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Impact of Atrial Fibrillation on Cognitive Function, Psychological Distress, Quality of Life, and Impulsiveness
Atrial fibrillation is the most common cardiac arrhythmia and a known risk factor for cerebrovascular stroke. Atrial fibrillation and longstanding hypertension may produce ischemic lesions leading to progressive cognitive impairment. The impact of atrial fibrillation alone on cognitive impairment has not been evaluated. Our objective was to compare cognitive function, quality of life, psychological distress, and impulsiveness in people with atrial fibrillation and a matched control group.
Source: The American Journal of Medicine - February 4, 2018 Category: General Medicine Authors: Rokas Serpytis, Aurelija Navickaite, Emilija Serpytiene, Jurate Barysiene, Germanas Marinskis, Dalius Jatuzis, Zaneta Petrulioniene, Aleksandras Laucevicius, Pranas Serpytis Tags: Clinical Research Study Source Type: research

Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials
• In patients with recent cryptogenic stroke, percutaneous closure of patent foramen ovale reduced recurrent stroke/transient ischemic attack compared with medical therapy, but was associated with higher risk of new-onset atrial fibrillation/flutter.• Select, young patients (≤60 years) present ing with recent cryptogenic stroke may benefit from percutaneous closure of patent foramen ovale at relatively low procedural risk.
Source: The American Journal of Medicine - December 8, 2017 Category: General Medicine Authors: Muthiah Vaduganathan, Arman Qamar, Ankur Gupta, Navkaranbir Bajaj, Harsh B. Golwala, Ambarish Pandey, Deepak L. Bhatt Tags: Brief Observation Source Type: research

Falls and Delirium: Platypnea-Orthodeoxia Syndrome
An 85-year-old woman's inability to remain standing was ultimately connected to an undiagnosed congenital defect. The patient was admitted to the geriatric unit of a university hospital for new frequent falls and subacute delirium, both of which began a month before presentation. Her medical history included ischemic stroke 10 years earlier, mild neurocognitive impairment, and Von Recklinghausen neurofibromatosis with isolated skin involvement.
Source: The American Journal of Medicine - November 20, 2017 Category: General Medicine Authors: A. Putot, C. Laborde, M. Fichot, P. Brunel, M. Deidda, H. Guepet, P. Manckoundia Tags: Diagnostic Dilemma Source Type: research

Diagonal Earlobe Crease Frank's Sign - a Predictor of Cerebral Vascular Events
Frank's sign was first described in 1973 by an American physician (T. Frank). It is a diagonal crease in the earlobe which starts from the tragus to the edge of the auricle in an angle of 45 degrees in varying depths. Frank sign was described as a predictor of future coronary heart disease and peripheral vascular diseases. The aim of the study was to examine the association between Frank sign and the development of ischemic stroke.
Source: The American Journal of Medicine - April 28, 2017 Category: Journals (General) Authors: Saleh Nazzal, Basem Hijazi, Luai Khalila, Arnon Blum Tags: Clinical Research Study Source Type: research

Diagonal Earlobe Crease (Frank's Sign): A Predictor of Cerebral Vascular Events
Frank's sign was first described in 1973 by an American physician (Sonders T. Frank). It is a diagonal crease in the earlobe that starts from the tragus to the edge of the auricle in an angle of 45 ° in varying depths. Frank's sign was described as a predictor of future coronary heart disease and peripheral vascular diseases. The aim of the study was to examine the association between Frank's sign and the development of ischemic stroke.
Source: The American Journal of Medicine - April 28, 2017 Category: General Medicine Authors: Saleh Nazzal, Basem Hijazi, Luai Khalila, Arnon Blum Tags: Clinical research study Source Type: research

Double the Trouble: Acute Coronary Syndrome and Ischemic Stroke in Polycythemia Vera
Vague symptoms turned out to be life-threatening conditions. A 50 year-old man with a history of polycythemia vera, presented to hospital with epigastric discomfort and clumsiness of the right hand for 5 days. Polycythemia vera was diagnosed 1 year prior with good control of hematocrit by intermittent phlebotomy. He did not have any other medical history, and was not taking any medications. He denied chest pain, shortness of breath, nausea, headache, vision change, or speech difficulty.
Source: The American Journal of Medicine - March 12, 2017 Category: Journals (General) Authors: Hitomi Hosoya, Jeffrey J. Levine, David H. Henry, Sheldon Goldberg Tags: Diagnostic Dilemma Source Type: research

Wunderlich Syndrome
A 55-year-old man presented to the Emergency Department with severe abdominal pain for 1 day. He had a history of hypertension, diabetes mellitus, and ischemic stroke. The pain was severe, sharp, and constant, in his left flank; it woke him up from sleep and radiated to the mid back. On physical examination, his vital signs were stable and he had tenderness over the left flank. However, he developed hypotension, with mean arterial pressures dropping to 55  mm Hg and lactic acidosis requiring aggressive volume resuscitation.
Source: The American Journal of Medicine - January 30, 2017 Category: Journals (General) Authors: Aron Simkins, Abhishek Maiti, Sujith V. Cherian Tags: Clinical communication to the editor Source Type: research

Cryptogenic Strokes and Patent Foramen Ovales: What's the Right Treatment?
More than 25% of all ischemic strokes per year are cryptogenic, that is, their cause is not determined after an appropriate evaluation. In 1988, it was reported that the incidence of a patent foramen ovale was 30 to 40% in young patients with a cryptogenic stroke compared with 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism, that is, a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation.
Source: The American Journal of Medicine - August 22, 2016 Category: Journals (General) Authors: James E. Dalen, Joseph S. Alpert Tags: Review Source Type: research

Cryptogenic Strokes and Patent Foramen Ovales: What ’s The Right Treatment?
More than 25% of all ischemic strokes per year are cryptogenic; that is their cause is not determined after an appropriate evaluation.In 1988 it was reported that the incidence of a patent foramen ovale (PFO) was 30 to 40% in young patients with a cryptogenic stroke compared to 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism; that is a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation.
Source: The American Journal of Medicine - August 22, 2016 Category: Journals (General) Authors: James E. Dalen, Joseph S. Alpert Tags: Review Source Type: research

The Reply
The authors thank Xue et al for their interest in our article titled “Association between Anemia, Bleeding, and Transfusion with Long-Term Mortality Following Non-Cardiac Surgery.”1 We share the authors' concern about the potential for residual confounding in this observational analysis of a large single-center surgical database. The initial analysis adjusted for age, sex, race, elective vs emergency/urgent surgery, procedure type, and the individual components of the Revised Cardiac Risk Index including coronary artery disease, heart failure, stroke/transient ischemic attack, creatinine>2 mg/dL, and diabetes mellitus.
Source: The American Journal of Medicine - August 21, 2016 Category: Journals (General) Authors: Nathaniel R. Smilowitz, Jeffrey S. Berger Tags: AJM online Source Type: research

Healthy Lifestyle and Functional Outcomes from Stroke in Women
While a healthy lifestyle has been associated with reduced risk of developing ischemic stroke, less is known about its effect on stroke severity.
Source: The American Journal of Medicine - February 17, 2016 Category: Journals (General) Authors: Pamela M. Rist, Julie E. Buring, Carlos S. Kase, Tobias Kurth Tags: Clinical Research Study Source Type: research

Improving medication adherence in patients with hypertension: a randomized trial
and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention.
Source: The American Journal of Medicine - August 21, 2015 Category: Journals (General) Authors: Ulla Hedegaard, Lene Juel Kjeldsen, Anton Pottegård, Jan Erik Henriksen, Jess Lambrectsen, Jørgen Hangaard, Jesper Hallas Tags: Clinical Research Study Source Type: research

Neither Abusiveness with Patients nor Naivety with Drugs
Kelly et al1 must be commended for condemning abusive language for individuals with addiction (eg, substance “abusers” or “addicts”) and recommending the use of “people with a substance use disorder.” Indeed, reducing stigma is vital for building the therapeutic alliance with these patients with low self-esteem. Sadly, this is not yet usual: Elkind,2 when discussing the risk of recurrent ischemic stroke, called smoking a “volitional behavior.” However, the condemnation of public health messages such as “war on drugs” or “You use, you lose” deserves comments.
Source: The American Journal of Medicine - June 17, 2015 Category: Journals (General) Authors: Alain Braillon Tags: AJM online Source Type: research

Misconceptions and Facts about Atrial Fibrillation
Atrial fibrillation is an increasingly common arrhythmia associated with substantial but largely preventable risk of ischemic stroke. There has been an exponential increase in research related to atrial fibrillation in recent years resulting in some major advances in the therapeutic management. Novel oral anticoagulant agents have become available and require thorough assessment of risk benefit ratio. While the knowledge is rapidly accumulating the basic principles of atrial fibrillation management remain proper recognition, risk stratification, and appropriate prevention of thromboembolic complications.
Source: The American Journal of Medicine - March 28, 2015 Category: Journals (General) Authors: Edgar Argulian, David Conen, Franz H. Messerli Tags: Review Source Type: research

Apparent Treatment-Resistant Hypertension among Individuals with History of Stroke or Transient Ischemic Attack
and Purpose. Blood pressure control is a paramount goal in secondary stroke prevention; however, high prevalence of uncontrolled blood pressure and use of multiple antihypertensive medication classes in stroke patients suggest this goal is not being met. We determined the prevalence and factors associated with apparent treatment-resistant hypertension in persons with/without stroke or transient ischemic attack..
Source: The American Journal of Medicine - March 11, 2015 Category: Journals (General) Authors: Virginia J. Howard, Rikki M. Tanner, Aaron Anderson, Marguerite R. Irvin, David A. Calhoun, Daniel T. Lackland, Suzanne Oparil, Paul Muntner Source Type: research

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