Cerebrovascular

Other nootropic agents in some stage of clinical development include nebracetam (9), nefinacetam (10), and BMY 21502 (11). Nebracetam, an aminomethyl pyrrolidinone derivative, is expected to be approved in Japan in 1994 (73). In clinical studies involving patients having cerebrovascular or senile dementia of the Alzheimer s type, clinical symptoms such as spontaneous or emotional expression were enhanced in up to 71% of cases. Long-term treatment using nebracetam in patients with cerebral infarction also afforded marked improvement in most cases with few side effects (74). A review of this compound has beenpubUshed (75). 

Due to the pivotal role of platelets in thrombus formation, especially in the arterial system, inhibition of platelet function has become a central pharmacological approach. Antiplatelet drugs are given in order to prevent and treat thromboembolic diseases such as coronary heart disease, peripheral and cerebrovascular disease. They have also revolutionized the procedures of invasive coronary interventions as they reduce the risk of restenosis and thrombosis. 

Leffler CW, Parfenova H, Jaggar JH et al (2006) Carbon monoxide and hydrogen sulfide gaseous messengers in cerebrovascular circulation. J Appl Physiol 100 1065-1076... 

In summary, the steadily increasing size of geriatric populations in developed countries and the resultant increases in age-related diseases of the brain have provided the impetus for intensive study of the processes underlying neurodegeneration. A better understanding of these processes will likely lead to better methods of treatment not only for progressive memory disorders such as Alzheimer disease, but also for motor disorders such as amyotrophic lateral sclerosis, and cerebrovascular disorders such as stroke. 

On the pathophysiological side, hyperactive nNOS has been implicated in A/-methyl-D-aspartate (NMDA)-receptor-mediated neuronal death in cerebrovascular-stroke. Some disturbances of smooth muscle tone within the gastrointestinal tract (e.g., gastroesophageal reflux disease) may also be related to an overproduction of NO by nNOS in peripheral nitrergic nerves. 

One of the earliest symptoms of hypertensive crisis is headache (usually occipital), followed by a stiff or sore neck, nausea, vomiting, sweating, fever, chest pain, dilated pupils, and bradycardia or tachycardia. If a hypertensive crisis occurs, immediate medical intervention is necessary to reduce the blood pressure Strokes (cerebrovascular accidents) and death have been reported. 

The MAOI antidepressant drag s are contraindicated in patients widi known hypersensitivity to die drug s, liver and kidney disease, cerebrovascular disease, hypertension, or congestive heart failure and in die elderly. These drag s are given cautiously to patients witii impaired liver function, history of seizures, parkinsonian symptoms, diabetes, or hyperthyroidism. 

Diabetes mellitus is a complicated, chronic disorder characterized by either insufficient insulin production by the beta cells of die pancreas or by cellular resistance to insulin. Insulin insufficiency results in elevated blood glucose levels, or hyperglycemia As a result of the disease, individuals with diabetes are at greater risk for a number of disorders, including myocardial infarction, cerebrovascular accident (stroke), blindness, kidney disease, and lower limb amputations. 

To summarize this account of cerebrovascular pathophysiology, a mild decrease in CBF is accompanied by a concomitant increase in MTT and preserved or increased CBV. Tissue with severely decreased CBF also demonstrates increased MTT, but decreased CBV. 

Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 1989 20 1407-1431. 

Greisenegger S, MuUner M, Tentschert S, Lang W, Lalouschek W. Effect of pretreatment with statins on the severity of acute ischemic cerebrovascular events. J Neurol Sci 2004 221 5-10. 

Ginsberg MD. H3fpothermic neuroprotection in cerebral ischemia. In Welch KMA, Caplan LR, Reis DJ, Siesjo BK, Weir B, editors Primer on cerebrovascular diseases. San Diego Academic Press 1997. p 272-275. 

Powers WJ, Grubb Jr, RL, Raichle ME. Clinical results of extracranial-intracranial bypass surgery in patients with hemod3mamic cerebrovascular disease. J Neurosurg 1989 70 61-67. 

Nagata S, Fujii K, Matsushima T, Fukui M, Sadoshima S, Kuwabara Y, Abe H. Evaluation of EC-IC bypass for patients with atherosclerotic occlusive cerebrovascular disease clinical and positron emission tomographic studies. Neurol Res 1991 13 209-216. 

Leira R, Davalos A, Silva Y, Gil-Peralta A, Tejada J, GarciaM, Castillo J Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society. Early neurological deterioration in intracerebral hemorrhage Predictors and associated factors. Neurology 2004 63(3) 461 67. 

Lesser RP, Liiders DH, Dinner DS, Morris HH. Epileptic seizures due to thrombotic and embolic cerebrovascular disease in older patients. Epilepsia 1985 26(6) 622-630. 

B. Cerebrovascular imaging (using one of the following modahties) CT based CTA head and neck... 

Mohr JP, Sacco RL. Morbidity and mortality of stroke. In Moore, WS editor. Surgery for cerebrovascular disease. W.B. Saunders Company, 1996 p 9-15. 

Most cases of AzD show cerebrovascular amyloid deposits and the amyloid protein of senile plaques is the same as that found in blood vessels. It is referred to as )S-amyloid protein and is part of a 695, 751 or 770 amino-acid amyloid precursor protein APP, which is a transmembrane protein and although its precise function is not clear, it is widely distributed and APP knock-out mice show reduced motor function. Normally so-called short 40 amino-acid-soluble derivatives of APP are produced by proteolytic cleavage of APP within the j] (A4) amino-acid sequence but APP can also be cleaved... 

Kontos, H. (1989). Oxygen radicals in cerebral ischemia. In Cerebrovascular Diseases (eds. M.D. Ginsberg and W.D. Dietrich) pp. 365-371. Raven Press, New York. 

Hyperbaric oxygen Hypertensive cerebrovascular injury Alcoholism... 

Ellis, E.F., Dodson, L.Y. and Police, R.J. (1991). Restoration of cerebrovascular responsiveness to hyperventilation by the oxygen scavenger N-acetylcysteine following experimental brain injury. J. Neurosurg. 75, 774-779. 

Kurakawa, M., Sato, F., Masuda, Y., Yoshida, T., Ochi, Y., Zushi, K., Fujiwara, L, Naruto, S., Uno, H. and Mat-sumoto, J. (1991). Synthesis and biological activity of Il-(4-(cinnamyl)-l-piperazinyl)-6,l l-dihydrodibenz[6,e] oxepin derivatives, potential agents for the treatment of cerebrovascular diseases. Chem. Pharm. Bull. 39, 2564-2573. 

Prior to myocardial infarction, coronary artery bypass graft (CABG), peripheral artery disease, cerebrovascular accident, or aspirin use... 

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