We investigated whether pre-treatment with statins is associated with surrogate markers of amyloid and hypertensive angiopathies in patients who need to start long-term oral anticoagulation therapy. ...A prospective multicenter study of patients naive for oral anticoagulants, who had an acute cardioembolic stroke. MRI was performed at admission to evaluate microbleeds, leukoaraiosis and superficial siderosis. We collected data on the specific statin compound, the dose and the statin intensity. We performed bivariate analyses and a logistic regression to investigate variables associated with microbleeds. We studied 470 patients (age 77.5 ± 6.4 years, 43.7% were men), and 193 (41.1%) of them received prior treatment with a statin. Microbleeds were detected in 140 (29.8%), leukoaraiosis in 388 (82.5%) and superficial siderosis in 20 (4.3%) patients. The presence of microbleeds, leukoaraiosis or superficial siderosis was not related to pre-treatment with statins. Microbleeds were more frequent in patients with prior intracerebral hemorrhage (OR 9.7, 95% CI 1.06-90.9) and in those pre-treated antiplatelets (OR 1.66, 95% CI 1.09-2.53). Prior treatment with statins was not associated with markers of bleeding-prone cerebral angiopathies in patients with cardioembolic stroke. Therefore, previous statin treatment should not influence the decision to initiate or withhold oral anticoagulation if these neuroimaging markers are detected.
Young women have poorer outcomes than men after stroke Martínez-Sánchez, Patricia; Fuentes, Blanca; Fernández-Domínguez, Jessica ...
Cerebrovascular diseases (Basel, Switzerland),
04/2011, Letnik:
31, Številka:
5
Journal Article
Recenzirano
Gender differences in stroke outcome have not been fully assessed in young patients.
We conducted an observational study of consecutive young ischemic stroke patients (≤ 50 years of age) admitted to ...a stroke unit (January 1999 to December 2009). Basal data, subtype of ischemic stroke, stroke severity Canadian Neurological Scale (CNS), length of hospital stay, inhospital complications, mortality and functional outcome at discharge modified Rankin Scale (mRS) score were analyzed. For stroke severity and outcome analyses, 2 age groups were established: 15-30 (very young group) and 31-50 years old (middle-aged young group).
A total of 310 patients were enrolled; 128 females and 182 males. The mean age was similar in women and men (41.07 ± 8.6 vs. 42.12 ± 8.2, NS). Migraine was more frequent in women, whereas arterial hypertension, hyperlipidemia, alcohol abuse, current smoking and atherothrombotic infarction were more frequent in men (p < 0.05). Females presented greater stroke severity than men median CNS (IQR) = 8 (3.5) vs. 9 (2.5), p = 0.014 except in the very young group median CNS (IQR) = 9 (1.8) vs. 8 (5), p = 0.022. Female sex was a predictor of unfavorable outcomes (mRS >2) at discharge in the total sample (OR = 3.33; 95% CI = 1.41-7.84) and in the middle-aged young group (OR = 2.62; 95% CI = 1.05-6.53), adjusted by baseline data, stroke subtype, inhospital complications, length of stay and stroke severity.
Female gender is associated with worse outcomes in adult ischemic stroke patients up to 50 years old. However, this effect is not observed in younger patients (15-30 years).
INTRODUCTIONEvidence from experimental and clinical studies is accumulating about the possible cerebral protective properties of antithypertensive drugs, mainly angiotensin receptor blockers (ARB) or ...angiotensin-converting enzyme inhibitors (ACEI). Our aim was to analyse the impact of prestroke use of antihypertensive drugs on stroke severity and outcome.
METHODSWe analysed 1968 consecutive patients with first-ever acute cerebral infarction admitted to an acute stroke unit. Stroke severity was evaluated using the Canadian Neurological Scale and the modified Rankin Score (mRS) was used to evaluate the outcome at discharge.
RESULTSPrevious diagnosis of arterial hypertension was reported in 1212 patients and 73% were on antihypertensive treatment. No significant differences in stroke severity were found between patients with or without previous arterial hypertension, either in patients with or without antihypertensive treatment. Patients taking antihypertensive drugs at stroke onset had lower rates of poor outcome than those not on antihypertensive treatment (47 vs. 53%; P = 0.047) and those taking ARB had better outcomes than those without ARB (mRS ≤ 275 vs. 65.8%; P = 0.029), with no differences in the analysis of other antihypertensive drugs. The multivariable logistic regression analysis showed that previous treatment with ARB was independently associated with reduced stroke severity (OR0.40; 95%CI 0.24–0.65; P < 0.001) and against poor outcome (OR0.41; 95%CI 0.23–0.78; P = 0.003).
CONCLUSIONOur study suggests that prestroke treatment with ARB may be associated with reduced stroke severity and also with better outcome. This finding agrees with experimental data that suggest a cerebral protective effect.
Carotid plaques undergo histologic changes early after an ischemic stroke. However, the evolution of carotid plaques echolucency after a recent brain ischemia is not well known. A prospective ...observational study that included consecutive stroke patients and asymptomatic individuals with plaques showing ≥50% stenosis on duplex ultrasound was conducted. Plaque echogenicity was measured with the standardized gray-scale median (GSM) and compared with respect to symptoms presence and time from stroke onset. One hundred twenty-six carotid plaques in 124 patients were studied and four groups of plaques were analyzed: (1) plaques seen within 24 h of stroke onset (32); (2) between 1-7 days (50); (3) more than 7 days after stroke onset (22) and; (4) plaques without associated symptoms (22). Plaques of group 1 had less echogenicity than those of groups 2-4: median GSM (interquartile range) 14 (16), 19.5 (19), 22.5 (21), 26.5 (16) respectively (p = 0.001). In conclusion, carotid plaque echogenicity is increased with time from stroke onset and could be an early marker of plaque remodeling.
OBJECTIVEWe tested the hypothesis that the risk of intracranial hemorrhage (ICH) in patients with cardioembolic ischemic stroke who are treated with oral anticoagulants (OAs) can be predicted by ...evaluating surrogate markers of hemorrhagic-prone cerebral angiopathies using a baseline MRI.
METHODSPatients were participants in a multicenter and prospective observational study. They were older than 64 years, had a recent cardioembolic ischemic stroke, and were new users of OAs. They underwent a baseline MRI analysis to evaluate microbleeds, white matter hyperintensities, and cortical superficial siderosis. We collected demographic variables, clinical characteristics, risk scores, and therapeutic data. The primary endpoint was ICH that occurred during follow-up. We performed bivariate and multivariate Cox regression analyses.
RESULTSWe recruited 937 patients (aged 77.6 ± 6.5 years; 47.9% were men). Microbleeds were detected in 207 patients (22.5%), moderate/severe white matter hyperintensities in 419 (45.1%), and superficial siderosis in 28 patients (3%). After a mean follow-up of 23.1 ± 6.8 months, 18 patients (1.9%) experienced an ICH. In multivariable analysis, microbleeds (hazard ratio 2.7, 95% confidence interval CI 1.1–7, p = 0.034) and moderate/severe white matter hyperintensities (hazard ratio 5.7, 95% CI 1.6–20, p = 0.006) were associated with ICH (C index 0.76, 95% CI 0.66–0.85). Rate of ICH was highest in patients with both microbleed and moderate/severe WMH (3.76 per 100 patient-years, 95% CI 1.62–7.4).
CONCLUSIONPatients taking OAs who have advanced cerebral small vessel disease, evidenced by microbleeds and moderate to severe white matter hyperintensities, had an increased risk of ICH. Our results should help to determine the risk of prescribing OA for a patient with cardioembolic stroke.
CLINICALTRIALS.GOV IDENTIFIERNCT02238470.
Ultrasound (US) techniques increase the ability of neurologists specializing in stroke to rapidly evaluate stroke patients, determine likely mechanisms of brain ischemia, determine arterial patency, ...quantify stenosis severity, and determine the most appropriate clinical management. Furthermore, the development of new US techniques based on the detection of US contrast agents may permit the evaluation of cerebral microcirculation and the identification of regions of angiogenesis, inflammation and thrombus during brain ischemia.
Neuromyelitis optica, or Devic's disease, is an inflammatory, demyelinating disease of the central nervous system that selectively affects the optic nerves and the spinal cord, with a high rate of ...relapses. Anti-aquaporin-4 (AQP4) antibodies are a highly specific marker for this condition.
A 66-year-old female with longitudinally extensive dorsal transverse myelitis with complete remission following steroidal treatment and later acute relapse, with palsy in one limb. The differential diagnoses considered included a spinal tumour and arteriovenous malformation of the spinal cord. Being positive for AQP4 was the decisive factor in the final diagnosis.
Early detection of anti-AQP4 antibodies together with appropriate immunotherapy can be the key to a better prognosis. An early diagnosis is essential to be able to start treatment at an early stage and thus prevent relapses and severe sequelae.
Polycythaemia vera (PV) is an haematological neoplasm that frequently presents neurological symptoms. However, chorea is a rare complication of this disease, occurring in less than 5% of the ...patients. Cognitive impairment related to PV unbalanced is also a rare complication, and it can improve with proper treatment. We present a 96-year-old-man with acute-onset hemichorea and frontal lobe syndrome with no vascular pathology in the basal ganglia or frontal region. A clear relationship was observed between the onset of involuntary movements and the cognitive impairment and worsening of haematological parameters in the patient. After causal and symptomatic treatment, the patient’s clinical status improved. In the elderly, PV must be considered as a cause of acute chorea and sudden cognitive impairment, as early diagnosis leads to effective treatment and prevention of complications.
Microbial counts (aerobic bacteria, psychrotrophs, Enterobacteriaceae, coliforms, Pseudomonas spp., Enterococcus spp., Staphylococcus spp., and molds and yeasts) were obtained for the shells of 240 ...table eggs in northwestern Spain. Eggs from six sources (40 samples in each) were analyzed: chicken eggs from five different housing systems (conventional battery cages, barn, free range, organic, and domestic breeding) and quail eggs (cages). A total of 120 Escherichia coli strains (20 from each source) were tested by the disk diffusion method for resistance to 12 antimicrobial drugs of veterinary and human health significance. Aerobic plate counts ranged from 1.96 ± 1.0 (barn) to 3.69 ± 0.7 (domestic) log CFU/cm(2). Counts for most microbial groups differed significantly between sources. Eggs from domestic production had the highest contamination loads (P < 0.05) for aerobic bacteria, Enterococcus spp., and molds and yeasts and the highest prevalence of E. coli. Twenty-three E. coli isolates (19.17%) were susceptible to all antimicrobials tested, and 80.83 % were resistant to one (22.50%) or more (58.33%) antimicrobials. The housing system had a significant influence (P < 0.05) on the average resistance per strain, with the highest resistance in conventional cage (2.85) and barn (3.10) systems followed by free range (1.55) and quail (1.95). Eggs from organic (1.00) and domestic (0.75) production systems had the lowest resistance per strain. The highest prevalence of resistance was observed for the groups of antimicrobials more frequently used on poultry farms. Our results suggest that a relationship exists between the prevalence of antimicrobial resistance in E. coli strains and the more frequent use of antimicrobials in conventional (cage, barn, and free range) than in domestic and organic chicken housing systems. Education covering good sanitary practices for handling eggs to avoid cross-contamination or inadequate cooking is needed.
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