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You Y, Zeng N, Wu W, Liu B, Rong S, Xu D. Association of Serum Homocysteine With Peripheral Arterial Disease in Patients Without Diabetes: A Study Based on National Health and Nutrition Examination Survey Database. Am J Cardiol 2024; 218:16-23. [PMID: 38458582 DOI: 10.1016/j.amjcard.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
This study aimed to investigate the association of serum homocysteine (Hcy) levels with peripheral arterial disease (PAD) in patients without diabetes on the basis of data from the National Health and Nutrition Examination Survey. The study used data from 3 survey cycles (1999 to 2004) in the National Health and Nutrition Examination Survey database as the research dataset. Serum Hcy levels were considered an independent variable, whereas PAD was a dependent variable. Weighted logistic regression and restricted cubic spline methods were used to explore the relation between Hcy level and PAD risk in patients without diabetes. A total of 4,819 samples were included. In the weighted logistics regression model, a significant positive association was observed between Hcy levels and the risk of PAD (odds ratio >1, p <0.05). Subgroup analysis results indicated a particularly significant association between Hcy levels and PAD risk in the older population (age ≥60 years), those with a history of smoking, and those without a history of myocardial infarction (all odds ratio >1, p <0.05) (p <0.05). Exploring the nonlinear association between Hcy levels and PAD risk through restricted cubic spline curves revealed an overall significant trend (p allover <0.05). In conclusion, elevated Hcy levels increased the risk of PAD, with a more pronounced effect observed in populations of patients without diabetes, especially in older patients (age ≥60 years), those with smoking history, and those without a history of myocardial infarction.
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Affiliation(s)
- Yi You
- Department of Cardiac and Vascular Surgery, Yueyang Central Hospital, Yueyang, China
| | - Naxin Zeng
- Department of Cardiac and Vascular Surgery, Yueyang Central Hospital, Yueyang, China
| | - Wengao Wu
- Department of Cardiac and Vascular Surgery, Yueyang Central Hospital, Yueyang, China
| | - Boyang Liu
- Department of Cardiac and Vascular Surgery, Yueyang Central Hospital, Yueyang, China
| | - Sheng Rong
- Department of Cardiac and Vascular Surgery, Yueyang Central Hospital, Yueyang, China
| | - Dong Xu
- Department of Cardiac and Vascular Surgery, Yueyang Central Hospital, Yueyang, China.
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Giorelli M, Leone R, Balzano RF. Spontaneous Multiple Cervical Artery Dissections and Recurrent Deep Vein Thrombosis in a Young Adult. J Clin Neurol 2023; 19:615-617. [PMID: 37901898 PMCID: PMC10622725 DOI: 10.3988/jcn.2023.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Maurizio Giorelli
- Department of Neurology, "Dimiccoli" General Hospital, Azienda Sanitaria Locale Barletta-Andria-Trani, Barletta, Italy.
| | - Ruggiero Leone
- Department of Neurology, "Dimiccoli" General Hospital, Azienda Sanitaria Locale Barletta-Andria-Trani, Barletta, Italy
| | - Rosario Francesco Balzano
- Department of Radiology, "Dimiccoli" General Hospital, Azienda Sanitaria Locale Barletta-Andria-Trani, Barletta, Italy
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Goraya JS, Berry S, Kaur A, Singh G. Arterial Ischemic Stroke-Peculiarities of Clinical Presentation and Risk Factors in Indian Children. Neuropediatrics 2021; 52:294-301. [PMID: 34102685 DOI: 10.1055/s-0041-1728773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There are not enough recent studies on arterial ischemic stroke (AIS) in Indian children. We retrospectively reviewed data on 95 children (69 boys), aged 3 months to 17 years, with AIS. Focal signs were noted in 84 (88%) with hemiparesis in 72 (76%). Diffuse signs were present in 33 (35%) with fever in 22 (23%), altered mental status in 20 (21%), and headache in 12 (13%). Seizures occurred in 29 (31%) children. Arteriopathy was observed in 57 (60%) children with mineralizing lenticulostriate vasculopathy (mLSV) in 22 (23%) being the most common, followed by moyamoya in 14 (15%), arterial dissection in 9 (10%), and focal cerebral arteriopathy (FCA) in 8 (8%). Preceding head/neck trauma was present in 27 (28%) children: 23 had minor head trauma (MHT), 3 neck trauma, and 1 unspecified. Other common risk factors (RFs) were iron deficiency in 10 children, homocysteinemia in 8 children, and tuberculous meningitis in 5 children. Complete or nearly complete recovery occurred in 42 (44%). Nine children developed epilepsy and five cognitive and language disability. Stroke recurrences occurred in nine children. Overall, arteriopathies accounted for majority of the cases of childhood AIS in our study with mLSV and moyamoya being the most frequent. Compared with data from Western countries, FCAs, postvaricella arteriopathy, and arterial dissections were less common. Of the nonarteriopathic RFs, MHT, iron deficiency, homocysteinemia, and neuroinfections were most frequent in our cohort in contrast to cardioembolic diseases and inherited procoagulant conditions, which are common in developed countries.
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Affiliation(s)
- Jatinder Singh Goraya
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Shivankshi Berry
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Amandeep Kaur
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Gagandeep Singh
- Division of Pediatric Neurology, Department of Pediatrics, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
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Li D, Wang E, Gao X, Li P. The correlation between methylenetetrahydrofolate reductase gene 677C > T polymorphism and fetal congenital defects: A meta-analysis. Pteridines 2020. [DOI: 10.1515/pteridines-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective To investigate the correlation between the methylenetetrahydrofolate reductase (MTHFR) gene 677C> T polymorphism and fetal congenital defects.
Method Original studies relevant to the MTHFR gene 677C>T single nucleotide polymorphism and fetal congenital defects were systematically searched in the electronic databases of Medline, EMBSE and China National Knowledge Infrastructure (CNKI). All relevant publications were screened for inclusion in the present work. The correlation between the MTHFR gene 677C > T single nucleotide polymorphism and the occurrence of fetal congenital defects was expressed as an odds ratio (OR) and its 95% confidence interval (95% CI). Publication bias was assessed by Begg’s funnel plot and Egger’s line regression test.
Results Nineteen case-control studies were ultimately included in the present meta-analysis. The pooled results indicated that the general risk of fetal congenital defects was significantly elevated in subjects with the 677T allele of the MTHFR gene in dominant (OR=1.07,95%CI:1.03-1.12, P<0.05), homozygous (OR=1.17,95%CI:1.06-1.30, P<0.05) and recessive genetic models (OR=1.16,95%CI:1.03-1.31, P<0.05) through the random effect method. However, significant publication bias was identified upon pooling the individual data and evaluating the correlation.
Conclusion According to the present evidence, the MTHFR gene 677C>T single nucleotide polymorphism is correlated with poor pregnancy outcomes, and subjects with the T allele have an increased risk of developing general fetal congenital defects.
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Affiliation(s)
- Dexia Li
- Department of Health Education , Maternal and Child Health Hospital of Zhangqiu District , Jinan City, Shandong Province, 250200 PR China
| | - Enxia Wang
- Department of Nutrition , Maternal and Child Health Hospital of Zhangqiu District , Jinan City, Shandong Province, 250200 PR China
| | - Xia Gao
- Department of Child Healthcare , Maternal and Child Health Hospital of Zhangqiu District , Jinan City, Shandong Province, 250200 PR China
| | - Ping Li
- Department of Pregnant Women Management Center , Maternal and Child Health Hospital of Zhangqiu District , Jinan City, Shandong Province, 250200 PR China
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Non-traumatic cervical artery dissection and ischemic stroke: A narrative review of recent research. Clin Neurol Neurosurg 2019; 187:105561. [DOI: 10.1016/j.clineuro.2019.105561] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 12/19/2022]
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Moretti R, Caruso P. The Controversial Role of Homocysteine in Neurology: From Labs to Clinical Practice. Int J Mol Sci 2019; 20:ijms20010231. [PMID: 30626145 PMCID: PMC6337226 DOI: 10.3390/ijms20010231] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 01/04/2019] [Indexed: 02/07/2023] Open
Abstract
Homocysteine (Hcy) is a sulfur-containing amino acid that is generated during methionine metabolism. Physiologic Hcy levels are determined primarily by dietary intake and vitamin status. Elevated plasma levels of Hcy can be caused by deficiency of either vitamin B12 or folate. Hyperhomocysteinemia (HHcy) can be responsible of different systemic and neurological disease. Actually, HHcy has been considered as a risk factor for systemic atherosclerosis and cardiovascular disease (CVD) and HHcy has been reported in many neurologic disorders including cognitive impairment and stroke, independent of long-recognized factors such as hyperlipidemia, hypertension, diabetes mellitus, and smoking. HHcy is typically defined as levels >15 micromol/L. Treatment of hyperhomocysteinemia with folic acid and B vitamins seems to be effective in the prevention of the development of atherosclerosis, CVD, and strokes. However, data from literature show controversial results regarding the significance of homocysteine as a risk factor for CVD and stroke and whether patients should be routinely screened for homocysteine. HHcy-induced oxidative stress, endothelial dysfunction, inflammation, smooth muscle cell proliferation, and endoplasmic reticulum (ER) stress have been considered to play an important role in the pathogenesis of several diseases including atherosclerosis and stroke. The aim of our research is to review the possible role of HHcy in neurodegenerative disease and stroke and to understand its pathogenesis.
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Affiliation(s)
- Rita Moretti
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, 34149 Trieste, Italy.
| | - Paola Caruso
- Neurology Clinic, Department of Medical, Surgical, and Health Sciences, University of Trieste, 34149 Trieste, Italy.
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Deniz Ç, Asil T, Tunç A. Extracranial and intracranial artery dissections: Experiences from a tertiary referral center. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.497896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen ZF, Young L, Yu CH, Shiao SPK. A Meta-Prediction of Methylenetetrahydrofolate-Reductase Polymorphisms and Air Pollution Increased the Risk of Ischemic Heart Diseases Worldwide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071453. [PMID: 29996520 PMCID: PMC6068673 DOI: 10.3390/ijerph15071453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/01/2018] [Accepted: 07/07/2018] [Indexed: 12/19/2022]
Abstract
Ischemic heart disease (IHD) is among the leading causes of death worldwide. Methylenetetrahydrofolate reductase (MTHFR) polymorphisms have been associated with IHD risk, but the findings presented with heterogeneity. The purpose of the present meta-analysis was to provide an updated evaluation by integrating machine-learning based analytics to examine the potential source of heterogeneity on the associations between MTHFR polymorphisms and the risk of various subtypes of IHD, as well as the possible impact of air pollution on MTHFR polymorphisms and IHD risks. A comprehensive search of various databases was conducted to locate 123 studies (29,697 cases and 31,028 controls) for MTHFR C677T, and 18 studies (7158 cases and 5482 controls) for MTHFR A1298C. Overall, MTHFR 677 polymorphisms were risks for IHD (TT: Risk ratio (RR) = 1.23, p < 0.0001; CT: RR = 1.04, p = 0.0028, and TT plus CT: RR = 1.09, p < 0.0001). In contrast, MTHFR 677 CC wildtype was protective against IHD (RR = 0.91, p < 0.00001) for overall populations. Three countries with elevated IHD risks from MTHFR C677T polymorphism with RR >2 included India, Turkey, and Tunisia. Meta-predictive analysis revealed that increased air pollution was associated with increased MTHFR 677 TT and CT polymorphisms in both the case and control group (p < 0.05), with the trend of increased IHD risk resulting from increased air pollution. These results associate the potential inflammatory pathway with air pollution and the folate pathway with MTHFR polymorphism. Future intervention studies can be designed to mitigate MTHFR enzyme deficiencies resulting from gene polymorphisms to prevent IHDs for at-risk populations.
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Affiliation(s)
- Zhao-Feng Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan.
| | - Lufei Young
- College of Nursing, Augusta University, Augusta, GA 30912, USA.
| | - Chong Ho Yu
- Department of Psychology, Azusa Pacific University, Azusa, CA 91702, USA.
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Gungor L, Polat M, Ozberk MB, Avci B, Abur U. Which Ischemic Stroke Subtype Is Associated with Hyperhomocysteinemia? J Stroke Cerebrovasc Dis 2018; 27:1921-1929. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/05/2018] [Accepted: 02/17/2018] [Indexed: 10/17/2022] Open
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Fu Y, Wang X, Kong W. Hyperhomocysteinaemia and vascular injury: advances in mechanisms and drug targets. Br J Pharmacol 2017; 175:1173-1189. [PMID: 28836260 DOI: 10.1111/bph.13988] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/27/2017] [Accepted: 08/12/2017] [Indexed: 12/14/2022] Open
Abstract
Homocysteine is a sulphur-containing non-proteinogenic amino acid. Hyperhomocysteinaemia (HHcy), the pathogenic elevation of plasma homocysteine as a result of an imbalance of its metabolism, is an independent risk factor for various vascular diseases, such as atherosclerosis, hypertension, vascular calcification and aneurysm. Treatments aimed at lowering plasma homocysteine via dietary supplementation with folic acids and vitamin B are more effective in preventing vascular disease where the population has a normally low folate consumption than in areas with higher dietary folate. To date, the mechanisms of HHcy-induced vascular injury are not fully understood. HHcy increases oxidative stress and its downstream signalling pathways, resulting in vascular inflammation. HHcy also causes vascular injury via endoplasmic reticulum stress. Moreover, HHcy up-regulates pathogenic genes and down-regulates protective genes via DNA demethylation and methylation respectively. Homocysteinylation of proteins induced by homocysteine also contributes to vascular injury by modulating intracellular redox state and altering protein function. Furthermore, HHcy-induced vascular injury leads to neuronal damage and disease. Also, an HHcy-activated sympathetic system and HHcy-injured adipose tissue also cause vascular injury, thus demonstrating the interactions between the organs injured by HHcy. Here, we have summarized the recent developments in the mechanisms of HHcy-induced vascular injury, which are further considered as potential therapeutic targets in this condition. LINKED ARTICLES This article is part of a themed section on Spotlight on Small Molecules in Cardiovascular Diseases. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.8/issuetoc.
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Affiliation(s)
- Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Health Science Center, Beijing, China.,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Xian Wang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Health Science Center, Beijing, China.,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Wei Kong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Health Science Center, Beijing, China.,Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
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TGFBR2 mutation and MTHFR-C677T polymorphism in a Mexican mestizo population with cervico-cerebral artery dissection. J Neurol 2016; 263:1066-73. [PMID: 27017342 DOI: 10.1007/s00415-016-8101-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
Spontaneous cervico-cerebral artery dissection (CCAD) is a common condition found among young patients with ischemic stroke. We examined the possible association between the polymorphism of methylenetetrahydrofolate reductase (MTHFR)-C677T and the gene mutation in transforming growth factor beta receptor II (TGFBR2) in a cohort of CCAD patients. One-hundred CCAD cases (65 males; mean age: 38.08 ± 10.68 years) and 100 matching controls were included. Ancestry informative markers (AIMs) were used to increase internal validity of the genetic analysis. Genotypes of the C677T polymorphism in the MTHFR gene were determined by polymerase chain reaction and restriction fragment length polymorphism; direct sequencing was used for a mutation analysis of the TGFBR2 gene. Associations were evaluated using a multivariate statistics, and Hardy-Weinberg equilibrium was analyzed. We also incorporated our data into a meta-analysis of the MTHFR-C677T. Sixty-three patients presented with vertebral and 37 with carotid artery dissection. Ancestry markers found a call rate on each over 95 %. All AIMs did not deviate from Hardy-Weinberg equilibrium (p > 0.05). The homozygous TT genotype was more frequent in cases (OR 2.04, CI 95 % 1.53-2.72, p = 0.005), whereas no significant difference was found on heterozygous CT genotype. TGFBR2 mutation was not present in our samples. In the meta-analysis of MTHFR/C677T variant, a total 613 cases and 1547 controls were analyzed; we found a moderate association for the recessive model genotype (OR 2.04, CI 95 % 1.53-2.72; p = 0.342; Z = 4.83; I (2) = 11.3). This study supports a positive association between the MTHFR-C677T polymorphism and genetically confirmed Mexican mestizo CCAD patients.
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Mawet J, Debette S, Bousser MG, Ducros A. The Link Between Migraine, Reversible Cerebral Vasoconstriction Syndrome and Cervical Artery Dissection. Headache 2016; 56:645-56. [PMID: 27016026 DOI: 10.1111/head.12798] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Headache is the common thread of migraine, reversible cerebral vasoconstriction syndrome (RCVS) and cervical artery dissection (CeAD), three medical conditions that otherwise appear to be very different. However, epidemiological, clinical and genetic data suggest that these conditions share common and complex features and are, at least partly, linked. The purpose of this manuscript is to review existing evidence for an association between migraine, RCVS and CeAD and discuss the potential underlying mechanisms.
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Affiliation(s)
- Jérôme Mawet
- Emergency Headache Center, Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (J. Mawet)
| | - Stéphanie Debette
- Institut National de la Santé et de la Recherche Médicale (INSERM) U897 Epidemiology and Biostatistics and Department of Neurology, Bordeaux University Hospital, Bordeaux, France (S. Debette)
| | - Marie-Germaine Bousser
- Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, Paris, France (M.-G. Bousser)
| | - Anne Ducros
- Department of Neurology, Montpellier University Hospital and Montpellier University, Montpellier, France (A. Ducros)
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Marangi A, Moretto G, Cappellari M, Micheletti N, Tomelleri G, Bovi P. Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature. Neuropsychiatr Dis Treat 2016; 12:1351-4. [PMID: 27354805 PMCID: PMC4910686 DOI: 10.2147/ndt.s106845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bilateral internal carotid artery dissection is a rare entity, and its presentation may include cerebral ischemia. We describe the case of a 69-year-old man with ischemic stroke and radiological evidence of intimal flap of both internal carotid arteries suggestive for dissection. During the hospitalization, our patient was found positive for a previous syphilis infection. We conducted a review of the literature, with evidence of a few cases of ischemic stroke presumably related to a prior syphilis. The absence of major cardiovascular risk factors in our patient leads us to believe that an etiopathogenetic link may exist between these two conditions.
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Affiliation(s)
- Antonio Marangi
- Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, Policlinico G.B Rossi, University of Verona, Verona, Italy
| | - Giuseppe Moretto
- Stroke Unit, Division of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Manuel Cappellari
- Stroke Unit, Division of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Nicola Micheletti
- Stroke Unit, Division of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giampaolo Tomelleri
- Stroke Unit, Division of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Paolo Bovi
- Stroke Unit, Division of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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