Background and purpose
Recently, brain and vascular imaging have been added to clinical variables to identify patients with transient ischaemic attack (TIA) with a high risk of stroke recurrence. The ...aim of our study was to externally validate the ABCD3‐I score and the same score taking into account intracranial circulation.
Methods
We analyzed data from 1137 patients with TIA from the PROMAPA study who underwent diffusion‐weighted magnetic resonance imaging (DWI) within 7 days of symptom onset. Clinical variables and diagnostic work‐up were recorded prospectively. The end‐points were subsequent stroke at 7 and 90 days follow‐up.
Results
A total of 463 (40.7%) subjects fulfilled all inclusion criteria. During follow‐up, eight patients (1.7%) had a stroke within 7 days, and 14 (3.1%) had a stroke within 3 months. In the Cox proportional hazard multivariate analyses, the combination of large‐artery atherosclerosis and positive DWI remained as independent predictors of stroke recurrence at 7‐ and 90‐day follow‐up HR 8.23, 95% confidence interval (CI) 2.89–23.46, P < 0.001. The ABCD3‐I score was a powerful predictor of subsequent stroke. The area under the receiver operating characteristic curve was 0.83 (95% CI 0.72–0.93) at 7 days and 0.69 (95% CI 0.53–0.85) at 90 days. When we include intracranial vessel disease in the score, the area under the curve increases but the difference observed was non‐significant.
Conclusion
The inclusion of vascular and neuroimaging information to clinical scales (ABCD3‐I score) provides important prognostic information and also helps management decisions, although it cannot give a complete distinction between high‐risk and low‐risk groups.
A full comparison of the satisfaction with treatment using the current Alzheimer's disease (AD) therapies from the perspective of caregivers has not yet been done. The aim of this study was thus to ...find out the degree of satisfaction with the main available drug treatments in monotherapy for AD from this point of view.
A cross-sectional, multicentre study of patients with possible/probable AD according to DSM-IV/NINCDS-ADRDA criteria, on monotherapy with donepezil, galantamine, rivastigmine or memantine, was carried out. Treatment satisfaction was measured by a caregiver proxy-administration of the generic SATMED-Q questionnaire range: 0 (not satisfied at all) to 100 (totally satisfied), overall and in 6 domains: tolerability, efficacy, medical care, ease and convenience, impact on daily activities and overall satisfaction.
A total of 829 patients were included: 63.3% women, aged 78.2 +/- 6.8 years; 546 (67.3%) on donepezil, 106 (13.1%) on rivastigmine, 99 (12.2%) on galantamine and 60 (7.4%) on memantine. SATMED-Q scores p values were adjusted by MMSE and treatment duration. Caregivers of patients on donepezil showed significantly higher SATMED-Q total (71.8 +/- 12.3; p < 0.05) and overall satisfaction domain scores (81.6 +/- 18.4; p < 0.01) than those of patients on any other drugs, as well as significantly higher ease and convenience of use domain (81.5 +/- 17.4; p < 0.01) and undesirable effects domain (96.0 +/- 12.9; p < 0.05) scores than those of rivastigmine- and galantamine-treated patients. Of the caregivers of donepezil-treated patients, 76.7% were satisfied with treatment versus 68.7, 61.4 and 46.7% of those caregivers whose patients were treated with galantamine, rivastigmine and memantine, respectively (p = 0.0002).
Caregivers of AD patients undergoing donepezil monotherapy seem to be more satisfied with treatment than those of patients receiving the other usual AD treatments in this study, particularly due to the ease and convenience of use of this drug. The higher level of satisfaction of these caregivers could be explained by the fact that, within the donepezil group, a high percentage of patients were treated with orally disintegrating tablets, which are easier for the patient to swallow.
The highest risk of subsequent stroke after a TIA occurs within the first week after the index event. However, the risk of stroke recurrence (SR) remains high during the first year of follow-up. We ...studied the temporal pattern and predictors of SR (at 7 days and from 7 days to 1-year follow-up). Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). We determined the short-term (at 7 days) and long-term (from 8 days to 1 year) risk of SR. Patients who underwent short-term recurrence and long-term recurrence were compared with regard to clinical findings, vascular territories, and etiology. Enough information (clinical variables and extracranial vascular imaging) was assessed in 1,137 (90.6 %) patients. The 7-day stroke risk was 2.6 %. 32 (3.0 %) patients had an SR after 7-day follow-up. Multiple TIA (HR 3.50, 1.67–7.35,
p
= 0.001) and large artery atherosclerosis (HR 2.51, 1.17–5.37,
p
= 0.018) were independent predictors of early SR, whereas previous stroke (HR 1.40, 1.03–1.92,
p
= 0.034) and coronary heart disease (2.65, 1.28–5.50,
p
= 0.009) were independent predictors of late SR. Notoriously, 80 % of SR happened in the same territory of the index TIA at 7-day follow-up, whereas only 38 % during the long-term follow-up (
p
< 0.001). Different predictors of SR were identified throughout the follow-up period. Moreover, the ischemic mechanism differed in early and late stroke recurrences.
Short-lasting unilateral neuralgiform headache with conjuntival injection and tearing (SUNCT) syndrome is a rare trigeminal autonomic cephalalgia. We report a patient with prolactinoma and ...cabergoline-induced SUNCT attacks and the literature is reviewed for a better understanding of the pathophysiology.
PDF
