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Behzadi F, Luy DD, Zsigray B, Uram Z, Iordanou J, Ng IB, Zywiciel JF, Germanwala AV. Posterior Circulation Ischemic Stroke Is Associated with More Severe Forward Head Posture in Patients with Cervicalgia. World Neurosurg 2024:S1878-8750(24)01320-2. [PMID: 39089651 DOI: 10.1016/j.wneu.2024.07.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Chronic risk factors of posterior circulation ischemic strokes remain unknown. There is, however, evidence that anatomical variations within the vertebrobasilar system could potentially lead to the development of posterior circulation strokes. We investigated the association of forward head posturing (FHP), a chronic anatomical change seen in patients with cervicalgia, with posterior circulation strokes. METHODS In this case-control study, we identified adult patients diagnosed with cervicalgia and ischemic posterior circulation infarcts from 2007 to 2023. Cases were paired with controls with cervicalgia without posterior circulation stroke and matched for known risk factors. C0-C2 angle, C2-C7 angle, and sagittal vertical axis shift were measured as metrics for FHP severity on lateral cervical spine x-rays. Paired t tests were applied to compare stroke risk factors and FHP between groups. RESULTS Participants included 206 patients (103 cases and 103 controls) with a mean age of 64.4 years; 51.5% were female. There were no statistically significant differences between risk factors for stroke, including hypertension, hyperlipidemia, diabetes, smoking, hypercoagulable state, and atrial fibrillation. There were statistically significant differences in C0-C2 angle (30.7° vs. 23.2°, P = 0.002) and sagittal vertical axis shift (35.4 mm vs. 25.3 mm, P < 0.001). CONCLUSIONS This case-control matched-pair study found that in adults with cervicalgia, posterior circulation ischemic stroke was associated with more severe FHP as noted in C0-C2 angle and sagittal vertical axis shift measurements. Further, this association may be due to chronic changes in circulation flow dynamics within the vertebrobasilar system with the postural change.
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Affiliation(s)
- Faraz Behzadi
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Diego D Luy
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Brandon Zsigray
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Zachary Uram
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jordan Iordanou
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Isaac B Ng
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Joseph F Zywiciel
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Anand V Germanwala
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
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Shahid R. Demographic Characteristics and Functional Outcome in Posterior Circulation Strokes. Ann Afr Med 2024; 23:328-334. [PMID: 39034555 PMCID: PMC11364332 DOI: 10.4103/aam.aam_196_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/08/2024] [Accepted: 02/22/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION The constantly increasing incidence of stroke in Saudi Arabia substantiates an urgent need to elucidate underlying risk factors and etiologies. In terms of improving outcomes, the predictors of functional outcomes need to be identified as well. As posterior circulation strokes (PCS) have not been studied in detail, the current study aimed to identify the risk factors, etiology, and predictors of outcome in PCS. METHODS This retrospective study included the data for 138 patients with PCS. Demographics, risk factors, clinical signs/symptoms, etiology, and outcome at discharge and 3-month follow-up were recorded. Factors associated with outcomes were identified, and the difference was ascertained using Chi-square, odds ratios, and 95% confidence intervals. RESULTS The mean participant age was 58 ± 14.8 years with 73% being males. The mean arrival time was 26.5 ± 31.6 h; with a mean National Institute of Health Stroke scale (NIHSS) score of 7.2 ± 5.6. Motor deficit and dysarthria were the most common presentations. Twenty percent of patients received intravenous recombinant tissue plasminogen activator, whereas endovascular thrombectomy was performed in 9 (6.5%). Follow-up outcome at 3 months was available in 113 (81.8%). Male sex, baseline modified Rankin scale of <2, low baseline NIHSS, and stable or improvement in baseline NIHSS during 24 h of admission were documented as predictors of a good outcome, whereas history of atrial fibrillation and prior stroke, high NIHSS at admission and worsening of symptoms during 24 h of admission, as well as bilateral body involvement were associated with poor outcome. CONCLUSION The functional outcomes and the predictors of functional outcomes did not differ from the previously published literature; however, significant differences were observed in the risk factors and etiological profile in our population. These differences are of potential interest to the researchers and clinicians, as they carry important therapeutic and prognostic implications and need to be verified through large prospective studies.
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Affiliation(s)
- Rizwana Shahid
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Aldriweesh MA, Aldbas AA, Khojah O, Yonbawi F, Shafaay EA, Aljahdali GL, Alshalhoub M, Bukhari MK, Qari Y, Almuntashri MM, Alshaikh AA, Alotaibi N, Almuntashri MA, Khathaami AMA, Makkawi S, Ghamdi SA. Clinical characteristics, Risk factors, and outcomes of Posterior circulation stroke: A retrospective study between younger and older adults in Saudi Arabia. J Stroke Cerebrovasc Dis 2024; 33:107676. [PMID: 38492657 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/13/2024] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION Posterior circulation stroke (PCS) may be less prevalent than its anterior counterpart but contributes to substantial morbidity and mortality. The aim was to characterize PCS's demographics, clinical presentation, management, and outcomes between younger and older adults in Saudi Arabia. METHODS This retrospective cohort study was conducted at two tertiary medical centers in Saudi Arabia between March 2016 and December 2020. All patients who presented with symptoms of posterior circulation stroke and had positive brain imaging were included. RESULTS The study involved 160 posterior circulation stroke patients, stratified into two age groups: 71 patients aged 18-59 years and 89 patients aged 60 years and above. The mean age of the entire cohort was 60.9 years, and 77 % were males. Hypertension was more prevalent in the older age group (88 % vs. 69 %, p=0.005), and smoking was significantly higher among younger patients (38 % vs. 15 %; p=0.0009). Only 22.4 % received thrombolysis and/or thrombectomy. Most strokes involved the posterior cerebral artery (45.6 %). Large artery atherosclerosis was the most common subtype. At discharge, younger patients had higher NIHSS compared to older patients. CONCLUSION Our investigation of 160 PCS patients in Saudi Arabia uncovers notable trends: a mere 22.4 % received thrombolysis and/or thrombectomy and a significant prevalence of posterior cerebral artery involvement due to large artery atherosclerosis. The study further reveals younger patients disproportionately had severe outcomes. Highlighting the need for improved stroke care and heightened awareness, this research contributes vital data to an underexplored domain, urging further study to optimize care and understand PCS dynamics in Saudi Arabia.
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Affiliation(s)
- Mohammed A Aldriweesh
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz A Aldbas
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Osama Khojah
- Department of Neurosciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Faisal Yonbawi
- Department of Neurosciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Edi A Shafaay
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Ghadeer L Aljahdali
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshalhoub
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; Emergency Department, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Khalid Bukhari
- Emergency Department, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia
| | - Yousef Qari
- King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia; Department of Neurology, King Abdullah Medical Complex, Ministry of Health, Jeddah, Kingdom of Saudi Arabia
| | - Manar M Almuntashri
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Aljoharah A Alshaikh
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; Neuroradiology Department, King Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia
| | - Naser Alotaibi
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Makki A Almuntashri
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; Neuroradiology Department, King Abdulaziz Medical City Riyadh, Kingdom of Saudi Arabia
| | - Ali M Al Khathaami
- Department of Neurology, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Seraj Makkawi
- Department of Neurosciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Saeed Al Ghamdi
- Division of Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center Jeddah, Kingdom of Saudi Arabia.
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Imam YZ, Chandra P, Singh R, Hakeem I, Al Sirhan S, Kotob M, Akhtar N, Kamran S, Al Jerdi S, Muhammad A, Haroon KH, Hussain S, Perkins JD, Elalamy O, Alhatou M, Ali L, Abdelmoneim MS, Joseph S, Morgan D, Uy RT, Bhutta Z, Azad A, Ayyad A, Elsotouhy A, Own A, Deleu D. Incidence, clinical features, and outcomes of posterior circulation ischemic stroke: insights from a large multiethnic stroke database. Front Neurol 2024; 15:1302298. [PMID: 38385041 PMCID: PMC10879388 DOI: 10.3389/fneur.2024.1302298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024] Open
Abstract
Background Posterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts. Methods A retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others. Results In total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p < 0.05). Dependency or death at discharge was seen in 39.5% and was associated with increasing age, and proximal and multilocation involvement; while at 90 days it was 27.4% and was associated with age, male sex, and having a MENA nationality (p < 0.05). Conclusion In a multiethnic cohort of posterior circulation stroke patients from the MENA region and South Asia, we noted a rising incidence over time, high prevalence of vascular risk factors, and poor outcomes in older men from the MENA region. We also uncovered considerable disparities between the MENA and non-MENA groups in stroke location and outcome. These disparities are crucial factors to consider when tailoring individualized patient care plans. Further research is needed to thoroughly investigate the underlying reasons for these variations.
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Affiliation(s)
- Yahia Z. Imam
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Prem Chandra
- Statistics, Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Ishrat Hakeem
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Mona Kotob
- College of Medicine, Qatar University, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Saadat Kamran
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Ahmad Muhammad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Suhail Hussain
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Jon D. Perkins
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Osama Elalamy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Mohamed Alhatou
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Liaquat Ali
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sujatha Joseph
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Ty Uy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Zain Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Azad
- College of Medicine, Qatar University, Doha, Qatar
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Ali Ayyad
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Elsotouhy
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Dirk Deleu
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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Pelletier J, Koyfman A, Long B. Pearls for the Emergency Clinician: Posterior Circulation Stroke. J Emerg Med 2023; 65:e414-e426. [PMID: 37806810 DOI: 10.1016/j.jemermed.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Posterior circulation (PC) stroke in adults is a rare, frequently misdiagnosed, serious condition that carries a high rate of morbidity. OBJECTIVE OF THE REVIEW This review evaluates the presentation, diagnosis, and management of PC stroke in the emergency department (ED) based on current evidence. DISCUSSION PC stroke presents most commonly with dizziness or vertigo and must be distinguished from more benign diagnoses. Emergency clinicians should consider this condition in patients with dizziness, even in younger patients and those who do not have traditional stroke risk factors. Neurologic examination for focal neurologic deficit, dysmetria, dysarthria, ataxia, and truncal ataxia is essential, as is the differentiation of acute vestibular syndrome vs. spontaneous episodic vestibular syndrome vs. triggered episodic vestibular syndrome. The HINTS (head impulse, nystagmus, and test of skew) examination can be useful for identifying dizziness presentations concerning for stroke when performed by those with appropriate training. However, it should only be used in patients with continuous dizziness who have ongoing nystagmus. Contrast tomography (CT), CT angiography, and CT perfusion have limited sensitivity for identifying PC strokes, and although magnetic resonance imaging is the gold standard, it may miss some PC strokes early in their course. Thrombolysis is recommended in patients presenting within the appropriate time window for thrombolytic therapy, and although some data suggest endovascular therapy for basilar artery and posterior cerebral artery infarcts is beneficial, its applicability for all PC strokes remains to be determined. CONCLUSIONS An understanding of PC stroke can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, Texas
| | - Brit Long
- San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.
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Lu WT, Du WT, Lu DS, You J, Li HY. Predictive value of serum initial brain natriuretic peptide and troponin on functional prognosis in noncardiogenic patients with anterior and posterior circulation cerebral infarction. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:985-993. [PMID: 36535282 PMCID: PMC9770063 DOI: 10.1055/s-0042-1755270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) and troponin have a close relationship with cardiogenic cerebral embolism (CCE), but their relationship with noncardiogenic patients with anterior circulation ischemia (ACI) and posterior circulation ischemia (PCI) is not clear. OBJECTIVE To explore the predictive value of serum initial BNP and troponin on the functional prognosis of patients with noncardiogenic ACI and PCI. METHODS Consecutive patients with first-episode cerebral infarction within 12 hours of symptom onset were enrolled in the present 1-year prospective cohort study. Serum levels of BNP and troponin were collected within 12 hours of onset. Infarction location was classified as ACI and PCI by magnetic resonance imaging (MRI). According to the modified Rankin Scale (mRS) score at 90 days after onset, ACI and PCI cases were respectively divided into a good prognosis group (mRS score between 0 and 2) and a poor prognosis group (mRS score between 3 and 6). The general state of health and results of laboratory examinations and other auxiliary examinations of all patients were recorded. Single-factor analysis and multivariate logistic regression analysis were used to assess the relationship between serum levels of BNP, troponin, and functional outcome. RESULTS The multivariate logistic regression found that higher levels of initial BNP (odds ratio [OR] = 1.024; 95% confidence interval [CI]: 1.006-1.041; p = 0.007) and C-reactive protein (CRP) (OR = 1.184; 95%CI: 1.024-1.369; p = 0.022) were independent predictors of poor functional prognosis of noncardiogenic PCI at 90 days after onset after adjusting for age, gender, ethnicity, history of hypertension and of diabetes. CONCLUSIONS The levels of initial BNP and CRP were related to poor functional outcomes in noncardiogenic PCI patients at 3 months, independent of troponin.
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Affiliation(s)
- Wan-Ting Lu
- People's Hospital of Xinjiang Uygur Autonomous Region, Department of Neurology, Urumqi, China.
| | - Wen-Ting Du
- People's Hospital of Xinjiang Uygur Autonomous Region, Department of Neurology, Urumqi, China.,Xinjiang Medical University, Department of Postgraduate, Urumqi, China.
| | - De-Sheng Lu
- Shihezi People's Hospital, Department of Neurosurgery, Shihezi, China.
| | - Jie You
- Xinjiang Medical University, Department of Postgraduate, Urumqi, China.
| | - Hong-yan Li
- People's Hospital of Xinjiang Uygur Autonomous Region, Department of Neurology, Urumqi, China.,Address for correspondence Hong-yan Li
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Feng Y, Liu J, Fan T, Zhang W, Yin X, E Y, Tan W, Huo Y. Vertebral Artery Stenoses Contribute to the Development of Diffuse Plaques in the Basilar Artery. Front Bioeng Biotechnol 2020; 8:168. [PMID: 32211395 PMCID: PMC7068210 DOI: 10.3389/fbioe.2020.00168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/19/2020] [Indexed: 12/19/2022] Open
Abstract
Vertebral artery (VA) stenosis is relevant to a high early risk of recurrent stroke and basilar artery (BA) is the most common intracranial site of atherosclerotic lesions. It is important to show predictive risk factors for transient ischemic attack (TIA) or posterior infarctions. The aim of the study is to investigate morphometry and hemodynamics in intracranial vertebral and basilar arteries of health and diseased patients to enhance the risk assessment. Based on the geometrical model reconstructed from CTA images in 343 patients, a transient three-dimensional computational model was used to determine the hemodynamics. Patients were classified in symmetric, asymmetric, hypoplastic, and stenotic groups while patients in the stenotic group were divided into unilateral, bilateral, bifurcation, and tandem stenotic sub-groups. Patients in bilateral, bifurcation, and tandem stenotic sub-groups had significantly lower basilar artery diameters than other groups. Patients in the stenotic group had significantly higher surface area ratio (SAR) of high time-averaged wall shear stress gradient (TAWSSG) and higher incidence of TIAs or posterior infarctions than other groups while patients in the tandem stenotic sub-group had the highest values (SAR-TAWSSG of 57 ± 22% and TIAs or posterior infarction incidence of 54%). The high SAR-TAWSSG is predisposed to induce TIAs or posterior infarction.
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Affiliation(s)
- Yundi Feng
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Tingting Fan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Wenxi Zhang
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Xiaoping Yin
- Department of Radiology, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
| | - Yajun E
- Department of Neurology, Affiliated Hospital of Hebei University, Hebei University, Baoding, China
| | - Wenchang Tan
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China.,PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.,Shenzhen Graduate School, Peking University, Shenzhen, China
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China.,Institute of Mechanobiology & Medical Engineering, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
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8
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Wijesinghe P, Steinbusch HWM, Shankar SK, Yasha TC, De Silva KRD. Circle of Willis abnormalities and their clinical importance in ageing brains: A cadaveric anatomical and pathological study. J Chem Neuroanat 2020; 106:101772. [PMID: 32165168 DOI: 10.1016/j.jchemneu.2020.101772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 01/30/2023]
Abstract
The circle of Willis (CW) located at the base of the brain forms an important collateral network to maintain adequate cerebral perfusion, especially in clinical situations requiring compensatory changes in blood flow. Morphopathological changes in the CW may relate to the severity of the symptoms of certain neurodegenerative and cerebrovascular disorders. The purpose of this study was to investigate the CW abnormalities and their clinical importance in ageing brains. The CW was examined macroscopically in 73 formalin-fixed samples to determine the degree of stenosis of each CW component, atherosclerosis of the CW, hypoplasia (threshold diameter < 1 mm), anatomical variations and aneurysms. Age-related neurodegenerative and cerebrovascular pathologies were screened using immunohistopathological techniques on specific neuroanatomical regions based on standard guidelines. The majority of the elderly brains -93 % (68/73) presented at least a single hypoplastic CW component at death. Anatomical variations were mostly identified in communicating arteries, followed by proximal posterior and anterior cerebral arteries. Arterial bifurcations were found to be the predominant sites for cerebral aneurysms. More than 90 % of the elderly brains presented CW atherosclerosis at death. CW abnormalities did not show any strong associations with neurodegenerative pathologies except for an "at risk" significant association observed between Braak's neurofibrillary tangle (NFT) stages 1-VI and CW atherosclerosis grades ≥ mild (p = 0.05). However, a significant association was observed between microscopic infarcts in deep white matter and hypoplasia in communicating arteries with Fisher's exact test (p < 0.05). Overall, CW abnormalities were predominant in the ageing brains, however their relationships to the occurrence and severity of the symptoms of neurodegenerative pathologies were found to be low.
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Affiliation(s)
- P Wijesinghe
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic & Research Laboratory and Human Brain Tissue and DNA Repository, Dept. Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; EURON - European Graduate School of Neuroscience, Maastricht, The Netherlands
| | - H W M Steinbusch
- Dept. Translational Neuroscience, Faculty Health, Medicine & Life Sciences, University of Maastricht, Maastricht, Netherlands; EURON - European Graduate School of Neuroscience, Maastricht, The Netherlands
| | - S K Shankar
- Dept. Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - T C Yasha
- Dept. Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - K R D De Silva
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic & Research Laboratory and Human Brain Tissue and DNA Repository, Dept. Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka; EURON - European Graduate School of Neuroscience, Maastricht, The Netherlands.
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Posterior circulation ischaemic stroke-a review part I: anatomy, aetiology and clinical presentations. Neurol Sci 2019; 40:1995-2006. [PMID: 31222544 DOI: 10.1007/s10072-019-03977-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
Posterior circulation ischaemia is a clinicopathological condition with complex symptomatology associated with an infarction within the vertebrobasilar arterial system. Posterior circulation strokes account for about 20-25% of all ischemic strokes and remain a significant cause of patient disability and mortality. Diagnosis can be challenging because presenting symptoms are often non-focal and because there is a substantial overlap in symptoms and signs of ischaemia in the anterior circulation. Despite better imaging techniques, diagnosis and treatment of life-threatening conditions, such as basilar artery occlusions, are often delayed. Therefore, early detection of symptoms and causes of posterior circulation ischaemia is essential for choosing the most appropriate therapy. In this review, we summarise the anatomy, aetiology, typical presentations and characteristic findings of common strokes resulting from disease in the vertebrobasilar arterial system.
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Dorňák T, Král M, Šaňák D, Kaňovský P. Intravenous Thrombolysis in Posterior Circulation Stroke. Front Neurol 2019; 10:417. [PMID: 31080436 PMCID: PMC6497784 DOI: 10.3389/fneur.2019.00417] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/05/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischemic stroke (ACIS) and posterior circulation ischemic stroke (PCIS). PCIS is a clinical syndrome associated with ischemia-related changes in the territory of the posterior circulation arteries. Embolism is the most common stroke mechanism in posterior circulation. PCIS represents 12–19% of all IVT-treated strokes. Methods and Results: We searched the PubMed database for assessments of intracerebral hemorrhage (ICH) and clinical outcome in PCIS patients treated with IVT. ICH occurs in 0–6.9% of posterior ischemic stroke depending on the definition of symptomatic ICH, and any ICH in 17–23.4% of posterior ischemic stroke. For patients with PCIS, 38–49% have a favorable outcome (mRS 0–1) after IVT. Better clinical outcomes occur more often in patients with PCIS than in those with ACIS. The mortality rate among PCIS patients treated with IVT ranges from 9 to 19%; it does not differ significantly between PCIS and ACIS. Conclusions: Up to date, no data about PCIS and IVT are available from RTCs. Based on limited results from retrospective clinical studies and case series, IVT is safer for use in PCIS than in ACIS. Patients with brainstem ischemia, vertebral artery occlusion, and absence of basilar or posterior cerebral artery occlusion could be considered for treatment with IVT even in borderline cases. Time to IVT in PCIS seems to be a less crucial factor than in ACIS. IVT for PCIS may be beneficial even after 4.5 h from symptom onset.
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Affiliation(s)
- Tomáš Dorňák
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
| | - Michal Král
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
| | - Daniel Šaňák
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
| | - Petr Kaňovský
- Department of Neurology, Palacky University and University Hospital, Olomouc, Czechia
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Pierik R, Uyttenboogaart M, Erasmus ME, Scheeren TWL, van den Bergh WM. Distribution of perioperative stroke in cardiac surgery. Eur J Neurol 2018; 26:184-190. [PMID: 30152579 PMCID: PMC6585627 DOI: 10.1111/ene.13793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/09/2018] [Indexed: 01/15/2023]
Abstract
Background and purpose The recent literature suggests that a cardiac origin in ischaemic stroke is more frequent than previously assumed. However, it is not always clear which patients benefit from additional cardiac investigations if obvious cardiac pathology is absent. Methods A single‐center retrospective observational study was performed with 7454 consecutive patients admitted to the intensive care unit after cardiac surgery in the period 2006–2015 and who had postoperative brain imaging. Cerebral imaging was studied for the occurrence of stroke including subtype and involved vascular territory. It was assumed that all perioperative thromboembolic strokes are of cardiac origin. Data obtained from a hospital cohort of consecutive patients who received a diagnosis of ischaemic stroke were used for comparison. Results Thromboembolic stroke occurred in 135 cardiac surgery patients in 56 (41%) of whom the posterior cerebral circulation was involved. In the control group, 100 out of 503 strokes (20%) were located in the posterior cerebral circulation. The relative risk for a posterior location for stroke after cardiac surgery compared to patients with ischaemic stroke without prior cardiac surgery was 2.09; 95% confidence interval 1.60–2.72. Conclusions Thromboembolic stroke after cardiac surgery occurs twice as often in the posterior cerebral circulation compared to ischaemic strokes in the general population. If confirmed in general stroke cohorts, the consequence of this finding may be that in patients with an ischaemic stroke that involves the posterior cerebral circulation the chance of a cardiac origin is increased and therefore might trigger additional cardiac investigations such as long‐term heart rhythm monitoring or echocardiography.
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Affiliation(s)
- R Pierik
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M E Erasmus
- Department of Cardiac Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Wijesinghe P, Shankar SK, Yasha TC, Gorrie C, Amaratunga D, Hulathduwa S, Kumara KS, Samarasinghe K, Suh YH, Steinbusch HWM, De Silva KRD. Vascular Contributions in Alzheimer's Disease-Related Neuropathological Changes: First Autopsy Evidence from a South Asian Aging Population. J Alzheimers Dis 2018; 54:1607-1618. [PMID: 27589527 DOI: 10.3233/jad-160425] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Evidence from various consortia on vascular contributions has been inconsistent in determining the etiology of sporadic Alzheimer's disease (AD). OBJECTIVE To investigate vascular risk factors and cerebrovascular pathologies associated in manifestation of AD-related neuropathological changes of an elderly population. METHODS Postmortem brain samples from 76 elderly subjects (≥50 years) were used to study genetic polymorphisms, intracranial atherosclerosis of the circle of Willis (IASCW), and microscopic infarcts in deep white matters. From this cohort, 50 brains (≥60 years) were subjected to neuropathological diagnosis using immunohistopathological techniques. RESULTS Besides the association with age, the apolipoprotein E ɛ4 allele was significantly and strongly associated with Thal amyloid-β phases ≥1 [odds ratio (OR) = 6.76, 95% confidence interval (CI) 1.37-33.45] and inversely with Braak neurofibrillary tangle (NFT) stages ≥III (0.02, 0.0-0.47). Illiterates showed a significant positive association for Braak NFT stages ≥IV (14.62, 1.21-176.73) and a significant negative association for microscopic infarcts (0.15, 0.03-0.71) in deep white matters. With respect to cerebrovascular pathologies, cerebral small vessel lesions (white matter hyperintensities and cerebral amyloid angiopathy) showed a higher degree of associations among them and with AD-related neuropathological changes (p < 0.05) compared to large vessel pathology (IASCW), which showed a significant association only with Braak NFT stages ≥I (p = 0.050). CONCLUSION These findings suggest that besides age, education, and genetic factors, other vascular risk factors were not associated with AD-related neuropathological changes and urge prompt actions be taken against cerebral small vessel diseases since evidence for effective prevention is still lacking.
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Affiliation(s)
- Printha Wijesinghe
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic and Research Laboratory, Department of Anatomy, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - S K Shankar
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - T C Yasha
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Catherine Gorrie
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, Australia
| | | | - Sanjayah Hulathduwa
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - K Sunil Kumara
- Department of Judicial Medical Office, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | - Kamani Samarasinghe
- Department of Pathology, University of Srijayewardenepura, Nugegoda, Sri Lanka
| | - Yoo-Hun Suh
- Department of Pharmacology, College of Medicine, Seoul National University, Seoul, Korea.,NRI, Gachon University, Incheon, South Korea
| | - Harry W M Steinbusch
- Department of Translational Neuroscience, Faculty Health, Medicine & Life Sciences, Maastricht University, Maastricht, Netherlands
| | - K Ranil D De Silva
- Interdisciplinary Center for Innovation in Biotechnology & Neuroscience, Genetic Diagnostic and Research Laboratory, Department of Anatomy, Faculty of Medical Sciences, University of Srijayewardenepura, Nugegoda, Sri Lanka
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Dorňák T, Král M, Sedláčková Z, Šaňák D, Čecháková E, Divišová P, Zapletalová J, Kaňovský P. Predictors for Intracranial Hemorrhage Following Intravenous Thrombolysis in Posterior Circulation Stroke. Transl Stroke Res 2018; 9:582-588. [PMID: 29333567 DOI: 10.1007/s12975-018-0608-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 01/01/2018] [Accepted: 01/05/2018] [Indexed: 01/10/2023]
Abstract
Intravenous thrombolysis (IVT) is a standard treatment for anterior (ACS) and posterior circulation stroke (PCS). However, due to the low occurrence of PCS and of intracranial hemorrhage (ICH) in PCS, the knowledge about ICH predictors following IVT in PCS is sparse. Our aim was to identify predictors for ICH following IVT in PCS. The set consisted of 1281 consecutive ischemic stroke (IS) patients treated with IVT, out of which 158 (103 males; mean age 65.6 ± 12.3 years) had PCS. Collected data include baseline characteristics, common stroke risk factors, pre-medication, stroke severity, admission blood glucose level, blood pressure and treatment with intravenous antihypertensive therapy before and during IVT, occlusion of arteries, recanalization rate, time to treatment, and clinical outcome at day 90. Overall, 11 (7%) patients had ICH. Atrial fibrillation (p = 0.004), neurological deficit at time of treatment in the National Institutes of Health Stroke Scale (p = 0.016), decreased level of consciousness (p = 0.003), occlusion of basilar artery (p = 0.007), occlusion of PCA (p = 0.001), and additional endovascular therapy (p = 0.001) were identified by logistic regression analysis as significant predictors for ICH in PCS. Patients with ischemic lesion in the brainstem, occlusion of vertebral artery, or absence of basilar and posterior cerebral artery occlusion might be considered for treatment with IVT even in borderline cases. Those patients seem to have less frequently favorable outcomes without an increase in ICH rate. Time to IVT in PCS seems not to influence ICH risk or chances for favorable outcomes as significantly as it does in ACS.
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Affiliation(s)
- Tomáš Dorňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University and University Hospital Olomouc, I. P. Pavlova 6, CZ-775 20, Olomouc, Czech Republic.
| | - Michal Král
- Comprehensive Stroke Center, Department of Neurology, Palacký University and University Hospital Olomouc, I. P. Pavlova 6, CZ-775 20, Olomouc, Czech Republic
| | - Zuzana Sedláčková
- Comprehensive Stroke Center, Department of Radiology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University and University Hospital Olomouc, I. P. Pavlova 6, CZ-775 20, Olomouc, Czech Republic
| | - Eva Čecháková
- Comprehensive Stroke Center, Department of Radiology, Palacký University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Petra Divišová
- Comprehensive Stroke Center, Department of Neurology, Palacký University and University Hospital Olomouc, I. P. Pavlova 6, CZ-775 20, Olomouc, Czech Republic
| | - Jana Zapletalová
- Department of Medical Biophysics, Palacký University, Olomouc, Czech Republic
| | - Petr Kaňovský
- Comprehensive Stroke Center, Department of Neurology, Palacký University and University Hospital Olomouc, I. P. Pavlova 6, CZ-775 20, Olomouc, Czech Republic
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Anufriev PL, Evdokimenko AN, Gulevskaya TS. [Cerebral infarctions in vertebrobasilar artery atherosclerosis]. Arkh Patol 2018; 80:3-10. [PMID: 29460889 DOI: 10.17116/patol20188013-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM to obtain more specific information on the morphology and pathogenesis of cerebral infarctions occurring in vertebrobasilar artery (VBA) atherosclerosis. MATERIAL AND METHODS Macro- and microscopic investigations of the brain, its arterial system, and heart were conducted in 69 autopsy cases with infarctions located in the vertebrobasilar system (VBS) in atherosclerosis. RESULTS 69 cases were found to have 206 VBA infarctions of various extent and locations. The detected infarctions were single and multiple in 27 and 42 cases, respectively. The detected infarctions included extensive (n=7), large (n=9), medium (n=63), small deep (lacunar) (n=97), and small superficial (n=30). The brain stem showed lacunar infarctions most frequently (76% of the infarctions at this site). Medium and small infarctions were identified at the same frequency in the cerebral hemispheres and cerebellum. The occurrence of 94% of the extensive and large infarctions was ascertained to be pathogenetically associated with atherothrombotic occlusion of the intracranial arteries in the VBS. 76% of the small infarctions occurred through the mechanism of cerebral vascular insufficiency in tandem atherostenosis of VBAs in conjunction with an additional decrease in cerebral blood flow under the influence of an extracerebral factor (coronary heart disease). Medium infarctions were approximately equifrequently due to the two aforementioned causes and, in some cases, to cardiogenic thromboembolism of VBAs. Infarctions were multiple in most cases; while recent large atherothrombotic infarctions were frequently concurrent with small organized infarctions resulting from tandem atherostenosis of VBAs. CONCLUSION This investigation could establish the relationship between the site, extent, and pathogenetic factors of infarctions in the VBA bed in atherosclerosis, as well as the prognostic value of small infarctions as predictors for severe ischemic stroke.
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von Sarnowski B, Schminke U, Grittner U, Tanislav C, Böttcher T, Hennerici MG, Tatlisumak T, Putaala J, Kaps M, Fazekas F, Enzinger C, Rolfs A, Kessler C. Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1). Cerebrovasc Dis 2017; 43:152-160. [PMID: 28088807 DOI: 10.1159/000454840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/24/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although 20-30% of all strokes occur in the posterior circulation, few studies have explored the characteristics of patients with strokes in the posterior compared to the anterior circulation so far. Especially data on young patients is missing. METHODS In this secondary analysis of data of the prospective multi-centre European sifap1 study that investigated stroke and transient ischemic attack (TIA) patients aged 18-55 years, we compared vascular risk factors, stroke aetiology, presence of white matter hyperintensities (WMH) and cerebral microbleeds (CMB) between patients with ischaemic posterior circulation stroke (PCS) and those having suffered from anterior circulation stroke (ACS) based on cerebral MRI. RESULTS We diagnosed PCS in 612 patients (29.1%, 407 men, 205 women) and ACS in 1,489 patients (70.9%). Their age (median 46 vs. 47 years, p = 0.205) and stroke severity (modified Rankin Scale: both 2, p = 0.375, Barthel Index 90 vs. 85, p = 0.412) were similar. PCS was found to be more frequent among the male gender (66.5 vs. 60.1% with ACS, p = 0.003). Vertebral artery (VA) dissection was more often the cause of PCS (16.8%) than was carotid artery dissection of ACS (7.9%, p < 0.001). Likewise, small vessel disease (Trial of Org 10172 in Acute Stroke Treatment [TOAST] = 3, PCS: 14.7%, ACS: 11.8%) and stroke of other determined aetiology (TOAST = 4, PCS: 24.5%, ACS: 16.0%) were more frequent in those with PCS. Furthermore, patent foramen ovale (PFO; PCS: 31.1%, ACS: 25.4%, p = 0.029) was more often detected in patients with PCS. In contrast, large-artery atherosclerosis (TOAST = 1, PCS: 15.4%, ACS: 22.2%) and cardio-embolic stroke (TOAST = 2, PCS: 15.6%, ACS: 18.0%) were less frequent in those with PCS (p < 0.001) as were preceding cerebrovascular events (10.1 vs. 14.1%, p = 0.014), TIA (4.8 vs. 7.7%, p = 0.016) and smoking (53.2 vs. 61.0%, p = 0.001). The presence, extent, and location of WMH and CMB did not differ between the 2 groups. CONCLUSIONS Our data suggested a different pattern of aetiology and risk factors in young patients with PCS compared to those with ACS. These findings especially call for a higher awareness of VA dissection and potentially for more weight of a PFO as a risk factor in young patients with PCS. Clinical trial registration-URL: http://www.clinicaltrials.gov; NCT00414583.
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Affiliation(s)
- Bettina von Sarnowski
- Department of Neurology, University Medicine, Ernst Moritz Arndt University, Greifswald, Germany
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Zhang X, Huang WJ, Yu ZG. Relationship Between the Hypersensitive c-Reactive Protein (hs-CRP) Level and the Prognosis of Acute Brainstem Infarction. Cell Biochem Biophys 2016; 72:107-10. [PMID: 25411049 DOI: 10.1007/s12013-014-0414-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study is to explore the relationship between the hypersensitive c-reactive protein (hs-CRP) level and the prognosis of acute brainstem infarction. Serum levels of hs-CRP were measured in 68 patients with acute brainstem infarction 72 h after disease onset. The hs-CRP levels in the U.S. National Institutes of Health Stroke Scale (NIHSS) score group and in the modified RANKIN scale (mRS) score group were compared. The independent risk factors of brainstem infarction were analyzed using Logistic binary regression. The hs-CRP level was significantly higher in the group with NIHSS >5 compared with the one with NIHSS ≤ 5 (P = 0.004). In the group with mRS > 2, the age, smoking history, and blood glucose level were significantly higher than those in the group with mRS ≤ 2 (P < 0.05), whereas the hs-CRP level was significantly higher (P = 0.001). Age and hs-CRP level were the independent prognostic factors of the brainstem infarction. The serum hs-CRP level is closely related with the severity and prognosis of brainstem infarction, and is an independent risk factor of acute brainstem infarction.
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Affiliation(s)
- Xia Zhang
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China.
| | - Wen-Juan Huang
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
| | - Zhi-Gang Yu
- Department of Neurology, Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, China
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Yi TY, Chen WH, Zhang MF, Chen YH, Cai RW, Wu ZZ, Wu YM, Shi YC, Chen BL, Guo TH, Wu CX, Yang MX, Chen XJ. Diagnostic ability of 3-dimensional contrast-enhanced MR angiography in identifying vertebral basilar artery stenosis. J Neurol Sci 2016; 363:121-5. [DOI: 10.1016/j.jns.2016.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
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Owolabi LF, Ibrahim A, Musa I. Infratentorial posterior circulation stroke in a Nigerian population: Clinical characteristics, risk factors, and predictors of outcome. J Neurosci Rural Pract 2016; 7:72-6. [PMID: 26933349 PMCID: PMC4750346 DOI: 10.4103/0976-3147.165427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Posterior circulation stroke (PCS), though less common, differs from stroke in anterior circulation in many aspects. Relatively, it portends a poorer prognosis. However, there is a paucity of data from African countries, in particular, where stroke is a menace. Objective: The study aimed to evaluate the etiology, clinical characteristics, outcome, and predictors of outcome in a cohort of patients with IPCS in Northwestern Nigeria. Materials and Methods: Out of 595 patients with stroke, we prospectively analyzed 57 patients with PCS in a Tertiary Care Center in Kano, Northwestern Nigeria. Patients were analyzed for demographic data, risk factors, clinical characteristics, stroke subtypes, mortality, and predictors of mortality. Results: Posterior circulation ischemic stroke accounted for 57 (9.6%) of 595 of all strokes seen in the study period. They comprised 44 males (mean age 47.8 ± 17.7) and 13 females (mean age 46.3 ± 13.7). Overall, their age ranged between 24 and 90 (mean age 47.4 ± 16.7). However, 52.7% of the patients were < 45 years of age. The most common site affected was the cerebellum seen in 33 (57.9%) patients. Hypertension was the most common risk factor (86%). Headache and vertigo were the most common features accounting for 83.6% and 86.3%, respectively. Thirty-eight (66.7%) patients had an ischemic stroke. Twenty-one (36.8%) of the patients died during the 1-month period of follow-up. Independent predictors of death in the study were hyperglycemia on admission and hemorrhagic stroke. Conclusions: IPCS occurred in a relatively younger age group. Headache and vertigo were the most common symptoms. The independent predictors of death in the study were hyperglycemia at presentation and hemorrhagic stroke.
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Affiliation(s)
- Lukman Femi Owolabi
- Department of Medicine, Neurology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
| | - Aliyu Ibrahim
- Department of Medicine, Neurology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
| | - Ibrahim Musa
- Department of Surgery, Murtala Muhammad Specialist Hospital, Kano, Nigeria
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Chung CP, Yong CS, Chang FC, Sheng WY, Huang HC, Tsai JY, Hsu HY, Hu HH. Stroke etiology is associated with outcome in posterior circulation stroke. Ann Clin Transl Neurol 2015; 2:510-7. [PMID: 26000323 PMCID: PMC4435705 DOI: 10.1002/acn3.188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/18/2015] [Accepted: 02/04/2015] [Indexed: 11/29/2022] Open
Abstract
Objective Stroke research and clinical trials have focused mainly on anterior circulation stroke (ACS). Since clinical characteristics, mechanisms, and outcomes of posterior circulation stroke (PCS) have been reported different from ACS, more PCS studies are required, particularly researching the etiologies, to help establish an optimal management strategy. Methods The present study analyzed patients of PCS who were consecutively admitted and registered in Taipei Veterans General Hospital Stroke Registry between 1 January 2012 to 28 February 2014. We demonstrated the distribution of etiologies, compared the clinical characteristics/outcomes among different etiology groups, and used univariate/multivariate analyses to identify the predictors for poor functional outcome (modified Rankin Scale ≥5) at discharge and 3 month. Results About 286 patients of PCS were included for analyses. Basilar artery atheromatous branch occlusive disease (BABO, 28.0%) and large artery dissection (25.9%) were the two most common etiologies, followed by large artery atherosclerotic stenosis/occlusion (LAA, 20.6%), cardioembolism (CE, 18.5%) and small vessel disease (7.0%). Age, vascular risk factors, infarct locations and patterns, and outcomes were different among these five etiology groups. Multivariate analyses showed that age >70 y/o (discharge/3 month, OR, 95% CI: 3.05, 1.23–7.56/8.39, 2.32–30.33), admission NIH Stroke Scale >9 (19.50, 8.69–43.75/13.45, 5.59–32.39), and etiology (LAA versus BABO: 5.00, 1.58–15.83/4.00, 1.19–13.4; CE versus BABO: 3.36, 1.02–11.09/4.66, 1.40–15.46) were independently associated with poor functional outcome. Interpretation The etiologies of PCS are heterogeneous and shown to be associated with functional outcomes. Our results have shed lights on future pathophysiological research and designs of clinical trials for PCS.
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Affiliation(s)
- Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital Taipei, Taiwan ; National Yang Ming University Taipei, Taiwan
| | - Chin-Sern Yong
- Department of Neurology, Taipei Veterans General Hospital Taipei, Taiwan
| | - Feng-Chi Chang
- National Yang Ming University Taipei, Taiwan ; Department of Radiology, Taipei Veterans General Hospital Taipei, Taiwan
| | - Wen-Yung Sheng
- Department of Neurology, Taipei Veterans General Hospital Taipei, Taiwan
| | - Hui-Chi Huang
- Department of Neurology, Taipei Veterans General Hospital Taipei, Taiwan ; National Taipei University of Nursing and Health Sciences Taipei, Taiwan
| | - Jui-Yao Tsai
- Department of Neurology, Taipei Veterans General Hospital Taipei, Taiwan ; National Taipei University of Nursing and Health Sciences Taipei, Taiwan
| | - Hung-Yi Hsu
- Department of Neurology, Tungs' Taichung Metro Harbor Hospital, School of Medicine, Chung Shan Medical University Taichung, Taiwan
| | - Han-Hwa Hu
- Department of Neurology, Taipei Veterans General Hospital Taipei, Taiwan ; National Yang Ming University Taipei, Taiwan
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Nouh A, Remke J, Ruland S. Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol 2014; 5:30. [PMID: 24778625 PMCID: PMC3985033 DOI: 10.3389/fneur.2014.00030] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 03/04/2014] [Indexed: 12/12/2022] Open
Abstract
Posterior circulation strokes represent approximately 20% of all ischemic strokes (1, 2). In contrast to the anterior circulation, several differences in presenting symptoms, clinical evaluation, diagnostic testing, and management strategy exist presenting a challenge to the treating physician. This review will discuss the anatomical, etiological, and clinical classification of PC strokes, identify diagnostic pitfalls, and overview current therapeutic regimens.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Jessica Remke
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Sean Ruland
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
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Risk factors and etiological subtype analysis of brainstem infarctions. J Neurol Sci 2014; 338:118-21. [DOI: 10.1016/j.jns.2013.12.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/10/2013] [Accepted: 12/17/2013] [Indexed: 11/23/2022]
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Sung SF, Chen CH, Chen YW, Tseng MC, Shen HC, Lin HJ. Predicting symptomatic intracerebral hemorrhage after intravenous thrombolysis: stroke territory as a potential pitfall. J Neurol Sci 2013; 335:96-100. [PMID: 24054716 DOI: 10.1016/j.jns.2013.08.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/05/2013] [Accepted: 08/27/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke vascular territories may influence response to thrombolysis, although supporting data are limited. The aim of the study was to test the hypothesis that the current available prediction scores might inaccurately estimate the risk of symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis in patients with posterior circulation stroke. METHODS We applied the Safe Implementation of Thrombolysis in Stroke (SITS) SICH risk score to data from four hospital-based stroke registries. Patients were grouped according to anterior or posterior circulation stroke. The main outcome measure was SICH per various definitions. Performance of the risk score was assessed with the c statistic. RESULTS Data of 518 thrombolyzed patients (434 anterior, 84 posterior) were studied. The overall rate of SICH varied from 3.5% to 6.9% depending on the SICH definition. Patients with posterior circulation stroke were less likely to have post-thrombolysis SICH per NINDS (P=0.042), per ECASS II (P=0.013), or any ICH (P=0.001), and their rate of SICH was markedly lower than predicted (1.2% versus 7.1% by the NINDS definition; 0% versus 4.8%, ECASS II; 0% versus 1.6%, SITS-MOST). The SITS SICH risk score shows moderate model discrimination across the SICH definitions, with c statistic ranging from 0.64 to 0.70. CONCLUSIONS The risk of SICH after intravenous thrombolysis in patients with posterior circulation stroke was low enough to render the SITS SICH risk score or other similar prediction models unnecessary. Awareness of stroke territory might help clinicians judiciously use the risk assessment models.
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Affiliation(s)
- Sheng-Feng Sung
- Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi City, Taiwan; Min-Hwei College of Health Care Management, Tainan, Taiwan
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Kim SH, Lee JY, Kim DH, Ham JH, Song YK, Lim EJ, Park CI, Chang SJ, Lee SS. Factors Related to the Initial Stroke Severity of Posterior Circulation Ischemic Stroke. Cerebrovasc Dis 2013; 36:62-8. [DOI: 10.1159/000351512] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 04/15/2013] [Indexed: 11/19/2022] Open
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Kim JS, Nah HW, Park SM, Kim SK, Cho KH, Lee J, Lee YS, Kim J, Ha SW, Kim EG, Kim DE, Kang DW, Kwon SU, Yu KH, Lee BC. Risk Factors and Stroke Mechanisms in Atherosclerotic Stroke. Stroke 2012; 43:3313-8. [PMID: 23160885 DOI: 10.1161/strokeaha.112.658500] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background and Purpose—
The aim of this study was to investigate differences in risk factors and stroke mechanisms between intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS) and between anterior and posterior circulation atherosclerosis.
Methods—
A multicenter, prospective, Web-based registry was performed on atherosclerotic strokes using diffusionweighted magnetic resonance imaging and magnetic resonance angiography. Stroke mechanisms were categorized as artery-to-artery embolism, in situ thrombo-occlusion, local branch occlusion, or hemodynamic impairment.
Results—
Onethousand patients were enrolled from 9 university hospitals. Age (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.018–1.049), male gender (OR, 3.399; 95% CI, 2.335–4.949), and hyperlipidemia (OR, 1.502; 95% CI, 1.117–2.018) were factors favoring ECAS (vs ICAS), whereas hypertension (OR, 1.826; 95% CI, 1.274–2.618;
P
=0.001) and diabetes mellitus (OR, 1.490; 95% CI, 1.105–2.010;
P
=0.009) were related to posterior (vs anterior) circulation diseases. Metabolic syndrome was a factor related to ICAS (vs ECAS) only in posterior circulation strokes (OR, 2.433; 95% CI, 1.005–5.890;
P
=0.007). Stroke mechanisms included arterytoartery embolism (59.7%), local branch occlusion (14.9%), in situ thrombo-occlusion (13.7%), hemodynamic impairment (0.9%), and mixed (10.8%). Anterior ICAS was more often associated with artery-to-artery embolism (51.8% vs 34.0%) and less often associated with local branch occlusion (12.3% vs 40.4%) than posterior ICAS (
P
<0.001).
Conclusions—
The prevalence of risk factors and stroke mechanisms differ between ICAS and ECAS, and between anterior and posterior circulation atherosclerosis. Posterior ICAS seems to be closely associated with metabolic derangement and local branch occlusion. Prevention and management strategies may have to consider these differences.
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Affiliation(s)
- Jong S. Kim
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Hyun-Wook Nah
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Sea Mi Park
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Su-Kyung Kim
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Ki Hyun Cho
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Jun Lee
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Yong-Seok Lee
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Jei Kim
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Sang-Won Ha
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Eung-Gyu Kim
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Dong-Eog Kim
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Dong-Wha Kang
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Sun U. Kwon
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Kyung-Ho Yu
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
| | - Byung-Chul Lee
- From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea (J.S.K., H.-W.N., S.M.P., S.-K.K., D.-W.K., S.U.K.); Chonnam National University Hospital, Gwangju, Korea (K.H.C.); Yeungnam University Hospital, Daegu, Korea (J.L.); Seoul National University Borame Medical Center, Seoul, Korea (Y.-S.L.); Chungnam National University Hospital, Daejeon, Korea (J.K.); Seoul Veterans Hospital, Seoul, Korea (S.-W.H.); Inje University Pusan Paik Hospital, Busan, Korea (E.-G.K.)
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Jung S, Kwon SB, Hwang SH, Noh JW, Lee YK. Ischemic stroke among the patients with end-stage renal disease who were undergoing maintenance dialysis. Yonsei Med J 2012; 53:894-900. [PMID: 22869470 PMCID: PMC3423841 DOI: 10.3349/ymj.2012.53.5.894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE In spite of higher incidence of stroke in end-stage renal disease (ESRD) patients compared to general population, the risk factor for stroke which is specific to ESRD is not fully understood. The ESRD patients who develop stroke may have certain additional risk factors compared to ESRD patients without stroke. We used registered data of Hallym Stroke Registry to elucidate the factors which affect development of ischemic stroke among the dialysis patients. MATERIALS AND METHODS We recruited patients with acute ischemic stroke in ESRD patients undergoing maintenance dialysis. Dialysis patients without stroke were selected as control group with age and gender matching. We compared the demographic features, stroke risk factors, and laboratory findings in ESRD patients with or without ischemic stroke. RESULTS The total of 25 patients with ESRD developed ischemic stroke. Fifty ESRD patients without stroke were chosen as the control group. The mean age of acute ischemic stroke patients was 59.80±9.94 and male gender was 48%. The most common ischemic stroke subtype was small vessel occlusion (n=12), followed by large artery atherosclerosis (n=7). The patients with stroke had more frequent history of hypertension and higher systolic/diastolic blood pressure at the time of admission than the ESRD patients without stroke. Total cholesterol and LDL-cholesterol levels were significantly lower in the stroke group. In multivariate analysis, LDL-cholesterol was found to be the only risk factor for ischemic stroke. CONCLUSION The results of our study reveal that LDL-cholesterol is associated with greater risk for ischemic stroke in the patients on dialysis.
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Affiliation(s)
- San Jung
- Department of Neurology, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Seok-Beom Kwon
- Department of Neurology, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Hee Hwang
- Department of Neurology, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Jung Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
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Mehndiratta M, Pandey S, Nayak R, Alam A. Posterior circulation ischemic stroke-clinical characteristics, risk factors, and subtypes in a north Indian population: a prospective study. Neurohospitalist 2012; 2:46-50. [PMID: 23983863 PMCID: PMC3745183 DOI: 10.1177/1941874412438902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Short penetrating and circumferential branches in the posterior circulation supply the brain stem, thalamus, cerebellum, occipital, and medial temporal lobes. MATERIALS AND METHODS We prospectively analyzed 80 participants of posterior circulation ischemic stroke from a registry of 944 participants attending a tertiary care referral university hospital. Patients were analyzed for demographics, stroke risk factors, clinical characteristics, neuroimaging, and stroke subtypes. RESULTS Posterior circulation ischemic stroke accounted for 80 (8.5%) of 944 of all strokes and 80 (10.45%) of 765 of ischemic stroke. Sixty-three were males with mean age 51.7 ± 14.4 years. Twenty-one participants were young (defined as age less than 45 years). Hypertension was found to be the most common risk factor (63.75%). Vertigo was the most common clinical symptom reported in 45 (56.25%) cases. Sixty-eight (85%) patients had large artery disease, 8 (10%) had documented cardioembolic source, 3 (3.75%) small artery disease, and 2 (2.5%) vasculitis. Posterior cerebral artery was most commonly involved. Topographically distal intracranial involvement was most frequent (66.25%) followed by proximal (30%) and middle intracranial territory (3.75%). CONCLUSIONS Our study demonatrated the occurrence of posterior circulation stroke in relatively younger age group compared to the Western world. We also found higher percentage of large artery disease, while cardioembolism as a less frequent cause of posterior circulation ischemic stroke in North Indian population. Distal territory involvement was most common in our study.
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Affiliation(s)
| | - Sanjay Pandey
- Department of Neurology, G.B. Pant Hospital, J.L.N. Marg, New Delhi, India
| | - Rajeev Nayak
- Department of Neurology, G.B. Pant Hospital, J.L.N. Marg, New Delhi, India
| | - Anwar Alam
- Department of Neurology, G.B. Pant Hospital, J.L.N. Marg, New Delhi, India
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De Silva KRD, Silva R, Gunasekera WSL, Jayesekera RW. Prevalence of typical circle of Willis and the variation in the anterior communicating artery: A study of a Sri Lankan population. Ann Indian Acad Neurol 2011; 12:157-61. [PMID: 20174495 PMCID: PMC2824931 DOI: 10.4103/0972-2327.56314] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 05/21/2009] [Accepted: 06/18/2009] [Indexed: 11/05/2022] Open
Abstract
Objective: To determine the extent of hypoplasia of the component vessels of the circle of Willis (CW) and the anatomical variations in the anterior communicating artery (AcomA) in the subjects who have died of causes unrelated to the brain and compare with previous autopsy studies. Materials and Methods: The external diameter of all the arteries forming the CW in 225 normal Sri Lankan adult cadaver brains was measured using a calibrated grid to determine the occurrence of “typical” CWs, where all of the component vessels had a diameter of more than 1 mm. Variations in the AcomA were classified into 12 types based on Ozaki et al., 1977. Results: 193 (86%) showed “hypoplasia”, of which 127 (56.4%) were with multiple anomalies. Posterior communicating artery (PcoA) was hypoplastic bilaterally in 93 (51%) and unilaterally in 49 (13%). Precommunicating segment of the posterior cerebral arteries (P1) was hypoplastic bilaterally in 3 (2%), unilaterally in 14 (4%), and AcomA was hypoplastic in 91 (25%). The precommunicating segment of the anterior cerebral arteries (A1) was hypoplastic unilaterally in 17 (5%). Types of variations in the AcomA were: single 145 (65%), fusion 52 (23%), double 22 (10%) [V shape, Y shape, H shape, N shape], triplication 1 (0.44%), presence of median anterior cerebral artery 5 (2%), and aneurysm 1 (0.44%). Conclusion: The occurrence of “typical” CW in autopsy brains was rare. Further studies would be necessary to determine if these anatomical variations could predispose to cerebral ischemia and premature stroke in the Sri Lankan population.
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Affiliation(s)
- K Ranil D De Silva
- Department of Anatomy, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
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Abstract
Background and Purpose—
Limited data exist on childhood posterior circulation arterial ischemic stroke (PCAIS). We describe clinical and radiological features of childhood PCAIS to determine whether there are differences in infarct topography, vascular abnormalities, risk factors, and stroke subtypes when compared to adults.
Methods—
Children with radiologically confirmed PCAIS were prospectively identified from August 2002 to February 2008. Infarcts were divided into proximal, middle, and distal posterior circulation segments utilizing an adult topographical classification system. Vascular abnormalities were described in terms of location, severity, and evolution over time. A pediatric modification of the TOAST classification system was used to define stroke subtypes.
Results—
Twenty seven (37%) of 73 children recruited to our registry had 34 radiologically confirmed PCAIS events. Infarct location was distal (25), middle (2), proximal (1), and multiple segments (6). Fourteen events were associated with single infarcts and 20 were associated with multiple infarcts. Magnetic resonance angiography was abnormal in 16 of 25 children with PCAIS at presentation with stenosis (8) or occlusion (8). Vascular lesions progressed (5), transiently worsened before stabilizing (2), remained stable or improved (8), or normalized (1) over 12 months. Stroke subtypes included nonprogressive steno-occlusive cerebral arteriopathy (9), cardioembolic (4), dissection (3), Moyamoya syndrome (3), other determined (4), probable (1), and undetermined etiology (3). Fifty-two percent of children had recurrent posterior (6) or anterior (8) strokes.
Conclusions—
Nonprogressive arteriopathies are the most common cause of childhood PCAIS, usually affecting distal segments. Atherosclerosis-related risk factors do not play an important role in stroke causation. PCAIS is frequently associated with recurrent events.
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Affiliation(s)
- Mark T. Mackay
- From Children’s Neuroscience Centre (M.T.M.) and Medical Imaging Department (L.C.), Royal Children’s Hospital Melbourne, Melbourne, Australia; Murdoch Children’s Research Institute (M.T.M., L.C.), Melbourne, Australia; Department of Paediatrics (M.T.M., L.C.), University of Melbourne, Victoria, Australia; Department of Radiology (S.P.P.), Children’s Hospital Boston and Harvard Medical School (S.P.P.), Boston, Mass
| | - Sanjay P. Prabhu
- From Children’s Neuroscience Centre (M.T.M.) and Medical Imaging Department (L.C.), Royal Children’s Hospital Melbourne, Melbourne, Australia; Murdoch Children’s Research Institute (M.T.M., L.C.), Melbourne, Australia; Department of Paediatrics (M.T.M., L.C.), University of Melbourne, Victoria, Australia; Department of Radiology (S.P.P.), Children’s Hospital Boston and Harvard Medical School (S.P.P.), Boston, Mass
| | - Lee Coleman
- From Children’s Neuroscience Centre (M.T.M.) and Medical Imaging Department (L.C.), Royal Children’s Hospital Melbourne, Melbourne, Australia; Murdoch Children’s Research Institute (M.T.M., L.C.), Melbourne, Australia; Department of Paediatrics (M.T.M., L.C.), University of Melbourne, Victoria, Australia; Department of Radiology (S.P.P.), Children’s Hospital Boston and Harvard Medical School (S.P.P.), Boston, Mass
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Seizures and epilepsy in patients with a posterior circulation infarct. J Stroke Cerebrovasc Dis 2010; 21:1-4. [PMID: 20833079 DOI: 10.1016/j.jstrokecerebrovasdis.2010.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/06/2010] [Accepted: 03/09/2010] [Indexed: 11/22/2022] Open
Abstract
Seizures occur mainly in patients with cortical infarcts in the anterior circulation. Those related to a posterior circulation infarct (POCI) are considered rare. This study investigated the characteristics of patients with seizures related to a POCI. A total of 180 consecutive patients admitted with a POCI had a 2- to 7-year follow-up; 24 of them (13.6%) developed seizures. Vascular risk factors, etiology and extension of the infarct, degree of neurologic impairment, and outcome were compared in the patients with and without seizures. Complex partial type seizure was the most common presentation. Stroke characteristics were largely the same in the patients with and without seizures. History of a previous stroke was noted in 62.5% of the seizure group and in 17.9% of the nonseizure group (P < .001). Clinical outcome was worse in the seizure group (P = .004). The relative incidence of seizures in patients with a POCI was not lower than that in the overall stroke population. The high incidence of recurrent stroke is the main risk factor for seizures in patients with a POCI. The seizures themselves are responsible for the increased dependence rate.
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Comparison of Clinical Backgrounds with Anterior Versus Posterior Circulation Infarcts. J Stroke Cerebrovasc Dis 2010; 19:393-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 06/17/2009] [Accepted: 07/10/2009] [Indexed: 11/21/2022] Open
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Akhtar N, Kamran SI, Deleu D, D'Souza A, Miyares F, Elsotouhy A, Al-Hail H, Mesraoua B, Own A, Salem K, Kamha A, Osman Y. Ischaemic posterior circulation stroke in State of Qatar. Eur J Neurol 2009; 16:1004-9. [PMID: 19538206 DOI: 10.1111/j.1468-1331.2009.02709.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ischaemic stroke features may show regional differences. Posterior circulation stroke (PCS) is of special interest, as symptomatology, course and outcome are usually different and complex. No significant studies or registries have reported on the characteristics and outcomes of PCS in our region. METHODS We prospectively collected data of 116 patients with PCS admitted from 2005 through 2008 in the only stroke admitting hospital in Qatar. Demographics, risk factors, clinical signs/symptoms, pattern of presentation, aetiology, imaging features, complications and outcome at discharge and follow-up were recorded. RESULTS Mean age was 53 years with 25% aged < or = 45, 85% were males. Demographically 47% were Arabs and 51% of South-Asian origin. Mean duration from onset to presentation was 29 h. Major risk factors were obesity (66%) and hypertension (61%). Minimal or fluctuating symptoms were present in 64%, while 9% had maximal deficit at onset. Thirty nine per cent had lesions in proximal territory and 23% in multiple territories. Around 41% had no occlusion, 16% had vertebro-basilar, 16% vertebral, 8% basilar occlusion. Etiologically 53% patients had large artery disease, 16% small vessel disease, and 17% cardioembolism. Seventy per cent of patients were discharged home, while 10% expired. Modified Rankin score (mRS) at discharge was < or = 2 in 53% and > or = 4 in 13% patients. At 30-day follow-up, 68% had mRS of < or = 2. Ninety-day survival status showed 89% alive with mRS < or = 2 in 73%. CONCLUSION The aetiology and lesion topography of PCS in this heterogeneous population differs from the pattern observed in other populations.
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Affiliation(s)
- N Akhtar
- Division of Neurology (Medicine), Hamad Medical Corporation, Doha, State of Qatar
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