Stroke Treatment in the Setting of Systemic Disease
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Neurologic Manifestations of Systemic Disease (D Lapides, Section Editor)
Stroke Treatment in the Setting of Systemic Disease Karissa C. Arthur, MD* Elizabeth Fracica, MD, MPH Michelle C. Johansen, MD PhD Address * Department of Neurology, The Johns Hopkins University School of Medicine, 600 N Wolf St. Phipps 4-446, Baltimore, MD, 21287, USA Email: [email protected]
* Springer Science+Business Media, LLC, part of Springer Nature 2020
This article is part of the Topical Collection on Neurologic Manifestations of Systemic Disease Keywords Ischemic stroke I Human immunodeficiency virus I Opportunistic infections I Sickle cell anemia I Vasculitis Abstract
While the possible stroke risks for more prevalent conditions, such as cardiac disease or cancer, are important to recognize, there are other equally devastating systemic diseases that can affect younger adults and, if not cautious, may be misdiagnosed if stroke is the initial presentation. Purpose of review We aim to discuss treatments of three rarer, but important systemic diseases associated with an increased incidence of ischemic stroke, specifically sickle cell anemia, human immunodeficiency virus (HIV), and Takayasu’s arteritis. Recent findings Given that individuals with these diseases are now living longer, there is increasingly a two-pronged approach to therapy in order to both (1) control the underlying disease process and (2) address traditional stroke-risk factors. Summary Ischemic stroke in a patient with HIV may be due to accelerated atherosclerosis, tobacco abuse, or other traditional stroke-risk factors. Therefore, stroke prevention and management are similar to that of the general population. Stroke in HIV can be due to opportunistic infections, in which case the underlying infection should be treated aggressively. For patients with sickle cell anemia, the focus of treatment is on decreasing HbS to prevent further stroke. Patients with Takayasu’s arteritis are treated with immunosuppression to decrease inflammation and prevent stroke.
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Curr Treat Options Neurol
(2020) 22:44
Introduction The global lifetime risk of stroke is estimated to be about 25% among men and women aged 25 years and older, with ischemic stroke being the most common subtype [1]. This lifetime risk of ischemic stroke has increased by 12.7% since 1990, mainly due to countries with middlesociodemographic indices experiencing declines in other causes of death [1]. Systemic diseases such as sickle cell anemia, human immunodeficiency virus (HIV), and immunologic diseases, such as Takayasu’s arteritis while rare, are known to be associated with increased risk of stroke and can be severe in their presentation [2, 3].
Additionally, as patients with systemic disease are living longer and treatments improving, physicians are observing more age-related complications. For example, individuals surviving with HIV are more likely to experience age-related diseases such as ischemic stroke than in the past [4]. In this review, we aim to discuss treatments of three rarer, bu
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