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Jacobsen E, Logallo N, Kvistad CE, Thomassen L, Idicula T. Characteristics and predictors of stroke mimics in young patients in the norwegian tenecteplase stroke trial (NOR-TEST). BMC Neurol 2023; 23:406. [PMID: 37968581 PMCID: PMC10647039 DOI: 10.1186/s12883-023-03425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 03/13/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Several studies have shown that stroke mimics occur more often among young patients. Our aims were to identify the common mimics in young patients under the age of 60 years who received thrombolysis, to analyze the risk of hemorrhage after treatment with thrombolysis, and to identify risk factors and clinical parameters that might identify mimics in this group. METHODS Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with acute ischemic stroke. Patients diagnosed with either acute cerebral ischemia or transient ischemic attack were categorized as stroke group, and patients with any diagnosis other than ischemic stroke or transient ischemic attack as mimics group. Patients were grouped post-hoc into young (< 60 years) and old (≥ 60 years). Logistic regression analyses were performed with mimics vs. stroke as dependent variable to identify predictors of mimics. RESULTS Of the 1091 patients included in the trial, 211 patients (19.3%) were under the age of 60 years. Out of the 1091 patients, 434 (39.8%) were female, median age 77 years (18-99 years), and median NIHSS was 4. Sixty-nine patients (32.7%) out of the 211 patients under the age of 60 were diagnosed as mimic. Mimics were significantly more frequent among the young (OR = 3.3, 32.7% vs. 12.8%, p = < 0.001). The most frequent mimics diagnoses among patients under 60 years of age were migraine (11.8%), no definite diagnosis (11.4%) and peripheral vertigo (3.3%). Mimics were independently associated with age < 50 years (OR = 4.97, p = < 0.001), not currently working/studying (OR = 3.38, p = 0.002) and not having aphasia on admission (OR = 2.95, p = 0.025). None of the mimics under the age of 60 years had symptomatic or asymptomatic intracerebral hemorrhage as a complication to thrombolysis. CONCLUSION We found significantly more mimics in the young, of which migraine was the most predominant diagnosis. Thrombolysis with alteplase or tenecteplase did not cause ICH in any mimics under 60 years.
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Affiliation(s)
- Eskil Jacobsen
- Norwegian University of Science and Technology, Trondheim (NTNU), Trondheim, 7034, Norway.
| | - Nicola Logallo
- Department of Neurology, Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, 5021, Norway
| | - Christopher Elnan Kvistad
- Department of Neurology, Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, 5021, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Lars Thomassen
- Department of Neurology, Centre for Neurovascular Diseases, Haukeland University Hospital, Bergen, 5021, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Titto Idicula
- Norwegian University of Science and Technology (NTNU), Trondheim, 7034, Norway
- Department of Neurology, St Olav University Hospital, Trondheim, Norway
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Tharaldsen AR, Sand KM, Dalen I, Wilhelmsen G, Næss H, Midelfart A, Rødahl E, Thomassen L, Hoff JM, Frid LM, Tandstad HK, Hegreberg G, Lundberg K, Karlsen TR, Setseng B, Rohweder G, Indredavik B, Kurz MW, Idicula T. Vision-related quality of life in patients with occipital stroke. Acta Neurol Scand 2020; 141:509-518. [PMID: 32078166 DOI: 10.1111/ane.13232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/05/2019] [Revised: 01/24/2020] [Accepted: 02/09/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study was to detect visual field defects (VFDs) after occipital infarction, investigate the rate of recovery and the impact of VFD upon vision-related quality of life (QoL). MATERIALS AND METHODS Multicenter, prospective study including patients with MRI verified acute occipital infarction (NOR-OCCIP project). Ophthalmological examination including perimetry was performed within 2 weeks and after 6 months. Vision-related QoL was assessed by the National Eye Institute Visual Function Questionnaire 25 (VFQ-25) at one and 6 months post-stroke. RESULTS We included 76 patients, reliable perimetry results were obtained in 66 patients (87%) at a median of 8 days after admittance and VFD were found in 52 cases (79%). Evaluation of VFD after 6 months revealed improvement in 52%. Patients with VFD had significantly lower composite score in VFQ-25 at both test points (77 vs 96, P = .001 and 87 vs 97, P = .009), in nine out of eleven subscales of VFQ-25 at 1 month and seven subscales after 6 months, including mental health, dependency, near and distance activities. Milder VFD had better results on VFQ-25 modified composite score (95 vs 74, P = .002).VFD improvement was related to improved VFQ-25 modified composite score (9.6 vs 0.8, P = .018). About 10% of patients with VFD reported driving 1 month post-stroke and 38% after 6 months. CONCLUSION VFD substantially reduces multiple aspects of vision-related QoL. Severity of VFD is related to QoL and VFD improvement results in better QoL. Neglecting visual impairment after stroke may result in deterioration of rehabilitation efforts. Driving post-stroke deserves particular attention.
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Affiliation(s)
| | - Kristin Modalsli Sand
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Internal Medicine Sørlandet Hospital Flekkefjord Flekkefjord Norway
| | - Ingvild Dalen
- Section of Biostatistics Department of Research Stavanger University Hospital Stavanger Norway
| | - Gunvor Wilhelmsen
- Department of Pedagogy in Teacher Education Faculty of Education Western Norway University of Applied Sciences Bergen Norway
| | - Halvor Næss
- Department of Clinical Medicine University of Bergen Bergen Norway
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
- Department of Neurology Haukeland University Hospital Bergen Norway
| | - Anna Midelfart
- Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Eyvind Rødahl
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Ophthalmology Haukeland University Hospital Bergen Norway
| | - Lars Thomassen
- Department of Clinical Medicine University of Bergen Bergen Norway
- Department of Neurology Haukeland University Hospital Bergen Norway
| | - Jana Midelfart Hoff
- Department of Neurology Haukeland University Hospital Bergen Norway
- Faculty of Health VID Specialized University Bergen Norway
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Ratajczak-Tretel B, Lambert AT, Johansen H, Halvorsen B, Bjerkeli V, Russell D, Sandset EC, Ihle-Hansen H, Eriksen E, Næss H, Novotny V, Khanevski AN, Truelsen TC, Idicula T, Ægidius KL, Tobro H, Krogseth SB, Ihle-Hansen H, Hagberg G, Kruuse C, Arntzen K, Bakkejord GK, Villseth M, Nakstad I, Eldøen G, Shafiq R, Gulsvik A, Kurz M, Rezai M, Sømark J, Tingvoll SH, Jonassen C, Ingebrigtsen S, Steffensen LH, Kremer C, Atar D, Aamodt AH. Atrial fibrillation in cryptogenic stroke and transient ischaemic attack - The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Rationale and design. Eur Stroke J 2019; 4:172-180. [PMID: 31259265 DOI: 10.1177/2396987319837089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/01/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose Paroxysmal atrial fibrillation is often suspected as a probable cause of cryptogenic stroke. Continuous long-term ECG monitoring using insertable cardiac monitors is a clinically effective technique to screen for atrial fibrillation and superior to conventional follow-up in cryptogenic stroke. However, more studies are needed to identify factors which can help selecting patients with the highest possibility of detecting atrial fibrillation with prolonged rhythm monitoring. The clinical relevance of short-term atrial fibrillation, the need for medical intervention and the evaluation as to whether intervention results in improved clinical outcomes should be assessed. Method The Nordic Atrial Fibrillation and Stroke Study is an international, multicentre, prospective, observational trial evaluating the occurrence of occult atrial fibrillation in cryptogenic stroke and transient ischaemic attack. Patients with cryptogenic stroke or transient ischaemic attack from the Nordic countries are included and will have the Reveal LINQ® Insertable cardiac monitor system implanted for 12 months for atrial fibrillation detection. Biomarkers which can be used as predictors for atrial fibrillation and may identify patients, who could derive the most clinical benefit from the detection of atrial fibrillation by prolonged monitoring, are being studied. Conclusion The primary endpoint is atrial fibrillation burden within 12 months of continuous rhythm monitoring. Secondary endpoints are atrial fibrillation burden within six months, levels of biomarkers predicting atrial fibrillation, CHA2DS2-VASc score, incidence of recurrent stroke or transient ischaemic attack, use of anticoagulation and antiarrhythmic drugs, and quality of life measurements. The clinical follow-up period is 12 months. The study started in 2017 and the completion is expected at the end of 2020.
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Affiliation(s)
- Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Bente Halvorsen
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Vigdis Bjerkeli
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Hege Ihle-Hansen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Eriksen
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Vojtech Novotny
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Thomas C Truelsen
- Department of Neurology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Titto Idicula
- Department of Neurology, St. Olav University Hospital, Trondheim, Norway
| | - Karen L Ægidius
- Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Håkon Tobro
- Department of Neurology, Telemark Hospital, Skien, Norway
| | - Siv B Krogseth
- Department of Neurology, Vestfold Hospital, Tønsberg, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - Guri Hagberg
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - Christina Kruuse
- Department of Neurology, Herlev Gentofte Hospital, Copenhagen, Denmark
| | | | | | - Maja Villseth
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Ingvild Nakstad
- Department of Neurology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Raheel Shafiq
- Department of Neurology, Molde Hospital, Molde, Norway
| | - Anne Gulsvik
- Department of Internal Medicine, Diakonhjemmet Hospital, Oslo, Norway
| | - Martin Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Mehdi Rezai
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Jesper Sømark
- Department of Neurology, Innlandet Hospital Trust, Lillehammer, Norway
| | | | - Christine Jonassen
- Center of Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway.,Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | | | | | - Christine Kremer
- Department of Neurology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology B, Oslo University Hospital, Ullevål, Oslo, Norway
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Logallo N, Lind J, Naess H, Idicula T, Brogger J, Waje-Andreassen U, Thomassen L. Middle cerebral artery stenosis: transcranial color-coded sonography based on continuity equation versus CT-angiography. Ultraschall Med 2012; 33:E326-E332. [PMID: 22872381 DOI: 10.1055/s-0032-1313076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Transcranial color-coded sonography (TCCS) and CT-angiography (CTA) are reliable tools for detection of intracranial stenosis. Current ultrasonographic criteria for middle cerebral artery (MCA) stenosis are usually limited to a dichotomized grading (< or ≥ 50 %). As for carotid arteries, continuity equation might provide a more accurate evaluation of degree of MCA stenosis. We aimed to apply continuity equation to calculate degree of MCA stenosis with TCCS and to compare these results with CTA. MATERIALS AND METHODS All patients admitted to our Neurovascular Center with ischemic stroke or TIA underwent TCCS examination. Degree of MCA stenosis was calculated based on continuity equation as (1 - [PSVprestenotic/PSVintrastenotic] × 100) %. CTA was performed when TCCS detected MCA stenosis, and degree of stenosis was calculated by diameter (D) as: (1 - [Dprestenotic/Dintrastenotic] × 100) %. Correlation between TCCS and CTA results was tested. Continuity equation method was compared to cut-off velocity method for detection of ≥ 50 % MCA stenosis. To assess TCCS inter-observer agreement, evaluation of MCA stenosis was repeated by another neurosonographer in a subgroup of patients. RESULTS The overall correlation coefficient between TCCS and CTA was 0.85 (p < 0.0001). Correlation coefficient for stenosis defined with CTA as ≥ 50 % was 0.94 (p < 0.0001). TCCS inter-observer agreement on degree of stenosis was 0.85 (p = 0.001). In detection of ≥ 50 % MCA stenosis, continuity equation method showed a sensitivity of 78 % (14/18) and a specificity of 86 % (19/22), while the cut-off velocity method showed a sensitivity of 67 % (12/18) and a specificity of 86 % (19/22). CONCLUSION This study shows that ultrasonographic evaluation of MCA stenosis applying the continuity equation provides reproducible and accurate results, and is more sensitive in detection of ≥ 50 % MCA stenosis than cut-off velocity method.
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Affiliation(s)
- N Logallo
- Department of Neurology, Neurovascular Center, Haukeland University Hospital
| | - J Lind
- Department of Radiology, Haukeland University Hospital
| | - H Naess
- Department of Neurology, Neurovascular Center, Haukeland University Hospital
| | - T Idicula
- Department of Neurology, Neurovascular Center, Haukeland University Hospital
| | - J Brogger
- Department of Neurology, Neurovascular Center, Haukeland University Hospital
| | - U Waje-Andreassen
- Department of Neurology, Neurovascular Center, Haukeland University Hospital
| | - L Thomassen
- Department of Clinical Medicine, University of Bergen
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