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Factor V Leiden, Factor II, Protein C, Protein S, and Antithrombin and Ischemic Strokes in Young Adults: A Meta-Analysis. Genes (Basel) 2022; 13:genes13112081. [DOI: 10.3390/genes13112081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022] Open
Abstract
Ischemic strokes are one of the leading causes of death worldwide. The aim of this meta-analysis is to elaborate on the role of inherited predisposition to thrombophilia in the etiology of ischemic strokes in young adults. The keywords factor V Leiden (FVL), factor II, prothrombin (PT), protein C (PC), protein S (PS), antithrombin (AT), ischemic stroke, and young were used to search different databases. We selected studies with participants who were between 18 and 65 years. A total of 104 studies were eligible for inclusion in the meta-analysis. All the studied genetic markers were risk factors for ischemic stroke according to our results (FVL OR = 1.74; PT OR = 1.95; PC OR = 10.20; PS OR = 1.74; AT OR = 3.47; p < 0.05). There was moderate heterogeneity for most of the results, and subgroup analyses were conducted by dividing the studies according to the geographic location, gender ratio, and selection criteria of the performed study. There were no significant differences between the groups, but different geographic location was a probable source of heterogeneity. All of the studied markers—FVL, prothrombin, PC, PS, and AT—were significantly associated with increased risk of ischemic stroke in young adults and, if tested, could improve the quality of care.
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Rare stroke mechanisms in 4154 consecutive patients: causes, predictors, treatment, and outcomes. Neurol Sci 2022; 43:6359-6369. [PMID: 35994133 PMCID: PMC9616760 DOI: 10.1007/s10072-022-06344-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022]
Abstract
Background Rare mechanisms of stroke (RMS) in acute ischemic stroke (AIS) have rarely been studied applying a systematic approach. Our aim was to define the frequency, etiologies, predictors, and outcomes of RMS in a consecutive series of AIS. Methods Data from consecutive patients from 2003 to 2016 were derived from the Acute STroke Registry and Analysis of Lausanne (ASTRAL). Frequency of subcategories of RMS was calculated. In a case–control design, RMS were compared to strokes of all other mechanisms. Outcome was assessed with 3-month Rankin-shift and 12-month mortality and recurrence rates. Results Out of 4154 AISs, 222 (5.3%) were found to have a RMS (42.0% female, median age 66 years). The most frequent RMS etiologies were medical interventions (25.6%), active oncological disease (22.5%), and vasculitis (11.7%). In multivariate analysis, RMS patients were younger, had more preceding and bilateral strokes, and a higher admission temperature. They were associated with less traditional risk factors and more systemic disease (such as AIDS, coagulopathy, and cancer). RMS also had more early ischemic changes on plain CT, less revascularization treatments, and more symptomatic hemorrhagic transformations. They presented significantly higher 3-month disability (Rankin-shift-ORadj 1.74), 12-month recurrence (ORadj 1.99), and mortality rates (ORadj 2.41). Conclusions RMS occurred in 5.3% of a large population of consecutive AISs and are most frequently related to medical interventions, cancer, and vasculitis. RMS patients have less traditional risk factors but more systemic comorbidities, hemorrhagic transformations, recurrences, and a worse long-term outcome. Identification of RMS has direct implications for early treatment and long-term outcome. Supplementary information The online version contains supplementary material available at 10.1007/s10072-022-06344-w.
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Kumar P, Mishra A, Prasad MK, Verma V, Kumar A. Relationship of Methylenetetrahydrofolate Reductase (MTHFR) C677T Variation With Susceptibility of Patients With Ischemic Stroke: A Meta-Analysis. Cureus 2022; 14:e28218. [PMID: 36017481 PMCID: PMC9393322 DOI: 10.7759/cureus.28218] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2022] [Indexed: 11/05/2022] Open
Abstract
Discovery and validation of genetic factors for multifactorial and polygenic disorders like stroke are needed to make progress in precision medicine. Although some traditional risk factors for stroke have been identified, they do not fully explain the pathophysiological mechanism of ischemic stroke. The research of genetic risk factors is becoming increasingly relevant in the understanding of stroke mechanisms and the finding of population-specific therapeutic targets. The methylenetetrahydrofolate reductase (MTHFR) gene is involved in homocysteine metabolism, and a high homocysteine level is a risk factor for stroke. Using a meta-analysis technique, we investigated the link between the MTHFR C677T gene polymorphism and the risk of ischemic stroke. We used the electronic databases PubMed, Medline, Embase, and Google Scholar to find articles in the Journal of Stroke. If heterogeneity was more than 50%, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model; otherwise, a fixed-effects model was used. A total of 67 case-control studies with 17,704 cases and 21,981 controls met our inclusion criteria. The Asian population was represented by 41 studies, whereas the Caucasian population was represented by 26. Under the recessive model, a gene polymorphism at the 677 location of the MTHFR gene is related to an elevated risk of ischemic stroke (OR: 1.29, 95% CI: 1.22-1.37, P < 0.001). People who have the MTHFR C677T gene polymorphism have a greater risk of stroke than people who do not.
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Zhang N, Zhang L, Wang Q, Zhao J, Liu J, Wang G. Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study. BMC Neurol 2020; 20:424. [PMID: 33225904 PMCID: PMC7681954 DOI: 10.1186/s12883-020-02005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.
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Affiliation(s)
- Nan Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jingwei Zhao
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
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Liampas I, Siokas V, Mentis AA, Aloizou A, Dastamani M, Tsouris Z, Aslanidou P, Brotis A, Dardiotis E. Serum Homocysteine, Pyridoxine, Folate, and Vitamin B12 Levels in Migraine: Systematic Review and Meta‐Analysis. Headache 2020; 60:1508-1534. [DOI: 10.1111/head.13892] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ioannis Liampas
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Vasileios Siokas
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Alexios‐Fotios A. Mentis
- Department of Microbiology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
- Public Health Laboratories Hellenic Pasteur Institute Athens Greece
| | - Athina‐Maria Aloizou
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Metaxia Dastamani
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Zisis Tsouris
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Paraskevi Aslanidou
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Alexandros Brotis
- Department of Neurosurgery University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
| | - Efthimios Dardiotis
- Department of Neurology University Hospital of LarissaSchool of MedicineUniversity of Thessaly Larissa Greece
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Probable risk factors of internal jugular vein stenosis in Chinese patients-A real-world cohort study. Clin Neurol Neurosurg 2020; 191:105678. [PMID: 31955125 DOI: 10.1016/j.clineuro.2020.105678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/18/2019] [Accepted: 01/12/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Extracranial venous anomalies, especially internal jugular vein stenosis (IJVS), have recently received increasing attention, however, its etiologies are uncertain. This study aimed to explore the probable risk factors of IJVS in Chinese PATIENTS AND METHODS: Eligible patients with IJVS confirmed by contrast-enhanced magnetic resonance venography (CE-MRV) were enrolled from October 2017 through October 2018. Probable risk factors were analyzed, including the conditions that may result in IJV wall damage, extraluminal compression, gender and age. RESULTS A total of 133 patients enrolled in the final analysis, including 73 females and 60 males, the mean age were 54.83 ± 15.25 years. In this IJVS cohort, the top two risks were previous hepatitis B virus (HBV) infection (48.9 %) and osseous compression (41.4 %). The IJVS cohort was divided into two subsets: extraluminal compression and non-compression. In the former, osseous compression (80.9 %) was the top risk factor, other risks including arterial (22.1 %) and lymph node compression (2.9 %). While, in the latter subset, the most common risk factor was previous HBV infection (46.2 %). In addition, cerebral venous sinus thrombosis (CVST) in non-compression subset was more common than that in extraluminal compression subset (21.5 % VS. 2.9 %, p = 0.001). When considered the gender (Male vs. Female), the ratios were 28.3 % vs. 0 % of smoking, p < 0.001, 16.67 % vs. 1.37 % of hyperhomocysteinemia, p = 0.002, and 11.67 % vs. 1.37 % of hyperuricemia, p = 0.023. In the subset with age less than 45 years, the top three risks included CVST (56.25 %), immunological diseases (55.56 %), and hyperhomocysteinemia (50.00 %), while, in the subset with the ages over 60 years, type-2 diabetes (66.66 %), carotid artery compression (53.33 %), previous HBV infection (52.31 %), and osseous compression (49.09 %) were more common than others. CONCLUSION This study illustrates the probable risks of IJVS may be diverse, in which osseous compression and previous HBV infection may be the top two probable risks of IJVS in Chinese. This is the biggest difference from previous reports based on Caucasian.
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Sarecka-Hujar B, Szołtysek-Bołdys I, Kopyta I, Dolińska B, Sobczak A. Concentrations of the Selected Biomarkers of Endothelial Dysfunction in Response to Antiepileptic Drugs: A Literature Review. Clin Appl Thromb Hemost 2019; 25:1076029619859429. [PMID: 31238702 PMCID: PMC6714895 DOI: 10.1177/1076029619859429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Epilepsy is a disease arising from morphological and metabolic changes in the brain. Approximately 60% of patients with seizures can be controlled with 1 antiepileptic drug (AED), while in others, polytherapy is required. The AED treatment affects a number of biochemical processes in the body, including increasing the risk of cardiovascular diseases (CVDs). It is indicated that the duration of AED therapy with some AEDs significantly accelerates the process of atherosclerosis. Most of AEDs increase levels of homocysteine (HCys) as well as may affect concentrations of new, nonclassical risk factors for atherosclerosis, that is, asymmetric dimethylarginine (ADMA) and homoarginine (hArg). Because of the role of these parameters in the pathogenesis of CVD, knowledge of HCys, ADMA, and hArg concentrations in patients with epilepsia treated with AED, both pediatric and adult, appears to be of significant importance.
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Affiliation(s)
- Beata Sarecka-Hujar
- 1 Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Izabela Szołtysek-Bołdys
- 2 Department of General and Inorganic Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Ilona Kopyta
- 3 Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Barbara Dolińska
- 1 Department of Pharmaceutical Technology, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Andrzej Sobczak
- 2 Department of General and Inorganic Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
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Alhazzani AA, Kumar A, Selim M. Association between Factor V Gene Polymorphism and Risk of Ischemic Stroke: An Updated Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 27:1252-1261. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/20/2017] [Accepted: 12/03/2017] [Indexed: 11/25/2022] Open
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Zhou X, Razmovski-Naumovski V, Kam A, Chang D, Li C, Bensoussan A, Chan K. Synergistic Effects of Danshen (Salvia Miltiorrhizae Radix et Rhizoma) and Sanqi (Notoginseng Radix et Rhizoma) Combination in Angiogenesis Behavior in EAhy 926 Cells. MEDICINES 2017; 4:medicines4040085. [PMID: 29160857 PMCID: PMC5750609 DOI: 10.3390/medicines4040085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 01/09/2023]
Abstract
Background: This study investigated the combination effects of the Danshen and Sanqi herb pair on angiogenesis in vitro. Methods: Nine combination ratios of Danshen-Sanqi extracts (DS-SQ) were screened for their angiogenic effects in the human vascular endothelial EAhy 926 cell line via cell proliferation, cell migration and tube formation activities against the damage to the cells exerted by DL-homocysteine (Hcy) and adenosine (Ado). The type of interaction (synergistic, antagonistic, additive) between Danshen and Sanqi was analyzed using combination index (CI) and isobologram models. The angiogenic activities of key bioactive compounds from Danshen and Sanqi were tested in the same models. Results: DS-SQ ratios of 2:8 and 3:7 (50-300 µg/mL) potentiated angiogenic synergistic effects (CI < 1) in all three assays. The observed wound healing effects of DS-SQ 2:8 was significantly attenuated by phosphatidylinositol-3 kinases (PI3K), mitogen-activated protein kinase (MEK) and extracellular signal-regulated kinases (ERK) inhibitors which inferred the potential mechanistic pathways. Out of all the tested compounds, Notoginsenoside R1 from Sanqi exhibited the most potent bioactivity in cell proliferation assay. Conclusions: This study provides scientific evidence to support the traditional use of the Danshen-Sanqi combination for vascular disease, in particular through their synergistic interactions on previously unexamined angiogenic pathways.
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Affiliation(s)
- Xian Zhou
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia.
| | - Valentina Razmovski-Naumovski
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia.
- South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Kensington 2052, Australia.
| | - Antony Kam
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia.
- School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore.
| | - Dennis Chang
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia.
| | - Chunguang Li
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia.
| | - Alan Bensoussan
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia.
| | - Kelvin Chan
- National Institute of Complementary Medicine (NICM), Western Sydney University, Penrith, NSW 2751, Australia.
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK.
- Faculty of Sciences, TCM Division, University of Technology Sydney, Ultimo, NSW 2007, Australia.
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Wang Y, Liu M, Pu C. 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack. Int J Stroke 2017; 12:302-320. [PMID: 28381199 DOI: 10.1177/1747493017694391] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.
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Affiliation(s)
- Yongjun Wang
- 1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Liu
- 2 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chuanqiang Pu
- 3 Department of Neurology, The General Hospital of Chinese People's Liberation Army, Beijing, China
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Taheraghdam AA, Dalirakbari N, Khalili M, Soltani M, Ahari SS. Hyperhomocysteinemia, low vitamin B12, and low folic acid: Are risk factors of cerebral vascular thrombosis in northwest Iran? JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:16. [PMID: 27904562 PMCID: PMC5121995 DOI: 10.4103/1735-1995.178755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/13/2015] [Accepted: 02/02/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cerebral vascular thrombosis (CVT) is the thrombosis of intracranial and sinuses. The aim of this is to estimate of risk of low folic acid, low vitamin B12, and hyperhomocysteinemia (hyper-Hcys) for CVT. MATERIALS AND METHODS A total of 24 patients with CVT and 36 healthy controls participated in a cross-sectional case-control study. The deficient levels of folic acid and vitamin B12 defined as <10th percentile of folic acid and vitamin B12 level and hyper-Hcys was defined as >90th percentile of homocysteine of control group. RESULTS Patients had higher levels of total homocysteine (tHcys) than controls (14.7 ± 6.5 vs. 6.4 ± 2.7 μmol/L, P = 0.001). Also, vitamin B12 level in case group was lower compared to control subjects (185.4 ± 58 vs. 299 ± 75 ng/mL, P = 0.001). Hyper-Hcys and low vitamin B12 were significantly more prevalent in CVT patients than controls. Although, significant independent association with risk of CVT was found for hyper-Hcys [adjusted odds ratio (OR) 14.3, 95% confidence interval (CI): 2.6-77.1, P = 0.002] and low vitamin B12 (adjusted OR 24.6, 95% CI: 2.3-262.9, P = 0.008). Association between low folic acid and risk of CVT was not significant. A significant negative correlation was found between the levels of tHcys and vitamin B12 (r = -0.32, P = 0.01). CONCLUSION Hyper-Hcys and low vitamin B12 were related with the high risk for CVT.
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Affiliation(s)
- Ali Akbar Taheraghdam
- Neurosciences Research Center, Department of Neurology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nooriyeh Dalirakbari
- Neurosciences Research Center, Department of Neurology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Khalili
- Neurosciences Research Center, Department of Neurology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Madjid Soltani
- Neurosciences Research Center, Department of Neurology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeid Sadeghieh Ahari
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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Gunes HN, Cokal BG, Guler SK, Yoldas TK, Malkan UY, Demircan CS, Yon MI, Yoldas Z, Gunes G, Haznedaroglu IC. Clinical associations, biological risk factors and outcomes of cerebral venous sinus thrombosis. J Int Med Res 2016; 44:1454-1461. [PMID: 28222615 PMCID: PMC5536748 DOI: 10.1177/0300060516664807] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease affecting young adults. The majority of the patients are female. The aim of this study is to assess the clinical associations, risk factors and outcomes of the patients with CVST. Methods The data of 75 patients with CVST admitted to our hospital between 2006 and 2016 were reviewed. Demographic and clinical features and the thrombophilic risk factors of the patients were recorded. The localizations of the thrombi were determined and modified Rankin score at the time of onset and discharge were calculated. Results The majority of our patients (78.7%) were female. Median age was 35 years (16-76). The most common symptom was headache (86.7%). In 82.6% of our patients, inherited or acquired risk factors for thrombosis were detected. Transverse sinus was the most common site of thrombosis followed by sigmoid and superior sagittal sinuses. Two thirds of the patients had involvement of multiple sinuses. The patients with the involvement of sagittal sinus had better disability at the time of admittance ( p = 0.013) while the number of involved sinuses was correlated worse disability ( p = 0.015). The neurologic states in the majority of the patients were improved by the end of the hospitalization period ( p = 0.001). There was no significant difference in disability score at discharge between men and women ( p = 0.080). No patient with CVST died in the hospitalization period. Conclusions This study is one of the largest cohort studies on CVST in our region. The results of the study disclosed that CVST had wide range of clinical manifestations and non-specific symptoms at the beginning. For that reason, in especially high risk groups for thrombosis, the diagnosis of CVST should be kept in mind.
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Affiliation(s)
- Hafize Nalan Gunes
- 1 Department of Neurology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Burcu Gokce Cokal
- 1 Department of Neurology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Selda Keskin Guler
- 1 Department of Neurology, Ankara Training and Research Hospital, Ankara, Turkey
| | | | | | | | - Mehmet Ilker Yon
- 1 Department of Neurology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Zeynep Yoldas
- 3 Zekai Tahir Burak Female Health Training and Research Hospital, Ankara, Turkey
| | - Gursel Gunes
- 2 Department of Hematology, Hacettepe University, Ankara, Turkey
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Polyneuropathy in levodopa-treated Parkinson's patients. J Neurol Sci 2016; 371:36-41. [PMID: 27871444 DOI: 10.1016/j.jns.2016.09.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/13/2016] [Accepted: 09/30/2016] [Indexed: 11/22/2022]
Abstract
Recently published studies show that the prevalence of polyneuropathy (PNP) is higher in patients with Parkinson's disease (PD) than in age-matched controls. Its pathogenesis, however is a matter of controversy. The major hypothesis is the toxicity of high concentrations of homocysteine (Hcy) possibly related to levodopa (LD) therapy. The aim of the present study was to determine the prevalence of PNP, independent of other etiologies, and to determine the relationship to demographic and clinical factors in LD-treated Parkinson's patients. A total of 102 patients (51 patients with PD and 51 sex- and age-matched healthy controls) were enrolled in the study. The presence of any risk factors for PNP, ascertained from the history and laboratory tests, was an exclusion criterion. The Toronto Clinical Scoring System (TCSS) was used for clinical assessment of PNP. The objective assessment was based on electroneurography (ENG) studies in which motor nerves (peroneal and tibial nerves) as well as sensory nerves (sural and superficial peroneal nerves) were bilaterally examined. The severity of the disease was determined using the UPDRS scale (Unified Parkinson's Disease Rating Scale) and the Hoehn-Yahr (H-Y) scale. In the PD group, the clinical and neurophysiological indicators of PNP, manifested as a symmetrical and predominantly sensory axonal neuropathy, were more frequent then in the control group and observed in 43.1% vs. 13.7% and 15.7% vs. 2% of subjects respectively. The presence of PNP correlated with age and the severity of PD. Patients with PD and PNP had a higher level of Hcy as compared to PD patients without PNP, however the difference was not statistically significant. The frequency of PNP in PD patients is higher than in controls. The characteristics and discrepancy between the number of patients with clinical and ENG detected PNP may suggest the small fiber neuropathy (SFN) as the dominant form of neuropathy in PD patients.
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Thaler MA, Feurer R, Thaler C, Sonntag N, Schleef M, Rondak IC, Poppert H. Activated Protein C Resistance Does Not Increase Risk for Recurrent Stroke or Death in Stroke Patients. PLoS One 2016; 11:e0160382. [PMID: 27508300 PMCID: PMC4980060 DOI: 10.1371/journal.pone.0160382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/13/2016] [Indexed: 11/18/2022] Open
Abstract
Background Activated protein C (APC) resistance is the most common inherited prothrombotic disorder. The role of APC resistance in ischemic stroke is controversially discussed. Objectives The aim of this single center follow up study was to investigate the effect of APC resistance on stroke recurrence and survival in stroke patients. Patients/Methods We retrospectively identified 966 patients who had had an ischemic stroke or transitory ischemic attack (TIA) and in whom laboratory tests for APC resistance had been conducted. These patients were contacted to determine the primary outcomes of recurrent ischemic stroke or death. Results A total of 858 patients with an average follow up time of 8.48 years were included. APC resistance did not influence cumulative incidence functions for stroke free and total survival. In multivariate analyses, crude and adjusted hazard ratios for recurrent stroke as well as for death where not significantly increased in patients with APC resistance. This also applies to the subgroups of young patients, patients with cryptogenic stroke and patients with atrial fibrillation. Conclusion APC-resistance is not a risk factor for subsequent stroke or death in patients with a first ischemic stroke or TIA. Testing for APC-resistance in stroke patients therefore cannot be routinely recommended.
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Affiliation(s)
- Markus Alexander Thaler
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Regina Feurer
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Christoph Thaler
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Natalie Sonntag
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Michael Schleef
- Institut für Klinische Chemie und Pathobiochemie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Ina-Christine Rondak
- Institut für Medizinische Statistik und Epidemiologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Holger Poppert
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Zacharia G, Shani D, Ortiz RA. Recurrent stroke in a patient with vitamin B 12 deficiency and MTHFR mutation. Neurol Clin Pract 2016; 7:e1-e4. [PMID: 29849257 DOI: 10.1212/cpj.0000000000000248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- George Zacharia
- Department of Hematology and Oncology (GZ, DS), and Department of Neurosurgery (RAO), Lenox Hill Hospital, New York
| | - Dana Shani
- Department of Hematology and Oncology (GZ, DS), and Department of Neurosurgery (RAO), Lenox Hill Hospital, New York
| | - Rafael A Ortiz
- Department of Hematology and Oncology (GZ, DS), and Department of Neurosurgery (RAO), Lenox Hill Hospital, New York
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Sepúlveda C, Palomo I, Fuentes E. Primary and secondary haemostasis changes related to aging. Mech Ageing Dev 2015; 150:46-54. [PMID: 26296601 DOI: 10.1016/j.mad.2015.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/02/2015] [Accepted: 08/11/2015] [Indexed: 12/17/2022]
Abstract
Life expectancy has increased in many countries as a result the world's population is aging. The projections indicate that the proportion of the elderly in a few decades will increase significantly. Aging carries with it a series of physiological changes; one of them is an imbalance in the hemostatic system. Thus the levels or activity of various proteins involved, such as most coagulation factors, natural anticoagulants and the fibrinolytic system are altered so that the hemostatic balance leans toward thrombosis. Also, platelet activity suggests a state of abnormal activation (P-selectin, beta thromboglobulin and platelet factor). In this review we will systematically examine the alterations in the hemostatic components that occur during aging. Therefore, understanding these hemostatic changes could contribute to developing strategies for the proper management of health in old age.
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Affiliation(s)
- Cesar Sepúlveda
- Department of Clinical Biochemistry and Immunohaematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca, Chile
| | - Iván Palomo
- Department of Clinical Biochemistry and Immunohaematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca, Chile; Centro de Estudios en Alimentos Procesados (CEAP), CONICYT- Regional, Gore Maule R09I2001, Chile.
| | - Eduardo Fuentes
- Department of Clinical Biochemistry and Immunohaematology, Faculty of Health Sciences, Interdisciplinary Excellence Research Program on Healthy Aging (PIEI-ES), Universidad de Talca, Talca, Chile; Centro de Estudios en Alimentos Procesados (CEAP), CONICYT- Regional, Gore Maule R09I2001, Chile.
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GLU298ASP and 4G/5G Polymorphisms and the Risk of Ischemic Stroke in Young Individuals. Can J Neurol Sci 2015; 42:310-6. [PMID: 26036781 DOI: 10.1017/cjn.2015.45] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Polymorphisms in the endothelial nitric oxide synthase (eNOS) and in the plasminogen activator inhibitor -1 (PAI-1) genes have been implicated in stroke pathogenesis but results are still controversial. The aim of this study was to examine the possible contribution of Glu298Asp in the eNOS and 4G/5G in the PAI-1polymorphisms with ischemic stroke in a young Mexican population. MATERIALS AND METHODS In a case-control study, conducted between January 2006 and June 2010, 204 patients ≤45 years of age with ischemic stroke and 204 controls matched by age and gender, were recruited. The Glu298Asp and 4G/5G polymorphisms were determined in all participants by polymerase chain reaction-restriction fragment length polymorphism. RESULTS There was a significant difference in the Glu298Asp genotype distribution (P=0.001) and allele frequency between the two groups (P=0.001). The 4G/5G genotype distribution (P=0.40) and the allele frequency was similar between groups; (P=0.13). There were independent factors for ischemic stroke: Asp carriage (GluAsp+AspAsp) (P=0.02); smoking (P=0.01); hypertension (P=0.03), and familial history of atherothrombotic disease (P=0.04). CONCLUSIONS The Asp allele from the Gu298Asp gene represents an independent risk factor for ischemic stroke in a young Mexican population. In contrast, the 4G/5G was not associated with an increased risk for this disease in the same group of patients, as previously has been demonstrated in other populations.
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Davydov DM, Zhdanov RI, Dvoenosov VG, Kravtsova OA, Voronina EN, Filipenko ML. Resilience to orthostasis and haemorrhage: A pilot study of common genetic and conditioning mechanisms. Sci Rep 2015; 5:10703. [PMID: 26024428 PMCID: PMC4650686 DOI: 10.1038/srep10703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/27/2015] [Indexed: 01/15/2023] Open
Abstract
A major challenge presently is not only to identify the genetic polymorphisms increasing risk to diseases, but to also find out factors and mechanisms, which can counteract a risk genotype by developing a resilient phenotype. The objective of this study was to examine acquired and innate vagal mechanisms that protect against physical challenges and haemorrhages in 19 athletes and 61 non-athletes. These include examining change in heart rate variability (HF-HRV; an indicator of vagus activity) in response to orthostatic challenge, platelet count (PLT), mean platelet volume (MPV), and single-nucleotide polymorphisms in genes that encode several coagulation factors, PAI-1, and MTHFR. Individual differences in PLT and MPV were significant predictors, with opposite effects, of the profiles of the HF-HRV changes in response to orthostasis. Regular physical training of athletes indirectly (through MPV) modifies the genetic predisposing effects of some haemostatic factors (PAI-1 and MTHFR) on vagal tone and reactivity. Individual differences in vagal tone were also associated with relationships between Factor 12 C46T and Factor 11 C22771T genes polymorphisms. This study showed that genetic predispositions for coagulation are modifiable. Its potential significance is promoting advanced protection against haemorrhages in a variety of traumas and injuries, especially in individuals with coagulation deficits.
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Affiliation(s)
- Dmitry M Davydov
- 1] Sholokhov Moscow State University for the Humanities, the Russian Institute for Advanced Study and Institute of Neurosciences and Cognitive Research, Verkhnyaya Radishevskaya 16-18, Moscow, 109240 [2] Laboratory of Neuroimmunopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, 8 Baltiyskaia ul., Moscow, 125315, Russia
| | - Renad I Zhdanov
- 1] Sholokhov Moscow State University for the Humanities, the Russian Institute for Advanced Study and Institute of Neurosciences and Cognitive Research, Verkhnyaya Radishevskaya 16-18, Moscow, 109240 [2] Institute of Fundamental Medicine and Biology, Kazan (Volga region) Federal University, 18 Kremlin ul., Kazan, 420008, Russia
| | - Vladimir G Dvoenosov
- Institute of Fundamental Medicine and Biology, Kazan (Volga region) Federal University, 18 Kremlin ul., Kazan, 420008, Russia
| | - Olga A Kravtsova
- Institute of Fundamental Medicine and Biology, Kazan (Volga region) Federal University, 18 Kremlin ul., Kazan, 420008, Russia
| | - Elena N Voronina
- Pharmacogenomics laboratory, Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Maxim L Filipenko
- Pharmacogenomics laboratory, Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, Novosibirsk, 630090, Russia
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Fu HJ, Zhao LB, Xue JJ, Wu ZX, Huang YP, Liu W, Gao Z. Elevated Serum Homocysteine (Hcy) Levels May Contribute to the Pathogenesis of Cerebral Infarction. J Mol Neurosci 2015; 56:553-61. [DOI: 10.1007/s12031-015-0497-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/14/2015] [Indexed: 11/24/2022]
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20
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Cui T. MTHFR C677T mutation increased the risk of Ischemic Stroke, especially in large-artery atherosclerosis in adults: an updated meta-analysis from 38 researches. Int J Neurosci 2015; 126:10-9. [DOI: 10.3109/00207454.2014.990559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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21
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Pirhoushiaran M, Ghasemi MR, Hami J, Zargari P, Sasan Nezhad P, Azarpazhooh MR, Sadr Nabavi A. The Association of Coagulation Factor V (Leiden) and Factor II (Prothrombin) Mutations With Stroke. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e11548. [PMID: 25763204 PMCID: PMC4329966 DOI: 10.5812/ircmj.11548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 03/24/2014] [Accepted: 08/30/2014] [Indexed: 11/25/2022]
Abstract
Background: Epidemiological studies indicate that over the past forty years, the stroke incidence rates has increased. Factors V and II mutations are established genetic-variant risk factors for venous thrombosis; however, their contribution to stroke is a controversial issue. Objectives: This study aimed to investigate the potential association of FV and FII mutations with stroke in an Iranian population. Patients and Methods: The study population consisted of 153 patients of different stroke subtypes (except cryptogenic strokes), admitted to Ghaem Hospital, Mashhad, Iran. The control group included 153 age- and sex-matched subjects without a history of cerebrovascular or neurologic diseases. Mutations of FV and FII were determined by using a TaqMan SNP Genotyping technique. The chi-square and Exact Fisher tests were used to analyze the baseline characteristics. Results were as follows: The calculated P-value for sex and diabetes mellitus were 0.907 and 1.000, respectively. The case and control groups were also matched in low density lipoprotein (P = 0.816), high density lipoprotein (P = 0.323), triglyceride (P = 0.846), and total cholesterol (P = 0.079). Results: Analysis of the FV showed that none of the study subjects were AA homozygous for this mutation and only 6 heterozygous subjects were detected in the case and control groups. Regarding FII variants, none of the study subjects were AG heterozygous and only 1 AA homozygous was detected in the control group. Conclusions: The prevalence of both FV and FII variants are population based. Iran is an ethnically diverse country. Therefore, for a comprehensive analysis of a potential association of FV and/or FII mutations with stroke among Iranian population, epidemiological studies could be conducted among different ethnic groups.
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Affiliation(s)
- Maryam Pirhoushiaran
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Reza Ghasemi
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Javad Hami
- Department of Anatomical Sciences, School of Medicine, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Peyman Zargari
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
| | - Payam Sasan Nezhad
- Ghaem Medical Center, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahmood Reza Azarpazhooh
- Ghaem Medical Center, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ariane Sadr Nabavi
- Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Medical Genetic Research Center (MGRC), School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Iranian Academic Centers for Education, Culture and Research (ACECR), Mashhad, IR Iran
- Corresponding Author: Ariane Sadr Nabavi, Department of Human Genetics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel/Fax: +98-5118002226, E-mail:
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Araji AA, Sawaya HR, Sawaya RA. Gene Mutations and Stroke in the Young Adult. J Stroke Cerebrovasc Dis 2014; 23:2554-2558. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/23/2014] [Accepted: 05/29/2014] [Indexed: 10/24/2022] Open
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23
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Profile of prothrombotic factors in Indian children with ischemic stroke. J Clin Neurosci 2014; 21:1315-8. [DOI: 10.1016/j.jocn.2013.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/18/2013] [Indexed: 11/21/2022]
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24
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Jiang B, Ryan KA, Hamedani A, Cheng Y, Sparks MJ, Koontz D, Bean CJ, Gallagher M, Hooper WC, McArdle PF, O'Connell JR, Stine OC, Wozniak MA, Stern BJ, Mitchell BD, Kittner SJ, Cole JW. Prothrombin G20210A mutation is associated with young-onset stroke: the genetics of early-onset stroke study and meta-analysis. Stroke 2014; 45:961-7. [PMID: 24619398 DOI: 10.1161/strokeaha.113.004063] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Although the prothrombin G20210A mutation has been implicated as a risk factor for venous thrombosis, its role in arterial ischemic stroke is unclear, particularly among young adults. To address this issue, we examined the association between prothrombin G20210A and ischemic stroke in a white case-control population and additionally performed a meta-analysis. METHODS From the population-based Genetics of Early Onset Stroke (GEOS) study, we identified 397 individuals of European ancestry aged 15 to 49 years with first-ever ischemic stroke and 426 matched controls. Logistic regression was used to calculate odds ratios (ORs) in the entire population and for subgroups stratified by sex, age, oral contraceptive use, migraine, and smoking status. A meta-analysis of 17 case-control studies (n=2305 cases <55 years) was also performed with and without GEOS data. RESULTS Within GEOS, the association of the prothrombin G20210A mutation with ischemic stroke did not achieve statistical significance (OR=2.5; 95% confidence interval [CI]=0.9-6.5; P=0.07). However, among adults aged 15 to 42 years (younger than median age), cases were significantly more likely than controls to have the mutation (OR=5.9; 95% CI=1.2-28.1; P=0.03), whereas adults aged 42 to 49 years were not (OR=1.4; 95% CI=0.4-5.1; P=0.94). In our meta-analysis, the mutation was associated with significantly increased stroke risk in adults ≤55 years (OR=1.4; 95% CI=1.1-1.9; P=0.02), with significance increasing with addition of the GEOS results (OR=1.5; 95% CI=1.1-2.0; P=0.005). CONCLUSIONS The prothrombin G20210A mutation is associated with ischemic stroke in young adults and may have an even stronger association among those with earlier onset strokes. Our finding of a stronger association in the younger young adult population requires replication.
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Affiliation(s)
- Baijia Jiang
- From the Departments of Neurology (B.J., A.H., M.J.S., M.A.W., B.J.S., S.J.K., J.W.C.), Medicine (K.A.R., Y.C., P.F.M., J.R.O., B.D.M.), and Epidemiology and Public Health (O.C.S.), University of Maryland School of Medicine, Baltimore; Centers for Disease Control and Prevention, Atlanta, GA (D.K., C.J.B., M.G., W.C.H.); Department of Veterans Affairs, Veterans Affairs Medical Center Baltimore, MD (Y.C., M.A.W., B.J.S., S.J.K., J.W.C.); and Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center, MD (B.D.M., S.J.K.)
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The role of genetic risk factors in arterial ischemic stroke in pediatric and adult patients: a critical review. Mol Biol Rep 2014; 41:4241-51. [PMID: 24584518 DOI: 10.1007/s11033-014-3295-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 02/13/2014] [Indexed: 01/07/2023]
Abstract
The incidence of arterial ischemic stroke (AIS) in childhood (about 2-13 per 100,000 children a year) is much lower than the incidence in the adult population. Still, adverse outcomes of acute brain ischemia in childhood include death (10% of AIS children), neurological sequel, epileptic seizures (over 50%) and recurrence (over 20%). The knowledge of childhood stroke etiopathogenesis is still insufficient and the diagnostic and therapeutic procedures--controversial. Risk factors for childhood stroke differ from those observed in adults due to differing exposure to external risk factors. The most frequently reported risk factors for pediatric ischemic stroke are cerebral arteriopathies and vascular malformations, cardiac diseases, infections, traumas and metabolic diseases. Because of its multifactorial etiology pediatric AIS probably has a multigenic inheritance pattern. The genetic susceptibility to AIS may be determined by specific polymorphic variants encoding markers of hemostasis regulation and they are some of the most important targets in searching for genetic determinants in pediatric AIS. The authors have reviewed the recent literature on risk factors of childhood ischemic stroke with the focus on genetic factors like polymorphisms of genes encoding coagulation factors II, V, VII and XIII, MTHFR, fibrinogen beta, and compared them with the results performed in adult patients.
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Rivera-García BE, Esparza-García JC, Aceves-Chimal JL, Leaños-Miranda A, Majluf-Cruz A, Isordia-Salas I. Platelet glycoprotein IIIA PIA1/A2 polymorphism in young patients with ST elevation myocardial infarction and idiopathic ischemic stroke. Mol Cell Biochem 2013; 384:163-71. [PMID: 24005535 DOI: 10.1007/s11010-013-1794-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/23/2013] [Indexed: 11/26/2022]
Abstract
It has been identified that platelet glycoprotein IIIa PIA1/A2 polymorphism plays an important role in atherothrombotic disease such as myocardial infarction and stroke, but results remain controversial. Here, we investigated whether the PIA2 allele is associated with ST myocardial infarction or idiopathic ischemic stroke in young individuals in two independent studies. In a case-control study 275 patients with ST elevation myocardial infarction ≤45 years of age and 278 controls were recruited. In a second study, 200 patients with idiopathic ischemic stroke ≤45 years of age and 200 controls were enrolled. In both studies cases and controls were matched by age and gender. The PIA1/A2 polymorphism was determined in all participants by a polymerase chain reaction-restriction fragment length polymorphism assay. There was a significant difference in the PIA1/A2 genotype distribution (P = 0.001) and allele frequency (P = 0.001), between ST elevation myocardial infarction and control groups, but not in the PIA1/A2 genotype distribution (P = 0.61) and allele frequency (P = 0.80), between idiopathic ischemic stroke. The allele PIA2 represented an independent risk for ST elevation myocardial infarction but not for idiopathic ischemic stroke. Hypertension, smoking, and family history of atherothrombotic disease were also associated with ST elevation myocardial infarction and idiopathic ischemic stroke. Our results suggest that PA2 allele represents a risk factor for ST elevation myocardial infarction in young Mexican individuals but not for idiopathic ischemic stroke.
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Hamedani AG, Cole JW, Cheng Y, Sparks MJ, O'Connell JR, Stine OC, Wozniak MA, Stern BJ, Mitchell BD, Kittner SJ. Factor V leiden and ischemic stroke risk: the Genetics of Early Onset Stroke (GEOS) study. J Stroke Cerebrovasc Dis 2013; 22:419-23. [PMID: 22100829 PMCID: PMC3288467 DOI: 10.1016/j.jstrokecerebrovasdis.2011.10.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/14/2011] [Accepted: 10/15/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Factor V Leiden (FVL) has been associated with ischemic stroke in children but not in adults. Although the FVL mutation is associated with increased risk for venous thrombosis, its association with ischemic stroke in young adults remains uncertain. Therefore, we examined the association between FVL and ischemic stroke in participants of the Genetics of Early Onset Stroke (GEOS) study. METHODS A population-based case control study identified 354 women and 476 men 15 to 49 years of age with first-ever ischemic stroke and 907 controls. Participant-specific data included vascular risk factors, FVL genotype and, for cases, the ischemic stroke subtype by modified Trial of ORG 10172 in Acute Stroke criteria. Logistic regression was used to calculate odds ratios for the entire population and for subgroups stratified by risk factors and ischemic stroke subtype. RESULTS The frequency of the FVL mutation was similar between ischemic stroke patients (3.6%; 95% confidence interval [CI] 2.5%-5.1%) and nonstroke controls (3.8%; 95% CI 2.7%-5.2%). This frequency did not change significantly when cases were restricted to patients with stroke of undetermined etiology (4.1%; 95% CI 2.6%-6.4%). CONCLUSIONS Among young adults, we found no evidence for an association between FVL and either all ischemic stroke or the subgroup with stroke of undetermined etiology.
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Affiliation(s)
- Ali G. Hamedani
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - John W. Cole
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Yuching Cheng
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Mary J. Sparks
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Jeffrey R. O'Connell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Oscar C. Stine
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Marcella A. Wozniak
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Barney J. Stern
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Braxton D. Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Steven J. Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
- Baltimore Veterans Affairs Medical Center, Baltimore, MD
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Hotait M, Sawaya R. Spontaneous Bilateral Vertebral Artery Dissection Secondary to PAI-1, MTHFR C677T and ACE Gene Mutations in a Young Man. Cerebrovasc Dis 2013; 35:182-3. [DOI: 10.1159/000346103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Favaretto E, Sartori M, Conti E, Legnani C, Palareti G. G1691A factor V and G20210A FII mutations, acute ischemic stroke of unknown cause, and patent foramen ovale. Thromb Res 2012; 130:720-4. [DOI: 10.1016/j.thromres.2012.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/17/2012] [Accepted: 07/17/2012] [Indexed: 12/22/2022]
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Hamzi K, Tazzite A, Nadifi S. Large-scale meta-analysis of genetic studies in ischemic stroke: Five genes involving 152,797 individuals. INDIAN JOURNAL OF HUMAN GENETICS 2012; 17:212-7. [PMID: 22345995 PMCID: PMC3276992 DOI: 10.4103/0971-6866.92105] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: Ischemic stroke descent has a genetic basis. Stroke represents a complex trait, which is assumed to be polygenic. On this topic, the role of a wide number of candidate genes has been investigated in stroke through association studies. MATERIALS AND METHODS: We performed a literature-based systematic review of genetic association studies in stroke abound several populations. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined for each gene-disease association. Following a review of 300 manuscripts, five candidate gene variants were analyzed among 152,797 individuals (45,433 cases and 107,364 controls). RESULTS: For these five candidate genes studied, the prothrombin OR is 1,57 (1,23-2,89), the factor V Leiden OR is 1,43 (0,67-6,24), the mean OR of angiotensin I converting enzyme (ACE) insertion/deletion (I/D) polymorphism is 1,11 (1,02-1,25), the summary OR for the C677T variant of 5,10-methylenetetrahydrofolate reductase (MTHFR) is 1,23 (0,61-1,47) and the pooled OR for the apolipoprotein E (APOE) gene is 0,95 (0,77-1,14) . CONCLUSION: These data suggest the genetic associations of some genes with ischemic stroke and it is necessary to compete with other genes. Our findings could represent an epidemiological base and a useful tool to address further molecular investigations and to realize more detailed meta-analyses.
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Affiliation(s)
- Khalil Hamzi
- Laboratory of Human Genetics and Molecular Pathology, Facullty of medicine, UH2C - Casablanca, Morocco
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Murthy SN, Matta AS, Mondal D, McNamara DB. Methods in assessing homocysteine metabolism. Metab Syndr Relat Disord 2012; 1:129-40. [PMID: 18370634 DOI: 10.1089/154041903322294452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Homocysteine, a sulfur-containing amino acid, is a metabolite of the essential amino acid methionine. High blood levels of homocysteine result in far-reaching biochemical and life-threatening consequences. Homocysteine exists at a critical biochemical intersection in the methionine cycle between S-adenosylmethionine, the ubiquitous methyl donor, and vitamins B(12) and folic acid. Indirect and direct vascular damage can be caused by homocysteine, a putative atherothrombotic risk factor. Homocysteine has been associated with vascular disease, particularly in subjects with significant carotid stenosis. Increasing evidence for a connection between homocysteine metabolism and cognitive function is surfacing, and this includes from mild cognitive decline (age-related memory loss) to vascular dementia and Alzheimer's disease. In the elderly population increase in homocysteine is commonly seen due to significant deficiencies in cobalamin (B(12)), folate and vitamin B(6.) All of these disease associations are thought to be interrelated via increased homocysteine and S-adenosylhomocysteine and subsequent hypomethylation of numerous substances, including DNA and proteins, rendering vascular structures more susceptible to damage. Decreasing plasma homocysteine, by providing nutritional cofactors for its metabolism has been shown to reduce the risk of cardiovascular events. The current methods of evaluation of homocysteine metabolism include assessment of cobalamin (B(12)) and folate and vitamin B(6) status and screening for mutations in the genes encoding the enzymes of metabolism. An accurate method for the estimation of plasma and tissue levels of homocysteine would contribute greatly to a proper understanding of the metabolism. In the current review emphasis will be on the estimation of homocysteine, and evaluation of one of the common mutations encountered in the metabolism of this amino acid.
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Affiliation(s)
- Subramanyam N Murthy
- Department of Medicine, Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, Louisiana
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They-They TP, Battas O, Slassi I, Rafai MA, Katumbay DT, Nadifi S. Prothrombin G20210A and factor V Leiden polymorphisms in stroke. J Mol Neurosci 2011; 46:210-6. [PMID: 21701789 DOI: 10.1007/s12031-011-9580-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Accepted: 06/12/2011] [Indexed: 12/23/2022]
Abstract
The molecular epidemiology of stroke is critically lacking in the developing world. We explored the relationships between genetics polymorphism and risk for ischemic stroke among the residents of Casablanca, Morocco. Ninety-one stroke patients matched 1:2 for their age, gender, and ethnic background to 182 healthy controls who were genotyped for the prothrombin G20210A mutation and factor V (FV) Leiden and were assessed for conventional risk factors for stroke. No significant association was found between prothrombin gene mutation with stroke (p = .054). Regarding stroke subtypes, significant relationships between patients with a large artery disease subtype of stroke and this mutation was found compared to controls (p = .046). As a genetic risk factor to develop this event, a strong association was observed when adjusted for conventional vascular risk factors (adjusted OR, 4.3; p = .029). No FV Leiden was found. We suggest that prothrombin mutation but not FV Leiden should be considered as a modest genetic risk factor for large artery disease stroke subtype in the Moroccan population.
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Affiliation(s)
- Thierry Paluku They-They
- Laboratory of Genetic and Molecular Pathology, Medical School, Hassan II University, 19, rue Tarik-Ibn-Ziad, BP 9154, 10000, Casablanca, Morocco.
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Abstract
To analyze risk factors for ischemic stroke and transient ischemic attack (TIA) in young adults under the age of 50. To make recommendations for additional research and practical consequences. From 97 patients with ischemic stroke or TIA under the age of 50, classical cardiovascular risk factors, coagulation disorders, history of migraine, use of oral contraceptives, cardiac abnormalities on ECG and echocardiography, and the results of duplex ultrasound were retrospectively analyzed. Literature was reviewed and compared to the results. 56.4% of the patients had hypertension, 12.1% increased total cholesterol, 20% hypertriglyceridemia, 31.5% an increased LDL-level, 32.6% a decreased HDL-level and 7.2% a disturbed glucose tolerance. Thrombophilia investigation was abnormal in 21 patients and auto-immune serology was abnormal in 15 patients. Ten of these patients were already known with a systemic disease associated with an increased risk for ischemic stroke (i.e. systemic lupus erythematosus). The ECG was abnormal in 16.7% of the cases, the echocardiography in 12.1% and duplex ultrasound of the carotid arteries was in 31.8% of the cases abnormal. Conventional cardiovascular risk factors are not only important in patients over the age of 50 with ischemic stroke or TIA, but also in this younger population under the age of 50. Thrombophilia investigation and/ or autoimmune serology should be restricted to patients without conventional cardiovascular risk factors and a history or other clinical symptoms associated with hypercoagulability and/ or autoimmune diseases.
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They-They TP, Nadifi S, Rafai MA, Battas O, Slassi I. Methylenehydrofolate reductase (C677T) polymorphism and large artery ischemic stroke subtypes. Acta Neurol Scand 2011; 123:105-10. [PMID: 20637011 DOI: 10.1111/j.1600-0404.2010.01348.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role for the methylenetetrahydrofolate reductase C677T gene variants in the risk of ischemic stroke is controversial. METHOD This first case-control study including 91 cases affected by ischemic stroke and 182 controls matched for age, sex, and same area was conducted in Casablanca, Morocco. Allele and genotype frequency were characterized by using PCR followed by HinfI enzymatic digestion. RESULTS We found no statistic association of T allele carriers genetic factors with stroke; odds ratio, 1.1; 95% confidence interval (CI), 0.59-2.04, P = 0.303. The results shown significant association of T allele carriers genetic factors with atherothrombotic subtype stroke (n = 42); odds ratio, 2.1; 95% CI: 1.17-3.8; P = 0.012, and adjusted odds ratio of 6.5; 95% CI: 1.86-23.1, P = 0.003, for TT genotype variant compared with CC wild genotype. CONCLUSION We suggested that MTHFR C677T variant may be a determinant of atherothrombotic event of ischemic stroke in Morocco.
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Affiliation(s)
- T P They-They
- Hassan II University, Ibn Rochd Hospital, District Hospitals, Casablanca, Morocco.
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Abstract
OBJECTIVE To evaluate the risk factors and treatment status of Chinese stroke patients aged 35-45 years old. METHODS We collected data from 1988 in-hospital stroke patients aged 35-45 years old from 36 hospitals in mainland China and compared it to 12,260 health controls with the same age. Information about stroke risk factors was obtained through a questionnaire. Multiple logistic regression and chi-square test were performed to explore the association between risk factors and stroke in young patients. RESULTS Of the stroke patients, 94.3% had an ischemic stroke and 73.0% were male. Frequencies of stroke risk factors were significantly higher in patients than those in controls, including history of hypertension (41.0% versus 9.0%, p<0.05), diabetes (5.2% versus 1.7%, p<0.05), hypercholesterolemia (4.2% versus 2.9%, p<0.05), heart diseases (7.2% versus 1.6%, p<0.05), stroke (14.9% versus 1.3%, p<0.05), smoking (38.8% versus 33.3%, p<0.05) and drinking (38.0% versus 24.9%, p<0.05). Furthermore, only 12.8% of patients with hypertension took antihypertensive drugs regularly, and 27.9% of diabetic patients took hypoglycemic drugs regularly. Risk factors when compared between male and female patients were as follows: history of heart diseases (5.9 versus 10.8, p<0.05), smoking (50.9 versus 6.5, p<0.05) and drinking (50.4 versus 5.8, p<0.05). CONCLUSION Majority of the Chinese stroke patients aged 35-45 years were male and had suffered an ischemic stroke. The history of stroke, heart disease and hypercholesterolemia could increase the risk of stroke in young adults, and the risk factors in the order of importance were hypertension, smoking, alcohol drinking, previous stroke, heart disease, diabetes mellitus and hyperlipidemia. Hypertension, smoking and alcohol drinking were found to be the main risk factors; treatment state and lifestyle should be improved for young stroke patients.
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Affiliation(s)
- Qi Bi
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Hamedani AG, Cole JW, Mitchell BD, Kittner SJ. Meta-analysis of factor V Leiden and ischemic stroke in young adults: the importance of case ascertainment. Stroke 2010; 41:1599-603. [PMID: 20616326 DOI: 10.1161/strokeaha.110.581256] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The factor V Leiden mutation is associated with ischemic stroke in children but not in adults. Whether it is associated with ischemic stroke in young adults, however, is uncertain. METHODS To address this issue, we performed a meta-analysis of 18 case-control studies of ischemic stroke in adults 50 years of age and younger published before June 2009. RESULTS Across all studies, factor V Leiden was detected in 154 of 2045 cases (7.5%) and 217 of 5307 controls (4.1%), yielding a fixed-effect odds ratio of 2.00 (95% CI, 1.59-2.51). However, further analyses revealed substantial heterogeneity among these studies (P=0.005 for Q-test of heterogeneity). Hypothesizing that this heterogeneity could be related to differences among studies in case selection criteria, we stratified the meta-analysis into studies for which case samples were enriched or not enriched to include cases having an increased likelihood of prothrombotic genetic involvement ("selected" ischemic stroke studies, n=9) and those that recruited cases from consecutive neurology referrals or hospitalizations ("unselected" ischemic stroke studies, n=8). Among the 9 "selected" ischemic stroke studies, factor V Leiden was more strongly associated with stroke (OR, 2.73; 95% CI, 1.98-3.75), whereas among the 8 "unselected" ischemic stroke studies, the association between factor V Leiden and stroke was substantially weaker (OR, 1.40; 95% CI, 0.998-1.95). This difference was found to be statistically significant (P=0.003 for Woolf test for heterogeneity). CONCLUSIONS We conclude that factor V Leiden is associated with ischemic stroke in young adults, particularly in patient populations in which there is an increased clinical suspicion of prothrombotic state.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201-1509, USA
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Stankovic S, Majkic-Singh N. Genetic aspects of ischemic stroke: coagulation, homocysteine, and lipoprotein metabolism as potential risk factors. Crit Rev Clin Lab Sci 2010; 47:72-123. [DOI: 10.3109/10408361003791520] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Varoglu AO, Kocatürk I, Tatar A. Prothrombin G20210A Mutation, Hypogonadotropic Hypogonadism, and Generalized Vitiligo-Related Ischemic Stroke in a Young Adult. Int J Neurosci 2010; 120:451-3. [DOI: 10.3109/00207451003797702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Case reports: heritable thrombophilia associated with deep venous thrombosis after shoulder arthroscopy. Clin Orthop Relat Res 2009; 467:2196-9. [PMID: 19452233 PMCID: PMC2706365 DOI: 10.1007/s11999-009-0895-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 05/05/2009] [Indexed: 01/31/2023]
Abstract
Thromboembolic complications after shoulder arthroscopy are rare and their cause has not been well determined. Heritable thrombophilia has been studied in relation to numerous clinical conditions, and it has been associated with thromboembolic complications after some orthopaedic surgeries, especially after total hip or knee arthroplasty. We report three patients who had deep vein thrombosis develop after shoulder arthroscopy. All three tested positive for heritable thrombophilia, a condition undetected until this complication occurred. This report highlights the possibility that unrecognized coagulation disorders might seriously influence the clinical outcome of minimally invasive surgery. We suggest heritable thrombophilia is a possible risk factor for or etiology of deep vein thrombosis after shoulder arthroscopy.
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Abstract
The term lacuna, or cerebral infarct, refers to a well-defined, subcortical ischemic lesion at the level of a single perforating artery, determined by primary disease of the latter. The radiological image is that of a small, deep infarct. Arteries undergoing these alterations are deep or perforating arteries with a diameter ranging between 100 and 400 microm, numbering 6-12, that generally originate at right angles directly from the main arteries. The concept of lacunar syndrome was introduced in clinical practice to describe those clinical pictures that generally, although not always, have a cerebral infarct of lacunar type as the underlying mechanism. Classic clinical syndromes induced by lacunar infarcts are, in decreasing order of frequency, pure motor stroke, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and dysarthria with motor disability of one hand, as well as a number of rare or incomplete syndromes. Small lacunar infarct that will then degenerate into a lacuna is caused by a reduction of blood flow to a perforating artery. In turn, this is the result of various arterial disorders, the most frequent of which include microatheroma, lipohyalinosis, fibrinoid necrosis, and Charcot-Bouchard aneurysm. Other forms of arteriopathy that can affect small vessels include amyloid angiopathy, and cerebral autosomic dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Hemodynamic disorders also can be a cause of the disease. Diagnosis is made with 1,5 Tesla MRI and prognosis is generally good.
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Tascilar N, Ekem S, Aciman E, Ankarali H, Mungan G, Ozen B, Unal A. Hyperhomocysteinemia as an Independent Risk Factor for Cardioembolic Stroke in the Turkish Population. TOHOKU J EXP MED 2009; 218:293-300. [DOI: 10.1620/tjem.218.293] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nida Tascilar
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Sureyya Ekem
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Esra Aciman
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Handan Ankarali
- Department of Biostatistics, Zonguldak Karaelmas University Medical Faculty
| | - Gorkem Mungan
- Department of Biochemistry, Zonguldak Karaelmas University Medical Faculty
| | - Banu Ozen
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
| | - Aysun Unal
- Department of Neurology, Zonguldak Karaelmas University Medical Faculty
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Palmieri V, Tufano A, Carmen Bonito M, Martino S, Sabatella M, Di Minno G, Celentano A. Right-to-left shunt, atrial septal aneurysm and thrombophilia in patients with cryptogenic stroke or TIA vs. those with venous thrombo-embolism. Int J Cardiol 2008; 130:99-102. [PMID: 17643530 DOI: 10.1016/j.ijcard.2007.06.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2007] [Accepted: 06/30/2007] [Indexed: 10/23/2022]
Abstract
Whether intracardiac right-to-left shunt (RLS) is an independent risk factor for cerebrovascular accidents is disputed. In patients with RLS, venous thrombo-embolism (VTE) may predispose to paradoxical embolic events, among which stroke and transient ischemic attack (TIA). Whether genetic or acquired thrombophilia is associated with RLS is unclear. Thus, we compared prevalences of intra- and extracardiac intrapulmonary RLS and of atrial septal aneurysm (ASA) between 29 nondiabetic patients with cryptogenic stroke (n=17) or TIA (n=12) and 19 patients with VTE but without history of stroke/TIA, or autoimmune systemic disease or migraine. Carotid atherosclerosis was excluded in all patients. RLS and ASA were also evaluated in 30 healthy volunteers. We found that intracardiac RLS (31%) and ASA (21%) were detected in stroke/TIA patients and not in our selected VTE patients (both p<0.05); however, those prevalences were comparable to those detected in our controls (20% intracardiac RLS, 7% ASA, respectively, both p=NS). Within patients, thrombophilia was not associated with intracardiac RLS, but tended to be associated with ASA (83% in those with vs. 43% in those without ASA, p=0.08). In conclusions, intracardiac RLS may have a role in selected populations in the frame the multi-factorial pathogenesis of stroke/TIA of embolic origin. ASA appears to be an independent risk factor for stroke/TIA with possible interaction with thrombophilia.
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Bhat T, Mir M, Qasim I, Misra S, Kirmani M. Genetic Polymorphism of 5, 10-Methylenetetrahydrofolate Reductase C677T in Kashmiri Population. ACTA ACUST UNITED AC 2008. [DOI: 10.3923/biotech.2008.822.825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kucukarabaci B, Gunes HV, Ozdemir G, Cosan D, Ozbabalik D, Dikmen M, Degirmenci I. Investigation of Association between Plasminogen Activator Inhibitor Type-1 (PAI-1) Gene 4G/5G Polymorphism Frequency and Plasma PAI-1 Enzyme Activity in Patients with Acute Stroke. ACTA ACUST UNITED AC 2008; 12:443-51. [DOI: 10.1089/gte.2008.0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Banu Kucukarabaci
- Department of Medical Biology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Hasan Veysi Gunes
- Department of Medical Biology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Gazi Ozdemir
- Department of Neurology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Didem Cosan
- Department of Medical Biology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Demet Ozbabalik
- Department of Neurology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Miris Dikmen
- Department of Pharmacology, Pharmacy Faculty, Anadolu University, Eskisehir, Turkey
| | - Irfan Degirmenci
- Department of Medical Biology, Medical Faculty, Eskisehir Osmangazi University, Eskisehir, Turkey
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Linnemann B, Schindewolf M, Zgouras D, Erbe M, Jarosch-Preusche M, Lindhoff-Last E. Are patients with thrombophilia and previous venous thromboembolism at higher risk to arterial thrombosis? Thromb Res 2008; 121:743-50. [PMID: 17804043 DOI: 10.1016/j.thromres.2007.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 07/14/2007] [Accepted: 07/18/2007] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Whether thrombophilic disorders, which are established risk factors for venous thromboembolism (VTE), also increase the risk of arterial thrombosis is still unknown. MATERIALS AND METHODS We analyzed data from 1081 consecutive patients (649 F/432 M, 16-93 years of age) with previous VTE registered in the MAISTHRO (MAin-ISar-THROmbosis) database with regard to arterial thrombotic events and contributing risk factors. Screening for thrombophilia included testing for factor V Leiden and prothrombin G20210A mutation, antiphospholipid antibodies and activities of factor VIII, protein C, protein S and antithrombin. RESULTS Of the entire study cohort, 40 patients (3.7%) had a prior myocardial infarction (MI), and 41 (3.8%) suffered a stroke. Other arterial thrombotic events were rare. Elevated factor VIII levels were more prevalent in MI patients than in controls (44.4 vs. 25.9%, p=0.044), but after adjusting for the traditional cardiovascular risk factors, this relationship was no longer significant. We observed a higher rate of lupus anticoagulant in MI patients with an adjusted odds ratio of 3.3 (95%CI 0.84-12.8, p=0.090). No difference in any other tested thrombophilia was observed in patients with MI or stroke relative to those without. CONCLUSION The cumulative incidence of arterial thrombotic events in VTE patients is low, and the inherited thrombophilias do not seem to substantially increase the risk of arterial thrombosis.
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Affiliation(s)
- Birgit Linnemann
- Division of Vascular Medicine, Department of Internal Medicine, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7 D-60590 Frankfurt/Main, Germany.
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Mojiminiyi OA, Marouf R, Al Shayeb AR, Qurtom M, Abdella NA, Al Wazzan H, Al Humood S, Samad MA, El-Muzaini H. Determinants and associations of homocysteine and prothrombotic risk factors in Kuwaiti patients with cerebrovascular accident. Med Princ Pract 2008; 17:136-42. [PMID: 18287798 DOI: 10.1159/000112968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Accepted: 05/15/2007] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the determinants and associations of some prothrombotic risk factors in patients with cerebrovascular accidents (CVAs). SUBJECTS AND METHODS In this case-control study, plasma total homocysteine (tHcy), lupus anticoagulant, protein C, protein S, activated protein C resistance (APC-R) and antithrombin were measured in 102 patients (60 males and 42 females) and 167 controls (87 males, 80 females). Serum vitamin B(12), folate, red cell folate, creatinine, lipid profile and glucose were also determined. Glomerular filtration rate (GFR) was calculated. RESULTS 13 (22%) of the 60 male patients, and 16 (39%) of the 42 female patients had hyperhomocysteinemia. Median (interquartile range) tHcy was higher in male patients [11.22 micromol/l (9.60-15.40)] than female patients [10.05 micromol/l (8.72-17.54)]. On binary logistic regression analysis, the significant (p < 0.05) determinants of tHcy were urea, creatinine and GFR. Comparing patients with control subjects showed that tHcy, age, fasting glucose, urea, serum creatinine, white blood cell count, protein S, APC-R and factor VIII were significantly higher, while protein C, factor II, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly lower in patients. Lupus anticoagulant was not associated with tHcy and not detected in patients and controls. Low concentrations of vitamins B(12) and folate were not associated with tHcy. Logistic regression analysis showed a significant association of tHcy with CVA (OR = 9.55; p = 0.047) in males in the presence of other traditional CVA risk factors but tHcy is not independently associated with CVA in females. CONCLUSION Hyperhomocysteinemia is common in Kuwaiti patients with CVA and tHcy probably interacts with prothrombotic factors (protein C, APC-R and factor VIII) to increase CVA risk. The main determinants, age and GFR markers, should be kept in mind when determining the risk associated with tHcy.
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Belvís R, Santamaría A, Martí-Fàbregas J, Leta RG, Cocho D, Borrell M, Fontcuberta J, Martí-Vilalta JL. Patent foramen ovale and prothrombotic markers in young stroke patients. Blood Coagul Fibrinolysis 2007; 18:537-42. [PMID: 17762528 DOI: 10.1097/mbc.0b013e3281420398] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Patent foramen ovale (PFO) is more frequent in cryptogenic stroke patients than in the general population. The aim of this study was to determine prothrombotic markers regarding PFO in young cryptogenic stroke patients. We prospectively included consecutive cryptogenic stroke patients younger than 55 years. PFO was diagnosed with simultaneous transcranial Doppler and transesophageal echocardiography. We analyzed the following prothrombotic markers: antiphospholipid antibodies (APS), protein C and protein S deficiencies, factor V Leiden FVG1691A, prothrombin gene mutation PTG20210A and coagulation factor XII mutation FXIIC46T. From June 2005 to July 2006 we studied 39 patients, mean age 44.7 +/- 8.6 years, 48.7% men. PFO was detected in 17 patients (43.6%). We found no differences between PFO and non-PFO patients regarding prothrombotic markers: APS (P = 0.851), protein S deficiency (P = 0.851), protein C deficiency (P = 0.249), FVG1691A (P = 0.202), PTG20210A (P = 0.401) or FXIIC46T (P = 0.966). Female gender was the only variable related to prothrombotic markers, independent of PFO (P = 0.001). The only prothrombotic marker related to PFO size (large PFO) was APS (P = 0.043). Large PFO were also related to deep venous thrombosis (P = 0.040) and atrial septal aneurysm (P = 0.010). PFO patients do not present more prothrombotic markers than non-PFO patients, but APS are more frequent in large PFO.
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Affiliation(s)
- Robert Belvís
- Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Rahemtullah A, Van Cott EM. Hypercoagulation Testing in Ischemic Stroke. Arch Pathol Lab Med 2007; 131:890-901. [PMID: 17550316 DOI: 10.5858/2007-131-890-htiis] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—The utility of laboratory testing for hypercoagulability in the setting of stroke is uncertain.
Objective.—To review the current literature and to make recommendations with regard to laboratory testing for various hypercoagulability risk factors for ischemic stroke.
Data Sources.—Published articles studying the utility of various hypercoagulation tests in predicting initial and/or recurrent stroke or transient ischemic attack as well as cerebral vein thrombosis were collected and reviewed, with an emphasis on prospective studies.
Conclusions.—Certain tests, such as C-reactive protein, homocysteine, antiphospholipid antibodies, and lipoprotein(a), may be useful in patients with a history of stroke or at high risk for stroke, as evidenced by prospective data. Factor V Leiden, prothrombin G20210A, protein C, protein S, and antithrombin are not recommended for routine testing but may be useful in certain populations, such as in pediatric patients or in patients with cerebral vein thrombosis.
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Affiliation(s)
- Aliyah Rahemtullah
- Coagulation Laboratory, Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
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Atanassova PA, Angelova E, Tzvetanov P, Semerdjieva M, Dimitrov BD. Modelling of increased homocysteine in ischaemic stroke: post-hoc cross-sectional matched case-control analysis in young patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:24-31. [PMID: 17420822 DOI: 10.1590/s0004-282x2007000100007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 10/20/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND & PURPOSE: Hyperhomocysteinaemia has been postulated to participate in pathogenesis of ischaemic stroke (IS). However, especially in young adults, there is possibility of significantly increased IS risk due to increased ‘normal’ homocysteinaemia, i.e., ‘hidden’ (‘pathologically dormant’) prevalence within a healthy, normally-defined range. We performed a post-hoc modelling investigation on plasma total homocysteinaemia (THCY) in gender- and age-matched young patients in the acute IS phase. We evaluated relationships between THCY and prevalence of other potential risk factors in 41 patients vs. 41 healthy controls. METHOD: We used clinical methods, instrumental and neuroimmaging procedures, risk factors examination, total plasma homocysteine measurements and other laboratory and statistical modelling techniques. RESULTS: IS patients and healthy controls were similar not only for matching variables, but also for smoking, main vitamin status, serum creatinine and lipid profile. Patients with IS, however, had lower vitamin B6 levels and higher THCY, fibrinogen and triglycerides (TGL). At multivariate stepwise logistic regression only increased THCY and TGL were significantly and independently associated with the risk for stroke (72% model accuracy, p model=0.001). An increase of THCY with 1.0 µmol/L was associated with 22% higher risk of ischaemic stroke [adjusted OR=1.22 (95%CI 1.03?1.44)]. In this way, novel lower cut-off value for HCY of 11.58 µmol/L in younger patients has been revealed (ROC AUC= 0.67, 95CI% 0.55-0.78, p=0.009). CONCLUSION: The new THCY cut-off clearly discriminated between absence and presence of IS (sensitivity>63%, specificity>68%) irrespectively of age and gender and may be applied to better evaluate and more precisely define, as earlier as possible, the young patients at increased IS risk.
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Affiliation(s)
- Penka A Atanassova
- Department of Neurology, Medical University 15A, V Aprilov Boulevard, Plovdiv 4000, Bulgaria.
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