Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Sep 2009
Apolipoprotein e, alcohol consumption, and risk of ischemic stroke: the Framingham Heart Study revisited.
Data on the association between alcohol consumption and ischemic stroke have been inconsistent. It is not known whether allele epsilon(4) of the apolipoprotein E (apoE) gene modifies the alcohol-stroke association. We sought to examine whether epsilon(4) allele of the apoE gene influences the association between alcohol consumption and ischemic stroke or high-density lipoprotein (HDL) cholesterol. ⋯ Our data do not provide evidence for an interaction between epsilon(4) allele and alcohol consumption on the risk of ischemic stroke in this population. Furthermore, apoE polymorphism did not influence the alcohol-HDL relation.
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J Stroke Cerebrovasc Dis · Sep 2009
Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit.
We analyzed patients with stroke in a neurorehabilitation unit to define incidence of dysphagia, compare clinical bedside assessment and videofluoroscopy (VFS), and define any correlation between dysphagia and clinical characteristic of patients. ⋯ Dysphagia occurs in more than a third of patients with stroke admitted to rehabilitation. Clinical assessment demonstrates good correlation with VFS. The grade of dysphagia correlates with dysarthria, aphasia, low FIM, and level of cognitive functioning. Large cortical strokes of nondominant side are associated with dysphagia.
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Disturbances in local blood flow influenced by arterial geometry contribute to atherogenesis. Carotid bifurcation hemodynamics depend on the relative sizes of the common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA), which vary considerably among individuals. The prevalence of carotid bifurcation atherosclerosis differs among race-ethnic groups and is generally lower in African Americans despite a more adverse vascular risk factor profile. We here examine whether there are race-ethnic differences in carotid bifurcation anatomy. ⋯ We found significant differences in the relative sizes of the ICA, ECA, and CCA among race-ethnic groups. African Americans had a proportionally smaller ICA and larger ECA in comparison with whites and Caribbean Hispanics.
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J Stroke Cerebrovasc Dis · Sep 2009
Case ReportsRecurrent ischemic stroke in paroxysmal nocturnal hemoglobinuria: paroxysmal nocturnal hemoglobinuria or missed patent foramen ovale?
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired bone-marrow disorder characterized by hemolytic anemia, hemoglobinuria, and cytopenia. Most patients die from venous thrombotic events. ⋯ We present a case of recurrent cerebral infarctions complicating PNH initially attributed to arterial thrombosis but ultimately determined to be a result of the disease and a concomitant patent foramen ovale identified only after repeated evaluations. This case emphasizes the pitfalls of diagnostic testing and the importance of a persistent search for a venous cause for cerebral embolic events in patients with hematologic diseases not classically known to involve the arterial system.