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Lodder J, Verkerke GJ, Delemarre BJ, Dodou D. Morphological and mechanical properties of the posterior leaflet chordae tendineae in the mitral valve. Proc Inst Mech Eng H 2015; 230:77-84. [PMID: 26645804 DOI: 10.1177/0954411915621093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 04/13/2015] [Accepted: 09/21/2015] [Indexed: 11/16/2022]
Abstract
A number of studies have investigated the morphological and mechanical properties of the chordae tendineae of the mitral valve, providing comparisons between basal, marginal, and strut chordae and between chordae at the anterior and posterior leaflets. This study contributes to the literature by comparing the failure load of the chordae tendineae attached to the three posterior leaflet scallops, the anterolateral scallop (P1), middle scallop (P2), and posteromedial scallop (P3) of the mitral valve. In all, 140 chordae isolated from 23 porcine hearts were tested. First, the cross-sectional diameters of all branches in each chorda were measured using a microscope. Next, after positioning the chorda in a tensile testing machine, a preload of 0.2 N was applied, and the chordal length was measured. Cyclic loading between 0 and 0.3 N, 10 times with a speed of 1.5 mm/s, was conducted, after which the machine travelled at 1.5 mm/s until the chorda broke. We found that P2 chordae were thicker than P1 and P3 chordae and longer than P1 chordae. P2 chordae failed at significantly higher loads than P1 and P3 chordae. For all three types of chordae, almost half of the failures occurred at the chordal branch that was closest to the leaflet.
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Affiliation(s)
- Joost Lodder
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gijsbertus J Verkerke
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Department of Biomechanical Engineering, Faculty of Engineering Technology, University of Twente, Enschede, The Netherlands
| | - Ben Jm Delemarre
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - Dimitra Dodou
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
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Pons van Dijk G, Lenssen AF, Leffers P, Kingma H, Lodder J. Taekwondo training improves balance in volunteers over 40. Front Aging Neurosci 2013; 5:10. [PMID: 23494518 PMCID: PMC3595983 DOI: 10.3389/fnagi.2013.00010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/28/2013] [Indexed: 11/13/2022] Open
Abstract
Balance deteriorates with age, and may eventually lead to falling accidents which may threaten independent living. As Taekwondo contains various highly dynamic movement patterns, Taekwondo practice may sustain or improve balance. Therefore, in 24 middle-aged healthy volunteers (40–71 year) we investigated effects of age-adapted Taekwondo training of 1 h a week during 1 year on various balance parameters, such as: motor orientation ability (primary outcome measure), postural and static balance test, single leg stance, one leg hop test, and a questionnaire. Motor orientation ability significantly increased in favor of the antero-posterior direction with a difference of 0.62° toward anterior compared to pre-training measurement, when participants corrected the tilted platform rather toward the posterior direction; female gender being an independent outcome predictor. On postural balance measurements sway path improved in all 19 participants, with a median of 9.3 mm/s (range 0.71–45.86), and sway area in 15 participants with 4.2 mm2/s (range 17.39–1.22). Static balance improved with an average of 5.34 s for the right leg, and with almost 4 s for the left. Median single leg stance duration increased in 17 participants with 5 s (range 1–16), and in 13 participants with 8 s (range 1–18). The average one leg hop test distance increased (not statistically significant) with 9.5 cm. The questionnaire reported a better “ability to maintain balance” in 16. In conclusion, our data suggest that age-adapted Taekwondo training improves various aspects of balance control in healthy people over the age of 40.
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Affiliation(s)
- G Pons van Dijk
- Department of Neurology, School for Mental Health and Neuroscience, University Hospital Maastricht Maastricht, Netherlands
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Knottnerus ILH, Winckers K, Ten Cate H, Hackeng TM, Lodder J, Rouhl RPW, Staals J, Govers-Riemslag JWP, Bekers O, van Oostenbrugge RJ. Levels of heparin-releasable TFPI are increased in first-ever lacunar stroke patients. Neurology 2012; 78:493-8. [PMID: 22302552 DOI: 10.1212/wnl.0b013e318246d6b7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES New insights in the pathophysiology of lacunar stroke (LS) suggest that it is caused by increased permeability of the blood-brain barrier due to endothelial activation. Because endothelial cells are the major production and storage site of tissue factor pathway inhibitor (TFPI), this protein can be used as marker of endothelial activation. In this observational study we measured the different pools of TFPI, as a marker of endothelial function, in first-ever lacunar stroke patients. METHODS We determined antigen levels of total and free full-length (FL) TFPI using ELISA in 149 patients and 42 controls. Heparin-releasable free FL TFPI was determined in a random subset of 17 patients and 15 controls. By brain MRI, we classified LS patients as having isolated lacunar infarct (ILA) or silent ischemic lesions (SILs). RESULTS Plasma levels of total TFPI were highest in patients with SILs compared with those with ILA, but this association disappeared after correction for age and levels of low-density lipoprotein cholesterol. However, levels of heparin-releasable free FL TFPI were higher in patients than in controls. CONCLUSIONS Although ambient plasma levels of total TFPI were not different in subtypes of LS, the increased levels of heparin-releasable TFPI in patients suggest a role of endothelial activation in the pathogenesis of LS.
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Affiliation(s)
- I L H Knottnerus
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands.
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van Tuijl J, van Raak E, de Krom M, Lodder J, Aldenkamp A. Early treatment after stroke for the prevention of late epileptic seizures: A report on the problems performing a randomised placebo-controlled double-blind trial aimed at anti-epileptogenesis. Seizure 2011; 20:285-91. [DOI: 10.1016/j.seizure.2010.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 11/22/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022] Open
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Hupperts R, Lodder J, Heuts-van Raak E, Wilmink J, Kessels A. Borderzone Brain Infarcts on CT Taking into Account the Variability in Vascular Supply Areas. Cerebrovasc Dis 2010. [DOI: 10.1159/000108041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zhang C, van Raak E, Rouhl R, Lodder J, Staals J, Knottnerus I, van Oostenbrugge R. Metabolic Syndrome Relates to Lacunar Stroke without White Matter Lesions: A Study in First-Ever Lacunar Stroke Patients. Cerebrovasc Dis 2010; 29:503-7. [DOI: 10.1159/000297967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 01/11/2010] [Indexed: 11/19/2022] Open
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Luijckx GJ, Boiten J, Kroonenburgh M, Kitslaar P, Kurvers H, Daemen M, Leunissen K, Beintema M, Lodder J. Systemic small-vessel disease is not exclusively related to lacunar stroke. A pilot study. J Stroke Cerebrovasc Dis 2009; 7:52-7. [PMID: 17895056 DOI: 10.1016/s1052-3057(98)80021-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/1997] [Accepted: 08/22/1997] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Lacunar infarcts usually results from a vasculopathy of the small vessels of the brain. It is not known whether this small-vessel disease is exclusively related to the brain or part of a more systemic small-vessel disease. In this study, patients with a lacunar stroke were investigated for manifestations of extracerebral small and large-vessel disease in comparison with cortical stroke patients. METHODS Twenty-nine patients with a lacunar stroke, presumably caused by small-vessel disease, and 30 patients with a cortical stroke, presumably caused by large-vessel disease, entered the study. Extracerebral large-vessel disease was investigated using carotid and renal duplex scanning and Doppler sonography of the large leg vessels. Extracerebral small-vessel disease was studied from photographs of the retina, renal perfusion scintigraphy before and after angiotensin-converting enzyme inhibition, plasma renin measurement, and capillary microscopy of the nailfold. RESULTS Vascular risk factor profile was similar in both stroke subgroups. Carotid large-vessel disease (stenosis > or =50%) was significantly less frequent among lacunar stroke patients (lacunar 3% v cortical 50%, (c)OR=0.04; 95% CI, 0.01 to 0.21, P<.01). Large-vessel disease of the renal artery (lacunar 23% v cortical 27%), and the legs (lacunar 38% v cortical 37%) was similar in both stroke groups. There was a high frequency of mild retinal arteriolosclerosis in both groups (lacunar 92% v cortical 80%). Renal blood flow changes were abnormal in 40% of the lacunar and 38% of the cortical stroke patients as a sign of renal small-vessel disease. Plasma renin concentrations did not differ between both groups. Both lacunar and cortical stroke patients had normal nailford capillary morphology, but red blood cell dynamics were reduced in both stroke groups, indicating small-vessel dysfunction. CONCLUSION Lacunar and cortical stroke patients have both manifestations of systemic small-and large-vessel disease. Therefore, systemic small-vessel disease is not exclusively related to lacunar stroke patients who presumably have cerebral small vessel disease. A similar conclusion can be reached in cortical stroke patients.
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Affiliation(s)
- G J Luijckx
- Department of Neurology, University Hospital Maastricht, the Netherlands
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Rouhl RPW, van Oostenbrugge RJ, Damoiseaux JGMC, Debrus-Palmans LL, Theunissen ROMFIH, Knottnerus ILH, Staals JEA, Delanghe JR, Tervaert JWC, Lodder J. Haptoglobin phenotype may alter endothelial progenitor cell cluster formation in cerebral small vessel disease. Curr Neurovasc Res 2009; 6:32-41. [PMID: 19355924 DOI: 10.2174/156720209787466082] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cerebral small vessel disease results in silent ischemic lesions (SIL) among which is leukoaraiosis. In this process, endothelial damage is probably involved. Endothelial progenitor cells (EPC), are involved in endothelial repair. By restoring the damaged endothelium, EPC could mitigate SIL and cerebral small vessel disease. Haptoglobin 1-1, one of three phenotypes of haptoglobin, relates to SIL and may therefore attenuate the endothelial repair by EPC. Our aim was to quantify EPC number and function and to assess haptoglobin phenotype and its effect on EPC function in patients with a high prevalence of SIL: lacunar stroke patients. We assessed EPC In 42 lacunar stroke patients and 18 controls by flow cytometry and culture with fetal calf serum, patient and control serum. We determined haptoglobin phenotype and cultured EPC with the three different haptoglobin phenotypes. We found that EPC cluster counts were lower in patients (96.9 clusters/well +/- 83.4 (mean +/- SD)), especially in those with SIL (85.0 +/- 64.3), than in controls (174.4 +/- 112.2). Cluster formation was inhibited by patient serum, especially by SIL patient serum, but not by control serum. Patients with haptoglobin 1-1 had less clusters in culture, and when haptoglobin 1-1 was added to EPC cultures, cluster numbers were lower than with the other haptoglobin phenotypes. We conclude that lacunar stroke patients, especially those with SIL, have impaired EPC cluster formation, which may point at decreased endothelial repair potential. The haptoglobin 1-1 phenotype is likely a causative factor in this impairment.
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Affiliation(s)
- R P W Rouhl
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Abstract
Transient ischemic attack (TIA) or a (minor) ischemic stroke increases the risk of a recurrent stroke or death. Antiplatelet therapy with aspirin or clopidogrel is, in the absence of a potential cardiac embolic source, common practice to lower this risk. Until recently, adjuvant dipyridamole or low intensity oral anticoagulation were not generally prescribed in secondary prevention. In this article, we will summarize and discuss the published results of the European/Australasian Stroke Prevention in Reversible Ischemia Trial (ESPRIT). In this trial, treatments with anticoagulants, aspirin alone and the combination of aspirin plus dipyridamole were compared, in a multicenter, three-armed, randomized, open-label study in patients with TIA or minor stroke.
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Affiliation(s)
- R P W Rouhl
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Gommer ED, Staals J, van Oostenbrugge RJ, Lodder J, Mess WH, Reulen JPH. Dynamic cerebral autoregulation and cerebrovascular reactivity: a comparative study in lacunar infarct patients. Physiol Meas 2008; 29:1293-303. [DOI: 10.1088/0967-3334/29/11/005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Voorend M, van der Ven AJAM, Kubat B, Lodder J, Bruggeman CA. Limited role for C. pneumoniae, CMV and HSV-1 in cerebral large and small vessel atherosclerosis. Open Neurol J 2008; 2:39-44. [PMID: 19018307 PMCID: PMC2577934 DOI: 10.2174/1874205x00802010039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 05/03/2008] [Accepted: 06/09/2008] [Indexed: 01/10/2023] Open
Abstract
Aims: To explore whether Chlamydia pneumoniae, Cytomegalovirus and Herpes Simplex Virus type 1 could be detected in large and small cerebral arteries, as well as in an area of brain parenchyma where white matter lesions (leukoaraiosis) can be found, in patients with clinically unmanifested cerebrovascular atherosclerosis. Methods and results( Arterial specimens from the basilar artery and middle cerebral artery, and brain samples from the basal ganglia and periventricular white matter were obtained. Neuropathological changes were assessed in Haematoxylin-Eosin stained sections. Polymerase chain reaction (PCR) was performed on paraffin embedded sections. Subsequently, we performed immunohistochemical staining on samples, which were found positive in PCR. We failed to detect C. pneumoniae, CMV, or HSV-1, in any of the cerebral large vessels. In the brain tissue, we found only one case positive for CMV, and one for C. pneumoniae. Conclusions (our findings suggest a limited role for C. pneumoniae, CMV and HSV-1 in cerebral large and small vessel atherosclerosis.
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Affiliation(s)
- M Voorend
- Department of Neurology, Cardiovascular research institute Maastricht (CARIM) University Hospital Maastricht.
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Rouhl RPW, van Oostenbrugge RJ, Knottnerus ILH, Staals JEA, Lodder J. Virchow-Robin spaces relate to cerebral small vessel disease severity. J Neurol 2008; 255:692-6. [PMID: 18286319 DOI: 10.1007/s00415-008-0777-y] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 10/02/2007] [Accepted: 10/16/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Virchow-Robin spaces (VRs) are perivascular spaces surrounding the deep perforating brain arteries. VRs dilatation is pathologic, and it could be a manifestation of cerebral small vessel disease. In the present study we assessed the relation between VRs and silent ischemic lesions in a cohort of patients with cerebral small vessel disease. METHODS We divided dilated VRs on MRI (1.5 Tesla) into three semi-quantitative categories in 165 first ever lacunar stroke patients. We counted asymptomatic lacunar infarcts and graded white matter lesions, and compared the prevalence of vascular risk factors in different categories of VRs. We also determined independent predictors of silent ischemic lesions. RESULTS VRs at basal ganglia level related to age, hypertension, asymptomatic lacunar infarcts, and white matter lesions. VRs at basal ganglia level predicted silent ischemic lesions (odds ratio 10.58 per higher VRs category; 95 %- confidence interval 3.40 - 32.92). CONCLUSION Dilated VRs in the basal ganglia relate to the severity of cerebral small vessel disease and might be a manifestation of the same small vessel abnormality that causes silent ischemic lesions. This adds a role for VRs as a potential marker for small vessel disease.
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Affiliation(s)
- R P W Rouhl
- Dept. of Neurology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Rasquin SMC, van Oostenbrugge RJ, Verhey FRJ, Lodder J. Vascular mild cognitive impairment is highly prevalent after lacunar stroke but does not increase over time: a 2-year follow-up study. Dement Geriatr Cogn Disord 2008; 24:396-401. [PMID: 17938568 DOI: 10.1159/000109747] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2007] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Although ample research has been done into cognitive disorders occurring after stroke, relatively few data are available on the development and the course of vascularmild cognitive impairment (VMCI) after first-ever lacunar stroke. METHODS A cohort of 95 patients with a first-ever symptomaticlacunar infarct, older than 40 years, MMSE>or=15 and no other neurological or major psychiatric deficits were included. Patients were assessed (clinically and with a neuropsychological test battery) at 1 and 24 months after stroke, and CT was repeated. VMCI was diagnosed when patients had a deficit in at least one cognitive domain, in the absence of dementia. RESULTS Approximately 75% of the patients had VMCI at 1 month; this percentage was somewhat lower at 2 years. Only initial stroke severity was an independent predictor of VMCI after stroke. CONCLUSION VMCI is highly prevalent after lacunar stroke, but does not increase during the first 2 years thereafter.
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Affiliation(s)
- S M C Rasquin
- Institute for Rehabilitation Research, Hoensbroek, The Netherlands.
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Lodder J, van Oostenbrugge R, Boreas A, Limburg M. [Secondary prevention of recurrent stroke by lowering cholesterol levels and blood pressure]. Ned Tijdschr Geneeskd 2006; 150:2622; author reply 2622-3. [PMID: 17203705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Abstract
The aim of this study was to describe the clinical experience in 184 consecutive stroke patients first-ever treated with recombinant tissue plasminogen activator (rt-PA) at a single Dutch centre, with special emphasis on results among the very old. Outcome parameters were the modified Rankin scale (mRs) at 3 months and symptomatic intracranial haemorrhage (SICH). Outcome was related to age. A total of 184 patients were treated of whom 45 were 80 years of age or older (24%). Sixty two (45%) of 139 patients < 80 years of age and 12 (27%) of 45 patients > or = 80 years of age had a favourable outcome defined as an mRs score of 0 or 1 (OR 2.21; 95% CI: 1.06 to 4.46). There was a good outcome (mRs score < or = 2) in 88 (63%) and 16 (36%) patients, respectively (OR 3.13; 95% CI: 1.55 to 6.30). SICH was observed in four of 139 (2.9%) patients < 80 years of age and in five of 45 (11.1%) patients > or = 80 years of age (OR 4.22; 95% CI: 1.08 to 16.46). The results of this study underline the uncertainty regarding the risk/benefit ratio of rt-PA treatment in acute stroke in patients over 80 years of age.
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Affiliation(s)
- R J van Oostenbrugge
- Department of Neurology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
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Gommer ED, Staals J, van Oostenbrugge RJ, Lodder J, Mess WH, Reulen JPH. Unaffected dynamic cerebral autoregulation in patients with lacunar infarct. Role of statins? KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aben I, Lodder J, Honig A, Lousberg R, Boreas A, Verhey F. Focal or generalized vascular brain damage and vulnerability to depression after stroke: a 1-year prospective follow-up study. Int Psychogeriatr 2006; 18:19-35. [PMID: 16403249 DOI: 10.1017/s104161020500270x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 09/08/2005] [Indexed: 11/06/2022]
Abstract
BACKGROUND Both the lesion location hypothesis and the vascular depression hypothesis have been proposed to explain the high incidence of depression in stroke patients. However, research studying both hypotheses in a single cohort is, at present, scarce. OBJECTIVE To test the independent effects of lesion location (left hemisphere, anterior region) and of co-occurring generalized vascular damage on the development of depression in the first year after ischemic stroke, while other risk factors for depression are controlled for. METHODS One hundred and ninety consecutive patients with a first-ever, supratentorial infarct were followed up for one year. CT was performed in the acute phase of stroke, while in 75 patients an additional MRI scan was also available. Depression was assessed at 1, 3, 6, 9, and 12 months after stroke using self-rating scales as screening tools and the SCID-I to diagnose depression according to DSM-IV criteria. RESULTS Separate analyses of the lesion location hypothesis and the vascular depression hypothesis failed to reveal significant support for either of these biological models of post-stroke depression. Similar negative results appeared from one overall, multivariate analysis including variables of both focal and generalized vascular brain damage, as well as other non-cerebral risk factors. In addition, level of handicap and neuroticism were independent predictors of depression in this cohort, as has been reported previously. CONCLUSION This study supports neither the lesion location nor the vascular depression hypothesis of post-stroke depression. A biopsychosocial model including both premorbid (prior to stroke) vulnerability factors, such as neuroticism and (family) history of depression, as well as post-stroke stressors, such as level of handicap, may be more appropriate and deserves further study.
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Affiliation(s)
- I Aben
- Department of Psychiatry & Neuropsychology, Institute Brain and Behavior, Maastricht University, Maastricht, Netherlands
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Lodder J, van Raak L, Hilton A, Hardy E, Kessels A. Diazepam to Improve Acute Stroke Outcome: Results of the Early GABA-Ergic Activation Study In Stroke Trial. Cerebrovasc Dis 2006; 21:120-7. [PMID: 16340187 DOI: 10.1159/000090210] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 09/08/2005] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND We tested whether diazepam, a GABA-ergic drug that also inhibits brain nitric monoxide formation, improves acute stroke prognosis. METHODS 880 patients, randomized within 12 h of acute stroke, received diazepam 10 mg or placebo by rectiole, as soon as possible, followed by 10-mg tablets twice daily for 3 days. Primary outcome was independence (Rankin score <3) at 3 months; secondary outcome was complete recovery (Barthel index >or=95 or Rankin score <or=1). RESULTS Intention-to-treat analyses on all 849 patients with full follow-up (50.4% on diazepam): odds ratio (OR) 1.14, 95% CI 0.87-1.49 for primary endpoint, and an OR of 1.26 (0.90-1.76) for complete recovery, both favoring diazepam. Adjusted analyses for all stroke patients (843): OR 1.20 (0.87-1.65), and 1.25 (0.89-1.74), respectively, and for all infarct patients (748): OR 1.31 (0.93-1.85), and 1.46 (1.02-2.09; p=0.037), respectively. Analyses restricted to cardioembolic infarct patients (200) showed treatment benefit for the primary outcome: OR 2.26, 95% CI 1.07-4.76, p=0.032, and complete recovery: OR 2.65, 95% CI 1.06-6.59, p=0.037. About one third of ischemic stroke patients had 'any adverse event', without any difference between treatment groups. In 95 intracerebral hemorrhage patients, frequency of pneumonia and death were higher in the diazepam group than in the placebo group: 35 and 10%, 22 and 12%, respectively. CONCLUSIONS Although point estimates favored diazepam treatment in various analyses, our data did not confirm our primary hypothesis. Diazepam treatment seems beneficial in cardioembolic infarct patients, is safe in acute ischemic stroke, but may better be avoided in intracerebral hemorrhage.
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Affiliation(s)
- J Lodder
- Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands
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Rasquin SMC, Verhey FRJ, Lousberg R, Lodder J. Cognitive performance after first ever stroke related to progression of vascular brain damage: a 2 year follow up CT scan study. J Neurol Neurosurg Psychiatry 2005; 76:1075-9. [PMID: 16024882 PMCID: PMC1739740 DOI: 10.1136/jnnp.2004.055541] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Stroke is one of the most common causes of cognitive impairment in the elderly. Ischaemic brain damage (white matter lesions and silent infarcts) progresses in a substantial number of stroke patients. The aim of this study was to investigate whether the progression of ischaemic brain damage is associated with cognitive functioning after first ever stroke. METHODS A total of 101 stroke patients were followed up for 2 years. Neuropsychological functioning was assessed at 1, 6, 12, and 24 months after stroke. Computed tomography was performed on all patients at baseline and 2 years after stroke. Progression in white matter lesions and (silent) infarcts was recorded. RESULTS Patients with progressive vascular brain damage performed worse on cognitive tasks, both 1 and 24 months after stroke, yet change in cognitive functioning was not different from that of patients without progressive vascular damage. During the follow up, improvement was noticed on most cognitive domains. CONCLUSIONS Although patients with progressive vascular brain damage after a first stroke performed somewhat worse on cognitive tests than those without such damage, both groups showed an improved or stable performance 2 years later. Thus, there is not a simple relation between progression of ischaemic brain damage and decline in cognitive functioning after first ever stroke.
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Affiliation(s)
- S M C Rasquin
- Brain and Behaviour Research Institute, Department of Psychiatry and Neuropsychology, PO Box 5800, 6200 MD Maastricht, the Netherlands
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Rasquin SMC, Lodder J, Visser PJ, Lousberg R, Verhey FRJ. Predictive accuracy of MCI subtypes for Alzheimer's disease and vascular dementia in subjects with mild cognitive impairment: a 2-year follow-up study. Dement Geriatr Cogn Disord 2005; 19:113-9. [PMID: 15591801 DOI: 10.1159/000082662] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2004] [Indexed: 11/19/2022] Open
Abstract
AIM The aim of this study was to investigate the prognostic accuracy of different subtypes of mild cognitive impairment (MCI): amnestic MCI, multiple domain MCI, and single non-memory domain MCI, for the development of Alzheimer's dementia (AD) and vascular dementia (VaD). PATIENTS Nondemented patients from a memory clinic cohort (n = 118), and a stroke cohort (n = 80, older than 55 years and with a cognitive impairment). RESULTS 'Multiple domain MCI' had the highest sensitivity for both AD (80.8%) and VaD (100%), and 'amnestic MCI' had the highest specificity (85.9% for AD, 100% for VaD). The positive predictive value was low for all subtypes (0.0-32.7%), whereas the negative predictive value was high (72.8-100%). DISCUSSION The subtype 'multiple domain MCI' has high sensitivity in identifying people at risk for developing AD or VaD. The predictive accuracy of the MCI subtypes was similar for both AD and VaD.
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Affiliation(s)
- S M C Rasquin
- Research Institute Brain and Behavior, Department of Psychiatry and Neuropsychology, University of Maastricht, University Hospital Maastricht, Maastricht, The Netherlands
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Rasquin SMC, Lodder J, Verhey FRJ. The Effect of Different Diagnostic Criteria on the Prevalence and Incidence of Post-Stroke Dementia. Neuroepidemiology 2005; 24:189-95. [PMID: 15802923 DOI: 10.1159/000084711] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
There is little agreement about the prevalence and incidence of vascular dementia (VaD) mainly because investigators have used different diagnostic criteria. The aim of this study was to examine the influence of different diagnostic criteria on the prevalence and cumulative incidence of VaD in first-ever stroke patients (n = 194) clinically evaluated at 1, 6, 12, and 24 months after stroke. Post-stroke VaD was diagnosed using the DSM-III, DSM-III-R, DSM-IV, ICD-10-NA, NINDS-AIREN, and ADDTC criteria. The prevalence of dementia was highest at 1 month; ranging from 11.3% with the NINDS-AIREN to 20.1% with the ICD-10-NA. The incidence was highest at 6 months, ranging from 2.6% with the ADDTC to 5.2% with the ICD-10-NA. Agreement among diagnostic criteria was high, with the exception of the ADDTC. In conclusion, both the prevalence and incidence of dementia are highest directly after stroke, but exact rates are influenced by the diagnostic criteria used.
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Affiliation(s)
- S M C Rasquin
- Department of Psychiatry and Neuropsychology, Research Institute Brain and Behaviour, University of Maastricht/University Hospital Maastricht, NL-6200 MD Maastricht, The Netherlands
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Abstract
UNLABELLED Many studies have investigated mild cognitive impairment (MCI) in the context of prodromal dementia, but few have investigated recovery from MCI. The aim of this study was to determine the prevalence of reversible MCI after stroke and to identify factors related to recovery. METHODS One hundred and eighteen patients with a first ever cerebral stroke were followed up for 2 years. Neuropsychological assessment was performed at 1, 6, 12, and 24 months poststroke. Possible predictors of reversible MCI were demographic variables, baseline MMSE scores, presence of stroke risk factors, and CT variables. Poststroke MCI was diagnosed when there was a deficit in at least one cognitive domain, without their being demented. Recovery was considered when MCI was no longer present. RESULTS Twenty-four (20.3%) patients were classified as having permanent reversible MCI and were compared with patients without recovery. Most patients recovered from MCI between the first and second assessments (19.7% versus 13.1% and 2.0% later on). Higher baseline MMSE scores and female sex were independent predictors of recovery (OR(High MMSE)=9.9; OR(female sex)=2.8). Neither stroke-related risk factors nor CT variables were predictors of favorable outcome. CONCLUSION About 20% of patients with poststroke MCI recover from MCI. Higher MMSE scores at baseline and female sex are independent predictors of this recovery.
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Affiliation(s)
- S M C Rasquin
- Research Institute Brain and Behavior, Department of Psychiatry, University of Maastricht/University Hospital Maastricht, PO Box 5800, 6202 MD Maastricht, The Netherlands
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Abstract
The effect of diazepam on NO-mediated cGMP synthesis was studied in rat brain slices. It was found that diazepam dose-dependently decreased cGMP synthesis in cerebellar slices, with an inhibition of 90% at 1 mM diazepam. cGMP levels in the presence of diazepam were not restored to control levels by the addition of 0.1 mM sodium nitroprusside, whereas the decrease in cerebellar cGMP levels induced by 0.1 mM L-NAME was restored by the simultaneous application of NO-donors. In addition to the decrease of cGMP levels in neuronal structures induced by 1 mM diazepam, we observed increased cGMP immunoreactivity in glial cells in the cerebellum, the hippocampus, and the cerebral cortex. The significance of this observation is discussed.
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Affiliation(s)
- L A M Aerden
- Department of Neurology, Rode Kruis Ziekenhuis, The Hague, The Netherlands.
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Aerden LAM, Kessels FAGH, Rutten BPF, Lodder J, Steinbusch HWM. Diazepam reduces brain lesion size in a photothrombotic model of focal ischemia in rats. Neurosci Lett 2004; 367:76-8. [PMID: 15308301 DOI: 10.1016/j.neulet.2004.05.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Revised: 05/25/2004] [Accepted: 05/26/2004] [Indexed: 10/26/2022]
Abstract
The neuroprotective effect of diazepam has been demonstrated in global ischemia models in vivo and in vitro [Neuroscience (2000) 471]. We studied the effect of diazepam on lesion volume in a photothrombotic model of focal brain ischemia in the rat, and the relation of such effect to time of drug administration. For this purpose we induced photochemically a focal brain lesion, and added diazepam 10 mg/kg intraperitoneally just before, at 1 and 4 h after lesion induction. After 24 h the rats were decapitated, and lesion volumes of 27 diazepam-treated rats were compared with that of 12 controls. Treated animals had a significant smaller lesion volume than controls, except those who received diazepam before induction of the lesion. We conclude that diazepam is neuroprotective in focal brain ischemia even when administered up to 4 h after ischemia onset.
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Affiliation(s)
- L A M Aerden
- Department of Neurology, Rode Kruis Ziekenhuis, Sportlaan 600, 2566 MJ Den Haag, The Netherlands.
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Rasquin SMC, Verhey FRJ, van Oostenbrugge RJ, Lousberg R, Lodder J. Demographic and CT scan features related to cognitive impairment in the first year after stroke. J Neurol Neurosurg Psychiatry 2004; 75:1562-7. [PMID: 15489388 PMCID: PMC1738816 DOI: 10.1136/jnnp.2003.024190] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Little is known about the relation between stroke related features and cognitive performance over time when stroke patients with dementia or less severe cognitive disorders are considered separately. We aimed to study the features (computed tomography (CT) scan and demographic) that could be related to vascular cognitive impairment one, six, and 12 months after stroke. METHODS A total of 176 patients with a first-ever brain infarct, a Mini Mental State Examination score > or = 15, age older than 40 years, and without pre-stroke dementia and other neurological or psychiatric disorders participated in this study. The following CT scan features were recorded: side of infarct, lacunar or territorial infarct, white matter lesions, silent infarcts, and brain atrophy. The demographic features studied were: age, level of education, and sex. Univariate and multivariate logistic regression analyses were performed to compare the three groups of patients (patients with dementia, patients with vascular cognitive impairment (VCI), and patients with vascular mild cognitive impairment (MCI)) with patients without cognitive disorders. RESULTS At one month none of the variables were predictors of dementia; at six months older age (odds ratio (OR) 9.4), low education (OR 14.7), and territorial infarct (OR 10.6) predicted dementia; and at 12 months low education (OR 8.7) and pre-stroke cerebrovascular damage (OR 7.4) predicted dementia. Predictors of VCI were low education (OR 3.4) and territorial infarct (OR 2.4) at one month post stroke; older age (OR 4.3) and low education (OR 4.1) at six months; and older age (OR 3.5) at 12 months. Predictors of vascular MCI were low education (OR 4.96) and territorial infarct (OR 3.58) at one month; and older age and lower education at six months (OR 3.4 and 3.7, respectively) and at 12 months (OR 3.5 and 2.28, respectively). CONCLUSIONS Territorial infarct, older age, and low educational level are predictors of cognitive disorders after stroke.
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Affiliation(s)
- S M C Rasquin
- Research Institute Brain and Behaviour, Department of Psychiatry and Neuropsychology, University of Maastricht/University Hospital Maastricht, the Netherlands
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de Jong S, Lodder J, Luijckx GJ. Is cerebral angiography redundant in undetermined cause of stroke in patients below 50 years when the stroke is lacunar? J Neurol Sci 2004; 222:83-5. [PMID: 15240200 DOI: 10.1016/j.jns.2004.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Revised: 03/19/2004] [Accepted: 04/14/2004] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the diagnostic work-up of young stroke patients angiography is still considered as mandatory to identify otherwise undetected causes of stroke. We hypothesized that stroke cause is more heterogeneous among patients with a territorial infarct, whereas in lacunar stroke it is generally small vessel disease. Therefore, angiography yields more often a specific stroke cause in territorial than in lacunar infarct patients. METHODS Angiograms of 39 lacunar and 41 territorial brain infarct patients, aged between 14 and 51 years, and who had unexplained stroke cause, were evaluated. RESULTS 1 of the 39 lacunar (3%), and 18 of the 41 territorial stroke patients (44%) had abnormal angiogram: odds ratio 0.03, 95% confidence interval: 0.01-0.017. The predictive value of lacunar stroke for a normal angiogram was 97%. CONCLUSION When undetermined cause of stroke in young patients is lacunar, it is highly predictive for a normal angiogram. Our data may be of value in deciding on performing angiography in individual young stroke patients, depending on whether the stroke is territorial or lacunar.
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Affiliation(s)
- S de Jong
- Department of Neurology, University Hospital Maastricht, The Netherlands
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Faber CG, Lodder J, Kessels F, Troost J. Thrombin generation in platelet-rich plasma as a tool for the detection of hypercoagulability in young stroke patients. Pathophysiol Haemost Thromb 2004; 33:52-8. [PMID: 12853713 DOI: 10.1159/000071642] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2002] [Accepted: 04/03/2003] [Indexed: 11/19/2022]
Abstract
The time course of the concentration of active thrombin in clotting plasma (the thrombogram) was measured by subsampling from platelet-rich plasma (PRP) and continuous chromogenic measurement of platelet-poor plasma (PPP) in 41 stroke patients under the age of 50, in whom stroke could not be attributed to cardioembolic disease, arterial dissection or vasculitis. A significant increase in the area under the thrombogram (endogenous thrombin potential, ETP) was seen in 23 patients. In 9 of them, ETP was increased in PRP but normal in PPP. High ETP in PRP was significantly associated with stroke, both in the middle and in the highest tercile of the ETP (odds ratio 5.1, range 1.8-15.1, and 3.7, range 1.3-10.3, respectively). A decreased sensitivity to the inhibitory action of thrombomodulin (TM) on thrombin generation was observed in 5 of 37 cases. No further definition of the cause of increased thrombin generation or TM resistance was attempted, except for the role of von Willebrand factor (vWF). ETP in PRP, platelet-derived procoagulant activity and vWF were correlated and higher in patients than in controls (p=0.002, p=0.045 and p=0.0006, respectively). This confirms the correlation between vWF level and stroke at young age found in epidemiological studies. It suggests that the role of vWF in thrombin generation, which has been demonstrated in vitro, may be the underlying mechanism of this correlation. In summary, hypercoagulability, defined as an increased capacity of the platelet plasma system to form thrombin, is found in over half of the patients under 50 years with an otherwise unexplained stroke. Sometimes it is due to increased plasma factor activity, sometimes to an increased procoagulant activity of the platelets.
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Affiliation(s)
- C G Faber
- Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands.
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Aben I, Verhey F, Strik J, Lousberg R, Lodder J, Honig A. A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. J Neurol Neurosurg Psychiatry 2003; 74:581-5. [PMID: 12700297 PMCID: PMC1738412 DOI: 10.1136/jnnp.74.5.581] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The high incidence of post-stroke depression has been claimed to reflect a specific, stroke related pathogenesis in which lesion location plays an important role. To substantiate this claim, post-stroke depression should occur more often than depression after another acute, life threatening, disabling disease that does not involve cerebrovascular damage. OBJECTIVES To compare the cumulative one year incidence of depression after stroke and after myocardial infarction, taking into consideration differences in age, sex, and the level of handicap. METHODS In a longitudinal design, 190 first ever stroke patients and 200 first ever myocardial infarction patients were followed up for one year. Depression self rating scales were used as a screening instrument to detect patients with depressive symptoms. Major and minor depression was assessed at one, three, six, nine, and 12 months after stroke or myocardial infarction according to DSM-IV criteria, using the structured clinical interview from DSM-IV. The severity of depressive symptoms was measured with the Hamilton depression rating scale. Level of disability and handicap was rated with the Rankin handicap scale. RESULTS The cumulative one year incidence of major and minor depression was 37.8% in stroke patients and 25% in patients with myocardial infarction (hazard ratio 1.6; p = 0.06). This difference disappeared after controlling for sex, age, and level of handicap. In addition, no differences were found in the severity of depressive symptoms or in the time of onset of the depressive episode after stroke or myocardial infarction. CONCLUSIONS Depression occurs equally often during the first year after stroke and after myocardial infarction when non-specific factors such as sex, age, and level of handicap are taken into account. Thus the relatively high incidence of post-stroke depression seems not to reflect a specific pathogenic mechanism. Further research is needed to investigate whether vascular factors play a common role in the development of depression after stroke and myocardial infarction.
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Affiliation(s)
- I Aben
- Department of Psychiatry and Neuropsychology, Institute Brain and Behaviour, University of Maastricht, Maastricht, Netherlands
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Teernstra OPM, Evers SMAA, Lodder J, Leffers P, Franke CL, Blaauw G. Stereotactic treatment of intracerebral hematoma by means of a plasminogen activator: a multicenter randomized controlled trial (SICHPA). Stroke 2003; 34:968-74. [PMID: 12649510 DOI: 10.1161/01.str.0000063367.52044.40] [Citation(s) in RCA: 232] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Treatment of intracerebral hematoma (ICH) is controversial. An advantage of neurosurgical intervention over conservative treatment of ICH has not been established. Recent reports suggest a favorable effect of stereotactic blood clot removal after liquefaction by means of a plasminogen activator. The SICHPA trial was aimed at investigating the efficacy of this treatment. METHODS A stereotactically placed catheter was used to instill urokinase to liquefy and drain the ICH in 6-hour intervals over 48 hours. From 1996 to 1999, 13 centers entered 71 patients into the study. Patients were randomized into a surgical group (n=36) and a nonsurgical group (n=35). Admission criteria were the following: age >45 years, spontaneous supratentorial ICH, Glasgow Eye Motor score ranging from 2 to 10, ICH volume >10 cm3, and treatment within 72 hours. The primary end point was death at 6 months. As secondary end points, ICH volume reduction and overall outcome measured by the modified Rankin scale were chosen. The trial was prematurely stopped as a result of slow patient accrual. RESULTS Seventy patients were analyzed. Overall mortality at day 180 after stroke was 57%; this included 20 of 36 patients (56%) in the surgical group and 20 of 34 patients (59%) in the nonsurgical group. A significant ICH volume reduction was achieved by the intervention (10% to 20%, P<0.05). Logistic regression analysis indicated the possibility of efficacy for surgical treatment (odds ratio, 0.23; 95% confidence interval, 0.05 to 1.20; P=0.08). The odds ratio of mortality combined with modified Rankin scale score 5 at 180 days was also not statistically significant (odds ratio, 0.52; 95% confidence interval, 1.2 to 2.3; P=0.38). CONCLUSIONS Stereotactic aspiration can be performed safely and in a relatively uniform manner; it leads to a modest reduction of 18 mL of hematoma reduction over 7 days when compared with control, which has a 7-mL reduction, and therefore may improve prognosis.
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Affiliation(s)
- O P M Teernstra
- Department of Neurosurgery, University Hospital Maastricht, The Netherlands.
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Abstract
This study investigated the occurrence of cognitive disorders 1 and 6 months after stroke in a cohort of patients with a first-ever stroke. In addition, it was investigated whether age, sex and level of education are risk factors for vascular cognitive disorders. Memory, simple speed, cognitive flexibility and overall cognitive functioning were examined in 139 patients at 1 and 6 months post-stroke. Inclusion criteria on admission were first cerebral stroke, age>/=40, no other neurological or psychiatric disorders and ability to communicate. Mean age was 69.3 years (S.D.=12.3). Patients were compared with a healthy control group matched for age, sex and level of education. A large group of patients who, at 1 month after stroke, scored below the cutoff on cognitive domains, scored above the cutoff on most of these cognitive domains at 6 months. For overall cognitive functioning, 16 out of 39, for memory, 13 out of 26 and for cognitive flexibility, 15 out of 49 patients, who at 1 month scored below the cutoff, scored above the cutoff at 6 months. Simple speed did not change; 12 patients scored above the cutoff and 7 patients scored below the cutoff at 6 months after stroke. Speaking in terms of improvement or deterioration, most people remained stable on the four cognitive domains (ranging from 37.6% to 83.5%), and a substantial group improved (ranging from 12.9% to 52.1%). Older and female patients had more cognitive disturbances. Overall, the conclusion is that the prognosis of cognitive functioning after stroke is general favourable, especially in younger patients.
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Affiliation(s)
- S M C Rasquin
- Institute of Brain and Behaviour, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Lodder J. Cerebral Vasospasm. Clin Neurol Neurosurg 2002. [DOI: 10.1016/s0303-8467(02)00024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND AND PURPOSE Earlier, we found that lacunar stroke patients with > or =1 asymptomatic lacunar infarcts on CT had leukoaraiosis and hypertension significantly more often than patients without such lesions, and we hypothesized that 2 types of small-vessel disease could be distinguished during life: arteriolosclerosis and microatheromatosis, respectively. Differences in prognosis might sustain this hypothesis of 2 lacunar stroke entities. Therefore, we performed a follow-up in 333 patients with first lacunar stroke, distinguishing those with > or =1 asymptomatic lacunar lesions (LACI+) from those without such lesions (LACI-). METHODS Cross-sectional follow-up was performed after 785+/-479 days (mean+/-SD) in 104 LACI+ patients and 865+/-545 days in 229 LACI- patients. RESULTS Mortality at the end of follow-up was 33% in LACI+ and 21% in LACI- patients [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.01 to 3.01]. Stroke recurrence rate was 21% in LACI+ and 11% in LACI- (OR, 2.09; 95% CI, 1.08 to 4.06). Forty percent of LACI+ and 26% of LACI- patients had unfavorable outcome at the end of follow-up (OR, 1.95; 95% CI, 1.17 to 3.26). Kaplan-Meier curves showed less favorable survival in LACI+ (log-rank test, P=0.0218) and survival free of stroke (log-rank test, P=0.0121) than in LACI-. When we restricted the analysis to patients with both silent lesions and leukoaraiosis (n=63) compared with those without (n=196), differences were even more pronounced. CONCLUSIONS Prognosis for mortality, recurrent stroke, and overall functional outcome in lacunar stroke patients with > or =1 silent lacunar lesions is more unfavorable than in patients without such lesions. These findings sustain the idea of 2 lacunar stroke entities.
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Affiliation(s)
- G de Jong
- Department of Neurology, Isala Clinics Location Weezenlanden, Zwolle, The Netherlands
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Boreas AMHP, Lodder J, Kessels F, de Leeuw PW, Troost J. Prognostic value of blood pressure in acute stroke. J Hum Hypertens 2002; 16:111-6. [PMID: 11850768 DOI: 10.1038/sj.jhh.1001304] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2001] [Revised: 08/02/2001] [Accepted: 09/14/2001] [Indexed: 11/08/2022]
Abstract
Manipulation of blood pressure (BP) in acute stroke may improve outcome. Despite various studies, data on the prognostic significance of early BP in stroke remain unclear. Therefore, we studied the relationship between various BP variables in the acute phase of stroke and functional outcome at 3 months. Blood pressures were collected by reviewing BP records of 817 patients who were admitted to our stroke unit between 1987 and 1992. Besides the first systolic and diastolic admission BP (SBP and DBP), we also used the mean of the daytime as well as the night-time systolic and diastolic BP values. Finally, we studied the relationship between the decrease in BP between day 0 and 4 and outcome. As dependent outcome variable we used the Rankin handicap score at 3 months dichotomized in a score >3 (poor outcome) vs a score 3 (good outcome). A total of 430 patients were admitted within 24 h following stroke onset. There was no significant relationship between the systolic and diastolic BP and the outcome at 3 months. Only night-time systolic BP 165 mm Hg (odds ratio (OR) 2.8; 95% CI 1.1-6.8), night-time diastolic BP 60 mm Hg (OR 8.1; 95% CI 1.1-58.3), and a decrease in daytime diastolic BP between day 0 and 4 of 10 mm Hg (OR 3.0; 95% CI 1.1-7.9) showed a significant relationship with poor outcome. Our findings suggest that admission BP values may not reliably reflect any impact of BP on stroke outcome. They also suggest a potential differential effect of BP manipulation: increasing or decreasing BP may be beneficial for patients with BP extremes in one direction, but detrimental for those with BP values in the opposite direction.
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Affiliation(s)
- A M H P Boreas
- Department of Neurology, University Hospital of Maastricht, The Netherlands.
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Lodder J. Traumatic rupture of the thyroid gland--a case report. S AFR J SURG 2001; 39:53-4. [PMID: 14601450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Traumatic rupture of the thyroid gland is a rare event. This report describes such an injury, in this case caused by a kick from a horse. Blunt injury to the anterior structures of the neck involving the major blood vessels and larynx has been described, but major blunt injury to the thyroid gland is rare.
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Aben I, Verhey F, Honig A, Lodder J, Lousberg R, Maes M. Research into the specificity of depression after stroke: a review on an unresolved issue. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25:671-89. [PMID: 11383972 DOI: 10.1016/s0278-5846(01)00158-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Iwo decades of research have failed to generate consistent insight into the specificity of poststroke depression (PSD). This is, at least in part, caused by methodological difficulties. Differences in symptom profile between PSD and depression with no or another medical cause were described, but no specific and unequivocal clinical picture has been established so far. Prevalence rates of PSD varied largely between studies. In community based studies using standardised diagnostic instruments for depression, relatively low prevalence rates were reported compared to inpatient or rehabilitation studies. PSD occurs most frequently in the first few months after stroke, while a new incidence peak may occur 2-3 years after stroke. Two systematic reviews on the relation between lesion location and depression did not support the claim that left hemisphere lesions are a risk factor for PSD. A new concept of vascular depression has been proposed, which relates depression in the elderly to acute or chronic damage to the cerebral vascular system. Future efforts should aim at increasing the uniformity of study designs, assessment tools should be further improved for use in cognitively impaired patients and appropriate control groups should be defined to study the characteristic features of PSD.
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Affiliation(s)
- I Aben
- Institute of Brain and Behaviour, Maastricht University, The Netherlands
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Lodder J. Prevention of Ischemic Stroke Edited by Fieschi C. and Fisher M., Martin Dunitz Publ., 1999. Clin Neurol Neurosurg 2001. [DOI: 10.1016/s0303-8467(01)00108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Boreas AM, Lodder J, Kessels F, de Leeuw PW, Troost J. Predictors of poststroke blood pressure level and course. J Stroke Cerebrovasc Dis 2001; 10:85-91. [PMID: 17903805 DOI: 10.1053/jscd.2001.24658] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2000] [Indexed: 11/11/2022] Open
Abstract
Blood pressure (BP) is often elevated in acute stroke. However, predictors of BP level and BP course during the first week after a stroke remain unknown. Knowledge of such factors may be of relevance when manipulation of early BP levels are considered as potentially therapeutic in acute stroke. In this study, BP data was collected by reviewing BP records of patients who were admitted with a first cerebral infarct to our stroke unit and who had their first BP recordings within 24 hours after stroke onset. Age and known hypertension before stroke were significantly associated with elevated poststroke BP level, whereas ischemic heart disease was associated with a lower BP level. BP decline in the poststroke period related to the initial BP elevation. BP in hypertensive patients remained higher than in nonhypertensive patients during the first poststroke week. Between day 0 and day 4 after stroke onset, only the daytime systolic BP decline showed a significant association with previously established hypertension. There was no difference in initial BP level, nor in the rate of BP decline between day 0 and 4 in patients with a lacunar infarct and those with an infarct involving the cortex. These findings indicate that BP increase poststroke is not a general phenomenon, nor is BP decline in the first poststroke week. Known hypertension is probably the strongest predictor of poststroke BP increase. Hypertensive patients are more sensitive to sympathetic stimulation. Therefore, when lowering of elevated BP early poststroke is tested as a potential neuroprotective modality, it may best be achieved by treating patients with sympathicolytic, antihypertensive drugs.
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Affiliation(s)
- A M Boreas
- Department of Neurology, Clinical Epidemiology and MTA, and Internal Medicine, University Hospital of Maastricht, Maastricht, The Netherlands
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Abstract
Data on the relationship between idiopathic Parkinson's disease (IPD) and stroke are conflicting. In this study, we examined the frequency of IPD in stroke patients registered in the Maastricht Stroke Registry. With the use of three different search strategies, we found eight individuals with IPD amongst a total of 1,516 stroke patients. We had expected to find approximately 30 IPD patients (relative risk 0.27; 95% confidence interval 0.11-0.53), based on IPD prevalence figures from a Dutch population-based study. We speculate that dopamine deficiency may protect against ischaemic brain damage, perhaps by reducing the effects of excitotoxicity.
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Affiliation(s)
- A Korten
- Department of Neurology, University Hospital Maastricht, The Netherlands.
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Lodder J, Luijckx G, van Raak L, Kessels F. Diazepam treatment to increase the cerebral GABAergic activity in acute stroke: a feasibility study in 104 patients. Cerebrovasc Dis 2000; 10:437-40. [PMID: 11070373 DOI: 10.1159/000016104] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In preparation of a trial on the neuroprotective effect of GABAergic activation by a benzodiazepine, we performed a feasibility study in 104 patients with acute (less than 24 h) stroke. 5 mg diazepam twice daily for 5 days (n = 44) was well tolerated, feasible, and appeared to be safe. Testing a dose of 10 mg twice daily for 5 days (n = 17) was stopped early because of drowsiness around day 5, interfering with regular patient care. A dose of 10 mg twice daily for 3 days was well tolerated, despite reported drowsiness in 12 of 43 patients. First-dose application by rectiole was feasible in 97% of the 104 patients. No blood pressure drop or respiratory arrest or insufficiency were detected, whereas the 2-week case fatality rate was similar to that of controls matched for age, sex, and stroke severity. We conclude that testing the GABAergic activity during the acute phase of stroke by 10 mg diazepam twice daily for 3 days is well tolerated and practically feasible, and it does not subject patients to an increased risk of potential serious adverse effects. Preparations for a large randomized trial are in a final stage.
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Affiliation(s)
- J Lodder
- Department of Neurology, University Hospital, Maastricht, The Netherlands.
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Boiten J, Wilmink JT, Lodder J, Troost J. [Thrombolytic therapy in patients with acute brain infarction: favorable preliminary results in Maastricht]. Ned Tijdschr Geneeskd 2000; 144:1062-9. [PMID: 10850109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE To assess the feasibility of acute thrombolysis for ischaemic stroke in clinical practice. DESIGN Prospective. METHOD On July 1st, 1998 thrombolytic therapy for ischaemic stroke was introduced in the University Hospital Maastricht, the Netherlands. All patients admitted with ischaemic stroke were prospectively registered during the first year. Of all patients with ischaemic stroke, it was determined how many were potentially eligible for thrombolysis within 3 hours of stroke symptom onset, and how many of these patients were actually treated with thrombolysis. Furthermore, the reasons for exclusion from thrombolytic therapy were assessed. Several baseline and clinical patient characteristics were noted. RESULTS During the first year 18 ischaemic stroke patients were treated with thrombolysis within 3 hours of stroke onset. These 18 patients constituted 7% of all 256 ischaemic stroke patients and 18% of the potentially eligible patients who arrived in the hospital within 3 hours. More than 40% of the ischaemic stroke patients were not eligible for thrombolysis due to late arrival in the hospital. There were no major complications in the 18 treated patients: 3 patients developed an asymptomatic haemorrhagic transformation of the infarct. CONCLUSION Acute thrombolysis for ischaemic stroke within 3 hours from stroke onset is feasible, and can under specific conditions be applied in clinical practice. Only 7% of all ischaemic stroke patients underwent thrombolysis. This percentage of patients could be increased by an earlier presentation of patients to the hospital.
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Affiliation(s)
- J Boiten
- Afd. Neurologie: dr.J.Boiten, Academisch Ziekenhuis, Maastricht
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Hellemons BS, Langenberg M, Lodder J, Vermeer F, Schouten HJ, Lemmens T, van Ree JW, Knottnerus JA. Primary prevention of arterial thromboembolism in non-rheumatic atrial fibrillation in primary care: randomised controlled trial comparing two intensities of coumarin with aspirin. BMJ 1999; 319:958-64. [PMID: 10514159 PMCID: PMC28250 DOI: 10.1136/bmj.319.7215.958] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of aspirin and coumarin in preventing thromboembolism in patients with non-rheumatic atrial fibrillation in general practice. DESIGN Randomised controlled trial. PARTICIPANTS 729 patients aged >/=60 years with atrial fibrillation, recruited in general practice, who had no established indication for coumarin. Mean age was 75 years and mean follow up 2. 7 years. SETTING Primary care in the Netherlands. INTERVENTIONS Patients eligible for standard intensity coumarin (international normalised ratio 2.5-3.5) were randomly assigned to standard anticoagulation, very low intensity coumarin (international normalised ratio 1.1-1.6), or aspirin (150 mg/day) (stratum 1). Patients ineligible for standard anticoagulation were randomly assigned to low anticoagulation or aspirin (stratum 2). MAIN OUTCOME MEASURES Stroke, systemic embolism, major haemorrhage, and vascular death. RESULTS 108 primary events occurred (annual event rate 5.5%), including 13 major haemorrhages (0.7% a year). The hazard ratio was 0.91 (0.61 to 1.36) for low anticoagulation versus aspirin and 0.78 (0.34 to 1.81) for standard anticoagulation versus aspirin. Non-vascular death was less common in the low anticoagulation group than in the aspirin group (0.41, 0.20 to 0.82). There was no significant difference between the treatment groups in bleeding incidence. High systolic and low diastolic blood pressure and age were independent prognostic factors. CONCLUSION In a general practice population (without established indications for coumarin) neither low nor standard intensity anticoagulation is better than aspirin in preventing primary outcome events. Aspirin may therefore be the first choice in patients with atrial fibrillation in general practice.
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Affiliation(s)
- B S Hellemons
- Department of General Practice, University of Maastricht, 6200 MD Maastricht, Netherlands.
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Hellemons BS, Langenberg M, Lodder J, Vermeer F, Schouten HJ, Lemmens TG, van Ree JW, Knottnerus JA. Primary prevention of arterial thromboembolism in nonrheumatic atrial fibrillation: the PATAF trial study design. Control Clin Trials 1999; 20:386-93. [PMID: 10440565 DOI: 10.1016/s0197-2456(99)00010-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Patients with nonrheumatic atrial fibrillation (NRAF) have a higher risk of thromboembolism than patients in sinus rhythm. Several trials have been conducted to establish the best preventive regimen in patients with NRAF, but not in the primary-care setting. The Primary Prevention of Arterial Thromboembolism in Nonrheumatic Atrial Fibrillation (PATAF) study, a primary-care-based trial, was set up to compare the preventive efficacy of low-intensity anticoagulation (AC), target range International Normalized Ratio (INR) 1.1 < INR < 1.6 and regular-intensity AC (2.5 < INR < 3.5) therapies with that of aspirin 150 mg/d for the occurrence of thromboembolism in NRAF patients. Patients eligible for regular-intensity AC were randomly assigned to aspirin at 150 mg/d, low-intensity AC, or regular AC in group I. In cases of noneligibility for regular AC, the trial randomized patients between aspirin and low-intensity AC (assigned to group II). Primary outcome events were stroke (including intracranial hemorrhage), systemic embolism, major hemorrhage, or vascular death. Analysis of the data was based on Cox regression to compute the hazard ratio (HR) with a 95% confidence interval, using the likelihood ratio test. The trial randomized 729 patients. Patient enrollment and follow-up has been stopped, and the final analysis is now complete. We shall publish the main results as soon as possible.
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Affiliation(s)
- B S Hellemons
- Department of General Practice, University of Maastricht, The Netherlands
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van Zagten M, Kessels F, Boiten J, Lodder J. Interobserver agreement in the assessment of cerebral atrophy on CT using bicaudate and sylvian-fissure ratios. Neuroradiology 1999; 41:261-4. [PMID: 10344510 DOI: 10.1007/s002340050743] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
To assess the interobserver variability of cerebral-atrophy measures on CT, three investigators measured the bicaudate ratio (BCR) and the sylvian-fissure ratio (SFR) on 20 CT studies of patients with ischaemic stroke. The intraclass correlation coefficient of BCR measurements was 0.82 [95% confidence interval (CI) 0.75-0.94], and that of SFR measurements 0.69 (95% CI 0.57-0.89). The range of pairwise-calculated Pearson correlation coefficients was smaller for measurement of the BCR (0.89-0.92) than for the SFR measurements (0.66-0.84).
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Affiliation(s)
- M van Zagten
- University Hospital Maastricht, Department of Neurology, The Netherlands
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Boon A, Lodder J, Cheriex E, Kessels F. Mitral annulus calcification and carotid atherosclerotic disease. Stroke 1999; 30:693. [PMID: 10066876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Lodder J. Lubeluzole treatment of acute ischemic stroke. Stroke 1998; 29:1067. [PMID: 9596259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Affiliation(s)
- J. Lodder
- University Hospital Maastricht, Department of Neurology, Maastricht, the Netherlands
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Schmal M, Marini C, Carolei A, Di Napoli M, Kessels F, Lodder J. Different vascular risk factor profiles among cortical infarcts, small deep infarcts, and primary intracerebral haemorrhage point to different types of underlying vasculopathy. A study from the L'Aquila Stroke Registry. Cerebrovasc Dis 1998; 8:14-9. [PMID: 9645976 DOI: 10.1159/000015810] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The type of small-vessel disease in small deep (lacunar) infarcts (SDIs) remains contentious as opposed to that in primary intracerebral haemorrhage (PICH), which is lipohyalinosis in most cases. Therefore, we compared risk factor profiles as indicators of underlying vessel pathology, between patients with SDI and patients with PICH, and those with a non-cardio-embolic infarct involving the cortex (CORTI). Multivariate regression analysis showed the diabetes mellitus [odds ratio (OR) 0.56; 95% confidence interval (CI) 0.34-0.90] and hypercholesterolaemia (OR 0.63; 95% CI 0.40-0.99) were more strongly associated with CORTI than with SDI. Carotid stenosis was associated with SDI in comparison with PICH (OR 7.5; 95% CI 1.02-54.94). Compared with PICH, CORTI was more strongly associated with diabetes mellitus (OR 3.27; 95% CI 1.38-7.76), carotid stenosis (OR 24.42; 95% CI 4.99-119.45), and hypercholesterolaemia (OR 3.12; 95% CI 1.47-6.65), whereas hypertension was associated with PICH (OR 0.37; 95% CI 0.18-0.79). These data support the hypothesis that small-vessel atheromatosis rather than small-vessel lipohyalinosis underlies lacunar infarcts in most cases.
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Affiliation(s)
- M Schmal
- Department of Neurology, University Hospital Maastricht, The Netherlands
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Vermeer F, Langenberg M, Hellemons B, Lodder J, Schouten H, van Ree J, Knottnerus J. Primary prevention of arterial thrombo-embolism in non-rheumatical atrial fibrillation. Results of the PATAF study. J Am Coll Cardiol 1998. [DOI: 10.1016/s0735-1097(98)82147-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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