Hypertension after brainstem stroke

Paroxysmal hypertension associated with diaphoresis and facial flushing occurs after brain injury and after spinal cord lesion above the level of sympathetic outflow. This excessive sympathetic activity is due to the failure of inhibitory impulses from supraspinal vasomotor centers to reach the spinal sympathetic outflow. A case of brainstem stroke, with weakness in all four extremities, is presented. The patient experienced paroxysms of hypertension with bladder spasms, which subsided after treatment of the spasms resulting from bladder infection. Serum levels of dopamine, norepinephrine, and epinephrine were elevated during the episode and were normal after subsidence of the paroxysms.     

Headache associated with acute ischemic stroke

Headache occurs frequently in acute ischemic stroke, but its frequency varies widely among different studies. We have prospectively studied headache features in patients with first-ever ischemic acute stroke and assessed the relationship between headache, stroke location, and etiology. The study included consecutive patients admitted to our Stroke Unit for a first-ever ischemic acute stroke. The study included 154 consecutive patients with ischemic stroke, and 54 of these (35.1%) had headache during stroke onset. Twelve patients (22.2%) with headache during stroke had history of headache; no patients without headache had history of headache. Headache was present in 25.8% (32/124) of the patients with anterior circulation stroke and in 73.3% (22/30) of the patients with posterior circulation stroke (p=0.001). Large artery disease was more frequent with than without headache (40.7% versus 14.0%, p=0.04). Headache was present in more than one-third of the patients with ischemic stroke. All patients with positive history for headache had headache during stroke onset. The cephalic pain was much more common among patients with infarcts in the posterior circulation than in patients in whom the anterior circulation was involved. Headache was more common when the cause of stroke was large artery disease. Received: 5 January 2001 / Accepted in revised form: 6 April 2001     

脑卒中后肩部问题

脑卒中后常见的肩部问题包括:肩关节半脱位、肩手综合征和肩痛。(1)肩关节半脱位治疗包括:矫正肩胛骨的位置,恢复肩原有的锁定机制;刺激肩关节周围固定肌的活动及张力;在不损伤关节及其周围结构的前提下,保持肩关节无痛性的全范围被动活动。(2)肩-手综合征治疗主要是减轻水肿和疼痛,改善手、腕关节的活动度。(3)肩痛的治疗包括改善肩胛骨活动度、体位摆放、增加被动活动度及指导患者采用正确的肩关节运动来逐步改善患者的症状。     

Delayed ischemic stroke associated with methamphetamine use

A 19-year-old woman had right occipital infarction 3 months after she had injected methamphetamine. No other possible causes of stroke could be found in this case. Magnetic resonance angiography revealed beading of the right posterior cerebral artery, which suggested vasculitis. Her symptoms were right-sided headache, left superior quadrant hemianopia, and left hypesthesia, which gradually improved without any treatment. Methamphetamine has been known to cause hemorrhagic and ischemic stroke relatively soon after administration. We report here that methamphetamine may also cause chronic cerebral vasculitis and delayed ischemic stroke.     

Factors associated with community ambulation in chronic stroke

Purpose: Loss of independent community ambulation is one of the most disabling consequences of stroke. The aim of this study was to investigate the association of multiple personal and post-stroke factors with community ambulation in persons between 1- and 3-year post-stroke. Methods: This was a cross-sectional study of 40 community-dwelling stroke patients, >18 years, between 1- and 3-year post-stroke. The main outcome measures used were self-report community ambulation questionnaire, demographic information, 10-M Walk Test, Timed Up and Go test, Activities-Specific Balance Confidence Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Trail-Making Test-Part B, Single Letter Cancellation Test. Results: Age, number of medications and use of a walking aid were found to be significantly associated with community ambulation (p?≤?0.05). Gait speed, walking balance and balance self-efficacy were also found to be significantly associated with community ambulation (p?≤?0.05). Balance self-efficacy was the only factor independently associated with community ambulation post-stroke (p?≤?0.05). Conclusion: Balance self-efficacy may be a significant determinant in the attainment of independent community ambulation post-stroke. This suggests that physical aspects such as gait speed and walking balance should not be considered in isolation when addressing community ambulation post-stroke.

• Implications for Rehabilitation

• Balance self-efficacy may play a significant role in the attainment of independent community ambulation in a chronic stroke population.

• Physiotherapy interventions addressing community ambulation post-stroke should consider methods for improving balance self-efficacy in chronic stroke, such as self management programmes.

     

脑卒中患者临床表现与预后的关系

目的　探讨脑卒中病人某些临床表现与预后的关系。方法　对我院 1997年 5月至 2 0 0 4年 4月收治的 189例脑卒中患者的临床表现与预后进行统计分析。结果　发现脑卒中患者中伴有意识障碍、视乳头水肿、双侧瞳孔不等大、应激性溃疡、抽搐者预后极差 ,与不伴有意识障碍、视乳头水肿、双侧瞳孔不等大、应激性溃疡、抽搐者对比有显著差异 (P均 <0 .0 1)。头痛、高血压、发热、电解质紊乱、肝肾功能不全对预后影响不大 ,与无头痛、高血压、发热、电解质紊乱、肝肾功能不全者对比无显著差异 (P均 >0 . 0 5 )。结论　脑卒中的预后与某些临床并发症有密切关系 ,并发症越多、越重 ,预后越差。     

Hypertension and stroke in a young man with obstructive sleep apnea syndrome

In the case reported here, a 34-year-old man with severe obstructive sleep apnea syndrome had arterial hypertension and had had a stroke that caused right hemiplegia. A review of the literature reveals a surprisingly high occurrence of arterial hypertension in subjects with obstructive sleep apnea syndrome, including children. The cause of hypertension in these patients is not clear. Surgical procedures and a new nonsurgical treatment have been successful in relieving the symptoms of obstructive sleep apnea. Our patient's symptoms resolved completely after uvulopalatopharyngoplasty and tonsillectomy. However, his arterial hypertension persisted.     

Fatigue associated with stroke and other neurologic conditions: Implications for stroke rehabilitation

OBJECTIVES: To examine the general phenomenon of fatigue in stroke and other neurologic disorders and to review what is currently known about its occurrence, including its frequency, duration, severity, and associated factors, to develop a strategy for treatment. DATA SOURCES: Computerized databases (eg, PubMed, PsycInfo, Science Citation Index, Ovid EMBASE, Ovid MEDLINE) searched from inception to May 2002. Additional references were identified from bibliographies of pertinent articles and books. STUDY SELECTION: Over 1000 articles were identified as relevant to fatigue experienced by patients with neurologic or nonneurologic disorders. Articles on fatigue in stroke and neurologic disorders, mechanisms, and/or treatment were selected for inclusion. DATA EXTRACTION: Authors reviewed the articles and assessed the purpose, study design, and conclusions for validity and relevance to the topic of fatigue in stroke. DATA SYNTHESIS: Fatigue is a common complaint among patients with neurologic disorders including stroke. Few studies have documented the high frequency of fatigue in poststroke patients and its negative impact on daily functioning and quality of life. Little is known about associated factors or about therapeutic strategies that may be used to alleviate it. Examination of fatigue in other neurologic populations suggests common characteristics and associated factors that may be useful in the development of potential therapeutic strategies. Pharmacologic and nonpharmacologic therapeutic interventions, such as stimulants, amantadine, or sleep and stress-management education, have been used with some success in neurologic and other patient populations (eg, multiple sclerosis, human immunodeficiency virus, acquired immune deficiency syndrome, cancer), but evidence of effectiveness based on randomized clinical trials is rare. CONCLUSIONS: Poststroke fatigue is common. Therapeutic strategies have been used to treat fatigue in other patient populations, but it is unclear whether these will be beneficial to poststroke patients. Frequency, severity, duration, impact, predisposing factors, and causes of poststroke fatigue, as well as the development of effective treatment, require further research. Criteria for assessment of fatigue and potential therapeutic interventions are outlined as a first step for stimulating further research.     

Hypertension and altered cardiovascular variability associated with obstructive sleep apnea

In the past 5 years several epidemiologic studies have demonstrated that sleep-related breathing disorders are an independent risk factor for hypertension, probably resulting from a combination of repetitive episodes of hypoxia, hypercapnea, arousals, and a striking surge in sympathetic excitation, and altered baroreflex control during sleep. Obstructive sleep apnea (OSA) may lead to the cardiac arrhythmias and myocardial ischemia and it is a possible risk factor for stroke. We confirmed that nasal CPAP has been shown to lower blood pressure in some hypertensive OSA patients. Early recognition and treatment of sleep-apnea may improve cardiovascular function.     

Factors associated with life satisfaction in Japanese stroke outpatients

Purpose. To measure life satisfaction in Japanese stroke outpatients and randomly-sampled community residents and to investigate variables influencing their life satisfaction.

Method. Data on the demographic and clinical profiles, Satisfaction in Daily Life (SDL), other measurements, were obtained from 869 stroke outpatients (552 males, 317 females) and 748 community-dwelling elderly (360 males, 388 females), aged 55 years and older. Differences in categorical variables and continuous variables were tested by chi-square test and ANCOVA with age as the covariate, respectively.

Results. The 11 SDL items were subjected to a factor analysis, which extracted two factors. Factor 1 (F1), labeled as ‘satisfaction with one's own abilities’, included satisfaction with housework, self-care, gait, physical health, hobby and leisure, social intercourse and mental health. Factor 2 (F2), ‘satisfaction with external factors’, included satisfaction with partner/family relationship, economic state and social security, and house facilities. Both F1 and F2 scores were significantly lower for stroke outpatients (M = 19.7 and 10.9, respectively) than for community-dwelling elderly (M = 28.2 and 12.0, respectively) (p < 0.001). Living conditions were significantly associated with F2, but not with F1. Males living alone scored lowest on F2 than the others for both groups. Among stroke outpatients, both F1 and F2 scores differed significantly by the type of hemiparesis and the severity of aphasia.

Conclusions. SDL of stroke outpatients, which was lower than community-dwelling elderly, differed by the type of hemiparesis, the severity of aphasia, and living conditions. The effects of living conditions might vary with gender.     

Factors associated with life satisfaction in Japanese stroke outpatients

PURPOSE: To measure life satisfaction in Japanese stroke outpatients and randomly-sampled community residents and to investigate variables influencing their life satisfaction. METHOD: Data on the demographic and clinical profiles, Satisfaction in Daily Life (SDL), other measurements, were obtained from 869 stroke outpatients (552 males, 317 females) and 748 community-dwelling elderly (360 males, 388 females), aged 55 years and older. Differences in categorical variables and continuous variables were tested by chi-square test and ANCOVA with age as the covariate, respectively. RESULTS: The 11 SDL items were subjected to a factor analysis, which extracted two factors. Factor 1 (F1), labeled as 'satisfaction with one's own abilities', included satisfaction with housework, self-care, gait, physical health, hobby and leisure, social intercourse and mental health. Factor 2 (F2), 'satisfaction with external factors', included satisfaction with partner/ family relationship, economic state and social security, and house facilities. Both F1 and F2 scores were significantly lower for stroke outpatients (M = 19.7 and 10.9, respectively) than for community-dwelling elderly (M = 28.2 and 12.0, respectively) (p < 0.001). Living conditions were significantly associated with F2, but not with F1. Males living alone scored lowest on F2 than the others for both groups. Among stroke outpatients, both F1 and F2 scores differed significantly by the type of hemiparesis and the severity of aphasia. CONCLUSIONS: SDL of stroke outpatients, which was lower than community-dwelling elderly, differed by the type of hemiparesis, the severity of aphasia, and living conditions. The effects of living conditions might vary with gender.     

Hypertension,stroke and the impact of atrial fibrillation

Radial artery occlusion (RAO) is a usually silent complication of transradial approach that may prevent future transradial procedures. It is caused by intimal hyperplasia, intima–media thickening and luminal thrombosis. RAO incidence has been reported with a wide range, probably due to different catheterization protocols and diagnosis tests adopted. Since simple pulse check at the level of radial cannulation is not reliable, plethysmography and duplex ultrasound are required to assure diagnosis. Besides the relevance of other clinical and procedural factors, inadequate heparinization and occlusive hemostasis constitute the main modifiable factors associated with risk of RAO. Finally, RAO should not be regarded as an irreversible condition since ulnar artery compression may restore patency in the case of early diagnosis, and recanalization techniques have been recently proposed to allow successful recatheterization in RAO patients.     

Barriers associated with exercise and community access for individuals with stroke

Increasing participation in physical activity among people with stroke continues to be a major challenge for healthcare professionals. We administered a survey to a group of 83 adults with unilateral stroke (mean age = 54.2 yr) to determine their perceived barriers to exercise. The five most common barriers in rank order were (1) cost of the program (61%), (2) lack of awareness of a fitness center in the area (57%), (3) no means of transportation to a fitness center (57%), (4) no knowledge of how to exercise (46%), and (5) no knowledge of where to exercise (44%). The least common barriers were (1) lack of interest (16%), (2) lack of time (11%), and (3) concern that exercise would worsen their condition (1%). People with stroke reported several barriers that prevented or reduced their participation in exercise. Healthcare professionals must identify and remove these barriers to promote greater participation in exercise among people with stroke.     

Hypertension associated polymorphisms in WNK1/WNK4 are not associated with hydrochlorothiazide response

Objectives

Our purpose was to investigate whether with-no-K[Lys] kinase (WNK) 1 and WNK4 genetic polymorphisms are associated with both hypertension and diuretics response.

Design and methods

Two WNK1 and one WNK4 polymorphisms were detected in two independent populations (n = 1592 and 602) for association with hypertension, and in two clinical trials of hydrochlorothiazide treatment (n = 542 and 274) for association with diuretics response.

Results

Two polymorphisms were found to be associated with hypertension risk with odds ratio of 1.55 for WNK1 rs1468326 (P < 0.001) and 1.88 for WNK4 rs9916754 (P < 0.001) in the first population, and 1.54 for WKN1 rs1468326, and 1.82 for WNK4 rs9916754 in the second population. However, two clinical trials found no relationship between these WNK polymorphisms and systolic/diastolic blood pressure responses to 4 or 8 weeks treatment of hydrochlorothiazide.

Conclusion

Our findings suggest that hypertension associated polymorphisms in WNK1 and WNK4 may not be predictors for antihypertensive response to diuretics.