PubMed · 14712158
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Andreas Stang. 2004. Ischemic stroke and temperature decrease.. https://doi.org/10.1097/01.ede.0000100147.48679.8a
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Patients with ischemic stroke are sometimes found to have an underlying inherited (deficiency of protein C, protein S, antithrombin III, activated protein C resistance, prothrombin gene mutation, hyperhomocysteinemia) or acquired thrombophilia (lupus anticoagulant and anticardiolipin antibodies, hyperhomocysteinemia). Patient selection for thrombophilia screening is, therefore, a frequent question in managing patients with ischemic stroke. In this review we discuss patient selection and timing for laboratory tests for thrombophilia screening in stroke patients based on a literature review and we calculated overall costs per year in Germany for testing patients older than 18 years with an ischemic stroke of undetermined cause. As there is a lack of studies comparing anticoagulation with antiplatelet therapy in patients with diagnosed thrombophilia, laboratory screening for thrombophilia even in a selected group of patients with cryptogenic ischemic stroke remains of questionable value at present. An exception appears to be testing for lupus anticoagulant and anticardiolipin antibodies in younger patients with suspected antiphospholipid syndrome (two positive test results necessary), because anticoagulation seems to be superior to aspirin in patients with antiphospholipid syndrome.
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Cerebral ischaemia is a dynamic process affecting the cerebral parenchyma, with transient or permanent clinical symptoms, of varying duration and severity, and which is due to the occlusion of an artery in most cases. The clinical characteristics of cerebral ischaemia include sudden focal cerebral or ocular deficits, which may or may not resolve and have further clinical repercussions. On more rare occasions, ischaemia can be detected in an inadvertent fashion during a general or neurological check-up. In 80% of cases, the anterior (carotid) arterial system is affected, while in the remaining 20%, the posterior (vertebrobasilar) system is involved. Cerebral ischaemia is a medical emergency requiring prompt management and a thorough understanding of clinical semiology as soon as acute manifestations appear. The detection and prediction of cerebral ischaemia will be facilitated through the use of novel neuroimaging techniques, aiding therapeutic decision-making.