Background And Purpose: Genetic factors influence risk for ischemic stroke and likely do so at multiple steps in the pathogenic process. Variants in genes related to inflammation contribute to risk of stroke. The purpose of this study was to confirm our earlier finding of an association between allele 2 of a variable number tandem repeat of the IL-1 receptor antagonist gene (IL1RN) and cerebrovascular disease.
View Article and Find Full Text PDFBackground: A family history of stroke is an independent risk factor for stroke.
Objective: To assess whether severity of neurologic deficit after stroke is associated with a family history of stroke.
Methods: The Ischemic Stroke Genetics Study, a five-center study of first-ever symptomatic ischemic stroke, assessed case subjects prospectively for a family history of stroke-affected first-degree relatives.
Acute ischemic stroke is now considered a neurological emergency for which there are new therapies. Neurosurgeons and neurologists need to remain apprised of advances in this field. The authors discuss approved and emerging therapies for patients suffering from acute ischemic stroke, based on a review of recent publications.
View Article and Find Full Text PDFNeurosurg Focus
May 2000
Neurosurgeons are frequently involved in choosing an antiplatelet therapy for their patients in the perioperative period. New data obtained from the Aspirin and Carotid Endarterectomy (ACE) Trial suggest that low-dose aspirin is superior to high-dose aspirin therapy in reducing rates of perioperative stroke and death. The ACE-related data are reviewed, and the authors provide an update on current Food and Drug Administration-approved antiplatelet therapies for secondary stroke prevention, as well as a summary of antiplatelet therapies being developed.
View Article and Find Full Text PDFThe electron transport chain enzyme complex I may play a role in Parkinson's disease (PD) pathogenesis. Association studies considering whether or not complex I-relevant gene polymorphisms contribute to PD risk are discordant. We evaluated four complex I-relevant gene polymorphisms alternatively reported to associate and not associate with PD (tRNA(Gln) T4336C, ND1 T4216C, ND2 G5460A, and the NDUFV2 exon 2 C182T transition).
View Article and Find Full Text PDFThere is increasing evidence that genetic factors are associated with ischemic stroke, including multiple recent reports of association with the gene PDE4D, encoding phosphodiesterase 4D, on chromosome 5q12. Genetic studies of stroke are important but can be logistically difficult to perform. This article reviews the design of the Siblings With Ischemic Stroke Study (SWISS) and discusses problems in performing a sibling-based pedigree study where proband-initiated consent is used to enroll pedigree members.
View Article and Find Full Text PDFDue to the growth and expansion of clinical research, particularly research conducted in practice-based settings, all practicing physicians should have a fundamental understanding of clinical research and the differences between clinical care and clinical research. Physicians considering adding clinical research to their everyday practice of medicine should carefully assess the practical and ethical dimensions of this decision on their practice. We discuss a framework that can help physicians assess a study they are considering hosting in their practice for seven requirements for ethical clinical research.
View Article and Find Full Text PDFCalls for increasing clinical research in routine care settings aim to improve the empirical and ethical foundations of evidence-based practice. In the treatment and prevention of stroke many troubling management questions remain uninvestigated by the clinical research enterprise. Many practicing physicians perceive available data as having limited applicability to their average patients.
View Article and Find Full Text PDFRisk for ischemic stroke is mediated by both environmental and genetic factors. Although several environmental exposures have been implicated, relatively little is known about the genetic basis of predisposition to this disease. Recent studies in Iceland identified risk polymorphisms in two putative candidate genes for ischemic stroke: phosphodiesterase 4D (PDE4D) and 5-lipoxygenase activating protein (ALOX5AP).
View Article and Find Full Text PDFTo understand the perceptions and attitudes about privacy safeguards in research and investigate the impact of letter-based proband-initiated contact on recruitment, we surveyed researchers in the Siblings With Ischemic Stroke Study (SWISS). All 49 actively recruiting sites provided at least 1 response, and 61% reported that potential probands were enthusiastic. Although 66% of researchers valued proband-initiated contact, only 23% said that probands viewed this strategy as important to protecting the privacy of siblings.
View Article and Find Full Text PDFThe authors reviewed the recruitment of stroke-affected sibling pairs using a letter-based, proband-initiated contact strategy. The authors randomly sampled 99 proband enrollment forms (Phase 1) and randomly sampled 50 sibling reply cards (Phase 2). The sibling response rate was 30.
View Article and Find Full Text PDFCurr Neurol Neurosci Rep
September 2004
The past several years have been marked by significant progress in identifying genetic anomalies in stroke-prone probands. These advances have occurred in both highly penetrant single-gene disorders and in common stroke, which is influenced by risk/susceptibility genes. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) can be challenging to diagnose because of the wide range of notch 3 mutations that can cause disease, but a new immunohistochemical technique using a skin biopsy sample appears to be highly sensitive and specific.
View Article and Find Full Text PDFTelemedicine has potential to increase the use of tissue plasminogen activator (t-PA) for ischemic stroke and is increasingly offered to provide stroke expertise to remote and underserved areas. The accuracy of stroke neurologists' use of telemedicine to read head computed tomography scans (CT) has not been demonstrated. We sought to determine the validity and reliability of neurologists' reading of acute stroke head CTs via teleradiology.
View Article and Find Full Text PDFBackground: The molecular basis for the genetic risk of ischemic stroke is likely to be multigenic and influenced by environmental factors. Several small case-control studies have suggested associations between ischemic stroke and polymorphisms of genes that code for coagulation cascade proteins and platelet receptors. Our aim is to investigate potential associations between hemostatic gene polymorphisms and ischemic stroke, with particular emphasis on detailed characterization of the phenotype.
View Article and Find Full Text PDFCurr Atheroscler Rep
July 2003
The past several years have been marked by significant progress in identifying genetic anomalies in stroke-prone probands. These advances have occurred in both highly penetrant single-gene disorders and in common stroke, which is influenced by risk/susceptibility genes. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) can be challenging to diagnose because of the wide range of notch 3 mutations that can cause disease, but a new immunohistochemical technique using a skin biopsy sample appears to be highly sensitive and specific.
View Article and Find Full Text PDFTo plan a multisite, ischemic stroke genetic study, stroke patients were surveyed about the availability and characteristics of a convenience sample of spouse/friend controls. 65% of all stroke-affected probands reported a living spouse. A more detailed survey was conducted at the University of Virginia, Charlottesville, Va.
View Article and Find Full Text PDFBackground And Purpose: Inflammation plays an important role in the development of atherosclerosis. The gene for the counterinflammatory cytokine interleukin-1 receptor antagonist (IL-1ra) is polymorphic, and high frequencies of allele 2 have been found to be associated with other inflammatory diseases. This study examined the association of allele and carrier frequencies of the IL-1ra gene with the presence of carotid atherosclerosis and plaque symptomaticity.
View Article and Find Full Text PDFBackground And Purpose: If sex differences in stroke risk factor profiles exist among African Americans in the United States, prevention strategies will need to reflect those differences. African Americans and women have been underrepresented in stroke prevention studies. The purpose of this study was to determine whether medical and lifestyle factors differ among women and men who have enrolled in the African-American Antiplatelet Stroke Prevention Study (AAASPS).
View Article and Find Full Text PDFPurpose: To explore outcome differences between propofol and midazolam (MDL) therapy for refractory status epilepticus (RSE).
Methods: Retrospective chart review of consecutive patients treated for RSE between 1995 and 1999.
Results: We found 14 patients treated primarily with propofol and six with MDL.