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Ebbesen MQB, Dreier JW, Andersen G, Johnsen SP, Christensen J. Stroke and Risk of Epilepsy: A Danish Nationwide Register-Based Study. Stroke 2024. [PMID: 38390714 DOI: 10.1161/strokeaha.123.044203] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/17/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Stroke is associated with a risk of epilepsy, but associations with age, sex, stroke type and severity, time trends, and mortality are uncertain. We studied the risk of epilepsy after stroke while accounting for sex, age, stroke types and severity, calendar time, and death. METHODS This was a prospective nationwide register-based, matched cohort study of patients admitted with a validated first stroke in Denmark from April 1, 2004, to December 16, 2018, excluding those with prior epilepsy. Patients with stroke were matched 10:1 on age, sex, and calendar time with reference people without prior epilepsy or stroke. We estimated the cumulative incidence of an epilepsy diagnosis in the Danish National Patient Registry (International Classification of Diseases Tenth Revision: G40) with death as a competing risk using competing risk regression and estimated adjusted hazard ratios by Cox regression models. RESULTS We identified 101 034 patients with stroke (46.5% female; mean age, 70.4 years) who survived 14 days after stroke along with 1 010 333 matched reference people. Two years after the stroke, the cumulative incidence of epilepsy was 3.0% (95% CI, 2.9-3.2) after ischemic stroke and 8.6% (95% CI, 8.0-9.2) after intracerebral hemorrhage versus 0.7% (95% CI, 0.7-0.7) in the matched references. Compared with the reference population, the 2-year hazard ratio of epilepsy was 21.7 (95% CI, 20.3-23.2) after ischemic stroke and 61.3 (95% CI, 51.1-73.4) after intracerebral hemorrhage. The risk of epilepsy increased with stroke severity; the 2-year cumulative incidence of epilepsy was 10.5% (95% CI, 9.5-11.4) for very severe ischemic stroke and 13.1% (95% CI, 11.1-15.1) after very severe intracerebral hemorrhage. CONCLUSIONS In this population-based study of patients with validated stroke, the absolute and relative risk estimates of poststroke epilepsy were lower compared with previous studies. Reasons for the lower risk estimates include accounting for the high mortality associated with stroke, which had a significant impact on risk especially for severe stroke.
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Affiliation(s)
- Mads Qvist Buur Ebbesen
- Department of Neurology, Aarhus University Hospital, Denmark (M.Q.B.E., G.A., J.C.)
- National Centre for Register-Based Research, Aarhus University, Denmark. (M.Q.B.E., J.W.D., J.C.)
- Department of Clinical Medicine, Aarhus University, Denmark. (M.Q.B.E., G.A., J.C.)
| | - Julie Werenberg Dreier
- National Centre for Register-Based Research, Aarhus University, Denmark. (M.Q.B.E., J.W.D., J.C.)
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Denmark. (J.W.D.)
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Denmark (M.Q.B.E., G.A., J.C.)
- Department of Clinical Medicine, Aarhus University, Denmark. (M.Q.B.E., G.A., J.C.)
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark (S.P.J.)
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Denmark (M.Q.B.E., G.A., J.C.)
- National Centre for Register-Based Research, Aarhus University, Denmark. (M.Q.B.E., J.W.D., J.C.)
- Department of Clinical Medicine, Aarhus University, Denmark. (M.Q.B.E., G.A., J.C.)
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Potter TBH, Tannous J, Pan AP, Bako A, Johnson C, Baig E, Kelly H, McCane CD, Garg T, Gadhia R, Misra V, Volpi J, Britz G, Chiu D, Vahidy FS. Stroke severity mediates the effect of socioeconomic disadvantage on poor outcomes among patients with intracerebral hemorrhage. Front Neurol 2023; 14:1176924. [PMID: 37384280 PMCID: PMC10293742 DOI: 10.3389/fneur.2023.1176924] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/08/2023] [Indexed: 06/30/2023] Open
Abstract
Background Socioeconomic deprivation drives poor functional outcomes after intracerebral hemorrhage (ICH). Stroke severity and background cerebral small vessel disease (CSVD) burden have each been linked to socioeconomic status and independently contribute to worse outcomes after ICH, providing distinct, plausible pathways for the effects of deprivation. We investigate whether admission stroke severity or cerebral small vessel disease (CSVD) mediates the effect of socioeconomic deprivation on 90-day functional outcomes. Methods Electronic medical record data, including demographics, treatments, comorbidities, and physiological data, were analyzed. CSVD burden was graded from 0 to 4, with severe CSVD categorized as ≥3. High deprivation was assessed for patients in the top 30% of state-level area deprivation index scores. Severe disability or death was defined as a 90-day modified Rankin Scale score of 4-6. Stroke severity (NIH stroke scale (NIHSS)) was classified as: none (0), minor (1-4), moderate (5-15), moderate-severe (16-20), and severe (21+). Univariate and multivariate associations with severe disability or death were determined, with mediation evaluated through structural equation modelling. Results A total of 677 patients were included (46.8% female; 43.9% White, 27.0% Black, 20.7% Hispanic, 6.1% Asian, 2.4% Other). In univariable modelling, high deprivation (odds ratio: 1.54; 95% confidence interval: [1.06-2.23]; p = 0.024), severe CSVD (2.14 [1.42-3.21]; p < 0.001), moderate (8.03 [2.76-17.15]; p < 0.001), moderate-severe (32.79 [11.52-93.29]; p < 0.001), and severe stroke (104.19 [37.66-288.12]; p < 0.001) were associated with severe disability or death. In multivariable modelling, severe CSVD (3.42 [1.75-6.69]; p < 0.001) and moderate (5.84 [2.27-15.01], p < 0.001), moderate-severe (27.59 [7.34-103.69], p < 0.001), and severe stroke (36.41 [9.90-133.85]; p < 0.001) independently increased odds of severe disability or death; high deprivation did not. Stroke severity mediated 94.1% of deprivation's effect on severe disability or death (p = 0.005), while CSVD accounted for 4.9% (p = 0.524). Conclusion CSVD contributed to poor functional outcome independent of socioeconomic deprivation, while stroke severity mediated the effects of deprivation. Improving awareness and trust among disadvantaged communities may reduce admission stroke severity and improve outcomes.
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Affiliation(s)
| | - Jonika Tannous
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Alan P. Pan
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Abdulaziz Bako
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Carnayla Johnson
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Eman Baig
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Hannah Kelly
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Charles D. McCane
- Department of Neurology, Houston Methodist, Houston, TX, United States
| | - Tanu Garg
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Rajan Gadhia
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Vivek Misra
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - John Volpi
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Gavin Britz
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
- Department of Neurological Surgery, Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
| | - David Chiu
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Farhaan S. Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
- Department of Neurological Surgery, Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
- Department of Population Health Sciences, Weill Cornell Medicine, White Plains, NY, United States
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Khripun AI, Pryamikov AD, Mironkov AB, Asratyan SA, Suryakhin VS, Petrenko NV, Luk'yanova EA. [Venous thromboembolic complications in patients with intracerebral hemorrhage]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:41-46. [PMID: 34553580 DOI: 10.17116/jnevro202112108241] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of various heparin therapy regimens for venous thromboembolic complications in patients with acute cerebral circulatory disorders of the hemorrhagic type. MATERIAL AND METHODS In a prospective single-center study, treatment results of 62 patients with hypertensive brain hematoma were analyzed. All patients were divided into two comparable groups: the group of «very early» prophylactic heparin therapy or the first 48 hours from the moment of the disease (n=35) and the group of «early» prophylactic heparin therapy, or later than 48 hours from the moment of the intracerebral hematoma development (n=27). The end points of the study were: venous thrombosis, pulmonary embolism (fatal and non-fatal), recurrent intracerebral hemorrhage, other clinically significant hemorrhagic complications, and intrahospital mortality. RESULTS In the group of «very early» and «early» prophylactic heparin therapy, the results were as follows: venous thrombosis 22.9% vs. 29.6% (p=0.36), total rate of PE 2.9% vs. 11.1% (p=0.03), nonfatal PE 0% vs. 7.4% (p=0.007), fatal PE 2.9% vs. 3.7% (p=0.76), recurrent intracerebral hemorrhage and other hemorrhagic complications 0% in both groups, intrahospital mortality was 54.3% versus 48.1% (p=0.54). CONCLUSION The earliest administration of direct anticoagulants in prophylactic doses in patients with hemorrhagic stroke leads to the decrease in the frequency of venous thrombosis and thromboembolic complications, without being accompanied by the development of repeated intracranial and other hemorrhagic events.
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Affiliation(s)
- A I Khripun
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A D Pryamikov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Buyanov City Clinical Hospital, Moscow, Russia
| | - A B Mironkov
- Pirogov Russian National Research Medical University, Moscow, Russia.,Buyanov City Clinical Hospital, Moscow, Russia
| | | | | | | | - E A Luk'yanova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Hassing LT, Verschoof MA, Koppen H. Alcohol Intoxication as a Stroke Mimic and the Incidence of Acute Alcohol Intoxication in Stroke. J Stroke Cerebrovasc Dis 2019; 28:104424. [PMID: 31624037 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIM Alcohol intoxication can be a posterior circulation stroke mimic as they share symptoms such as dysarthria, gait disturbances and nystagmus. We describe alcohol intoxication as a stroke mimic and the frequency of acute alcohol intoxication among stroke patients. METHODS Prospective observational single-center study (2014-2017, Haga Ziekenhuis, the Hague). In all patients older than 16 years presenting as possible acute stroke less than 6 hours of onset, blood ethanol was measured; greater than 0.1 blood alcohol concentration (BAC) was considered elevated. RESULTS In total 974 patients were included: 60 (6%) had elevated blood ethanol (mean: 1.3 BAC). In 180 of 974 patients (18%) a stroke mimic was diagnosed: 12 were due to alcohol intoxication (1% of total cohort, 7% of stroke mimic, mean ethanol level: 2.2 BAC). Half of these patients denied or downplayed their alcohol consumption. Stroke and concurrent alcohol intoxication occurred in 38 of 794 strokes (5%, mean ethanol level: 1.1 BAC). Compared to other stroke patients, these 38 patients presented more often after working hours (mean 6.38pm versus 2.23pm) and received alteplase and endovascular therapy less often (24% versus 43%, P = .018 and 3% versus 10%, P = .241, respectively). CONCLUSIONS Of all patients presenting as possible acute stroke, 6% also drank alcohol. 18% of the whole cohort was diagnosed with a stroke mimic. Acute alcohol intoxication as sole diagnosis was diagnosed in 1% of the total cohort and 7% of stroke mimics, 50% denied or downplayed their alcohol consumption. 5% of all stroke patients also drank alcohol, they were significantly less likely to receive alteplase or endovascular treatment.
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Affiliation(s)
- Laurien T Hassing
- Department of Neurology, Haga Ziekenhuis, The Hague, The Netherlands.
| | | | - Hille Koppen
- Department of Neurology, Haga Ziekenhuis, The Hague, The Netherlands
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