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Biomedical subjects

Jesse Weinberger

Publications and source records attributed to Jesse Weinberger.

12 recordsLinked to original sources
PubMed2003

The prevalence of asymptomatic intracranial large-vessel occlusive disease: the role of diabetes.

OBJECTIVE: To investigate the prevalence of asymptomatic intracranial stenosis using transcranial Doppler ultrasonography in patients with evidence of asymptomatic carotid stenosis. BACKGROUND: Symptomatic atherosclerotic intracranial largeartery stenosis accounts for approximately 10% of ischemic strokes annually. It is unknown whether a significant risk for stroke is associated with asymptomatic intracranial stenosis, especially in patients with known asymptomatic carotid disease. DESIGN AND METHODS: Transcutaneous real-time B-mode Doppler ultrasonography was performed on 510 patients referred for the evaluation of asymptomatic carotid bruits. A peak systolic flow velocity > 1.40 m/s indicated carotid stenosis. Transcranial Doppler ultrasound was performed to identify intracranial large-artery disease. The peak systolic flow velocity indicating stenosis was > 120 cm/s for anterior circulation and > 100 cm/s for posterior circulation. Demographic and cerebrovascular risk factor information was recorded at the time of examination. Chi-square analysis with Pearson correction was performed to examine the significance of the findings. RESULTS: Five hundred ten patients (252 male, 258 female) aged 71.4 +/- 10.45 years were studied. The laboratory's accuracy was previously established as 93% for each technique for laboratory certification. Two hundred patients (39.2%) were found to have extracranial carotid stenosis, and 66 (12.9%) were found to have intracranial stenosis. Thirty-seven patients (56%, P < .01) were found to have concurrent stenosis. In patients with intracranial stenosis, 19 (28.8%, P < .03) had diabetes, and 26 (39.4%, p < .03) had coronary disease. There was no corresponding correlation with extracranial carotid disease and diabetes or coronary artery disease. CONCLUSIONS: The prevalence of patients with asymptomatic intracranial stenosis with concurrent carotid stenosis was greater than expected. Coexisting diabetes and coronary disease were significant risk factors in this population. Doppler ultrasonography may be a useful technique in delineating asymptomatic intracranial stenosis in those patients with existing carotid stenosis. Further studies are needed to clarify the risk of this population for stroke from asymptomatic intracranial stenosis and to determine optimal therapy.

Adult↗
PubMed2003

Magnetic resonance imaging of meningoradiculomyelitis in early disseminated Lyme disease.

Lyme disease, a multisystem illness caused by the spirochete Borrelia burgdorferi, is the most common vector-borne disease in the United States. There are 3 clinical stages of Lyme disease: early localized, early disseminated, and late persistent disease. Neuroborreliosis, infection of the nervous system by B. burgdorferi, may occur during early disseminated or late persistent disease. Spinal cord involvement in early disseminated disease is extremely rare. In patients with early disseminated neuroborreliosis, treatment with antibiotics often leads to rapid recovery and may prevent further complications of Lyme disease. The authors present the clinical and radiographic findings, both before and after treatment, in a patient with meningoradiculomyelitis due to early disseminated Lyme disease.

Adult↗
PubMed2002

Lipid lowering by simvastatin induces regression of human atherosclerotic lesions: two years' follow-up by high-resolution noninvasive magnetic resonance imaging.

BACKGROUND: Statins are widely used to treat hypercholesterolemia and atherosclerotic disease. Noninvasive MRI allows serial monitoring of atherosclerotic plaque size changes. Our aim was to investigate the effects of lipid lowering with simvastatin on atherosclerotic lesions. METHODS AND RESULTS: A total of 44 aortic and 32 carotid artery plaques were detected in 21 asymptomatic hypercholesterolemic patients at baseline. The effects of statin on these atherosclerotic lesions were evaluated as changes versus baseline in lumen area (LA), vessel wall thickness (VWT), and vessel wall area (VWA) by MRI. Maximal reduction of plasma total and LDL cholesterol by simvastatin (23% and 38% respectively; P<0.01 versus baseline) was achieved after approximately 6 weeks of therapy and maintained thereafter throughout the study. Significant (P<0.01) reductions in maximal VWT and VWA at 12 months (10% and 11% for aortic and 8% and 11% for carotid plaques, respectively), without changes in LA, have been reported. Further decreases in VWT and VWA ranging from 12% to 20% were observed at 18 and 24 months. A slight but significant increase (ranging from 4% to 6%) in LA was seen in both carotid and aortic lesions at these later time points. CONCLUSION: The present study demonstrates that maintained lipid-lowering therapy with simvastatin is associated with significant regression of established atherosclerotic lesions in humans. Our observations indicate that lipid-lowering therapy is associated with sustained vascular remodeling and emphasize the need for longer-term treatment.

Anticholesteremic Agents↗
PubMed2002

Prevention of ischemic stroke.

The primary risk factors for stroke are known, and attention to primary care of these disorders should reduce the incidence of stroke significantly. Control of hypertension, diabetes, and hyperlipidemia have all been shown to reduce the rate of stroke. Identification of potential cardioembolic sources of stroke, particularly atrial fibrillation, can prevent stroke with appropriate application of anticoagulation. Duplex Doppler B-mode sonography can establish the extent of carotid artery disease in patients with cervical bruit or risk factors for atherosclerosis, and indicate which conditions should be managed medically or surgically. Patients with a history suggestive of transient ischemic attacks can also be screened noninvasively with duplex sonography to determine if they have a critical carotid stenosis and require carotid endarterectomy. New advances in platelet antiaggregant therapy with ticlopidine, clopidegril, and the combination of aspirin with dipyridamole have also reduced the rate of stroke to a greater degree than standard treatment with aspirin. The incidence of this devastating illness could possibly be reduced by 50% with attentive primary care management. The cardiologist is often involved in the treatment of patients at risk for stroke, and is in an ideal position to provide this care.

Arteriosclerosis↗
PubMed2002

Prevention of Ischemic Stroke.

The primary risk factors for stroke are known, and attention to primary care of these disorders should reduce the incidence of stroke significantly. Control of hypertension, diabetes, and hyperlipidemia have all been shown to reduce the rate of stroke. Identification of potential cardioembolic sources of stroke, particularly atrial fibrillation, can prevent stroke with appropriate application of anticoagulation. Duplex Doppler B-mode sonography can establish the extent of carotid artery disease in patients with cervical bruit or risk factors for atherosclerosis, and indicate which conditions should be managed medically or surgically. Patients with a history suggestive of transient ischemic attacks can also be screened noninvasively with duplex sonography to determine if they have a critical carotid stenosis and require carotid endarterectomy. New advances in platelet antiaggregant therapy with ticlopidine, clopidogrel, and the combination of aspirin with dipyridamole have also reduced the rate of stroke to a greater degree than standard treatment with aspirin. The incidence of this devastating illness could possibly be reduced by 50% with attentive primary care management. The cardiologist is often involved in the treatment of patients at risk for stroke, and is in an ideal position to provide this care.

Journal Article↗
PubMed2002

Noninvasive imaging of atherosclerotic plaque in the arch of the aorta with transcutaneous B-mode ultrasonography.

Atherosclerotic plaque at the arch of the aorta has been identified as a potential source for atheroembolic stroke. Imaging of aortic arch plaque can be performed with transesophageal echocardiography (TEE), but TEE is an invasive procedure. A new noninvasive method has been developed to image aortic arch plaque employing transcutaneous real time B-mode ultrasonography with color flow duplex Doppler. B-mode imaging has an 86% accuracy for identifying complex aortic arch plaques as compared with TEE. Noninvasive imaging of the aortic arch can be employed in diagnosing the etiology of cerebrovascular disease in patients with stroke or transient ischemic attack in conjunction with duplex B-mode sonography of the extracranial carotid arteries. It also provides a noninvasive method for studying atherosclerotic plaque in the aortic arch which is applicable for investigational studies of the mechanisms of atherosclerosis and evaluation of pharmacological agents designed to treat atherosclerotic disease.

Aorta, Thoracic↗
PubMed2002

Stroke and TIA. Prevention and management of cerebrovascular events in primary care.

Stroke is a major cause of death and disability in the United States. Control of risk factors--particularly hypertension, diabetes, elevated serum lipids, and atrial fibrillation--can significantly reduce the incidence of stroke. Platelet antiaggregant therapy has a role in primary and secondary stroke prevention. Patients with transient ischemic attacks presenting with carotid stenosis > 70% can be managed surgically, whereas those with less stenosis can be treated with platelet antiaggregant therapy. Acute stroke is a medical emergency. Thrombolytic therapy with tissue plasminogen activator within 3 hours of event onset can significantly improve outcomes in selected ischemic stroke patients. Patients with intracerebral hemorrhage usually present with acute onset of identifiable neurologic deficits.

Aged↗
PubMedDate not supplied

Drug therapy of neurovascular disease.

Recent advances in the prevention and pharmacotherapy of cerebrovascular disease have provided more favorable clinical outcomes. For the treatment of an acute ischemic stroke, the early use of thrombolytic agents can reduce the degree of brain damage while improving functional outcomes. However, trials evaluating various classes of other neuroprotective agents have not shown benefit to date. For the prevention of second stroke, the use of antiplatelet drugs, HMG-CoA reductase inhibitors, and angiotensin-converting enzyme inhibitors with a diuretic have shown benefit in reducing new events. In patients with underlying heart disease or atrial fibrillation, warfarin appears to be the drug of choice in preventing stroke. Early treatment of hemorrhagic stroke with calcium channel blockers can improve the functional outcome. Innovative therapies are now available for the treatment of migraine and vascular dementia. Primary prevention of stroke remains the optimal therapeutic strategy and includes treatment of systemic hypertension and hypercholesterolemia.

Adult↗