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Biomedical subjects

J Biller

Publications and source records attributed to J Biller.

At least 37 records · Page 2Linked to original sources
PubMed1998

Reversible segmental cerebral arterial vasospasm and cerebral infarction: possible association with excessive use of sumatriptan and Midrin.

OBJECTIVE: To describe a patient who developed reversible segmental cerebral arterial vasospasm and cerebral infarction while taking excessive amounts of sumatriptan succinate and a combination drug (Midrin) consisting of isometheptene mucate, 65 mg, dichloralphenazone, 100 mg, and acetaminophen, 325 mg. DESIGN: Case report. SETTING: Tertiary care center. PATIENT: A 43-year-old man who developed a left occipital infarct after taking a total of 23 sumatriptan succinate tablets (25 mg per tablet) and 32 Midrin tablets during a 7-day period and who on digital subtraction angiography was shown to have segmental cerebral arterial narrowing in multiple vessels. An extensive evaluation for other possible risk factors for cerebral infarction was unrevealing. MAIN OUTCOME AND RESULTS: Discontinuation of sumatriptan and Midrin regimens and administration of nicardipine hydrochloride led to nearly total resolution of the angiographic findings, and the patient had no recurrent strokes. CONCLUSIONS: One should consider the diagnosis of drug-induced vasospasm in patients with cerebral infarction and a history of excessive use of sumatriptan and Midrin. The initial angiographic abnormalities may resemble those found in patients with primary angiitis of the central nervous system.

Acetaminophen↗
PubMed1998

Is hormone replacement a risk factor for ischemic stroke in women with factor V Leiden mutation?

OBJECTIVE: To describe a patient with multifocal cerebral ischemia whose only identified potential risk factors were use of postmenopausal hormone replacement and heterozygosity to factor V Leiden mutation. DESIGN: A case report. SETTING: A tertiary care center. PATIENT: A 51-year-old woman taking hormone replacement (0.625 mg/d of estrogen alternating with 10 mg/d of medroxyprogesterone) presented with a generalized tonic-clonic seizure. She had persistent multifocal non-enhancing lesions on magnetic resonance imaging of the brain. A stereotactic biopsy of the brain performed to exclude gliomatosis cerebri was consistent with cerebral ischemia. An extensive evaluation to uncover the cause of stroke revealed only heterozygosity to factor V Leiden mutation. MAIN OUTCOME AND RESULTS: Hormonal replacement was discontinued and the patient had no recurrent ischemic strokes. CONCLUSIONS: Postmenopausal hormonal replacement may be a risk factor for ischemic stroke in women with the factor V Leiden mutation. Ongoing trials of hormonal replacement provide an opportunity to test this hypothesis.

Brain Ischemia↗
PubMed1998

Medical and surgical management of intracerebral hemorrhage.

Intracerebral hemorrhage accounts for about 10% of all strokes. The diagnosis of this stroke subtype has been revolutionized by the use the computed tomography scanner. Therapeutic intervention in the form of medical and surgical management is reviewed. The critical management issues center on identifying the etiology of hemorrhage, controlling blood pressure, and controlling intracranial pressure.

Brain Neoplasms↗
PubMed1998

Adverse haematological effects of ticlopidine. Prevention, recognition and management.

Ticlopidine is an antiplatelet agent that is used to reduce the occurrence of atherothrombotic arterial events. There have been major multicentre placebo-controlled trials evaluating its use in stroke, peripheral arterial disease and unstable angina. In rare cases, adverse haematological effects have been seen with ticlopidine. Ticlopidine has been associated with neutropenia in some of the major trials and in subsequent case reports it has been associated with aplastic anaemia, thrombocytopenia and thrombotic thrombocytopenic purpura, which have been fatal in some instances. Ticlopidine should be used only in patients with an established indication for its use. Patients should be educated about the potential adverse effects and complications associated with ticlopidine, including possible death. Finally, there should be careful attention to haematological monitoring to screen for and promptly detect any adverse effects.

Anemia, Aplastic↗
PubMed1997

Subtypes of ischemic stroke in children and young adults.

Specific strategies for primary and secondary stroke prevention in children and young adults can only be recommended once the causes of stroke in these age groups are well described. ICD-9 codes were used to identify children aged 1 to 18 years with acute ischemic stroke. Young adults aged > 18 to 45 years were identified from the Indiana University and Northwestern University Young Adults Stroke Registries. Validated criteria were used to subtype ischemic stroke as atherothrombotic (AT), cardioembolic (CE), small-vessel (SV), other determined cause, or unknown cause. Ninety-two children and 116 young adults were identified. Stroke subtypes in children/young adults (percentages) were as follows: AT 0/16 (p < 0.001), CE 15/14 (p = 1.0), SV 0/3 (p = 0.26), other 49/44 (p = 0.40), and unknown 36/23 (p = 0.04). Children had more prothrombotic causes (25% versus 14%, p = 0.03), and young adults had more dissections (3% versus 15%, p = 0.005). Children aged 15 to 18 years had causes of ischemic stroke more similar to those in young adults. The cause of ischemic stroke is less often identified in children than it is in young adults. Children have more prothrombotic causes of stroke, and adults have more atherothrombotic causes and dissections. Lacunar strokes are rare in both children and young adults. The age of 15 years should be used to separate childhood from young-adult ischemic stroke.

Adolescent↗
PubMed1997

Manipulation of coagulation factors in acute stroke.

In patients with an acute cerebral infarction, anticoagulation may spare tissue in the ischaemic penumbra from irreversible necrosis by preventing thrombus extension from a vascular bed with good collateral circulation to one with poor collateral circulation. In addition to the possibility of limiting infarct volume, anticoagulation may be given acutely to prevent early recurrent cerebral infarction or to prevent or treat thrombus outside the nervous system (i.e. deep venous thrombosis or pulmonary embolus). In one controlled trial of a low molecular weight heparin, administration of nadroparin calcium within 48 hours of onset of cerebral infarction decreased the combined incidence of dependency and all-cause mortality at 6 months. Another controlled trial in patients with cerebral venous thrombosis demonstrated the benefit of continuous intravenous adjusted-dose unfractionated (UF) heparin compared with placebo. Although results of anticoagulation appear promising in patients with acute cerebral infarction and cerebral venous thrombosis, the benefits of these agents remain unconfirmed. The results of large multicentre trials using a heparinoid (ORG 10172) and subcutaneous UF heparin in patients with acute cerebral infarction are expected within the year.

Acute Disease↗
PubMed1997

Prevention of primary event. Ischemic stroke risk detection and reduction.

Risk detection and reduction methods for persons at high risk of ischemic stroke involve screening and identification of risk factors. Population-based health surveys affirm a persistent dilemma in the inability to reduce the frequency of ischemic stroke risk factors, such as hypertension, cigarette smoking, obesity, and physical inactivity levels. These alarming trends indicate that "mass approach" policies and programs need to be implemented or rethought to attain maximum levels of benefit in ischemic stroke risk reduction for the entire community.

Brain Ischemia↗
PubMed1997

[Stroke therapy in children].

OBJECTIVE: To evaluate the treatment modalities used in children (ages 1-18 years) with cerebral infarction. BACKGROUND: [corrected] Cerebrovascular disease in children is more common than once suspected but its treatment has not been rigorously studied. MATERIAL AND METHODS: We reviewed all cases of cerebral infarction at the James Whitcomb Riley Hospital for Children at the Indiana University Medical Center from 01.01.80 to 31.12.95. RESULTS: Ninety-three children who experienced ischemic strokes were followed over the past fifteen years. Fifty-seven males and thirty-six females comprised the sample. Mean age was 6.9 years at the time of stroke. No medication or surgical intervention was the therapeutic recommendation in 44% of patients. For cardioembolic strokes, warfarin was used later in the course for a few patients who went on to have atrial fibrillation or valve replacement. Aspirin was used in all patients with carotid artery dissections. Aspirin was used in most children with Moya-Moya, with calcium channel blockers and surgical intervention used in later cases. Exchange transfusion followed by monthly transfusion and chelation therapy has been the treatment of choice for children with cerebral infarction complicating sickle cell disease. CONCLUSIONS: In most instances, treatment was widely disparate, probably reflecting the lack of firm therapeutic guidelines for this age group, with a better understanding of the etiology and pathophysiology of strokes in children, multicenter, international, randomized therapeutic trials based strictly on an etiological basis should be organized in the future.

Adolescent↗
PubMed1995

Ischemic stroke in young adults. Experience in 329 patients enrolled in the Iowa Registry of stroke in young adults.

OBJECTIVES: To describe the likely causes of ischemic stroke in a population of young adults and to report the influence of strict algorithms on the diagnosis of the likely cause of stroke in this cohort. DESIGN: Between July 1, 1977, and January 1, 1993, we registered 329 young adults with ischemic stroke in our registry. Diagnostic studies were selected on a case-by-case basis. Presumed causes of stroke were determined using clinical information and the results of diagnostic tests. In each case, a second causative diagnosis was made using the criteria developed for a large clinical trial. SETTING: Patients referred to the Division of Cerebrovascular Diseases in the Department of Neurology at the University of Iowa Hospitals and Clinics, Iowa City, by physicians in Iowa and adjacent states. PATIENTS: Three hundred twenty-nine young adults (182 men and 147 women) aged 15 to 45 years with ischemic stroke; 102 persons, 48 men and 54 women, were aged 30 years or younger. RESULTS: Cerebral arteriography was performed in 227 cases, and the findings were abnormal in 146. Transthoracic echocardiography revealed abnormalities in 82 of 221 patients examined. We identified approximately 60 different disorders that were presumed to be the cause of stroke. There were no major changes in the frequency of subtype diagnoses between the first 144 patients and the subsequent 185. Use of strict diagnostic criteria increased the number of cases of stroke of undetermined etiology (from 45 to 113), and the number attributed to large artery atherosclerosis declined from 71 to 32. CONCLUSIONS: The causes of ischemic stroke in young adults are numerous. Because treatment options in this group are influenced by a presumed cause, an evaluation on a case-by-case basis is warranted. Our experience suggests that a likely cause will be detected in most cases and that a regimented battery of tests may not be required. If strict diagnostic criteria are used, the diagnosis of stroke of undetermined etiology considerably increases. While such strict criteria are important in clinical trials that test new interventions, the value of the application of such methodologies to an unusual population, such as stroke in young adults, needs clarification. In particular, the usefulness of categorizing a stroke as undetermined when two or more possible causes are identified needs to be explored.

Adolescent↗
PubMed1995

Cervical (C2) herpes zoster infection followed by pontine infarction.

This article reports a man who had herpes varicella zoster cervicalis with delayed stroke in the posterior circulation. Empiric treatment was acyclovir, methylprednisolone, and aspirin. Pontine infarction involving migration of the virus via cervicovascular innervation from C2 dorsal root ganglia to the vertebrobasilar circulation with attendant angiitis/angiopathy and thrombosis is proposed.

Basilar Artery↗
PubMed1995

Magnetic resonance versus computed tomographic imaging in acute stroke.

BACKGROUND AND PURPOSE: This study was an attempt to determine whether CT and MRI are comparable or if one is superior to the other in the early detection of ischemic stroke or hematoma. METHODS: Patients with acute stroke were sought within 3 hours of onset for clinical examination and prospective evaluation by concurrently performed CT and MRI. Repeated clinical and imaging studies were undertaken when possible immediately after imaging and at 24 hours, 3 to 5 days, and 3 months. The study neurologists were blinded to the results of imaging, as were the study radiologists to the clinical findings. The study radiologists read the scans in sequence, mapping each imaging on standard templates before viewing a later scan. No retrospective revisions of imaging mapping of earlier images were undertaken. RESULTS: Sixty-eight patients were recruited within 4 hours and an additional 12 patients within 24 hours. Seventy-five strokes were due to infarction and five to hemorrhage. The median time to first scan was 132 minutes. Although some of the infarctions in 75 patients were detected within 1 hour, the fraction of positive first scans approached an asymptote at 2 to 3 hours. Overall, with the use of conventional non-contrast-enhanced CT and T1- and T2-weighted MRI, neither was superior in the very early detection of either hematoma or infarction. There was a marginally significant correlation between early positive brain imaging and the severity of the stroke. Some patients had initially positive CT and/or MRI scans, but their neurological examination had returned to normal by 24 hours. Overall, CT was better than baseline MRI at predicting 24-hour outcome. After 24 hours, both CT and MR more conspicuously defined the lesion limits than they did at baseline. CONCLUSIONS: With the technology available through 1991, neither CT nor MRI proved superior in the detection of the earliest signs of stroke.

Adolescent↗
PubMed1995

Ischemic cerebrovascular disease and hormone therapy for infertility and transsexualism.

To highlight an emerging risk factor for stroke in the young, we report two patients who experienced ischemic cerebrovascular symptoms in unusual clinical settings of hormone therapy. Expanding indications for estrogenic therapy, including infertility and gender identity disorders, may constitute an emerging risk factor for ischemic stroke in young individuals.

Adult↗