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Battey TWK, Dreizin D, Bodanapally UK, Wnorowski A, Issa G, Iacco A, Chiu W. A comparison of segmented abdominopelvic fluid volumes with conventional CT signs of abdominal compartment syndrome in a trauma population. Abdom Radiol (NY) 2019; 44:2648-2655. [PMID: 30953097 DOI: 10.1007/s00261-019-02000-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare the utility of abdominopelvic fluid volume measurements with established computed tomography signs for refractory post-traumatic abdominal compartment syndrome. METHODS This retrospective observational cohort study included 64 consecutive adult trauma patients with preoperative CT and diagnosis of refractory abdominal compartment syndrome requiring decompressive laparotomy at a level I trauma referral center between 2004 and 2014. We hypothesized that abdominal fluid volume measurements would be more predictive of the need for early laparotomy than previously described conventional CT signs of refractory ACS. Abdominopelvic fluid volumes were determined quantitatively using semi-automated segmentation software. The following conventional imaging parameters were recorded: abdominal anteroposterior:transverse ratio (round belly sign); infrahepatic vena cava diameter; distal abdominal aortic diameter; largest single small bowel wall diameter; hydronephrosis, inguinal herniation; and mesenteric and body wall edema. For outcome analysis, patients were stratified into two groups: those who underwent early (< 24 h) and late (≥ 24 h) decompressive laparotomy following CT. Correlation analysis, comparison of means, and multivariate logistic regression were performed. RESULTS Abdominal fluid volumes (p = 0.001) and anteroposterior:transverse ratio (p = 0.009) were increased and inferior vena cava diameter (p = 0.009) was decreased in the early decompressive laparotomy group. Multivariate analysis including conventional CT variables, fluid volumes, and laboratory values revealed abdominal fluid volumes (p = 0.012; Δ in log odds of 1.002/mL) as the only independent predictor of early decompressive laparotomy. CONCLUSIONS Segmented abdominopelvic free fluid volumes had greater predictive utility for decision to perform early decompressive laparotomy than previously described ACS-related CT signs in trauma patients who developed refractory abdominal compartment syndrome.
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Ostwaldt AC, Battey TWK, Irvine HJ, Campbell BCV, Davis SM, Donnan GA, Kimberly WT. Comparative Analysis of Markers of Mass Effect after Ischemic Stroke. J Neuroimaging 2018; 28:530-534. [PMID: 29797614 DOI: 10.1111/jon.12525] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/02/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Midline shift determined on magnetic resonance imaging (MRI) or computed tomography (CT) images is a well-validated marker of mass effect after large hemispheric infarction and associated with mortality. In this study, we targeted a population with moderately sized strokes. We compared midline shift to other imaging markers and determined their ability to predict long-term outcome. METHODS MRI scans were studied from the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) cohort. Midline shift, acute stroke lesion volume, lesional swelling volume, change in ipsilateral hemisphere volume, the ratio of ipsilateral to contralateral hemisphere volume, and the reduction in lateral ventricle volume were measured. The relationships of these markers with poor outcome (modified Rankin scale score 3-6 at day 90) were assessed. Receiver-operating characteristic (ROC) curves were generated to compare the performance of each metric. RESULTS Of the 71 included patients, 59.2% had a poor outcome that was associated with significantly larger values for midline shift, lesional swelling volume, and ratio of hemisphere volumes. Lesional swelling volume, change in hemisphere volume, ratio of hemisphere volumes, and lateral ventricle displacement were each correlated with midline shift (Spearman r = .60, .49, .61, and -.56, respectively; all P < .0001). ROC curve analysis showed that lesional swelling volume (area under the curve [AUC] = .791) predicted poor outcome better than midline shift (AUC = .682). For predicting mortality, ROC curve analysis showed that these three markers were equivalent. CONCLUSION The ratio of ipsilateral to contralateral hemisphere volume, baseline lesion volume and lesional swelling volume best predicted poor outcome across a spectrum of stroke sizes.
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Affiliation(s)
- Ann-Christin Ostwaldt
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA
| | - Thomas W K Battey
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA
| | - Hannah J Irvine
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA
| | - Bruce C V Campbell
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Stephen M Davis
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - W Taylor Kimberly
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA
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3
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Bevers MB, Battey TWK, Ostwaldt AC, Jahan R, Saver JL, Kimberly WT, Kidwell CS. Apparent Diffusion Coefficient Signal Intensity Ratio Predicts the Effect of Revascularization on Ischemic Cerebral Edema. Cerebrovasc Dis 2018. [PMID: 29533946 DOI: 10.1159/000487406] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Apparent diffusion coefficient (ADC) imaging is a biomarker of cytotoxic injury that predicts edema formation and outcome after ischemic stroke. It therefore has the potential to serve as a "tissue clock" to describe the extent of ischemic injury and potentially predict response to therapy. The goal of this study was to determine the relationship between baseline ADC signal intensity, revascularization, and edema formation. METHODS We examined the ADC signal intensity ratio (ADCr) of the stroke lesion (defined as the baseline DWI hyperintense region) compared to the contralateral normal hemisphere in 65 subjects from the Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy trial. The associations between ADCr, neurologic outcome, and cerebral edema were examined. Finally, we explored the interaction between baseline ADCr and vessel recanalization at day 7 on post-stroke edema. RESULTS We found that lower initial ADCr was associated with a worse outcome on the modified Rankin Scale (mRS) at 90 days (52.2% of those with ADCr <64% were mRS 5-6 vs. 19.1% with ADCr ≥64%, p = 0.006). Those subjects with reconstitution of flow distal to the initial vessel occlusion showed greater normalization of ADCr on follow-up scan (increase in ADCr of 16.4 ± 2.07 vs. 1.99 ± 4.33%, p = 0.0039). In those patients with low baseline ADCr, successful revascularization was associated with reduced edema (median swelling volume 164 mL [interquartile range (IQR) 53.3-190 mL] vs. 20.7 mL [IQR 3.20-55.1 mL], p = 0.024). CONCLUSIONS This study reaffirms the association of ADCr with outcome after stroke, supports the idea that reperfusion may attenuate rather than enhance post-stroke edema, and indicates that the degree of edema with and without revascularization may be predicted by ADCr.
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Affiliation(s)
- Matthew B Bevers
- Divisions of Stroke, Cerebrovascular and Critical Care Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Thomas W K Battey
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ann-Christin Ostwaldt
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Reza Jahan
- Department of Radiology, Ronald Reagan - UCLA Medical Center, Los Angeles, California, USA
| | - Jeffrey L Saver
- Comprehensive Stroke Center and Department of Neurology, Ronald Reagan - UCLA Medical Center, Los Angeles, California, USA
| | - W Taylor Kimberly
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chelsea S Kidwell
- Department of Neurology, University of Arizona College of Medicine, Tucson, Arizona, USA
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4
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Grunwald Z, Beslow LA, Urday S, Vashkevich A, Ayres A, Greenberg SM, Goldstein JN, Leasure A, Shi FD, Kahle KT, Battey TWK, Simard JM, Rosand J, Kimberly WT, Sheth KN. Perihematomal Edema Expansion Rates and Patient Outcomes in Deep and Lobar Intracerebral Hemorrhage. Neurocrit Care 2017; 26:205-212. [PMID: 27844466 DOI: 10.1007/s12028-016-0321-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Perihematomal edema (PHE) expansion rate may predict functional outcome following spontaneous intracerebral hemorrhage (ICH). We hypothesized that the effect of PHE expansion rate on outcome is greater for deep versus lobar ICH. METHODS Subjects (n = 115) were retrospectively identified from a prospective ICH cohort enrolled from 2000 to 2013. Inclusion criteria were age ≥ 18 years, spontaneous supratentorial ICH, and known onset time. Exclusion criteria were primary intraventricular hemorrhage (IVH), trauma, subsequent surgery, or warfarin-related ICH. ICH and PHE volumes were measured from CT scans and used to calculate expansion rates. Logistic regression assessed the association between PHE expansion rates and 90-day mortality or poor functional outcome (modified Rankin Scale > 2). Odds ratios are per 0.04 mL/h. RESULTS PHE expansion rate from baseline to 24 h (PHE24) was associated with mortality for deep (p = 0.03, OR 1.13[1.02-1.26]) and lobar ICH (p = 0.02, OR 1.03[1.00-1.06]) in unadjusted regression and in models adjusted for age (deep p = 0.02, OR 1.15[1.02-1.28]; lobar p = 0.03, OR 1.03[1.00-1.06]), Glasgow Coma Scale (deep p = 0.03, OR 1.13[1.01-1.27]; lobar p = 0.02, OR 1.03[1.01-1.06]), or time to baseline CT (deep p = 0.046, OR 1.12[1.00-1.25]; lobar p = 0.047, OR 1.03[1.00-1.06]). PHE expansion rate from baseline to 72 h (PHE72) was associated with mRS > 2 for deep ICH in models that were unadjusted (p = 0.02, OR 4.04[1.25-13.04]) or adjusted for ICH volume (p = 0.02, OR 4.3[1.25-14.98]), age (p = 0.03, OR 5.4[1.21-24.11]), GCS (p = 0.02, OR 4.19[1.2-14.55]), or time to first CT (p = 0.03, OR 4.02[1.19-13.56]). CONCLUSIONS PHE72 was associated with poor functional outcomes after deep ICH, whereas PHE24 was associated with mortality for deep and lobar ICH.
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Affiliation(s)
- Zachary Grunwald
- Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA.
| | - Lauren A Beslow
- Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA
| | - Sebastian Urday
- Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA
| | - Anastasia Vashkevich
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alison Ayres
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven M Greenberg
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joshua N Goldstein
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Audrey Leasure
- Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA
| | - Fu-Dong Shi
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Kristopher T Kahle
- Departments of Neurosurgery, Pediatrics, and Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, USA
| | - Thomas W K Battey
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Marc Simard
- Departments of Neurosurgery, Pathology and Physiology, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Jonathan Rosand
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Taylor Kimberly
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, 15 York Street, Bldg. LLCI, 10th Floor, 1003C, New Haven, CT, 06510, USA
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5
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Anderson CD, Falcone GJ, Phuah CL, Radmanesh F, Brouwers HB, Battey TWK, Biffi A, Peloso GM, Liu DJ, Ayres AM, Goldstein JN, Viswanathan A, Greenberg SM, Selim M, Meschia JF, Brown DL, Worrall BB, Silliman SL, Tirschwell DL, Flaherty ML, Kraft P, Jagiella JM, Schmidt H, Hansen BM, Jimenez-Conde J, Giralt-Steinhauer E, Elosua R, Cuadrado-Godia E, Soriano C, van Nieuwenhuizen KM, Klijn CJM, Rannikmae K, Samarasekera N, Al-Shahi Salman R, Sudlow CL, Deary IJ, Morotti A, Pezzini A, Pera J, Urbanik A, Pichler A, Enzinger C, Norrving B, Montaner J, Fernandez-Cadenas I, Delgado P, Roquer J, Lindgren A, Slowik A, Schmidt R, Kidwell CS, Kittner SJ, Waddy SP, Langefeld CD, Abecasis G, Willer CJ, Kathiresan S, Woo D, Rosand J. Genetic variants in CETP increase risk of intracerebral hemorrhage. Ann Neurol 2016; 80:730-740. [PMID: 27717122 PMCID: PMC5115931 DOI: 10.1002/ana.24780] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/26/2022]
Abstract
Objective In observational epidemiologic studies, higher plasma high‐density lipoprotein cholesterol (HDL‐C) has been associated with increased risk of intracerebral hemorrhage (ICH). DNA sequence variants that decrease cholesteryl ester transfer protein (CETP) gene activity increase plasma HDL‐C; as such, medicines that inhibit CETP and raise HDL‐C are in clinical development. Here, we test the hypothesis that CETP DNA sequence variants associated with higher HDL‐C also increase risk for ICH. Methods We performed 2 candidate‐gene analyses of CETP. First, we tested individual CETP variants in a discovery cohort of 1,149 ICH cases and 1,238 controls from 3 studies, followed by replication in 1,625 cases and 1,845 controls from 5 studies. Second, we constructed a genetic risk score comprised of 7 independent variants at the CETP locus and tested this score for association with HDL‐C as well as ICH risk. Results Twelve variants within CETP demonstrated nominal association with ICH, with the strongest association at the rs173539 locus (odds ratio [OR] = 1.25, standard error [SE] = 0.06, p = 6.0 × 10−4) with no heterogeneity across studies (I2 = 0%). This association was replicated in patients of European ancestry (p = 0.03). A genetic score of CETP variants found to increase HDL‐C by ∼2.85mg/dl in the Global Lipids Genetics Consortium was strongly associated with ICH risk (OR = 1.86, SE = 0.13, p = 1.39 × 10−6). Interpretation Genetic variants in CETP associated with increased HDL‐C raise the risk of ICH. Given ongoing therapeutic development in CETP inhibition and other HDL‐raising strategies, further exploration of potential adverse cerebrovascular outcomes may be warranted. Ann Neurol 2016;80:730–740
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Affiliation(s)
- Christopher D Anderson
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Guido J Falcone
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA.,Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Chia-Ling Phuah
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Farid Radmanesh
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - H Bart Brouwers
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Thomas W K Battey
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Alessandro Biffi
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA.,Division of Behavioral Neurology, Department of Neurology, MGH, Boston, MA.,Division of Psychiatry, Department of Psychiatry, MGH, Boston, MA
| | - Gina M Peloso
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
| | - Dajiang J Liu
- Department of Public Health Sciences, Institute of Personalized Medicine, Penn State College of Medicine, Hershey, PA
| | - Alison M Ayres
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA
| | | | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Devin L Brown
- Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor, MI
| | - Bradford B Worrall
- Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, VA
| | - Scott L Silliman
- Department of Neurology, University of Florida College of Medicine, Jacksonville, FL
| | - David L Tirschwell
- Stroke Center, Harborview Medical Center, University of Washington, Seattle, WA
| | - Matthew L Flaherty
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Peter Kraft
- Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jeremiasz M Jagiella
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Helena Schmidt
- Institute of Molecular Biology and Biochemistry, Medical University Graz, Graz, Austria
| | - Björn M Hansen
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Division of Neurology, Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Jordi Jimenez-Conde
- Neurovascular Research Unit, Department of Neurology, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain
| | - Eva Giralt-Steinhauer
- Neurovascular Research Unit, Department of Neurology, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain
| | - Roberto Elosua
- Neurovascular Research Unit, Department of Neurology, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godia
- Neurovascular Research Unit, Department of Neurology, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina Soriano
- Neurovascular Research Unit, Department of Neurology, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain
| | - Koen M van Nieuwenhuizen
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kristiina Rannikmae
- Division of Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Neshika Samarasekera
- Division of Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Catherine L Sudlow
- Division of Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.,Institute for Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrea Morotti
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Urbanik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria.,Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Bo Norrving
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Division of Neurology, Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Joan Montaner
- Neurovascular Research Laboratory and Neurovascular Unit, Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory and Neurovascular Unit, Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics, Terrassa Mutual Teaching and Research Foundation, Terrassa Mutual Hospital, Terrassa, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory and Neurovascular Unit, Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Roquer
- Neurovascular Research Unit, Department of Neurology, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Municipal Institute of Medical Investigation-Hospital of the Sea, Autonomous University of Barcelona, Barcelona, Spain
| | - Arne Lindgren
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Division of Neurology, Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Steven J Kittner
- Department of Neurology, Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore, MD
| | - Salina P Waddy
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Carl D Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC
| | - Goncalo Abecasis
- Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Cristen J Willer
- Division of Cardiology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.,Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI
| | - Sekar Kathiresan
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA.,Cardiovascular Disease Prevention Center, MGH, Boston, MA
| | - Daniel Woo
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA
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6
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Malik R, Traylor M, Pulit SL, Bevan S, Hopewell JC, Holliday EG, Zhao W, Abrantes P, Amouyel P, Attia JR, Battey TWK, Berger K, Boncoraglio GB, Chauhan G, Cheng YC, Chen WM, Clarke R, Cotlarciuc I, Debette S, Falcone GJ, Ferro JM, Gamble DM, Ilinca A, Kittner SJ, Kourkoulis CE, Lemmens R, Levi CR, Lichtner P, Lindgren A, Liu J, Meschia JF, Mitchell BD, Oliveira SA, Pera J, Reiner AP, Rothwell PM, Sharma P, Slowik A, Sudlow CLM, Tatlisumak T, Thijs V, Vicente AM, Woo D, Seshadri S, Saleheen D, Rosand J, Markus HS, Worrall BB, Dichgans M. Low-frequency and common genetic variation in ischemic stroke: The METASTROKE collaboration. Neurology 2016; 86:1217-26. [PMID: 26935894 DOI: 10.1212/wnl.0000000000002528] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/14/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the influence of common and low-frequency genetic variants on the risk of ischemic stroke (all IS) and etiologic stroke subtypes. METHODS We meta-analyzed 12 individual genome-wide association studies comprising 10,307 cases and 19,326 controls imputed to the 1000 Genomes (1 KG) phase I reference panel. We selected variants showing the highest degree of association (p < 1E-5) in the discovery phase for replication in Caucasian (13,435 cases and 29,269 controls) and South Asian (2,385 cases and 5,193 controls) samples followed by a transethnic meta-analysis. We further investigated the p value distribution for different bins of allele frequencies for all IS and stroke subtypes. RESULTS We showed genome-wide significance for 4 loci: ABO for all IS, HDAC9 for large vessel disease (LVD), and both PITX2 and ZFHX3 for cardioembolic stroke (CE). We further refined the association peaks for ABO and PITX2. Analyzing different allele frequency bins, we showed significant enrichment in low-frequency variants (allele frequency <5%) for both LVD and small vessel disease, and an enrichment of higher frequency variants (allele frequency 10% and 30%) for CE (all p < 1E-5). CONCLUSIONS Our findings suggest that the missing heritability in IS subtypes can in part be attributed to low-frequency and rare variants. Larger sample sizes are needed to identify the variants associated with all IS and stroke subtypes.
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Hwang DY, Dell CA, Sparks MJ, Watson TD, Langefeld CD, Comeau ME, Rosand J, Battey TWK, Koch S, Perez ML, James ML, McFarlin J, Osborne JL, Woo D, Kittner SJ, Sheth KN. Clinician judgment vs formal scales for predicting intracerebral hemorrhage outcomes. Neurology 2015; 86:126-33. [PMID: 26674335 DOI: 10.1212/wnl.0000000000002266] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/03/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the performance of formal prognostic instruments vs subjective clinical judgment with regards to predicting functional outcome in patients with spontaneous intracerebral hemorrhage (ICH). METHODS This prospective observational study enrolled 121 ICH patients hospitalized at 5 US tertiary care centers. Within 24 hours of each patient's admission to the hospital, one physician and one nurse on each patient's clinical team were each asked to predict the patient's modified Rankin Scale (mRS) score at 3 months and to indicate whether he or she would recommend comfort measures. The admission ICH score and FUNC score, 2 prognostic scales selected for their common use in neurologic practice, were calculated for each patient. Spearman rank correlation coefficients (r) with respect to patients' actual 3-month mRS for the physician and nursing predictions were compared against the same correlation coefficients for the ICH score and FUNC score. RESULTS The absolute value of the correlation coefficient for physician predictions with respect to actual outcome (0.75) was higher than that of either the ICH score (0.62, p = 0.057) or the FUNC score (0.56, p = 0.01). The nursing predictions of outcome (r = 0.72) also trended towards an accuracy advantage over the ICH score (p = 0.09) and FUNC score (p = 0.03). In an analysis that excluded patients for whom comfort care was recommended, the 65 available attending physician predictions retained greater accuracy (r = 0.73) than either the ICH score (r = 0.50, p = 0.02) or the FUNC score (r = 0.42, p = 0.004). CONCLUSIONS Early subjective clinical judgment of physicians correlates more closely with 3-month outcome after ICH than prognostic scales.
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Affiliation(s)
- David Y Hwang
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.).
| | - Cameron A Dell
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Mary J Sparks
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Tiffany D Watson
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Carl D Langefeld
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Mary E Comeau
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Jonathan Rosand
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Thomas W K Battey
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Sebastian Koch
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Mario L Perez
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Michael L James
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Jessica McFarlin
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Jennifer L Osborne
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Daniel Woo
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Steven J Kittner
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
| | - Kevin N Sheth
- From the Division of Neurocritical Care and Emergency Neurology (D.Y.H., K.N.S.), Department of Neurology, Yale School of Medicine, New Haven, CT; the Maryland Stroke Center (C.A.D., M.J.S., T.D.W.), Baltimore; the Center for Public Health Genomics and Department of Biostatistical Sciences (C.D.L., M.E.C.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC; the Center for Human Genetic Research (J.R., T.W.K.B.), Boston, MA; the University of Miami (S.K., M.L.P.), Miller School of Medicine, FL; Duke University Medical Center (M.L.J., J.M.), Durham, NC; the Department of Neurology (J.L.O., D.W.), University of Cincinnati College of Medicine, OH; and the Baltimore Veterans Administration Medical Center and University of Maryland School of Medicine (S.J.K.)
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Abstract
IMPORTANCE Intracerebral hemorrhage (ICH) is the most severe form of stroke. Survivors are at high risk of recurrence, death, and worsening functional disability. OBJECTIVE To investigate the association between blood pressure (BP) after index ICH and risk of recurrent ICH. DESIGN, SETTING, AND PARTICIPANTS Single-site, tertiary care referral center observational study of 1145 of 2197 consecutive patients with ICH presenting from July 1994 to December 2013. A total of 1145 patients with ICH survived at least 90 days and were followed up through December 2013 (median follow-up of 36.8 months [minimum, 9.8 months]). EXPOSURES Blood pressure measurements at 3, 6, 9, and 12 months, and every 6 months thereafter, obtained from medical personnel (inpatient hospital or outpatient clinic medical or nursing staff) or via patient self-report. Exposure was characterized in 3 ways: (1) recorded systolic and diastolic measurements; (2) classification as adequate or inadequate BP control based on American Heart Association/American Stroke Association recommendations; and (3) stage of hypertension based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 7 criteria. MAIN OUTCOMES AND MEASURES Recurrent ICH and its location within the brain (lobar vs nonlobar). RESULTS There were 102 recurrent ICH events among 505 survivors of lobar ICH and 44 recurrent ICH events among 640 survivors of nonlobar ICH. During follow-up adequate BP control was achieved on at least 1 measurement by 625 patients (54.6% of total [range, 49.2%-58.7%]) and consistently (ie, at all available time points) by 495 patients (43.2% of total [range, 34.5%-51.0%]). The event rate for lobar ICH was 84 per 1000 person-years among patients with inadequate BP control compared with 49 per 1000 person-years among patients with adequate BP control. For nonlobar ICH the event rate was 52 per 1000 person-years with inadequate BP control compared with 27 per 1000 person-years for patients with adequate BP control. In analyses modeling BP control as a time-varying variable, inadequate BP control was associated with higher risk of recurrence of both lobar ICH (hazard ratio [HR], 3.53 [95% CI, 1.65-7.54]) and nonlobar ICH (HR, 4.23 [95% CI, 1.02-17.52]). Systolic BP during follow-up was associated with increased risk of both lobar ICH recurrence (HR, 1.33 per 10-mm Hg increase [95% CI, 1.02-1.76]) and nonlobar ICH recurrence (HR, 1.54 [95% CI, 1.03-2.30]). Diastolic BP was associated with increased risk of nonlobar ICH recurrence (HR, 1.21 per 10-mm Hg increase [95% CI, 1.01-1.47]) but not with lobar ICH recurrence (HR, 1.36 [95% CI, 0.90-2.10]). CONCLUSIONS AND RELEVANCE In this observational single-center cohort study of ICH survivors, reported BP measurements suggesting inadequate BP control during follow-up were associated with higher risk of both lobar and nonlobar ICH recurrence. These data suggest that randomized clinical trials are needed to address the benefits and risks of stricter BP control in ICH survivors.
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Affiliation(s)
- Alessandro Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, Boston2J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts Gener
| | - Christopher D Anderson
- Center for Human Genetic Research, Massachusetts General Hospital, Boston2J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts Gener
| | - Thomas W K Battey
- Center for Human Genetic Research, Massachusetts General Hospital, Boston2J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts Gener
| | - Alison M Ayres
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital, Boston2J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts Gener
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9
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Brouwers HB, Battey TWK, Musial HH, Ciura VA, Falcone GJ, Ayres AM, Vashkevich A, Schwab K, Viswanathan A, Anderson CD, Greenberg SM, Pomerantz SR, Ortiz CJ, Goldstein JN, Gonzalez RG, Rosand J, Romero JM. Rate of Contrast Extravasation on Computed Tomographic Angiography Predicts Hematoma Expansion and Mortality in Primary Intracerebral Hemorrhage. Stroke 2015; 46:2498-503. [PMID: 26243220 DOI: 10.1161/strokeaha.115.009659] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In primary intracerebral hemorrhage, the presence of contrast extravasation after computed tomographic angiography (CTA), termed the spot sign, predicts hematoma expansion and mortality. Because the biological underpinnings of the spot sign are not fully understood, we investigated whether the rate of contrast extravasation, which may reflect the rate of bleeding, predicts expansion and mortality beyond the simple presence of the spot sign. METHODS Consecutive intracerebral hemorrhage patients with first-pass CTA followed by a 90-second delayed postcontrast CT (delayed CTA) were included. CTAs were reviewed for spot sign presence by 2 blinded readers. Spot sign volumes on first-pass and delayed CTA and intracerebral hemorrhage volumes were measured using semiautomated software. Extravasation rates were calculated and tested for association with hematoma expansion and mortality using uni- and multivariable logistic regressions. RESULTS One hundred and sixty-two patients were included, 48 (30%) of whom had ≥1 spot sign. Median spot sign volume was 0.04 mL on first-pass CTA and 0.4 mL on delayed CTA. Median extravasation rate was 0.23 mL/min overall and 0.30 mL/min among expanders versus 0.07 mL/min in nonexpanders. Extravasation rates were also significantly higher in patients who died in hospital: 0.27 mL/min versus 0.04 mL/min. In multivariable analysis, the extravasation rate was independently associated with in-hospital mortality (odds ratio, 1.09 [95% confidence interval, 1.04-1.18], P=0.004), 90-day mortality (odds ratio, 1.15 [95% confidence interval, 1.08-1.27]; P=0.0004), and hematoma expansion (odds ratio, 1.03 [95% confidence interval, 1.01-1.08]; P=0.047). CONCLUSIONS Contrast extravasation rate, or spot sign growth, further refines the ability to predict hematoma expansion and mortality. Our results support the hypothesis that the spot sign directly measures active bleeding in acute intracerebral hemorrhage.
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Affiliation(s)
- H Bart Brouwers
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston.
| | - Thomas W K Battey
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Hayley H Musial
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Viesha A Ciura
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Guido J Falcone
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Alison M Ayres
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anastasia Vashkevich
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kristin Schwab
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Christopher D Anderson
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stuart R Pomerantz
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Claudia J Ortiz
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Joshua N Goldstein
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - R Gilberto Gonzalez
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Javier M Romero
- From the Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Center for Human Genetic Research (H.B.B., T.W.K.B., H.H.M., G.J.F., C.D.A., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (H.B.B., G.J.F., A. Viswanathan, C.D.A., J.N.G., J.R.), Hemorrhagic Stroke Research Group (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), J. Philip Kistler Stroke Research Center (H.B.B., T.W.K.B., H.H.M., G.J.F., A.M.A., A. Vashkevich, K.S., A. Viswanathan, C.D.A., S.M.G., J.N.G., J.R.), Neuroradiology Service, Department of Radiology (V.A.C., S.R.P., C.J.O., R.G.G., J.M.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Harvard Medical School, Boston
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Raffeld MR, Biffi A, Battey TWK, Ayres AM, Viswanathan A, Greenberg SM, Rosand J, Anderson CD. APOE ε4 and lipid levels affect risk of recurrent nonlobar intracerebral hemorrhage. Neurology 2015; 85:349-56. [PMID: 26115730 DOI: 10.1212/wnl.0000000000001790] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/27/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Genetic variants ε2/ε4 within the APOE gene are established risk factors for lobar intracerebral hemorrhage (ICH). Published preliminary data suggest a potential role for APOE ε4 in risk of nonlobar ICH. We therefore investigated the role of APOE in recurrent nonlobar ICH, and sought to clarify whether effects of APOE on circulating lipids mediate this association. METHODS Three hundred sixty-three survivors of nonlobar ICH were followed prospectively for ICH recurrence, with APOE genotype determined at enrollment. All participants had clinical, demographic, and laboratory data captured at time of index ICH and during follow-up. Using a multivariate model, we performed association and interaction analyses of the relationships among APOE genotype, lipid levels, and recurrent nonlobar ICH. RESULTS We observed 29 nonlobar ICH recurrences among 363 survivors. APOE ε4 was associated with recurrent nonlobar ICH (hazard ratio = 1.31; 95% confidence interval = 1.02-2.69; p = 0.038) after adjustment for age/sex/ethnicity and cardiovascular risk factors. Increasing low-density lipoprotein (LDL) levels were associated with decreased risk of recurrent nonlobar ICH (p = 0.027), as were decreasing HDL levels (p = 0.046). LDL levels modified the association of APOE ε4 with recurrent nonlobar ICH (mediation p < 0.05). No associations were identified between APOE ε2 and recurrent nonlobar ICH. CONCLUSION APOE ε4 is associated with recurrent ICH in nonlobar brain regions, providing further evidence for its causal role in ICH unrelated to cerebral amyloid angiopathy. LDL levels modulated this effect, suggesting that circulating lipid levels may mediate a portion of the role of APOE ε4 in nonlobar ICH.
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Affiliation(s)
- Miriam R Raffeld
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Alessandro Biffi
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Thomas W K Battey
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Alison M Ayres
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston.
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Radmanesh F, Falcone GJ, Anderson CD, McWilliams D, Devan WJ, Brown WM, Battey TWK, Ayres AM, Raffeld MR, Schwab K, Sun G, Deka R, Viswanathan A, Goldstein JN, Greenberg SM, Tirschwell DL, Silliman SL, Selim M, Meschia JF, Brown DL, Worrall BB, Langefeld CD, Woo D, Rosand J. Rare Coding Variation and Risk of Intracerebral Hemorrhage. Stroke 2015; 46:2299-301. [PMID: 26111891 DOI: 10.1161/strokeaha.115.009838] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/15/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage has a substantial genetic component. We performed a preliminary search for rare coding variants associated with intracerebral hemorrhage. METHODS A total of 757 cases and 795 controls were genotyped using the Illumina HumanExome Beadchip (Illumina, Inc, San Diego, CA). Meta-analyses of single-variant and gene-based association were computed. RESULTS No rare coding variants were associated with intracerebral hemorrhage. Three common variants on chromosome 19q13 at an established susceptibility locus, encompassing TOMM40, APOE, and APOC1, met genome-wide significance (P<5e-08). After adjusting for the APOE epsilon alleles, this locus was no longer convincingly associated with intracerebral hemorrhage. No gene reached genome-wide significance level in gene-based association testing. CONCLUSIONS Although no coding variants of large effect were detected, this study further underscores a major challenge for the study of genetic susceptibility loci; large sample sizes are required for sufficient power except for loci with large effects.
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Affiliation(s)
- Farid Radmanesh
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Guido J Falcone
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Christopher D Anderson
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - David McWilliams
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - William J Devan
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - W Mark Brown
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Thomas W K Battey
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Alison M Ayres
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Miriam R Raffeld
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Kristin Schwab
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Guangyun Sun
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Ranjan Deka
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Anand Viswanathan
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Joshua N Goldstein
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Steven M Greenberg
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - David L Tirschwell
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Scott L Silliman
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Magdy Selim
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - James F Meschia
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Devin L Brown
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Bradford B Worrall
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Carl D Langefeld
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Daniel Woo
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Jonathan Rosand
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.).
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Urday S, Beslow LA, Goldstein DW, Vashkevich A, Ayres AM, Battey TWK, Selim MH, Kimberly WT, Rosand J, Sheth KN. Measurement of perihematomal edema in intracerebral hemorrhage. Stroke 2015; 46:1116-9. [PMID: 25721012 DOI: 10.1161/strokeaha.114.007565] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Perihematomal edema (PHE) is a marker of secondary injury in intracerebral hemorrhage (ICH). PHE measurement on computed tomography (CT) is challenging, and the principles used to detect PHE have not been described fully. We developed a systematic approach for CT-based measurement of PHE. METHODS Two independent raters measured PHE volumes on baseline and 24-hour post-ICH CT scans of 20 primary supratentorial ICH subjects. Boundaries were outlined with an edge-detection tool and adjusted after inspection of the 3 orthogonal planes. PHE was delineated with the additional principle that it should be (a) more hypodense than the corresponding area in the contralateral hemisphere and (b) most hypodense immediately surrounding the hemorrhage. We examined intra- and interrater reliability using intraclass correlation coefficients and Bland-Altman plots for interrater consistency. CT-based PHE was also compared using magnetic resonance imaging-based PHE detection for 18 subjects. RESULTS Median PHE volumes were 22.7 cc at baseline and 20.4 cc at 24 hours post-ICH. There were no statistically significant differences in PHE measurements between raters. Interrater and intrarater reliability for PHE were excellent. At baseline and 24 hours, interrater intraclass correlation coefficients were 0.98 (0.96-1.00) and 0.98 (0.97-1.00); intrarater intraclass correlation coefficients were 0.99 (0.99-1.00) and 0.99 (0.98-1.00). Bland-Altman analysis showed the bias for PHE measurements at baseline and 24 hours, -0.5 cc (SD, 5.4) and -3.2 cc (SD, 5.0), was acceptably small. PHE volumes determined by CT and magnetic resonance imaging were similar (23.9±16.9 cc versus 23.9±16.0 cc, R(2) = 0.98, P<0.0001). CONCLUSIONS Our method measures PHE with excellent reliability at baseline and 24 hours post-ICH.
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Affiliation(s)
- Sebastian Urday
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - Lauren A Beslow
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - David W Goldstein
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - Anastasia Vashkevich
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - Alison M Ayres
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - Thomas W K Battey
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - Magdy H Selim
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - W Taylor Kimberly
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - Jonathan Rosand
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.)
| | - Kevin N Sheth
- From the Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT (S.U., L.A.B., D.W.G., K.N.S.); Center for Human Genetic Research, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (A.V., A.M.A., T.W.K.B., W.T.K., J.R.); and Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.H.S.).
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Rannikmäe K, Davies G, Thomson PA, Bevan S, Devan WJ, Falcone GJ, Traylor M, Anderson CD, Battey TWK, Radmanesh F, Deka R, Woo JG, Martin LJ, Jimenez-Conde J, Selim M, Brown DL, Silliman SL, Kidwell CS, Montaner J, Langefeld CD, Slowik A, Hansen BM, Lindgren AG, Meschia JF, Fornage M, Bis JC, Debette S, Ikram MA, Longstreth WT, Schmidt R, Zhang CR, Yang Q, Sharma P, Kittner SJ, Mitchell BD, Holliday EG, Levi CR, Attia J, Rothwell PM, Poole DL, Boncoraglio GB, Psaty BM, Malik R, Rost N, Worrall BB, Dichgans M, Van Agtmael T, Woo D, Markus HS, Seshadri S, Rosand J, Sudlow CLM. Common variation in COL4A1/COL4A2 is associated with sporadic cerebral small vessel disease. Neurology 2015; 84:918-26. [PMID: 25653287 DOI: 10.1212/wnl.0000000000001309] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We hypothesized that common variants in the collagen genes COL4A1/COL4A2 are associated with sporadic forms of cerebral small vessel disease. METHODS We conducted meta-analyses of existing genotype data among individuals of European ancestry to determine associations of 1,070 common single nucleotide polymorphisms (SNPs) in the COL4A1/COL4A2 genomic region with the following: intracerebral hemorrhage and its subtypes (deep, lobar) (1,545 cases, 1,485 controls); ischemic stroke and its subtypes (cardioembolic, large vessel disease, lacunar) (12,389 cases, 62,004 controls); and white matter hyperintensities (2,733 individuals with ischemic stroke and 9,361 from population-based cohorts with brain MRI data). We calculated a statistical significance threshold that accounted for multiple testing and linkage disequilibrium between SNPs (p < 0.000084). RESULTS Three intronic SNPs in COL4A2 were significantly associated with deep intracerebral hemorrhage (lead SNP odds ratio [OR] 1.29, 95% confidence interval [CI] 1.14-1.46, p = 0.00003; r(2) > 0.9 between SNPs). Although SNPs associated with deep intracerebral hemorrhage did not reach our significance threshold for association with lacunar ischemic stroke (lead SNP OR 1.10, 95% CI 1.03-1.18, p = 0.0073), and with white matter hyperintensity volume in symptomatic ischemic stroke patients (lead SNP OR 1.07, 95% CI 1.01-1.13, p = 0.016), the direction of association was the same. There was no convincing evidence of association with white matter hyperintensities in population-based studies or with non-small vessel disease cerebrovascular phenotypes. CONCLUSIONS Our results indicate an association between common variation in the COL4A2 gene and symptomatic small vessel disease, particularly deep intracerebral hemorrhage. These findings merit replication studies, including in ethnic groups of non-European ancestry.
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Affiliation(s)
| | - Gail Davies
- Authors' affiliations are listed at the end of the article
| | | | - Steve Bevan
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | | | | | - Ranjan Deka
- Authors' affiliations are listed at the end of the article
| | - Jessica G Woo
- Authors' affiliations are listed at the end of the article
| | - Lisa J Martin
- Authors' affiliations are listed at the end of the article
| | | | - Magdy Selim
- Authors' affiliations are listed at the end of the article
| | - Devin L Brown
- Authors' affiliations are listed at the end of the article
| | | | | | - Joan Montaner
- Authors' affiliations are listed at the end of the article
| | | | | | - Björn M Hansen
- Authors' affiliations are listed at the end of the article
| | | | | | - Myriam Fornage
- Authors' affiliations are listed at the end of the article
| | - Joshua C Bis
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | - Cathy R Zhang
- Authors' affiliations are listed at the end of the article
| | - Qiong Yang
- Authors' affiliations are listed at the end of the article
| | - Pankaj Sharma
- Authors' affiliations are listed at the end of the article
| | | | | | | | | | - John Attia
- Authors' affiliations are listed at the end of the article
| | | | | | | | - Bruce M Psaty
- Authors' affiliations are listed at the end of the article
| | - Rainer Malik
- Authors' affiliations are listed at the end of the article
| | - Natalia Rost
- Authors' affiliations are listed at the end of the article
| | | | | | | | - Daniel Woo
- Authors' affiliations are listed at the end of the article
| | - Hugh S Markus
- Authors' affiliations are listed at the end of the article
| | - Sudha Seshadri
- Authors' affiliations are listed at the end of the article
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Kimberly WT, Battey TWK, Pham L, Wu O, Yoo AJ, Furie KL, Singhal AB, Elm JJ, Stern BJ, Sheth KN. Glyburide is associated with attenuated vasogenic edema in stroke patients. Neurocrit Care 2014; 20:193-201. [PMID: 24072459 DOI: 10.1007/s12028-013-9917-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Brain edema is a serious complication of ischemic stroke that can lead to secondary neurological deterioration and death. Glyburide is reported to prevent brain swelling in preclinical rodent models of ischemic stroke through inhibition of a non-selective channel composed of sulfonylurea receptor 1 and transient receptor potential cation channel subfamily M member 4. However, the relevance of this pathway to the development of cerebral edema in stroke patients is not known. METHODS Using a case-control design, we retrospectively assessed neuroimaging and blood markers of cytotoxic and vasogenic edema in subjects who were enrolled in the glyburide advantage in malignant edema and stroke-pilot (GAMES-Pilot) trial. We compared serial brain magnetic resonance images (MRIs) to a cohort with similar large volume infarctions. We also compared matrix metalloproteinase-9 (MMP-9) plasma level in large hemispheric stroke. RESULTS We report that IV glyburide was associated with T2 fluid-attenuated inversion recovery signal intensity ratio on brain MRI, diminished the lesional water diffusivity between days 1 and 2 (pseudo-normalization), and reduced blood MMP-9 level. CONCLUSIONS Several surrogate markers of vasogenic edema appear to be reduced in the setting of IV glyburide treatment in human stroke. Verification of these potential imaging and blood biomarkers is warranted in the context of a randomized, placebo-controlled trial.
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Affiliation(s)
- W Taylor Kimberly
- Center for Human Genetic Research and Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,
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Battey TWK, Valant V, Kassis SB, Kourkoulis C, Lee C, Anderson CD, Falcone GJ, Jimenez-Conde J, Fernandez-Cadenas I, Pare G, Rundek T, James ML, Lemmens R, Lee TH, Tatlisumak T, Kittner SJ, Lindgren A, Mateen FJ, Berkowitz AL, Holliday EG, Majersik J, Maguire J, Sudlow C, Rosand J. Recommendations from the international stroke genetics consortium, part 2: biological sample collection and storage. Stroke 2014; 46:285-90. [PMID: 25492904 DOI: 10.1161/strokeaha.114.006851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Thomas W K Battey
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Valerie Valant
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Sylvia Baedorf Kassis
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Christina Kourkoulis
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Chaeyoung Lee
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Christopher D Anderson
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Guido J Falcone
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Jordi Jimenez-Conde
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Israel Fernandez-Cadenas
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Guillaume Pare
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Tatjana Rundek
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Michael L James
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Robin Lemmens
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Tsong-Hai Lee
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Turgut Tatlisumak
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Steven J Kittner
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Arne Lindgren
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Farrah J Mateen
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Aaron L Berkowitz
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Elizabeth G Holliday
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Jennifer Majersik
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Jane Maguire
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Cathie Sudlow
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
| | - Jonathan Rosand
- From the Center for Human Genetic Research (T.W.K.B., V.V., S.B.K., C.K., C.D.A., G.J.F., J.R.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., C.K., C.D.A., G.J.F., J.R.), and Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge (T.W.K.B., C.K., C.D.A., G.J.F., J.R.); School of Systems Biomedical Science, Soongsil University, Seoul, South Korea (C.L.); Department of Neurology, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona, Barcelona, Spain (J.J.-C.); Stroke Pharmacogenomics and Genetics Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Terrassa, Spain (I.F.-C.); Department of Pathology and Molecular Medicine, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (G.P.); Miller School of Medicine, University of Miami (T.R.); Departments of Anesthesiology and Neurology, Duke University, Durham (M.L.J.); Department of Neurosciences, VIB-Vesalius Research Center, Experimental Neurology-Laboratory of Neurobiology, KU Leuven, University of Leuven, Leuven, Belgium (R.L.); Department of Neurology, University Hospitals Leuven, Leuven, Belgium (R.L.); Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (T.-H.L.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Department of Neurology, Veterans Administration Medical Center and University of Maryland School of Medicine, Baltimore (S.J.K.); Department of Clinical Sciences, Neurology, Lund University and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); Department of Neurology, Brigham and Women's Hospital, Boston (A.L.B.); School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia (E.G.H.); Hunter Medical Research Institute, Newcastle, New South Wales
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Majersik JJ, Cole JW, Golledge J, Rost NS, Chan YFY, Gurol ME, Lindgren AG, Woo D, Fernandez-Cadenas I, Chen DT, Thijs V, Worrall BB, Kamal A, Bentley P, Wardlaw JM, Ruigrok YM, Battey TWK, Schmidt R, Montaner J, Giese AK, Roquer J, Jiménez-Conde J, Lee C, Ay H, Martin JJ, Rosand J, Maguire J. Recommendations from the international stroke genetics consortium, part 1: standardized phenotypic data collection. Stroke 2014; 46:279-84. [PMID: 25492903 DOI: 10.1161/strokeaha.114.006839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer J Majersik
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - John W Cole
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Jonathan Golledge
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Natalia S Rost
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Yu-Feng Yvonne Chan
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - M Edip Gurol
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Arne G Lindgren
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Daniel Woo
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Israel Fernandez-Cadenas
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Donna T Chen
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Vincent Thijs
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Bradford B Worrall
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Ayeesha Kamal
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Paul Bentley
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Joanna M Wardlaw
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Ynte M Ruigrok
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Thomas W K Battey
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Reinhold Schmidt
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Joan Montaner
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Anne-Katrin Giese
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Jaume Roquer
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Jordi Jiménez-Conde
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Chaeyoung Lee
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Hakan Ay
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Juan Jose Martin
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Jonathan Rosand
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
| | - Jane Maguire
- From the Department of Neurology, University of Utah, Salt Lake City (J.J. Majersik); University of Maryland Medical Center, and Veterans Affairs Medical Center, Baltimore (J.W.C.); Queensland Research Center for Peripheral Vascular Disease, Department of Vascular and Endovascular Surgery, James Cook University and the Townsville Hospital, Townsville, Queensland, Australia (J.G.); Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston (N.S.R., M.E.G., H.A., J. Rosand); Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY (Y.-F.Y.C.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (A.G.L.); Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden (A.G.L.); Department of Neurology, University of Cincinnati, OH (D.W.); Neuroscience Department, Stroke Pharmacogenomics and Genetics, Fundacio Docencia i Recerca MutuaTerrassa, Hospital Mutua de Terrassa, Barcelona, Spain (I.F.-C.); Department of Public Health Sciences (D.T.C.) and Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium (V.T.); Department of Neurology, University Hospitals Leuven, Belgium (V.T.); VIB - Vesalius Research Center, B-3000, Leuven, Belgium (V.T.); Stroke Service, Department of Medicine, Section of Neurology, Aga Khan University, Karachi, Pakistan (A.K.); Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London, United Kingdom (P.B.); Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom (J.M.W.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (Y.M.R.); Program in Medical and Population Genetics, Broad Institute, Boston, MA (T.W.K.B., J. Rosand); Clinical
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Battey TWK, Karki M, Singhal AB, Wu O, Sadaghiani S, Campbell BCV, Davis SM, Donnan GA, Sheth KN, Kimberly WT. Brain edema predicts outcome after nonlacunar ischemic stroke. Stroke 2014; 45:3643-8. [PMID: 25336512 DOI: 10.1161/strokeaha.114.006884] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In malignant infarction, brain edema leads to secondary neurological deterioration and poor outcome. We sought to determine whether swelling is associated with outcome in smaller volume strokes. METHODS Two research cohorts of acute stroke subjects with serial brain MRI were analyzed. The categorical presence of swelling and infarct growth was assessed on diffusion-weighted imaging (DWI) by comparing baseline and follow-up scans. The increase in stroke volume (ΔDWI) was then subdivided into swelling and infarct growth volumes using region-of-interest analysis. The relationship of these imaging markers with outcome was evaluated in univariable and multivariable regression. RESULTS The presence of swelling independently predicted worse outcome after adjustment for age, National Institutes of Health Stroke Scale, admission glucose, and baseline DWI volume (odds ratio, 4.55; 95% confidence interval, 1.21-18.9; P<0.02). Volumetric analysis confirmed that ΔDWI was associated with outcome (odds ratio, 4.29; 95% confidence interval, 2.00-11.5; P<0.001). After partitioning ΔDWI into swelling and infarct growth volumetrically, swelling remained an independent predictor of poor outcome (odds ratio, 1.09; 95% confidence interval, 1.03-1.17; P<0.005). Larger infarct growth was also associated with poor outcome (odds ratio, 7.05; 95% confidence interval, 1.04-143; P<0.045), although small infarct growth was not. The severity of cytotoxic injury measured on apparent diffusion coefficient maps was associated with swelling, whereas the perfusion deficit volume was associated with infarct growth. CONCLUSIONS Swelling and infarct growth each contribute to total stroke lesion growth in the days after stroke. Swelling is an independent predictor of poor outcome, with a brain swelling volume of ≥11 mL identified as the threshold with greatest sensitivity and specificity for predicting poor outcome.
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Affiliation(s)
- Thomas W K Battey
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Mahima Karki
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Aneesh B Singhal
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Ona Wu
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Saloomeh Sadaghiani
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Bruce C V Campbell
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Stephen M Davis
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Geoffrey A Donnan
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - Kevin N Sheth
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.)
| | - W Taylor Kimberly
- From the Center for Human Genetic Research (T.W.K.B., M.K., W.T.K.), Division of Neurocritical Care and Emergency Neurology (T.W.K.B., M.K., W.T.K.), J. Philip Kistler Stroke Research Center (T.W.K.B., M.K., A.B.S., O.W., S.S., W.T.K.), and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology (O.W.), Massachusetts General Hospital, Boston; Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (B.C.V.C., S.M.D.); Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia (B.C.V.C., G.A.D.); and Division of Neurocritical Care and Emergency Neurology, Yale New Haven Hospital, CT (K.N.S.).
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Falcone GJ, Radmanesh F, Brouwers HB, Battey TWK, Devan WJ, Valant V, Raffeld MR, Chitsike LP, Ayres AM, Schwab K, Goldstein JN, Viswanathan A, Greenberg SM, Selim M, Meschia JF, Brown DL, Worrall BB, Silliman SL, Tirschwell DL, Flaherty ML, Martini SR, Deka R, Biffi A, Kraft P, Woo D, Rosand J, Anderson CD. APOE ε variants increase risk of warfarin-related intracerebral hemorrhage. Neurology 2014; 83:1139-46. [PMID: 25150286 DOI: 10.1212/wnl.0000000000000816] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE We aimed to assess the effect of APOE ε variants on warfarin-related intracerebral hemorrhage (wICH), evaluated their predictive power, and tested for interaction with warfarin in causing wICH. METHODS This was a prospective, 2-stage (discovery and replication), case-control study. wICH was classified as lobar or nonlobar based on the location of the hematoma. Controls were sampled from ambulatory clinics (discovery) and random digit dialing (replication). APOE ε variants were directly genotyped. A case-control design and logistic regression analysis were utilized to test for association between APOE ε and wICH. A case-only design and logistic regression analysis were utilized to test for interaction between APOE ε and warfarin. Receiver operating characteristic curves were implemented to evaluate predictive power. RESULTS The discovery stage included 319 wICHs (44% lobar) and 355 controls. APOE ε2 was associated with lobar (odds ratio [OR] 2.46; p < 0.001) and nonlobar wICH (OR 1.67; p = 0.04), whereas ε4 was associated with lobar (OR 2.09; p < 0.001) but not nonlobar wICH (p = 0.35). The replication stage (63 wICHs and 1,030 controls) confirmed the association with ε2 (p = 0.03) and ε4 (p = 0.003) for lobar but not for nonlobar wICH (p > 0.20). Genotyping information on APOE ε variants significantly improved case/control discrimination of lobar wICH (C statistic 0.80). No statistical interaction between warfarin and APOE was found (p > 0.20). CONCLUSIONS APOE ε variants constitute strong risk factors for lobar wICH. APOE exerts its effect independently of warfarin, although power limitations render this absence of interaction preliminary. Evaluation of the predictive ability of APOE in cohort studies is warranted.
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Affiliation(s)
- Guido J Falcone
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Farid Radmanesh
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - H Bart Brouwers
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Thomas W K Battey
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - William J Devan
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Valerie Valant
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Miriam R Raffeld
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Lennox P Chitsike
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Alison M Ayres
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Kristin Schwab
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Joshua N Goldstein
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Anand Viswanathan
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Steven M Greenberg
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Magdy Selim
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - James F Meschia
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Devin L Brown
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Bradford B Worrall
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Scott L Silliman
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - David L Tirschwell
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Matthew L Flaherty
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Sharyl R Martini
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Ranjan Deka
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Alessandro Biffi
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Peter Kraft
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Daniel Woo
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Jonathan Rosand
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Christopher D Anderson
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH.
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Radmanesh F, Falcone GJ, Anderson CD, Battey TWK, Ayres AM, Vashkevich A, McNamara KA, Schwab K, Romero JM, Viswanathan A, Greenberg SM, Goldstein JN, Rosand J, Brouwers HB. Risk factors for computed tomography angiography spot sign in deep and lobar intracerebral hemorrhage are shared. Stroke 2014; 45:1833-5. [PMID: 24876264 PMCID: PMC4116606 DOI: 10.1161/strokeaha.114.005276] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Patients with intracerebral hemorrhage (ICH) who present with a spot sign on computed tomography angiography are at increased risk of hematoma expansion and poor outcome. Because primary ICH is the acute manifestation of chronic cerebral small vessel disease, we investigated whether different clinical or imaging characteristics predict spot sign presence, using ICH location as a surrogate for arteriolosclerosis- and cerebral amyloid angiopathy-related ICH. METHODS Patients with primary ICH and available computed tomography angiography at presentation were included. Predictors of spot sign were assessed using uni- and multivariable regression, stratified by ICH location. RESULTS Seven hundred forty-one patients were eligible, 335 (45%) deep and 406 (55%) lobar ICH. At least one spot sign was present in 76 (23%) deep and 102 (25%) lobar ICH patients. In multivariable regression, warfarin (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.01-5.71; P=0.04), baseline ICH volume (OR, 1.20; 95% CI, 1.09-1.33, per 10 mL increase; P<0.001), and time from symptom onset to computed tomography angiography (OR, 0.89; 95% CI, 0.80-0.96, per hour; P=0.009) were associated with the spot sign in deep ICH. Predictors of spot sign in lobar ICH were warfarin (OR, 3.95; 95% CI, 1.87-8.51; P<0.001) and baseline ICH volume (OR, 1.20; 95% CI, 1.10-1.31, per 10 mL increase; P<0.001). CONCLUSIONS The most potent associations with spot sign are shared between deep and lobar ICH, suggesting that the acute bleeding process that arises in the setting of different chronic small vessel diseases shares commonalities.
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Affiliation(s)
- Farid Radmanesh
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Guido J Falcone
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Christopher D Anderson
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Thomas W K Battey
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Alison M Ayres
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Anastasia Vashkevich
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Kristen A McNamara
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Kristin Schwab
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Javier M Romero
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Anand Viswanathan
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Steven M Greenberg
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Joshua N Goldstein
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - Jonathan Rosand
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.)
| | - H Bart Brouwers
- From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
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20
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Brouwers HB, Chang Y, Falcone GJ, Cai X, Ayres AM, Battey TWK, Vashkevich A, McNamara KA, Valant V, Schwab K, Orzell SC, Bresette LM, Feske SK, Rost NS, Romero JM, Viswanathan A, Chou SHY, Greenberg SM, Rosand J, Goldstein JN. Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol 2014; 71:158-64. [PMID: 24366060 DOI: 10.1001/jamaneurol.2013.5433] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Many clinical trials focus on restricting hematoma expansion following acute intracerebral hemorrhage (ICH), but selecting those patients at highest risk of hematoma expansion is challenging. OBJECTIVE To develop a prediction score for hematoma expansion in patients with primary ICH. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study at 2 urban academic medical centers among patients having primary ICH with available baseline and follow-up computed tomography for volumetric analysis (817 patients in the development cohort and 195 patients in the independent validation cohort). MAIN OUTCOMES AND MEASURES Hematoma expansion was assessed using semiautomated software and was defined as more than 6 mL or 33% growth. Covariates were tested for association with hematoma expansion using univariate and multivariable logistic regression. A 9-point prediction score was derived based on the regression estimates and was subsequently tested in the independent validation cohort. RESULTS Hematoma expansion occurred in 156 patients (19.1%). In multivariable analysis, predictors of expansion were as follows: warfarin sodium use, the computed tomography angiography spot sign, and shorter time to computed tomography (≤ 6 vs >6 hours) (P < .001 for all), as well as baseline ICH volume (<30 [reference], 30-60 [P = .03], and >60 [P = .005] mL). The incidence of hematoma expansion steadily increased with higher scores. In the independent validation cohort (n = 195), our prediction score performed well and showed strong association with hematoma expansion (odds ratio, 4.59; P < .001 for a high vs low score). The C statistics for the score were 0.72 for the development cohort and 0.77 for the independent validation cohort. CONCLUSIONS AND RELEVANCE A 9-point prediction score for hematoma expansion was developed and independently validated. The results open a path for individualized treatment and trial design in ICH aimed at patients at highest risk of hematoma expansion with maximum potential for therapeutic benefit.
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Affiliation(s)
- H Bart Brouwers
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S
| | - Yuchiao Chang
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Guido J Falcone
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S
| | - Xuemei Cai
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Alison M Ayres
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Thomas W K Battey
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts Gen
| | - Anastasia Vashkevich
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kristen A McNamara
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Valerie Valant
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts Gen
| | - Kristin Schwab
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Susannah C Orzell
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Linda M Bresette
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Steven K Feske
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Natalia S Rost
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S
| | - Javier M Romero
- Neuroradiology Service, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anand Viswanathan
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kis
| | - Sherry H-Y Chou
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital, Harvard Medical School, Boston2Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic S
| | - Joshua N Goldstein
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston3Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Harvard Medical School, Boston4J. Philip Kis
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21
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Woo D, Falcone GJ, Devan WJ, Brown WM, Biffi A, Howard TD, Anderson CD, Brouwers HB, Valant V, Battey TWK, Radmanesh F, Raffeld MR, Baedorf-Kassis S, Deka R, Woo JG, Martin LJ, Haverbusch M, Moomaw CJ, Sun G, Broderick JP, Flaherty ML, Martini SR, Kleindorfer DO, Kissela B, Comeau ME, Jagiella JM, Schmidt H, Freudenberger P, Pichler A, Enzinger C, Hansen BM, Norrving B, Jimenez-Conde J, Giralt-Steinhauer E, Elosua R, Cuadrado-Godia E, Soriano C, Roquer J, Kraft P, Ayres AM, Schwab K, McCauley JL, Pera J, Urbanik A, Rost NS, Goldstein JN, Viswanathan A, Stögerer EM, Tirschwell DL, Selim M, Brown DL, Silliman SL, Worrall BB, Meschia JF, Kidwell CS, Montaner J, Fernandez-Cadenas I, Delgado P, Malik R, Dichgans M, Greenberg SM, Rothwell PM, Lindgren A, Slowik A, Schmidt R, Langefeld CD, Rosand J. Meta-analysis of genome-wide association studies identifies 1q22 as a susceptibility locus for intracerebral hemorrhage. Am J Hum Genet 2014; 94:511-21. [PMID: 24656865 PMCID: PMC3980413 DOI: 10.1016/j.ajhg.2014.02.012] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/24/2014] [Indexed: 11/25/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the stroke subtype with the worst prognosis and has no established acute treatment. ICH is classified as lobar or nonlobar based on the location of ruptured blood vessels within the brain. These different locations also signal different underlying vascular pathologies. Heritability estimates indicate a substantial genetic contribution to risk of ICH in both locations. We report a genome-wide association study of this condition that meta-analyzed data from six studies that enrolled individuals of European ancestry. Case subjects were ascertained by neurologists blinded to genotype data and classified as lobar or nonlobar based on brain computed tomography. ICH-free control subjects were sampled from ambulatory clinics or random digit dialing. Replication of signals identified in the discovery cohort with p < 1 × 10(-6) was pursued in an independent multiethnic sample utilizing both direct and genome-wide genotyping. The discovery phase included a case cohort of 1,545 individuals (664 lobar and 881 nonlobar cases) and a control cohort of 1,481 individuals and identified two susceptibility loci: for lobar ICH, chromosomal region 12q21.1 (rs11179580, odds ratio [OR] = 1.56, p = 7.0 × 10(-8)); and for nonlobar ICH, chromosomal region 1q22 (rs2984613, OR = 1.44, p = 1.6 × 10(-8)). The replication included a case cohort of 1,681 individuals (484 lobar and 1,194 nonlobar cases) and a control cohort of 2,261 individuals and corroborated the association for 1q22 (p = 6.5 × 10(-4); meta-analysis p = 2.2 × 10(-10)) but not for 12q21.1 (p = 0.55; meta-analysis p = 2.6 × 10(-5)). These results demonstrate biological heterogeneity across ICH subtypes and highlight the importance of ascertaining ICH cases accordingly.
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Affiliation(s)
- Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
| | - Guido J Falcone
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - William J Devan
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - W Mark Brown
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Alessandro Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Timothy D Howard
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Christopher D Anderson
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - H Bart Brouwers
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Valerie Valant
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Thomas W K Battey
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Farid Radmanesh
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Miriam R Raffeld
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Sylvia Baedorf-Kassis
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Ranjan Deka
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Mary Haverbusch
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Charles J Moomaw
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Guangyun Sun
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Matthew L Flaherty
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Sharyl R Martini
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Dawn O Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Mary E Comeau
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Jeremiasz M Jagiella
- Department of Neurology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Helena Schmidt
- Institute of Molecular Biology and Medical Biochemistry, Medical University Graz, Graz 8010, Austria
| | - Paul Freudenberger
- Institute of Molecular Biology and Medical Biochemistry, Medical University Graz, Graz 8010, Austria
| | - Alexander Pichler
- Department of Neurology, Medical University of Graz, Graz 8036, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz 8036, Austria; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz 8036, Austria
| | - Björn M Hansen
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund 221 85, Sweden; Department of Neurology, Skåne University Hospital, Lund 221 85, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund 221 85, Sweden; Department of Neurology, Skåne University Hospital, Lund 221 85, Sweden
| | - Jordi Jimenez-Conde
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Eva Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Roberto Elosua
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Elisa Cuadrado-Godia
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Carolina Soriano
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Peter Kraft
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - Alison M Ayres
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kristin Schwab
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Natalia S Rost
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anand Viswanathan
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - David L Tirschwell
- Stroke Center, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Devin L Brown
- Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Scott L Silliman
- Department of Neurology, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | - Bradford B Worrall
- Department of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Chelsea S Kidwell
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA
| | - Joan Montaner
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona 08035, Spain
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona 08035, Spain; Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútuaterrassa, Barcelona 08010, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona 08035, Spain
| | - Rainer Malik
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich 80539, Germany; Munich Cluster for Systems Neurology (Synergy), Munich 80539, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich 80539, Germany; Munich Cluster for Systems Neurology (Synergy), Munich 80539, Germany
| | - Steven M Greenberg
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, UK
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund 221 85, Sweden; Department of Neurology, Skåne University Hospital, Lund 221 85, Sweden
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz 8036, Austria
| | - Carl D Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA.
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Jha R, Battey TWK, Pham L, Lorenzano S, Furie KL, Sheth KN, Kimberly WT. Fluid-attenuated inversion recovery hyperintensity correlates with matrix metalloproteinase-9 level and hemorrhagic transformation in acute ischemic stroke. Stroke 2014; 45:1040-5. [PMID: 24619394 DOI: 10.1161/strokeaha.113.004627] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Matrix metalloproteinase-9 (MMP-9) is elevated in patients with acute stroke who later develop hemorrhagic transformation (HT). It is controversial whether early fluid-attenuated inversion recovery (FLAIR) hyperintensity on brain MRI predicts hemorrhagic transformation (HT). We assessed whether FLAIR hyperintensity was associated with MMP-9 and HT. METHODS We analyzed a prospectively collected cohort of acute stroke subjects with acute brain MRI images and MMP-9 values within the first 12 hours after stroke onset. FLAIR hyperintensity was measured using a signal intensity ratio between the stroke lesion and corresponding normal contralateral hemisphere. MMP-9 was measured using enzyme-linked immunosorbent assay. The relationships between FLAIR ratio (FR), MMP-9, and HT were evaluated. RESULTS A total of 180 subjects were available for analysis. Patients were imaged with brain MRI at 5.6±4.3 hours from last seen well time. MMP-9 blood samples were drawn within 7.7±4.0 hours from last seen well time. The time to MRI (r=0.17, P=0.027) and MMP-9 level (r=0.29, P<0.001) were each associated with FR. The association between MMP-9 and FR remained significant after multivariable adjustment (P<0.001). FR was also associated with HT and symptomatic hemorrhage (P=0.012). CONCLUSIONS FR correlates with both MMP-9 level and risk of hemorrhage. FLAIR changes in the acute phase of stroke may predict hemorrhagic transformation, possibly as a reflection of altered blood-brain barrier integrity.
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Affiliation(s)
- Ruchira Jha
- From the Department of Neurology, Massachusetts General Hospital, Boston, MA (R.J., T.W.K.B., L.P., W.T.K.); Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.); and Department of Neurology, Yale New Haven Hospital, New Haven, CT (K.N.S.)
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23
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Falcone GJ, Biffi A, Brouwers HB, Anderson CD, Battey TWK, Ayres AM, Vashkevich A, Schwab K, Rost NS, Goldstein JN, Viswanathan A, Greenberg SM, Rosand J. Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage. JAMA Neurol 2013; 70:988-94. [PMID: 23733000 DOI: 10.1001/jamaneurol.2013.98] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Hematoma volume is the strongest predictor of outcome in intracerebral hemorrhage (ICH). Despite known differences in the underlying biology between deep and lobar ICHs, limited data are available on location specificity of factors reported to affect hematoma volume. OBJECTIVE To evaluate whether determinants of ICH volume differ by topography, we sought to estimate location-specific effects for potential predictors of this radiological outcome. DESIGN Prospective cohort study. SETTING Academic medical center. PARTICIPANTS A total of 744 supratentorial primary ICH patients (388 deep and 356 lobar) aged older than 18 years admitted between January 1, 2000, and December 31, 2010. MAIN OUTCOMES AND MEASURES Intracerebral hemorrhage volume measured from the computed tomography scan obtained on presentation to the emergency department. Linear regression analysis, stratified by ICH location, was implemented to identify determinants of log-transformed ICH volume. RESULTS Median ICH volume was larger in lobar hemorrhages (39 mL; interquartile range, 16-75 mL) than in deep hemorrhages (13 mL; interquartile range, 5-40 mL; P < .001). In multivariable linear regression, independent predictors of deep ICH volume were intensity of anticoagulation (β = 0.32; standard error [SE] = 0.08; P < .001; test for trend across 4 categories of the international normalized ratio), history of coronary artery disease (β = 0.33; SE = 0.17; P = .05), male sex (β = 0.28; SE = 0.14; P = .05), and age (β = -0.02; SE = 0.01; P = .001). Independent predictors of lobar ICH volume were intensity of anticoagulation (β = 0.14; SE = 0.06; P = .02) and antiplatelet treatment (β = 0.27; SE = 0.13; P = .03). CONCLUSIONS AND RELEVANCE Predictors of hematoma volume only partially overlap between deep and lobar ICHs. These findings suggest that the mechanisms that determine the extent of bleeding differ for deep and lobar ICHs. Further studies are needed to characterize the specific biological pathways that underlie the observed associations.
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Affiliation(s)
- Guido J Falcone
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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24
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Battey TWK, Falcone GJ, Ayres AM, Schwab K, Viswanathan A, McNamara KA, DiPucchio ZY, Greenberg SM, Sheth KN, Goldstein JN, Rosand J. Confounding by indication in retrospective studies of intracerebral hemorrhage: antiepileptic treatment and mortality. Neurocrit Care 2013; 17:361-6. [PMID: 22965324 DOI: 10.1007/s12028-012-9776-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Intracerebral hemorrhage (ICH) is a highly fatal disease with few proven treatments. Data to guide clinician decisions for therapies, including antiepileptic drugs (AED), are limited. Published studies on AED treatment in ICH have provided conflicting results. We investigated the effect of AED treatment on 90-day mortality after ICH in a large prospectively ascertained cohort. METHODS We conducted a retrospective analysis of a prospectively assembled cohort of patients with ICH in the supratentorial regions, comparing 90-day mortality and modified Rankin Score among 543 patients treated with AED during hospitalization and 639 AED-free ICH. Supratentorial ICH location was categorized as lobar or deep hemispheric. RESULTS Multivariate analysis demonstrated an association between AED treatment and reduced 90-day mortality in supratentorial ICH (OR = 0.62, 95 % CI 0.42-0.90, p = 0.01) and the subset of lobar ICH (OR = 0.49, 95 % CI 0.25-0.96, p = 0.04). When analyses were restricted to subjects surviving longer than 5 days from ICH, however, no association between AED treatment and a 90-day outcome, regardless of hemorrhage location (all p > 0.15), was detected, despite more than adequate power to detect the originally observed association. CONCLUSION These results suggest that AED treatment in acute ICH is not associated with 90-day mortality or outcome and that any detected association could arise by confounding by indication, in which the most severely affected patients are those in whom AEDs are prescribed. They provide a cautionary example of the limitations of drawing conclusions about treatment effects from observational data.
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Affiliation(s)
- Thomas W K Battey
- Hemorrhagic Stroke Research Group, Massachusetts General Hospital, Boston, MA, USA
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Battey TWK, Falcone GJ, Sheth KN, Goldstein JN, Rosand J. Authors' reply: Confounding by indication in retrospective studies of intracerebral hemorrhage: antiepileptic treatment and mortality. Neurocrit Care 2013; 18:287-8. [PMID: 23408339 DOI: 10.1007/s12028-013-9820-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Biffi A, Battey TWK, Ayres AM, Cortellini L, Schwab K, Gilson AJ, Rost NS, Viswanathan A, Goldstein JN, Greenberg SM, Rosand J. Warfarin-related intraventricular hemorrhage: imaging and outcome. Neurology 2011; 77:1840-6. [PMID: 22049204 DOI: 10.1212/wnl.0b013e3182377e12] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Oral anticoagulation therapy (OAT) with warfarin increases mortality and disability after intracerebral hemorrhage (ICH), the result of increased ICH volume and risk of hematoma expansion. We investigated whether OAT also influences risk of development of intraventricular hemorrhage (IVH), the volume of IVH and IVH expansion, and whether IVH is a substantive mediator of the overall effect of OAT on ICH outcome. METHODS We performed a retrospective analysis of a prospectively collected single-center cohort of 1,879 consecutive ICH cases (796 lobar, 865 deep, 153 cerebellar, 15 multiple location, 50 primary IVH) from 1999 to 2009. ICH and IVH volumes at presentation, as well as hematoma expansion (>33% or >6 mL increase) and IVH expansion (>2 mL increase), were determined using established semiautomated methods. Outcome was assessed at 90 days using either the modified Rankin Scale or Glasgow Outcome Scale. RESULTS Warfarin use was associated with IVH risk, IVH volume at presentation, and IVH expansion in both lobar and deep ICH (all p < 0.05) in a dose-response relationship with international normalized ratio. Warfarin was associated with poor outcome in both lobar and deep ICH (p < 0.01), and >95% of this effect was accounted for by baseline ICH and IVH volumes, as well as ICH and IVH expansion. CONCLUSION Warfarin increases IVH volume and risk of IVH expansion in lobar and deep ICH. These findings (along with effects on ICH volume and expansion) likely represent the mechanisms by which anticoagulation worsens ICH functional outcome.
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Affiliation(s)
- A Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
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Montie EW, Wheeler E, Pussini N, Battey TWK, Barakos J, Dennison S, Colegrove K, Gulland F. Magnetic resonance imaging quality and volumes of brain structures from live and postmortem imaging of California sea lions with clinical signs of domoic acid toxicosis. Dis Aquat Organ 2010; 91:243-256. [PMID: 21133324 DOI: 10.3354/dao02259] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Our goal in this study was to compare magnetic resonance images and volumes of brain structures obtained alive versus postmortem of California sea lions Zalophus californianus exhibiting clinical signs of domoic acid (DA) toxicosis and those exhibiting normal behavior. Proton density-(PD) and T2-weighted images of postmortem-intact brains, up to 48 h after death, provided similar quality to images acquired from live sea lions. Volumes of gray matter (GM) and white matter (WM) of the cerebral hemispheres were similar to volumes calculated from images acquired when the sea lions were alive. However, cerebrospinal fluid (CSF) volumes decreased due to leakage. Hippocampal volumes from postmortem-intact images were useful for diagnosing unilateral and bilateral atrophy, consequences of DA toxicosis. These volumes were similar to the volumes in the live sea lion studies, up to 48 h postmortem. Imaging formalin-fixed brains provided some information on brain structure; however, images of the hippocampus and surrounding structures were of poorer quality compared to the images acquired alive and postmortem-intact. Despite these issues, volumes of cerebral GM and WM, as well as the hippocampus, were similar to volumes calculated from images of live sea lions and sufficient to diagnose hippocampal atrophy. Thus, postmortem MRI scanning (either intact or formalin-fixed) with volumetric analysis can be used to investigate the acute, chronic and possible developmental effects of DA on the brain of California sea lions.
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Affiliation(s)
- Eric W Montie
- College of Marine Science, University of South Florida, Florida 33701, USA.
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28
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Montie EW, Pussini N, Schneider GE, Battey TWK, Dennison S, Barakos J, Gulland F. Neuroanatomy and volumes of brain structures of a live California sea lion (Zalophus californianus) from magnetic resonance images. Anat Rec (Hoboken) 2009; 292:1523-47. [PMID: 19768743 DOI: 10.1002/ar.20937] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The California sea lion (Zalophus californianus) has been a focal point for sensory, communication, cognition, and neurological disease studies in marine mammals. However, as a scientific community, we lack a noninvasive approach to investigate the anatomy and size of brain structures in this species and other free-ranging, live marine mammals. In this article, we provide the first anatomically labeled, magnetic resonance imaging-based atlas derived from a live marine mammal, the California sea lion. The brain of the California seal lion contained more secondary gyri and sulci than the brains of terrestrial carnivores. The olfactory bulb was present but small. The hippocampus of the California sea lion was found mostly in the ventral position with very little extension dorsally, quite unlike the canids and the mustelids, in which the hippocampus is present in the ventral position but extends dorsally above the thalamus. In contrast to the canids and the mustelids, the pineal gland of the California sea lion was strikingly large. In addition, we report three-dimensional reconstructions and volumes of cerebrospinal fluid, cerebral ventricles, total white matter (WM), total gray matter (GM), cerebral hemispheres (WM and GM), cerebellum and brainstem combined (WM and GM), and hippocampal structures all derived from magnetic resonance images. These measurements are the first to be determined for any pinniped species. In California sea lions, this approach can be used not only to relate cognitive and sensory capabilities to brain size but also to investigate the neurological effects of exposure to neurotoxins such as domoic acid.
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Affiliation(s)
- Eric W Montie
- College of Marine Science, University of South Florida, 140 Seventh Avenue South, KRC 2107, St. Petersburg, FL 33701, USA.
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