Treatment of chronic cerebrovascular disorders

Background: Several studies showed a close link between metabolic syndrome (MetS), type 2 diabetes (T2DM) and cerebrovascular diseases. There is considerable debate regarding the role of uric acid (UA) as a risk factor in these conditions. Objective: The aim of this narrative review is to discuss the links between UA, MetS, T2DM and cerebrovascular disease. Methods: An extensive review has been conducted based on the scientific literature published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and Google Scholar from January to May 2019. Additional relevant studies published after the initial review were also considered during the period of June 2019-October 2019, during which, this manuscript was written. The Mesh Terms considered were: uric acid, antioxidant, oxidant, metabolic syndrome, diabetes, cerebrovascular diseases, stroke, haemorrhagic stroke, neurocognitive disorders, and their combinations. Results: The literature review shows a dose-dependent inflammatory action of UA, which occurs with serum concentrations >4 mg/dl (>0.24 mmol/l), representing one of the contributors to the chronic inflammatory process that underlies metabolic and cerebrovascular diseases. Conclusion: UA, which is associated with arterial hypertension and cardiovascular diseases, represents one of the indicators of oxidative homeostasis. Increasing concentrations represent a status of active inflammation which is observed with metabolic and cerebrovascular diseases.

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A case series of ischemic stroke with coronavirus disease 2019 in two Egyptian centers

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00259-z ◽

2020 ◽

Vol 56 (1) ◽

Author(s):

Nevine El Nahas ◽

Tamer Roushdy ◽

Eman Hamid ◽

Sherien Farag ◽

Hossam Shokri ◽

...

Keyword(s):

Ischemic Stroke ◽

Severe Acute Respiratory Syndrome ◽

Cerebrovascular Disorders ◽

Case Series ◽

Neurological Manifestations ◽

Case Presentation ◽

Novel Virus

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that has been reported to have various neurological manifestations. Cerebrovascular disorders have been encountered as a coronavirus disease 2019 (COVID-19) presentation in our center during the pandemic. Case presentation We are presenting 10 cases with cerebrovascular manifestations after having COVID-19 few days prior to stroke. Conclusion Cerebrovascular manifestations can occur in association with COVID-19 and may have significant implications on prognosis and management.

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Attitude and experience of neurologists towards percutaneous endoscopic gastrostomy: an Egyptian study

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00233-9 ◽

2020 ◽

Vol 56 (1) ◽

Author(s):

Sherien Farag ◽

Shady S. Georgy ◽

Mai Fathy ◽

Ahmed elSadek ◽

Khaled O. Abdulghani

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Neurological Diseases ◽

Public Awareness ◽

Cerebrovascular Disorders ◽

Common Symptom ◽

Nasogastric Feeding ◽

Endoscopic Gastrostomy ◽

Intervention Failure ◽

Self Administered Questionnaire ◽

Nasogastric Tube Insertion

Abstract Background Dysphagia is a common symptom among various neurological diseases. Guidelines recommend gastrostomy insertion for prolonged dysphagia with lower rate of intervention failure encountered with percutaneous endoscopic gastrostomy (PEG) as compared to nasogastric tube insertion. Methods Neurology consultants only were included and completed a self-administered questionnaire concerning their practice backgrounds and previous experience with PEG feeding during their practice. Results Ninety-eight percent stated that they would recommend PEG for patients with prolonged need of nasogastric feeding. However, only 88% actually referred patients to perform PEG, with the cerebrovascular disorders being the most common cases to be referred. The main barriers the surveyed neurologists faced were family resistance and financial reasons (53.5%). Interestingly, younger neurologists practicing for less than 15 years referred patient to perform PEG significantly more frequent than older ones (p = 0.01). About 18% of our sample confirmed the lack of sufficient knowledge about the benefits of PEG feeding, and only 22% previously attended scientific sessions about the benefits and indications of PEG. Conclusion Based on our study, we recommend that PEG should be more encouraged in indicated neurological cases. Scientific sessions targeting neurologists and public awareness about the benefits of PEG and its relatively infrequent complications are highly demanded.

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Pandemics and Burden of Stroke and Epilepsy in Sub-Saharan Africa: Experience from a Longstanding Health Programme

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052766 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2766

Author(s):

Massimo Leone ◽

Fausto Ciccacci ◽

Stefano Orlando ◽

Sandro Petrolati ◽

Giovanni Guidotti ◽

...

Keyword(s):

Neurological Disorders ◽

Combined Treatment ◽

Cerebrovascular Disorders ◽

Sub Saharan Africa ◽

Noncommunicable Diseases ◽

People Living With Hiv ◽

Sub Saharan ◽

Health Programme ◽

Excess Deaths ◽

Hiv Aids

Eighty percent of people with stroke live in low- to middle-income nations, particularly in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades. More than one-third of all epilepsy−related deaths occur in SSA. HIV infection is a risk factor for neurological disorders, including stroke and epilepsy. The vast majority of the 38 million people living with HIV/AIDS are in SSA, and the burden of neurological disorders in SSA parallels that of HIV/AIDS. Local healthcare systems are weak. Many standalone HIV health centres have become a platform with combined treatment for both HIV and noncommunicable diseases (NCDs), as advised by the United Nations. The COVID-19 pandemic is overwhelming the fragile health systems in SSA, and it is feared it will provoke an upsurge of excess deaths due to the disruption of care for chronic diseases such as HIV, TB, hypertension, diabetes, and cerebrovascular disorders. Disease Relief through Excellent and Advanced Means (DREAM) is a health programme active since 2002 to prevent and treat HIV/AIDS and related disorders in 10 SSA countries. DREAM is scaling up management of NCDs, including neurologic disorders such as stroke and epilepsy. We described challenges and solutions to address disruption and excess deaths from these diseases during the ongoing COVID-19 pandemic.

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000358 ◽

2020 ◽

Vol 5 (2) ◽

pp. 152-158

Author(s):

Yuhua Fan ◽

Jian Yu ◽

Hongbing Chen ◽

Jian Zhang ◽

Jiangang Duan ◽

...

Keyword(s):

Secondary Prevention ◽

Clinical Management ◽

Sinus Thrombosis ◽

Cerebrovascular Disorders ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Current Evidence ◽

Current Guideline ◽

Venous Sinus Thrombosis ◽

Venous Thromboembolic Events

AimCerebral venous sinus thrombosis (CVST) is a less common cerebrovascular disease that predominantly affects young patients. The incidence of CVST is 2–5/10 000 000/year, accounting for 0.5%–1% of all stroke. To reduce mortality and morbidity associated with CVST, Chinese Stroke Association commissioned the authors to write the current guideline on the management of CVST.MethodsPubMed (MEDLINE), CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July 2019. Data were synthesised by evidence tables. Each recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow Committees. Levels of evidence grading algorithm of Chinese Stroke Association was used to grade each recommendation.ResultsThis guideline mainly focuses on the diagnostic evaluation, therapeutic strategies and secondary prevention of CVST. CT/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected CVST. Anticoagulation therapy with low-molecular weight heparin should be initiated in patients with CVST immediately. After the acute stage, warfarin is recommended for 3–6 months to prevent the recurrence of CVST and other venous thromboembolic events.ConclusionsThe guideline summarises the current evidence regarding the management of CVST, and provides references for diagnosis, treatment and secondary prevention of CVST in China.

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Oral session 10: Cerebrovascular disorders (2)

Journal of Neurology ◽

10.1007/bf02291292 ◽

1992 ◽

Vol 239 (S2) ◽

pp. S54-S56

Keyword(s):

Oral Session ◽

Cerebrovascular Disorders

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Diabetes Mellitus, Cognitive Impairment, and Traditional Chinese Medicine

International Journal of Endocrinology ◽

10.1155/2015/810439 ◽

2015 ◽

Vol 2015 ◽

pp. 1-14 ◽

Cited By ~ 22

Author(s):

S. W. Seto ◽

G. Y. Yang ◽

H. Kiat ◽

A. Bensoussan ◽

Y. W. Kwan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chinese Medicine ◽

Side Effects ◽

Traditional Chinese Medicine ◽

Cognitive Dysfunction ◽

Scientific Evidence ◽

Cerebrovascular Disorders ◽

Blood Glucose Control ◽

Epidemiological Studies ◽

Therapeutic Benefits

Diabetes mellitus (DM) is a metabolic disorder affecting a large number of people worldwide. Numerous studies have demonstrated that DM can cause damage to multiple systems, leading to complications such as heart disease, cancer, and cerebrovascular disorders. Numerous epidemiological studies have shown that DM is closely associated with dementia and cognition dysfunction, with recent research focusing on the role of DM-mediated cerebrovascular damage in dementia. Despite the therapeutic benefits of antidiabetic agents for the treatment of DM-mediated cognitive dysfunction, most of these pharmaceutical agents are associated with various undesirable side-effects and their long-term benefits are therefore in doubt. Early evidence exists to support the use of traditional Chinese medicine (TCM) interventions, which tend to have minimal toxicity and side-effects. More importantly, these TCM interventions appear to offer significant effects in reducing DM-related complications beyond blood glucose control. However, more research is needed to further validate these claims and to explore their relevant mechanisms of action. The aims of this paper are (1) to provide an updated overview on the association between DM and cognitive dysfunction and (2) to review the scientific evidence underpinning the use of TCM interventions for the treatment and prevention of DM-induced cognitive dysfunction and dementia.

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Spotlight on cerebrovascular disorders

Journal of Neurology ◽

10.1007/s00415-004-0423-2 ◽

2004 ◽

Vol 251 (3) ◽

pp. 373-375

Author(s):

Michael Strupp

Keyword(s):

Cerebrovascular Disorders

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