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The central nervous system (CNS) has no lymphatic system as such, and although usually well protected from direct infection, its resistance to any infection that does occur is low. The patterns of infective illness are relatively few, but the organisms that can produce disease are many.
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After half a century of clinical experience and research, management of pulmonary arterial hypertension remains a challenge. Currently, data to support the use of standard therapies for pulmonary arterial hypertension (oxygen supplementation, diuretics, digoxin, anticoagulation, and calcium channel blockers) are mostly retrospective, uncontrolled prospective, or derived from other diseases with similar but not identical manifestations.
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The following Clinical Topic Tour provides an overview of hypertension (HTN) and was adapted from materials published by the NHLBI.
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In populations, blood pressures fit a normal distribution, but the attendant risks of heart disease and stroke increase curvilinearly with increasing levels of blood pressure, without any obvious breakpoint ( Fig. 63-1 ). Thus, the separation of normal from high blood pressure is arbitrary, and the definition of hypertension has been a moving target.
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The following Clinical Topic Tour provides an overview of stroke and was adapted from materials published by the National Institute of Neurological Disorders and Stroke and the Centers for Disease Control and Prevention.
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What?s new? The risk of recurrent stroke after TIA or minor stroke is higher than previously thought The early risk of recurrent stroke can be calculated using a simple clinical score, the ?ABCD? score The MATCH trial has shown no additional benefit with clopidogrel and aspirin over clopidogrel alone in prevention of recurrent stroke or vascular events The ESPRIT trial has shown benefit of aspirin and dipyridamole over aspirin alone in the secondary prevention of stroke The efficacy of carotid surgery for secondary prevention of stroke in patients with symptomatic carotid stenosis is highly dependent on the timing of surgery There are various clinical and pathological subtypes of stroke, and identification of the subtype is necessary for correct management.
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Stroke is an increasing public health concern throughout the world as the leading cause of long-term disability. It is well known that there exist differences related to epidemiology, pathophysiology, comorbidity, and functional outcome of stroke patients with advanced age compared with the young.
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A stroke is an interruption of blood circulation to the brain causing a neurologic deficit reflecting the area of the brain affected. Stroke can be ischemic or hemorrhagic. 1 Ischemic stroke is most prevalent.
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Nothing in clinical neurology exceeds the demands on the clinician more than diagnosing and managing the patient with headache, a process that demands a combination of clinical skill and good interpersonal relationships. The physician dealing with the patient who presents with headache will by the history determine the likely diagnosis; by the brief, structured examination receive some reassurance that there is no lurking lesion causing the problem; and by his or her ability to see past the patient's naive words of complaint, recognize a pattern of symptomatology, allowing a confident diagnosis that will allow equally confident management.
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Hypertension is an independent risk factor for coronary artery disease (CAD) and stroke, leading causes of morbidity and mortality in North America. Concern has been raised that there is inadequate outpatient detection, evaluation, and treatment of hypertension, and that this is resulting in increased hospital admissions with complications of untreated hypertension: heart failure, and end-stage renal disease [1] .
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