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Pu Y, Liu L, Wang Y, Zou X, Pan Y, Soo Y, Leung T, Zhao X, Wong KS, Wang Y. Geographic and sex difference in the distribution of intracranial atherosclerosis in China. Stroke 2013; 44:2109-14. [PMID: 23760212 DOI: 10.1161/strokeaha.113.001522] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Geographic variation and sex difference in the distribution of intracranial atherosclerosis (ICAS) have not been fully discussed before in Chinese patients with cerebral ischemia. We performed this study with the aim to investigate geographic and sex difference in the distribution of ICAS in China. METHODS In this prospective multicenter study, we evaluated 2864 consecutive patients who experienced an acute cerebral ischemia within 7 days of symptom onset in 22 hospitals in China. All the inclusive patients underwent 3-dimensional time-of-flight MR angiography and duplex color Doppler ultrasound or contrast-enhanced MR angiography to document the presence of intracranial or extracranial stenosis. Intracranial large-artery atherosclerosis was defined as ≥50% diameter reduction on MR angiography. RESULTS The proportion of patients with ICAS was significantly higher in north China than in south China (50.22% versus 41.88%; P<0.0001). Patients in the north were likely to consume more alcohol and smoke more cigarettes and had significantly higher proportion of diabetes mellitus, family history of stroke, history of cerebral ischemia, heart disease, and higher body mass index. In patients aged >63 years, the percentage of ICAS in women was notably higher than in men (51.51% versus 45.40%; P=0.028). In elderly patients, women had higher proportion of diabetes mellitus, hypertension, hyperlipidemia, and heart disease than men. CONCLUSIONS There exists geographic and sex difference in the distribution of symptomatic ICAS in China. Public health measures should strengthen improving social determinants of health and risk factor prevention/control in high-risk populations for decreasing stroke risk.
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Affiliation(s)
- Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital of Capital Medical University, Beijing, China
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152
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Kalev-Zylinska ML, Symes W, Little KCE, Sun P, Wen D, Qiao L, Young D, During MJ, Barber PA. Stroke patients develop antibodies that react with components of N-methyl-D-aspartate receptor subunit 1 in proportion to lesion size. Stroke 2013; 44:2212-9. [PMID: 23723305 DOI: 10.1161/strokeaha.113.001235] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Antibodies against neuronal antigens develop in patients after stroke and some may serve as biomarkers of neuronal injury. We aimed to determine whether antibodies against subunit 1 (GluN1) of the N-methyl-D-aspartate receptor also develop after stroke and if so, whether they correlate with stroke characteristics. METHODS Forty-eight patients with ischemic stroke and 96 healthy controls were tested for the presence of serum antibodies targeting GluN1. Testing was conducted using 20-kDa recombinant GluN1-S2 peptide (by ELISA and Western blotting) and on rat brain tissue (by Western blotting and immunohistochemistry). Clinical examinations and computed tomographic brain scans were performed to assess clinical state and infarct size and location. RESULTS Of the 48 patients with ischemic stroke, 21 (44%) had antibodies that reacted with the recombinant GluN1-S2. There was no evidence of antibody binding to intact GluN1 in brain tissue. Western blot appearances suggested reactivity with GluN1 degradation products. Patients with anti-GluN1-S2 antibodies were more likely to have higher National Institutes of Health Stroke Scale scores, larger infarcts, and more frequent cortical involvement. Of the 96 controls, only 3 (3%), all aged>50 years, had antibodies that reacted with GluN1-S2 at low levels. CONCLUSIONS Antibodies that bind recombinant GluN1-S2 peptides (but not the intact GluN1 protein) develop transiently in patients after stroke in proportion to infarct size, suggesting that these antibodies are raised secondarily to neuronal damage. The anti-GluN1-S2 antibodies may provide useful information about the presence and severity of cerebral infarction. This will require confirmation in larger studies.
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Affiliation(s)
- Maggie L Kalev-Zylinska
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand.
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153
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Affiliation(s)
- Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, 260 Stetson St, Suite 2300, PO Box 670525, Cincinnati, OH 45267-0525, USA.
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154
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Wheeler HM, Mlynash M, Inoue M, Tipirneni A, Liggins J, Zaharchuk G, Straka M, Kemp S, Bammer R, Lansberg MG, Albers GW. Early diffusion-weighted imaging and perfusion-weighted imaging lesion volumes forecast final infarct size in DEFUSE 2. Stroke 2013; 44:681-5. [PMID: 23390119 PMCID: PMC3625664 DOI: 10.1161/strokeaha.111.000135] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE It is hypothesized that early diffusion-weighted imaging (DWI) lesions accurately estimate the size of the irreversibly injured core and thresholded perfusion-weighted imaging (PWI) lesions (time to maximum of tissue residue function [Tmax] >6 seconds) approximate the volume of critically hypoperfused tissue. With incomplete reperfusion, the union of baseline DWI and posttreatment PWI is hypothesized to predict infarct volume. METHODS This is a substudy of Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2); all patients with technically adequate MRI scans at 3 time points were included. Baseline DWI and early follow-up PWI lesion volumes were determined by the RAPID software program. Final infarct volumes were assessed with 5-day fluid-attenuated inversion recovery and were corrected for edema. Reperfusion was defined on the basis of the reduction in PWI lesion volume between baseline and early follow-up MRI. DWI and PWI volumes were correlated with final infarct volumes. RESULTS Seventy-three patients were eligible. Twenty-six patients with >90% reperfusion show a high correlation between early DWI volume and final infarct volume (r=0.95; P<0.001). Nine patients with <10% reperfusion have a high correlation between baseline PWI (Tmax >6 seconds) volume and final infarct volume (r=0.86; P=0.002). Using all 73 patients, the union of baseline DWI and early follow-up PWI is highly correlated with final infarct volume (r=0.94; P<0.001). The median absolute difference between observed and predicted final volumes is 15 mL (interquartile range, 5.5-30.2). CONCLUSIONS Baseline DWI and early follow-up PWI (Tmax >6 seconds) volumes provide a reasonable approximation of final infarct volume after endovascular therapy.
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Affiliation(s)
- Hayley M Wheeler
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, CA 94305, USA.
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155
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Rezvani MR, Ghandehari K. Is opium addiction a risk factor for ischemic heart disease and ischemic stroke? J Res Med Sci 2012; 17:958-61. [PMID: 23825997 PMCID: PMC3698656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 08/16/2012] [Accepted: 08/18/2012] [Indexed: 12/03/2022]
Abstract
BACKGROUND The main source of studies about effects of opium consumption on heart and brain attacks originates from Iran Therefore the aim of the present study was to assess opium addiction as a probable influencing factor for ischemic heart disease and ischemic stroke. MATERIALS AND METHODS A cross-sectional study was carried out in two Cardiology and Neurology clinics in Eastern Iran in 2011. Diagnosis of Ischemic Heart Disease (IHD) and Ischemic Stroke (IS) was made by Cardiologist and Stroke Neurologist respectively. The influence of gender, hypertension, diabetes, hyperlipidemia, cigarette smoking, oral and inhaled opium consumption on distribution of IHD and IS were evaluated. RESULTS Five hundred fifty eight patients (307 females, 251 males) with mean age 56.2 years enrolled the study. On adjusted odds ratios of our whole 558 patients, only hypertension and diabetes had a significant influence on occurrence of IHD; (P = 0.000 and P = 0.000) respectively. Oral and inhaled routes of opium addiction did not have a significant effect on occurrence of IHD; [OR = 1.172, 95% CI = 0.624-2.203, P = 0.621] and [OR = 1.820, 95% CI = 0.811-4.085, P = 0.147] respectively. Hypertension and diabetes were significant risk factors of IS in our 558 patients at multivariate analysis; (P = 0.000, P = 0.020). Oral opium addiction was as significant protective factor of IS in our study group; OR = 0.211, 95% CI = 0.079-0.564, P = 0.002, while inhaled opium addiction did not have a significant effect on occurrence of IS in our patients at; OR = 1.760, 95% CI = 0.760-4.076, P = 0.187. CONCLUSION Oral opium consumption is a protective factor of IS but not IHD. Inhaled opium addiction does not have a significant influence on occurrence of IS and IHD.
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Affiliation(s)
- Mohammad Reza Rezvani
- Department of Internal Medicine, Birjand University of Medical Sciences, Mashhad, Iran
| | - Kavian Ghandehari
- Department of Neurology, Ghaem Hospital, Ahmadabad Street, Mashhad, Iran,Address for correspondence: Dr. Kavian Ghandehari, Department of Neurology, Ghaem Hospital, Ahmadabad Street, Mashhad, Iran. E-mail:
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156
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Abstract
We report a case of complete bilateral cerebellar infarction diagnosed in utero by routine prenatal ultrasound and magnetic resonance imaging in a 26-week-old fetus. This posterior fossa ischemic stroke with secondary hemorrhage caused transient obstructive hydrocephalus and likely occurred subsequent to vertebrobasilar artery thrombosis. Such posterior fossa ischemic insults diagnosed in utero are rare with scarce clinical reports. The serial imaging characteristics, clinical, and developmental implications of this case are reviewed.
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Affiliation(s)
- Safdar A. Ansari
- Department of Neurology, at Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Jill V. Hunter
- Department of Radiology, Section of Pediatric Neuroradiology, at Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Lisa M. Nassif
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, at Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Gary D. Clark
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, at Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Melissa B. Ramocki
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, at Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
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157
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Bang OY, Seok JM, Kim SG, Hong JM, Kim HY, Lee J, Chung PW, Park KY, Kim GM, Chung CS, Lee KH. Ischemic stroke and cancer: stroke severely impacts cancer patients, while cancer increases the number of strokes. J Clin Neurol 2011; 7:53-9. [PMID: 21779292 PMCID: PMC3131539 DOI: 10.3988/jcn.2011.7.2.53] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 11/22/2010] [Accepted: 11/22/2010] [Indexed: 12/15/2022] Open
Abstract
Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This review covers the epidemiology, underlying mechanisms, and acute and preventive treatments for cancer-related stroke. First, the characteristics of stroke (clinical and radiological features) and systemic cancer (type and extent) in patients with cancer-specific stroke are discussed. Second, the role of laboratory tests in the early identification of patients with cancer-specific stroke is discussed. Specifically, serum D-dimer levels (as a marker of a hypercoagulable state) and embolic signals on transcranial Doppler (suggestive of embolic origin) may provide clues regarding changes in the levels of coagulopathy related to cancer and anticoagulation. Finally, strategies for stroke treatment in cancer patients are discussed, emphasizing the importance of preventive strategies (i.e., the use of anticoagulants) over acute revascularization therapy in cancer-related stroke. Conclusion Recent studies have revealed that the characteristics of cancer-related stroke are distinct from those of conventional stroke. Our understanding of the characteristics of cancer-related stroke is essential to the correct management of these patients. The studies presented in this review highlight the importance of a personalized approach in treating stroke patients with cancer.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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158
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Abstract
PURPOSE Stroke is the second leading cause of death and a major cause of morbidity and mortality worldwide. Evidence of variations in adiponectin (AdipoQ) genes that are associated with ischemic stroke has not been consistent, and it is unclear whether the same loci contribute to these associations in the Korean population. Using a Korean population, we tested ischemic stroke-associated AdipoQ markers. MATERIALS AND METHODS In a preliminary genome-wide association study using 320 250 k Affymetrix NSP chips, AdipoQ was found to be associated with ischemic stroke in Koreans. To study of AdipoQ, a further 673 ischemic stroke patients and 267 unrelated individuals without a history of stroke or transient ischemic attack were examined in a case-control study. RESULTS Six polymorphisms (rs182052G > A, rs16861205G > A, rs822391T > C, rs822396A > G, rs12495941G > T and rs3774261A > G) that had a minor allele frequency of over 1% were strongly associated with stroke (p < 0.05). Two of these, rs822391T > C and rs822396A > G showed this association on both dominant and additive logistic regression analysis after adjusting for age and sex. The haplotypes ht 1 (AGGCGG and AAGTAG) were significantly associated with susceptibility to stroke. CONCLUSION Our findings show that polymorphisms in AdipoQ are associated with risk for ischemic stroke in the Korean population. This study lends further support to the putative role of AdipoQ in stroke.
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Affiliation(s)
- My-Young Cheong
- Genomics Resource Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea
| | - Ok-Sun Bang
- Department of Medical Research, Korean Institute of Medicine, Daejeon, Korea
| | - Min-Ho Cha
- Department of Medical Research, Korean Institute of Medicine, Daejeon, Korea
| | - Young-Kyu Park
- Genomics Resource Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea
| | - Seung-Ho Kim
- Genomics Resource Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea
| | - Young Joo Kim
- Genomics Resource Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea
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159
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Kim SJ, Seok JM, Bang OY, Kim GM, Kim KH, Jeon P, Chung CS, Lee KH, Alger JR, Liebeskind DS. MR mismatch profiles in patients with intracranial atherosclerotic stroke: a comprehensive approach comparing stroke subtypes. J Cereb Blood Flow Metab 2009; 29:1138-45. [PMID: 19367294 PMCID: PMC2731671 DOI: 10.1038/jcbfm.2009.38] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Most clinical trials have focused on the presence of perfusion- and diffusion-weighted imaging (PWI-DWI) mismatch by more than 20%, and different stroke subtypes were lumped together. We hypothesized that intracranial large artery atherosclerotic stroke (IC-LAA) would show different PWI-DWI and magnetic resonance angiography (MRA)-DWI mismatch profiles, compared with other stroke subtypes. Consecutive patients underwent pretreatment multiparametric magnetic resonance imaging for the acute middle cerebral artery infarcts within 6 h of symptom onset. We assessed the difference in the DWI-PWI mismatch ratio, severity of hypoperfusion, and MRA-DWI mismatch among the stroke subtypes. Of 86 patients, 19 (22.1%) had IC-LAA; 42 (48.8%) cardioembolic stroke, 15 (17.4%) extracranial-LAA, and 10 (11.6%) had cryptogenic embolic stroke. Although the volume of the penumbra was not different among the groups, the mismatch ratio was higher (P=0.003) and the severity of hypoperfusion was lower in the IC-LAA group (P=0.001). The MRA-DWI mismatch was more prevalent in the IC-LAA group than in other groups (P<0.001). Collateral grading, assessed in 41 patients, was more likely to be intermediate/excellent in the IC-LAA group (P<0.001). Multivariate testing revealed that a larger mismatch ratio and less severe hypoperfusion, and MRA-DWI mismatch were independently associated with IC-LAA. Our data show that patients with IC-LAA had different mismatch profiles, which were related to better collaterals, compared with other subtypes.
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Affiliation(s)
- Suk Jae Kim
- Department of Neurology, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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160
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Abaci A, Kabakci G, Tokgözoglu L, Ersoy U, Kes S. Transient cerebral ischemic attack and left atrial free-floating thrombus: a case report. Clin Cardiol 2009; 21:432-4. [PMID: 9631274 PMCID: PMC6655974 DOI: 10.1002/clc.4960210613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A patient with rheumatic mitral stenosis was found to have a free-floating thrombus in the left atrium during echocardiography. Subsequently, the patient underwent surgical treatment. At surgery, a free thrombus was found within the left atrium. The postoperative course of the patient was satisfactory.
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Affiliation(s)
- A Abaci
- Department of Cardiology, Hacettepe University School of Medicine, Ankara, Turkey
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161
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Abstract
One approach to studying pediatric stroke is to analyze a national database that contains data on a significant number of children. We examined an administrative dataset of hospital discharges from the United States, Kids' Inpatient Database 2003 (KID2003), for ICD-9 codes associated with hemorrhagic or ischemic stroke in children aged >30 days to 20 years. 3156 children were discharged with a diagnosis of ischemic stroke and 2022 with hemorrhagic stroke after statistical weighting. The odds for a male discharged with hemorrhagic stroke was 1.5 (CI: 1.35-1.68) and for ischemic stroke was 1.37 (CI: 1.24-1.51) compared with a female. The odds for males discharged with a stroke were greatest for ages 16 to 20 years and least for 4 years. This study confirms a male predominance for stroke. The odds for hospitalization with a stroke diagnosis are greatest in very young and older adolescent males. Hemorrhage is an important stroke subtype in children.
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Affiliation(s)
- Warren Lo
- Department of Pediatrics and Neurology, The Ohio State University, Columbus, Ohio 43205-2664, USA.
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162
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Leary MC, Caplan LR. Cardioembolic stroke: An update on etiology, diagnosis and management. Ann Indian Acad Neurol 2008; 11:S52-S63. [PMID: 35721445 PMCID: PMC9204115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 01/09/2007] [Accepted: 01/09/2008] [Indexed: 11/25/2022] Open
Abstract
Stroke and ischemic heart diseases are among the most common causes of death and disability throughout the world. Even more worrisome is the suggestion that stroke rates may further increase in certain developing nations. The purpose of this article is to review the particular subtype of stroke known as cardioembolic stroke. A cardioembolic stroke occurs when the heart pumps unwanted materials into the brain circulation, resulting in the occlusion of a brain blood vessel and damage to the brain tissue. The etiology, clinical manifestations, diagnosis and management of cardioembolic stroke are reviewed.
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Affiliation(s)
- Megan C. Leary
- Division of Stroke and Cerebrovascular Disease, Palmer 127, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Louis R. Caplan
- Division of Stroke and Cerebrovascular Disease, Palmer 127, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA,For correspondence: Dr. Louis R. Caplan, Division of Stroke and Cerebrovascular Disease, Palmer 127, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. E-mail:
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163
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Abstract
Antiphospholipid syndrome (APS) is primarily considered to be an autoimmune pathological condition that is also referred to as "Hughes syndrome". It is characterized by arterial and/or venous thrombosis and pregnancy pathologies in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disease or secondary to a connective tissue disorder, most frequently systemic lupus erythematosus (SLE). Damage to the nervous system is one of the most prominent clinical constellations of sequelae in APS and includes (i) arterial/ venous thrombotic events, (ii) psychiatric features and (iii) other non- thrombotic neurological syndromes. In this overview we compare the most important vascular ischemic (occlusive) disturbances (VIOD) with neuro-psychiatric symptomatics, together with complete, updated classifications and hypotheses for the etio-pathogenesis of APS with underlying clinical and laboratory criteria for optimal diagnosis and disease management.
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Affiliation(s)
- Penka A Atanassova
- Department of Neurology, Medical University, 15A V. Aprilov Blvd., Plovdiv, 4000, Bulgaria.
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164
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Abstract
Nonarteritic anterior ischemic optic neuropathy (NAION) has been reported rarely in men after taking sildenafil or other phosphodiesterase 5 inhibitors for erectile dysfunction (ED). The incidence of NAION in men receiving sildenafil treatment for ED was estimated using pooled safety data from global clinical trials and European observational studies. Based on clinical trial data in more than 13,000 men and on more than 35,000 patient-years of observation in epidemiologic studies, we estimated an incidence of 2.8 cases of NAION per 100,000 patient-years of sildenafil exposure. This is similar to estimates reported in general US population samples (2.52 and 11.8 cases per 100,000 men aged >or=50 years). The data cited herein do not suggest an increased incidence of NAION in men who took sildenafil for ED.
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Affiliation(s)
- L Gorkin
- World Wide Outcomes Research, Global Epidemiology, US Medical Research, Pfizer Inc, NY, USA.
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