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Yamamoto K, Ueda H, Uchiyama D, Takeji Y, Taniguchi T, Morimoto T, Tabata H, Ishizu K, Morofuji T, Hayashi M, Isotani A, Shirai S, Ohno N, Kakumoto S, Ando K, Minatoya K, Kimura T. Cerebrovascular Disease Detected on Preprocedural Computed Tomography in Patients With Severe Aortic Stenosis Undergoing Aortic Valve Replacement. J Am Heart Assoc 2024:e035078. [PMID: 38979790 DOI: 10.1161/jaha.124.035078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/16/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND There is a scarcity of data on the prevalence and clinical impact of cerebrovascular disease detected on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with severe aortic stenosis. METHODS AND RESULTS Among patients with severe aortic stenosis undergoing AVR, the authors compared clinical outcomes between patients with and without cerebrovascular disease detected on preprocedural CT, which was defined as chronic brain infarction or hemorrhage. The primary outcome measure in this study was a composite of all-cause death or stroke. Among 567 study patients, 200 patients (35.3%) had cerebrovascular disease on preprocedural CT. Among 200 patients with cerebrovascular disease on preprocedural CT, only 28.5% of patients had a clinical history of symptomatic stroke. The cumulative 3-year incidence of death or stroke was higher in patients with cerebrovascular disease on preprocedural CT than in those without cerebrovascular disease on preprocedural CT (40.7% versus 24.1%, log-rank P<0.001). After adjusting for confounders, the higher risk of patients with cerebrovascular disease on preprocedural CT relative to those without remained significant for death or stroke (hazard ratio [HR], 1.42 [95% CI, 1.02-1.98]; P=0.04). Among 200 patients with cerebrovascular disease on preprocedural CT, patients with prior symptomatic stroke compared with those without were not associated with higher adjusted risk for death or stroke (HR, 1.18 [95% CI, 0.72-1.94]; P=0.52). CONCLUSIONS Among patients with severe aortic stenosis undergoing AVR, a substantial proportion had cerebrovascular disease on preprocedural CT, with a clinical history of symptomatic stroke in one-fourth of patients. Regardless of history of symptomatic stroke, patients with cerebrovascular disease on preprocedural CT had worse clinical outcomes compared with those without cerebrovascular disease on preprocedural CT.
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Affiliation(s)
- Ko Yamamoto
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Hiroyuki Ueda
- Department of Radiology Kokura Memorial Hospital Kitakyushu Japan
| | - Daiji Uchiyama
- Department of Radiology Kokura Memorial Hospital Kitakyushu Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Sciences Kanazawa Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Kobe Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology Hyogo College of Medicine Nishinomiya Japan
| | - Hiroyuki Tabata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences Kagoshima University Kagoshima Japan
| | - Kenichi Ishizu
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Toru Morofuji
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Masaomi Hayashi
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Akihiro Isotani
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Shinichi Shirai
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery Kokura Memorial Hospital Kitakyushu Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology Kokura Memorial Hospital Kitakyushu Japan
| | - Kenji Ando
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takeshi Kimura
- Department of Cardiology Hirakata Kohsai Hospital Hirakata Japan
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Meinel TR, Leber SL, Janisch M, Vynckier J, Mujanovic A, Boronylo A, Kaesmacher J, Seiffge DJ, Roten L, Arnold M, Enzinger C, Gattringer T, Fischer U, Kneihsl M. Association of covert brain infarct phenotype with stroke recurrence in first-ever manifest ischemic stroke according to etiology. Eur Stroke J 2024; 9:441-450. [PMID: 38288699 DOI: 10.1177/23969873241229612] [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: 05/23/2024] Open
Abstract
INTRODUCTION Covert brain infarcts (CBI) are frequent incidental findings on MRI and associated with future stroke risk in patients without a history of clinically evident cerebrovascular events. However, the prognostic value of CBI in first-ever ischemic stroke patients is unclear and previous studies did not report on different etiological stroke subtypes. We aimed to test CBI phenotypes and their association with stroke recurrence in first-ever ischemic stroke patients according to stroke etiology. PATIENTS AND METHODS This study is a pooled data analysis of two prospectively collected cohorts of consecutive first-ever ischemic stroke patients admitted to the comprehensive stroke centers of Bern (Switzerland) and Graz (Austria). CBI phenotypes were identified on brain MRI within 72 h after admission. All patients underwent a routine follow-up (median: 12 months) to identify stroke recurrence. RESULTS Of 1577 consecutive ischemic stroke patients (median age: 71 years), 691 patients showed CBI on brain MRI (44%) and 88 patients had a recurrent ischemic stroke (6%). Baseline CBI were associated with stroke recurrence in multivariable analysis (HR 1.9, 95% CI 1.1-3.3). CBI phenotypes with the highest risk for stroke recurrence were cavitatory CBI in small vessel disease (SVD)-related stroke (HR 7.1, 95% CI 1.6-12.6) and cortical CBI in patients with atrial fibrillation (HR 3.0, 95% CI 1.1-8.1). DISCUSSION AND CONCLUSION This study reports a ≈ 2-fold increased risk for stroke recurrence in first-ever ischemic stroke patients with CBI. The risk of recurrent stroke was highest in patients with cavitatory CBI in SVD-related stroke and cortical CBI in patients with atrial fibrillation.Subject terms: Covert brain infarcts, stroke.
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Affiliation(s)
- Thomas Raphael Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan L Leber
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Janisch
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Jan Vynckier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anna Boronylo
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Julian Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas Gattringer
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurology University Hospital Basel, University of Basel, Basel, Switzerland
| | - Markus Kneihsl
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Neurology University Hospital Basel, University of Basel, Basel, Switzerland
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Pathan N, Kharod MK, Nawab S, Di Scipio M, Paré G, Chong M. Genetic Determinants of Vascular Dementia. Can J Cardiol 2024:S0828-282X(24)00293-9. [PMID: 38579965 DOI: 10.1016/j.cjca.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
Vascular dementia (VaD) is a prevalent form of cognitive impairment with underlying vascular etiology. In this review, we examine recent genetic advancements in our understanding of VaD, encompassing a range of methodologies including genome-wide association studies, polygenic risk scores, heritability estimates, and family studies for monogenic disorders revealing the complex and heterogeneous nature of the disease. We report well known genetic associations and highlight potential pathways and mechanisms implicated in VaD and its pathological risk factors, including stroke, cerebral small vessel disease, and cerebral amyloid angiopathy. Moreover, we discuss important modifiable risk factors such as hypertension, diabetes, and dyslipidemia, emphasizing the importance of a multifactorial approach in prevention, treatment, and understanding the genetic basis of VaD. Last, we outline several areas of scientific advancements to improve clinical care, highlighting that large-scale collaborative efforts, together with an integromics approach can enhance the robustness of genetic discoveries. Indeed, understanding the genetics of VaD and its pathophysiological risk factors hold the potential to redefine VaD on the basis of molecular mechanisms and to generate novel diagnostic, prognostic, and therapeutic tools.
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Affiliation(s)
- Nazia Pathan
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Muskaan Kaur Kharod
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sajjha Nawab
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Matteo Di Scipio
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Michael Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada.
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Najmi I, Benmaamar S, Zejli S, Bouchal S, El Fakir S, El Rhazi K, Belahsen MF. Silent brain infarctions in patients with acute cardioembolic stroke. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:80-89. [PMID: 38697714 DOI: 10.1016/j.jdmv.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/10/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION AND AIM The advances and the wide use of brain imaging have considerably increased the prevalence of silent brain infarctions (SBI). We aim in this study to determine the prevalence of SBI in patients presenting with acute cardioembolic stroke and the predictive cardiovascular risk factors. METHODS This retrospective study included 267 patients presenting with acute cardioembolic stroke in the emergency and/or neurology departments of the Hassan II University Hospital Center. Clinical, biological and echocardiographic characteristics were recorded. All patients were screened for SBI by brain imaging. RESULTS The prevalence of SBI in our series was 46%. A group of 203 non-valvular patients and a group of 64 valvular patients were distinguished. In non-valvular group, the average age was 72.97±10.53years. The prevalence of SBI was 45.3%. Forty-four percent of patients with SBI had atrial fibrillation (AF). In multivariate regression analysis, the history of previous stroke, CHA2DS2-VASc Score≥4, enlarged left atrium (LA), the association of AF with enlarged LA and the lability of International Normalized Ratio in patients initially treated with anticoagulants were significantly associated with the occurrence of SBI (P=0.013, P=0.032, P=0.0001, P=0.01, P=0.03, respectively). Territorial location was significantly the most frequent (P=0.007). In valvular group, the average age was 57.19±14.38years. The prevalence of SBI was 48.4%. In multivariate regression analysis, SBI were significantly associated with moderate or severe mitral stenosis (P=0.02) and with the enlarged LA (P=0.02). In all patients, Modified Rankin Scale at 3 months of discharge from the acute stroke was significantly higher (mRS≥3) in patients with SBI (P=0.04). CONCLUSIONS SBI requires good management of associated cardiovascular risk factors in a population presenting with initial cardioembolic stroke.
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Affiliation(s)
- Imane Najmi
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco.
| | - Soumaya Benmaamar
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Sara Zejli
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco
| | - Siham Bouchal
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Samira El Fakir
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Mohammed Faouzi Belahsen
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
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Ip BYM, Ko H, Lam BYK, Au LWC, Lau AYL, Huang J, Kwok AJ, Leng X, Cai Y, Leung TWH, Mok VCT. Current and Future Treatments of Vascular Cognitive Impairment. Stroke 2024; 55:822-839. [PMID: 38527144 DOI: 10.1161/strokeaha.123.044174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Bonaventure Yiu Ming Ip
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
- Kwok Tak Seng Centre for Stroke Research and Intervention, Hong Kong SAR, China (B.Y.M.I., X.L., T.W.H.L.)
| | - Ho Ko
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
| | - Bonnie Yin Ka Lam
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
| | - Lisa Wing Chi Au
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
| | - Alexander Yuk Lun Lau
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
| | - Junzhe Huang
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
| | - Andrew John Kwok
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
| | - Xinyi Leng
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Kwok Tak Seng Centre for Stroke Research and Intervention, Hong Kong SAR, China (B.Y.M.I., X.L., T.W.H.L.)
| | - Yuan Cai
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
| | - Thomas Wai Hong Leung
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Kwok Tak Seng Centre for Stroke Research and Intervention, Hong Kong SAR, China (B.Y.M.I., X.L., T.W.H.L.)
| | - Vincent Chung Tong Mok
- Division of Neurology, Department of Medicine and Therapeutics (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Li Ka Shing Institute of Health Sciences (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., X.L., C.Y., T.W.H.L., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Margaret K. L. Cheung Research Centre for Management of Parkinsonism (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Lau Tat-Chuen Research Centre of Brain Degenerative Diseases in Chinese (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., A.Y.L.L., J.H., A.J.K., C.Y., V.C.T.M.), Faculty of Medicine, The Chinese University of Hong Kong
- Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong (B.Y.M.I., H.K., B.Y.K.L., L.W.C.A., J.H., A.J.K., C.Y., V.C.T.M.)
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6
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Meinel TR, Triulzi CB, Kaesmacher J, Mujanovic A, Pasi M, Leung LY, Kent DM, Sui Y, Seiffge D, Bücke P, Umarova R, Arnold M, Roten L, Nguyen TN, Wardlaw J, Fischer U. Management of covert brain infarction survey: A call to care for and trial this neglected population. Eur Stroke J 2023; 8:1079-1088. [PMID: 37427426 PMCID: PMC10683731 DOI: 10.1177/23969873231187444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype. METHODS We conducted a web-based, structured, international survey from November 2021 to February 2022 among neurologists and neuroradiologists. The survey captured respondents' baseline characteristics, general approach toward CBI and included two case scenarios designed to evaluate management decisions taken upon incidental detection of an embolic-phenotype and a small-vessel-disease phenotype. RESULTS Of 627 respondents (38% vascular neurologists, 24% general neurologists, and 26% neuroradiologists), 362 (58%) had a partial, and 305 (49%) a complete response. Most respondents were university hospital senior faculty members experienced in stroke, mostly from Europe and Asia. Only 66 (18%) of respondents had established institutional written protocols to manage CBI. The majority indicated that they were uncertain regarding useful investigations and further management of CBI patients (median 67 on a slider 0-100, 95% CI 35-81). Almost all respondents (97%) indicated that they would assess vascular risk factors. Although most would investigate and treat similarly to ischemic stroke for both phenotypes, including initiating antithrombotic treatment, there was considerable diagnostic and therapeutic heterogeneity. Less than half of respondents (42%) would assess cognitive function or depression. CONCLUSIONS There is a high degree of uncertainty and heterogeneity regarding management of two common types of CBI, even among experienced stroke physicians. Respondents were more proactive regarding the diagnostic and therapeutic management than the minimum recommended by current expert opinions. More data are required to guide management of CBI; meantime, more consistent approaches to identification and consistent application of current knowledge, that also consider cognition and mood, would be promising first steps to improve consistency of care.
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Affiliation(s)
- Thomas R Meinel
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Camilla B Triulzi
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Lester Y Leung
- Department of Neurology, Tufts Medical Center, Boston, MA, USA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, MA, USA
| | - Yi Sui
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Neurology, Shenyang First People’s Hospital, Shenyang Brain Institute, Shenyang, China
| | - David Seiffge
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roza Umarova
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanh N Nguyen
- Neurology and Radiology, Boston Medical Center, Boston, MA, USA
| | - Joanna Wardlaw
- Division of Neuroimaging Sciences, Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Urs Fischer
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
- Neurology, Basel University Hospital, University of Basel, Basel, Switzerland
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7
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Pezawas T. ECG Smart Monitoring versus Implantable Loop Recorders for Atrial Fibrillation Detection after Cryptogenic Stroke-An Overview for Decision Making. J Cardiovasc Dev Dis 2023; 10:306. [PMID: 37504563 PMCID: PMC10380665 DOI: 10.3390/jcdd10070306] [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: 04/18/2023] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 07/29/2023] Open
Abstract
Up to 20% of patients with ischemic stroke or transient ischemic attack have a prior history of known atrial fibrillation (AF). Additionally, unknown AF can be detected by different monitoring strategies in up to 23% of patients with cryptogenic or non-cardioembolic stroke. However, most studies had substantial gaps in monitoring time, especially early after the index event. Following this, AF rates would be higher if patients underwent continuous monitoring early after stroke, avoiding any gaps in monitoring. The few existing randomized studies focused on patients with cryptogenic stroke but did not focus otherwise specifically on prevention strategies in patients at high risk for AF (patients at higher age or with high CHA2DS2-VASC scores). Besides invasive implantable loop recorders (ILRs), external loop recorders (ELRs) and mobile cardiac outpatient telemetry (MCOT) are non-invasive tools that are commonly used for long-term ECG monitoring in cryptogenic-stroke patients in the ambulatory setting. The role of MCOT and hand-held devices within ECG smart monitoring in the detection of AF for the prevention of and after cryptogenic stroke is currently unclear. This intense review provides an overview of current evidence, techniques, and gaps in knowledge and aims to advise which patients benefit most from the current available devices.
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Affiliation(s)
- Thomas Pezawas
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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8
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Platzbecker K, Müller-Fielitz H, Foraita R, Koepp MJ, Voss A, Pflock R, Linder R, Pigeot I, Schink T, Schwaninger M. In atrial fibrillation epilepsy risk differs between oral anticoagulants: active comparator, nested case-control study. Europace 2023; 25:euad087. [PMID: 37013704 PMCID: PMC10228540 DOI: 10.1093/europace/euad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is a risk factor for brain infarction, which can lead to epilepsy. We aimed to investigate whether treatment of AF with direct oral anticoagulants (DOACs) affects the risk of epilepsy in comparison to treatment with the vitamin K antagonist phenprocoumon (PPC). METHODS AND RESULTS We performed an active comparator, nested case-control study based on the German Pharmacoepidemiological Research Database that includes claims data from statutory health insurance providers of about 25 million persons since 2004. In 2011-17, 227 707 AF patients initiated treatment with a DOAC or PPC, of which 1828 cases developed epilepsy on current treatment with an oral anticoagulant. They were matched to 19 084 controls without epilepsy. Patients with DOAC treatment for AF had an overall higher risk of epilepsy with an odds ratio of 1.39, 95% CI (1.24; 1.55) compared to current PPC treatment. Cases had higher baseline CHA2DS2-VASc scores and more frequently a history of stroke than controls. After excluding patients with ischaemic stroke prior to the diagnosis of epilepsy, the risk of epilepsy was still higher on DOACs than on PPC. In contrast, within a cohort of patients with venous thromboembolism, the risk of epilepsy on treatment with DOACs was less elevated [adjusted odds ratio 1.15, 95% CI (0.98; 1.34)]. CONCLUSION In patients with AF initiating oral anticoagulation, treatment with a DOAC was associated with an increased risk of epilepsy compared to the vitamin K antagonist PPC. Covert brain infarction may explain the observed elevated risk of epilepsy.
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Affiliation(s)
- Katharina Platzbecker
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Helge Müller-Fielitz
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Matthias J Koepp
- Department of Clinical and Experimental Epilepsy, University College London Queen Square Institute of Neurology, Queen Square, Box 29, London WC1N 3BG, United Kingdom
| | - Annemarie Voss
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - René Pflock
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Roland Linder
- Techniker Krankenkasse, Bramfelder Straße 140, 22305 Hamburg, Germany
| | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bibliothekstraße 5, 28334 Bremen, Germany
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Markus Schwaninger
- Institute for Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel, Germany
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9
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Iatrogenic Strokes and Covert Brain Infarcts After Percutaneous Cardiac Procedures: An Update. Can J Cardiol 2023; 39:200-209. [PMID: 36435326 DOI: 10.1016/j.cjca.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Millions of cardiac procedures are performed worldwide each year, making the potential complication of periprocedural iatrogenic stroke an important concern. These strokes can occur intraoperatively or within 30 days of a procedure and can be categorised as either overt or covert, occurring without obvious acute neurologic symptoms. Understanding the prevalence, risk factors, and strategies for preventing overt and covert strokes associated with cardiac procedures is imperative for reducing periprocedural morbidity and mortality. In this narrative review, we focus on the impacts of perioperative ischemic strokes for several of the most common interventional cardiac procedures, their relevance from a neurologic standpoint, and future directions for the care and research on perioperative strokes. Depending on the percutaneous procedure, the rates of periprocedural overt strokes can range from as little as 0.01% to as high as 2.9%. Meanwhile, covert brain infarctions (CBIs) occur much more frequently, with rates for different procedures ranging from 10%-84%. Risk factors include previous stroke, atherosclerotic disease, carotid stenosis, female sex, and African race, as well as other patient- and procedure-level factors. While the impact of covert brain infarctions is still a developing field, overt strokes for cardiac procedures lead to longer stays in hospital and increased costs. Potential preventative measures include screening and vascular risk factor control, premedicating, and procedural considerations such as the use of cerebral embolic protection devices. In addition, emerging treatments from the neurologic field, including neuroprotective drugs and remote ischemic conditioning, present promising avenues for preventing these strokes and merit investigation in cardiac procedures.
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10
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Escudero-Martínez I, Morales-Caba L, Segura T. Atrial fibrillation and stroke: A review and new insights. Trends Cardiovasc Med 2023; 33:23-29. [PMID: 34890796 DOI: 10.1016/j.tcm.2021.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 02/01/2023]
Abstract
The link between heart and brain continues to be a matter of great interest for the scientific community. One of the most established associations between the two is that the heart is a significant source of emboli and is responsible for 20-25% of all ischemic strokes. The most frequent underlying cause of cardioembolic stroke is atrial fibrillation (AF), a disease that affects almost 3 million people in the USA and 4.5 million in Europe. AF increases the risk of ischemic stroke by a factor of 3 to 5 times. It is estimated that AF is responsible for 15% of all strokes worldwide. A more comprehensive understanding of this association and development of intensive stroke prevention measures are needed, as we know that AF incidence and prevalence will increase over the coming years, becoming one of the largest epidemics and public health challenges we face.
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Affiliation(s)
- Irene Escudero-Martínez
- Stroke Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain.
| | - Lluis Morales-Caba
- Stroke Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe - Universidad de Valencia, Valencia, Spain
| | - Tomás Segura
- Department of Medical Sciences, Faculty of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain; Stroke Unit, Department of Neurology, Hospital General Universitario de Albacete, Spain
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11
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Palà E, Escudero-Martínez I, Penalba A, Bustamante A, Lamana-Vallverdú M, Mancha F, Ocete RF, Piñero P, Galvao-Carmona A, Gómez-Herranz M, Pérez-Sánchez S, Moniche F, González A, Montaner J. Association of blood-based biomarkers with radiologic markers and cognitive decline in atrial fibrillation patients. J Stroke Cerebrovasc Dis 2022; 31:106833. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022] Open
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12
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Schaller-Paule MA, Fritz D, Schaefer JH, Hattingen E, Foerch C, Seiler A. Distribution Pattern Analysis of Cortical Brain Infarcts on Diffusion-Weighted Magnetic Resonance Imaging: A Hypothesis-Generating Approach to the Burden of Silent Embolic Stroke. J Am Heart Assoc 2022; 11:e026438. [PMID: 36172947 DOI: 10.1161/jaha.122.026438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In patients with covert cerebrovascular disease or proximal source of embolism, embolic silent brain infarction may precede major stroke events. Therefore, characterization of particularly cortical silent brain infarction is essential for identifying affected patients and commencing adequate secondary prevention. This study aimed to investigate differences in the distribution pattern of cortical ischemic stroke lesions to assess potential predilection sites of cortical silent brain infarction. Methods and Results We prospectively included all consecutive patients with stroke presenting from January 1 to December 31, 2018. Diffusion-weighted imaging lesions were used to generate voxel-based lesion maps and assigned to atlas-based cortical regions of interest in middle cerebral artery territories. Each region-of-interest lesion frequency was related to the respective region-of-interest volume to identify frequently affected and underrepresented cerebral cortex areas. Diffusion-weighted imaging data for voxel-based lesion maps were available in 334 out of 633 patients. Primary analysis revealed that small- (<0.24 cc) and medium-sized (0.24-2640 cc) lesions distributed predominantly along regions associated with sensorimotor or language function. Detailed analysis within middle cerebral artery territories showed an approximated frequency of missed cortical stroke lesions of up to 67% in the right and 69% in the left hemisphere. In particular, the frontal, temporal, and occipital cortices were underrepresented. Larger lesion size and areas associated with higher cortical function led to hospital admission. Conclusions Cortical brain infarcts in hospitalized patients are not dispersed equally but are predominantly located in brain structures associated with motor control and sensory and language function. Matching underrepresented cerebral cortex regions to symptoms not yet associated with stroke warrants further exploration.
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Affiliation(s)
- Martin A Schaller-Paule
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Daniel Fritz
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Jan Hendrik Schaefer
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Elke Hattingen
- Institute of Neuroradiology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Christian Foerch
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Alexander Seiler
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
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13
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Li L, Murthy SB. Cardiovascular Events After Intracerebral Hemorrhage. Stroke 2022; 53:2131-2141. [DOI: 10.1161/strokeaha.122.036884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular events after primary intracerebral hemorrhage (ICH) have emerged as a leading cause of poor functional outcomes and mortality during the long-term recovery after an ICH. These events encompass arterial ischemic events such as ischemic stroke and myocardial infarction, arterial hemorrhagic events that include recurrent ICH, and venous thrombotic events such as venous thromboembolism. The purpose of this review is to summarize the cardiovascular complications after ICH, epidemiology and associated risk factors, and their impact on ICH outcomes. Additionally, we will highlight possible pathophysiological mechanisms to explain the short- and long-term increased risks of ischemic and hemorrhagic events after ICH. Finally, we will highlight potential secondary stroke and venous thrombotic prevention strategies often not considered after ICH, balanced against the risk of ICH recurrence.
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Affiliation(s)
- Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (L.L.)
| | - Santosh B. Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, NY (S.B.M.)
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14
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Ganesh A, Goyal M, Wilson AT, Ospel JM, Demchuk AM, Mikulis D, Poublanc J, Krings T, Anderson R, Tymianski M, Hill MD. Association of Iatrogenic Infarcts With Clinical and Cognitive Outcomes in the Evaluating Neuroprotection in Aneurysm Coiling Therapy Trial. Neurology 2022; 98:e1446-e1458. [PMID: 35169007 DOI: 10.1212/wnl.0000000000200111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/11/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Small iatrogenic brain infarcts are often seen on diffusion-weighted MRI (DWI) following surgical or endovascular procedures, but there are few data on their clinical effects. We examined the association of iatrogenic infarcts with outcomes in the ENACT (Evaluating Neuroprotection in Aneurysm Coiling Therapy) randomized controlled trial of nerinetide in patients undergoing endovascular repair of intracranial aneurysms. METHODS In this post hoc analysis, we used multivariable models to evaluate the association of the presence and number of iatrogenic infarcts on DWI with neurologic impairment (NIH Stroke Scale [NIHSS]), functional status (modified Rankin Scale [mRS]), and cognitive and neuropsychiatric outcomes (30-minute test battery) at 1-4 days and 30 days postprocedure. We also related infarct number to a z score-derived composite outcome score using quantile regression. RESULTS Among 184 patients (median age 56 years [interquartile range (IQR) 50-64]), 124 (67.4%) had postprocedural DWI lesions (median 4, IQR 2-10.5). Nerinetide treatment was associated with fewer iatrogenic infarcts but no overall significant clinical treatment effects. Patients with infarcts had lower Mini-Mental State Examination (MMSE) scores at 2-4 days (median 28 vs 29, adjusted coefficient [acoef] -1.11, 95% CI -1.88 to -0.34, p = 0.005). Higher lesion counts were associated with worse day 1 NIHSS (adjusted odds ratio for NIHSS ≥1: 1.07, 1.02-1.12, p = 0.009), day 2-4 mRS (adjusted common odds ratio [acOR] 1.05, 1.01-1.09, p = 0.005), and day 2-4 MMSE (acoef -0.07, -0.13 to -0.003, p = 0.040) scores. At 30 days, infarct number remained associated with worse mRS (acOR 1.04, 1.01-1.07, p = 0.016) and Hopkins Verbal Learning Test (HVLT) delayed recall scores (acoef -0.21, -0.39 to -0.03, p = 0.020). Patients with infarcts trended towards lower 30-day Digit Symbol Substitution Test (DSST) scores (acoef -3.73, -7.36 to -0.10, p = 0.044). Higher lesion count was associated with worse composite outcome scores at both 1-4 days and 30 days (30-day acoef -0.12, 95% CI -0.21 to -0.03, p = 0.008). Among those with infarcts, day 1 NIHSS and day 2-4 mRS correlated with 30-day NIHSS, DSST, HVLT, and mRS scores, whereas day 2-4 MMSE correlated with 30-day NIHSS and DSST scores (Spearman ρ 0.47, p = 0.001). DISCUSSION Iatrogenic brain infarcts were associated with subtle differences in postprocedural (1-4 days) and 30-day outcomes on different measures in this middle-aged cohort, with earlier dysfunction correlating with later differences. TRIAL REGISTRATION INFORMATION Clinical trials registration NCT00728182.
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Affiliation(s)
- Aravind Ganesh
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Mayank Goyal
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Alexis T Wilson
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Johanna Maria Ospel
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Andrew M Demchuk
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - David Mikulis
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Julien Poublanc
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Timo Krings
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Roberta Anderson
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Michael Tymianski
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
| | - Michael D Hill
- From the Calgary Stroke Program, Department of Clinical Neurosciences (A.G., M.G., A.T.W., J.M.O., A.M.D., M.D.H.), Department of Community Health Sciences (A.G., M.D.H.), Hotchkiss Brain Institute (A.G., M.G., A.M.D., M.D.H.), and Department of Radiology (M.G., A.M.D., M.D.H.), University of Calgary, Canada; Department of Radiology (J.M.O.), University Hospital Basel, University of Basel, Switzerland; Department of Medical Imaging (D.M., J.P.) and Division of Neuroradiology (T.K.), Toronto Western Hospital, University Health Network and University of Toronto; NoNO Inc. (R.A., M.T.), Toronto; Division of Neurosurgery and Neurovascular Therapeutics Program (M.T.), University Health Network, Toronto; Departments of Surgery and Physiology (M.T.), University of Toronto; Toronto Western Hospital Research Institute (M.T.); and Department of Medicine (M.D.H.), University of Calgary Cumming School of Medicine, Canada
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Incompleteness of circle of Willis and silent brain infarction in patients with internal carotid artery stenosis. J Clin Neurosci 2022; 98:73-77. [DOI: 10.1016/j.jocn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/29/2021] [Accepted: 02/01/2022] [Indexed: 11/20/2022]
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Fohner AE, Bartz TM, Tracy RP, Adams HHH, Bis JC, Djousse L, Satizabal CL, Lopez OL, Seshadri S, Mukamal KJ, Kuller LH, Psaty BM, Longstreth WT. Association of Serum Neurofilament Light Chain Concentration and MRI Findings in Older Adults: The Cardiovascular Health Study. Neurology 2022; 98:e903-e911. [PMID: 34921102 PMCID: PMC8901174 DOI: 10.1212/wnl.0000000000013229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neurofilament light chain (NfL) in blood is a sensitive but nonspecific marker of brain injury. This study sought to evaluate associations between NfL concentration and MRI findings of vascular brain injury in older adults. METHODS A longitudinal cohort study included 2 cranial MRI scans performed about 5 years apart and assessed for white matter hyperintensities (WMH) and infarcts. About 1 year before their second MRI, 1,362 participants (median age 77 years, 61.4% women) without a history of TIA or stroke had measurement of 4 biomarkers: NfL, total tau, glial fibrillary acidic protein (GFAP), and ubiquitin carboxyl-terminal hydrolase L1. Most (n = 1,279) also had the first MRI scan, and some (n = 633) had quantitative measurements of hippocampal and WMH. In primary analyses, we assessed associations of NfL with a 10-point white matter grade (WMG) and prevalent infarcts on second MRI and with worsening WMG and incident infarct comparing the 2 scans. A p value <0.0125 (0.05/4) was considered significant for these analyses. We also assessed associations with hippocampal and WMH volume. RESULTS In fully adjusted models, log2(NfL) concentration was associated with WMG (β = 0.27; p = 2.3 × 10-4) and worsening WMG (relative risk [RR] 1.24; p = 0.0022), but less strongly with prevalent brain infarcts (RR 1.18; p = 0.013) and not with incident brain infarcts (RR 1.18; p = 0.18). Associations were also present with WMH volume (β = 2,242.9, p = 0.0036). For the other 3 biomarkers, the associations for log2 (GFAP) concentration with WMG and worsening WMG were significant. DISCUSSION Among older adults without a history of stroke, higher serum NfL concentration was associated with covert MRI findings of vascular brain injury, especially the burden of WMH and its worsening. Whether these results offer opportunities for the use of NfL as a noninvasive biomarker of WMH or to control vascular risk factors remains to be determined.
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Affiliation(s)
- Alison E Fohner
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA.
| | - Traci M Bartz
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Russell P Tracy
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Hieab H H Adams
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Joshua C Bis
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Luc Djousse
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Claudia L Satizabal
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Oscar L Lopez
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Sudha Seshadri
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Kenneth J Mukamal
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Lewis H Kuller
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - Bruce M Psaty
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
| | - W T Longstreth
- From the Department of Epidemiology (A.E.F., B.M.P., W.T.L.), Institute of Public Health Genetics (A.E.F.), Department of Biostatistics (T.M.B.), Cardiovascular Health Research Unit (J.C.B., B.M.P., A.E.F.), Department of Medicine (B.M.P.), Department of Health Services (B.M.P.), and Department of Neurology (W.T.L.), University of Washington, Seattle; Departments of Pathology & Laboratory Medicine and Biochemistry (R.P.T.), Larner College of Medicine, University of Vermont, Burlington; Departments of Clinical Genetics and Radiology and Nuclear Medicine (H.H.H.A.), Erasmus University Medical Center, Rotterdam, the Netherlands; Division of Aging, Department of Medicine (L.D.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases and Department of Neurology (C.L.S., S.S.), University of Texas Health Science Center at San Antonio; Boston University School of Medicine (C.L.S., S.S.); Framingham Heart Study (C.L.S., S.S.), MA; Departments of Neurology and Psychiatry (O.L.L.) and Epidemiology (L.H.K.), University of Pittsburgh, PA; and Department of Medicine (K.J.M.), Beth Israel Deaconess Medical Center, Boston, MA
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Meinel TR, Roten L, Wardlaw J, Fischer U. Letter by Meinel et al. regarding article, "Incidental findings on 3 T neuroimaging: cross‑sectional observations from the population‑based Rhineland Study". Neuroradiology 2022; 64:429-430. [PMID: 34997856 DOI: 10.1007/s00234-022-02893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Thomas Raphael Meinel
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Stroke Research Center Bern, Freiburgstrasse 8, CH-3010, Bern, Switzerland.
| | - Laurent Roten
- Department of Cardiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Joanna Wardlaw
- Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Institute Centre at the University of Edinburgh, Edinburgh, UK
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
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Schattner A. Silent Brain Infarction - Time for Changing the Paradigm? Am J Med 2022; 135:12-14. [PMID: 34508701 DOI: 10.1016/j.amjmed.2021.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Ami Schattner
- Professor of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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Schilter M, Epstein A, Vynckier J, Mujanovic A, Belachew NF, Beyeler M, Siepen B, Goeldlin M, Scutelnic A, Seiffge DJ, Jung S, Gralla J, Dobrocky T, Arnold M, Kaesmacher J, Fischer U, Meinel TR. Chronic cerebral infarctions and white matter lesions link to long-term survival after a first ischemic event: A cohort study. J Neuroimaging 2022; 32:1134-1141. [PMID: 35922890 PMCID: PMC9804158 DOI: 10.1111/jon.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE To investigate the association of different phenotypes, count, and locations of chronic covert brain infarctions (CBI) with long-term mortality in patients with first-ever manifest acute ischemic stroke (AIS) or transient ischemic attack (TIA). Additionally, to analyze their potential interaction with white matter hyperintensities (WMH) and predictive value in addition to established mortality scores. METHODS Single-center cohort study including consecutive patients with first-ever AIS or TIA with available MRI imaging from January 2015 to December 2017. Blinded raters adjudicated CBI phenotypes and WMH (age-related white matter changes score) according to established definitions. We compared Cox regression models including prespecified established predictors of mortality using Harrell's C and likelihood ratio tests. RESULTS A total of 2236 patients (median [interquartile range] age: 71 [59-80] years, 43% female, National Institutes of Health Stroke Scale: 2 [1-6], median follow-up: 1436 days, 21% death during follow-up) were included. Increasing WMH (per point adjusted Hazard Ratio [aHR] = 1.29 [1.14-1.45]), but not CBI (aHR = 1.21 [0.99-1.49]), were independently associated with mortality. Neither CBI phenotype, count, nor location was associated with mortality and there was no multiplicative interaction between CBI and WMH (p > .1). As compared to patients without CBI or WMH, patients with moderate or severe WMH and additional CBI had the highest hazards of death (aHR = 1.62 [1.23-2.13]). The Cox regression model including CBI and WMH had a small but significant increment in Harrell's C when compared to the model including 14 clinical variables (0.831 vs. 0.827, p < .001). DISCUSSION WMH represent a strong surrogate biomarker of long-term mortality in first-ever manifest AIS or TIA patients. CBI phenotypes, count, and location seem less relevant. Incorporation of CBI and WMH slightly improves predictive capacity of established risk scores.
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Affiliation(s)
- Marina Schilter
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Alessandra Epstein
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Jan Vynckier
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Nebiyat Filate Belachew
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Morin Beyeler
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Bernhard Siepen
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - David Julian Seiffge
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Simon Jung
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - Urs Fischer
- Department of NeurologyBasel University Hospital, University of BaselBernSwitzerland
| | - Thomas Raphael Meinel
- Department of Neurology, Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
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20
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Covert Brain Infarction in Emergency Department Patients: Prevalence, Clinical Correlates, and Treatment Opportunities. Ann Emerg Med 2021; 79:265-269. [PMID: 34955329 DOI: 10.1016/j.annemergmed.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/14/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Covert brain infarctions are focal lesions detected on brain imaging consistent with ischemia in the absence of a history of overt stroke or neurologic dysfunction. Covert brain infarctions are associated with an increased risk of future stroke. We evaluated the prevalence of covert brain infarctions in patients undergoing computed tomography (CT) in the emergency department (ED), as well as clinician response to the findings. METHODS Patients aged more than 50 years who underwent CT of the head and were seen and discharged from our ED from January to September 2018 were identified. Patients with a history of stroke, or prior brain imaging with ischemia, were excluded. Patient data and clinician response (patient notification, neurology referral, and risk factor modification) were collected. RESULTS We included 832 patients, with an average age of 62 years, and 50% of the patients were women. Covert brain infarctions were present in 11% of patients (n=95). Only 9% of patients with covert brain infarctions were clearly made aware of the finding. Of the patients with covert brain infarctions, 27% were already on aspirin and 28% on a statin. Aspirin was added for 2 patients, and statin medication was not started on any patient. The blood pressure medication was added or adjusted for 2 patients with covert brain infarctions. The neurology department was consulted for 9% of the patients with covert brain infarctions. CONCLUSION The prevalence of covert brain infarctions in patients older than 50 years presenting to the ED who underwent CT of the head and were subsequently discharged from the ED was 11%. Only 9% of these patients were made aware of the finding, with minimal intervention for stroke prevention at the time of their visit. Interventions targeting this population should be considered.
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21
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Covert Brain Infarcts in Patients with Philadelphia Chromosome-Negative Myeloproliferative Disorders. J Clin Med 2021; 11:jcm11010013. [PMID: 35011753 PMCID: PMC8745571 DOI: 10.3390/jcm11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022] Open
Abstract
Backgrounds and Purpose. Philadelphia chromosome-negative myeloproliferative disorders (Ph-negative MPD) are a rare group of hematological diseases, including three distinct pathologies: essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). They most often manifest with thrombotic complications, including cerebrovascular events. Covert brain infarcts (CBIs) are defin ed as predominantly small ischemic cerebral lesions that are detected using magnetic resonance imaging (MRI) in the absence of clinical stroke events. The relationship between MPD and CBIs remains unclear. Methods. Included in the study were 103 patients with the diagnosis of Ph-MPD (according to WHO 2016 criteria) (median age—47 (35; 54) years; 67% female). In total, 38 patients had ET, 42 had PV, and 23 had PMF. They underwent clinical examination, routine laboratory analyses (complete blood count), brain MRI, ultrasound carotid artery, flow-mediated dilatation (as a measure of endothelial dysfunction—FMD). Results. Overall, 23 patients experienced an ischemic stroke (as per MRI and/or clinical history), of which 16 (15.5%) could be classified as CBIs. The rate of CBIs per MPD subtype was statistically non-significant between groups (p = 0.35): ET–13.2%, PV–21.4%, and PMF–8.7%. The major vascular risk factors, including arterial hypertension, carotid atherosclerosis, and prior venous thrombosis, were not associated with CBIs (p > 0.05). Age was significantly higher in patients with CBIs compared to patients without MRI ischemic lesions: 50 (43; 57) years vs. 36 (29; 48) (p = 0.002). The frequency of headaches was comparable between the two groups. CBIs were associated with endothelial dysfunction (OR - 0.71 (95% CI: 0.49–0.90; p = 0.02)) and higher hemoglobin levels (OR—1.21 (95% CI: 1.06–1.55); p =0.03). Conclusions. CBIs are common in patients with Ph-negative MPD. Arterial hypertension and carotid atherosclerosis were not associated with CBIs in this group of patients. The most significant factors in the development of CBIs were endothelial dysfunction (as measured by FMD) and high hemoglobin levels. Patients with Ph-negative MPD and CBIs were older and had more prevalent endothelial dysfunction.
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22
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Fast Independent Component Analysis Algorithm-Based Functional Magnetic Resonance Imaging in the Diagnosis of Changes in Brain Functional Areas of Cerebral Infarction. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:5177037. [PMID: 34912182 PMCID: PMC8645397 DOI: 10.1155/2021/5177037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022]
Abstract
The aim of this study was to analyze the application value of functional magnetic resonance imaging (FMRI) optimized by the fast independent component correlation algorithm (ICA algorithm) in the diagnosis of brain functional areas in patients with lumbar disc herniation (LDH). An optimized fast ICA algorithm was established based on the ICA algorithm. 50 patients with cerebral infarction were selected as the research objects, and 30 healthy people were selected as the control group. The 50 patients from the observation group were examined by fMRI based on Fast ICA algorithm, while the control group was tested by fMRI based on the routine ICA algorithm. The performances of the two algorithms, the analysis results of the two groups of brain functional areas, cerebral blood flow (CBF), resting state functional connectivity (rsFC), behavioral data, and image data correlation of patients were compared. The results showed that the sensitivity, specificity, and accuracy of Fast ICA algorithm were 97.83%, 89.52%, and 96.27%, respectively, which in the experimental group were greatly better than the control group (88.73%, 72.19%, and 89.72%), showing statistically significant differences (P < 0.05). The maximum Dice coefficient of FAST ICA algorithm was 0.967, and FAST ICA algorithm was better obviously than the traditional ICA algorithm (P < 0.05). The cerebral blood flow of the healthy superior frontal gyrus (SFG) and healthy superior marginal gyrus (SMG) of the observation group with good motor function recovery were 1.02 ± 0.22 and 1.53 ± 0.61, respectively; both indicators showed an increasing trend, and those in the experimental group were much higher in contrast to the control group, showing statistically obvious differences (P < 0.05). Besides, the detection results of cerebral blood flow (CBF) in the healthy SFG and healthy SMG were negatively correlated with the results of connection test B. In summary, the fMRI based on the Fast ICA algorithm showed a good diagnostic effect in the changes of brain functional areas in patients with cerebral infarction. The experimental results showed that the cerebral blood flow in the brain area was related to motor or cognitive function. The results of this study provided a reliable reference for the examination and diagnosis of brain functional areas in patients with cerebral infarction.
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23
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Suchy-Dicey A, Muller C, Shibata D, Howard BV, Cole SA, Longstreth WT, Devereux RB, Buchwald D. Comparing Vascular Brain Injury and Stroke by Cranial Magnetic Resonance Imaging, Physician-Adjudication, and Self-Report: Data from the Strong Heart Study. Neuroepidemiology 2021; 55:398-406. [PMID: 34428763 PMCID: PMC8448943 DOI: 10.1159/000517804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/10/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Epidemiologic studies often use self-report as proxy for clinical history. However, whether self-report correctly identifies prevalence in minority populations with health disparities and poor health-care access is unknown. Furthermore, overlap of clinical vascular events with covert vascular brain injury (VBI), detected by imaging, is largely unexamined. METHODS The Strong Heart Study recruited American Indians from 3 regions, with surveillance and adjudication of stroke events from 1989 to 2013. In 2010-2013, all 817 survivors, aged 65-95 years, underwent brain imaging, neurological history interview, and cognitive testing. VBI was defined as imaged infarct or hemorrhage. RESULTS Adjudicated stroke was prevalent in 4% of participants and separately collected, self-reported stroke in 8%. Imaging-defined VBI was detected in 51% and not associated with any stroke event in 47%. Compared with adjudication, self-report had 76% sensitivity and 95% specificity. Participants with adjudicated or self-reported stroke had the poorest performance on cognitive testing; those with imaging-only (covert) VBI had intermediate performance. CONCLUSION In this community-based cohort, self-report for prior stroke had good performance metrics. A majority of participants with VBI did not have overt, clinically recognized events but did have neurological or cognitive symptoms. Data collection methodology for studies in a resource-limited setting must balance practical limitations in costs, accuracy, feasibility, and research goals.
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Affiliation(s)
- Astrid Suchy-Dicey
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | - Clemma Muller
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | - Dean Shibata
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | | | - Shelley A Cole
- Texas Biomedical Research Institute, San Antonio, Texas, USA
| | - W T Longstreth
- Department of Neurology, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | | | - Dedra Buchwald
- Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
- Initiative for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
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24
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Goyal M, Ganesh A, Tymianski M, Hill MD, Ospel JM. Iatrogenic Diffusion-Weighted Imaging Lesions: What Is Their Impact and How Can It Be Measured? Stroke 2021; 52:1929-1936. [PMID: 33827240 DOI: 10.1161/strokeaha.120.033984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infarct volume in acute ischemic stroke is closely linked with clinical outcome, with larger infarct volumes being associated with a worse prognosis. Small iatrogenic infarcts, which can occur as a result of surgical or endovascular procedures, are often only seen on diffusion-weighted MR imaging. They often do not lead to any overtly appreciable clinical deficits, hence the term covert or silent infarcts. There is relative paucity of data on the clinical impact of periprocedural hyperintense diffusion-weighted MR imaging lesions, partly because they commonly remain undiagnosed. Clearly, a better understanding of iatrogenic periprocedural diffusion-weighted MR imaging lesions and their clinical significance is needed. In this article, we describe the current limitations of our understanding of the significance of iatrogenic diffusion-weighted MR imaging lesions using exemplary data from the ENACT trial (Safety and Efficacy of NA-1 in Patients With Iatrogenic Stroke After Endovascular Aneurysm Repair) and outline a framework for how to investigate their clinical impact.
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Affiliation(s)
- Mayank Goyal
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.,Department of Radiology (M.G., M.D.H.), University of Calgary, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada
| | | | - Michael D Hill
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.,Department of Radiology (M.G., M.D.H.), University of Calgary, Canada
| | - Johanna Maria Ospel
- Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.,Department of Neuroradiology, University Hospital Basel, Switzerland (J.M.O.)
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25
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Kasner SE. Antithrombotic therapy for cervical arterial dissection. Lancet Neurol 2021; 20:328-329. [PMID: 33765421 DOI: 10.1016/s1474-4422(21)00073-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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26
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Hsieh MT, Hsieh CY, Tsai TT, Wang YC, Sung SF. Performance of ICD-10-CM Diagnosis Codes for Identifying Acute Ischemic Stroke in a National Health Insurance Claims Database. Clin Epidemiol 2020; 12:1007-1013. [PMID: 33061648 PMCID: PMC7524174 DOI: 10.2147/clep.s273853] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The validity of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding for the identification of acute ischemic stroke (AIS) in Taiwan’s National Health Insurance claims database has not been investigated. This study aimed to construct and validate the case definition algorithms for AIS based on ICD-10-CM diagnostic codes. Patients and Methods This study identified all hospitalizations with ICD-10-CM code of I63* in any position of the discharge diagnoses from the inpatient claims database and all patients with a final diagnosis of AIS from the stroke registry between Jan 2018 and Dec 2019. Hospitalizations in the claims data that could be successfully linked to those in the registry data were regarded as true episodes of AIS. Otherwise, their electronic medical records and images were manually reviewed to ascertain whether they were true episodes of AIS. Using the true episodes of AIS as the reference standard, the positive predictive value (PPV) and sensitivity of various case definition algorithms for AIS were calculated. Results A total of 1227 hospitalizations were successfully linked. Among the 155 hospitalizations that could not be linked, 54 were determined to be true episodes of AIS. Using ICD-10-CM code of I63* in any position of the discharge diagnoses to identify AIS yielded a PPV and sensitivity of 92.7% and 99.4%, respectively. The PPV increased to 99.8% with >12% decrease in the sensitivity when AIS was restricted to those with I63* as the primary diagnosis. When AIS was defined to be I63* as the primary, first secondary, or second secondary diagnosis, both PPV and sensitivity were greater than 97%. Conclusion This study demonstrated the validity of various case definition algorithms for AIS based on ICD-10-CM coding and can provide a reference for future claims-based stroke research.
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Affiliation(s)
- Meng-Tsang Hsieh
- Stroke Center and Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan.,School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yang Hsieh
- Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.,School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Tung Tsai
- Stroke Center and Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
| | - Yi-Ching Wang
- Stroke Center and Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan
| | - Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan.,Department of Information Management and Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan.,Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
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