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Nozaki F, Kusunoki T, Kumada T, Shibata M, Fujii T. Risk Factors for Cerebral Infarction in Duchenne Muscular Dystrophy: Review With our 2 Cases. J Stroke Cerebrovasc Dis 2019; 28:2453-2458. [PMID: 31311695 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/16/2019] [Accepted: 06/22/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although the incidence of cerebral infarction is higher in Duchenne muscular dystrophy (.75 per 100) than in the general population (7.5-11.4 per 100 000), only 18 cases have been reported, and prevention and management guidelines for infarction in this disorder remain lacking. PATIENTS AND METHODS We encountered 2 cases of Duchenne muscular dystrophy with cerebral infarction. To clarify risk factors for such infarction in Duchenne muscular dystrophy, we reviewed 20 cases, including our 2 patients. RESULTS Age at onset of infarction ranged from 4 to 31 years (n = 19). Most patients were 16-21 years old (14 of 19; 73.7%). Eighteen patients (90%) had dilated cardiomyopathy (DCM), showing a higher frequency than in the age-matched general Duchenne muscular dystrophy population. Left ventricular ejection fraction (LVEF) ranged from 10.2% to 42% (median, 20%; n = 9). Detectable cardiac thrombus and atrial fibrillation were rare (2 of 17; 11.8%, and 1 of 17; 5.9%, respectively). CONCLUSIONS Presence of DCM with low LVEF seems to be the strongest risk factor for cerebral infarction in Duchenne muscular dystrophy.
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Affiliation(s)
- Fumihito Nozaki
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan.
| | - Takashi Kusunoki
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan
| | - Tomohiro Kumada
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan
| | - Minoru Shibata
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan
| | - Tatsuya Fujii
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan
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Zhang M, Zhao R, Yu T, Li J, Zhang M, Jiang S, Wang L, Zhang G, Li R, Zhu B, Guan D. Sudden cardiac death of Duchenne muscular dystrophy with NT-proBNP in pericardial fluid as a useful biomarker for diagnosis of the cause of death: a case report. Forensic Sci Res 2017; 5:165-169. [PMID: 32939432 PMCID: PMC7476613 DOI: 10.1080/20961790.2017.1333249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/18/2017] [Indexed: 01/16/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is one of the most common and severest muscular dystrophies. Although it can be a cause of death when associated with cardiac muscle and/or respiratory muscles, no cases of sudden deaths in the setting of undiagnosed DMD with cardiac involvement have been reported in the literatures. Previous studies showed that N-terminal-proBNP (NT-proBNP) was a robust laboratory biomarker to diagnose and monitor cardiac failure in clinical situations, suggesting that it may be used as an auxiliary indicator for diagnosis on left ventricular dysfunction in sudden cardiac deaths in forensic settings. Here, we reported a case of 29-year-old man who died suddenly. Autopsy revealed that muscles of the body were almost replaced by fatty and fibrotic tissues. The heart was enlarged with disarray and degeneration of cardiomyocytes in cardiac muscle. Total absence of dystrophin was detected by immunohistochemical staining, which confirmed DMD. Postmortem biochemical test of pericardial fluid revealed a high level of NT-proBNP, indicating dysfunction of the left ventricle before death. The cause of death was certified as an early dilated cardiomyopathy (DCM)/dysfunction of the left ventricle secondary to DMD, suggesting that sudden cardiac death with cardiac dysfunction could be identified by immunohistochemical method in combination with pericardial fluid NT-proBNP determination after systemic autopsy.
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Affiliation(s)
- Mengzhou Zhang
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Rui Zhao
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China.,Remote Forensic Consultation Center, Collaborative Innovation Center of Judicial Civilization, China University of Political Science and Law, Beijing, China
| | - Tianshui Yu
- Remote Forensic Consultation Center, Collaborative Innovation Center of Judicial Civilization, China University of Political Science and Law, Beijing, China
| | - Jiaoyong Li
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Miao Zhang
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Shukun Jiang
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Linlin Wang
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Guohua Zhang
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Rubo Li
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Baoli Zhu
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China
| | - Dawei Guan
- Department of Forensic Pathology, China Medical University School of Forensic Medicine, Shenyang, China.,Remote Forensic Consultation Center, Collaborative Innovation Center of Judicial Civilization, China University of Political Science and Law, Beijing, China
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Winterholler M, Holländer C, Kerling F, Weber I, Dittrich S, Türk M, Schröder R. Stroke in Duchenne Muscular Dystrophy: A Retrospective Longitudinal Study in 54 Patients. Stroke 2016; 47:2123-6. [PMID: 27354222 DOI: 10.1161/strokeaha.116.013678] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/19/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Duchenne muscular dystrophy (DMD) is the most frequent skeletal muscle myopathy. Nearly all patients develop cardiomyopathy in their second decade of life. The purpose of this study was to evaluate the frequency, cause, and outcome of stroke in a German cohort of patients with DMD. METHODS Retrospective analysis of medical records of 54 DMD patients, who lived in a regional facility for handicapped people (Wichernhaus Altdorf, Germany) between 1963 and 2013. RESULTS Fifty-four DMD patients were followed up for 7.4 years on average. Mean age at admission and discharge from the long-term care facility or death were 11.4 and 18.8 years, respectively. Covering a total observation period of 400 patient-years, we identified 4 DMD patients with juvenile arterial ischemic strokes. Off-label systemic thrombolysis in 2 patients resulted in a nearly complete regression of stroke-related symptoms, but 1 patient died of septic pneumonia and cardiac failure 24 days after thrombolysis therapy. In the other 2 patients, who had their ischemic strokes in 1994 and 1998, severe infarction-related symptoms persisted, and 1 patient died 13 days later. DMD-associated cardiomyopathy without evidence of atrial fibrillation was the only risk factor for ischemic stroke in all patients. CONCLUSIONS This study indicates an increased risk for ischemic strokes in DMD patients. Regular cardiological assessment of all DMD patients is mandatory to evaluate the individual risk profile for cardioembolic events and to adapt therapeutic strategies.
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Affiliation(s)
- Martin Winterholler
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Christian Holländer
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Frank Kerling
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Irina Weber
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Dittrich
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Türk
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Rolf Schröder
- From the Department of Neurology, Hospital Rummelsberg, Schwarzenbruck, Germany (M.W., F.K., I.W.); Rummelsberger Diakonie, Wichernhaus Altdorf, Altdorf, Germany (C.H.); and Department of Pediatric Cardiology (S.D.), Department of Neurology (M.T.), and Institute of Neuropathology (R.S.), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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