.org/10.1371/journal.pone.0245318.
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Although it is essential to shorten the interval to initial treatment in the care of acute ischemic stroke, some hospitals in Japan reject requests for hospital acceptance from on-scene emergency medical service personnel because of limited resources, which can cause delays in care. We aimed to assess the risk factors for difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases. We conducted a retrospective analysis of the national ambulance records of the Fire and Disaster Management Agency in Japan in 2016. Multivariable logistic regression analysis was used to assess the association between difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases and prehospital factors. During the study period, a total of 222,926 patients were included, and 5283 patients (2.4%) experienced difficulties in hospital acceptance. In multivariable analysis, nights (adjusted odds ratio [AOR] 1.54, 95% confidence interval [CI] 1.45–1.64), weekends (AOR 1.32, 95% CI 1.24–1.40), <25 percentile ratio of emergency physicians and neurosurgeons to all physicians (AOR 1.13, 95% CI 1.03–1.23) (AOR 1.36, 95% CI 1.25–1.48), and mean age of physicians (AOR 1.06, 95% CI 1.05–1.07) were significantly associated with difficulties of hospital acceptance of patients suspected to have cerebrovascular disease. There was a marked regional variation in the difficulties of hospital acceptance. Among the national ambulance records of patients suspected to have cerebrovascular diseases, certain prehospital factors such as weekends were positively associated with difficulty of hospital acceptance. A comprehensive strategy for hospital acceptance of patients with cerebrovascular diseases considering regional variation is required.
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Quarenta, J., M. Gonçalves-Pinho, A. Freitas, and S. Nascimento Ferreira. "Stroke care in people with and without schizophrenia: a retrospective, observational study." European Psychiatry 65, S1 (June 2022): S290. http://dx.doi.org/10.1192/j.eurpsy.2022.740.
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Introduction Serious mental illness tends to course with a higher prevalence of comorbidities and schizophrenia is a disabling disease that affects approximately 1% of the world population. Worldwide, cerebrovascular accidents are an important cause of mortality and disability and in Portugal they are one of the leading causes of death in the general population. There is growing evidence that the prevalence of strokes is higher in people with schizophrenia, with pronounced age and gender variations. Objectives To describe the sociodemographic and clinical differences among patients hospitalized with a primary diagnosis of cerebrovascular disease with and without a secondary diagnosis of schizophrenia in Portugal. Methods We performed a retrospective observational study using a natiowide hopitalization database containing all hosptalizations registered in Portuguese hosptals from 2008 to 2015. Based on the International Classification of diseases version 9, clinical modification, hospitalizations with a primary diagnosis of stroke were selected (431;433;434), and from those, the ones with a secundary diagnosis of schizophrenia (295.xx) were isolated for a sociodemographic and clinical comparative study. Comorbidities were analysed using the Chalson index score. Results Episodes associated with a secondary diagnosis of schizophrenia were younger (mean: 66 vs 73.7 years; p<0.001) and had longer median LoS (10.0 vs 8.0 days; p<0.001). In-hospital mortality was lower in patients with schizophrenia (11.7% vs 13.2%). Conclusions The understanding of the association of cerebrovascular accidents with schizophrenia is complex. Although some studies show conflicting evidence, more attention should be given to the investigation of the incidence, prevalence and impact of cerebrovascular diseases within this particular population. Disclosure No significant relationships.
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Zamora, Jose Luis Cabrera. "Prevalence of Peripheral Arterial Disease in a Primary Health Care Area Cerro Municipality." Open Access Journal of Cardiology 8, no. 1 (2024): 1–5. http://dx.doi.org/10.23880/oajc-16000196.
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Summary: Cardiovascular diseases are the most important cause of death in subjects over 50 years of age in developed countries. Arterial pathology as a whole, whether presented as coronary, cerebrovascular, or peripheral arterial disease, is an important cause of chronic disease, functional limitation and decreased quality of life and is associated with greater general and specific morbidity. Objectives: Estimate the prevalence of peripheral arterial disease in its initial stages and the associated classic risk factors in a population from the primary health care area of the Cerro Municipality. Material and Methods: Population-based, prospective, longitudinal and cross-sectional, the study population included all subjects over 55 years of age, belonging to the Cerro Polyclinic who attended Angiology and Vascular Surgery consultation, in the period from 2012 to 2013. Of the 962 subjects treated, 707 were over 55 years old and of these, 94 met the inclusion criteria for the study. All of them knew the epidemiological purpose of the study and gave their consent. Results: 94 patients over 55 years of age participated in the study, with a prevalence at the time of inclusion of 13% diagnosed with PAD in its initial Fontaine stages. Conclusions: The prevalence of PAD, in its initial stages, was 13%, with 73.4% being asymptomatic and 27.6% symptomatic, the main risk factor being smoking with 57.5%, followed by Hypercholesterolemia and arterial hypertension, the association was confirmed with its location in other vascular beds, 14.9% in patients who had previously presented coronary events, 8.5% cerebrovascular events.
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Alves, Vinícius de Padua Vieira, Ananda Altoé, Vanessa Veloso, Clecia Lucia Santos Ferreira, Nina Ventura, and Diogo Goulart Corrêa. "Computed tomography features of cerebrovascular complications in intensive care unit patients with severe COVID-19." Radiologia Brasileira 54, no. 5 (October 2021): 283–88. http://dx.doi.org/10.1590/0100-3984.2021.0023.
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Abstract Objective: To report the computed tomography (CT) features of acute cerebrovascular complications in severely ill patients with confirmed coronavirus disease 2019 (COVID-19) in the intensive care unit. Materials and Methods: We conducted a retrospective analysis of 29 intensive care unit patients with confirmed COVID-19 who underwent CT of the brain. We describe the CT features of the cerebrovascular complications of COVID-19, as well the demographic characteristics and clinical features, together with the results of laboratory tests, such as complete blood cell count, coagulation testing, renal function testing, and C-reactive protein assay. Results: Two patients were excluded because of brain death. Among the remaining 27 patients, CT revealed acute cerebrovascular complications in six (three men and three women; 49-81 years of age), whereas no such complications were seen in 21 (15 men and six women; 36-82 years of age). Conclusion: Radiologists should be aware of the risks of cerebrovascular complications of COVID-19 and the potential underlying etiologies. COVID-19-associated coagulopathy is likely multifactorial and may increase the risk of ischemic and hemorrhagic infarction.
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Shamalov, N. A., L. V. Klimov, M. A. Soldatov, T. V. Kiseleva, V. N. Shamalova, N. A. Marskaya, and O. V. Lyang. "Acute cerebrovascular accidents in patients with new coronavirus infection COVID-19." Neurology, Neuropsychiatry, Psychosomatics 16, no. 1 (February 22, 2024): 82–86. http://dx.doi.org/10.14412/2074-2711-2024-1-82-86.
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The incidence of neurological complications in COVID-19 can reach 8–10% of all cases of new coronavirus infection; acute cerebrovascular accidents (ACA) dominate in their structure, which cause significant social and economic costs due to the high mortality and disability rates in this group of patients. The main pathophysiological mechanism leading to the development of ischemic cerebrovascular accidents (ischemic stroke, transient ischemic attack) is the phenomenon of hypercoagulation, which, together with the systemic inflammatory response to the viral infection, leads to the formation of macro- and microthrombi and the development of ischemic disorders of cerebral circulation. The ischemic stroke associated with COVID-19 is characterized by the onset at a younger age, the predominance of cryptogenic and cardioembolic pathogenetic variants, a more frequent occlusion of large cerebral vessels and thus a more pronounced clinical picture of the disease. The reserves for reducing mortality and disability in patients with cerebrovascular disease, especially stroke, during the spread of COVID-19 lie both in the prevention, treatment and rehabilitation of COVID-19 in patients at high risk of developing cardiovascular diseases and in ensuring specialized medical care for this category of patients.
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Donahue, Manus J., and Megan K. Strother. "Novel Noninvasive Magnetic Resonance Imaging Methods in Cerebrovascular Disease." US Neurology 10, no. 01 (2014): 23. http://dx.doi.org/10.17925/usn.2014.10.01.23.
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Neuroimaging is a critical component of patient care in multiple stages of cerebrovascular disease. Most imaging focuses on measurements of tissue or vascular structure, with comparatively less emphasis on function. Furthermore, imaging approaches that rely on exogenous contrast agents or ionizing radiation are common and provide crucial information regarding treatment decisions; however, they are suboptimal for monitoring patients longitudinally or in response to therapy due to dose restrictions and related health concerns. We review the state of noninvasive magnetic resonance imaging (MRI) approaches that have demonstrated clinical potential in patients with cerebrovascular disease, yet have not been incorporated into routine radiologic protocols at most hospitals. These approaches include blood oxygenation level-dependent (BOLD) for cerebrovascular reactivity, arterial spin labeling (ASL) for cerebral blood flow quantification, chemical exchange saturation transfer (CEST) for macromolecule, and pH determination and arterial vessel wall imaging for plaque visualization. The strengths and limitations of these approaches are presented, as well as a summary of their implementation in stroke.
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Verdelho, Ana, Joanna Wardlaw, Aleksandra Pavlovic, Leonardo Pantoni, Olivier Godefroy, Marco Duering, Andreas Charidimou, Hugues Chabriat, and Geert Jan Biessels. "Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee." European Stroke Journal 6, no. 1 (February 28, 2021): 5–17. http://dx.doi.org/10.1177/23969873211000258.
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Purpose Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. Methods The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. Findings Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options. Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.
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Velek, Premysl, Marije J. Splinter, M. Kamran Ikram, M. Arfan Ikram, Maarten J. G. Leening, Johan van der Lei, Tim olde Hartman, et al. "Changes in the Diagnosis of Stroke and Cardiovascular Conditions in Primary Care During the First 2 COVID-19 Waves in the Netherlands." Neurology 98, no. 6 (December 29, 2021): e564-e572. http://dx.doi.org/10.1212/wnl.0000000000013145.
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Background and ObjectivesAlthough there is evidence of disruption in acute cerebrovascular and cardiovascular care during the coronavirus disease 2019 (COVID-19) pandemic, its downstream effect in primary care is less clear. We investigated how the pandemic affected utilization of cerebrovascular and cardiovascular care in general practices (GPs) and determined changes in GP-recorded diagnoses of selected cerebrovascular and cardiovascular outcomes.MethodsFrom electronic health records of 166,929 primary care patients aged 30 or over within the Rotterdam region, the Netherlands, we extracted the number of consultations related to cerebrovascular and cardiovascular care, and first diagnoses of selected cerebrovascular and cardiovascular risk factors (hypertension, diabetes, lipid disorders), conditions, and events (angina, atrial fibrillation, TIA, myocardial infarction, stroke). We quantified changes in those outcomes during the first COVID-19 wave (March–May 2020) and thereafter (June–December 2020) by comparing them to the same period in 2016–2019. We also estimated the number of potentially missed diagnoses for each outcome.ResultsThe number of GP consultations related to cerebrovascular and cardiovascular care declined by 38% (0.62, 95% confidence interval 0.56–0.68) during the first wave, as compared to expected counts based on prepandemic levels. Substantial declines in the number of new diagnoses were observed for cerebrovascular events: 37% for TIA (0.63, 0.41–0.96) and 29% for stroke (0.71, 0.59–0.84), while no significant changes were observed for cardiovascular events (myocardial infarction [0.91, 0.74–1.14], angina [0.77, 0.48–1.25]). The counts across individual diagnoses recovered following June 2020, but the number of GP consultations related to cerebrovascular and cardiovascular care remained lower than expected throughout the June to December period (0.93, 0.88–0.98).DiscussionWhile new diagnoses of acute cardiovascular events remained stable during the COVID-19 pandemic, diagnoses of cerebrovascular events declined substantially compared to prepandemic levels, possibly due to incorrect perception of risk by patients. These findings emphasize the need to improve symptom recognition of cerebrovascular events among the general public and to encourage urgent presentation despite any physical distancing measures.
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Donahue, Manus J., and Megan K. Strother. "Novel Non-invasive Magnetic Resonance Imaging Methods in Cerebrovascular Disease." European Neurological Review 8, no. 2 (2013): 153. http://dx.doi.org/10.17925/enr.2013.08.02.153.
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Neuroimaging is a critical component of patient care in multiple stages of cerebrovascular disease. Most imaging focuses on measurements of tissue or vascular structure, with comparatively less emphasis on function. Furthermore, imaging approaches that rely on exogenous contrast agents or ionising radiation are common and provide crucial information regarding treatment decisions; however, they are suboptimal for monitoring patients longitudinally or in response to therapy due to dose restrictions and related health concerns. We review the state of non-invasive magnetic resonance imaging (MRI) approaches that have demonstrated clinical potential in patients with cerebrovascular disease, yet have not been incorporated into routine radiological protocols at most hospitals. These approaches include blood oxygenation level-dependent (BOLD) for cerebrovascular reactivity, arterial spin labelling (ASL) for cerebral blood flow quantification, chemical exchange saturation transfer (CEST) for macromolecule and pH determination and arterial vessel wall imaging for plaque visualisation. The strengths and limitations of these approaches are presented, as well as a summary of their implementation in stroke.
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Bonow, Robert H., Christopher C. Young, David I. Bass, Anne Moore, and Michael R. Levitt. "Transcranial Doppler ultrasonography in neurological surgery and neurocritical care." Neurosurgical Focus 47, no. 6 (December 2019): E2. http://dx.doi.org/10.3171/2019.9.focus19611.
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Transcranial Doppler (TCD) ultrasonography is an inexpensive, noninvasive means of measuring blood flow within the arteries of the brain. In this review, the authors outline the technology underlying TCD ultrasonography and describe its uses in patients with neurosurgical diseases. One of the most common uses of TCD ultrasonography is monitoring for vasospasm following subarachnoid hemorrhage. In this setting, elevated blood flow velocities serve as a proxy for vasospasm and can herald the onset of ischemia. TCD ultrasonography is also useful in the evaluation and management of occlusive cerebrovascular disease. Monitoring for microembolic signals enables stratification of stroke risk due to carotid stenosis and can also be used to clarify stroke etiology. TCD ultrasonography can identify patients with exhausted cerebrovascular reserve, and after extracranial-intracranial bypass procedures it can be used to assess adequacy of flow through the graft. Finally, assessment of cerebral autoregulation can be performed using TCD ultrasonography, providing data important to the management of patients with severe traumatic brain injury. As the clinical applications of TCD ultrasonography have expanded over time, so has their importance in the management of neurosurgical patients. Familiarity with this diagnostic tool is crucial for the modern neurological surgeon.
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Donahue, Manus J., and Jeroen Hendrikse. "Improved detection of cerebrovascular disease processes: Introduction to the Journal of Cerebral Blood Flow and Metabolism special issue on cerebrovascular disease." Journal of Cerebral Blood Flow & Metabolism 38, no. 9 (August 30, 2018): 1387–90. http://dx.doi.org/10.1177/0271678x17739802.
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Approximately 15 million individuals suffer a stroke worldwide each year, and stroke results in death or permanent disability in two-thirds of these individuals. Due to increased knowledge and management of modifiable risk factors, stroke incidence in developed countries is declining, however remains high at just under 1 million patients per year in the United States alone. Further improving management of patients with cerebrovascular disease (CVD) ultimately will require development and clinical adoption of sensitive markers of hemodynamic and metabolic failure, as well as trials that evaluate how to interpret these markers to optimize therapies. Realizing this goal and reducing the complete burden of CVD is dependent on an improved understanding of the pathophysiological processes that underlie CVD in all stages, including sub-clinical disease processes, acute stroke, and post-stroke recovery mechanisms. This document serves as an introduction to the Journal of Cerebral Blood Flow and Metabolism special issue on cerebrovascular diseases, which is comprised of contributions from experts in each of the above stages of CVD, and outlines current standards for patient management and emerging directions that have potential for improving patient care over the next decade.
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Singh, Bhagteshwar, Suzannah Lant, Sofia Cividini, Jonathan W. S. Cattrall, Lynsey C. Goodwin, Laura Benjamin, Benedict D. Michael, et al. "Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis." PLOS ONE 17, no. 6 (June 2, 2022): e0263595. http://dx.doi.org/10.1371/journal.pone.0263595.
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Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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Shih, Hsin-I., Tzu-Yuan Chao, Yi-Ting Huang, Yi-Fang Tu, Tzu-Ching Sung, Jung-Der Wang, and Chia-Ming Chang. "Increased Medical Visits and Mortality among Adults with Cardiovascular Diseases in Severely Affected Areas after Typhoon Morakot." International Journal of Environmental Research and Public Health 17, no. 18 (September 8, 2020): 6531. http://dx.doi.org/10.3390/ijerph17186531.
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Natural disasters have negative health impacts on chronic diseases in affected populations. Severely affected areas are usually rural areas with limited basic infrastructure and a population have that has limited access to optimal healthcare after a disaster. Patients with cardiovascular diseases are required to maintain quality care, especially after disasters. A population-based case-control study enrolled adults from the National Health Insurance Registry who had ischemic heart disease and cerebrovascular disease histories and lived in the area affected by Typhoon Morakot in 2009. Monthly medical visits for acute cerebrovascular and ischemic heart diseases markedly increased at approximately 1–2 months after the typhoon. Survival analysis during the two years following the typhoon indicated a significant increase in mortality in adults with an acute ischemic heart disease history who lived in the severely affected area. Mortality hazard analysis showed that among affected adults with previous cerebrovascular diseases and acute ischemic heart diseases, patients with diabetes (adjusted hazard ratio [HR]: 1.3–1.7), Chronic Kidney Disease (CKD) (adjusted HR: 2.0–2.7), chronic obstructive pulmonary diseases (COPD) and asthma (adjusted HR: 1.7–2.1), liver cirrhosis (adjusted HR: 2.3–3.3) and neoplasms (adjusted HR: 1.1–2.1) had significantly increased mortality rates. Consequently, high-quality and accessible primary healthcare plans should be made available to maintain and support affected populations after disasters.
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Osmanov, Esedulla M., Vladimir A. Reshetnikov, Rustam R. Manyakov, Amina S. Garaeva, Lauriia Kh Korkmazova, and Valeriya V. Demenkova. "Comorbid status of patients with hypertension." Terapevticheskii arkhiv 95, no. 1 (February 24, 2023): 11–16. http://dx.doi.org/10.26442/00403660.2023.01.202039.
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Aim. To establish age and gender characteristics, nosological structure of comorbidity among persons 2099 years with hypertension.
Materials and methods. The study is based on data from 21 514 electronic health records of the population (2099 years old) with hypertension, mean age 63.0 years, 68.2% women. Diseases associated with hypertension with a frequency above 10% were analyzed.
Results. In the sample of people with hypertension, concomitant diseases were detected in 82.7% of cases, 1 disease accompanies 21.0% of the sample with hypertension, 2 diseases 17.9%, 3 diseases 14.0%, 4+ diseases 29.8%. The frequency of association of hypertension with 1 concomitant disease at the 2029 years is 60.8% of cases, at 3039 years 65.1%, at 4049 years 73.9%, at 5059 years 81.1%, 6069 years 85.8%, 7079 years 87.3%, 80+ years 86.2% of cases. Among women with hypertension, the average number of concomitant diseases is higher compared to men (3.47 vs 2.4 cases; p0.001). Among young and middle-aged people, hypertension in most cases is associated with osteochondrosis, osteoarthritis, chronic pancreatitis, gastritis and duodenitis, retinal diseases, thyroid diseases, the female with hypertension accompanied by benign breast disease and menopausal disorders. Hypertension in the elderly is most often associated with cerebrovascular disease, coronary heart disease, diabetes mellitus, senile cataract, but osteochondrosis and osteoarthritis also do not lose their relevance.
Conclusion. The existing system of organization of medical care cannot meet the needs of patients with comorbidity, which indicates the need to reorient medical care towards patient-centered care.
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Sileno, Sean, Razvan M. Chirila, and Dana M. Harris. "Use of statins, amiodarone, direct oral anticoagulants and NSAIDs in chronic liver disease: a guide for general clinicians." Romanian Journal of Internal Medicine 58, no. 4 (December 1, 2020): 181–87. http://dx.doi.org/10.2478/rjim-2020-0018.
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AbstractPatients with chronic liver disease have associated comorbidities that require treatment, including cardiovascular disease, arrhythmias, cerebrovascular accidents and pain. These medications may affect the liver disease. Due to the complexity of medical problems in patients with chronic liver disease, treating clinicians benefit from targeted guidance for their care.
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Cheng, Rui Lian, and Mei Xia Yan. "Using the Seldinger Technique Cerebral Angiography (DSA) Line of Intravascular Interventional Treatment for Patients with Care." Applied Mechanics and Materials 651-653 (September 2014): 348–51. http://dx.doi.org/10.4028/www.scientific.net/amm.651-653.348.
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In the event of cerebrovascular disease, simple medical treatment is very difficult to have expected effect. Interventional therapy is a new type of diagnosis and treatment in cerebrovascular technology, with advantage of less trauma, safer, more curative effect, quicker recovery, and easier to accept. Neurology department in the hospital i belonging to had performed the Seldinger technique cerebral angiography (DSA) for 68 patients with intravascular interventional therapy from January 2013 to January 2014. Through the establishment of special preoperative and postoperative nursing dedicative team, implement the system of process type intensive care good results have been achieved.
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Richard, Edo, Roy Kuiper, Marcel G. W. Dijkgraaf, and Willem A. Van Gool. "Vascular Care in Patients with Alzheimer's Disease with Cerebrovascular LesionsâA Randomized Clinical Trial." Journal of the American Geriatrics Society 57, no. 5 (May 2009): 797–805. http://dx.doi.org/10.1111/j.1532-5415.2009.02217.x.
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Yamada, Tomoyuki, Takahiro Tanaka, Yuji Kira, Junichi Sato, Akihito Kosaka, and Akiko Ishihara. "P-275 Safety and Efficacy of Coronary and Cerebrovascular Angiography During Same Procedure in Patients with Cerebrovascular Disease." CVD Prevention and Control 4 (May 2009): S130. http://dx.doi.org/10.1016/s1875-4570(09)60467-8.
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Kim, Yong Kyun, Kil-Byung Lim, Sang Chul Lee, Jin-Woo Park, Hong-Jae Lee, Bum Sun Kwon, and Ho Jun Lee. "Effects of a Rivastigmine Patch on Self-Care Activities in Patients with Alzheimer's Disease plus Cerebrovascular Disease." Dementia and Geriatric Cognitive Disorders Extra 4, no. 3 (October 29, 2014): 395–401. http://dx.doi.org/10.1159/000363622.
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Imaizumi, Takahiro, Masahiro Nakatochi, Yoshiro Fujita, Rie Nomura, Kenshi Watanabe, Michitaka Maekawa, Taishi Yamakawa, Takayuki Katsuno, and Shoichi Maruyama. "The association between intensive care unit-acquired hypernatraemia and mortality in critically ill patients with cerebrovascular diseases: a single-centre cohort study in Japan." BMJ Open 7, no. 8 (August 2017): e016248. http://dx.doi.org/10.1136/bmjopen-2017-016248.
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ObjectivesHypernatraemia is one of the major electrolyte disorders associated with mortality among critically ill patients in intensive care units (ICUs). It is unclear whether this applies to patients with cerebrovascular diseases in whom high sodium concentrations may be allowed in order to prevent cerebral oedema. This study aimed to examine the association between ICU-acquired hypernatraemia and the prognosis of patients with cerebrovascular diseases.DesignA retrospective cohort study.SettingThe incidence of ICU-acquired hypernatraemia was assessed retrospectively in a single tertiary care facility in Japan.ParticipantsAdult patients (≥18 years old) whose length of stay in ICU was >2 days and those whose serum sodium concentrations were 130–149 mEq/L on admission to ICU were included.Outcome measures28-day in-hospital mortality risk was assessed by Cox regression analysis. Hypernatraemia was defined as serum sodium concentration ≥150 mEq/L. Using multivariate analysis, we examined whether ICU-acquired hypernatraemia and the main symptom present at ICU admission were associated with time to death among ICU patients. We also evaluated how the maximum and minimum sodium concentrations during ICU stay were associated with mortality, using restricted cubic splines.ResultsOf 1756 patients, 121 developed ICU-acquired hypernatraemia. Multivariate Cox proportional hazard analysis revealed an association between ICU-acquired hypernatraemia and 28-day mortality (adjusted HR, 3.07 (95% CI 2.12 to 4.44)). The interaction between ICU-acquired hypernatraemia and cerebrovascular disease was significantly associated with 28-day mortality (HR, 3.03 (95% CI 1.29 to 7.15)). The restricted cubic splines analysis of maximum serum sodium concentration in ICU patients determined a threshold maximum of 147 mEq/L. There was no significant association between minimum sodium concentration and mortality.ConclusionsICU-acquired hypernatraemia was associated with an increased mortality rate among critically ill patients with cerebrovascular diseases; the threshold maximum serum sodium concentration associated with mortality was 147 mEq/L.
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Becher, Tobias, Stefan Baumann, Frederik Eder, Simon Perschka, Dirk Loßnitzer, Christian Fastner, Michael Behnes, Christina Doesch, Martin Borggrefe, and Ibrahim Akin. "Comparison of peri and post-procedural complications in patients undergoing revascularisation of coronary artery multivessel disease by coronary artery bypass grafting or protected percutaneous coronary intervention with the Impella 2.5 device." European Heart Journal: Acute Cardiovascular Care 8, no. 4 (June 29, 2017): 360–68. http://dx.doi.org/10.1177/2048872617717687.
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Background: While coronary artery bypass grafting remains the standard treatment of complex multivessel coronary artery disease, the advent of peripheral ventricular assist devices has enhanced the safety of percutaneous coronary intervention. We therefore evaluated the safety in terms of inhospital outcome comparing protected high-risk percutaneous coronary intervention with the Impella 2.5 device and coronary artery bypass grafting in patients with complex multivessel coronary artery disease. Methods: This retrospective study included patients with complex multivessel coronary artery disease (SYNTAX score >22) undergoing either coronary artery bypass grafting before the implementation of a protected percutaneous coronary intervention programme with a peripheral ventricular assist device or protected percutaneous coronary intervention with the Impella 2.5 device following the start of the programme. The primary endpoint consisted of inhospital major adverse cardiac and cerebrovascular events. The combined secondary endpoint included peri and post-procedural adverse events. Results: A total of 54 patients (mean age 70.1±9.9 years, 92.6% men) were enrolled in the study with a mean SYNTAX score of 34.5±9.8. Twenty-six (48.1%) patients underwent protected percutaneous coronary intervention while 28 (51.9%) patients received coronary artery bypass grafting. The major adverse cardiac and cerebrovascular event rate was numerically higher in the coronary artery bypass grafting group (17.9 vs. 7.7%; P=0.43) but was not statistically significant. The combined secondary endpoint was not different between the groups; however, patients undergoing coronary artery bypass grafting experienced significantly more peri-procedural adverse events (28.6 vs. 3.8%; P<0.05). Conclusion: Patients with complex multivessel coronary artery disease undergoing protected percutaneous coronary intervention with the Impella 2.5 device experience similar intrahospital major adverse cardiac and cerebrovascular event rates when compared to coronary artery bypass grafting. Protected percutaneous coronary intervention represents a safe alternative to coronary artery bypass grafting in terms of inhospital adverse events.
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Alavian, Sharon, and Wendy Hutchinson. "As patients get older, we should be aware of salt levels in factor products." Journal of Haemophilia Practice 3, no. 1 (January 1, 2016): 67–70. http://dx.doi.org/10.17225/jhp00060.
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Abstract Hypertension is a well-known risk factor for ischaemic heart disease and cerebrovascular events. Globally, there is a drive to try to reduce salt intake. In an older population, where hypertension is likely to have a high prevalence, are health care professionals aware of the sodium content in replacement factor?
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Norrman, Anders, Linus Schiöler, Axel C. Carlsson, Kristina Bengtsson Boström, Per Hjerpe, Charlotta Ljungman, Georgios Mourtzinis, et al. "BLOOD PRESSURE DIGIT PREFERENCE IN HYPERTENSIVE PATIENTS ATTENDING PRIMARY HEALTH CARE IS ASSOCIATED WITH FUTURE CARDIOVASCULAR EVENTS." Journal of Hypertension 42, Suppl 1 (May 2024): e74-e75. http://dx.doi.org/10.1097/01.hjh.0001019988.85084.7e.
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Objective: Digit preference refers to rounding blood pressure (BP) values more often than would occur by chance. Studies show that practices with high digit preference are linked to fewer antihypertensive prescriptions, and patients attending such practices have an increased cardiovascular (CV) event risk. The objective is to investigate how the fraction BP digit preference in hypertensive patients in primary health care centres relates to future CV events. Design and method: From the Swedish Primary Care Cardiovascular Database, 74,751 patients (41,728 women) in 48 primary care centers in Sweden with a recorded diagnosis of hypertension during 2001–2008 were included. The fraction of systolic and diastolic BP values ending in 5 or 10 during 2007–08 at each center was calculated. Cox regression analysis assessed the relation between digit preference at each primary health care center and CV events (ischemic heart disease, cerebrovascular disease, CV death) during 2009–2013, i.e. follow-up was 1–5 years. Covariates included age, gender, income, diabetes, ischemic heart disease cerebrovascular disease, and region. Results: Patient mean age in 2008 was 70±14 years. The fraction of digit preference varied between 32% and 100% between centres (Figure 1). There was a significant association between the utilization of digit preference at a primary health care centre and risk for future CV events for these patients (Figure 2). A proxy for quality of care by centre was estimated as fractions of patients with lipids, creatinine, and microalbuminuria assessed during 2007–2008. This revealed no association between markers of quality of care and prevalence of digit preference. Conclusions: BP digit preference is associated with future CV events. This may be attributed to inaccurate measurements procedures for BP measurements, faulty evaluation of actual BP levels and risk, treatment not offered appropriately, or other means of possible inappropriate quality of care.
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Barrows, Robin Joyce, Ulrike Krumsdorf, Alexandra Zankl, Hugo Katus, and Christiane Pia Tiefenbacher. "Significance of Close Surveillance of Patients with Peripheral Arterial Disease." Angiology 60, no. 4 (September 30, 2008): 462–67. http://dx.doi.org/10.1177/0003319708322923.
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Background. Peripheral arterial disease (PAD) indicates generalized atherosclerosis but is still underdiagnosed and undertreated. Methods. Data were collected from patients with PAD from the Department of Cardiology and Angiology, University of Heidelberg, Germany. The prevalence of cardiovascular risk factors and medication were documented. Results. Atherogenic risk factors, cardiovascular disease, and cerebrovascular disease were highly prevalent. By continuous care at the university clinic, in addition to family medicine treatment, the use of platelet inhibitors, antihypertensives, and lipid-lowering therapy was increased. Ankle—brachial index and walking distance improved. Conclusion. Long-term treatment at the university clinic had positive effects on atherogenic risk factors. The regular use of secondary preventive medication was improved. Still, this patient population remained undertreated and showed a high incidence of vascular event rates and a need for vascular interventions. This study implies the importance of both specialists and general practitioners in the care of these individuals.
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Zarola, F., and B. Middei. "Occurrence of Epileptic Complications in Patients with Cerebrovascular Disease in Charge to the Home Care Center: A Clinical Experience." Journal of Biomedical Research & Environmental Sciences 2, no. 3 (March 25, 2021): 213–15. http://dx.doi.org/10.37871/jbres1213.
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Most studies in literature about the occurrence of the so-called vascular epilepsy suggest that this complication is an episodic and relatively rare event mostly due to clinical conditions related to haemorrhagic ictus while chronic vascular disease (multifocal vascular encephalopathy, vasculopathy with lacunar infarcts or minor stroke and ischemic strokes) is not usually considered as risk factors for the onset of secondary epilepsy. Furthermore, the epilepsy of the elderly is often ascribed to the atrophy of the brain tissues linked to both age and chronic hypoxia induced by Atherosclerosis (ATS) or a complication of pharmacological therapies in the elderly (anticholinesterases, neuroleptics, anticoagulants). In fact, in our clinical and practical experience in the district outpatients clinic and home care center, numerous clinical cases have been subject to diagnosis and treatment of late epilepsy following an ischemic stroke. In this study we had thepurpose to describe our experience of occurrence of epileptic complications in patients with morewide Cerebrovascular Disease (CVD) patterns. We studied a group of 15 patients (8 Male and 7 Female) affected by CVD and by recent recently onset epilepsy. Our study found that Cerebrovascular disease CVD constitutes a significant risk factor for secondary epilepsy in the groups with elder age even though younger subjects can be involved after being affected by relevant cerebrovascular events. In opposition to the opinion assumed in common clinical practice an important part of these causal events are ischemic and non-haemorrhagic as previously known.
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Ponfick, Matthias, Ralf Wiederer, and Dennis A. Nowak. "Outcome of Intensive Care Unit–Dependent, Tracheotomized Patients with Cerebrovascular Diseases." Journal of Stroke and Cerebrovascular Diseases 24, no. 7 (July 2015): 1527–31. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.021.
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Terekhova, Anna Leont'evna, Aleksey Vadimovich Zilov, Arkadiy L'vovich Vertkin, and Galina Afanas'evna Mel'nichenko. "Leading causes of death and concomitant pathology in patients with type 2 diabetes mellitus according to autopsy data." Diabetes mellitus 14, no. 4 (December 15, 2011): 61–64. http://dx.doi.org/10.14341/2072-0351-5819.
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Aims. The aim of this study was to estimate the prevalence rate of concomitant pathology and its influence on leading causes of death in patients withtype 2 diabetes mellitus according to clinical charts and pathologist's reports. Materials and methods. We have studied the database of Moscow City Hospital №50 in order to pick out confirmed cases of type 2 DM, treated inthe period from 2006 to 2008 years (302 patients, 9,97%). Prevalence rate of concomitant pathology and leading causes of death were then carefullystudied on this ground. Results. We examined clinical charts of 302 patients with type 2 DM - 219 female (72.5%) at the age of 76 [70;80] and 83 male at theage of 75 [68;80]. Cardiovascular pathology and cerebrovascular disease (acute cerebrovascular event and/or postinfarction encephalic cysts,discirculatory encephalopathy) (50.66%) showed high prevalence. Respiratory system diseases (25.8%), excessive body weight and obesity (21.5%),gallstone disease (19.86%), malignant neoplasm (16.2%), prostatic hyperplasia (found in 35 male patients, 42.17%), gynecologic pathology (foundin 23 female patients, 10.5%) and infectious inflammatory diseases of kidneys and urinary tract (8.6%) were also disclosed. Leading causes of deathwere found to be acute cerebrovascular events (28.8%), postinfarction cardiosclerosis (23.18%), acute/recurring myocardium infarction (19.54%)and malignant neoplasm (14.57%). High polypathy prevalence was discovered in studied cohort, and in one third of cases patients perished fromcombination of concurrent diseases.Conclusion: High prevalence rate of intercurrent diseases and polymorbidity in patients with type 2 diabetes mellitus substantiate the need for thoroughexamination at different stages of medical care, treatment of existing malfunctions, as well as preventive measures against complications.
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Курмангулов, А. А., М. Ю. Бачурина, and Н. А. Гаджиев. "DYNAMICS OF CEREBROVASCULAR DISEASES STATISTICAL INDICATORS IN ASSOCIATION WITH THE CORONAVIRUS PANDEMIC." Vestnik SurGU. Meditsina 16, no. 2 (2023): 52–58. http://dx.doi.org/10.35266/2304-9448-2023-2-52-58.
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The study aims to evaluate the dynamics of primary morbidity, mortality, and disability indicators in the adult population affected by cerebrovascular diseases in the Tyumen region (without аutonomous districts) and in the Russian Federation. A continuous statistical observation was conducted using direct ranking method and time series evaluation. The study of key disease demographic data in the Tyumen region and the Russian Federation from 2011 to 2021 demonstrates that novel coronavirus infection impacted the primary morbidity, mortality,and disability indicators of cerebrovascular diseases in adult population. The year 2020 is acknowledged as challenging to assess due to considerable instability in the Russian healthcare system. First, there is intersection of patients, limitation and total absence of medical care, preventive check-ups, and the annual health examination at the beginning of COVID-19 spread. In terms of primary morbidity, mortality, and disability of cerebrovascular diseases, the Tyumen region demonstrates more stable indicators in comparison to the Russian Federation.
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Altaei, Osama A., and Abbass N. Al-Sharifi. "Prevalence of peripheral arterial disease among patients with acute coronary syndrome, a sample of Iraqi patients in Al-Yarmook Teaching Hospital 2016." Journal of the Faculty of Medicine Baghdad 63, no. 2 (July 13, 2021): 50–56. http://dx.doi.org/10.32007/jfacmedbagdad.6321824.
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Abstract
Background: A significant proportion of patients with ischemic heart disease have been associated with peripheral arterial disease, yet it is still underestimated by our health system as many of patients are asymptomatic and this condition remains under diagnosed and therefore undertreated.
Objective: To study prevalence of peripheral arterial disease of the lower limbs in patient with acute coronary syndrome and its association with certain risk factors.
Method: A cross sectional descriptive study was conducted in the coronary care unit at Al-Yarmouk Teaching Hospital from the 1st of January 2016 to the 1st of November 2016 where hundred and fifty (150) patients enrolled to the coronary care unit with approved acute coronary syndrome, had been evaluated for peripheral arterial disease by assessing Demographic, risk factors and clinical features of the patients, including age groups, gender, hypertension, diabetes mellitus, smoking, dyslipidemia, family history. of coronary artery disease, previous history of cerebrovascular accident, body mass index, leg pain, measurement of ankle brachial index using hand held continuous wave Doppler device.
Results: in 150 acute coronary syndrome patients were included male were (70.7%) , peripheral arterial disease was found in 31.2% through measuring ankle brachial index, 51% of those patients were asymptomatic and 29.8% with atypical leg pain and 12.8% with intermittent leg pain and 6.4% had pain at rest. And ankle brachial index in the 150 patients with acute coronary syndrome were 68.8% normal (ankle brachial index =1.4-0.91) and 21.3% (ankle brachial index =0.9-0.71) and 7.3 %( ankle brachial index =0.69-0.41) and 2.6% (ankle brachial index ≤0.40).
Factors independently related to peripheral arterial disease were old age (>60 years) which constitutes 51% and p value was 0.013, and smoking which constitutes 46.8% and P value was 0.04, and dyslipidemia which constitutes 74% and P value was 0.03, and finally previous history of cerebrovascular accident which constitutes 21.2% and P value was 0.0018.
Conclusion: The prevalence of peripheral arterial disease in patients presenting with acute coronary syndrome is considerable and significant, the majority of patients were asymptomatic, it is associated with increased cardiovascular risk. Factors like aging, hypertension, diabetes mellitus, smoking, previous history of cerebrovascular accident, and dyslipidemia were strong predictors of peripheral arterial disease.
Key word: peripheral arterial disease , acute coronary syndrome, hypertension, diabetes mellitus.
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Dain, Aleksandra S., Yimei Li, Sahal Master, Shri Karthikeyan, Leslie Raffini, Kelly D. Getz, and Janet L. Kwiatkowski. "Impact of the 2014 NHLBI Hydroxyurea Guidelines on Cerebrovascular Events in Sickle Cell Disease." Blood 142, Supplement 1 (November 28, 2023): 1129. http://dx.doi.org/10.1182/blood-2023-190822.
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Background: Cerebrovascular disease (CVD) is a common cause of morbidity in patients with sickle cell disease (SCD). An estimated 37% of children with SCD have silent cerebral infarcts (SCI) by age 14, leading to increased stroke risk and neurocognitive impairment. In the DISPLACE trial (Kanter et al, 2021), 2.9% of patients had abnormal cerebral blood flow as measured on transcranial Doppler ultrasound (TCD). The 2014 National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend hydroxyurea (HU) for all patients with SCD-SS and SCD-Sβ 0 starting at age 9 months, a significant shift from prior practice. In patients who have already developed TCD abnormalities, HU is protective against stroke and CVD progression. The real-world impact of universal early HU on the development of CVD, particularly on SCI, is not well defined . We hypothesize that the 2014 guidelines led to an increase in HU use and a reduction in the initial development of CVD. Methods: We performed a single center, retrospective cohort study investigating trends in HU prescriptions and CVD before and after the publication of the 2014 NHLBI guidelines. Patients with SCD-SS and SCD-Sβ 0 who initiated hematology care at the Children's Hospital of Philadelphia between 2009 and 2023 were identified using an institutional registry. Incident HU was defined as the first outpatient HU prescription in patients with a minimum of two orders. Incident CVD was defined as a composite outcome consisting of the first documentation of: abnormal TCD, brain magnetic resonance imaging (MRI) with silent infarct, or overt ischemic stroke. Patients with known CVD before care initiation, prematurity < 28 weeks gestational age, or non-SCD neurologic disease were excluded. For time-to-HU analysis, patients with HU prescriptions before enrollment at our center also were excluded. Patients were followed from their first hematology visit until the outcome of interest or censoring. Censoring criteria included loss to follow up, transition of care, or bone marrow transplant. All brain MRI and TCD reports were manually reviewed. Ages at HU initiation pre- and post- guideline were compared using the Wilcoxon rank-sum test . Times to 1) HU and 2) CVD were summarized using Kaplan-Meier estimators, with the guideline publication date of September 1, 2014 incorporated as a time-varying exposure. Unadjusted associations were calculated using a Cox proportional hazard regression. Results: A total of 446 patients met inclusion criteria and contributed to analyses. Median age at baseline was 2.4 months, and median duration of follow-up was 5.0 years (IQR: 2.3-8.7). Most patients (430/446, 96%) had SCD SS, and 51% were male. The proportion of patients ever prescribed HU increased with time (Fig 1), with a peak prevalence of 82% in 2022. Of 385 patients not exposed to HU at baseline, 277 (72%) were prescribed HU during study follow-up. Incident HU prescriptions significantly increased after NHLBI guideline publication (HR 3.40, CI: 2.50 to 4.63, p < 0.001) with an older age at HU initiation before (median 4.0 y, IQR 2.5-7.7) than after (median 2.9 y, IQR 1.1-5.8) publication of the guideline (p = 0.002). Over a total of 2,395 person-years of follow-up, 66 incident CVD outcomes occurred in this longitudinal cohort, corresponding to a cumulative incidence of 14.8%. These events included 53 SCI, 10 abnormal TCD, and 3 overt ischemic strokes. CVD outcome occurrence was lower after guideline publication than before (HR 0.58, CI: 0.32-1.05), though the association did not reach statistical significance (p = 0.071, Fig. 2). Discussion: After the NHLBI guideline publication, HU prescriptions increased significantly at our center.Our data suggest that the 2014 guideline-directed care may have led to a greater than 40% reduction in CVD, though this reduction was not statistically significant in our small sample size. Despite guideline recommendations and strong evidence for the role of HU in reducing pain and acute chest syndrome, few patients across the United States are prescribed HU therapy. Adherence and care continuity challenges further lessen the number of patients benefitting from HU. Evidence of efficacy of early and universal HU in CVD prevention would strengthen guideline recommendations and improve clinical care in patients with SCD. Ongoing analysis includes an expanded cohort and adjustment for clinical covariates to better examine the direct impact of early HU on CVD.
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Ursum, Jennie, Mark M. J. Nielen, Jos W. R. Twisk, Mike J. L. Peters, François G. Schellevis, Michael T. Nurmohamed, and Joke C. Korevaar. "Cardiovascular Disease-related Hospital Admissions of Patients with Inflammatory Arthritis." Journal of Rheumatology 42, no. 2 (December 15, 2014): 188–92. http://dx.doi.org/10.3899/jrheum.140476.
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Objective.Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care–based population of patients with IA and controls.Methods.All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data.Results.There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2–2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0–4.9).Conclusion.Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.
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Dhamoon, Mandip S., Alison Thaler, Kapil Gururangan, Amit Kohli, Daniella Sisniega, Danielle Wheelwright, Connor Mensching, et al. "Acute Cerebrovascular Events With COVID-19 Infection." Stroke 52, no. 1 (January 2021): 48–56. http://dx.doi.org/10.1161/strokeaha.120.031668.
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Background and Purpose: Coronavirus disease 2019 (COVID-19) has been associated with an increased incidence of thrombotic events, including stroke. However, characteristics and outcomes of COVID-19 patients with stroke are not well known. Methods: We conducted a retrospective observational study of risk factors, stroke characteristics, and short-term outcomes in a large health system in New York City. We included consecutively admitted patients with acute cerebrovascular events from March 1, 2020 through April 30, 2020. Data were stratified by COVID-19 status, and demographic variables, medical comorbidities, stroke characteristics, imaging results, and in-hospital outcomes were examined. Among COVID-19-positive patients, we also summarized laboratory test results. Results: Of 277 patients with stroke, 105 (38.0%) were COVID-19-positive. Compared with COVID-19-negative patients, COVID-19-positive patients were more likely to have a cryptogenic (51.8% versus 22.3%, P <0.0001) stroke cause and were more likely to suffer ischemic stroke in the temporal ( P =0.02), parietal ( P =0.002), occipital ( P =0.002), and cerebellar ( P =0.028) regions. In COVID-19-positive patients, mean coagulation markers were slightly elevated (prothrombin time 15.4±3.6 seconds, partial thromboplastin time 38.6±24.5 seconds, and international normalized ratio 1.4±1.3). Outcomes were worse among COVID-19-positive patients, including longer length of stay ( P <0.0001), greater percentage requiring intensive care unit care ( P =0.017), and greater rate of neurological worsening during admission ( P <0.0001); additionally, more COVID-19-positive patients suffered in-hospital death (33% versus 12.9%, P <0.0001). Conclusions: Baseline characteristics in patients with stroke were similar comparing those with and without COVID-19. However, COVID-19-positive patients were more likely to experience stroke in a lobar location, more commonly had a cryptogenic cause, and had worse outcomes.
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Karpova, O. V., and E. V. Bril’. "Aspects of the Use of Antithrombotic Therapy in Vascular Neurology." A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin, no. 3 (October 2023): 21–26. http://dx.doi.org/10.33266/2782-6430-2023-3-21-26.
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The development of Acute Cerebrovascular Events – ACV is one of the main causes of mortality and disability. Currently, in developed countries, due to the development of new technologies and improvement of medical care and prevention, there is a tendency to decrease the mortality and morbidity of cerebrovascular disease (CVD). Timely and adequate use of antithrombotic therapy in patients in this category for primary and secondary prevention of ACV is an extremely important aspect of management and reliably reduces the risks of recurrent cerebrovascular accidents, increases survival and contributes to a more favorable prognosis for the recovery of impaired functions and quality of life in the long term.
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Duzgun, Ulkuhan, Ali Riza Sonkaya, Bilgin Öztürk, Oktay Sarı, Eray Serdar Yurdakul, Ümit Savaşçı, Deniz Doğan, and Ömer Karadaş. "The Effect of Risk Factors on the Clinical Course and Treatment of Older Patients with Coronavirus Disease 2019." Neurological Sciences and Neurophysiology 39, no. 1 (2022): 40–47. http://dx.doi.org/10.4103/nsn.nsn_114_21.
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Introduction: Coronavirus disease 2019 (COVID-19) is known to have higher morbidity and mortality rates, parallel to the increased risk factors in the elderly. We aimed to define the risk factors related to mortality and morbidity in older patients hospitalized with COVID-19 disease in this study. Materials and Methods: This retrospective cross-sectional study included patients aged ≥65 years who were hospitalized with a confirmed diagnosis of COVID-19. We analyzed their demographic data, clinical findings, comorbidities, laboratory and radiologic findings, treatment protocols, and outcomes. Results: A total of 58 patients were included in the study. A total of eight (13.8%) patients died during the clinical follow-up and treatment, and 50 (86.2%) patients were discharged. The most common comorbidities among all patients were hypertension (HT) (69%) and diabetes mellitus (39.7%). The most common symptoms include fever (51.7%), cough (44.8%), and dyspnea (43.1%), and the most common neurologic findings were headache (27.6%) and impaired consciousness (27.6%). Intensive care unit admission was significantly higher among patients with comorbidities of HT, cerebrovascular disease, atrial fibrillation (AF), and chronic obstructive pulmonary disease. The rate of death was significantly higher in patients with a history of smoking, cerebrovascular disease, AF, and HT. Although there was a statistically significant positive correlation between the death rate and leukocyte, neutrophil, C-reactive protein, lactate dehydrogenase, D-dimer, interleukin-6, and procalcitonin levels, a negative correlation was observed in lymphocyte levels. Conclusion: Age-related comorbid conditions, especially HT, cerebrovascular disease, and AF, caused increased morbidity and mortality rates in older patients with COVID-19.
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Obeid, Slayman, Nooraldaem Yousif, Allan Davies, Ruben Loretz, Lanja Saleh, David Niederseer, Husam A. Noor, et al. "Prognostic role of plasma galectin-3 levels in acute coronary syndrome." European Heart Journal: Acute Cardiovascular Care 9, no. 8 (December 2020): 869–78. http://dx.doi.org/10.1177/2048872620974612.
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Aim: Cystatin C, neutrophil gelatinase-associated lipocalin and galectin-3 have emerged as biomarker candidates to predict cardiovascular outcomes and mortality in the general population as well as in patients with coronary artery or renal disease. However, their predictive role and clinical utility in patients with acute coronary syndromes alone or in combination beyond currently used risk scores remains to be determined. Methods and results: Cystatin C, neutrophil gelatinase-associated lipocalin, and galectin-3 were measured in plasmas of 1832 patients at the time of presentation with acute coronary syndromes requiring percutaneous coronary intervention or coronary artery bypass grafting. The primary outcomes were major adverse cardiac and cerebrovascular events (defined as the composite of all-cause mortality, cerebrovascular events, any repeat revascularization or myocardial infarction) and all-cause mortality after 1 year and occurred in 192 (10.5%) and 78 (4.3%) of patients, respectively. All three biomarkers were increased in those with major adverse cardiac and cerebrovascular events compared with those without ( p<0.001). However, only galectin-3 (all-cause mortality: hazard ratio=1.027 (95% confidence interval (1.011–1.043); p=0.001), major adverse cardiac and cerebrovascular events: hazard ratio=1.025 (95% confidence interval (1.012–1.037); p<0.001)) but not cystatin C nor neutrophil gelatinase-associated lipocalin emerged as independent predictors of both major adverse cardiac and cerebrovascular events and death. The risks were particularly high in the highest quartile of galectin-3. The integration of galectin-3 into the global registry of acute coronary events (GRACE) score improved the prediction of major adverse cardiac and cerebrovascular events and all-cause mortality significantly. The areas under the receiver operator characteristics curves increased from 0.6701 to 0.6932 for major adverse cardiac and cerebrovascular events ( p=0.0474) and from 0.804 to 0.8199 for all-cause mortality ( p=0.0197). Finally, we applied net reclassification improvement index using different cut-offs for major adverse cardiac and cerebrovascular events which showed negative results (for the cut-offs of 5% and 15%, net reclassification improvement index 0.028, p=0.586, for the cut-offs of 10% and 20%, net reclassification improvement index 0.072, p=0.1132 and for the cut-offs of 10% and 30% the net reclassification improvement index is 0.0843, p=0.077). Conclusion: In acute coronary syndromes patients, galectin-3 has moderate prognostic accuracy, provides statistically significant incremental value in some, but not all models, and that the magnitude of any improvement would seem of questionable clinical value.
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Yadav, Krishna Kumar, and Rajesh Kumar Mandal. "Clinical and Etiological Profile of Ischemic Stroke in a Tertiary Care Hospital of Nepal." International Journal of Health Sciences and Research 12, no. 6 (June 24, 2022): 214–17. http://dx.doi.org/10.52403/ijhsr.20220628.
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Background: Stroke is one of the most common neurological diseases, often leading to disability and death. Ischemic stroke accounts for 80-85% of all stroke cases. This Study aimed to evaluate the clinical and etiological profile of patients of ischemic cerebrovascular stroke. Materials and Methods: This was a cross sectional, observational study of 93 patients of ischemic cerebrovascular stroke, conducted at Bir Hospital, Kathmandu during January 2018 to December 2019. The patients detailed history, examinations, blood investigation, CT Scan head and Echocardiography was done. The data were recorded in Excel a sheet and analyzed by SPSS 20. Results: The mean age of ischemic stroke patients was 63.28 +_ 15.52 with a range from 30 to 94 years. The stroke was predominant in male with 52(55.91 %). The most common risk factors for stroke were hypertension 54(58.06%), followed by smoking 48(51.61%), LVH 45(48.38%), hypercholesterolemia 26(27.95%), diabetes mellitus 11(11.82%), atrial fibrillation 3(3.22%) and coronary artery disease 1(1.07%). Hemiplegia was present in all the patients. Other common symptoms included dysarthria due to facial deviation in 73.11%, speech aphasia in 6.45 % and altered sensorium/loss of consciousness in 1.07 % patients. Conclusion: Stroke is not limited to elderly population; younger adults are also vulnerable for stroke. Hypertension, smoking, hypercholesterolemia, diabetes mellitus are common risk factors which can be modified for prevention of stroke. Key words: Ischemic stroke; hemiplegia; risk factors..
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Cimminiello, Claudio, Guido Arpaia, Hernan Polo Friz, Patrizia Boracchi, Giuseppe Marano, Gabriella Spezzigu, and Adriana Visonà. "A prospective multicentre study on the treatment of cardiovascular risk factors and claudication symptoms in patients with peripheral artery disease (the IDOMENEO study)." Vasa 44, no. 5 (September 2015): 371–79. http://dx.doi.org/10.1024/0301-1526/a000456.
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Abstract. Background: The objective of this prospective multicentre cohort study was to characterise the use of pharmacological and non-pharmacological treatment for cardiovascular disease (CVD) risk factors and intermittent claudication (IC) symptoms in clinical practice patients with peripheral artery disease (PAD), and to determine the care gap with international guidelines and evidence-based therapy. Patients and methods: From 2011 through 2013, participating centres enrolled consecutive patients with PAD of atherosclerotic origin demonstrated by ultrasound, ankle brachial index (ABI) 0.9 and symptoms of IC. A seven item grid was built for the assessment of care gap (percentage of patients eligible for a treatment who did not receive it). Results: All patients (232) presented at least one CVC risk factor, 90.2% at least two, and 91.5% had either established CAD or cerebrovascular disease or at least two CVD risk factors. Care gap was lower than 25% for any method to stop smoking, lipid lowering agents, antiplatelet and/or anticoagulation therapy and any kind of exercise program; between 25% and 50% for ACE-inhibitors/angiotensin II antagonist therapy; between 50% and 75% for beta-blocker therapy; and higher than 75% for supervised exercise program and use of cilostazol. Patients with and without CAD/cerebrovascular disease were differently treated with clopidogrel (27.3% and 4.8%, p≤0.001), any antiplatelet/anticoagulant therapy (98.7% and 83.3%, p≤0.001) and beta-blockers (46.8% and 16.0%, p≤0.001). Conclusions: Many gaps with evidence-based recommendations are still present in the pattern of the use of pharmacological and non-pharmacological treatment for CVD risk factors and IC symptoms in clinical practice PAD patients.