Cerebrovascular diseases
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The number of persons reaching the age 80 years and over is increasing in most populations. Literature focusing on hypertensive intracerebral hemorrhage (ICH) in this age group is lacking. Therefore, we aimed to analyze the main clinical characteristics of ICH of the advanced old age, in the context of hypertension. ⋯ ICH occurring in hypertensive patients aged > or =80 years has several differences from that seen in younger people; however, these differences do not seem to impact on early outcome.
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Cerebrovascular diseases · Jan 2007
Biography Historical ArticleJohann Jacob Wepfer Award 2007 of the European Stroke Conference to Prof. Charles Picton Warlow.
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Cerebrovascular diseases · Jan 2007
Randomized Controlled Trial Multicenter StudyRationale, design and baseline data of a randomized, double-blind, controlled trial comparing two antithrombotic regimens (a fixed-dose combination of extended-release dipyridamole plus ASA with clopidogrel) and telmisartan versus placebo in patients with strokes: the Prevention Regimen for Effectively Avoiding Second Strokes Trial (PRoFESS).
Individuals with transient ischemic attack and ischemic stroke have a high risk of recurrent stroke and death. While acetylsalicylic acid (ASA, aspirin) is proven and accepted as standard therapy in these patients, recent trials demonstrate that a combination of ASA and dipyridamole (DP) or clopidogrel may be superior to ASA. Blocking the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may also reduce recurrent stroke. The ongoing PRoFESS (Prevention Regimen for Effectively Avoiding Second Strokes) trial is designed to evaluate whether ASA + extended-release DP compared to clopidogrel, and whether telmisartan in addition to usual care in individuals after a stroke, will reduce the risk of further strokes. ⋯ PRoFESS is the largest secondary stroke prevention trial to date and will directly compare two antiplatelet regimens as well as the benefit of telmisartan versus placebo.
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Cerebrovascular diseases · Jan 2007
ReviewThe accuracy of transcranial Doppler in the diagnosis of middle cerebral artery stenosis.
It was the aim of this study to systematically review available literature on the accuracy of transcranial Doppler (TCD) compared with angiography for the diagnosis of > or =50% middle cerebral artery stenosis in patients with transient ischemic attack or ischemic stroke. ⋯ Although limited to few reports, this analysis demonstrates fair TCD performance against angiography. Since increasing velocity cutoffs do not yield decreasing sensitivity and increasing specificity, further studies are required to determine optimal velocity values and possibly other criteria such as velocity ratios to develop a screening test with balanced performance parameters.
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Cerebrovascular diseases · Jan 2007
ReviewSymptomatic intracerebral hemorrhage following thrombolytic therapy for acute ischemic stroke: a review of the risk factors.
Symptomatic intracerebral hemorrhage (SICH) following thrombolytic therapy for acute ischemic stroke is associated with a high rate of morbidity and mortality. Knowledge of the risk factors associated with SICH following thrombolyitc therapy may provide insight into the pathophysiological mechanisms underlying the development of SICH, lead to the development of treatments that reduce the risk of SICH and have implications for the design of future stroke trials. ⋯ Twelve studies met inclusion criteria for the systematic review. Extent of hypoattenuated brain parenchyma on pretreatment CT and elevated serum glucose or history of diabetes were independent risk factors for thrombolysis-associated SICH in six of the twelve studies. Symptom severity was an independent risk factor in three of the studies and advanced age, increased time to treatment, high systolic blood pressure, low platelets, history of congestive heart failure and low plasminogen activator inhibitor levels were found to be independent risk factors for SICH in a single study. Although these data should not alter the current guidelines for the use of rt-PA in acute stroke, they may help develop future strategies aimed at reducing the rate of thrombolysis-associated SICH.