Seminars in Cerebrovascular Diseases and Stroke最新文献

{"title":"Stroke Education in the Undergraduate Curriculum of US Medical Schools","authors":"Susan Billings-Gagliardi PhD","doi":"10.1053/j.scds.2005.04.003","DOIUrl":"10.1053/j.scds.2005.04.003","url":null,"abstract":"<div><p>Examination of the AAMC CurrMIT database, individual medical school web sites, results from the AAMC Medical School Graduation Questionnaire, and published literature produced little systematic information about how and where stroke education is provided in undergraduate medical school curricula. In 31 US medical schools that met criteria for inclusion in this review, cerebrovascular disease is directly addressed in an average of 4.8 sessions during the preclerkship curriculum. Fewer than 20% of these schools report that they address stroke prevention. Less data are available about the amount and content of stroke education in required clerkships. Approximately 80% of all US medical schools require a neurology clerkship or a clerkship in which neurologists participate; about half are scheduled in Year 3. Recommendations include defining a core competency in stroke for all graduating medical students, developing new approaches to enhance undergraduate training in stroke, and systematically gathering data about stroke education and its outcomes from multiple sources.</p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 3","pages":"Pages 134-138"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2005.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88144891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential Neurology: Audiovisual Patient Vignettes on CD-ROM as a Teaching Aid for Medical Students","authors":"Matthew E. Bain MD ,&nbsp;José Biller MD","doi":"10.1053/j.scds.2005.04.004","DOIUrl":"10.1053/j.scds.2005.04.004","url":null,"abstract":"<div><p>To assess third- and fourth-year medical students’ opinions in the use of previously recorded and edited live patient interviews as a teaching tool during a 1-month clinical neurology rotation. The global burden of neurological disease is on the rise and is projected to reach nearly 15% by the year 2020. The amount of time devoted to neurologic education during medical school is limited. To expand the range of neurologic problems to which students are exposed, we have compiled an archive of 100 audiovisual case vignettes on CD-ROM which students view during their neurology clerkship. The vignettes served as a tool for our former Departmental Chairman (Dr Biller) to discuss diagnosis, ancillary testing, and basic patient management skills with third- and fourth-year medical students during interactive case conferences. A survey conducted among students regarding the vignettes reflects a high degree of approval. Ninety-two percent of the students rated the overall experience with the case vignettes as either “excellent” or “good.” CD-ROM case vignettes are felt to represent a novel way of expanding students’ experience during a brief neurology clerkship. The hope is that use of such archival vignettes will help students hone their diagnostic and therapeutic skills in neurology regardless of their chosen specialty.</p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 3","pages":"Pages 139-143"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2005.04.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87449337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forthcoming Issues","authors":"","doi":"10.1053/S1528-9931(05)00036-1","DOIUrl":"https://doi.org/10.1053/S1528-9931(05)00036-1","url":null,"abstract":"","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 3","pages":"Page iii"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/S1528-9931(05)00036-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136849603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Guidelines in Stroke","authors":"Caroline Kang,&nbsp;Michael Schneck MD","doi":"10.1053/j.scds.2005.04.007","DOIUrl":"10.1053/j.scds.2005.04.007","url":null,"abstract":"<div><p>Clinical practice guidelines have been developed to improve patient outcomes, reduce variability in care, and decrease health care expenditures by providing an organized framework to diagnosis and treatment. Numerous guidelines have been published about different aspects of stroke care. The application of guidelines to the “real world” situation of the individual patient has often been less successful, however. The rationale for guidelines, as they pertain to cerebrovascular disease, are reviewed as well as some of the barriers to guideline implementation.</p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 3","pages":"Pages 155-158"},"PeriodicalIF":0.0,"publicationDate":"2004-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2005.04.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79329728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcortical vascular dementia caused by bilateral internal carotid artery occlusion (Moyamoya) in a 47-year-old Hispanic woman","authors":"Roland P. Jones ,&nbsp;Gustavo C. Román","doi":"10.1053/j.scds.2004.10.007","DOIUrl":"10.1053/j.scds.2004.10.007","url":null,"abstract":"<div><p><span><span><span>We report a case of subcortical vascular dementia in a young Hispanic woman, without vascular risk factors, who was found to have extensive ischemic brain lesions due to bilateral intracranial </span>carotid artery occlusions<span><span> (Moyamoya disease). A combination of ECIC surgeries, donepezil and </span>antiplatelet therapy resulted in increased </span></span>cerebral perfusion<span>, improvement of cognitive deficits, and prevention of further ischemic or hemorrhagic strokes. </span></span>Moyamoya disease<span><span> has been rarely described as a cause of vascular dementia. Differential diagnosis includes atherosclerotic disease, multiple sclerosis, and </span>CADASIL.</span></p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 2","pages":"Pages 121-125"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2004.10.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78174331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The neuropathology of vascular dementia","authors":"Gustavo C. Román,&nbsp;Oscar Benavente","doi":"10.1053/j.scds.2004.10.002","DOIUrl":"10.1053/j.scds.2004.10.002","url":null,"abstract":"<div><p><span><span>Ischemic infarction is the main lesion underlying vascular dementia<span> (VaD) but cases also occur after brain hemorrhage<span>, as well as with hypoperfusive brain ischemia<span>. Ischemic strokes include large-vessel cortico-subcortical strokes and lacunes resulting from small-vessel disease. </span></span></span></span>Arteriolosclerosis<span><span> and fibrinoid necrosis<span><span> are the most common forms of small-vessel disease in the elderly. Although it was originally proposed that vascular dementia could result from repeated strokes with loss of &gt;100 mL of brain tissue loss (multi-infarct dementia), it is currently held that the location of the stroke is probably more relevant to cognitive loss and dementia. In fact, a single, strategically located stroke may interrupt cortico-subcortical circuits important for memory and cognition. Hypoperfusive lesions include border-zone cortico-subcortical infarcts, </span>temporal lobe<span> sclerosis<span>, and periventricular incomplete ischemic leukoencephalopathy<span>. The latter two lesions are commonly seen in the elderly as a result of narrowing and tortuosity of medullary arterioles irrigating these distal territories, plus cardiac pump failure. </span></span></span></span></span>Binswanger disease<span> is characterized by extensive periventricular ischemic leukoencephalopathy that spares the arcuate U-fibers, and presence of lacunar strokes. CADASIL is a genetic form of vascular dementia characterized by a cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. CADASIL is due to a mutation of the </span></span></span><em>Notch3</em><span><span><span> gene in chromosome 19. Intracerebral hemorrhages in strategic locations may produce vascular dementia. Lesions in the </span>basal forebrain that damage cholinergic nuclei, such as those resulting from a </span>ruptured aneurysm<span><span> of the anterior communicating artery, may produce vascular dementia. Some patients with </span>subarachnoid hemorrhage<span><span> develop normal-pressure hydrocephalus. Cerebral amyloid angiopathy<span> (congophilic angiopathy) may cause lobar hemorrhages and dementia. Vascular lesions, in particular, </span></span>microinfarcts<span>, are frequently found in patients with a clinical diagnosis of Alzheimer disease. These mixed forms of dementia are likely to become the most common form of dementia in the elderly.</span></span></span></span></p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 2","pages":"Pages 87-96"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2004.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91228981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive dysfunction after coronary artery bypass graft surgery","authors":"Dawn E. Jaroszewski ,&nbsp;Lucas Restrepo","doi":"10.1053/j.scds.2004.10.005","DOIUrl":"10.1053/j.scds.2004.10.005","url":null,"abstract":"<div><p><span>Coronary artery bypass graft surgery (CABG) is one of the most commonly performed major surgical procedures. However, patients having undergone CABG may experience neurological problems such as stroke, delirium, and cognitive difficulties. Observations suggest that these complications are caused by several synergistic factors, most prominently </span>brain ischemia<span><span> secondary to cerebral hypoperfusion and/or embolization of heterogeneous endovascular debris. Embolic signals are commonly detected during surgery using intraoperative </span>transcranial Doppler monitoring. After surgery, magnetic resonance imaging of the brain may detect scattered areas of brain ischemia in patients with or without delirium. The large majority of these patients do not exhibit focal neurological deficits suggestive of ischemic stroke. We review the literature pertaining to postoperative encephalopathy, with emphasis on prevention, diagnosis, and treatment.</span></p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 2","pages":"Pages 109-116"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2004.10.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85214523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular dementia: Recent advances in cerebrovascular disease and cognition","authors":"Gustavo C. Román MD (Guest Editor)","doi":"10.1053/j.scds.2004.10.010","DOIUrl":"10.1053/j.scds.2004.10.010","url":null,"abstract":"","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 2","pages":"Pages 77-78"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2004.10.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87197042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies in vascular dementia","authors":"Gustavo C. Román","doi":"10.1053/j.scds.2004.10.006","DOIUrl":"10.1053/j.scds.2004.10.006","url":null,"abstract":"<div><p><span><span>The main controversies in the field of vascular dementia<span> (VaD) include the nosological classification of this disorder, the definition of dementia, the differences between the different sets of diagnostic criteria, the concept of </span></span>Binswanger disease<span><span><span>, the role of vascular lesions in Alzheimer disease, and the results of </span>cholinesterase<span> trials in VaD. Vascular Cognitive Disorder (VCD) is the most current nosological classification for the global diagnostic category of cognitive impairment of vascular origin, ranging from </span></span>mild cognitive impairment<span> (MCI) to vascular dementia. It includes specific disease entities such as poststroke VaD, CADASIL, Binswanger disease, and AD plus CVD. Vascular cognitive impairment (VCI) is limited to cases of vascular MCI without dementia, by analogy with the concept of amnesic MCI, currently considered the earliest clinically diagnosable stage of Alzheimer disease (AD). The main problem of VaD stems from the currently accepted definition of dementia that requires memory loss as the </span></span></span><em>sine qua non</em><span> for the diagnosis. This may result in over-sampling of patients with AD worsened by stroke (AD+CVD). We have proposed an operational definition of dementia in VaD based on the presence of abnormal executive control function, severe enough to interfere with social or occupational functioning. This may increase the sensitivity and specificity of the NINDS-AIREIN criteria. In donepezil trials in VaD that excluded prestroke MCI, the placebo groups were different from those in AD without CVD, and in AD+CVD trials.</span></p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 2","pages":"Pages 117-120"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2004.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73689372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Silent stroke”: An oxymoron meaning “dementia”","authors":"Donald R. Royall","doi":"10.1053/j.scds.2004.10.003","DOIUrl":"10.1053/j.scds.2004.10.003","url":null,"abstract":"<div><p><span>Brain MRI demonstrates the presence, in a large percent of elderly patients, of ischemic cerebrovascular disease (ICVD), usually as white-matter lesions and lacunar strokes. These lesions are considered clinically silent because they fail to produce sensory or motor deficits. Nonetheless, these lesions disrupt prefrontal-subcortical circuits that mediate executive control functions (ECF). The loss of ECF is manifested as behavioral and mood changes and as executive dysfunction leading to loss of autonomy in activities of daily living and may escape detection. Many cases are likely to be diagnosed as “Alzheimer disease” (AD) instead. This is because preclinical levels </span>of AD pathology<span> (ie, sufficient to affect hippocampal and memory function) are very common in the elderly. Mild-cognitive impairment (MCI) has been estimated to affect 40% of persons over the age of 65, in contrast to “dementia,” which affects at most 15%. However, memory impairment alone is insufficient for the diagnosis of dementia. Other cognitive domains must also be affected, and these must be sufficient to explain disability. It is very likely that comorbid “silent” frontal system ICVD converts a significant fraction of MCI cases to “AD.” This explains, first, the high prevalence of frontal system ICVD in clinically diagnosed AD; second, the inverse association between ICVD and Braak stage in clinically diagnosed AD; and third, the recent identification of traditional risks factors for ICVD as being also risk factors for AD.</span></p></div>","PeriodicalId":101154,"journal":{"name":"Seminars in Cerebrovascular Diseases and Stroke","volume":"4 2","pages":"Pages 97-101"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.scds.2004.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81617434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}