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Ben Amor S, Achour A, Elhraiech A, Jarrar E, Ghali H, Ben Ameur O, Amara N, Hassine A, Saied H, Neffati E, Smadja D. A Simple Score for Predicting Paroxysmal Atrial Fibrillation in Patients with Embolic Stroke of Undetermined Source in a Tunisian Cohort Study. Curr Neurovasc Res 2024; 21:CNR-EPUB-138350. [PMID: 38321906 DOI: 10.2174/0115672026301430240201094411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The annualized recurrent stroke rate in patients with Embolic Stroke of Undetermined Source (ESUS) under antiplatelet therapy is around 4.5%. Only a fraction of these patients will develop atrial fibrillation (FA), to which a stroke can be attributed retrospectively. The challenge is to identify patients at risk of occult AF during follow-up. OBJECTIVE This work aims to determine clinical factors and electrocardiographic and ultrasound parameters that can predict occult AF in patients with ESUS and build a simple predictive score applicable worldwide. METHODS This is a single-center, registry-based retrospective study conducted at the stroke unit of Sahloul University Hospital, Sousse, Tunisia, between January 2016 and December 2020. Consecutive patients meeting ESUS criteria were monitored for a minimum of one year, with a standardized follow-up consisting of outpatient visits, including ECG every three months and a new 24-hour Holter monitoring in case of palpitations. We performed multivariate stepwise regression to identify predictors of new paroxysmal AF among initial clinical, electrocardiographic (ECG and 24-hour Holter monitoring) and echocardiographic parameters. The coefficient of each independent covariate of the fitted multivariable model was used to generate an integerbased point-scoring system. RESULTS Three hundred patients met the criteria for ESUS. Among them, 42 (14%) patients showed at least one episode of paroxysmal AF during a median follow-up of two years. In univariate analysis, age, gender, coronary artery disease, history of ischemic stroke, higher NIHSS at admission and lower NIHSS at discharge, abnormal P-wave axis, prolonged P-wave duration, premature atrial contractions (PAC) frequency of more than 500/24 hours, and left atrial (LA) mean area of more than 20 cm2 were associated with the risk of occurrence of paroxysmal AF. We proposed an AF predictive score based on (1.771 x NIHSS score at admission) + (10.015 x P-wave dispersion; coded 1 if yes and 0 if no) + (9.841x PAC class; coded 1 if ≥500 and 0 if no) + (9.828x LA class surface; coded 1 if ≥20 and 0 if no) + (0.548xNIHSS score at discharge) + 0.004. A score of ≥33 had a sensitivity of 76% and a specificity of 93%. CONCLUSION In this cohort of patients with ESUS, NIHSS at both admission and discharge, Pwave dispersion, PAC≥500/24h on a 24-hour Holter monitoring, and LA surface area≥20 cm2 provide a simple AF predictive score with very reasonable sensitivity and specificity and is applicable almost worldwide. An external validation of this score is ongoing.
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Affiliation(s)
- Sana Ben Amor
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Assil Achour
- Cardiology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Aymen Elhraiech
- Cardiology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Emna Jarrar
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Ons Ben Ameur
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Neserine Amara
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Anis Hassine
- Stroke Unit, Neurology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Houyem Saied
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Eleys Neffati
- Cardiology Department, Centre Hospitalier Sahloul, Sousse, Tunisia
- Faculty of medicine Ibn El Jazzar, University of Sousse, Sousse, Tunisia
| | - Didier Smadja
- Stroke Unit, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
- Paris-Saclay University, France
- INSERM U-1266, Paris-Cité, France
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Jarrar E, Naija S, Grissa O, Amor SB. Eagle Syndrome: a Rare Etiology of Ischemic Stroke : A Case Report. Clin Neuroradiol 2021; 32:869-871. [PMID: 34596692 DOI: 10.1007/s00062-021-01096-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/28/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Emna Jarrar
- Neurology Department, University Hospital Sahloul, Sousse, Tunisia.
- Faculty of Medicine, University of Sousse, Sousse, Tunisia.
| | - Salma Naija
- Neurology Department, University Hospital Sahloul, Sousse, Tunisia
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Ons Grissa
- Neurology Department, University Hospital Sahloul, Sousse, Tunisia
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Sana Ben Amor
- Neurology Department, University Hospital Sahloul, Sousse, Tunisia
- Faculty of Medicine, University of Sousse, Sousse, Tunisia
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Zone Abid I, Jarrar E, Feki J, Kamoun F, Triki C, Ben Nsir S. Early Onset and Severe Progression of Neuro-ophthalmological Manifestations in a Case with Parry–Romberg Syndrome. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0039-1692136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractParry–Romberg syndrome is a rare disorder characterized by unilateral facial atrophy affecting the skin, subcutaneous tissue, and muscles, and sometimes extending to the osteocartilaginous structures. Ophthalmological and neurological involvements are relatively rare. We present a case of an early onset of left hemifacial atrophy, a progressive severe left ocular impairment, and the presence of a neurological disorder in the left hemisphere of the brain. The neuro-ophthalmological manifestations on the left side include enophthalmos, mild pseudoptosis, moderate asymmetry of the eyebrows, diffuse chorioretinal atrophy, reduced visual acuity, reduced central retinal thickness (162 µm) with the interruption of the ellipsoid zone, and the alteration of the outer nuclear layer, with associated reduced responses in photopic and scotopic amplitudes. The patient reported high intensity left brain white matter and a brief clinical focal seizure. This case report adds to the repertoire spectrum of this rare syndrome. The presentation calls for a multidisciplinary care for patients like our case.
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Affiliation(s)
- Imen Zone Abid
- Unité de Recherche “Neuropédiatrie,” UR12ES16, Faculté de médecine de Sfax, Sfax, Tunisia
- Service d'ophtalmologie, CHU Habib Bourguiba, Sfax, Tunisia
| | - Emna Jarrar
- Service de Neurologie Pédiatrique, CHU HédiChaker, Sfax, Tunisia
| | - Jamel Feki
- Unité de Recherche “Neuropédiatrie,” UR12ES16, Faculté de médecine de Sfax, Sfax, Tunisia
- Service d'ophtalmologie, CHU Habib Bourguiba, Sfax, Tunisia
| | - Fatma Kamoun
- Unité de Recherche “Neuropédiatrie,” UR12ES16, Faculté de médecine de Sfax, Sfax, Tunisia
- Service de Neurologie Pédiatrique, CHU HédiChaker, Sfax, Tunisia
| | - Chahnez Triki
- Unité de Recherche “Neuropédiatrie,” UR12ES16, Faculté de médecine de Sfax, Sfax, Tunisia
- Service de Neurologie Pédiatrique, CHU HédiChaker, Sfax, Tunisia
| | - Sihem Ben Nsir
- Unité de Recherche “Neuropédiatrie,” UR12ES16, Faculté de médecine de Sfax, Sfax, Tunisia
- Service de Neurologie Pédiatrique, CHU HédiChaker, Sfax, Tunisia
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