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Hu J, Wang H, Zhou Y. Genetically predicted chronic rhinosinusitis and the risk of stroke: a two-sample Mendelian randomization study. Front Neurol 2024; 14:1294321. [PMID: 38274878 PMCID: PMC10808795 DOI: 10.3389/fneur.2023.1294321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
Objective The causal association between chronic rhinosinusitis (CRS) and stroke remains uncertain due to the susceptibility of observational studies to confounding and the possibility of reverse causality. This study aims to examine the potential causal relationship between CRS and the risk of stroke, encompassing various subtypes. Methods In this research, we utilized genome-wide association study (GWAS) data for CRS from FinnGen. We identified significant single-nucleotide polymorphisms (SNPs) associated with CRS and used them as instrumental variables (IVs). GWAS data for any ischemic stroke (AIS), ischemic stroke (IS), large-artery atherosclerotic stroke (LAS), small-vessel strokes (SVS), cardioembolic strokes (CES), intracerebral hemorrhage (ICH), lobar ICH, and non-lobar ICH came from multi-ancestry GWAS datasets. We conducted two-sample Mendelian randomization (MR) analyses using inverse variance weighting (IVW), weighted median, and MR-Egger regression methods to investigate potential causal relationships between CRS and stroke. Both heterogeneity and pleiotropy were evaluated by sensitivity analyses. Result The IVW analysis revealed no significant associations between CRS and AIS (OR = 0.99, 95% CI [0.93-1.05], p = 0.73), IS (OR = 0.97, 95% CI [0.81-1.17], p = 0.09), SVS (OR = 0.96, 95% CI [0.82-1.12], p = 0.58), LAS (OR = 0.91, 95% CI [0.77-1.08], p = 0.09), CES (OR = 0.97, 95% CI [0.81-1.17], p = 0.79), ICH (OR = 1.28, 95% CI [0.74-2.22], p = 0.28), lobar ICH (OR = 1.22, 95% CI [0.60-2.50], p = 0.28), and non-lobar ICH (OR = 1.25, 95% CI [0.65-2.40], p = 0.79). Sensitivity analysis found no evidence of horizontal pleiotropy. Conclusion According to genetic evidence, this Mendelian randomization (MR) study does not indicate a causal relationship between CRS and stroke in European populations. However, further studies are necessary to comprehensively evaluate the potential association between CRS and stroke.
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Affiliation(s)
- Jingjing Hu
- Department of Emergency Medicine, Hangzhou Third People’s Hospital, Hangzhou, China
| | - Hui Wang
- Department of Geratology, Hangzhou Third People’s Hospital, Hangzhou, China
| | - Yidan Zhou
- Department of Emergency Medicine, Hangzhou Third People’s Hospital, Hangzhou, China
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Papadopoulou AM, Marinou A. Rhinosinusitis and Stroke: A Systematic Review. Cureus 2023; 15:e40923. [PMID: 37496556 PMCID: PMC10367432 DOI: 10.7759/cureus.40923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/28/2023] Open
Abstract
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.
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Affiliation(s)
- Anna-Maria Papadopoulou
- Department of Otolaryngology, Head and Neck Surgery, "G.Gennimatas" General Hospital of Athens, Athens, GRC
| | - Athanasia Marinou
- Department of Otolaryngology, Head and Neck Surgery, "G.Gennimatas" General Hospital of Athens, Athens, GRC
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Young KS, Kiam JS, Metcalf K, Nassif R. Sphenoid sinusitis: a rare cause of ischaemic stroke. BMJ Case Rep 2021; 14:e242943. [PMID: 34607813 PMCID: PMC8491291 DOI: 10.1136/bcr-2021-242943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew Streptococcus constellatus, a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.
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Affiliation(s)
| | - Jian Shen Kiam
- Ear Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - Kneale Metcalf
- Neurosciences, Norfolk and Norwich University Hospitals NHS Trust, Norwich, Norfolk, UK
| | - Ramez Nassif
- Ear Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, UK
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Hepburn K, Kim D, Darbar A, Pollock C. Unusual cause of headache following renal transplantation. Nephrology (Carlton) 2020; 25:873-874. [PMID: 32666657 DOI: 10.1111/nep.13750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kirsten Hepburn
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Dana Kim
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Archie Darbar
- Department of Infectious Diseases, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Carol Pollock
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Fabre C, Atallah I, Wroblewski I, Righini CA. Maxillary sinusitis complicated by stroke. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:449-451. [PMID: 30072286 DOI: 10.1016/j.anorl.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Neurological complications of acute sinusitis are exceptional, but potentially serious. CASE REPORT The authors report the case of a 6-year-old diabetic girl who presented with middle cerebral artery ischemic stroke secondary to inflammatory arteritis of the left internal carotid artery in a context of bilateral acute maxillary sinusitis. MRI confirmed ischaemic stroke associated with carotid arteritis and complete obstruction of the maxillary sinuses. A favourable outcome was observed after endoscopic drainage of the sinuses associated with broad-spectrum antibiotic therapy. DISCUSSION This complication was probably due to spread of an infectious inflammatory reaction of the intrapetrosal carotid artery and its branches via the pterygoid venous plexus. To our knowledge, this is the first published case report of maxillary sinusitis complicated by stroke.
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Affiliation(s)
- C Fabre
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France.
| | - I Atallah
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France; Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France
| | - I Wroblewski
- Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France; Réanimation et surveillance continue pédiatrique, pôle Couple Enfant, CHU de Grenoble, Grenoble, France
| | - C A Righini
- Service hospitalo-universitaire d'ORL et chirurgie cervico-faciale, CHU Michalon CS 10217, 38043, Grenoble cedex 9, France; Faculté de médecine, universités des Alpes, Grenoble, France; UGA/UMR/CNRS 5309/Inserm 1209, institut Albert-Bonniot, Grenoble, France
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Aydın E, Yerli H, Tanrıkulu S, Hizal E. Mucosal cysts of the maxillary sinus in solid organ transplant population: computerised tomography follow-up results. Balkan Med J 2014; 30:305-8. [PMID: 25207125 DOI: 10.5152/balkanmedj.2013.8475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 04/22/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The clinical significance of maxillary sinus mucosal cysts in liver and kidney transplant recipients remains unclear. AIM To investigate the course of maxillary mucosal cysts in liver and kidney transplantation patients. STUDY DESIGN Retrospective clinical study. METHODS Paranasal sinus computed tomography scans of 169 renal and 43 hepatic transplant recipients were reviewed. The incidence, size and growth characteristics of maxillary mucosal cysts in the renal and hepatic transplant population were noted. RESULTS Overall incidence of maxillary sinus mucosal cyst in transplantation patients was found to be 24.5%, with a male to female ratio of 2:1 (p<0.05). Follow-up views of 26 patients showed that the size of the cysts increased in 19, decreased in 4, and remained the same in 3 patients. Mean growth rate of the cysts was calculated to be 6.30 ± 7.02 mm(2) per month. Most of the cysts were located on the inferior wall of the maxillary sinus. CONCLUSION Incidence of the maxillary mucosal cysts in renal and hepatic transplant recipients does not differ from general population, but these cysts have a greater tendency to grow. Specific measures are not needed for isolated, asymptomatic maxillary mucosal cysts in transplant populations.
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Affiliation(s)
- Erdinç Aydın
- Department of Otolaryngology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Hasan Yerli
- Department of Radiology, Başkent University Faculty of Medicine, İzmir, Turkey
| | - Suna Tanrıkulu
- Clinic of Otolaryngology, Ürgüp State Hospital, Nevşehir, Turkey
| | - Evren Hizal
- Department of Otolaryngology, Başkent University Faculty of Medicine, Ankara, Turkey
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Kang JH, Wu CS, Keller JJ, Lin HC. Chronic rhinosinusitis increased the risk of stroke: a 5-year follow-up study. Laryngoscope 2013; 123:835-40. [PMID: 23377773 DOI: 10.1002/lary.23829] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
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Wu CW, Chao PZ, Hao WR, Liou TH, Lin HW. Risk of Stroke among Patients with Rhinosinusitis: A Population-Based Study in Taiwan. Am J Rhinol Allergy 2012. [DOI: 10.2500/ajra.2012.26.3783a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Chin-Wen Wu
- Departments of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Pin-Zhir Chao
- Departments of Otolaryngology, and Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Rui Hao
- Departments of Cardiovascular Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Departments of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Injury Prevention, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
- Evidence Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Poulopoulos M, Finelli PF. Neurological complications with acute sphenoid sinusitis a surgical emergency? Neurocrit Care 2007; 7:169-71. [PMID: 17846721 DOI: 10.1007/s12028-007-0036-6] [Citation(s) in RCA: 7] [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
BACKGROUND Isolated acute sphenoid sinusitis is an uncommon sinus infection, frequently misdiagnosed and not usually considered in the differential diagnosis of acute severe headache, with the potential of serious neurologic complications. OBJECTIVES To describe two patients with acute sphenoid sinusitis who presented with acute onset of severe headache and consider the role of surgical management. DESIGN Case report. SETTING Tertiary care hospital. RESULTS Patient 1 developed right cavernous sinus thrombosis and permanent visual loss in one eye, requiring sphenoidotomy following failure of medical treatment. Patient 2 experienced failure of the medical treatment. However, sphenoidotomy abated all his symptoms without any neurologic sequelae. CONCLUSION It is important to be aware of acute sphenoid sinusitis in the setting of new onset severe headache, when imaging studies are unrevealing for intracranial pathology. Considering the serious consequences of failed medical treatment vis-à-vis the safety and efficacy of sphenoidotomy we propose surgical intervention at the time of diagnosis.
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Affiliation(s)
- Markos Poulopoulos
- Department of Neurology, Hartford Hospital and University of Connecticut School of Medicine, 80 Seymour Street, Hartford, CT 06102-5037, USA
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Li JYZ, Yong TY, Khoo E, Russ GR, Grove DI, Coates PTH, McDonald SP. Isolated sphenoid fungal sinusitis in a renal transplant recipient presenting with bilateral abducens nerve palsy. Transpl Int 2007; 20:640-2. [PMID: 17578528 DOI: 10.1111/j.1432-2277.2007.00490.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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