Cerebrovascular diseases
-
Cerebrovascular diseases · Jan 2003
ReviewLong-term outcome after ischaemic stroke/transient ischaemic attack.
During the first 30 days after a stroke, the case fatality is about 25% and the major cause of death is the index stroke and its sequelae. The most consistent predictor of 30-day mortality after stroke is stroke severity. Other predictors include increasing age, a history of previous stroke, cardiac failure, and a high blood glucose concentration and white blood cell count. ⋯ The most powerful predictor of early recurrent stroke (within 30 days after stroke) is an atherosclerotic ischaemic stroke caused by large-artery atherosclerosis with >50% stenosis, whereas the strongest predictor of stroke recurrence over 5 years is diabetes. Other predictors of recurrent stroke include increasing age, previous TIA, atrial fibrillation, high alcohol consumption, haemorrhagic index stroke, and hypertension at discharge. The clinical implication of these findings is that strategies for optimizing long-term outcome after TIA and stroke should be directed toward reducing the high risk of recurrent stroke and coronary events by removing/recanalizing the symptomatic atherosclerotic plaque, controlling the underlying causal vascular risk factors, and administering long-term, effective antiplatelet therapy.
-
The occurrence of stroke in patients with human immunodeficiency virus (HIV) infection has been traditionally associated with opportunistic infections and tumors, and advanced stages of immunosuppression. However, this reality is undergoing major changes. Effective antiretroviral regimens are now able to forestall the progression of HIV infection and avoid early mortality. ⋯ Cerebrovascular hemodynamic function is impaired in HIV-infected patients with evidence of abnormal vasoreactivity even in otherwise healthy individuals. The potential contribution from these novel mechanisms should be added to the high incidence of classic vascular risk factors in the HIV-infected population and the cardiac abnormalities frequently observed in these patients. Large-scale epidemiological studies should be carried out to define the true incidence of stroke in HIV-infected patients and the factors associated with its occurrence.