Pseudoephedrine-induced Hemorrhage Associated with a Cerebral Vascular Malformation

Rhinosinusitis and Stroke: A Systematic Review

Rhinosinusitis is one of the most common inflammatory diseases. It has been recognized that intracranial vessels are involved and there might be an association with stroke occurrence. The aim of this study was to evaluate the association between rhinosinusitis and cardiovascular diseases, especially stroke, through a literature review. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed on PubMed a literature search from February 2000 to February 2022, using the search terms 'rhinosinusitis' OR 'chronic rhinosinusitis' AND 'stroke' OR 'ischemic stroke'. Fourteen studies were eligible and included in the analysis. Overall, the studies encompassed a total of 1,006,338 patients included in this review. All studies concluded that there is a statistically significant correlation between clinical or radiological sinus inflammation and the risk of stroke, which is independent of traditional stroke risk factors. In conclusion, rhinosinusitis is associated with an increased incidence of stroke.

Chronic rhinosinusitis increased the risk of stroke: a 5-year follow-up study

OBJECTIVES/HYPOTHESIS

It has been recognized that chronic rhinosinusitis (CRS) involves intracranial vessels and may be associated with stroke occurrence. However, the detailed epidemiological profile of stroke risk among patients with CRS is still not well understood. Therefore, this study aimed to explore the frequency and risk for stroke among patients with CRS by conducting a large scale population-based cohort study in Taiwan.

METHODS

All study cohorts were retrieved from the Taiwan Longitudinal Health Insurance Database. This study included 15,846 CRS subjects in the study cohort and 47,538 randomly selected subjects in the comparison cohort. We individually tracked each subject in this study for a 5 year period following their index dates to identify each subject that received a subsequent diagnosis of stroke. Stratified Cox proportional hazards regressions were analyzed to compare the 5 year risk of subsequent stroke following a diagnosis of CRS.

RESULTS

The incidence rate of stroke during the 5-year follow-up period was 10.65 (95% CI: 9.93-11.41) per 100 person years and 7.53 (95% CI: 7.18-7.89) per 100 person years for the study and comparison cohort, respectively. The covariate-adjusted hazard ratio (HR) for stroke revealed that that subjects with CRS were more likely than comparison subjects to have a diagnosis of ischemic stroke during the 5-year follow-up period (HR = 1.34, 95% CI = 1.18-1.53). However, there was no significant difference in the risk of subarachnoid hemorrhage (HR = 1.52, 95% CI = 0.94-2.47) or intracerebral hemorrhage (HR = 0.96, 95% CI = 0.71-1.31).

CONCLUSIONS

Patients with CRS were at higher risk for stroke occurrence during the 5 year follow-up.

The pathophysiology, clinical impact, and management of nasal congestion in allergic rhinitis

BACKGROUND

Nasal congestion is a cardinal symptom of allergic rhinitis (AR). It is difficult to treat and is associated with decreased quality of life.

OBJECTIVE

This article reviews the clinical features of nasal congestion, its complex pathophysiology in the context of AR, its clinical impact, and the strengths and weaknesses of available treatments.

METHODS

Primary studies and reviews in the peer-reviewed, English-language literature were identified through searches of MEDLINE (1966-2008) and the Cochrane Library (1996-2008) using the terms nasal congestion, allergic rhinitis, pathophysiology, quality of life, and burden. Additional references were obtained by searching the reference lists of the identified articles. Abstracts from the 2006 and 2007 meetings of the American Academy of Allergy, Asthma, and Immunology were also searched. Pertinent articles were included in the review if they were recently published and patient-focused, and if their authors were recognized leaders in the field.

RESULTS

A survey of 2355 patients with AR or their guardians found that almost half of respondents rated nasal congestion the most bothersome symptom; in a survey of 2500 adults with AR, 78% rated nasal congestion either extremely or moderately bothersome. Histamine and leukotrienes are major mediators of the allergic inflammation associated with nasal congestion, as indicated by reductions in nasal cross-sectional area in response to histamine challenge (P<0.001) and increases in nasal airway resistance in response to leukotriene challenge (P<0.05).Therapy for nasal congestion in AR is often hampered by limitations associated with the individual agents; for example, decongestants are effective in the control of nasal congestion, but their use is restricted by their adverse-event profiles. A meta-analysis of 16 controlled studies involving 2267 patients with AR found that intranasal corticosteroids provided significantly greater relief of nasal congestion than oral antihistamines (95% CI for combined standardized mean difference, -0.73 to -0.53). The results of several clinical trials have suggested that leukotriene-receptor antagonists may be associated with reduced nasal congestion; however, no agents in this class are currently approved for the treatment of nasal congestion in AR.

CONCLUSION

There is a need for therapies that are well tolerated and effective in relieving nasal congestion in AR.