Stroke; a journal of cerebral circulation
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Comparative Study
Cardiac autonomic nervous system and risk of arrhythmias in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited systemic microangiopathy with prevalently cerebral manifestations. Among the causes of death, sudden unexpected death seems to occur in a significant number of CADASIL patients. Because potential causes of sudden unexpected death may include cardiac arrhythmias and myocardial infarction, we evaluated risk factors for life-threatening arrhythmias, such as reduced heart rate variability, sympathetic overactivity and QT interval (QTc) prolongation, in 23 CADASIL patients. The relationship of these changes with brain MRI pattern was also investigated. ⋯ We found a statistically significant reduction in all frequency domain parameters of heart rate variability associated with a higher low frequency/high frequency ratio for CADASIL patients with respect to normal subjects. These data are consistent with autonomic derangement and suggests that CADASIL patients may be at risk for life-threatening arrhythmias. This could at least in part explain their higher recurrence of sudden unexpected death and should be taken into account in planning therapy.
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Comparative Study
Spontaneous and endothelial-independent vasodilation are impaired in patients with spontaneous carotid dissection: a case-control study.
We undertook this case-control study in patients with unilateral spontaneous dissection of the cervical internal carotid artery to investigate spontaneous and endothelium-independent dilation of the nondissected, contralateral carotid arteries and the ipsilateral brachial artery using high-resolution ultrasound. ⋯ Vasodilation abnormalities may be a predisposing factor for spontaneous dissection of the cervical internal carotid artery.
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Studies on cognitive impairment without dementia (CIND) after stroke are scarce and there are no widely accepted diagnostic criteria for this condition. The purpose of this study was to determine the frequency of CIND in a hospital cohort before and after stroke during a 2-year follow up according to two alternative operational criteria. ⋯ Patients with CIND are frequent before and after stroke and prone to delayed dementia. Both criteria are valid for identifying CIND cases and predicting long-term conversion to dementia, but NPE-c may be more adequate for the long-term follow up and IQ-c for detecting changes from prestroke status.
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Cerebrospinal fluid drainage is often indicated in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage but is believed to increase the risk of rebleeding. We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for acute hydrocephalus. ⋯ This study does not confirm an importantly increased risk of rebleeding during external ventricular drainage or lumbar punctures for acute hydrocephalus after aneurysmal subarachnoid hemorrhage.