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Background: Among the primary environmental issues affecting global health, air pollution is considered the leading cause of concern. Globally, around 800,000 deaths were attributed to air pollution according to WHO. Evidence suggests that there has been a strong association of air pollution with stroke. Approximately, 25% of stroke mortality was due to air pollution according to a study in 2013. Objective: The aim of this review was to analyze the association between stroke, intracerebral hemorrhage, and subarachnoid hemorrhage and air pollution and its burden globally with a special focus on South Asia along with its association with the COVID-19 pandemic. Results: There is growing research data linking air pollution to cardiovascular disorders including stroke. Short-term and long-term air pollution exposures have been shown to increase stroke incidence in epidemiological data. Air pollution, both gaseous and particle, show a strong and tight temporal relationship with stroke hospitalizations and death. The link between ICH and SAH to air pollution is less strong and less well studied as compared to ischemic stroke. Stroke and air pollution both are highly prevalent in South Asia. It is possible that the high prevalence of stroke in south Asia may be linked to the high frequency of air pollution in addition to other conventional risk factors. Decreased stroke admissions and mortality and reduced cardiovascular mortality reported during coronavirus disease 2019 (COVID) lockdown may be attributable to decreased levels of air pollution. Conclusion: Even though air pollution poses a significant threat to human health, a great number of countries still fail to achieve internationally agreed air quality standards. Air pollution should be recognized among the most significant controllable risk factors for cardiovascular and cerebrovascular disease prevention and treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Previous studies have shown that the occurrence of cerebrovascular-specific diseases was common in cancer patients. However, the association between colorectal cancer and cerebrovascular-specific diseases remains to be fully elucidated. In this large-population cohort study, we found that the mortality of cerebrovascular-specific diseases mortality in colorectal cancer patients was significantly higher than the general US population. In addition, we investigated several potential predictors of cerebrovascular-specific diseases mortality in colorectal cancer. This study may be useful for the prevention, risk stratification and therapeutic optimization of cerebrovascular-specific diseases in colorectal cancer patients. Background: Colorectal cancer (CRC) is one of the most prevalent diseases and the second leading cause of death worldwide. However, the relationship between CRC and cerebrovascular-specific mortality (CVSM) remains elusive, and less is known about the influencing factors associated with CVSM in CRC. Here, we aimed to analyze the incidence as well as the risk factors of CVSM in CRC. Methods: Patients with a primary CRC diagnosed between 1973 and 2015 were identified from the Surveillance Epidemiology and End Results database, with follow-up data available until 31 December 2016. Conditional standardized mortality ratios were calculated to compare the incidence of CVSM between CRC patients and the general U.S. population. Univariate and multivariate survival analyses with a competing risk model were used to interrogate the risk factors for CVSM. Results: A total of 563,298 CRC individuals were included. The CVSM in CRC patients was significantly higher than the general population in all age subgroups. Among the competing causes of death in patients, the cumulative mortality caused by cerebrovascular-specific diseases steadily increased during the study period. While age, surgery, other/unknown race and tumors located at the transverse colon positively influenced CVSM on both univariate and multivariate analyses, male patients and those who had radiotherapy, chemotherapy, a more recent year (2001–2015) of diagnosis, a grade II or III CRC, rectal cancer, or multiple primary or distant tumors experienced a lower risk of CVSM. Interpretation: Our data suggest a potential role for CRC in the incidence of CVSM and also identify several significant predictors of CVSM that may be helpful for risk stratification and the therapeutic optimization of cerebrovascular-specific diseases in CRC patients. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between hepatitis C virus (HCV) infection, cardiovascular risk factors and cerebro-cardiovascular (CCV) disease.Methods: The source of data was the Egypt Health Issues Survey conducted in 2015. Participants were 11 256 individuals with complete HCV testing, age 25-59 years. Data on demographics, cardiovascular risk factors, CCV disease (myocardial infarction and/or cerebral stroke) and HCV infection were retrieved. Descriptive, bivariate, multivariable logistic regression and sensitivity analyses were performed to determine the independent association of past HCV exposure or chronic infection with diabetes, hypertension and CCV disease.Results: 3.9% of participants were antibody positive/RNA negative and considered to have past HCV exposure; 7.9% had detectable HCV-RNA and were considered to have chronic infection. Participants with negative antibodies and no history of liver disease (n = 9928) were the control group. In addition to the previously known risk factors, multivariable analyses revealed that diabetes was independently associated with past HCV exposure (OR = 1.71, 95% CI: 1.27-2.32) and HCV chronic infection (OR = 1.56, 95% CI: 1.23-1.97), whereas CCV disease was independently associated with past exposure (OR = 2.69, 95% CI: 1.62-4.46) and not with chronic infection. No evidence of an association between hypertension and either HCV status was found.Conclusion: The association of both past HCV exposure and chronic infection with diabetes and that of past HCV exposure with CCV disease may suggest targeting HCV-positive reactors for preventive and curative programmes addressing extrahepatic complications. [ABSTRACT FROM AUTHOR]

The aim of the present study was to perform a meta-analysis of published data to determine the significance of clinical factors and exposures to the risk of perinatal arterial ischaemic stroke ( PAIS) and provide guidance for clinical diagnosis and treatment. A comprehensive literature search of the PubMed, Embase, MEDLINE and Cochrane Library databases for relevant observational studies (cohort/case−control) from March 1984 to March 2016 was undertaken. Two review authors independently examined the full text records to determine which studies met the inclusion criteria and evaluated risk factors for PAIS. Risk ratios, odds ratios and 95% confidence intervals were estimated. A total of 11 studies were included in the analyses. Intrapartum fever >38°C, pre-eclampsia, oligohydramnios, primiparity, forceps delivery, vacuum delivery, fetal heart rate abnormalities, abnormal cardiotocography tracing, cord abnormalities, birth asphyxia, emergency caesarean section, tight nuchal cord, meconium-stained amniotic fluid, umbilical arterial pH <7.10, Apgar score at 5 min <7, resuscitation at birth, hypoglycaemia, male gender and small for gestational age were identified as risk factors for PAIS. This systemic review and meta-analysis provides a preliminary evidence-based assessment of the risk factors for PAIS. Patients with any of the risk factors identified in this analysis should be given careful consideration to ensure the prevention of PAIS. Future studies focusing on the combined effects of multiple prenatal, perinatal and neonatal risk factors for PAIS are warranted. [ABSTRACT FROM AUTHOR]

Key points Hyperfibrinogenaemia (HFg) results in vascular remodelling, and fibrinogen (Fg) and amyloid β (Aβ) complex formation is a hallmark of Alzheimer's disease. However, the interconnection of these effects, their mechanisms and implications in cerebrovascular diseases are not known., Using a mouse model of HFg, we showed that at an elevated blood level, Fg increases cerebrovascular permeability via mainly caveolar protein transcytosis., This enhances deposition of Fg in subendothelial matrix and interstitium making the immobilized Fg a readily accessible substrate for binding Aβ and cellular prion protein (PrPC), the protein that is thought to have a greater effect on memory than Aβ., We showed that enhanced formation of Fg-Aβ and Fg-PrPC complexes are associated with reduction in short-term memory., The present study delineates a new mechanistic pathway for vasculo-neuronal dysfunctions found in inflammatory cardiovascular and cerebrovascular diseases associated with an elevated blood level of Fg., Abstract Many cardiovascular diseases are associated with inflammation and as such are accompanied by an increased blood level of fibrinogen (Fg). Besides its well-known prothrombotic effects Fg seems to have other destructive roles in developing microvascular dysfunction that include changes in vascular reactivity and permeability. Increased permeability of brain microvessels has the most profound effects as it may lead to cerebrovascular remodelling and result in memory reduction. The goal of the present study was to define mechanisms of cerebrovascular permeability and associated reduction in memory induced by elevated blood content of Fg. Genetically modified, transgenic hyperfibrinogenic (HFg) mice were used to study cerebrovascular transcellular and paracellular permeability in vivo. The extent of caveolar formation and the role of caveolin-1 signalling were evaluated by immunohistochemistry (IHC) and Western blot (WB) analysis in brain samples from experimental animals. Formation of Fg complexes with amyloid β (Aβ) and with cellular prion protein (PrPC) were also assessed with IHC and WB analysis. Short-term memory of mice was assessed by novel object recognition and Y-maze tests. Caveolar protein transcytosis was found to have a prevailing role in overall increased cerebrovascular permeability in HFg mice. These results were associated with enhanced formation of caveolae. Increased formation of Fg-PrPC and Fg-Aβ complexes were correlated with reduction in short-term memory in HFg mice. Using the model of hyperfibrinogenaemia, the present study shows a novel mechanistic pathway of inflammation-induced and Fg-mediated reduction in short-term memory. [ABSTRACT FROM AUTHOR]

BACKGROUND: A limited number of studies on long-term effects of particulate matter with aerodynamic diameter < 2.5 µm (PM2 5) on health suggest it can be an important cause of morbidity and mortality. In Asia where air quality is poor and deteriorating, local data on long-term effects of PM2.5 to support policy on air quality management are scarce. OBJECTIVES: We assessed long-term effects of PM2.5 on the mortality in a single Asian city. METHODS: For 10-13 years, we followed up a cohort of 66,820 participants ≥ 65 years of age who were enrolled and interviewed in all 18 Elderly Health Centres of the Department of Health, Hong Kong, in 1998-2001. Their residential addresses were geocoded into x- and y-coordinates, and their proxy exposures to PM2.5 at their addresses in 1 x 1 km grids were estimated from the U.S. National Aeronautics and Space Administration (NASA) satellite data. We used Cox regression models to calculate hazard ratios (HRs) of mortality associated with PM2.5. RESULTS: Mortality HRs per 10-µg/m³ increase in PM2.5 were 1.14 (95% CI: 1.07, 1.22) for all natural causes, 1.22 (95% CI: 1.08, 1.39) for cardiovascular causes, 1.42 (95% CI: 1.16, 1.73) for ischemic heart disease, 1.24 (95% CI: 1.00, 1.53) for cerebrovascular disease, and 1.05 (95% CI: 0.90, 1.22) for respiratory causes. CONCLUSIONS: Our methods in using NASA satellite data provide a readily accessible and affordable approach to estimation of a sufficient range of individual PM2.5 exposures in a single city. This approach can expand the capacity to conduct environmental accountability studies in areas with few measurements of fine particles. [ABSTRACT FROM AUTHOR]

Introduction: Blunt cerebrovascular injury (BCVI) is reported to occur in 1-2 % of blunt trauma patients. Clinical and radiologic risk factors for BCVI have been described to help identify patients that require screening for these injuries. However, recent studies have suggested that BCVI frequently occurs even in the absence of these risk factors. The purpose of this study was to determine the incidence of BCVI in blunt trauma patients without risk factors and whether these patients could be identified by a more liberal CTA screening protocol. Methods: We conducted a retrospective cohort study of all blunt trauma patients seen between November 2010 and May 2014. In May 2012, a clinical practice guideline for CTA screening for BCVI was implemented. The records of all patients with BCVI were reviewed for the presence of risk factors for BCVI previously described in the literature. Results: During the 43 month study period, 6,602 blunt trauma patients were evaluated, 2,374 prior to, and 4,228 after implementation of the clinical practice guideline. Nineteen percent of all blunt trauma patients underwent CTA of the neck after protocol implementation compared to only 1.5 % prior to protocol implementation (p = 0.001). As a result, a 5-fold increase in the identification of BCVI was observed (p = 0.00003). Thirty-seven percent of patients with BCVI identified with the enhanced CT screening protocol had none of the signs, symptoms, or risk factors usually associated with these injuries. Conclusions: Our findings demonstrate that reliance on clinical or radiologic risk factors alone as indications for screening for BCVI is inadequate. We recommend routine CTA screening for BCVI in all patients who have sustained a mechanism of injury sufficient to warrant either a CT of the cervical spine or a CTA of the chest. [ABSTRACT FROM AUTHOR]

The article reviews neurological injury in transcatheter aortic valve implantation (TAVI), with an emphasis on cerebrovascular diseases. Topics discussed include overall incidence of cerebrovascular events (CVEs), spectrum of neurological injury in TAVI and standardized definitions for perioperative CVEs. Also mentioned are the risk factors for CVEs, prognosis after CVEs and strategies to prevent the use of TAVI as treatment for CVEs.

HIV-associated neurocognitive disorder remains prevalent in HIV-infected individuals despite effective antiretroviral therapy. As these individuals age, comorbid cerebrovascular disease will likely impact cognitive function. Effective tools to study this impact are needed. This study used diffusion tensor imaging (DTI) to characterize brain microstructural changes in HIV-infected individuals with and without cerebrovascular risk factors. Diffusion-weighted MRIs were obtained in 22 HIV-infected subjects aged 50 years or older (mean age = 58 years, standard deviation = 6 years; 19 males, three females). Tensors were calculated to obtain fractional anisotropy (FA) and mean diffusivity (MD) maps. Statistical comparisons accounting for multiple comparisons were made between groups with and without cerebrovascular risk factors. Abnormal glucose metabolism (i.e., impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) was associated with significantly higher MD (false discovery rate (FDR) critical p value = 0.008) and lower FA (FDR critical p value = 0.002) in the caudate and lower FA in the hippocampus (FDR critical p value = 0.004). Pearson correlations were performed between DTI measures in the caudate and hippocampus and age- and education-adjusted composite scores of global cognitive function, memory, and psychomotor speed. There were no detectable correlations between the neuroimaging measures and measures of cognition. In summary, we demonstrate that brain microstructural abnormalities are associated with abnormal glucose metabolism in the caudate and hippocampus of HIV-infected individuals. Deep gray matter structures and the hippocampus may be vulnerable in subjects with comorbid abnormal glucose metabolism, but our results should be confirmed in further studies. [ABSTRACT FROM AUTHOR]

In this study, we are presenting some link between water hardness, calcium and magnesium levels, cardiovascular diseases and cerebrovascular disease (CVD and CBVD) in Decatur County of Georgia, USA. The drinking water samples from different regions and sources were analyzed by using the ethylenediaaminetetraacetic acid (EDTA) - metal complexation method. In the study we found that the surface water sources (lakes, ponds and river water) contained low concentrations of water hardness ranging from 3.66mg/l to 33.05mg/L and calcium and magnesium ranged from 3.15-30.15mg/L and 0.38- 2.90mg/L respectively. The municipal drinking waters showed hardness; 37.23mg/L to 44.25 mg/L, calcium; and 3.06 mg/L to 4.45mg/L, magnesium. The drinking waters obtained outside the municipal city limits mainly from boreholes (well ground waters) showed geographic variations ranging from 43.69mg/L to 68.06mg/L for hardness of water; and for calcium and magnesium ranging from 37.40 mg/L to 58.05mg/L and 2.00mg/L to 21.77mg/L, respectively. The mortality rate caused by CVD is lower outside the municipal city limits compared to within the Bainbridge city limit. The ratio of high calcium and low magnesium appears to be responsible for an inverse correlation between the calcium and magnesium concentrations to CBVD mortality rate in Decatur County. A positive correlation between the levels of magnesium and CBVD was observed. This study has raised question concerning the involvement of magnesium levels in drinking water with CBVD and its supposed beneficial effects against CVD. [ABSTRACT FROM AUTHOR]

Background and objectives: In spite that stroke has become a public health problem in Mexico, there are few information regarding several issues on stroke epidemiology. The main objectives of the present study were to determine, by means of a multicentric stroke registry, the prevalence of the stroke types, their vascular risk factors and the short-term outcome. Patients and methods: Prospective observational study of consecutive cases of stroke recruited in 25 hospitals (in 14 states of Mexico). The following information was obtained: demographic data, vascular risk factors, mechanisms and causes of stroke types, and clinical outcome. Descriptive statistical analysis (frequencies and medians) using χ² y Kruskal-Wallis for contrasting differences among stroke types. Resulted: We studied 2000 patients: women 55%, men 45% (p < 0.001) with median age of 64 years (IQR 49-75). Stroke types: tranient ischemic attack 5%, cerebral infarction 52%, intracerebral hemorrhage (ICH) 28%, subarachnoid hemorrhage (SAH) 12.0%, and cerebral venous thrombosis (CVT) 3.0%. Causes of cerebral infarct: atherosclerosis 14.7%, cardioembolism 24.7%, small vessel disease 19.4%, other 4.6%, undetermined 36.6%. Causes of ICH: hypertensive 67%, vascular malformations 7.8%, amiloid angiopaty 4%, hematologic disorders 4%, other 8%, undetermined 10%. Causes of SAH: aneurysm 86%, perimesencephalic 6%, other 2%, undetermined 6%. Causes CVT: puerperium/ pregnancy 47%, contraceptives agents 13%, other 17%, undetermined 23%. Short-term clinical outcome (30 days): Excellent recovery (Rankin 0/1) 41%; mild and moderate disability (R 2/3) 18%; severe disability (R 4/5) 20% and death 21%. Conclusions: Main mechanisms and causes of stroke in Mexico are described, revealing a higher frequency of ICH and CVT in Mexico than occidental countries. More than half of patients had poor outcome because they died or had some grade of disability. [ABSTRACT FROM AUTHOR]

Objective: The high stroke morbidity and related mortality in Central-Eastern European countries might be related to several factors. In this study we used a large, database from Tîrgu Mureş (Romania) to investigate the impact of risk factors on the short-term outcome of stroke. We opted for this method as hospital databases usually provide more detailed information on risk factors, stroke severity and correlated outcome than population based registries. Methods: We analyzed the data of 1478 consecutively hospitalized stroke patients during a period of one year, regardless of the ward they were admitted to. We recorded risk factors, stroke severity and correlated with the short-term outcome (i.e. in-hospital outcome, assessed by Glasgow Outcome Scale) of stroke. Results: Significantly more men and patients with a lower age than the European average were admitted. 26% of admitted patients had a previous cerebrovascular disease in their history. The prevalence of modifiable risk factors such as hypertension, diabetes, hyperlipidaemia, smoking, etc was higher than in other European countries. Overall case fatality was 10.4% and 75% of discharged patients had some degree of disability. Outcome at discharge was worse with higher systolic and diastolic blood pressure, increased heart rate, higher serum glucose, higher white blood cell count as well as decreased consciousness and increased age. Conclusions: In this large hospital based database we found an alarming number of untreated and frequently aggregated risk factors. Our findings emphasize the role of modifiable risk factors as well as indicate major opportunities for more efficient stroke prevention. [ABSTRACT FROM AUTHOR]

Background: ischaemic cerebrovascular small vessel disease (SVD) is a prevalent and under-diagnosed condition that triggers vascular cognitive impairment (VCI).Objective: to describe the neuropsychological and clinical profiles in SVD (Binswanger's disease, BD; lacunar state, LS) from the clinician's perspective at the VCI stage.Methods: a total of 1257 patients admitted to a tertiary center with a diagnosis of stroke, neuroradiological vascular disease, cognitive impairment/dementia, during a 13-year period were investigated. We prospectively assessed cognition in a subset of 141 patients with VCI (LS n = 28, BD n = 69, large vessel disease—LVD—n = 44) with MMSE, CAMDEX-H, WAIS-R, EXIT-25 and Trail making test.Results: executive dysfunction (ECD) (n = 89, 91.7% versus n = 10, 22.7%; P < 0.001) and gait disturbances (n = 74, 76.3% versus n = 15, 34.1%; P < 0.001) characterized SVD. Prior strokes (n = 9, 9.3% versus n = 23, 52.3%; P < 0.001) and embologenous cardiopathy (n = 39, 40.2% versus n = 28, 63.6%; P < 0.04) featured LVD cases. BD was defined by hypertension (n = 52, 75.4% versus n = 30, 44.1%; P < 0.001), ECD (n = 65, 94.2% versus n = 34, 47.2%; P < 0.001) and VCI onset with cognitive impairment but not strokes (n = 44, 63.8% versus n = 34, 50%; P < 0.01).Conclusions: ECD and a frontal gait are SVD's clinical landmarks in our sample. LS and BD cases share a similar cognitive profile. [ABSTRACT FROM AUTHOR]

Objective: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center. Patients and Methods: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically. Results: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p< 0.05). Mortality was significantly low among patients with hyperlipidemia (p< 0.05). There was no statistically significant correlation between stroke recurrence and any of parameters investigated (p> 0.05). In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05). Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05). Conclusion: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month. [ABSTRACT FROM AUTHOR]

Background: Non-HDL cholesterol is a potential newer risk factor for cerebrovascular diseases (CVD). Objective: To explore the association of non-HDL cholesterol with cerebrovascular disease. Methods: This case control study was carried out in the Department of Biochemistry, BSMMU, Dhaka during the period of January to December 2007 to evaluate the association of non-HDL cholesterol with CVD in Bangladeshi population. A total number of 135 subjects of both sexes were grouped as Group-?? (CVD cases) and Group-II (Healthy controls). Group-I include 85 cases of which 59 were ischaemic cerebrovascular diseases (ICVD) and 26 were haemorrhagic cerebrovascular diseases (HCVD). By taking the history and doing clinical examination and laboratory investigations, diabetes mellitus, malignant disease, renal disease, liver disease and diuretic medication were excluded from study subjects. Serum non-HDL cholesterol was measured in all study subjects. Statistical analysis was performed by using SPSS for windows version 12.0. Mean values of the findings were compared between groups. One way ANOVA test and multiple comparison (Bonferroni't') test were used to see the level of significance. Results: Serum non-HDL cholesterol found significantly increased in CVD, ICVD and HCVD cases in comparison to control subjects. But ICVD and HCVD cases did not differ with respect to serum non-HDL cholesterol. Conclusion: The result shows that elevated non-HDL cholesterol is associated with CVD. Prospective study with large sample size is required to evaluate the elevated Non-HDL cholesterol as a risk factor of CVD. [ABSTRACT FROM AUTHOR]

Focal brain lesions are assumed to produce language deficits by two basic mechanisms: local cortical dysfunction at the lesion site, and remote cortical dysfunction due to disruption of the transfer and integration of information between connected brain regions. However, functional imaging studies investigating language outcome after aphasic stroke have tended to focus only on the role of local cortical function. In this positron emission tomography functional imaging study, we explored relationships between language comprehension performance after aphasic stroke and the functional connectivity of a key speech-processing region in left anterolateral superior temporal cortex. We compared the organization of left anterolateral superior temporal cortex functional connections during narrative speech comprehension in normal subjects with left anterolateral superior temporal cortex connectivity in a group of chronic aphasic stroke patients. We then evaluated the language deficits associated with altered left anterolateral superior temporal cortex connectivity in aphasic stroke. During normal narrative speech comprehension, left anterolateral superior temporal cortex displayed positive functional connections with left anterior basal temporal cortex, left inferior frontal gyrus and homotopic cortex in right anterolateral superior temporal cortex. As a group, aphasic patients demonstrated a selective disruption of the normal functional connection between left and right anterolateral superior temporal cortices. We observed that deficits in auditory single word and sentence comprehension correlated both with the degree of disruption of left-right anterolateral superior temporal cortical connectivity and with local activation in the anterolateral superior temporal cortex. Subgroup analysis revealed that aphasic patients with preserved positive intertemporal connectivity displayed better receptive language function; these patients also showed greater than normal left inferior frontal gyrus activity, suggesting a possible ‘top-down’ compensatory mechanism. These results demonstrate that functional connectivity between anterolateral superior temporal cortex and right anterior superior temporal cortex is a marker of receptive language outcome after aphasic stroke, and illustrate that language system organization after focal brain lesions may be marked by complex signatures of altered local and pathway-level function. [ABSTRACT FROM PUBLISHER]

Background: Cerebrovascular disease is a major public health problem in both industrialized countries and developing nations. In Mexico there are not enough studies to know the epidemiological behaviour of this disease. Objectives: To describe and analyze epidemiological variables in a specific group of patients with cerebral vascular disease admitted to hospitals in Mexico City. Patients and methods: In a multicenter, retrospective and observational study, the coordinators of each school reviewed tomographic studies and clinical records of patients admitted in five hospitals in Mexico City with the diagnosis of cerebral vascular disease in 2005. The analysis included the following variables: age, gender and other cardiovascular risk factors such as hypertension, diabetes mellitus, smoking and atrial fibrillation. The prognosis was established as discharge due to improvement or death. Results: The diagnosis was made in 669 patients aged 39 to 99 years (mean: 72 years [SD 12.10]) Of these, 286 were women (42.7%). It was reported 488 cases of ischemic type (72.94%), 135 parenchymal haemorrhages (20.17%) and 46 subarachnoid haemorrhages (6.8%). The territory of the middle cerebral artery was the most commonly affected (84.30%) and systemic arterial hypertension was the most common risk factor in this group of patients. The average days of hospital stay was 9.87 (standard deviation: 9.57) and mortality was reported in 26% (174 patients). Conclusion: Our study provides epidemiological information of a new and reliable global public health problem. The ageing of our population coupled with the combination with other risk factors increase the frequency of cerebral vascular disease. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of death and disability in developed countries. While both modifiable and non-modifiable risk factors are acknowledged, studies have shown that these may account for just 50% of stroke risk and that other factors, including genetic ones, may be important. Over recent years family history, twin and candidate gene studies have supported this and various mendelian stroke syndromes have now been identified in humans. This article provides an up-to-date summary of the common single gene disorders associated with stroke as a principle manifestation, including their genetic basis, pathogenesis, presentation and suggested management. Often these disorders present with stroke at a young age; this article provides a practical approach to the management and investigation of a young stroke patient. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence of risk factors and experience of interventions in stroke survivors, and identify barriers to secondary prevention in rural South Africa. Methods: A clinician visited individuals in the Agincourt field site (in South Africa's rural north east) who were identified in a census as possible stroke following to confirm the diagnosis of stroke. We explored the impact of stroke on the individual's family, and health-seeking behaviour following stroke by conducting in-depth interviews in the households of 35 stroke survivors. We held two workshops to understand the knowledge, experience, and views of primary care nurses, who provide the bulk of professional health care. Findings: We identified 103 stroke survivors (37 men), 73 (71%) of whom had hypertension, but only 8(8%) were taking antistroke survivors has sought help, which involved allopathic health care for most of them (81.79%). 42 had also sought help from traditional healers and churches, while another 13 people had sought help only from those sources. Of the 35 survivors who were interviewed, 29 reported having been prescribed anti-hypertensive pills after their stroke. Barriers to secondary prevention included cost of treatment, reluctance to use pills, difficulties with access to drugs, and lack of equipment to measure blood pressure. A negative attitude to allopathic care as not an important factor. Conclusion: In this rural area hypertension is the most important modifiable risk factor in stroke survivors. Effective secondary prevention may reduce the incidence of recurrent strokes, but there is no system to deliver such care. New strategies for care are needed involving both allopathic-health care providers. [ABSTRACT FROM AUTHOR]

Patients with nonvalvular atrial fibrillation (AF) have an increased risk of stroke, but the absolute rate of stroke varies widely depending on coexistent vascular disease. We assessed the stroke rate and predictive value of two published schemes for stroke risk stratification in a population-derived cohort of 259 elderly people with nonvalvular AF followed for a median of 5.3 years. The rate of ischemic stroke was 2.8% per year (95% confidence interval [CI] 1.9, 3.9). Thirty-one percent were predicted to be at low risk, and their stroke rate was 1.7% per year (95% CI 0.6, 3.8). Many people with AF in this population-derived cohort had relatively low rates of stroke. Further studies to reliably stratify stroke risk in patients with AF are needed. [ABSTRACT FROM AUTHOR]

Describes the benefits of long term anticoagulant treatment for patients with stroke and non-rheumatic atrial fibrillation. Purpose of using the treatment on cardioembolic stroke; Compatibility of the result with the hypothesis on the risk of stroke and death; Comparison of the positive and negative result of the study.

Background: Scuba divers work in high pressure conditions which may cause some changes in physiological status to adapt to this situation. In this study, the carotid intima-media thickness (CIMT) was assessed in divers as a risk factor of cerebrovascular and cardiovascular disorders. Methods: This historical cohort study was performed on 16 male professional scuba divers as case group and 30 healthy people as controls with age range of 26-66 years. CIMT of both carotids of supine participants was measured by a 10 MHz linear ultrasonic probe quantitatively. Relationship between experience of diving and carotid IMT was evaluated. Results: All the participants were males (mean age 42.9 ± 10.58. and for the control group was (47.05 ± 12.31 years). The mean right CIMT in divers and control group was 524.31 ± 149.40 and 443.66 ± 59.62 micrometer, respectively. Furthermore, the mean left CIMT in divers and control group was 624.57 ± 116.15 and 458.44 ± 49.56 micrometer, respectively. Conclusion: The findings demonstrated that long-term occupational diving leads to increased intima-media thickness in scuba divers. [ABSTRACT FROM AUTHOR]

Blunt cerebrovascular injuries (BCVI) have been increasingly recognized in the past decade due to the initiation of different screening protocols. We present the case of an anterior cerebral artery rupture with free contrast extravasation following a severe traumatic brain injury. Epidemiology, modalities of screening and treatment of BCVI are discussed. This report reminds that the screening of BCVI may be essential after a severe TBI. [ABSTRACT FROM AUTHOR]

Cerebral vascular disease (CVD) encompasses a set of clinical disorders due to the insufficient supply of blood to the brain. There are several risk factors which we can classify as modifiable and not modifiable. Representing as well one of the main problems of public health in all industrialized countries. In Mexico the EVC occupies 6th place as cause of death. Objective: To determine the incidence and risk factors of CVD in patients in the service of medicine internal General Hospital the Pearl in January of 2009 to March 2011. To know the prevalence in terms of gender, age and risk factors associated with the type of CVD. In addition to establishing the percentage of deaths in the total population in study. Methodology: It's a retrospective and observational study of revenues in the service of the institution to study internal medicine. Results: A total of 147 records, leaving a total of 80 for the study inclusion criteria were reviewed. Conclusions: the primary prevention of the CVD method is more secure and economical to improve the quality of life of our patients that due to its high incidence and prevalence represented a significant human and economic cost. [ABSTRACT FROM AUTHOR]

Background: The mortality of atherosclerotic cerebrovascular disease is on the rise, and changes in intimal and media thickness are a leading cause of cerebral ischemia-related death. Levels of low density lipoprotein cholesterol (LDLC), total cholesterol (TC), and chronic stress (CS) are all recognized risk factors for atherosclerosis (AS). However, the leading independent risk factor is indistinct. This study explored the effects of chronic stress, LDLC, and TC on AS and intimal and media thickness, preliminarily explored the main risk factor of AS, and analyzed the related histocyte mechanisms for macrophages and endothelial cells. Methods: Conditions include normal, high-fat diet (HF), and HF plus CS. The correlations between intimal and media thickness and general risk factors were analyzed using χ2, Spearman's rho test, and multiple linear regression. Univariate Cox regression was used to identify potential factors that affect the non-depression time (NDT). We performed a ROC curve to determine the ability of this condition to predict the thickness. Immunohistochemistry was implemented to detect macrophagocytes and endotheliocytes. Results: Based on χ2 and Spearman's rho test, LDLC, TC, and CS are all related with intimal and media thickness (P < 0.05). However, in multiple linear regression, CS is still a risk factor of thickness (P < 0.05) but LDLC and TC are not. High levels of LDLC, TC, and CS were correlated with poor NDT (P < 0.05). This condition can predict the thickness sensitively. The endarterium is richest in macrophagocytes, and the arrangement of endotheliocytes is disordered and cracked under CS. Conclusion: CS is the main independent risk factor for AS and intimal (and media) thickness, rather than LDLC or TC. [ABSTRACT FROM AUTHOR]

Background: As estimated by the World Health Organization, most adults in Europe, including the Republic of Moldova, have an inadequate diet and a sedentary lifestyle that causes energy disturbances, subsequent damage of vessels and the onset of cerebrovascular disease. Methods: 1012 individuals participated in the current study: experimental group - 500 patients with stroke, control group - 512 relatively healthy individuals. The nutritional factor and lifestyle peculiarities were assessed on the basis of a lifestyle interview. Results: We found that 23.2% of patients with stroke until the event have physical activity less than one hour/day (control group - 2.4%), 35.3% of the patients were obese (control group - 17. 2%), 12.3% of the patients used very few fruits and vegetables in their daily menu (the control group - 10.4%), 44.0% preferred fatty meat (control group - 29.4%), 47.3% prefer salty foods. In the experimental sample 45.9% of investigated patients recognized that they consumed two times more food compared to relatively healthy people. Conclusion: Our results indicated that inadequate diet along with sedentary lifestyle may induce severe cerebrovascular pathologies, and the promotion of active lifestyle and proper nutrition should be started as early as possible in childhood. [ABSTRACT FROM AUTHOR]