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Biomedical subjects

Louis Caplan

Publications and source records attributed to Louis Caplan.

7 recordsLinked to original sources
PubMed2005

Effect of pre-stroke use of ACE inhibitors on ischemic stroke severity.

BACKGROUND: Recent trials suggest that angiotensin-converting enzyme inhibitors (ACEI) are effective in prevention of ischemic stroke, as measured by reduced stroke incidence. We aimed to compare stroke severity between stroke patients who were taking ACEI before their stroke onset and those who were not, to examine the effects of pretreatment with ACEI on ischemic stroke severity. METHODS: We retrospectively studied 126 consecutive patients presenting within 24 hours of ischemic stroke onset, as confirmed by diffusion-weighted magnetic resonance imaging (DWI). We calculated the NIHSS score at presentation, as the primary measure of clinical stroke severity, and categorized stroke severity as mild (NIHSS [less than or equal to] 7), moderate (NIHSS 8-13) or severe (NIHSS [greater than or equal to] 14). We analyzed demographic data, risk-factor profile, blood pressure (BP) and medications on admissions, and determined stroke mechanism according to TOAST criteria. We also measured the volumes of admission diffusion- and perfusion-weighted (DWI /PWI) magnetic resonance imaging lesions, as a secondary measure of ischemic tissue volume. We compared these variables among patients on ACEI and those who were not. RESULTS: Thirty- three patients (26%) were on ACE-inhibitors. The overall median baseline NIHSS score was 5.5 (range 2-21) among ACEI-treated patients vs. 9 (range 1-36) in non-ACEI patients (p = 0.036). Patients on ACEI prior to their stroke had more mild and less severe strokes, and smaller DWI and PWI lesion volumes compared to non-ACEI treated patients. However, none of these differences were significant. Predictably, a higher percentage of patients on ACEI had a history of heart failure (p = 0.03). Age, time-to-imaging or neurological evaluation, risk-factor profile, concomitant therapy with lipid lowering, other antihypertensives or antithrombotic agents, or admission BP were comparable between the two groups. CONCLUSION: Our results suggest that ACE-inhibitors may reduce the clinical severity of stroke, as measured by NIHSS score. Further, larger-scale, prospective studies are needed to validate our findings, and to elucidate the mechanism(s) of ACEImediated benefits in patients with ischemic stroke.

Aged↗
PubMed2005

Arterial occlusive lesions recanalize more frequently in women than in men after intravenous tissue plasminogen activator administration for acute stroke.

BACKGROUND AND PURPOSE: Previous reports suggest that women achieve better outcome than men after intravenous thrombolysis for ischemic stroke. Coagulation and fibrinolysis differ between sexes. These findings prompted us to investigate possible gender differences in arterial recanalization after intravenous tissue plasminogen activator (IV tPA). METHODS: We identified 100 consecutive patients who presented with acute ischemic stroke and received IV tPA within 6 hours of onset. Only patients with large artery anterior circulation strokes, as determined by MRI/MRA or CT/CTA before treatment, who had follow-up vascular study within 72 hour after treatment were included. We compared demographics, clinical features, admission medications, symptom-to-needle and treatment-to-repeat vascular imaging times, baseline National Institutes of Health Stroke Severity score, radiological and laboratory data, stroke mechanism, and outcome between the sexes. RESULTS: 39 patients met all inclusion/exclusion criteria (22 men and 17 women). The recanalization rate was significantly higher in women (94% versus 59%; P=0.02). This difference remained statistically significant after excluding patients whose strokes were attributed to internal carotid artery occlusive lesions, and when the analysis was limited to those treated within 3 hours of stroke onset. All other confounding variables did not differ significantly between the sexes. CONCLUSIONS: In our cohort, vascular occlusive lesions were more likely to recanalize in women than men in response to IV tPA. These preliminary findings need to be validated in larger prospective studies.

Aged↗
PubMed2002

Extensive cerebral venous thrombosis associated with moderate hyperhomocyst(e)inemia and successfully treated with thrombolysis.

Cerebral venous thrombosis (CVT) is a relatively rare condition caused by multiple etiologies, usually secondary to hypercoagulable states. The optimal treatment is controversial, especially in the presence of hemorrhagic infarcts. We describe an unusual patient with extensive CVT associated with moderate hyperhomocyst(e)inemia who was aggressively treated with chemical and mechanical thrombolysis with an excellent outcome.

Adult↗
PubMed2001

Spontaneous Arterial Dissection.

There is no controlled study for the best treatment or management of cervico-cerebral artery dissection (CAD). Rationale initial empiric treatment in acute CAD to prevent secondary embolism is partial thromboplastin time (PTT)-guided anticoagulation by intravenous heparin followed by anticoagulation with warfarin. Carotid surgery for treatment of CAD is not recommended anymore with the possible exception of persisting severe stenosis of the proximal internal carotid artery (ICA). There could be use of carotid angioplasty by balloon dilatation and stenting in selected cases of severe cerebral hemodynamic impairment by bilateral CAD. Duration of secondary prophylaxis by anticoagulation is best guided by Doppler sonography follow-up, and should be continued until normalization of blood flow or until at least 1 year after the vessel is occluded. There is no evidence that pseudoaneurysms increase the risk for embolic complication, and there is no evidence for surgery or continuation of anticoagulation in patients with pseudoaneurysms. Caution should be recommended for exercises that involve excessive head movements (eg, bungee jumping, trampoline jumping, and chiropractic maneuvers). The patient should be informed that recurrent rate is low in nonfamilial cases. Doppler sonography is a low-cost and high-sensitivity method for patients at risk.

Journal Article↗