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Cerebral Vascular Diseases
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Stroke or cerebrovascular accident is defined as an acute neurological dysfunction resulting from vascular pathology. Despite its declining incidence, stroke remains the third leading cause of death and disability in the U.S., with over half a million new occurrences annually.1 Estimates place the annual cost in terms of medical care and loss of productivity at close to $8 billion.2
Essential paperwork
Published in Sabina Dosani, Peter Cross, Making it in British Medicine, 2018
Arthur Pink is a 72-year-old retired docker. Six months ago he was diagnosed with multi-infarct dementia and his wife Grace has been struggling to control his diabetes as he has become reluctant to cooperate with blood glucose monitoring. He has been hypertensive for 20 years, but recently has been forgetting to take his antihypertensives. One morning he falls to the floor and Grace notices that he cannot move his left side. He is admitted to hospital where your team is on call. You diagnose a cerebrovascular accident. Despite treatment and secondary preventive measures, he dies four days later.
Clinical Management of Spasticity and Contractures in Stroke
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
Judith F. M. Fleuren, Jaap H. Buurke, Alexander C. H. Geurts
Stroke, or cerebrovascular accident, is an acquired brain injury due to an acute disturbance of blood supply to the brain, leading to ischemia. Blood flow interruption can be caused by thrombotic or embolic occlusion (ischemic stroke) or by rupture of a cerebral artery (hemorrhagic stroke). Approximately 110,000 strokes occur in England every year and 800,000 in the United States of America (National Audit Office, 2010; Mozzafarian et al., 2015). It is one of the top five causes of death and the largest cause of adult disability in Western countries. The World Health Organization has predicted that disability-adjusted life years (DALYs) lost to stroke will rise from 38 million in 1990 to 61 million in 2020 (WHO, 2004).
Managing complications after transcatheter aortic valve implantation
Published in Expert Review of Medical Devices, 2022
Giuliano Costa, Claudia Reddavid, Elena Dipietro, Marco Barbanti
Although TAVI procedure has become more and more predictable and new generation devices ensured better outcomes, the incidence of stroke after TAVI did not significantly decrease over the last decade, occurring in about 2% of patients at 30 days [74]. Importantly, the occurrence of cerebrovascular events after TAVI is associated with significant morbidity and mortality [87]. Cerebrovascular events may present as transient episodes related to intra-procedural hypotension (i.e. hemodynamic compromise, prolonged rapid ventricular pacing), which may lead to decreased cerebral perfusion especially in patients with cerebrovascular disease at baseline. Nevertheless, the main cause of cerebrovascular accident is the embolization of atheroma, calcium, thrombus or tissue fragments occurring after the displacement of native degenerated leaflets by the metallic TAV frame. Finally, a not negligible portion of stroke occurring after first hours from the procedure might be related to thromboembolism episodes due to new-onset AF episodes in patients who do not assume an appropriate anticoagulation therapy [88].
Ocular ischaemia: signs, symptoms, and clinical considerations for primary eye care practitioners
Published in Clinical and Experimental Optometry, 2022
Michael Kalloniatis, Henrietta Wang, Paula Katalinic, Angelica Ly, Warren Apel, Lisa Nivison-Smith, Katherine F Kalloniatis
Cerebrovascular accident (stroke) is a major cause of disease and death, accounting for 5.3% of all deaths nationwide in Australia.1 As the tenth leading cause of disease burden, stroke accounts for 2.7% of the total burden of disease in Australia and had an estimated health system expenditure of more than A$633 million in 2015-2016.1 Worldwide, stroke is the second leading cause of death and a major cause of disability.2 Early diagnosis and management of stroke have been associated with better functional outcomes and reduced hospitalisation periods.3 Acute cerebrovascular accidents result in loss of perfusion to a region of the brain, leading to a reduction in both oxygen and nutrients.4 Subsequent neuronal damage and associated neurological deficits can occur as a result of loss of perfusion.5 There are two main types of strokes: ischaemic and haemorrhagic.5 Although haemorrhagic strokes are associated with a higher risk of mortality, ischaemic strokes are approximately ten times more common than haemorrhagic strokes6 and thus this review will focus on ischaemic strokes.
Ketamine for depression
Published in International Review of Psychiatry, 2021
Blood pressure should be assessed before treatment with ketamine and individuals with comorbid hypertension should have their blood pressure management optimized before commencing ketamine. Blood pressure should be monitored after dosing until the blood pressure returns to acceptable levels. In an analysis of 684 infusions in 66 patients, with ketamine administered IV at 0.5 mg/kg over 40 min, the biggest increases in blood pressure were measured at 30 min (systolic 3.28 mmHg, diastolic 3.17 mmHg) (Riva-Posse et al., 2018). Although hypertensive patients had higher blood pressure peaks during the infusions, values returned to baseline during post-infusion monitoring at 70 min. For patients with congestive cardiac failure or a history of cerebrovascular accident particular caution should be taken or alternative treatments considered (Short et al., 2018).