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Having brain CT (computed tomography) scan is limited by the financial means patients in Madagascar. Neurological examination becomes essential the management of stroke. Our goal was to establish the correlation between clinical criteria and brain CT scan result. Methods: we did a retrospective, descriptive and analytical study of patients admitted for stroke at the neurology department of the Joseph Raseta University Hospital in Befelatanana from October 2018 to September 2019. Results: Two hundred thirty seven cases were retained. The presence of higher functions problems’ is correlated with stroke of the superficial arteries and its absence with stroke of the perforating arteries. The Alternate syndrome predicted stroke of the brainstem and cerebellum. Conclusion: A well-conducted clinical examination helps manage stroke while waiting for a brain CT scan. The clinical criteria provide the topography of the artery affected during the stroke. [ABSTRACT FROM AUTHOR]

Oxylipins and fatty acids may be novel therapeutic targets for cardiovascular disease. The objective was to determine if plasma oxylipins or fatty acids can influence the odds of cardiovascular/cerebrovascular events. In 98 patients (25 female, 73 male) with peripheral artery disease, the prevalence of transient ischemic attacks, cerebrovascular accidents, stable angina, and acute coronary syndrome was n = 16, 10, 16, and 24, respectively. Risk factors such as being male, diagnosed hypertension, diabetes mellitus, and hyperlipidemia were not associated with events. Plasma fatty acids and oxylipins were analyzed with gas chromatography and HPLC-MS/MS, respectively. None of 24 fatty acids quantified were associated with events. In contrast, 39 plasma oxylipins were quantified, and 8 were significantly associated with events. These 8 oxylipins are known regulators of vascular tone. For example, every 1 unit increase in Thromboxane B2/Prostaglandin F1α and every 1 nmol/L increase in plasma 16-hydroxyeicosatetraenoic acid, thromboxane B2, or 11,12-dihydroxyeicosatrienoic acid (DiHETrE) increased the odds of having had ≥2 events versus no event ( p < 0.05). The greatest predictor was plasma 8,9-DiHETrE, which increased the odds of acute coronary syndrome by 92-fold. In conclusion, specific oxylipins were highly associated with clinical events and may represent specific biomarkers and (or) therapeutic targets of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Résumé: Dans cette étude multicentrique prospective à visée descriptive sur 30 mois une sélection de dossiers a été effectuée devant la suspicion clinique d'un accident vasculaire cérébral en phase aigüe (moins de 24 h). Les patients ont tous été explorés avec un appareil d'IRM de 1,5 Tesla par des séquences « Flair » suivies des séquences de diffusion avec le calcul du coefficient apparent de diffusion (ADC). Parmi 232 dossiers retenus sur 1567, d'âge moyen 53,5 ans, les antécédents des patients étaient dominés par l'hypertension artérielle et le diabète respectivement dans 62,5 % et 56 % des cas. Les motifs de consultation étaient l'hémiplégie dans 69,5 % des cas suivie de l'aphasie dans 23,2 %. Dans 92 % des cas l'infarctus à la phase aiguë n'était pas visible sur les séquences Flair. L'ischémie cérébrale était révélée dans 100 % des cas chez tous les patients explorés par les séquences de diffusion avec calcul de l'ADC. La thrombolyse était le traitement pratiqué en urgence avec un taux de réussite à 91 % des cas. In this multicenter prospective study with descriptive aim over 30 months, a selection of the files was carried out in front of the clinical suspicion of an acute cerebral vascular accident (less than 24 hours). The patients were all explored with a 1.5 Tesla MRI by Flair sequences followed by diffusion sequences with apparent diffusion coefficient (ADC) calculation. Among 232 cases retained out of 1567, with a mean age of 53.5 years, patients' histories were dominated by hypertension and diabetes respectively in 62.5% and 56%. The reasons for consultation were hemiplegia in 69.5% followed by aphasia in 23.2%. In 92% of cases acute infarction was not visible on Flair sequences. Cerebral ischemia was revealed in 100% of cases in all patients investigated by ADC-based diffusion sequences. Thrombolysis was the emergency treatment with a success rate of 91% of cases. [ABSTRACT FROM AUTHOR]

Summary Objectives The auditory startle reaction (ASR) and startle reflex to somatosensory inputs (SSS) are stereotypical responses to sudden and unexpected stimuli, which are generated in the caudal brainstem reticular formation. Changes of ASR are relatively well known in stroke. Here, we aimed to investigate central pathways of SSS and plasticity changes of SSS circuits in different stages and localizations of stroke, by comparing with ASR. Methods We prospectively included 39 patients with stroke between June 2009 and June 2013, and 23 age and gender-matched healthy subjects. ASR and SSS were recorded over orbicularis oculi, sternocleidomastoid, biceps brachii (BB), and abductor policis brevis muscles (APB) using surface electrodes. Results There were supratentorial and infratentorial lesions in both acute and chronic stages. Overall, ASR probability was similar between groups ( P = 0.981). However, ASR probability was increased for BB and APB recordings on symptomatic sides of stroke patients with high amplitudes and long durations, most prominently on symptomatic sides of pontine strokes. Latencies and presence rates of SSS did not differ between any subgroups of stroke and healthy subjects. Conclusion ASR is facilitated in arm and hand muscles on symptomatic sides of stroke patients, whereas SSS did not show any significant changes according to stroke. [ABSTRACT FROM AUTHOR]

Abstract: The reversible cerebral vasoconstriction syndrome (RCVS) is an under-estimated transient acute cerebrovascular disorder. It has long been mistaken as central nervous system vasculitis whereas it is now believed to result from an acute but prolonged vasospasm of cerebral arteries. This disorder can be precipitated by postpartum or vasoactive drug. However, it occurs spontaneously in a significant number of cases. The characteristic clinico-radiological presentation and disease course of the RCVS has been delineated only recently. Mean age at onset is 40–45years, with a female predominance. A provocative factor can be identified in 12–60% out of the patients. Clinical presentation is predominantly marked by recurrent thunderclap headaches, but can be complicated with focal neurological deficit or seizures. Brain imaging is normal in most cases, but can reveal hemorrhagic or ischemic complications. Cortical subarachnoid hemorrhage is a suggestive finding. A posterior reversible encephalopathy syndrome (PRES) can be seen occasionally. Cerebral angiography reveals multifocal arterial narrowing with string and bead appearance. Cerebrospinal fluid reveals no or mild abnormalities. The disease resumes spontaneously within several days to weeks, whereas vasoconstriction reverses within 1 to 3months. This clinico-radiological presentation should be promptly recognized in order to avoid unnecessary investigations and aggressive treatment, and lead to search for a triggering factor. Further studies are required in order to clarify the precipitating role of several drugs, and clinical trials are needed to reduce the occurrence of strokes. [Copyright &y& Elsevier]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Background: After stroke, the early and persistent decline in aerobic capacity leads to diminish walking capacities. The aim of the study is to investigate the effects of aerobic cycloergometer interval-training on the walking performances in subacute and chronic stroke survivors. Method: A prospective design was used. Fourteen patients whose stroke had occurred more than 3months and less than 2years performed an aerobic training session with a cycloergometer for 8weeks. A maximal exercise test, a 6-min walking test, a 20-m test and an isokinetic muscle strength test were realized before and after training session. Results: There was a significant increase after aerobic training in maximal power (Pmax) (mean 23.2%, P <0.0001), in VO 2peak (mean 14.8%, P =0.04), and in the knee extension and flexion muscle peak torque on the nonparetic side and extension on the paretic side in isokinetic mode (mean from 13 to 29%, P =from 0.019 to P =0.0007) and in the walking performances on the 6-min walk test (mean 15.8%, P =0.0002). Conclusion: Patients with subacute and chronic stroke can improve aerobic capacity, muscle strength and walking performances after cycloergometer interval-training. Although these results must be interpreted with caution considering the small size of our sample, they suggest that aerobic training is a safe and potentially effective training after stroke and an alternative to walking treadmill training. [Copyright &y& Elsevier]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Use of oral anticoagulants is common in elderly persons. Oral anticoagulation can be used safely in the elderly if careful titration of the loading dose, careful changes in maintenance doses as well as consideration of drug interactions are taken into account. Frequent monitoring of the INR is essential, especially with changes in medical status and in co-medication. Correction of elevated INRs can be done following the recommendations. If vitamin K is used in stable patients, only small doses are required. In patients with atrial fibrillation, ischemic stroke risk and bleeding risk are predicted by overlapping factors. So patients who profit most from stroke risk reduction also show high bleeding risk. Risk stratification for ischemic stroke can be done easily with CHADS2-Score. Fall risk tends to be overestimated as a contraindication, whereas cognitive decline in combination with an unstable social network argues against anticoagulation. In the end, the decision to start or withhold anticoagulation has to be taken individually. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To observe whether medical complications, the evolution of neurological disorders and dependence and/or the discharge destinations are different for patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery compared to patients treated medically for severe or malignant cerebral infarction in the same cerebral territory, during their hospitalization in a physical medicine and rehabilitation department. Patients and methods: This retrospective study compared patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery and patients treated medically for severe or malignant cerebral infarction in the same cerebral territory. Patients were paired according to age, lesion side and hospitalization period. Results: Twelve patients treated by craniectomy (age 43±10.44) were paired with 12 patients treated medically (age 49±7.66). The two groups were comparable in terms of general undesirable medical events. The medical events related to craniectomy are described. The evolution of patient deficiencies, the length of the hospital stay (194±118.93 days vs 152±94.64 days), the Functional Independence Measure at discharge (87±21.28 vs 95±22.19) and the number of direct home discharges (7 vs 9) did not significantly differ between groups. Discussion and conclusion: No more medical problems were observed in the patients treated by craniectomy than in the patients treated medically, except for the medical events specifically related to craniectomy, which extended the hospital stay but had no major repercussions. [Copyright &y& Elsevier]

Ischemic stroke is a very frequent neurological disorder. It's incidence is increasing as western societies are aging. Effective therapies that reduce mortality and increase the chances of living symptom-free or, at least, in independence are available. Intravenous or intraarterial thrombolysis is an effective treatment with a number needed to treat of 6 if given within 4.5 hours after symptom onset. The safe use of thrombolysis requires an effective and repeatedly trained workflow established within a team of a neurologist and specialized nursing staff in an optimized environment (admission, imaging facility, laboratory, stroke unit). After peracute treatment, the patient should be transferred to a stroke unit. This unit is a spatially defined intermediate care unit with specifically trained personnel (physicians, nurses, therapists). Treating the patient in a stroke unit is as effective in improving outcome as thrombolysis and also reduces the length of hospital stay. In contrast to thrombolysis, which can be provided, on average, to only 5% of stroke patients, stroke unit care is applicable to most. The organization of medical care in most European countries and in Switzerland separate the acute phase from subacute rehabilitation and chronic stroke treatment. This can be highly confusing for the patient who, during the course of the disease, meets different physicians, nurses and therapists with often diverging opinions about prognosis and therapies. Consistent treatment approaches and patient/ caregiver information is necessary and can only be implemented by providing a homogeneous pathway for continuous stroke care. [ABSTRACT FROM AUTHOR]

Abstract: Most studies of functional outcomes in hemiplegic stroke patients use standard disability rating scales (such as the Barthel Index). However, planning the allocation of assistance and resources requires additional information about these patients’ expectations and needs. Aims of the study: To assess functional independence in daily living and house holding, changes in home settings, type of technical aid and human helps, and expectations in hemiplegic patients 1 to 2 years after the stroke. Methods: Sixty-one out of 94 patients admitted to the neurovascular unit of French university hospital for a first-ever documented stroke were consecutively enrolled. The study was restricted to patients under 75, since patients over 75 do not follow the same care network. Patients were examined at their homes or interviewed by phone 17 months (on average) after the stroke. Standard functional assessment tools (such as the Barthel Index and the instrumental activities of daily living [IADL] score) were recorded, along with descriptions of home settings and instrumental and human help. Lastly, patients and caregivers were asked to state their expectations and needs. Results: Although only one person was living in a nursing home after the stroke, 23 (34%) of the other interviewees had needed to make home adjustments or move home. Seven patients (11%) were dependent in terms of the activities of daily living (a Barthel Index below 60) and 11 (18%) had difficulty in maintaining domestic activities and community living (an IADL score over 10). Although the remaining patients had made a good functional recovery, 23 were using technical aids and 28 needed family or caregiver assistance, including 23 patients with full functional independence scores. Twenty-five patients (42%) were suffering from depression as defined by the diagnosis and statistical manual of mental disorders (4th edition, text revision, DSM IV-R). The patients’ prime concerns were related to recovery of independence, leisure activities and financial resources. Family members’ expectations related to the complexity of administrative matters, lack of information and the delay in service delivery. Discussion and conclusion: In under-75 hemiplegic stroke patients, high scores on standard disability rating scales do not always mean that no help is required. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Introduction: Celiac disease is a common condition with a prevalence of about 1%. Clinical extradigestive presentations are various and stroke can be one of the neurological manifestations. Exegesis: Two cases of stroke occurring in young adults are described, leading to the diagnosis of celiac disease. Hyperhomocysteinemia or cerebral arterial vasculopathy in one case and antiphospholipid syndrome in the other case are thought to be involved in the pathogenesis of stroke during celiac disease. Conclusion: The possible presence of celiac disease should be discussed in unexplained young adult stroke. [Copyright &y& Elsevier]

Abstract: Primary stroke can be due to embolism or an obstructive process of the vascular wall. Embolism may come from a parietal lesion of a large artery in the neck (traumatic dissections), from a cryptic cardiopathy, from a venous thrombosis associated with a right-left shunt. Among pathologies of endocranial arteries, the most frequent is the acute, postviral arteriopathy of the sus-clinoïd carotid, which evolves toward stabilisation or regression. Insidious obstructive arteriopathies of the Willis circle, including development of a transparenchymal suppletive circulation (Moya-Moya disease), cumulate chronic circulatory insufficiency and repetitive strokes. Inflammatory multifocal cerebral arteriopathies mainly involve mean and small arteries. Most of them are secondary to a multisystemic disease, but some are primary. The basic investigation is anatomical and begins with MRI. Emergency conventional cerebral angiography is discussed when heparinotherapy is difficult to decide (evolutive thrombosis), or when an endovascular intervention appears possible (anoeuvrism). Secondarily, conventional angiography is indicated in any chronic situation where a precise anatomical follow-up is necessary. Investigations of the cardiovascular system, of the thrombophilic risk, of a dysimmune process are discussed according to the clinico-anatomical diagnosis. [Copyright &y& Elsevier]

Abstract: Background: The relationship between diabetes mellitus and risk of stroke is well established. This risk is more elevated for hypertensive diabetics men. Objective: To determine the incidence and the risk factors of stroke among hypertensive diabetics. Methods: This prospective study has considered baseline demographic, behavioural and biological parameters collected in 2002 among black Congolese hypertensive diabetics from Kinshasa till the onset of stroke or not in 2006. Results: Out of 492 followed-up patients (279 women, 213 men, 57±10 years), 41.9% were old of age ≥ 60 years, and 16.5% experienced acute stroke. In univariate analysis, a significant association between age ≥ 60 years, cigarette smoking, excessive alcohol intake, diabetes duration ≥ 2 years, pulse pressure ≥ 60mmHg, acute bacterian pneumonia, left ventricule hypertrophy, hypertensive retinopathy, diabetic retinopathy, diabetic foot, diabetic neuropathy, congestive heart failure, chronic renal failure, lack of diabetic treatment compliance and the occurance of acute stroke. However, multivariate analysis identified only acute bacterian pneumonia, diabetic retinopathy, diabetic neuropathy, chronic renal failure and pulse pressure ≥ 60mmHg as the independent risk factors of stroke onset among these black congolese hypertensive diabetics with the following and respective values of relative risk (hazard ratio): 6,2 (IC 95%: 3.2 to 11.9; P <0.0001), 2,2 (IC 95%: 1.2 to 4.1; P <0.01), 3.6 (IC 95%: 1.9 to 6.8; P <0.0001), 6.4 (IC 95%: 2.9 to 14.1; P <0.01) and 4.1 (IC 95%: 1.6 to 10.3; P <0.0001). Conclusion: The rate of stroke onset is high among these hypertensive diabetics. This is the consequence of independent and respective action of infection, diabetic retinopathy, diabetic neuropathy, chronic renal failure and arterial stiffness. [Copyright &y& Elsevier]

Summary: Aims of the study: New motor deficit after surgery for deep-seated gliomas can occur from subcortical ischemia of the pyramidal tract. Motor evoked potentials (MEPs) validly indicate impending motor tract ischemia in cerebrovascular surgery. This study determines the feasibility and clinical utility of MEP monitoring for ischemic complication avoidance during surgery for deep-seated, specifically insular gliomas. Methods: MEPs were recorded during 100 operations of insular gliomas. Intraoperative MEP results were correlated with postoperative clinical and imaging results. Results: Useful MEP monitoring was possible in 89/100 cases, 88 of which were assessable since one patient died early postoperatively. Stable recordings warranted unimpaired motor outcome in 47/88 cases (53%). Surgical intervention reversed MEP attenuation in 26 of the remaining 41 cases (30% of the overall series) to prevent motor deficit except transient paresis in 12 (14%). Irreversible MEP changes without loss in eight cases (9%) resulted in only transient new deficit in seven cases, except one with permanent new paresis. Permanent paresis also occurred in seven cases (8%) where complete MEP loss could not be prevented. Permanent paresis arose exclusively through stroke of the deep motor pathways, whereas transient deficit typically corresponded to transitory ischemia of the pyramidal tract. MEP changes attributable to ischemic events frequently occurred spatially and temporally uncorrelated to resection in critical proximity of the motor tract. Conclusions: Ischemia in deep-seated glioma surgery usually occurs uncorrelated to resection close to the pyramidal tract. MEP monitoring efficiently helps detect ischemia early and to avert definite stroke and permanent new paresis in part of these cases. [Copyright &y& Elsevier]

Abstract: Haemorrhagic stroke is frequent and associated with a high mortality and morbidity. Less than 30% of patients are still alive five years after onset and few patients regain functional independence. The worsening effect of anticoagulation has been demonstrated and the failure to rapidly normalize coagulation further increases haematoma expansion. In a recent phase II trial, recombinant activated factor VII given within 4 hours of stroke onset, reduced haematoma growth, mortality and disability. An aggressive blood pressure and intracranial pressure control early after the haemorrhage seems beneficial. A large prospective randomized study (the STICH trial) did not demonstrate any beneficial effect of surgery. [Copyright &y& Elsevier]

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Post-stroke recovery is based on plastic changes in the central nervous system that can compensate the loss of activity in affected brain regions. In particular, monohemispheric stroke is thought to result in disinhibition of the contralesional unaffected hemisphere. Neurorehabilitation programs improve function partly by enhancing cortical reorganization. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive way of producing potent changes in cortical excitability. Therefore, the application of rTMS was recently proposed to promote functional recovery in stroke patients, owing to the induced neuroplasticity. This review discusses the first clinical results that were obtained by rTMS in patients with post-stroke motor deficit, visuospatial neglect, or aphasia. These results are promising and depend on the site and frequency of stimulation. In summary, functional recovery might be obtained either when rTMS is applied at low-frequency (around 1 Hz) over the disinhibited, unaffected hemisphere in order to restore defective inhibition or when rTMS is applied at high-frequency (5 Hz or more) over the affected hemisphere in order to reactivate hypoactive regions. The overall procedure remains to be optimized, in particular regarding the number of rTMS sessions and the time of rTMS application after stroke. Cortical stimulation is an exciting perspective for improving functional recovery from stroke. Transient application of non-invasive transcranial stimulation during the time of the rehabilitation process will be preferable to the temporary implantation of epidural cortical electrodes, as recently proposed. Therefore, in the future, acute or recent stroke might be a major indication of rTMS in neurological practice. [Copyright &y& Elsevier]

Abstract: Concerning any socioprofessional category, some addictive drugs like cocaine are responsible for many complications. The authors relate two case reports of young patients who suffered from cardiovascular accidents due to this drug. The first one was diagnosed with an ischemic stroke caused by carotid artery dissection and a leg distal vascular obliteration, the second one with a myocardial infarction with transient left ventricular dysfunction. Through these two case reports, the authors take stock of the pathophysiological and therapeutic knowledge of cardiovascular accidents after cocaine intake. [Copyright &y& Elsevier]

The precise role of microglia in stroke and cerebral ischemia has been the subject of debate for a number of years. Microglia are capable of synthesizing numerous soluble and membrane-bound biomolecules, some known to be neuroprotective, some neurotoxic, whereas others have less definitive bioactivities. The molecular mechanisms through which microglia activate these molecules have thus become an important area of ischemia research. Here we provide a survey review that summarizes the key actions of microglial factors in cerebral ischemia including complement proteins, chemokines, pro-inflammatory cytokines, neurotrophic factors, hormones, and proteinases, as well several important messenger molecules that play a part in how these factors respond to extracellular signals during ischemic injuries. We also provide some new perspectives on how microglial intracellular signaling may contribute to the seemingly contradictory roles of several microglial effector molecules. [ABSTRACT FROM AUTHOR]

Abstract: Objectives. – To identify and describe the most useful functional disability scales for assessing post-stroke hemiplegic patients and those used largely in clinical trials. Methods. – A literature review of Medline about the functional parameters for balance, gait and mobility, upper extremity functional abilities, and activities of daily living. The metrologic properties of the scales were specified as were their clinical use. Results. – Thirty-three scales were evaluated and classified into five categories: balance (6 scales), gait and mobility (4), upper limb function (11), global motricity scales (5) and independance in activities of daily living (7). Discussion and conclusion. – Many functional scales are useful for assessing post-stroke hemiplegic patients. To assess balance, the Postural Assessment Stroke Scale and Berg Balance Scale are the most interesting. The Functional Ambulation Classification and the Timed Up and Go Test are the most relevant to assess gait and mobility. The Action Research Arm Test is largely used to assess upper limb functional abilities. The Functional Independence Measure and the Barthel Index are largely used to assess independence in activities of daily living. [Copyright &y& Elsevier]

Abstract: Introduction. – Postural control aims to build up and align the body orientation (posture) and stabilize body segments. The existence of two separate mechanisms, one for the control of body orientation with respect to gravity and one for its stabilisation, is an emerging concept that allows a better understanding of postural disorders, including pushing, after stroke. Objectives. – Literature review concerning pushing, one of the most puzzling postural behaviours after stroke. Methods. – Critical review of papers indexed in Medline and book chapters dealing with pushing. Results. – There is no agreement about the definition of pushing: some authors consider that pushers push himself toward the paretic side using the healthy arm or leg; others consider that pushers lean (list) toward the side opposite the lesion and resist any attempt to become more upright. Surprisingly, the push itself has never been measured. Some ordinal scales have been recently proposed, but their psychometric properties have not been analysed. These methodological insufficiencies explain in part the disagreements about frequency (from 5% to 50% of patients with stroke) and cause(s) of pushing. Conclusion. – Pushing may be the most dramatic clinical manifestations of an extreme bias in the construction of the biological vertical. We argue for a better assessment of vertical perception/representation after stroke involving the three modalities of the biological (subjective) vertical: the visual vertical, the haptic or tactile vertical, and especially the postural vertical. [Copyright &y& Elsevier]

Abstract: Objectives. – To describe the incidence, circumstances, and consequences of falls in patients admitted in a rehabilitation ward after a stroke. Methods. – Prospective monitoring of falls over four years in a neurological rehabilitation unit. Use of fall registry. Inclusion criteria: age&#60;75 years, admission&#60;45 days after stroke onset, single stroke of 1 cerebral hemisphere (nonlacunar) or of the brain stem. Only falls due to loss of balance were considered; falls caused by a seizure or syncope were not considered. Results. – Of 217 consecutive patients with the inclusion criteria, 34 had fallen at least once (15.7%) and 10 twice (4.1%). Fall incidence, defined as the number of falls per patient per day was 2.2 per thousand. Half of the patients fell the first three weeks after admission. Most falls involved getting to or from the wheelchair or the bed; 1 patient had recovered minimal postural abilities at the gym but was not independent. Traumatic lesions were noted in 13 patients: they were minor in nine and severe in four, including three fractures. Conclusion. – Falls due to loss of balance are a major problem in patients undergoing rehabilitation after a stroke. Getting to and from wheelchairs in the bedroom and bathroom by patients who are not allowed to do so play a key role in many falls. Prevention programs should consider this information. [Copyright &y& Elsevier]

In a registry of 250 patients treated for atrial fibrillation (160 recurrent, 90 permanent forms), we prospectively looked for associated risk factors for cerebrovascular complications. After a 4-years follow-up, 19 patients had presented a cerebral accident (13 strokes, 4 transient ischemic attacks, 2 cerebral hemorrhages). Prognostic factors for cerebrovascular complications were hypertension, valvular heart disease, and age ≥70 years. When restricting the analysis to stroke and transient ischemic attacks, prognostic factors were limited to hypertension and age ≥70 years. In conclusion, hypertension and age ≥70 years are the main independent risk factors for cerebral ischemic attacks in out-of-hospital patients treated for atrial fibrillation. [Copyright &y& Elsevier]

Transient or permanent focal brain injury following acute thromboembolic occlusion develops from a complex cascade of pathophysiological events. The processes of excitotoxicity, peri-infarct depolarisation, inflammation, and apoptosis within the ischemic penumbra are proposed. While the translation of therapeutic agents from the animal models to human clinical trials have been disappointing, there remains an atmosphere of optimism as a result of the development of new diagnostic and therapeutic approaches, which include physiological, as opposed to pharmacological, intervention. This article provides an insight into the understanding of cerebral ischemia, together with current and future treatment strategies.Key words: cerebral ischemia, stroke, pathophysiology.La lésion cérébrale focale permanente ou transitoire qui se produit après une occlusion thromboembolique aiguë se développe à partir d'une cascade complexe d'événements pathophysiologiques. Les processus d'excitotoxicité, de dépolarisation post-infarctus, d'inflammation et d'apoptose dans la pénombre ischémique sont mis en cause. Bien que le transfert d'agents thérapeutiques des modèles animaux aux essais cliniques humains ait donné des résultats décevants, la mise au point de nouvelles approches diagnostiques et thérapeutiques, comportant une intervention physiologique plutôt que pharmacologique, est encourageante. Le présent article donne un aperçu de la compréhension de l'ischémie cérébrale ainsi que des stratégies thérapeutiques actuelles et futures.Mots clés : ischémie cérébrale, accident vasculaire cérébral, pathophysiologie.[Traduit par la Rédaction] [ABSTRACT FROM AUTHOR]

Many diseases associated with ageing have an underlying oxidative stress and accompanying inflammatory component, for example, Alzheimer's disease or atherosclerosis. Reviewed in this manuscript are: the role of oxidative stress in activating the transcription factor nuclear factor kappa B (NFκB), the role of NFκB in activating pro-inflammatory gene transcription, strong oxidants produced by cells, anti-oxidant defense systems, the central role of phase 2 enzymes in the anti-oxidant defense, dietary phase 2 enzyme inducers and evidence that dietary phase 2 enzymes decrease oxidative stress. It is likely that a diet containing phase 2 enzyme inducers may ameliorate or even prevent diseases that have a prominent inflammatory component to them. Research should be directed into the potential therapeutic effects of dietary phase 2 enzyme inducers in ameliorating diseases with an underlying oxidative stress and inflammatory component to them.Key words: Alzheimer's disease, atherosclerosis, diet, glutathione, inflammation, stroke.Un grand nombre de maladies associées au vieillissement ont un stress oxydatif sous-jacent accompagné d'une composante inflammatoire, par exemple l'athérosclérose. Dans cet article, nous réviserons les thèmes suivants : le rôle du stress oxydatif dans l'activation de la transcription du facteur nucléaire kappa B (FNκB), le rôle du FNκB dans l'activation de la transcription des gènes pro-inflammatoires, les puissants oxydants produits par les cellules, les systèmes de défense antioxydants, le rôle central des enzymes de phase 2 dans la défense antioxydante, les inducteurs d'enzymes de phase 2 alimentaires et la mise en évidence de la diminution du stress oxydatif par les enzymes de phase 2 alimentaires. Il semble très possible qu'un régime contenant des inducteurs d'enzymes de phase 2 puissent diminuer les symptômes des maladies ou même prévenir les maladies ayant une forte composante inflammatoire. Nous suggérons d'orienter la recherche vers l'étude des effets thérapeutiques potentiels des inducteurs d'enzymes de phase 2 alimentaires sur la diminution des symptômes des maladies ayant un stress oxydatif sous-jacent accompagné d'une composante inflammatoire.Mots clés : maladie d'Alzheimer, athérosclérose, régime, glutathion, inflammation, accident vasculaire cérébral.[Traduit par la Rédaction] [ABSTRACT FROM AUTHOR]

Abstract: We report on two patients hospitalized in intensive care unit for ischemic strokes presenting the feature of marantic endocarditis complicating lung''s adenocarcinoma. These two cases turned out to be very interesting because of the occurrence of ischemic strokes even though the patients were receiving the recommended treatment, namely anticoagulation with heparin, in well-adjusted doses. The management of nonbacterial thrombotic endocarditis remains a challenge and its mortality is still high. [Copyright &y& Elsevier]

Abstract: Atrial fibrillation (AF) is the most frequent cardiac arrhythmia and its prevalence rises with age. AF may cause stroke and heart failure but the relationship between AF and mortality is less clear. It is difficult to determine if cardiovascular events in patients with AF are attributable to the arrhythmia itself or if they are merely related to the comorbidities frequently associated with AF. Review of the literature suggests that lone AF (without structural heart disease), a rare clinical entity except in young patients, is not an independent risk factor for mortality. On the other hand, if illnesses usually associated with AF are present (hypertension, heart failure…), AF has a negative impact on outcome in terms of survival and morbidity. Current antiarrhythmic medications have not shown reduction in mortality of AF patients, but new agents and catheter ablation are promising paths to explore in order to decrease AF burden. [ABSTRACT FROM AUTHOR]