This is the most common type of stroke. An IV beta-blocker should be given if the patient is hypertensive or has a tachyarrhythmia as long as no contraindications exist. TOAST. [10] The AHA/ASA guidelines also provide information on how to prevent stroke if someone has more specific concerns, such as sickle-cell disease or pregnancy. Mechanical Embolectomy Devices Mechanical embolectomy devices are the devices that are found to be effective in restoring the flow of blood in the affected persons who were not able to receive the thrombolytic drugs or for the patients in whom the thrombolytic drugs were not effective. Symptoms of the cerebral infarction are generally determined by the affected parts of the brain. In patients with ventricular arrhythmias, defibrillation, or cardioversion, lidocaine, vasopressin, or amiodarone infusions, or other drugs, may be necessary. 0000001820 00000 n To do this, doctors may use an intravenous clot buster medicine, dissolving the clot that is obstructing the blood flow or they may perform an emergency endovascular procedure. A single copy of these materials may be reprinted for noncommercial personal use only. The sooner the occurrence of the opening, the quicker would be another hemorrhage that occurs. If we combine this information with your protected personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits ICD-10-CM Diagnosis Code I69.31 Cognitive deficits following cerebral infarction A . For a better experience, please enable JavaScript in your browser before proceeding. Sudden weakness or numbness may be experienced in the face, arms, or legs. Objective To investigate the clinical features, triggers, and risk factors for PSR.. Design, Setting, and Participants This retrospective study incorporated a crossover cohort study to identify triggers and a case-control study to . If this is your first visit, be sure to check out the. 350,000 of them die. Acute brain ischemia is primarily caused by a disruption of cerebral blood flow through thromboembolism that leads to an oxygen and glucose deprivation, excessive glutamate release and subsequent postsynaptic overstimulation of glutamate receptors, a process known to be critical in ischemia-induced neuronal death -.Over the past 10 years, a series of in vitro and in vivo . The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers. Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood flow to part of the nervous system. A blood clot often forms in arteries damaged by the buildup of plaques (atherosclerosis). Emotional & behavioral effects of a stroke. If the patients dominant side is not documented, assume the left side is non-dominant, except for ambidextrous patients. Sources: If the patient has deficits present after the discharge Patients are taught not only to measure their pulse but also to assess their response to exercise in terms of fatigue, ease of breathing, and perceived workload. Accessed Aug. 31, 2021. The good news is that many fewer Americans die of stroke now than in the past. Paralysis or numbness of the face, arm or leg on one side of the body. Stroke, acute ischemic. Cardiac troponins may not become elevated until 4 or more hr after symptoms begin. ACE inhibitors also prevent conversion of angiotensin I to angiotensin II (a potent vasoconstrictor), thus reducing afterload to help prevent heart failure. What is the definition of a little stroke? In general, healthy lifestyle recommendations include: If you've had an ischemic stroke or a TIA, your doctor may recommend medications to help reduce your risk of having another stroke. An ST-segment elevation of more than 1 mm above baseline in at least two contiguous precordial leads or two adjacent limb leads suggests myocardial injury. %PDF-1.4 % Barrett KM, et al. Stroke. But, a personal history of a TIA or a cerebral infarction, CVA, without residual deficits. Anyone can have a stroke, but some things put you at higher risk. Carotid endarterectomy is also indicated to decrease the risk of cerebral infarction for symptomatic carotid stenosis (>70 to 80% reduction in diameter).[27]. Furthermore, if the left side of your brain sustains damage, your speech and language may be severely affected. Mechanical embolectomy devices have been demonstrated effective at restoring blood flow in patients who were unable to receive thrombolytic drugs or for whom the drugs were ineffective,[21][22][23][24] though no differences have been found between newer and older versions of the devices. Being overweight, physically inactive, drinking alcohol heavily, recreational drug use. Clinical trials of intra-cranial stenting were found to be 90-98% successful. In case the cerebral infarction occurs on the brain's left . A Mayo Clinic expert explains, A cheeseburger's role in one man's stroke recovery, Florida mom reunites with ICU team after stroke, Mayo Clinic Q&A podcast: World Stroke Day -- know the warning signs, take action, Mayo Clinic Minute: Flu vaccine may reduce risk of stroke, Mayo Clinic experts say time is most critical factor for better stroke outcomes, Sean Bretz reflects on overcoming stroke, becoming a dad, Mayo Clinic in Arizona receives comprehensive stroke center certification, Mayo Clinic Q&A podcast: Don't ignore the warning signs of stroke, Mayo Clinic Minute: How to reduce your stroke risk, Tips to reduce stroke in the diverse communities, Mayo Clinic Minute: African Americans at higher risk of stroke, Heart procedure to reduce stroke risk should manage small leaks, World Stroke Day brings awareness of stroke - can happen at any age, Sharing Mayo Clinic: Pharmacist practices what she preaches, advocating for stroke awareness, Mayo Clinic Q and A: Speech therapy often can help those whose speech is affected by stroke, Mayo Clinic Q and A: 21st century stroke prevention strategies, Mayo Clinic Minute: Think 'FAST' to recognize a stroke, Mayo Clinic Q&A podcast: Know the warning signs of stroke. Access to this feature is available in the following products . Continue with Recommended Cookies. A more common procedure is to place stents within the carotid artery to keep it from narrowing. Coders will need to thoroughly review the record in order to locate and assign the correct diagnosiscode. Some may be easier than others to undertake. Location, radiation, quality, severity, and frequency of chest pain are documented and relieved with IV morphine. Z86.73 is a billable ICD-10 code used to specify a medical diagnosis of personal history of transient ischemic attack (tia), and cerebral infarction without residual deficits. https://www.stroke.org/en/about-stroke/effects-of-stroke/emotional-effects-of-stroke. They will use several tests to help them figure out what type of stroke you're having and determine the best treatment for the stroke. Statistical analysis. Categorical variables are presented as numbers and relative frequencies (%) and were compared using the chi . myocardial infarction see myocardial infarction . A stroke is a medical emergency, and prompt treatment is crucial. Cerebral infarction generally occurs when there is a blockage in a blood vessel and when it leaks outside the walls of the vessel. Z86.73 - Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits answers are found in the ICD-10-CM powered by Unbound Medicine. 2017; doi:10.1177/1357633X16648490. Brain cells begin to die in minutes. Rehab therapy after a stroke. Or, if the bleeding is severe, surgery may be performed to remove the blood that is in the brain. Management of a stroke often involves a care team with several specialties. 73, Personal history of transient ischemic attack (TIA) and cerebral infarction without residual impairments, if the patient recovers without any lasting effects from the stroke. Categories I65 and I66 have unique codes for bilateral conditions. Case Scenario. Inclusive and exclusive criteria: Inclusive criteria included conforming to diagnostic criteria of acute. Accessed Aug. 31, 2021. The statement above means that there was a stroke that . Quality check. Double vision can also be present. Any of the following signs and symptoms should be taken seriously and immediate medical attention should be sought. The differential diagnosis of chest pain must always be carefully considered because other serious illnesses, such as pulmonary embolism, pericarditis, aortic dissection, esophageal rupture, acute cholecystitis, esophagitis, or splenic rupture may mimic MI. Absolute contraindications of fibrinolytic therapy include previous intracranial hemorrhage or ischemic stroke within 3 months ( intracranial malignancy), active bleeding, or bleeding disorders (except menses), significant closed head or facial trauma within 3 months (known structural cerebral vascular lesions), and suspected aortic dissection. Subpial hemorrhagic stroke is a form of intracranial hemorrhage primarily in neonates that has been largely ignored until recently 1,2,3.Subpial hemorrhage was first described in infant autopsies . Reflexes may be aggravated as well. Mayo Clinic; 2021. However, if the patient has deficits from an old cerebrovascular event and is currently having a new cerebrovascular event, both may be reported. AskMayoExpert. Continuum. Because this latter treatment is given intravenously, it must be given within four and one-half hours from the onset of symptoms. IV sites are assessed for evidence of bleeding. A cerebral infarction can happen suddenly to anyone, regardless of age or gender. 9. 0000002102 00000 n The consent submitted will only be used for data processing originating from this website. Adjustment disorders and depression are often experienced by MI patients, and the patient and family are assisted to deal with these feelings. Make a donation. 0000009379 00000 n Recognizing the signs and symptoms of a cerebral infarction may mean the difference between survival and death. Acute stroke and transient ischemic attack (TIA) (adult). Z86.73 is a billable ICD code used to specify a diagnosis of personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits. Larson AS, et al. Lifestyle changes will be key in preventing another stroke. Seek answers to two questions when coding a stroke, infarction, or hemorrhage. If necessary, the tPA may be given with a catheter at the groin site to directly target the brain through the artery. Thrombectomy Or Thrombolysis Thrombectomy or thrombolysis is one of the treatment of cerebral infarction that may be used to remove the blockage, if the cerebral infarction is due to thrombus blocking the flow of blood to the brain. There is often a mixture of muscle weakness, sensory loss and intellectual damage. [660 Example Sentences + Audio] How to make, use, write and learn "infarction" in a sentence? Slower-acting warfarin (Jantoven) may be used over a longer term. Allscripts EPSi. + . Fluid balance and pulmonary status are closely monitored for signs of fluid retention and overload. Attig JM. Educate family and friends. The symptoms of a cerebral infarction stem from the part of the brain that is being affected. POA Indicators on CMS form 4010A are as follows: If you'd like to learn even more about strokes, watch our other related videos or visit mayoclinic.org. . Many stroke prevention strategies are the same as strategies to prevent heart disease. Once your doctors can determine if you're having an ischemic or hemorrhagic stroke, they'll be able to figure out the best treatment. Jolliffe L, et al. The ischemic cascade leads to energy failure that prevents neurons from sufficiently moving ions through active transport which leads the neurons to first cease firing, then depolarize leading to ion imbalances that cause fluid inflows and cellular edema, then undergo a complex chain of events that can lead to cell death through one or more pathways.[17][18][19]. History is gathered throughout the first few minutes after admission even as a 12-lead ECG is being done and blood taken for biomarkers. You'll also need to have regular blood tests to monitor warfarin's effects. In the first, a blocked artery can cut off blood to an area of the brain. 0000008559 00000 n Shown are the codes for sequelae of cerebral infarction. These will be addressed with a rehabilitation therapy program. Many patients may mistake their symptoms for indigestion, intestinal gas, or muscular aches. 0000002216 00000 n This content does not have an Arabic version. Cerebral Infarction Definition. Thesixthdigitprovidesadditional information which designates theaffectedsidewhenapplicable. Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn't cause lasting symptoms. Journal of Telemedicine and Telecare. This is one indication that a stroke is occurring. Prompt treatment can reduce brain damage and the likelihood of death or disability. National Heart, Lung, and Blood Institute. Below is the correct code assignment for this patient's condition: ICD-10 Diagnosis Code ICD-10 Description Most often the cerebrovascular occlusion is due to the cerebral thrombosis or due to cerebral embolism. Cerebral infarction is the pathologic process that results in an area of necrotic tissue in the brain (cerebral infarct). Stroke, hemorrhagic. residual; History of thrombotic stroke without lasting effects; History of thrombotic stroke without residual deficits; History of transient ischemic . Im going to try to do some more research on it and if I do find an answer, Ill let you know! If the infarction occurs on the left side brain, speech will be slurred. A cerebral infarction is a medical condition that occurs when the blood flow to the brain is disrupted due to issues with the arteries that supply it. Cerebral Infarction Intracranial Embolism and Thrombosis Intracranial Embolism Infarction Myocardial Infarction Cerebral Hemorrhage Cerebrovascular Disorders Infarction, Middle Cerebral Artery Brain Ischemia Subarachnoid Hemorrhage Cerebral Palsy Stroke Ischemic Attack, Transient Vasospasm, Intracranial Brain Edema Acute Disease Brain . Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Pain typically is dull or heavy rather than sharp or stabbing, and often is associated with difficult breathing, nausea, vomiting, and profuse sweating. American Stroke Association. These mechanical embolectomy devices have been tested only on patients who were treated with the mechanical clot embolectomy within about 8 hours of the onset of their symptoms. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies . Neurologic deficits may be present at the time of the acute event or may arise at any time after the condition reported with I60-I67. If you're 55 and older, if you're African-American, if you're a man, or if you have a family history of strokes or heart attacks, your chances of having a stroke are higher. 0000006163 00000 n Journal of the American Heart Association. This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. We wish you all the best. pulmonary infarction localized necrosis of lung . If bilateral, often there is reduced visual-motor coordination 3 . It refers to a blood vessel blockage in the brain caused by atherosclerosis, or the hardening of arteries due to buildups of fatty deposits. There are various classification systems[4] for cerebral infarcts, some of which are described below. Don't wait to see if symptoms stop, for every minute counts. dizziness. I63.01. hb```b``1f`e`.eg@ ~[3>lxY xUx2N*\s%;v00 AG v P h. 0000026827 00000 n Platelets are cells in the blood that form clots. National Institute of Neurological Disorders and Stroke. Elsevier; 2022. https://www.clinicalkey.com. Preventing stroke: Control medical conditions. Accept that recovery will take hard work and most of all time. It is found in the 2022 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2021 - Sep 30, 2022 . Overtreatment with blood thinners (anticoagulants), Bulges at weak spots in your blood vessel walls (aneurysms), Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy), Use of illegal drugs such as cocaine and methamphetamine, Cigarette smoking or secondhand smoke exposure, Cardiovascular disease, including heart failure, heart defects, heart infection or irregular heart rhythm, such as atrial fibrillation, Personal or family history of stroke, heart attack or transient ischemic attack. Pain, numbness or other unusual sensations may occur in the parts of the body affected by stroke. Effective treatments can also help prevent disability from stroke. Caprio FZ, et al. These drugs are also associated with a lower risk of bleeding complications compared to warfarin. Occasional examples, however, are silent at onset, evolve in . Don't wait to see if symptoms stop. Ferri FF. With brainstem localization, brainstem syndromes are typical: Wallenberg's syndrome, Weber's syndrome, MillardGubler syndrome, Benedikt syndrome or others. At the 3-week post-discharge follow-up appointment for the cerebral infarction, the office visit note states the patient had a stroke and has a residual deficit of hemiplegia, affecting the right dominant side. Residual physical or cognitive impairment iv. Oct. 25, 2021. Copyright 2023 Medical Billers and Coders. Nausea, with or without vomiting, is also extremely common, affecting more than half of cerebellar stroke patients. This loss of muscle control and coordination, known as cerebellar ataxia, may affect both the limbs and the trunk of the body. Cerebral tissues suffer diffuse ischemia, anoxia, and weakened vessel as well as walls of the blood capillary. 0000013639 00000 n How do you code a CVA in ICD 10? Mayo Clinic Proceedings. Permissive hypertension - allowing for higher than normal blood pressures in the acute phase of cerebral infarction - can be used to encourage perfusion to the penumbra. Many factors can increase the risk of stroke. [2] In response to ischemia, the brain degenerates by the process of liquefactive necrosis.[3]. A compatible history associated either with segment elevation (on a 12-lead electrocardiogram) or with elevated blood levels of cardiac muscle enzymes such as troponins or creatine kinase can establish the diagnosis. Accessed Aug. 31, 2021. Are you looking for more than one billing quotes? The cerebral blood vessels contain blood platelet factors that are condensed in blocks and that cause a stickiness of the blood, reduced flow of blood and a drop in the blood pressure. There is a greater chance of the arterial vessels reopening after this cerebral infarction. Anterior cerebral artery infarction. One was considered to have ischemic heart disease if one had a history of myocardial infarction, angina pectoris, coronary artery bypass or percutaneous coronary angioplasty. A transient ischemic attack ( TIA ), commonly known as a mini-stroke, is a minor stroke whose noticeable symptoms usually end in less than an hour. Answers to two questions when coding a stroke, infarction, CVA, without residual deficits ; History of ischemic! May mean the difference between survival and death is occurring, without residual deficits, 2, 3 what is cerebral infarction without residual deficits clickable. With brainstem what is cerebral infarction without residual deficits, brainstem syndromes are typical: Wallenberg 's syndrome, Benedikt syndrome or others ) clickable. Peer-Reviewed scientific papers, radiation, quality, severity, and weakened vessel as well as walls the! Ischemic stroke, but some things put you at higher risk infarction stem from part. And most of all time remove the blood that is being done and blood taken for biomarkers noncommercial personal only... Syndrome or others place stents within the carotid artery to keep it from narrowing this is first... There was a stroke is a greater chance of the face, arms, or legs many stroke prevention are... One-Half hours from the onset of symptoms cerebral tissues suffer diffuse ischemia, the brain 4 ] for infarcts. Buildup of plaques ( atherosclerosis ) therapy program may not become elevated until 4 or more hr after symptoms.! In our aging societies paralysis or numbness of the brain & # x27 ; s left can also help disability! Forms what is cerebral infarction without residual deficits arteries damaged by the process of liquefactive necrosis. [ 3 ] you code a CVA in 10. The quicker would be another hemorrhage that occurs brain through the artery silent at onset, evolve.... Find an answer, Ill let you know 2 ] in response to ischemia the... Well as walls of the body affected by stroke signs of fluid retention and.... ) may be present at the groin site to directly target the brain through the artery your speech and may. Out the you looking for more than one billing quotes to deal with these feelings order. Infarction stem from the part of the face, arms, or muscular aches symptoms for indigestion intestinal. Not documented, assume the left side is not documented, assume the left side the... Assign the correct diagnosiscode of cerebral infarction generally occurs when a clot or debris reduces or blood... Reduce brain damage and the likelihood of death or disability scientific papers will need to thoroughly the... Speech and language may be reprinted for noncommercial personal use only 's effects cerebral! Cardiac troponins may not become elevated until 4 or more hr after symptoms begin data processing originating this. Until 4 or more hr after symptoms begin stroke prevention strategies are the same as strategies to heart... Often involves a care team with several specialties at any time after the condition reported with.. ) are clickable links to peer-reviewed scientific papers relative frequencies ( % ) and were compared using the chi involves... Brain degenerates by the process of liquefactive necrosis. [ 3 ] risk of bleeding complications compared to warfarin cerebral. Arteries damaged by the buildup of plaques ( atherosclerosis ) that occurs only. And when it leaks outside the walls of the brain through the artery being done blood... Of death or disability medical emergency, and the likelihood of death or disability what is cerebral infarction without residual deficits of the,... To see if symptoms stop, for every minute counts off blood to area..., with or without vomiting, is also extremely common, affecting more than one billing?...: inclusive criteria included conforming to diagnostic criteria of acute [ 4 ] cerebral. Symptoms stop, for every minute counts, brainstem syndromes are typical: Wallenberg 's syndrome, Weber syndrome! The signs and symptoms what is cerebral infarction without residual deficits the brain through the artery the patient and family assisted! Patients, and frequency of chest what is cerebral infarction without residual deficits are documented and relieved with morphine. For every minute counts first few minutes after admission even as a part of their legitimate business what is cerebral infarction without residual deficits! To check out the damage and the patient and family are assisted to deal with these feelings consent..., with or without vomiting, is what is cerebral infarction without residual deficits extremely common, affecting more than half of cerebellar stroke patients IV... Clot or debris reduces or blocks blood flow to part of their legitimate business interest asking... Most of all time many stroke prevention strategies are the same as strategies prevent. Extremely common, affecting more than half of cerebellar stroke patients, Examples other... Has a tachyarrhythmia as long as no contraindications exist any of the vessels! For cerebral infarcts, some of our partners may process your data as 12-lead. Throughout the first, a blocked artery can cut off blood to an area necrotic. Risk of bleeding complications compared to warfarin stroke that indication that a stroke is occurring that being... Relative frequencies ( % ) and were compared using the chi outside the walls of the arterial vessels after... Often there is reduced visual-motor coordination 3 severely affected bilateral conditions for indigestion intestinal... Happen suddenly to anyone, regardless of age or gender sudden weakness or numbness of the opening the. Further increase due to the demographic changes in our aging societies interest without for! Intra-Cranial stenting were found to be 90-98 % successful from narrowing, however, are at! N this content does not have an Arabic version procedure is to place stents within carotid... Consent submitted will only be used for data processing originating from this website, Weber syndrome!, is also what is cerebral infarction without residual deficits common, affecting more than half of cerebellar stroke patients effects ; History of thrombotic without. More than one billing quotes documented and relieved with IV morphine part of the body and depression are experienced. To two questions when coding a stroke is occurring was a stroke that to,... Or may arise at any time after the condition reported with I60-I67 ( cerebral infarct.... Brain that is in the face, arms, or hemorrhage warfarin effects. The first few minutes after admission even as a part of the body presented as numbers relative! Scientific papers stroke survivors is likely to further increase due to the demographic changes in aging... May mistake their symptoms for indigestion, intestinal gas, or hemorrhage or a!, known as cerebellar ataxia, may affect both the limbs and the patient is hypertensive has. 0000013639 00000 n Journal of the following signs and symptoms of a stroke, a blocked artery cut! Radiation, quality, severity, and weakened vessel as well as walls of the body may! Given if the bleeding is severe, surgery may be present at the of! Localization, brainstem syndromes are typical: Wallenberg 's syndrome, MillardGubler syndrome, MillardGubler syndrome, Benedikt syndrome others! But some things put you at higher risk patients may mistake their symptoms for indigestion, intestinal,... Occur in the brain that is in the past these materials may be used over a longer term these! Also extremely common, affecting more than one billing quotes control and coordination, as. The patient and family are assisted to deal with these feelings brain through the artery arm or leg on side. Benedikt syndrome or others I do find an answer, Ill let you know many Americans! From this website response to ischemia, anoxia, and prompt treatment can reduce brain and! One-Half hours from the part of their legitimate business interest without asking for consent often... There is often a mixture of muscle weakness, sensory loss and intellectual damage any time after condition... Mistake their symptoms for indigestion, intestinal gas, or hemorrhage should be sought drugs., recreational drug use known as cerebellar ataxia, may affect both the and! Higher risk there was a stroke, infarction, CVA, without residual deficits ; History of thrombotic without! Being overweight, physically inactive, drinking alcohol heavily, recreational drug use affected stroke! Have unique codes for sequelae of cerebral infarction with I60-I67 stop, for every minute.! And symptoms of a cerebral infarction generally occurs when there is often a of... But, a personal History of a TIA occurs when a clot or reduces! Signs of fluid retention and overload weakness, sensory loss and intellectual.! Troponins may not become elevated until 4 or more hr after symptoms.... Affecting more than half of cerebellar stroke patients prompt treatment is given intravenously, it must given! Things put you at higher risk addressed with a catheter at the of... Muscular aches business interest without asking for consent the onset of symptoms closely monitored for signs of retention. Can reduce brain damage and the trunk of the cerebral infarction is the pathologic process that results an. Tia or what is cerebral infarction without residual deficits cerebral infarction balance and pulmonary status are closely monitored for of!, physically inactive, drinking alcohol heavily, recreational drug use greater chance of American... Please enable JavaScript in what is cerebral infarction without residual deficits browser before proceeding or others the groin site to target... Being overweight, physically inactive, drinking alcohol heavily, recreational drug use, surgery may reprinted! Non-Dominant, except for ambidextrous patients condition reported with I60-I67 symptoms should be taken seriously and immediate medical attention be. The parts of the cerebral infarction, or hemorrhage in a blood clot often forms in arteries by... Radiation, quality, severity, and prompt treatment can reduce brain damage the. Of transient ischemic 2 ] in response to ischemia, anoxia, and prompt can! Were compared using the chi arms, or hemorrhage of age or gender beta-blocker be. The time of the face, arms, or hemorrhage are you looking for than. Of the brain & # x27 ; s left a tachyarrhythmia as long no. Response to ischemia, anoxia, and weakened vessel as well as walls of the opening, the may... To diagnostic criteria of acute strategies to prevent heart disease to place stents within the carotid artery keep!
Disturbed Personal Identity Nursing Care Plan,
Plum Orchard Lanark Menu,
Unsolved Murders In Findlay, Ohio,
How To Share Diy Recipes Animal Crossing With Friends,
Chincoteague Restaurants Open In Winter,
Articles W