In a large series of patients with cervical artery dissection (CeAD), a major cause of ischemic stroke in young and middle-aged adults, we aimed to examine frequencies and correlates of family ...history of CeAD and of inherited connective tissue disorders.
We combined data from 2 large international multicenter cohorts of consecutive patients with CeAD in 23 neurologic departments participating in the CADISP-plus consortium, following a standardized protocol. Frequency of reported family history of CeAD and of inherited connective tissue disorders was assessed. Putative risk factors, baseline features, and 3-month outcome were compared between groups.
Among 1,934 consecutive patients with CeAD, 20 patients (1.0%, 95% confidence interval: 0.6%-1.5%) from 17 families (0.9%, 0.5%-1.3%) had a family history of CeAD. Family history of CeAD was significantly more frequent in patients with carotid location of the dissection and elevated cholesterol levels. Two patients without a family history of CeAD had vascular Ehlers-Danlos syndrome with a mutation in COL3A1. This diagnosis was suspected in 2 additional patients, but COL3A1 sequencing was negative. Two patients were diagnosed with classic and hypermobile Ehlers-Danlos syndrome, one patient with Marfan syndrome, and one with osteogenesis imperfecta, based on clinical criteria only.
In this largest series of patients with CeAD to date, family history of symptomatic CeAD was rare and inherited connective tissue disorders seemed exceptional. This finding supports the notion that CeAD is a multifactorial disease in the vast majority of cases.
Background Frequencies of cognitive impairment and dementia have not been assessed in spontaneous intracerebral hemorrhage (ICH). The objective of this study was to determine the frequencies and ...patterns of cognitive impairment and dementia in a cross-sectional study of consecutive patients hospitalized in a single university medical center. Methods Of 183 consecutive patients hospitalized between 2002 and 2006, 80 survivors were contacted and 78 were included (mean time since stroke 40 months). Thirty patients were scored with the Informant Questionnaire on Cognitive Decline in the Elderly and Instrumental Activities of Daily Living in a telephone interview, and 48 underwent a comprehensive clinical and neuropsychological assessment. Results Dementia was observed in 18 of 78 patients (23%; 95% confidence interval CI 13-32%) and cognitive impairment without dementia was seen in 37 of 48 patients (77%; 95% CI 65-89%). The cognitive disorders mainly concerned episodic memory (52%), psychomotor speed (44%), and executive function (37%), followed by language and visuoconstructive abilities. In a logistic regression analysis, Rankin score >1 at discharge and hemorrhage volume were the initial factors to be selected as a predictor of long-term dementia. Conclusions This single-center, cross-sectional study revealed that the prevalence of dementia and cognitive impairment without dementia after ICH are high and are similar to those observed in cerebral infarct. Further longitudinal, prospective studies are required to assess accurately the prevalence, mechanisms and predictors of post-ICH dementia.
Intracranial artery calcification (IAC) is frequently observed on brain computed tomography (CT) scans in stroke patients. This retrospective study was designed to determine the prevalence, risk ...factors, and clinical relevance of IAC in a cohort of patients with ischemic stroke.
We included all eligible patients admitted to Amiens University Hospital for acute ischemic stroke between January and December 2006 and assessed using 64-slice multidetector-row CT (n = 340). Patients were classified according to the presence or absence of IAC in the internal carotid arteries, middle cerebral arteries, vertebral arteries, and basilar artery. GFR was estimated using the MDRD equation. Chronic kidney disease (CKD) was defined as a GFR < 60 ml/min/1.73 m(2). We also studied a control group of patients admitted for neurologic diseases other than stroke.
Two hundred fifty-nine stroke patients (76.2%) displayed IAC, which was independently associated with carotid atherosclerosis > 50%, age, and GFR. One hundred three nonstroke patients (60.2%) had IAC, with age, arterial hypertension, and GFR as independently associated factors. For all patients taken together, age, arterial hypertension, stroke, and GFR were independently associated with IAC.
These results confirm the high prevalence of IAC in patients with and without ischemic stroke and show for the first time that IAC is associated with the presence of CKD in these patients. The frequency of IAC was significantly higher in stroke patients than in nonstroke patients. The association between IAC and stroke outcome requires further investigation.
To the editor： In migraine with aura （MA）, atypical aura may occur and can raise difficult diagnostic questions due to their clinical expression, their mode of onset or their duration.＇ Differential ...diagnostics, including cerebrovascular disease, must be always considered and brain magnetic resonance imaging （MRI） is usually required to carefully search for the underlying cause. Here we report a patient who presented with neuroradiologic imaging findings during prolonged migraine aura.
A screening test is required to improve the diagnosis of poststroke cognitive impairment. The Montreal Cognitive Assessment (MoCA), a newly designed screening test, has been found to be more ...sensitive than Mini-Mental State Examination (MMSE), but its clinical value has not been established by means of a comprehensive neuropsychological battery. This study was designed to assess the value of MoCA and MMSE to detect poststroke cognitive impairment determined by a neuropsychological battery.
Both screening tests and a neuropsychological battery were administered during the acute phase in 95 patients referred for recent infarct or hemorrhage. Raw MMSE and MoCA scores were used with published cutoffs and new cutoff scores for MMSE and MoCA were also computed after adjustment for age and education.
Using raw scores, MoCA was more frequently impaired (P=0.0001) than MMSE. MoCA showed good sensitivity (sensitivity, 0.94) but moderate specificity (specificity, 0.42; positive predictive value, 0.77; negative predictive value, 0.76), whereas an inverse profile was observed for MMSE (sensitivity, 0.66; specificity, 0.97; positive predictive value, 0.98; negative predictive value, 0.58). Adjusted scores with new cutoffs (MMSE(adj) ≤24, MoCA(adj) ≤20) provided good sensitivity and very good specificity for both tests (MMSE(adj): sensitivity, 0.7, specificity, 0.97, positive predictive value, 0.98, negative predictive value, 0.61; MoCA(adj): sensitivity, 0.67, specificity, 0.9, positive predictive value, 0.93, negative predictive value, 0.57). On receiver operating characteristic curve analysis, areas under the curve of all scores were >0.88.
The previously reported high sensitivity of MoCA is associated with low specificity. Both screening tests are moderately sensitive to acute poststroke cognitive impairment. This study provides indications for the diagnosis of poststroke cognitive impairment.
The use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for ...low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied.
In this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes.
A total of 2860 patients were enrolled and followed for a median of 3.5 years; 1430 were assigned to each LDL cholesterol target group. The mean LDL cholesterol level at baseline was 135 mg per deciliter (3.5 mmol per liter), and the mean achieved LDL cholesterol level was 65 mg per deciliter (1.7 mmol per liter) in the lower-target group and 96 mg per deciliter (2.5 mmol per liter) in the higher-target group. The trial was stopped for administrative reasons after 277 of an anticipated 385 end-point events had occurred. The composite primary end point occurred in 121 patients (8.5%) in the lower-target group and in 156 (10.9%) in the higher-target group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61 to 0.98; P = 0.04). The incidence of intracranial hemorrhage and newly diagnosed diabetes did not differ significantly between the two groups.
After an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter. (Funded by the French Ministry of Health and others; Treat Stroke to Target ClinicalTrials.gov number, NCT01252875.).
ObjectivesDespite its frequency, determinants of poststroke global hypoactivity with apathy (GHA) remain partly defined. This study was aimed at examining the prevalence of GHA, to identify confusing ...sources of hypoactivity and to define its neuroimaging determinants using multivariate Voxel Lesion Symptom-Mapping (mVLSM) analyses.ContentMethods: In a subgroup of 325 patients of GRECogVASC cohort, GHA was assessed as well as confusing factors (depression, anxiety, severity of neurological deficit and gait disorders). Results: GHA was present in 120 patients (36.9%, 95%CI: 31.7–42.2) and was associated with depressive symptoms (R2 = 0.3, p = 0.0001), cognitive impairment (R2 = 0.015, p = 0.02) and neurological deficit (R2 = 0.110, p = 0.0001). Accordingly 9 (7.5%) patients only had GHA without confusing factor, i.e., primary GHA. In conventional VLSM analysis, GHA was associated with a large number of subcortical lesions that vanished after controlling for confusing factors. mVLSM analysis selected 4 strategic sites associated with GHA: right corticospinal tract (R2 = 0.11; p = 0.0001), left frontostriatal tract (R2 = 0.11; p = 0.0001), left thalamus (R2 = 0.04; p = 0.0001) and left amygdala (R2 = 0.01; p = 0.013). After controlling for confusion factors, these regions remained significant but explained a lower amount of variance. Conclusion: Our findings support that poststroke GHA is mainly due to associated disorders such as depression, neurological deficit, and cognitive impairment and to a lower extent to specific lesion locations, 4 of them (right corticospinal tract, left frontostriatal tract, mediodorsal thalamus and amygdala) found to be independent.
Des marqueurs pronostiques cliniques et radiologiques de l’infarctus cérébral sont décrits. Peu d’études se sont intéressées aux D-Dimères dans l’évaluation pronostique de l’infarctus cérébral après ...procédure de revascularisation.
L’objectif principal était la recherche d’une relation entre le score de Rankin à 3–6 mois et les D-dimères après un infarctus cérébral du sujet jeune traité par revascularisation.
Cent deux patients de moins de 65 ans, ayant présenté un infarctus cérébral au CHU d’Amiens entre janvier 2015 et décembre 2020, avec un dosage des D-dimères disponible, ont été inclus rétrospectivement. Nous avons étudié la relation entre le dosage des D-dimères et les scores de Rankin et NIHSS à 3–6 mois.
Nous avons démontré une relation significative entre l’élévation des D-dimères et le score de Rankin. Cette relation était valable avec le score NIHSS. L’étude en sous-groupe a suggéré une relation entre l’élévation des D-dimères et une diminution de la différence de score NIHSS entre l’entrée et la sortie d’hospitalisation, c’est-à-dire une évolution clinique défavorable.
Nos résultats étaient concordants avec les données de la littérature et apportaient plus de précision chez la population jeune ayant bénéficié d’une procédure de revascularisation. La poursuite d’investigations concernant les D-dimères, par exemple l’étude de leur cinétique, dans le pronostic post-infarctus cérébral paraît intéressante afin d’optimiser la prise en charge de tels patients.
Notre travail permet de montrer l’intérêt du dosage des D-dimères dans l’évaluation pronostique des infarctus cérébraux du sujet jeune.
Les troubles neurocognitifs post-AVC concernent 53,4 % des patients après un AVC, dont 2/3 au stade léger. Le mécanisme de ces troubles reste difficile à préciser, et il existe un phénotype clinique ...Alzheimer dans 1/3 des cas.
Étude du devenir cognitif post AVC chez des patients ayant présenté une perturbation cognitive post-AVC, de par un bilan neuropsychologique (NP), en fonction du statut amyloïde, analysé par tomographie par émission de positons (TEP) au F18-Florbetapir.
La relation entre statut cognitif et amyloïde, était analysée par une courbe de survie de Kaplan Meier avec tests du LogRank de Mantel Cox. Ont été étudiés aussi, la relation entre le statut amyloïde et troubles cognitifs majeurs, ou concernant un sous domaine. Les caractéristiques des patients ont été soumis à une régression factorielle rétrograde.
La fréquence des TEP amyloïdes positifs était de 14 sur les 91 patients soit 15,4 %.
La présence d’un déficit cognitif post-AVC est significativement associée à la présence d’une TEP amyloïde positive (p=0,0001). La présence d’un trouble cognitif majeur est associée à une TEP amyloïde positive (p=0,003), comme le sont les troubles affectant la mémoire (p=0,003) et le langage (p=0,002).
Les facteurs, âge à l’AVC (p=0,005) et IADL cognitif pré-AVC (p=0,0001) sont associés à la survenue d’un déficit cognitif.
Notre étude conforte les résultats sur le MMSE de Mok et al., avec un effectif plus important, un suivi plus long et un bilan NP complet. Quant aux 2 autres études s’étant intéressées au sujet, elles sont négatives et la discordance avec notre étude peut s’expliquer par leur manque de puissance et l’attrition.
L’amyloïdopathie est associée premièrement, à la survenue d’un déficit cognitif, deuxièmement à la survenue d’un trouble cognitif majeur, et d’un trouble concernant les domaines de la mémoire et du langage.
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