phenprocoumon and Cerebral-Infarction

Ischemic optic neuropathy is caused by ischemia of the optic nerve head in the region of the lamina cribrosa. Differentiation is made between arteritic (AION) and nonarteritic (NAION) forms. AION is the most common ophthalmological manifestation of giant cell arteritis and is usually well controlled with systemic steroid therapy. Temporal artery biopsy for confirmation of the diagnosis is mandatory. NAION is not a disease entity but rather the common pathogenetic pathway of a large variety of diseases and conditions and is often the result of several interacting factors. For this reason, there is no "standard therapy" for NAION. Careful interdisciplinary work up in NAION frequently reveals previously unrecognized diseases requiring treatment according to internal medicine standards. Adequate treatment frequently results in improvement of the affected eye and reduced risk of NAION in the other eye or of brain infarction.

Topics: Adrenal Cortex Hormones; Adult; Age Factors; Aged; Anticoagulants; Biopsy; Cerebral Infarction; Clinical Trials as Topic; Female; Giant Cell Arteritis; Humans; Male; Middle Aged; Optic Disk; Optic Neuritis; Optic Neuropathy, Ischemic; Phenprocoumon; Retinitis; Risk Factors; Temporal Arteries; Treatment Outcome; Ultrasonography, Doppler, Transcranial; Visual Fields

Antithrombotic medication can be performed by means of heparins (non-fractionated heparin, low molecular heparins) or the pentasaccharide Fondaparinux as well as with oral vitamin K antagonists. The use of a low molecular heparin is initially recommended for the sake of practicability and safety in case of patients suffering from deep venous thrombosis of the leg and pelvis with subsequent long-term oral medication using a vitamin K antagonist (Marcumar) for anticoagulation. The most frequent indications for long-term anticoagulation are deep leg and pelvis thromboses, pulmonary embolism with atrial fibrillation, artificial prosthetic valves and open oval foramen with ischaemic cerebral infarction. In case of patients with chronic atrial fibrillation it is expedient to initiate permanent anticoagulation according to a risk score. For the purpose of controlling oral anticoagulation it is recommended to employ the INR value in place of Quick's value because these data are better comparable. In case of atherothrombotic diseases secondary prevention will always indicate administration of a thrombocyte aggregation inhibitor. In such cases acetylsalicylic acid is recommended as the standard preparation.

Topics: Administration, Oral; Adult; Age Factors; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Atherosclerosis; Atrial Fibrillation; Blood Coagulation Tests; Cerebral Infarction; Drug Therapy, Combination; Female; Fibrinolytic Agents; Fondaparinux; Heart Valve Prosthesis; Hemorrhage; Heparin; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Phenprocoumon; Platelet Aggregation Inhibitors; Polysaccharides; Preoperative Care; Prevalence; Primary Prevention; Pulmonary Embolism; Risk Factors; Sex Factors; Stroke; Time Factors; Venous Thrombosis

For patients who suffered a TIA or a stroke the risk of a second event is high. The recurrence rate, however, can be significantly reduced by a number of prophylactic strategies. Methods for secondary stroke prevention include a healthy lifestyle, intensive body exercise, a low cholesterol diet, and the cessation of smoking. High levels of blood pressure, cholesterol and blood glucose should be rigorously controlled. In particular, blood pressure levels should remain below 135/85 mmHg including a physiological day/night profile. All patients at high risk for cardiac embolism should receive oral anticoagulants. As the risk for embolic events increases with age (especially in patients with atrial fibrillation), a rigid "age-cutoff" for anticoagulation is not justified.

Topics: Administration, Oral; Adult; Anticholesteremic Agents; Anticoagulants; Antihypertensive Agents; Blood Coagulation Disorders; Brain Ischemia; Carotid Artery, Internal; Carotid Stenosis; Cerebral Infarction; Clinical Trials as Topic; Contraceptives, Oral; Embolism; Endarterectomy, Carotid; Exercise; Female; Humans; Hypertension; Hypolipidemic Agents; Ischemic Attack, Transient; Life Style; Male; Phenprocoumon; Platelet Aggregation Inhibitors; Recurrence; Simvastatin; Smoking Cessation; Stroke

A 29-year-old woman was admitted to hospital with an acute right-sided hemiplegia and sensory disorders, as well as upper right quadrant anopsia. There were no other significant abnormalities. She had previously been healthy and was free of any predisposing risk factors for thromboembolism. Neurological examination elicited a homonymous right upper quadrant hemianopsia, dysesthesia of the right half of the face and hypesthesia and hypalgesia of the right side of the body. In addition there was paresis of the right arm and a positive right Babinski reflex.. There was no evidence for any underlying haematological, metabolic, infectious or vascular disease. Computed tomography of the head revealed a small hypodense area immediately adjacent to the posterior part of the left internal capsule, compatible with a lacunar infarction, a finding confirmed by magnetic resonance imaging and relating to the area supplied by the thalamic branch of the posterior cerebral artery. Transoesophageal echocardiography demonstrated a patent foramen ovale.. Almost complete regression of all signs occurred within two months on anticoagulation with heparin intravenously for two weeks followed by oral phenprocoumon (Quick's value 30-40%) and intensive physiotherapy. Five weeks after onset of treatment the paresis was obviously regressing and pyramidal tract signs had disappeared. Sensitivity to touch over the right half of the body was still diminished and the homonymous paracentral scotoma still present.. Lacunar infarction of the brain in young patients has an excellent prognosis, as long as it is treated intensively according to its cause.

Topics: Acute Disease; Adult; Anticoagulants; Cerebral Infarction; Combined Modality Therapy; Diagnosis, Differential; Female; Hemianopsia; Hemiplegia; Heparin; Humans; Hypesthesia; Phenprocoumon; Physical Therapy Modalities; Remission Induction; Time Factors

Patients (pts.) with atrial fibrillation (AF) and atrial thrombi are known to have an increased risk for cerebral embolism. However, little is known about the clinical course of atrial thrombi and the incidence of cerebral embolism in those patients during anticoagulation therapy. The high sensitivity of MR imaging (MRI) including diffusion-weighted imaging (DWI) suggests that this technique could provide an improved estimate of cerebral embolism associated with the presence of left atrial thrombi. The aims of this prospective study were to evaluate 1) the prevalence of clinically silent and apparent cerebral embolism in pts. with newly diagnosed AF and atrial thrombi using MRI/DWI, 2) the long-term fate of atrial thrombi under continues anticoagulation therapy and 3) the incidence of cerebral embolism during a follow-up period of 12 months with continuous anticoagulation therapy.. The study group consisted of 32 pts. with 1) newly diagnosed AF and evidence of left atrial (LA) thrombi detected by TEE and 2) a new start of anticoagulation therapy [International Normalized Ratio (INR) 2.0 - 3.0]. 19 pts. with 1) newly diagnosed AF and no evidence of atrial thrombi and 2) an equivalent anticoagulation regimen served as the control group. In both groups a) MRI/DWI studies of the brain (weeks 0, 4, 8, 12, 20, 28, 36, 44, and 52), b) transesophageal echocardiographic studies (TEE) for assessment of LA-Thrombi (weeks 0 and 52) and c) clinical neurological assessments (weeks 0, 20 and 52) were performed.. In the study group (AF and LA-Thrombi) 11 out of 32 pts. (34 %) displayed signs of acute (n = 8) or chronic (n = 3) cerebral embolism in the initial MRI studies. In 4 out of 32 pts. (13 %), MRI/DWI depicted new or additional cerebral emboli (n = 12) during the follow-up period despite continuous anticoagulation therapy. 2 (n = 2/4; 50 %) of these patients had clinically apparent neurological deficits. In the control group 1 out of 19 pts. (5 %) showed evidence of chronic cerebral embolism as assessed by MRI/DWI at the beginning of the study (week 0). No embolic cerebral lesions were detected during the 12-month follow-up. Within 12 months only 63 % (n = 20/32) of LA thrombi in the study group resolved completely under anticoagulation.. 1. The incidence of clinically inapparent cerebral emboli in pts. with newly diagnosed AF and atrial thrombi is much higher than the incidence of clinically apparent emboli and has been underestimated in the past. 2. New cerebral embolism may occur even with continued effective anticoagulation therapy in 13 % of pts. 3. Only 63 % of atrial thrombi resolve completely within 12 months under anticoagulation therapy.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Atrial Fibrillation; Cerebral Infarction; Diffusion Magnetic Resonance Imaging; Echocardiography, Transesophageal; Female; Follow-Up Studies; Heart Atria; Heart Diseases; Heparin; Humans; Incidence; Intracranial Embolism; Magnetic Resonance Imaging; Male; Middle Aged; Partial Thromboplastin Time; Phenprocoumon; Prospective Studies; Risk Factors; Sensitivity and Specificity; Thrombosis; Time Factors

Topics: Anticoagulants; Cerebral Infarction; Double-Blind Method; Humans; International Normalized Ratio; Morpholines; Multicenter Studies as Topic; Phenprocoumon; Randomized Controlled Trials as Topic; Rivaroxaban; Secondary Prevention; Stroke; Thiophenes

Topics: Adult; Anticoagulants; Aspirin; Cerebral Infarction; Fibrinolytic Agents; Foramen Ovale, Patent; Hemianopsia; Humans; Magnetic Resonance Imaging; Male; Phenprocoumon; Platelet Aggregation Inhibitors; Scotoma; Tomography, X-Ray Computed; Treatment Outcome; Visual Fields

Movement disorders have only rarely been reported in association with antiphospholipid syndrome (APS). In such cases, chorea is the most common disorder observed, with occasional reports of hemidystonia, Parkinsonism, and hemiballism. We report here on 3 cases of APS (3 women ages 16, 46, and 56 years) who presented with movement disorders, including tics, tremor, myoclonus, and a corticobasal syndrome, never or rarely reported in association with this disease. Mild executive dysfunction was observed in all 3 patients. We also report the successful treatment of two of these patients with mild oral anticoagulation (INR 2-3). Movement disorders in APS seem more clinically heterogeneous than previously thought. Oral anticoagulation should be considered in the treatment of movement disorders associated with APS.

Topics: Adolescent; Antiphospholipid Syndrome; Brain; Cerebral Infarction; Diagnosis, Differential; Dyskinesias; Electroencephalography; Electromyography; Female; Follow-Up Studies; Frontal Lobe; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Middle Aged; Movement Disorders; Myoclonus; Neurologic Examination; Neuropsychological Tests; Occipital Lobe; Phenindione; Phenprocoumon; Sneddon Syndrome; Spinocerebellar Degenerations; Tics; Tourette Syndrome; Tremor; Warfarin

A 61-year-old man was admitted to hospital because of right-sided hypaesthesia. Additionally he reported a brief speech disturbance some weeks before. Neurological examination indicated right-sided sensomotoric hemiparesis and left-sided upper quadrant anopia. 6 years ago recurrent transient ischaemic attacks (TIA) was diagnosed caused by paradoxical embolism through a persistent foramen ovale (PFO). The PFO was closed with a 45 mm Sideris button occluder device. After this, he reported no symptoms of cerebral ischaemia and he did not take any antiplatelet therapy.. Transesophageal echocardiography (TEE) showed a left atrial thrombus attached to the occluder. Cerebral computed tomography revealed infarction in regions supplied by the right posterior cerebral artery and left media cerebral artery. As additional risk factor for thrombosis a heterozygous factor V Leiden mutation was diagnosed.. Multiple cerebral infarctions caused by a thrombus attached to an occluder system 6 years after interventional closure of persistent foramen ovale in a patient with heterozygous factor V Leiden mutation.. The patient was anticoagulated (phenprocoumon) and the thrombus gradually dissolved.. A thrombosis on a Sideris occluder device may cause cerebral infarctions even years after transcatheter closure of a PFO.

Topics: Anticoagulants; Cardiac Surgical Procedures; Cerebral Infarction; Echocardiography, Transesophageal; Embolism, Paradoxical; Factor V; Heart Septal Defects, Atrial; Humans; Ischemic Attack, Transient; Male; Middle Aged; Phenprocoumon; Prostheses and Implants; Risk Factors; Thrombosis; Tomography, X-Ray Computed

Topics: Administration, Oral; Age Factors; Aged; Anticoagulants; Aspirin; Atrial Fibrillation; Cerebral Hemorrhage; Cerebral Infarction; Clinical Trials as Topic; Contraindications; Fibrinolytic Agents; Humans; Male; Middle Aged; Phenprocoumon; Recurrence; Risk Factors

Topics: Anticoagulants; Aspirin; Atrial Fibrillation; Cerebral Infarction; Dose-Response Relationship, Drug; Humans; Phenprocoumon; Platelet Aggregation Inhibitors; Recurrence; Risk Factors; Substance Withdrawal Syndrome

Topics: Adult; Anticoagulants; Anticonvulsants; Carbamazepine; Cerebral Infarction; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme System; Dose-Response Relationship, Drug; Drug Synergism; Enzyme Activation; Epilepsy; Humans; Liver; Male; Mixed Function Oxygenases; Phenprocoumon; Prothrombin Time

Topics: 4-Hydroxycoumarins; Aged; Cerebral Infarction; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Phenprocoumon; Recurrence; Time Factors