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Osteraas ND. Sex-based difference in selected stroke etiologies: cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, dissection, migraine, pregnancy/puerperium/OC use. J Stroke Cerebrovasc Dis 2024; 33:107753. [PMID: 38703878 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024] Open
Abstract
Females are at higher risk than males for a multitude of cerebrovascular conditions, both common and rare; partially resulting from a complex interplay between differing process involving genetics, hormonal influences, common cerebrovascular risk factors among others. Specific topics including cervical artery dissection, cerebral dural sinus venous thrombosis, reversible cerebral vasoconstriction syndrome, migraine, along with these disorders in the setting of pregnancy, puerperium and oral contraceptive utilization. Epidemiology, pathophysiology, presentation, basics of management and outcomes are presented, with sex differences throughout.
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Affiliation(s)
- Nicholas Dykman Osteraas
- Department of Neuroscience at Saint Lukes Hospital, Advocate Aurora Health. 2900 W Oklahoma Ave, Milwaukee, WI 53215, United States.
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Largeau B, Bergeron S, Auger F, Salmon Gandonnière C, Jonville-Béra AP, Ehrmann S, Gautier S, Bordet R. Experimental Models of Posterior Reversible Encephalopathy Syndrome: A Review From Pathophysiology to Therapeutic Targets. Stroke 2024; 55:484-493. [PMID: 38126184 DOI: 10.1161/strokeaha.123.044533] [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] [Indexed: 12/23/2023]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity characterized by nonspecific symptomatology (eg, headache, visual disturbances, encephalopathy, and seizures) and classically cortical and subcortical vasogenic edema predominantly affecting the parietooccipital region. PRES etiologies are usually dichotomized into toxic PRES (eg, antineoplastic drugs, illicit drugs) and clinical condition-associated PRES (eg, acute hypertension, dysimmune disorders). Although the pathophysiology of PRES remains elusive, 2 main pathogenic hypotheses have been suggested: cerebral hyperperfusion due to acute hypertension and cerebral hypoperfusion related to endothelial dysfunction. Research into the pathogenesis of PRES has emerged through the development of animal models in the last decade. The motivation for developing a suitable PRES model is 2-fold: to fill in knowledge gaps of the pathophysiological mechanisms involved, and to open new perspectives for clinical assessment of pharmacological targets to improve therapeutic management of PRES. All current models of PRES have a hypertensive background, on which other triggers (acute hypertension, inflammatory, drug toxicity) have been added to address specific facets of PRES (eg, seizures). The initial model consisted in inducing a reduced uterine perfusion pressure that mimics preeclampsia, a leading cause of PRES. More recently, a model of stroke-prone spontaneously hypertensive rats on high-salt diet, originally developed for hypertensive small vessel disease and vascular cognitive impairment, has been studied in PRES. This review aims to discuss, depending on the research objective, the benefits and limitations of current experimental approaches and thus to define the desirable characteristics for studying the pathophysiology of PRES and developing new therapies.
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Affiliation(s)
- Bérenger Largeau
- CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France (B.L.)
| | - Sandrine Bergeron
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille Neuroscience & Cognition, Unité Mixte de Recherche (UMR) 1172, équipe Troubles Cognitifs Dégénératifs et Vasculaires, Centre Hospitalier Universitaire (CHU) de Lille, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, France (S.B., S.G., R.B.)
| | - Florent Auger
- Université de Lille, Centre National de la Recherche Scientifique (CNRS), INSERM, CHU Lille, Institut Pasteur de Lille, US 41, Unités Mixtes de Service 2014, Plateformes Lilloises en Biologie et Santé, Lille, France (F.A.)
| | - Charlotte Salmon Gandonnière
- CHRU de Tours, Service de Médecine Intensive Réanimation, réseau CRICS-TRIGGERSEP F-CRIN (Clinical Research in Intensive Care Sepsis Trial Group for Global Evaluation Research in Sepsis, a French Clinical Research Infrastructure Network) Research Network, Tours, France (C.S.G.)
| | - Annie-Pierre Jonville-Béra
- Université de Tours, Université de Nantes, INSERM, Methods in Patients-Centered Outcomes and Health Research (SPHERE), UMR 1246, CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France (A.-P.J.-B.)
| | - Stephan Ehrmann
- Université de Tours, INSERM, Centre d'étude des Pathologies Respiratoires (CEPR), UMR 1100, CHRU de Tours, Service de Médecine Intensive Réanimation, CIC 1415, réseau CRICS-TRIGGERSEP F-CRIN Research Network, Tours, France (S.E.)
| | - Sophie Gautier
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille Neuroscience & Cognition, Unité Mixte de Recherche (UMR) 1172, équipe Troubles Cognitifs Dégénératifs et Vasculaires, Centre Hospitalier Universitaire (CHU) de Lille, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, France (S.B., S.G., R.B.)
| | - Régis Bordet
- Université de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille Neuroscience & Cognition, Unité Mixte de Recherche (UMR) 1172, équipe Troubles Cognitifs Dégénératifs et Vasculaires, Centre Hospitalier Universitaire (CHU) de Lille, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance, France (S.B., S.G., R.B.)
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