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Biomedical subjects

Richard A Bernstein

Publications and source records attributed to Richard A Bernstein.

12 recordsLinked to original sources
PubMed2006

Reversible cerebral vasoconstriction syndromes.

Reversible cerebral vasoconstriction syndromes (RCVS) comprise a set of conditions having in common the apoplectic onset of headache mimicking subarachnoid hemorrhage, focal or multifocal neurologic deficits with a predilection for visual processing disorders, multifocal vasoconstriction on cerebral angiography, noninflammatory spinal fluid, and a generally benign prognosis. RCVS may occur in the setting of the puerperium, after intracranial surgery, in association with prescription or illicit drug use, in migraineurs, or without a clear trigger. Distinction from central nervous system vasculitis is important and is often possible using routine clinical assessment, without brain biopsy. No treatments are of proven value in RCVS. Empiric treatments include the use of calcium channel blockers, steroids, induced hypertension or blood pressure lowering, and rarely endovascular therapy. The key to successful management is accurate diagnosis and cognizance of the tendency of RCVS to resolve without long-term immunosuppressive treatment.

Journal Article↗
PubMed2006

Cholesterol lowering to prevent stroke: who, when, and how?

The epidemiologic link between increased low-density-lipoprotein (LDL) cholesterol and ischemic stroke is controversial. However, recent trials make it clear that LDL reduction by statin agents in high-risk patients reduces the risk of ischemic stroke. The risk of first stroke is reduced within 1 to 2 years of statin therapy in patients at high risk for ischemic vascular disease. Patients with any history of cerebrovascular disease who are treated with statins have a reduced risk of coronary ischemic events and of all major vascular ischemic events, independent of any history of coexisting coronary artery disease. In particular, patients with recent transient ischemic attack or ischemic stroke show significantly reduced risks of both recurrent stroke and coronary events when they are treated with high-dose statin therapy. Most patients with ischemic cerebrovascular disease should be placed on statin drugs. However, most stroke patients are not currently treated to recommended levels with these agents, providing ample room for improvement in physician performance.

Journal Article↗
PubMed2006

Risks of stroke from general surgical procedures in stroke patients.

Neurologists often assess the risk of stroke from general surgical procedures in patients who have cerebrovascular disease. Common questions for neurologists include: Should a symptomatic or an asymptomatic carotid stenosis be revascularized before general surgery? What is the risk of surgery in patients who have stenoses in the cervicocephalic vasculature? What is the risk of recurrent stroke in patients who have a history of stroke requiring surgery? Can antithrombotic therapy be interrupted for surgery? and How soon after a stroke may elective surgeries be performed? Although definite answers to these questions are lacking, available clinical evidence and knowledge of cerebrovascular pathophysiology can help inform recommendations.

Humans↗
PubMed2005

Novel mitochondrial DNA ND5 mutation in a patient with clinical features of MELAS and MERRF.

BACKGROUND: The mitochondrial DNA gene encoding subunit 5 of complex I (ND5) has turned out to be a hot spot for mutations associated with mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes (MELAS) and various overlap syndromes. OBJECTIVE: To describe a novel mutation in the ND5 gene in a young man man with an overlap syndrome of MELAS and myoclonus epilepsy with ragged-red fibers. DESIGN: Case report. PATIENT: A 25-year-old man had recurrent strokes, seizures, and myoclonus. His mother also had multiple strokes. A muscle biopsy specimen showed no ragged-red fibers but several strongly succinate dehydrogenase-reactive blood vessels. RESULTS: Biochemical analysis showed isolated complex I deficiency and molecular analysis revealed a novel heteroplasmic mutation (G13042A) in the ND5 gene. CONCLUSIONS: These data confirm that ND5 is a genetic hot spot for overlap syndromes, including MELAS and strokelike and myoclonus epilepsy with ragged-red fibers.

Adult↗
PubMed2005

Recent advances in the management of acute intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is the most deadly form of stroke, and its acute treatment has suffered from a lack of guidance by reliable clinical trial data. In the past year, however, important clinical trials have helped point toward effective acute management. Studies have shown that magnetic resonance imaging is as accurate as computed tomography in diagnosing acute ICH, although this study is not always feasible in critically ill patients. Ultra-early hemostatic therapy has shown promise in limiting early hematoma expansion and rebleeding. The role of early surgery in patient management has been partially clarified. Finally, a novel treatment for intraventricular hemorrhage has shown promise in speeding clot resolution. All of these advances provide grounds for optimism that multimodal, evidence-based treatment of acute ICH will be reality in the near future.

Acute Disease↗
PubMed2005

Oral clopidogrel load in aspirin-resistant capsular warning syndrome.

INTRODUCTION: Capsular warning syndrome (CWS) carries a significant risk of permanent stroke. There are no proven therapies for preventing completed stroke in this unstable situation. METHODS: Clinical observation in two patients with aspirin-resistant CWS treated with a loading dose of oral clopidogrel. RESULTS: Both patients had excellent neurological outcome, although one sustained an asymptomatic brain infarction. CONCLUSION: High-dose oral clopidogrel plus aspirin merits formal evaluation in high-risk transient brain ischemia such as CWS, preferably in a randomized trial compared to aspirin alone.

Administration, Oral↗
PubMed2005

Recurrent artery-to-artery embolism during intravenous t-PA therapy for acute ischemic stroke.

INTRODUCTION: Treatment of acute ischemic stroke with systemic thrombolysis in the presence of a proximal thrombo-embolic source carries a theoretical risk of thrombus fragmentation and recurrent embolization. Intracardiac thrombus has received the most attention as a potential source of recurrent emboli, and in the past, it was considered a relative contra-indication to tissue plaminogen activator (t-PA) treatment. More recent data show that recurrent embolization from a cardiac source during t-PA infusion is rare. CASE REPORT: This article describes recurrent symptomatic basilar artery embolization during t-PA infusion from acute thrombus in the proximal cervical vertebral artery. DISCUSSION: This case provides evidence that intravenous t-PA must be used cautiously in the presence of large proximal thrombo-embolic sources and that intraluminal thrombus in a large cervical artery should be considered one such source.

Humans↗
PubMed2005

Postpartum angiopathy and other cerebral vasoconstriction syndromes.

The phenomenon of reversible cerebral arterial segmental vasoconstriction has been associated with several conditions including pregnancy and puerperium ("postpartum angiopathy"), thunderclap headache, and use of vasoconstrictive medications. Patients with cerebral vasoconstriction typically present with sudden, severe, and recurrent ("thunderclap") headaches and can develop strokes. Cerebral vasoconstriction syndromes are under- recognized, are poorly characterized, and are frequently misdiagnosed as primary cerebral vasculitis. This article presents an illustrative case report and reviews the historical aspects, clinical and imaging characteristics, etiology, differential diagnosis, management, and prognosis of cerebral vasoconstriction syndromes.

Adult↗