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Biomedical subjects

P B Gorelick

Publications and source records attributed to P B Gorelick.

At least 19 recordsLinked to original sources
PubMed2000

Stroke in African Americans.

There is an excess burden of cerebrovascular disease in African Americans. This article will define possible reasons for excess stroke risk, review racial differences in stroke subtype and stroke prevention programs in the African American Community, and delineate sequelae of stroke. The authors provide insights about stroke prevention in African Americans and highlight challenges to reduce the burden of cerebrovascular disease in this high-risk group.

Black People↗
PubMed1999

Ischemia in the territory of a hypoplastic vertebrobasilar system.

BACKGROUND: Congenital variations in the configuration and size of the cerebral vessels may predispose to ischemic stroke. OBJECTIVES/METHODS: To illustrate that a hypoplastic basilar artery may lead to posterior circulation ischemia in adults, eight cases are reported from two university medical centers. RESULTS: Five men and three women with a mean age of 49.8 years are reported. Four of the patients had other conventional stroke risk factors. Two patients had brainstem strokes, and six had TIA. All patients had hypoplastic basilar arteries. Seven patients had at least one hypoplastic vertebral artery (bilateral in five cases), and six patients had both posterior cerebral arteries originating from the internal carotid arteries. CONCLUSIONS: A hypoplastic basilar artery is frequently accompanied by vertebral artery hypoplasia, and this can predispose adults to posterior circulation ischemia. This entity can be suspected on the basis of MR angiogram, but conventional angiography will provide definitive diagnosis. Optimal medical and surgical treatment of this condition is unresolved.

Adult↗
PubMed1999

Therapeutic benefit. Aspirin revisited in light of the introduction of clopidogrel.

BACKGROUND: Antiplatelet agents are widely recognized for their efficacy in reducing the occurrence of vascular events in patients with atherothrombotic disease. Aspirin is currently considered to be the "reference standard" antiplatelet agent and is recommended by the American Heart Association for use in patients with a wide range of manifestations of cardiovascular disease on the basis of its high benefit-to-risk and benefit-to-cost ratios. Recently, clopidogrel (Plavix, Bristol-Myers Squibb Co), another antiplatelet agent, was approved by the Food and Drug Administration for many of the same indications as aspirin. SUMMARY OF REVIEW: Because physicians will be faced with deciding whether to switch from the well-established practice of recommending aspirin for use in patients with atherothrombotic disease, both aspirin and clopidogrel are compared with respect to the primary factors that influence such decisions (ie, their relative efficacy, safety, cost, and convenience of use). CONCLUSIONS: Based on the available evidence, aspirin is preferred for the majority of stroke or myocardial infarction patients at risk of recurrent atherothrombotic events. Clopidogrel may, however, provide valuable therapeutic benefit over aspirin in patients with peripheral arterial disease and in stroke or myocardial infarction patients for whom aspirin treatment is contraindicated or for whom aspirin fails to achieve the desired therapeutic effect.

Aspirin↗
PubMed1999

Plasma lipids and stroke.

High plasma levels of lipids are an important modifiable risk factor for coronary heart disease, but are not established as a risk factor for stroke. Pathophysiologic evidence that links lipids to major systemic artery disease, and the results of clinical trials of coronary heart disease prevention in relation to lipid-lowering suggest that lipids may play an important role in the causation of stroke. We discuss the controversy concerning plasma lipids as a risk factor for stroke. A clinical trial targeted at lowering levels of lipids with the aim of primary stroke prevention would be a timely and important contribution. Armed with this information, we could further clarify the plasma lipid-stroke controversy and move into the 21st century with a better understanding of stroke prevention.

Humans↗
PubMed1999

Risk factors and their management for stroke prevention: outlook for 1999 and beyond.

Stroke is a leading cause of death and morbidity, but incidence rates vary dramatically from one population to another. The reasons for this heterogeneity are being explored in several large-scale epidemiologic studies around the world. Much of the heterogeneity in stroke can be related to the prevalence of risk factors, but some populations have a higher stroke incidence than would be predicted from risk factor levels. Hypertension, including borderline hypertension, is probably the most important stroke risk factor based on degree of risk and prevalence. However, cardiac morbidity, cigarette smoking, diabetes, physical inactivity, and high levels of alcohol consumption are also strongly related to stroke risk. High levels of blood cholesterol and homocysteine may also increase stroke risk. Mortality after stroke is highest within the first 30 days but remains elevated to a degree that depends on the presenting stroke syndrome, stroke subtype, and other co-morbidities. Lacunar strokes have the best short- and long-term prognoses. Strokes due to large-vessel atherosclerosis frequently worsen; these and cardioembolic strokes have the poorest long-term prognosis. The risk for recurrence is also highest within 30 days after a first stroke, depending on the type of infarct, history of hypertension, and blood glucose levels on admission. Predictors of late recurrence include cardiac disease, hypertension, and heavy alcohol use. Only about half of stroke survivors are independent 6 months after a stroke, and quality of life is decreased. Understanding factors that predispose to stroke and determine its outcome will help in the design of acute stroke trials and in prevention programs.

Humans↗
PubMed1998

"Naturalization" of the alien hand: case report.

The alien hand syndrome is an involuntary motor phenomenon that occurs infrequently and mostly in stroke patients. A case is reported of a 67-year-old man with left hemiparesis whose hand crept and crawled, especially at night, which caused him to awaken by grasping his collar. The disturbing nocturnal activity of the hand was stilled by placing it in a common oven mitt.

Aged↗
PubMed1998

Vascular dementia: a contemporary review of epidemiology, diagnosis, prevention, and treatment.

The past decade has seen a renewed interest in vascular dementia. Key epidemiologic studies have examined the prevalence, incidence, course and risk factors of vascular dementia. New classification systems have been developed to improve the reliability of the diagnosis, and there have been advances in diagnostic methodology, such as neuroimaging and neuropsychological assessment. New treatments for vascular dementia are being developed to protect the brain from cerebral ischemia and to limit progression of cognitive impairment. Diagnostic criteria for vascular dementia remain to be validated by carefully designed, systematic, clinicopathologic study. Once such criteria are validated, meaningful study of subgroups of vascular dementia can be explored. Until the relationship between vascular dementia and Alzheimer's disease is better defined, the nosology for vascular dementia may be defined best as dementia associated with stroke.

Dementia, Vascular↗
PubMed1998

Calcific cerebral embolism in systemic calciphylaxis.

Calciphylaxis represents a rare complication of end-stage renal disease with hyperparathyroidism. We report the case of a 26-year-old woman with systemic calciphylaxis secondary to chronic renal failure who developed mitral annular calcification and a right middle cerebral artery stroke. The high-density lesion seen on CT scan of the brain probably represents a calcified cerebral embolus originating from the mitral valve.

Adult↗
PubMed1998

The recruitment triangle: reasons why African Americans enroll, refuse to enroll, or voluntarily withdraw from a clinical trial. An interim report from the African-American Antiplatelet Stroke Prevention Study (AAASPS).

Recruitment and retention of study subjects are key to the success of a clinical trial. In the case of minority patients, this may be challenging as minority patients have been underserved by the medical health-care system. Furthermore, minority patients are more likely to experience barriers to entry into a clinical trial such as mistrust of the medical system, economic disadvantages, lack of awareness of study programs, and communication barriers. An open-ended questionnaire was used to determine reasons why subjects in the African-American Antiplatelet Stroke Prevention Study (AAASPS) remained in the study or voluntarily withdrew in the absence of an adverse event. Potential enrollees who refused to participate in the AAASPS also were queried. Enrollees who remained in the program consistently stated that they participated to reduce the risk of stroke recurrence and to help others by finding a "cure" for stroke. Those who withdrew or refused to participate consistently stated that they were afraid of being used as "guinea pigs." A "recruitment triangle" emerged that might predict a patient's likelihood of participation in a clinical trial. The sides of the triangle include the patient, key family members and friends, and the primary medical doctor and other medical personnel. The organizers of a clinical trial need to be aware of the "recruitment triangle" and establish strategies to heighten and maintain its integrity.

Black or African American↗