151
|
Yadav S, Schanz R, Maheshwari A, Khan MS, Slark J, de Silva R, Bentley P, Froguel P, Kooner J, Shrivastav P, Prasad K, Sharma P. Bio-Repository of DNA in stroke (BRAINS): a study protocol. BMC MEDICAL GENETICS 2011; 12:34. [PMID: 21366918 PMCID: PMC3061889 DOI: 10.1186/1471-2350-12-34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/02/2011] [Indexed: 11/25/2022]
Abstract
Background Stroke is one of the commonest causes of mortality in the world and anticipated to be an increasing burden to the developing world. Stroke has a genetic basis and identifying those genes may not only help us define the mechanisms that cause stroke but also identify novel therapeutic targets. However, large scale highly phenotyped DNA repositories are required in order for this to be achieved. Methods The proposed Bio-Repository of DNA in Stroke (BRAINS) will recruit all subtypes of stroke as well as controls from two different continents, Europe and Asia. Subjects recruited from the UK will include stroke patients of European ancestry as well as British South Asians. Stroke subjects from South Asia will be recruited from India and Sri Lanka. South Asian cases will also have control subjects recruited. Discussion We describe a study protocol to establish a large and highly characterized stroke biobank in those of European and South Asian descent. With different ethnic populations being recruited, BRAINS has the ability to compare and contrast genetic risk factors between those of differing ancestral descent as well as those who migrate into different environments.
Collapse
Affiliation(s)
- Sunaina Yadav
- Imperial College Cerebrovascular Research Unit (ICCRU), Imperial College London, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
152
|
Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study). J Hypertens 2011; 29:309-18. [DOI: 10.1097/hjh.0b013e3283410404] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
153
|
|
154
|
Variations of blood pressure in stroke unit patients may result from alternating body positions. J Stroke Cerebrovasc Dis 2010; 21:459-66. [PMID: 21185742 DOI: 10.1016/j.jstrokecerebrovasdis.2010.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 10/28/2010] [Accepted: 11/07/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Blood pressure (BP) is one of the major vital parameters monitored in the stroke unit. The accuracy of indirect BP measurement is strongly influenced by the position of both patient and arm during the measurement. Acute stroke patients are often nursed in lateral decubitus positions. The effect of these alternating body positions in relation to affected body side on the outcome and reliability of BP readings in acute stroke patients is unknown. METHODS An automatic oscillometric BP device was used. BP was measured in both arms in the (back) supine and both lateral decubitus positions. RESULTS In total, 54 consecutive acute stroke patients were included. Thirty-five patients had right-sided deficits and 19 patients had left-sided deficits. Supine BP readings were similar in the right and left arms regardless of side of deficit. Measurements of BP in the lateral decubitus positions resulted in significantly lower BP readings in the uppermost arm (around 12 mm Hg in both arms) and significantly higher readings in the right lowermost arm (around 6 mm Hg) compared to the supine position. This effect seemed less pronounced when the left lowermost arm was measured. There was no relation between change of BP readings in various lateral positions and side of stroke. CONCLUSIONS Alternating lateral decubitus positions according to nursing standards in acute stroke patients lead to a mean 18 mm Hg BP fluctuation. This may largely be explained by hydrostatic pressure effects, partly by anatomic factors in the left lowermost arm, but not by the side of stroke.
Collapse
|
155
|
Tripathi M, Vibha D. Stroke in young in India. Stroke Res Treat 2010; 2011:368629. [PMID: 21234342 PMCID: PMC3017944 DOI: 10.4061/2011/368629] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 11/10/2010] [Indexed: 01/13/2023] Open
Abstract
Stroke in young has special significance in developing countries. This is so because some etiologies like cardioembolic infections are more common than in developed countries, and the affection of economically productive group adds further to the overall disease burden. The paper discusses the burden of stroke in young and its implications in a developing country like India along with an approach to identifying different causes that are known to occur in this age group.
Collapse
Affiliation(s)
- Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
156
|
Cerebrovascular disease incidence in central Spain (NEDICES): A population-based prospective study. J Neurol Sci 2010; 298:85-90. [DOI: 10.1016/j.jns.2010.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/23/2010] [Accepted: 08/05/2010] [Indexed: 11/19/2022]
|
157
|
Abstract
BACKGROUND Most disabling strokes are due to blockage of a large artery in the brain by a blood clot. Prompt removal of the clot with intra-arterial thrombolytic drugs or mechanical devices, or both, can restore blood flow before major brain damage has occurred, leading to improved recovery. However, these so-called percutaneous vascular interventions can cause bleeding in the brain. OBJECTIVES To assess the safety and efficacy of percutaneous vascular interventions in patients with acute ischaemic stroke. SEARCH STRATEGY We searched the Trials Registers of the Cochrane Stroke Group and Cochrane Peripheral Vascular Diseases Group (last searched May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 5), MEDLINE (1980 to May 2010), EMBASE (1980 to May 2010) and eight additional databases. We also searched trials registers, screened reference lists, contacted researchers and equipment manufacturers, and handsearched journals and conference proceedings. SELECTION CRITERIA Randomised, controlled and unconfounded trials of any percutaneous vascular intervention compared with control in patients with definite ischaemic stroke. DATA COLLECTION AND ANALYSIS Two review authors applied the inclusion criteria, extracted data and assessed trial quality. We obtained both published and unpublished data if available MAIN RESULTS We included four trials involving 350 patients. Not all trials contributed data to each outcome. The trials tested either intra-arterial urokinase or recombinant pro-urokinase versus an open control. One trial used guidewire-mediated clot disruption in some patients randomised to the intervention group. Most data came from trials that started treatment up to six hours after stroke; one small trial started treatment up to a median of 12.5 hours after stroke. Most data came from trials of middle cerebral artery territory infarction. Compared with non-thrombolytic standard medical treatment, the intervention administered up to six hours after ischaemic stroke significantly increased the proportion of patients with favourable outcome (modified Rankin 0 to 2) three months after stroke (relative risk (RR) 1.47, 95% confidence interval (CI) 1.07 to 2.02). The intervention also significantly increased the risk of symptomatic intracranial haemorrhage within 24 hours of treatment (RR 3.85, 95% CI 0.91 to 16.36). There was no significant heterogeneity between the included trials. AUTHORS' CONCLUSIONS Overall, intervention results in a significant increase in the proportion of patients with a favourable outcome, despite a significant increase in intracranial haemorrhage. Further trials are needed to confirm or refute these findings and, given the cost and practical difficulties, to establish whether percutaneous techniques are feasible and cost effective in wider clinical practice.
Collapse
Affiliation(s)
- Killian O'Rourke
- Dublin Neurological Institute, Mater University Hospital, 57 Eccles Street, Dublin 7, Ireland
| | | | | | | |
Collapse
|
158
|
Hassan Y, Aziz NA, Al-Jabi SW, Looi I, Zyoud SH. Impact of angiotensin-converting enzyme inhibitors administration prior to acute ischemic stroke onset on in-hospital mortality. J Cardiovasc Pharmacol Ther 2010; 15:274-81. [PMID: 20624923 DOI: 10.1177/1074248410373751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Angiotensin-converting enzyme inhibitors (ACEIs) have shown promising results in decreasing the incidence and the severity of ischemic stroke in populations at risk and in improving ischemic stroke outcomes. OBJECTIVES The objectives of this study were to investigate the impact of ACEI use before ischemic stroke onset on in-hospital mortality and to identify the independent predictors of in-hospital mortality among patients with ischemic stroke. METHODS AND MATERIALS A retrospective cohort study of all patients with acute ischemic stroke attending the hospital from June 1, 2008 to November 30, 2008 was performed. Data were collected from medical records and included demographic information, diagnostic information, risk factors, previous ACEI use, and vital discharge status. Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis. RESULTS A total of 327 patients with acute ischemic stroke were studied, of which 119 (36.4%) had documented previous ACEI use. During the study period, 52 (15.9%) of the patients with acute ischemic stroke died in hospital. In-hospital mortality was significantly lower among patients who were on ACEI before the attack (P = 0.002). The independent predictors for in-hospital mortality among patients with ischemic stroke were age >or=65 years (P < .001), the presence of diabetes mellitus (P = .012), renal impairment (P = .002), and heart failure (P = .001). Moreover, prior use of ACEI was an independent predictor for survival after ischemic stroke attack (P < .001). CONCLUSION This study provides evidence that the prophylactic administration of ACEI before ischemic stroke may be a potential life-saving strategy. Furthermore, knowledge of in-hospital mortality predictors is necessary to improve survival rate after acute stroke.
Collapse
Affiliation(s)
- Yahaya Hassan
- Clinical Pharmacy Program, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.
| | | | | | | | | |
Collapse
|
159
|
Abstract
Previous exposure to a nonlethal ischemic insult protects the brain against subsequent harmful ischemia. N-methyl-D-aspartate (NMDA) receptors are a highly studied target of neuroprotection after ischemia. Recently, NMDA receptor subtypes were implicated in neuronal survival and death. We focused on the contribution of NR2A and cyclic-AMP response element (CRE)-binding protein (CREB) signaling to ischemic tolerance using primary cortical neurons. Ischemia in vitro was modeled by oxygen-glucose deprivation (OGD). Ischemic tolerance was induced by applying 45-mins OGD 24 h before 180-mins OGD. Sublethal OGD also induced cross-tolerance against lethal glutamate and hydrogen peroxide. After sublethal OGD, expression of phosphorylated CREB and CRE transcriptional activity were significantly increased. When CRE activity was inhibited by CREB-S133A, a mutant CREB, ischemic tolerance was abolished. Inhibiting NR2A using NVP-AAM077 attenuated preconditioning-induced neuroprotection and correlated with decreased CRE activity levels. Activating NR2A using bicuculline and 4-aminopiridine induced resistance to lethal ischemia accompanied by elevated CRE activity levels, and this effect was abolished by NVP-AAM077. Elevated brain-derived neurotrophic factor (BDNF) transcriptional activities were observed after sublethal OGD and administration of bicuculline and 4-aminopiridine. NR2A-containing NMDA receptors and CREB signaling have important functions in the induction of ischemic tolerance. This may provide potential novel therapeutic strategies to treat ischemic stroke.
Collapse
|
160
|
Shin HY, Lee YJ, Kim HJ, Park CK, Kim JH, Wang KC, Kim DG, Koh GY, Paek SH. Protective role of COMP-Ang1 in ischemic rat brain. J Neurosci Res 2010; 88:1052-63. [PMID: 19885826 DOI: 10.1002/jnr.22274] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In cerebral ischemia, the induction of angiogenesis may represent a natural defense mechanism that enables the hypoxic brain to avoid progression into infarction. Angiopoietin-1 (Ang1) is known to produce non-leaky and stable blood vessel formation mainly by the Tie2 receptor. Therefore, we envisioned that the application of cartilage oligomeric matrix protein-Ang1 (COMP-Ang1), a soluble, stable, and potent form of Ang1, would promote angiogenesis and provide a protective effect following unilateral middle cerebral artery occlusion (MCAO) in rats. To this end, we employed a 2-hour-MCAO model, and treated rats with adenovirus encoding COMP-Ang1 (Ade-COMP-Ang1) or control virus encoding beta-gal (Ade-beta-gal). Time course magnetic resonance images (MRIs) revealed significantly reduced infarct volume in the rats treated with Ade-COMP-Ang1 with an improvement of post-ischemic neurological deficits compared with rats treated with Ade-beta-gal. Moreover, compared to the rats treated with Ade-beta-gal, the rats treated with Ade-COMP-Ang1 showed an increase in blood vessels, especially in the border zone adjacent to the infarction, increased number of endogenous neuronal progenitor cells in the ischemic brain, and decreased number of TUNEL-positive cells. Taken together, COMP-Ang1 reduced infarct volume and consequently attenuated post-ischemic neurological deficits through enhanced angiogenesis and increased viable cell mass of neuronal cells.
Collapse
Affiliation(s)
- Hye Young Shin
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
161
|
Homburg PJ, Rozie S, van Gils MJ, Jansen T, de Weert TT, Dippel DW, van der Lugt A. Atherosclerotic Plaque Ulceration in the Symptomatic Internal Carotid Artery Is Associated With Nonlacunar Ischemic Stroke. Stroke 2010; 41:1151-6. [DOI: 10.1161/strokeaha.109.576256] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Atherosclerotic carotid plaque ulceration is considered a marker of previous plaque rupture and subsequent thromboembolism. It can be accurately detected with multidetector CTA. We hypothesized that atherosclerotic plaque ulceration is associated with nonlacunar ischemic stroke rather than lacunar stroke.
Methods—
Prospectively, 750 consecutive patients with transient ischemic attack or ischemic stroke symptoms in the anterior cerebral circulation were evaluated for the presence of atherosclerotic plaque ulceration in the symptomatic carotid artery with multidetector CTA. Patients with stroke attributable to cardiac embolism or other specific etiologies and patients with amaurosis fugax were excluded. Ischemic strokes in the remaining 534 patients were classified as nonlacunar (n=236) or lacunar (n=298) based on clinical symptoms and multidetector CT of the brain. Ulceration was defined as extension of contrast material beyond the vascular lumen into the surrounding plaque.
Results—
Plaque ulceration in the symptomatic carotid artery was more common in nonlacunar strokes (n=47; 20%) as compared to lacunar strokes (n=20; 7%;
P
<0.001). After adjustment for age, gender, cardiovascular risk factors, and degree of stenosis, ulcerations were independently associated with nonlacunar stroke compared to lacunar stroke (odds ratio, 2.70; 95% confidence interval, 1.43–5.09).
Conclusions—
Atherosclerotic carotid plaque ulceration is associated with nonlacunar ischemic stroke, independent of the degree of carotid stenosis. These results suggest that nonlacunar stroke and lacunar stroke are caused by different pathophysiological mechanisms.
Collapse
Affiliation(s)
- Philip J. Homburg
- From Department of Radiology (P.J.H., S.R., M.J.v.G., T.J., T.T.d.W., A.v.d.L.) and Neurology (D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Sietske Rozie
- From Department of Radiology (P.J.H., S.R., M.J.v.G., T.J., T.T.d.W., A.v.d.L.) and Neurology (D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Marjon J. van Gils
- From Department of Radiology (P.J.H., S.R., M.J.v.G., T.J., T.T.d.W., A.v.d.L.) and Neurology (D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Tessa Jansen
- From Department of Radiology (P.J.H., S.R., M.J.v.G., T.J., T.T.d.W., A.v.d.L.) and Neurology (D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Thomas T. de Weert
- From Department of Radiology (P.J.H., S.R., M.J.v.G., T.J., T.T.d.W., A.v.d.L.) and Neurology (D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Diederik W.J. Dippel
- From Department of Radiology (P.J.H., S.R., M.J.v.G., T.J., T.T.d.W., A.v.d.L.) and Neurology (D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Aad van der Lugt
- From Department of Radiology (P.J.H., S.R., M.J.v.G., T.J., T.T.d.W., A.v.d.L.) and Neurology (D.W.J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| |
Collapse
|
162
|
Gomes M, Soares MO, Dumville JC, Lewis SC, Torgerson DJ, Bodenham AR, Gough MJ, Warlow CP. Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial). Br J Surg 2010; 97:1218-25. [DOI: 10.1002/bjs.7110] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Health outcomes and costs are both important when deciding whether general (GA) or local (LA) anaesthesia should be used during carotid endarterectomy. The aim of this study was to assess the cost-effectiveness of carotid endarterectomy under LA or GA in patients with symptomatic or asymptomatic carotid stenosis for whom surgery was advised.
Methods
Using patient-level data from a large, multinational, randomized controlled trial (GALA Trial) time free from stroke, myocardial infarction or death, and costs incurred were evaluated. The cost-effectiveness outcome was incremental cost per day free from an event, within a time horizon of 30 days.
Results
A patient undergoing carotid endarterectomy under LA incurred fewer costs (mean difference £178) and had a slightly longer event-free survival (difference 0·16 days, but the 95 per cent confidence limits around this estimate were wide) compared with a patient who had GA. Existing uncertainty did not have a significant impact on the decision to adopt LA, over a wide range of willingness-to-pay values.
Conclusion
If cost-effectiveness was considered in the decision to adopt GA or LA for carotid endarterectomy, given the evidence provided by this study, LA is likely to be the favoured treatment for patients for whom either anaesthetic approach is clinically appropriate.
Collapse
Affiliation(s)
| | - M Gomes
- Department of Economics and Related Studies, University of York, York, UK
| | - M O Soares
- Department of Health Sciences, University of York, York, UK
| | - J C Dumville
- Department of Health Sciences, University of York, York, UK
| | - S C Lewis
- Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
| | - D J Torgerson
- Department of Health Sciences, University of York, York, UK
| | - A R Bodenham
- Department of Anaesthesia, Leeds General Infirmary, Leeds, UK
| | - M J Gough
- Vascular Surgical Unit, Leeds General Infirmary, Leeds, UK
| | - C P Warlow
- Division of Clinical Neurosciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
163
|
Binici Z, Intzilakis T, Nielsen OW, Køber L, Sajadieh A. Excessive Supraventricular Ectopic Activity and Increased Risk of Atrial Fibrillation and Stroke. Circulation 2010; 121:1904-11. [PMID: 20404258 DOI: 10.1161/circulationaha.109.874982] [Citation(s) in RCA: 266] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Prediction of stroke and atrial fibrillation in healthy individuals is challenging. We examined whether excessive supraventricular ectopic activity (ESVEA) correlates with risk of stroke, death, and atrial fibrillation in subjects without previous stroke or heart disease.
Methods and Results—
The population-based cohort of the Copenhagen Holter Study, consisting of 678 healthy men and women aged between 55 and 75 years with no history of cardiovascular disease, atrial fibrillation, or stroke, was evaluated. All had fasting laboratory tests and 48-hour ambulatory ECG monitoring. ESVEA was defined as ≥30 supraventricular ectopic complexes (SVEC) per hour or as any episodes with runs of ≥20 SVEC. The primary end point was stroke or death, and the secondary end points were total mortality, stroke, and admissions for atrial fibrillation. Median follow-up was 6.3 years. Seventy subjects had SVEC ≥30/h, and 42 had runs of SVEC with a length of ≥20 SVEC. Together, 99 subjects (14.6%) had ESVEA. The risk of primary end point (death or stroke) was significantly higher in subjects with ESVEA compared with those without ESVEA after adjustment for conventional risk factors (hazard ratio=1.64; 95% confidence interval, 1.03 to 2.60;
P
=0.036). ESVEA was also associated with admissions for atrial fibrillation (hazard ratio=2.78; 95% confidence interval, 1.08 to 6.99;
P
=0.033) and stroke (hazard ratio=2.79; 95% confidence interval, 1.23 to 6.30;
P
=0.014). SVEC, as a continuous variable, was also associated with both the primary end point of stroke or death and admissions for atrial fibrillation.
Conclusions—
ESVEA in apparently healthy subjects is associated with development of atrial fibrillation and is associated with a poor prognosis in term of death or stroke.
Collapse
Affiliation(s)
- Zeynep Binici
- From the Department of Cardiology, Copenhagen University Hospital of Amager (Z.B., T.I., A.S.); Department of Cardiology, Copenhagen University Hospital of Bispebjerg (Z.B., O.W.N., A.S.); and Department of Cardiology, Rigshospitalet Copenhagen University Hospital (L.K.), Copenhagen, Denmark
| | - Theodoros Intzilakis
- From the Department of Cardiology, Copenhagen University Hospital of Amager (Z.B., T.I., A.S.); Department of Cardiology, Copenhagen University Hospital of Bispebjerg (Z.B., O.W.N., A.S.); and Department of Cardiology, Rigshospitalet Copenhagen University Hospital (L.K.), Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- From the Department of Cardiology, Copenhagen University Hospital of Amager (Z.B., T.I., A.S.); Department of Cardiology, Copenhagen University Hospital of Bispebjerg (Z.B., O.W.N., A.S.); and Department of Cardiology, Rigshospitalet Copenhagen University Hospital (L.K.), Copenhagen, Denmark
| | - Lars Køber
- From the Department of Cardiology, Copenhagen University Hospital of Amager (Z.B., T.I., A.S.); Department of Cardiology, Copenhagen University Hospital of Bispebjerg (Z.B., O.W.N., A.S.); and Department of Cardiology, Rigshospitalet Copenhagen University Hospital (L.K.), Copenhagen, Denmark
| | - Ahmad Sajadieh
- From the Department of Cardiology, Copenhagen University Hospital of Amager (Z.B., T.I., A.S.); Department of Cardiology, Copenhagen University Hospital of Bispebjerg (Z.B., O.W.N., A.S.); and Department of Cardiology, Rigshospitalet Copenhagen University Hospital (L.K.), Copenhagen, Denmark
| |
Collapse
|
164
|
Use of magnetic resonance imaging to predict outcome after stroke: a review of experimental and clinical evidence. J Cereb Blood Flow Metab 2010; 30:703-17. [PMID: 20087362 PMCID: PMC2949172 DOI: 10.1038/jcbfm.2010.5] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite promising results in preclinical stroke research, translation of experimental data into clinical therapy has been difficult. One reason is the heterogeneity of the disease with outcomes ranging from complete recovery to continued decline. A successful treatment in one situation may be ineffective, or even harmful, in another. To overcome this, treatment must be tailored according to the individual based on identification of the risk of damage and estimation of potential recovery. Neuroimaging, particularly magnetic resonance imaging (MRI), could be the tool for a rapid comprehensive assessment in acute stroke with the potential to guide treatment decisions for a better clinical outcome. This review describes current MRI techniques used to characterize stroke in a preclinical research setting, as well as in the clinic. Furthermore, we will discuss current developments and the future potential of neuroimaging for stroke outcome prediction.
Collapse
|
165
|
Askoxylakis V, Thieke C, Pleger ST, Most P, Tanner J, Lindel K, Katus HA, Debus J, Bischof M. Long-term survival of cancer patients compared to heart failure and stroke: a systematic review. BMC Cancer 2010; 10:105. [PMID: 20307299 PMCID: PMC2851688 DOI: 10.1186/1471-2407-10-105] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/22/2010] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cancer, heart failure and stroke are among the most common causes of death worldwide. Investigation of the prognostic impact of each disease is important, especially for a better understanding of competing risks. Aim of this study is to provide an overview of long term survival of cancer, heart failure and stroke patients based on the results of large population- and hospital-based studies. METHODS Records for our study were identified by searches of Medline via Pubmed. We focused on observed and relative age- and sex-adjusted 5-year survival rates for cancer in general and for the four most common malignancies in developed countries, i.e. lung, breast, prostate and colorectal cancer, as well as for heart failure and stroke. RESULTS Twenty studies were identified and included for analysis. Five-year observed survival was about 43% for all cancer entities, 40-68% for stroke and 26-52% for heart failure. Five-year age and sex adjusted relative survival was 50-57% for all cancer entities, about 50% for stroke and about 62% for heart failure. In regard to the four most common malignancies in developed countries 5-year relative survival was 12-18% for lung cancer, 73-89% for breast cancer, 50-99% for prostate cancer and about 43-63% for colorectal cancer. Trend analysis revealed a survival improvement over the last decades. CONCLUSIONS The results indicate that long term survival and prognosis of cancer is not necessarily worse than that of heart failure and stroke. However, a comparison of the prognostic impact of the different diseases is limited, corroborating the necessity for further systematic investigation of competing risks.
Collapse
Affiliation(s)
- Vasileios Askoxylakis
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christian Thieke
- Department of Radiation Therapy, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sven T Pleger
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Patrick Most
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Judith Tanner
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Katja Lindel
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Marc Bischof
- Department of Radiooncology and Radiation Therapy, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| |
Collapse
|
166
|
Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010; 375:895-905. [PMID: 20226988 DOI: 10.1016/s0140-6736(10)60308-x] [Citation(s) in RCA: 1248] [Impact Index Per Article: 89.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure. We aimed to reliably establish the prognostic significance of visit-to-visit variability in blood pressure, maximum blood pressure reached, untreated episodic hypertension, and residual variability in treated patients. METHODS We determined the risk of stroke in relation to visit-to-visit variability in blood pressure (expressed as standard deviation [SD] and parameters independent of mean blood pressure) and maximum blood pressure in patients with previous transient ischaemic attack (TIA; UK-TIA trial and three validation cohorts) and in patients with treated hypertension (Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm [ASCOT-BPLA]). In ASCOT-BPLA, 24-h ambulatory blood-pressure monitoring (ABPM) was also studied. FINDINGS In each TIA cohort, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SD SBP over seven visits in UK-TIA trial: 6.22, 95% CI 4.16-9.29, p<0.0001), independent of mean SBP, but dependent on precision of measurement (top-decile HR over ten visits: 12.08, 7.40-19.72, p<0.0001). Maximum SBP reached was also a strong predictor of stroke (HR for top-decile over seven visits: 15.01, 6.56-34.38, p<0.0001, after adjustment for mean SBP). In ASCOT-BPLA, residual visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (eg, top-decile HR for stroke: 3.25, 2.32-4.54, p<0.0001), independent of mean SBP in clinic or on ABPM. Variability on ABPM was a weaker predictor, but all measures of variability were most predictive in younger patients and at lower (<median) values of mean SBP in every cohort. INTERPRETATION Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events. FUNDING None.
Collapse
Affiliation(s)
- Peter M Rothwell
- Stroke Prevention Research Unit, University Department of Clinical Neurology, John Radcliffe Hospital, Headington, Oxford, UK.
| | | | | | | | | | | | | | | |
Collapse
|
167
|
Sabut SK, Sikdar C, Mondal R, Kumar R, Mahadevappa M. Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke. Disabil Rehabil 2010; 32:1594-603. [PMID: 20210592 DOI: 10.3109/09638281003599596] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sukanta K. Sabut
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, West Bengal, India
| | - Chanda Sikdar
- Department of Physical Medicine and Rehabilitation, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India
| | - Ramkrishna Mondal
- Department of Physical Medicine and Rehabilitation, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India
| | - Ratnesh Kumar
- Department of Physical Medicine and Rehabilitation, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India
| | - Manjunatha Mahadevappa
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, West Bengal, India
| |
Collapse
|
168
|
Etgen T, Köhler M, Sander D. Bilateral superior altitudinal hemianopia: missing the goal, but hitting the stroke cause. J Stroke Cerebrovasc Dis 2010; 19:165-6. [PMID: 20189094 DOI: 10.1016/j.jstrokecerebrovasdis.2009.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 03/10/2009] [Accepted: 03/17/2009] [Indexed: 11/16/2022] Open
Abstract
Bilateral superior altitudinal hemianopia is an uncommon clinical presentation of ischemic stroke. We report a patient who had an ischemic stroke with a pure bilateral superior altitudinal hemianopia resulting from bilateral ischemia in the optic radiation. This symptom was first overlooked and a delusion was suspected. A thorough clinical examination is essential to avoid any misdiagnosis or to overlook correct treatment.
Collapse
|
169
|
|
170
|
Abstract
The reader may be eager to examine in which diseases ozonetherapy can be proficiently used and she/he will be amazed by the versatility of this complementary approach (Table 9 1). The fact that the medical applications are numerous exposes the ozonetherapist to medical derision because superficial observers or sarcastic sceptics consider ozonetherapy as the modern panacea. This seems so because ozone, like oxygen, is a molecule able to act simultaneously on several blood components with different functions but, as we shall discuss, ozonetherapy is not a panacea. The ozone messengers ROS and LOPs can act either locally or systemically in practically all cells of an organism. In contrast to the dogma that “ozone is always toxic”, three decades of clinical experience, although mostly acquired in private clinics in millions of patients, have shown that ozone can act as a disinfectant, an oxygen donor, an immunomodulator, a paradoxical inducer of antioxidant enzymes, a metabolic enhancer, an inducer of endothelial nitric oxide synthase and possibly an activator of stem cells with consequent neovascularization and tissue reconstruction.
Collapse
Affiliation(s)
- Velio Bocci
- Department of Physiology, University of Siena, via A. Moro 2, 53100 Siena, Italy
| |
Collapse
|
171
|
Lamirel C, Newman N, Biousse V. [Transient visual loss: a practical approach]. J Fr Ophtalmol 2009; 32:760-4. [PMID: 19932522 DOI: 10.1016/j.jfo.2009.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Accepted: 10/13/2009] [Indexed: 10/20/2022]
Abstract
Transient vision loss results from a variety of disorders including benign dry eye as well as vision- or life-threatening disorders such as giant cell arteritis. The goal of the initial evaluation is to determine the most likely mechanism based on the past medical history, characteristics of visual loss, and ophthalmologic and neurologic examinations. The ophthalmologist is often the first physician consulted and plays an essential role. Indeed, identification of the mechanism of transient visual loss allows the care-taker to properly decide on the work-up, its timing (emergency or otherwise), and subsequent treatment.
Collapse
Affiliation(s)
- C Lamirel
- Department of ophthalmology, Emory University School of Medicine, 1365-B Clifton Road, Atlanta, GA 303022, USA
| | | | | |
Collapse
|
172
|
Yamada Y, Fuku N, Tanaka M, Aoyagi Y, Sawabe M, Metoki N, Yoshida H, Satoh K, Kato K, Watanabe S, Nozawa Y, Hasegawa A, Kojima T. Identification of CELSR1 as a susceptibility gene for ischemic stroke in Japanese individuals by a genome-wide association study. Atherosclerosis 2009; 207:144-9. [DOI: 10.1016/j.atherosclerosis.2009.03.038] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/26/2009] [Accepted: 03/26/2009] [Indexed: 01/06/2023]
|
173
|
Brazzelli M, Sandercock PA, Chappell FM, Celani MG, Righetti E, Arestis N, Wardlaw JM, Deeks JJ. Magnetic resonance imaging versus computed tomography for detection of acute vascular lesions in patients presenting with stroke symptoms. Cochrane Database Syst Rev 2009:CD007424. [PMID: 19821415 DOI: 10.1002/14651858.cd007424.pub2] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is increasingly used for the diagnosis of acute ischaemic stroke but its sensitivity for the early detection of intracerebral haemorrhage has been debated. Computed tomography (CT) is extensively used in the clinical management of acute stroke, especially for the rapid exclusion of intracerebral haemorrhage. OBJECTIVES To compare the diagnostic accuracy of diffusion-weighted MRI (DWI) and CT for acute ischaemic stroke, and to estimate the diagnostic accuracy of MRI for acute haemorrhagic stroke. SEARCH STRATEGY We searched MEDLINE and EMBASE (January 1995 to March 2009) and perused bibliographies of relevant studies for additional references. SELECTION CRITERIA We selected studies that either compared DWI and CT in the same patients for detection of ischaemic stroke or examined the utility of MRI for detection of haemorrhagic stroke, had imaging performed within 12 hours of stroke onset, and presented sufficient data to allow construction of contingency tables. DATA COLLECTION AND ANALYSIS Three authors independently extracted data on study characteristics and measures of accuracy. We assessed data on ischaemic stroke using random-effects and fixed-effect meta-analyses. MAIN RESULTS Eight studies with a total of 308 participants met our inclusion criteria. Seven studies contributed to the assessment of ischaemic stroke and two studies to the assessment of haemorrhagic stroke. The spectrum of patients was relatively narrow in all studies, sample sizes were small, there was substantial incorporation bias, and blinding procedures were often incomplete. Amongst the patients subsequently confirmed to have acute ischaemic stroke (161/226), the summary estimates for DWI were: sensitivity 0.99 (95% CI 0.23 to 1.00), specificity 0.92 (95% CI 0.83 to 0.97). The summary estimates for CT were: sensitivity 0.39 (95% CI 0.16 to 0.69), specificity 1.00 (95% CI 0.94 to 1.00). The two studies on haemorrhagic stroke reported high estimates for diffusion-weighted and gradient-echo sequences but had inconsistent reference standards. We did not calculate overall estimates for these two studies. We were not able to assess practicality or cost-effectiveness issues. AUTHORS' CONCLUSIONS DWI appears to be more sensitive than CT for the early detection of ischaemic stroke in highly selected patients. However, the variability in the quality of included studies and the presence of spectrum and incorporation biases render the reliability and generalisability of observed results questionable. Further well-designed studies without methodological biases, in more representative patient samples, with practicality and cost estimates are now needed to determine which patients should undergo MRI and which CT in suspected acute stroke.
Collapse
Affiliation(s)
- Miriam Brazzelli
- Division of Clinical Neurosciences, University of Edinburgh, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU
| | | | | | | | | | | | | | | |
Collapse
|
174
|
Neuroprotective effects of N-stearoyltyrosine on transient global cerebral ischemia in gerbils. Brain Res 2009; 1287:146-56. [DOI: 10.1016/j.brainres.2009.06.070] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2009] [Revised: 06/20/2009] [Accepted: 06/23/2009] [Indexed: 12/29/2022]
|
175
|
Singer DE, Chang Y, Fang MC, Borowsky LH, Pomernacki NK, Udaltsova N, Go AS. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med 2009; 151:297-305. [PMID: 19721017 PMCID: PMC2777526 DOI: 10.7326/0003-4819-151-5-200909010-00003] [Citation(s) in RCA: 495] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Guidelines recommend warfarin use in patients with atrial fibrillation solely on the basis of risk for ischemic stroke without antithrombotic therapy. These guidelines rely on ischemic stroke rates observed in older trials and do not explicitly account for increased risk for hemorrhage. OBJECTIVE To quantify the net clinical benefit of warfarin therapy in a cohort of patients with atrial fibrillation. DESIGN Mixed retrospective and prospective cohort study of patients with atrial fibrillation between 1996 and 2003. SETTING An integrated health care delivery system. PATIENTS 13 559 adults with nonvalvular atrial fibrillation. MEASUREMENTS Warfarin exposure, patient characteristics, CHADS(2) score (1 point for each of congestive heart failure, hypertension, age, and diabetes and 2 points for stroke), and outcome events were ascertained from health plan records and databases. Net clinical benefit was defined as the annual rate of ischemic strokes and systemic emboli prevented by warfarin minus intracranial hemorrhages attributable to warfarin, multiplied by an impact weight. The base-case impact weight was 1.5, reflecting the greater clinical impact of intracranial hemorrhage versus thromboembolism. RESULTS Patients accumulated more than 66 000 person-years of follow-up. The adjusted net clinical benefit of warfarin for the cohort overall was 0.68% per year (95% CI, 0.34% to 0.87%). Adjusted net clinical benefit was greatest for patients with a history of ischemic stroke (2.48% per year [CI, 0.75% to 4.22%]) and for those 85 years or older (2.34% per year [CI, 1.29% to 3.30%]). The net clinical benefit of warfarin increased from essentially zero in CHADS(2) stroke risk categories 0 and 1 to 2.22% per year (CI, 0.58% to 3.75%) in CHADS(2) categories 4 to 6. The patterns of results were preserved when weighting factors for intracranial hemorrhage of 1.0 and 2.0 were used. LIMITATIONS Residual confounding is a possibility. Some outcome events were probably missed by the screening algorithm or when medical records were unavailable. CONCLUSION Expected net clinical benefit of warfarin therapy is highest among patients with the highest untreated risk for stroke, which includes the oldest age category. Risk assessment that incorporates both risk for thromboembolism and risk for intracranial hemorrhage provides a more quantitatively informed basis for the decision on antithrombotic therapy in patients with atrial fibrillation. PRIMARY FUNDING SOURCE National Institute on Aging; National Heart, Lung, and Blood Institute; and Massachusetts General Hospital.
Collapse
Affiliation(s)
- Daniel E Singer
- Massachusetts General Hospital, Boston, Massachussetts 02114, USA.
| | | | | | | | | | | | | |
Collapse
|
176
|
Abstract
Stroke is the major cause of disability in the Western world and is the third greatest cause of death, but there are no widely effective treatments to prevent the devastating effects of stroke. Extensive and growing evidence implicates inflammatory and immune processes in the occurrence of stroke and particularly in the subsequent injury. Several inflammatory mediators have been identified in the pathogenesis of stroke including specific cytokines, adhesion molecules, matrix metalloproteinases, and eicosanoids. An early clinical trial suggests that inhibiting interleukin-1 may be of benefit in the treatment of acute stroke.
Collapse
|
177
|
Graham JE, Ripsin CM, Deutsch A, Kuo YF, Markello S, Granger CV, Ottenbacher KJ. Relationship between diabetes codes that affect Medicare reimbursement (tier comorbidities) and outcomes in stroke rehabilitation. Arch Phys Med Rehabil 2009; 90:1110-6. [PMID: 19577023 DOI: 10.1016/j.apmr.2009.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 01/08/2009] [Accepted: 01/16/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the extent to which diabetes codes that increase reimbursement (tier comorbidities) under the prospective payment system are related to length of stay and functional outcomes in stroke rehabilitation. DESIGN Secondary data analysis. SETTING Inpatient rehabilitation facilities (N=864) across the United States. PARTICIPANTS Patients (N=135,097) who received medical rehabilitation for stroke in 2002-2003. INTERVENTION None. MAIN OUTCOME MEASURES Length of stay, FIM instrument, and discharge setting. Diabetes status was assigned to 1 of 3 categories: tier (increases reimbursement), nontier (no reimbursement effect), and no diabetes. RESULTS Mean +/- standard deviation age of the sample was 70.4+/-13.4 years, and 31% had diabetes (6% tier, 25% nontier). Diabetes status by age demonstrated significant (P<.05) interaction effects, which lead to the following age-specific findings. In younger stroke patients (60y), tier diabetes was associated with shorter lengths of stay compared with both groups, lower FIM discharge scores compared with both groups, and lower odds of discharge home relative to the no-diabetes group. In older stroke patients (80y), tier diabetes was associated with longer lengths of stay compared with both groups and with higher FIM discharge scores compared with the nontier group. CONCLUSIONS The diabetes-related conditions identified as tier comorbidities under the prospective payment system are significant predictors of stroke rehabilitation outcomes, but these relationships are moderated by patient age.
Collapse
Affiliation(s)
- James E Graham
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX 77555-1137, USA.
| | | | | | | | | | | | | |
Collapse
|
178
|
Coca A, Redón J, Cea-Calvo L, Lozano JV, Navarro J, Fernández-Pérez C, Bonet A, González-Esteban J. Estimated risk of a first stroke and conditioning factors in Spanish hypertensive women. The RIMHA study. Blood Press 2009; 15:237-44. [PMID: 17078178 DOI: 10.1080/08037050600913474] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Stroke is the leading cause of mortality in women in Spain. RIMHA is a cross-sectional multicenter study in hypertensive women aged 55 or more in primary care to estimate the 10-year risk for a first stroke. Clinical history, cardiovascular risk factors and diseases, electrocardiogram, blood samples and blood pressure (BP) were recorded. Stroke and coronary risk were estimated using the appropriate Framingham scales; 12875 patients were included (mean age 68.0+/-8.5 years, 29.1% with diabetes, 19.7% with cardiovascular disease). Electrocardiographic left ventricular hypertrophy (LVH) was present in 19.2% BP was controlled in 42.9% of non-diabetic (BP<140/90 mmHg) and 9.7% of diabetic patients (BP<130/80 mmHg). The 10-year risk (+/- SD) for a first stroke was estimated as 15.8+/-16.3%, and the coronary risk as 12.0+/-6.3. In the multivariate analysis, the most contributing factors for stroke risk estimation were age, systolic BP, LVH and atrial fibrillation. In conclusion, the 10-year estimated stroke risk for Spanish hypertensive women aged 55 years or more was higher than the estimated coronary risk, in accordance with the high rates of morbidity and mortality due to stroke among women in Spain. The most powerful risk factors were older age, poor BP control, LVH and atrial fibrillation.
Collapse
Affiliation(s)
- Antonio Coca
- Hypertension Unit, Hospital Clinic (IDIBAPS), University of Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
179
|
Medin J, Nordlund A, Ekberg K. Sick leave, disability pension and health-care-seeking behaviour prior to stroke, among people aged 30–65: A case–control study. Brain Inj 2009; 21:457-63. [PMID: 17522985 DOI: 10.1080/02699050701317643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PRIMARY OBJECTIVE To explore sick leave, disability pension and health-care-seeking behaviour among people 30-65 years of age prior to their stroke in 2001 in the county of Ostergötland, Sweden. RESEARCH DESIGN A register-based, retrospective case-control study for the period 1 January 1998-31 December 2000. Cases (n=212): patients aged 30-65 with first-ever stroke in 2001. Controls (n=4606): people aged 30-65, randomly selected from the same base population. MAIN OUTCOMES AND RESULTS More than 91 days of accumulated sick leave among women was associated with increased likelihood of developing stroke (OR=1.89). Among men, 29-90 days and more than 91 days on sick leave increased the likelihood of stroke (OR=2.34 and OR=3.43, respectively). CONCLUSION Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. Accumulated sick leave may be a tool for identifying men and women with higher risk of stroke.
Collapse
Affiliation(s)
- Jennie Medin
- National Centre of Work and Rehabilitation, Linköping University, Linköping, Sweden.
| | | | | |
Collapse
|
180
|
Sardanelli F, Di Leo G, Aliprandi A, Flor N, Papini GD, Roccatagliata L, Cotticelli B, Nano G, Cornalba G. Evaluation of carotid vessel wall enhancement with image subtraction after gadobenate dimeglumine-enhanced MR angiography. Eur J Radiol 2009; 70:589-94. [DOI: 10.1016/j.ejrad.2008.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 02/05/2008] [Accepted: 02/05/2008] [Indexed: 11/25/2022]
|
181
|
Stroke and plasma markers of milk fat intake--a prospective nested case-control study. Nutr J 2009; 8:21. [PMID: 19457271 PMCID: PMC2689251 DOI: 10.1186/1475-2891-8-21] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 05/21/2009] [Indexed: 02/07/2023] Open
Abstract
Background Dairy products are high in saturated fat and are traditionally a risk factor for vascular diseases. The fatty acids 15:0 and 17:0 of plasma lipids are biomarkers of milk fat intake. The aim of the present study was to evaluate the risk of a first-ever stroke in relation to the plasma milk fat biomarkers. Methods A prospective case-control study was nested within two population based health surveys in Northern Sweden. Among 129 stroke cases and 257 matched controls, plasma samples for fatty acid analyses were available in 108 cases and 216 control subjects. Proportions of 15:0 and 17:0 of plasma lipids, weight, height, blood lipids, blood pressures, and lifestyle data were employed in conditional logistic regression modelling. Results The proportions of fatty acids 17:0 and 15:0+17:0 of total plasma phospholipids were significantly higher in female controls than cases, but not in men. 17:0 and 15:0+17:0 were significantly and inversely related to stroke in the whole study sample as well as in women. The standardised odds ratio (95% CI) in women to have a stroke was 0.41 (0.24–0.69) for 17:0 in plasma phospholipids. Adjustment for traditional cardiovascular risk factors, physical activity and diet had marginal effects on the odds ratios. A similar, but non-significant, trend was seen in men. Conclusion It is hypothesised that dairy or milk fat intake may be inversely related to the risk of a first event of stroke. The intriguing results of this study should be interpreted with caution. Follow up studies with greater power, and where intakes are monitored both by dietary recordings and fatty acid markers are needed.
Collapse
|
182
|
Wolma J, Nederkoorn PJ, Goossens A, Vergouwen MDI, van Schaik IN, Vermeulen M. Ethnicity a risk factor? The relation between ethnicity and large- and small-vessel disease in White people, Black people, and Asians within a hospital-based population. Eur J Neurol 2009; 16:522-7. [DOI: 10.1111/j.1468-1331.2009.02530.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
183
|
de Weert TT, Cretier S, Groen HC, Homburg P, Cakir H, Wentzel JJ, Dippel DWJ, van der Lugt A. Atherosclerotic plaque surface morphology in the carotid bifurcation assessed with multidetector computed tomography angiography. Stroke 2009; 40:1334-40. [PMID: 19265048 DOI: 10.1161/strokeaha.108.538439] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Complicated (irregular or ulcerated) carotid plaques have proven to be independent predictors of stroke. We analyzed the frequency and location of plaque irregularities in a large cohort of patients with ischemic cerebrovascular disease and the relation with severity of stenosis, cardiovascular risk factors, and symptomatology. METHODS Multidetector CT angiography images from 406 patients were evaluated. Plaque surface morphology was classified as smooth, irregular, or ulcerated. The location of the ulceration was defined as proximal or distal to the point of maximum stenosis. RESULTS Atherosclerotic plaques with an open lumen were present in 448 carotid arteries; these plaques were classified as: smooth, 276 (62%); irregular, 99 (22%); and ulcerated, 73 (16%). Sixty-two (69%) of the ulcerations were located proximal to the point of maximum luminal stenosis. Complicated plaques were significantly (P<0.001) more common in carotid arteries with stenosis >30% than in those with stenosis <30%. There is an association between complicated plaques and hypercholesterolemia (OR, 3.0) and a trend toward an association with smoking (OR, 1.9). Complicated plaques are more often present in the symptomatic carotid artery than in the contralateral asymptomatic carotid artery; however, this is fully attributed to a significantly higher degree of stenosis in the symptomatic arteries. CONCLUSIONS Multidetector CT angiography allows the classification of atherosclerotic carotid plaque surface. Complicated plaques are frequent in atherosclerotic carotid disease, especially with higher stenosis degree. Ulcerations are mostly located in the proximal part of the atherosclerotic plaque. Hypercholesterolemia and smoking are related with the presence of complicated plaques.
Collapse
Affiliation(s)
- Thomas T de Weert
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
184
|
Delayed peripheral administration of the N-terminal tripeptide of IGF-1 (GPE) reduces brain damage following microsphere induced embolic damage in young adult and aged rats. Neurosci Lett 2009; 454:53-7. [PMID: 19429053 DOI: 10.1016/j.neulet.2009.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 02/20/2009] [Accepted: 03/02/2009] [Indexed: 11/20/2022]
Abstract
We have previously reported that peripheral administration of GPE prevents neuronal injury after ischemic reperfusion injury in young adult rats. This study examined the ameliorating effects of GPE-treatment after embolic injury induced by microsphere injection in young adult and aged male rats. Unilateral injury was induced by injecting microspheres into the right internal carotid artery in both young adult (3-4 months) and aged (16-17 months) male rats. Either GPE (12mg/kg) or the vehicle was infused intravenously over 1h starting 3h after embolic injury and the degree of brain injury, astrocytosis and vascular remodeling were examined using histological and immunohistochemical analysis 8 days later. Changes in core temperature, blood glucose concentration, oxygen saturation and heart rate were monitored. Microsphere injection induced multiple sites of focal damage in the ipsilateral subcortical regions. Massive numbers of microglia accumulated within the core of the tissue damage whereas astrocytes were located in the penumbra. There was no difference in the degree of brain injury between the young and aged control rats. However the aged rats showed less injury-induced astrocytosis and greater vascular remodeling. Intravenous infusion of GPE 3h after the injury reduced overall damage scores in both young (p<0.01) and aged rats (p<0.05). GPE-treatment reduced astrocytosis in young, but not aged animals and did not significantly alter the vascular remodeling in either age group. The data suggested that the neuroprotection of the tripeptide is independent of cerebral reperfusion and is not age selective.
Collapse
|
185
|
Zintzaras E, Rodopoulou P, Sakellaridis N. Variants of the arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene and risk of stroke: a HuGE gene-disease association review and meta-analysis. Am J Epidemiol 2009; 169:523-32. [PMID: 19126581 DOI: 10.1093/aje/kwn368] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Variants of the arachidonate 5-lipoxygenase-activating protein (ALOX5AP) gene have been implicated as a risk factor for stroke. However, genetic association studies that have examined the association between ALOX5AP gene variants (HapA haplotype, HapB haplotype, and SG polymorphisms) and stroke have produced conflicting results. Therefore, the authors performed a meta-analysis of all studies with ALOX5AP genotyping (5,194 stroke cases and 4,566 controls). The meta-analysis showed significant heterogeneity among studies (P(Q) = 0.03, I(2) = 63%) and a nonsignificant association between the HapA haplotype (SG13S25G-SG13S114T-SG13S89G-SG13S32A) and stroke risk (random-effects (RE) odds ratio (OR) = 1.13, 95% confidence interval (CI): 0.88, 1.45). Regarding the HapB haplotype (SG13S377A-SG13S114A-SG13S41A-SG13S35G), there was no association with stroke risk (RE OR = 1.03, 95% CI: 0.77, 1.37). The SG13S114, SG13S89, SG13S25, SG13S32, SG13S35, and SG13S42 polymorphisms were not associated with stroke. The SG13S106 and SG13S377 polymorphisms revealed evidence of marginal association (RE OR = 1.23 (95% CI: 1.03, 1.46) and RE OR = 1.25 (95% CI: 1.04, 1.50), respectively). However, cumulative meta-analysis for the HapA haplotype showed a downward trend of odds ratios over time, and recursive cumulative meta-analysis indicated insufficient evidence for claiming or denying an association. Tests for bias revealed no evidence of biases. Rigorous genetic association studies investigating gene-gene-environment interactions may generate more conclusive claims about the genetics of stroke.
Collapse
Affiliation(s)
- Elias Zintzaras
- Department of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.
| | | | | |
Collapse
|
186
|
Sweileh WM, Sawalha AF, Zyoud SH, Al-Jabi SW, Abaas MA. Discharge medications among ischemic stroke survivors. J Stroke Cerebrovasc Dis 2009; 18:97-102. [PMID: 19251184 DOI: 10.1016/j.jstrokecerebrovasdis.2008.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 08/07/2008] [Accepted: 08/26/2008] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze the types and cost of medications prescribed at discharge for ischemic stroke survivors. METHODS This is a descriptive study of medications prescribed for ischemic stroke survivors admitted to Al-watani hospital during a 6-month period. RESULTS A total of 95 consecutive stroke patients were included in the study period; 78 (82.1%) survivors were having ischemic stroke subtype and were designated the study group. The average age of the survivors was 66.9 +/- 12.7 years. Survivors had prevalent risk factors such as diabetes mellitus (70%), hypertension (68%), and ischemic heart disease (34.6%). On average, survivors experienced a minimum of 0.73 complications (range 0-3) with the most common being infections (n = 35, 44.8%). Forty-two per cent of the ischemic stroke survivors were taking antiplatelet drugs prior to the current attack. At discharge, ischemic stroke survivors were prescribed an average of 4.9 medications from 4.3 different drug classes. All ischemic stroke survivors were prescribed antiplatelet therapy at discharge. Aspirin monotherapy was prescribed for 61 survivors while the combination of aspirin/clopidogrel antiplatelet therapy was prescribed for 17 survivors. The average monthly cost for prophylactic therapy and for medications used to treat post-stroke complication was approximately 52 USD per survivor. CONCLUSION Most of the patients in the study group were having the traditional risk factors for ischemic stroke and were suffering form typical post-stroke complications. Lack of medical insurance will impose a heavy financial burden on stroke survivors in Palestine.
Collapse
Affiliation(s)
- Waleed M Sweileh
- College of Pharmacy, An-Najah National University, Nablus, Palestine.
| | | | | | | | | |
Collapse
|
187
|
|
188
|
O'Rourke K, Berge E, Walsh C, Kelly P. Percutaneous vascular interventions for acute ischaemic stroke. Hippokratia 2009. [DOI: 10.1002/14651858.cd007574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
189
|
Dougall A, Fiske J. Access to special care dentistry, part 9. Special care dentistry services for older people. Br Dent J 2009; 205:421-34. [PMID: 18953303 DOI: 10.1038/sj.bdj.2008.891] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This article looks at three common neurological conditions associated with later years: stroke, Parkinson's disease and dementia. All of them impact on oral health, access to dental services and delivery of dental care, and treatment goals need to be adapted to take into account patients' changing needs, medical status, pattern of recovery or the stage of dementia that they have reached. The article concludes by considering the topic of elder abuse. The dental team may have a role both in identifying abuse and ensuring appropriate action is taken.
Collapse
Affiliation(s)
- A Dougall
- Division One/Special Care Dentistry, Dublin Dental School and Hospital, Lincoln Place, Dublin 2, Ireland
| | | |
Collapse
|
190
|
Hankey GJ. Costs and health care system issues. HANDBOOK OF CLINICAL NEUROLOGY 2009; 92:373-388. [PMID: 18790285 DOI: 10.1016/s0072-9752(08)01919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Graeme J Hankey
- Stroke Unit, Department of Neurology, Royal Perth Hospital and School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| |
Collapse
|
191
|
Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, Torgerson D, Dellagrammaticas D, Horrocks M, Liapis C, Banning AP, Gough M, Gough MJ. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008; 372:2132-42. [PMID: 19041130 DOI: 10.1016/s0140-6736(08)61699-2] [Citation(s) in RCA: 344] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid-artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easier under local anaesthesia than under general anaesthesia. METHODS We undertook a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. Participants were randomly assigned to surgery under general (n=1753) or local (n=1773) anaesthesia between June, 1999 and October, 2007. The primary outcome was the proportion of patients with stroke (including retinal infarction), myocardial infarction, or death between randomisation and 30 days after surgery. Analysis was by intention to treat. The trial is registered with Current Control Trials number ISRCTN00525237. FINDINGS A primary outcome occurred in 84 (4.8%) patients assigned to surgery under general anaesthesia and 80 (4.5%) of those assigned to surgery under local anaesthesia; three events per 1000 treated were prevented with local anaesthesia (95% CI -11 to 17; risk ratio [RR] 0.94 [95% CI 0.70 to 1.27]). The two groups did not significantly differ for quality of life, length of hospital stay, or the primary outcome in the prespecified subgroups of age, contralateral carotid occlusion, and baseline surgical risk. INTERPRETATION We have not shown a definite difference in outcomes between general and local anaesthesia for carotid surgery. The anaesthetist and surgeon, in consultation with the patient, should decide which anaesthetic technique to use on an individual basis. FUNDING The Health Foundation (UK) and European Society of Vascular Surgery.
Collapse
|
192
|
Greisenegger S, Zehetmayer S, Bauer P, Endler G, Ferrari J, Lang W, Janisiw M, Steiner L, Cheng S, Lalouschek W, Mannhalter C. Polymorphisms in inflammatory genes and the risk of ischemic stroke and transient ischemic attack: results of a multilocus genotyping assay. Clin Chem 2008; 55:134-8. [PMID: 19028820 DOI: 10.1373/clinchem.2008.112151] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Single-nucleotide polymorphisms (SNPs) in inflammation-related genes have been linked to an increased risk of ischemic stroke. Most of these SNP results have not been replicated, however, and metaanalyses of the effects of inflammation-related genes are rare. We investigated 49 SNPs in 34 genes previously reported to be related to inflammation in our study. We tested 459 patients with acute ischemic stroke or transient ischemic attack and 459 controls individually matched by sex and age. METHODS We studied genetic variation by PCR analysis and subsequent hybridization to linear arrays of sequence-specific oligonucleotides. We used univariate conditional logistic regression analysis to test for associations of conventional vascular risk factors and the SNPs with stroke. Variables showing significant differences (P < 0.05) between cases and controls were included in a multivariate model. ROC curves were plotted to assess the contribution of genetic variation to stroke risk in addition to that of conventional risk factors. RESULTS Univariate regression analysis revealed 3 SNPs with significant allelic differences between patients and controls, which fulfilled the criteria for further analysis. Only one of these SNPs, the C5 (complement component 5) 2416A>G variant (rs17611), remained significant after the multivariate analysis (odds ratio, 0.585; P = 0.0037). ROC curve analysis revealed no contribution of this genetic variation to stroke risk. CONCLUSIONS We found evidence for an association of the 2416A>G polymorphism in the C5 gene with the risk for ischemic stroke. Our data suggest that the C5 gene particularly influences the risk for patients with microangiopathy.
Collapse
Affiliation(s)
- Stefan Greisenegger
- Department of Neurology, Institute of Medical Statistics, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Vienna, Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
193
|
Affiliation(s)
- William Whiteley
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
| | | | | | | | | |
Collapse
|
194
|
|
195
|
Stroke in elderly patients: management and prognosis in the ED. Am J Emerg Med 2008; 26:742-9. [DOI: 10.1016/j.ajem.2007.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 10/13/2007] [Accepted: 10/14/2007] [Indexed: 11/17/2022] Open
|
196
|
McColl BW, Allan SM, Rothwell NJ. Systemic infection, inflammation and acute ischemic stroke. Neuroscience 2008; 158:1049-61. [PMID: 18789376 DOI: 10.1016/j.neuroscience.2008.08.019] [Citation(s) in RCA: 243] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 08/08/2008] [Accepted: 08/11/2008] [Indexed: 12/16/2022]
Abstract
Extensive evidence implicates inflammation in multiple phases of stroke etiology and pathology. In particular, there is growing awareness that inflammatory events outside the brain have an important impact on stroke susceptibility and outcome. Numerous conditions, including infection and chronic non-infectious diseases, that are established risk factors for stroke are associated with an elevated systemic inflammatory profile. Recent clinical and pre-clinical studies support the concept that the systemic inflammatory status prior to and at the time of stroke is a key determinant of acute outcome and long-term prognosis. Here, we provide an overview of the impact of systemic inflammation on stroke susceptibility and outcome. We discuss potential mechanisms underlying the impact on ischemic brain injury and highlight the implications for stroke prevention, therapy and modeling.
Collapse
Affiliation(s)
- B W McColl
- Faculty of Life Sciences, Michael Smith Building, University of Manchester, Manchester M13 9PT, UK.
| | | | | |
Collapse
|
197
|
Yamada Y, Metoki N, Yoshida H, Satoh K, Kato K, Hibino T, Yokoi K, Watanabe S, Ichihara S, Aoyagi Y, Yasunaga A, Park H, Tanaka M, Nozawa Y. Genetic Factors for Ischemic and Hemorrhagic Stroke in Japanese Individuals. Stroke 2008; 39:2211-8. [DOI: 10.1161/strokeaha.107.507459] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yoshiji Yamada
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Norifumi Metoki
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Hidemi Yoshida
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Kei Satoh
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Kimihiko Kato
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Takeshi Hibino
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Kiyoshi Yokoi
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Sachiro Watanabe
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Sahoko Ichihara
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Yukitoshi Aoyagi
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Akitomo Yasunaga
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Hyuntae Park
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Masashi Tanaka
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| | - Yoshinori Nozawa
- From the Department of Human Functional Genomics (Y.Y., S.I.), Life Science Research Center, Mie University, Tsu, Japan; Department of Internal Medicine (N.M.), Hirosaki Stroke Center, Hirosaki, Japan; Department of Vascular Biology (H.Y., K.S.), Institute of Brain Science, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Cardiovascular Medicine (K.K., T.H., K.Y.), Gifu Prefectural Tajimi Hospital, Tajimi, Japan; Department of Cardiology (S.W.), Gifu Prefectural
| |
Collapse
|
198
|
Stroke due to atrial fibrillation and the attitude to prescribing anticoagulant prevention in Italy. J Neurol 2008; 255:796-802. [DOI: 10.1007/s00415-008-0615-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 03/19/2007] [Accepted: 03/28/2007] [Indexed: 10/21/2022]
|
199
|
Dharmasaroja P. Prevalence of extracranial carotid stenosis in Thai ischemic stroke/TIA patients. J Neurol Sci 2008; 269:92-5. [DOI: 10.1016/j.jns.2007.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2007] [Revised: 12/20/2007] [Accepted: 12/21/2007] [Indexed: 11/29/2022]
|
200
|
Bo M, Massaia M, Speme S, Cappa G, Strumia K, Cerrato P, Ponzio F, Molaschi M. Cognitive function after carotid endarterectomy: greater risk of decline in symptomatic patients with left internal carotid artery disease. J Stroke Cerebrovasc Dis 2008; 14:221-8. [PMID: 17904030 DOI: 10.1016/j.jstrokecerebrovasdis.2005.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2005] [Accepted: 06/30/2005] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The risk of cognitive decline in patients undergoing carotid endarterectomy (CE) for left internal carotid artery (ICA) (LICA) disease before or after the occurrence of ischemic symptoms has not been fully elucidated. We evaluated whether patients undergoing CE for symptomatic LICA stenosis have greater risk of cognitive decline than patients with asymptomatic LICA disease or right ICA disease. METHODS In a series of patients aged 65 years and older, consecutively undergoing CE and free from cognitive impairment, cognitive function was evaluated through the age- and education-adjusted Mini Mental State Examination and the Clock Drawing Task at baseline and at the end of the study period (average follow-up: 44.4 +/- 14.3 months). RESULTS The analysis included 103 patients (mean age 72.6 +/- 7.0 years; 73 men), of whom 50 had LICA disease (29 symptomatic). At the end of the study period, Mini Mental State Examination score was reduced in patients with symptomatic LICA disease (P < .001) but not in other patients, whereas the Clock Drawing Task score was reduced in both patients with LICA and right ICA. Patients with symptomatic LICA disease had greater risk of cognitive decline than other individuals, either measured by the Mini Mental State Examination score (F = 5.18, P = .002) or by the Clock Drawing Task score (F = 9.42, P = .001). CONCLUSIONS Patients undergoing CE for symptomatic LICA disease appear to be at increased risk of cognitive decline than other individuals. Further studies are needed to confirm these findings and to evaluate whether LICA endarterectomy before occurrence of cerebrovascular ischemic symptoms may provide additive benefit in the prevention of cognitive decline.
Collapse
Affiliation(s)
- Mario Bo
- Section of Gerontology, Department of Medical and Surgical Disciplines, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | |
Collapse
|