Should This Patient With Ischemic Stroke Receive Fluoxetine?

You admit T.R., a 75-year-old man, to your inpatient rehabilitation unit 10 days after a stroke. He has a medical history of hypertension and type II diabetes. On the day of his admission to the neurology service, he experienced a sudden onset of severe left-sided weakness with a facial droop and slurring of speech. His husband was driving them both to a social event at the time and detoured immediately to the emergency department, where the patient received tissue plasminogen activator (tPA) for a large, right middle cerebral artery thrombosis seen on magnetic resonance imaging.
Source: PM and R - Category: Rehabilitation Authors: Tags: Point/Counterpoint Source Type: research

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We present the hypothesis that pre-existing vascular damage (due to aging, cardiovascular disease, diabetes, hypertension or other conditions) facilitates infiltration of the virus into the central nervous system (CNS), increasing neuro-inflammation and the likelihood o f neurological symptoms. We also discuss the role of a neuroinflammatory cytokine profile in both blood–brain barrier dysfunction and macrovascular disease (e.g. ischemic stroke and thromboembolism). Future studies are needed to better understand the involvement of the microvasculature in coronavi rus neuropathology, and to test the diagnostic potenti...
Source: Fluids and Barriers of the CNS - Category: Neuroscience Source Type: research
CONCLUSIONS: This study clearly demonstrated that multivascular disease was a powerful predictor for cardiovascular mortality and morbidity in patients receiving hemodialysis. PMID: 32684556 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
CONCLUSIONS: This study suggested a positive association between plasma TMAO and ischemic stroke. Further studies are required to explore the role of plasma TMAO concentrations in predicting stroke risk. PMID: 32641646 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
Abstract Males and females possess distinct biological differences that manifest in diverse risk profiles for acute and chronic diseases. A well-documented example of this is ischemic stroke. It has been demonstrated that older females have greater prevalence of, and worse outcome after, ischemic stroke than do males and younger females. Loss of estrogen after menopause is heavily implicated as a contributing factor for this phenomenon; however, there is mounting evidence to suggest that certain risk factors tend to occur more often in older females, such as hypertension and atrial fibrillation, while others more ...
Source: Experimental Neurology - Category: Neurology Authors: Tags: Exp Neurol Source Type: research
Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In western countries with aging populations, atrial fibrillation poses a significant health concern, as it is associated with a high risk of thromboembolism, stroke, congestive heart failure, and myocardial infarction. Thrombi are generated in the left atrial appendage, and subsequent embolism into the cerebral circulation is a major cause of ischemic stroke. Therefore, patients have a lifetime risk of stroke, and those at high risk, defined as a CHA2DS2-VASc2 (congestive heart failure, hypertension, age>75 years, diabetes mel...
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research
This study assesses the current practices of physicians in Lebanon routinely involved in ischemic stroke (IS) management. We conducted a prospective observational study of patients hospitalized at 8 different Lebanese hospitals in the period August 1, 2015 to July 31, 2016, with a diagnosis of acute stroke. Baseline characteristics and data on diagnostic studies, as well as treatments received during hospitalization and at discharge, were collected and analyzed. Two hundred and three strokes/transient ischemic attacks (TIAs) were recorded but only 173 patients (85%) with ischemic events were included in the study. The pati...
Source: Functional Neurology - Category: Neurology Tags: Funct Neurol Source Type: research
In this study, we aim to quantify global cardiac microcalcification in patients at risk for cardiovascular disease as assessed by NaF uptake on PET/CT and correlate this uptake with CHADS2 and CHA2DS2-VASc scores. We hypothesize that global cardiac microcalcification will correlate positively with CHADS2 and CHA2DS2-VASc scores. Methods: We identified 40 patients at-risk of cardiovascular disease from the CAMONA trial (55±11.9 years, 22 females, 18 males). CHADS2 (0.75±0.19) and CHADS2-VASc (1.8±1.25) scores were calculated for each patient based on relevant clinical parameters pertaining to each scori...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Clinical Science (Poster Session) Source Type: research
Int J Angiol DOI: 10.1055/s-0040-1708477Atrial fibrillation (AF), the most prevalent arrhythmic disease, tends to foster thrombus formation due to hemodynamic disturbances, leading to severe disabling and even fatal thromboembolic diseases. Meanwhile, patients with AF may also present with acute coronary syndrome (ACS) and coronary artery disease (CAD) requiring stenting, which creates a clinical dilemma considering that majority of such patients will likely receive oral anticoagulants (OACs) for stroke prevention and require additional double antiplatelet treatment (DAPT) to reduce recurrent cardiac events and in-stent th...
Source: International Journal of Angiology - Category: Cardiology Authors: Tags: Invited Papers Source Type: research
ConclusionsFactor Xa inhibitors may be viable treatment options for CF-LVAD patients for whom warfarin therapy has failed. Large prospective studies are necessary to confirm these results.
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Anticoagulation for prevention of stroke is a well established modality of treatment in atrial fibrillation. But a significant number of them have bleeding complications. Hence the option of left atrial appendage closure with multiple types of devices have been developed. Left atrial appendage with its sluggish flow is the most common location for thrombus formation in atrial fibrillation. Following devices have been used with varying success: Watchman Amplatzer Cardiac Plug/Amulet Lariat suture ligation Atriclip PROTECT-AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillatio...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs
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