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Bagnato MR, Ciullo I, Diomedi M. Recurrent lacunar strokes in a patient with small vessel disease: rare but not negligible cause of Foix-Chavany-Marie syndrome. Neurol Sci 2024; 45:2401-2402. [PMID: 38296880 DOI: 10.1007/s10072-024-07358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Affiliation(s)
- Maria Rosaria Bagnato
- Department of Systems Medicine, Stroke Unit, University of Tor Vergata, Rome, Italy.
| | - Ilaria Ciullo
- Department of Systems Medicine, Stroke Unit, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Department of Systems Medicine, Stroke Unit, University of Tor Vergata, Rome, Italy
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Koohi F, Harshfield EL, Shatunov A, Markus HS. Does Thrombosis Play a Causal Role in Lacunar Stroke and Cerebral Small Vessel Disease? Stroke 2024; 55:934-942. [PMID: 38527140 PMCID: PMC10962440 DOI: 10.1161/strokeaha.123.044937] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/02/2023] [Accepted: 12/05/2023] [Indexed: 03/27/2024]
Abstract
BACKGROUND The importance of thromboembolism in the pathogenesis of lacunar stroke (LS), resulting from cerebral small vessel disease (cSVD), is debated, and although antiplatelets are widely used in secondary prevention after LS, there is limited trial evidence from well-subtyped patients to support this approach. We sought to evaluate whether altered anticoagulation plays a causal role in LS and cSVD using 2-sample Mendelian randomization. METHODS From a recent genome-wide association study (n=81 190), we used 119 genetic variants associated with venous thrombosis at genome-wide significance (P<5*10-8) and with a linkage disequilibrium r2<0.001 as instrumental variables. We also used genetic associations with stroke from the GIGASTROKE consortium (62 100 ischemic stroke cases: 10 804 cardioembolic stroke, 6399 large-artery stroke, and 6811 LS). In view of the lower specificity for LS with the CT-based phenotyping mainly used in GIGASTROKE, we also used data from patients with magnetic resonance imaging-confirmed LS (n=3199). We also investigated associations with more chronic magnetic resonance imaging features of cSVD, namely, white matter hyperintensities (n=37 355) and diffusion tensor imaging metrics (n=36 533). RESULTS Mendelian randomization analyses showed that genetic predisposition to venous thrombosis was associated with an increased odds of any ischemic stroke (odds ratio [OR], 1.19 [95% CI, 1.13-1.26]), cardioembolic stroke (OR, 1.32 [95% CI, 1.21-1.45]), and large-artery stroke (OR, 1.41 [95% CI, 1.26-1.57]) but not with LS (OR, 1.07 [95% CI, 0.99-1.17]) in GIGASTROKE. Similar results were found for magnetic resonance imaging-confirmed LS (OR, 0.94 [95% CI, 0.81-1.09]). Genetically predicted risk of venous thrombosis was not associated with imaging markers of cSVD. CONCLUSIONS These findings suggest that altered thrombosis plays a role in the risk of cardioembolic and large-artery stroke but is not a causal risk factor for LS or imaging markers of cSVD. This raises the possibility that antithrombotic medication may be less effective in cSVD and underscores the necessity for further trials in well-subtyped cohorts with LS to evaluate the efficacy of different antithrombotic regimens in LS.
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Affiliation(s)
- Fatemeh Koohi
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom
| | - Eric L. Harshfield
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom
| | - Alexey Shatunov
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom
| | - Hugh S. Markus
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom
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Zedde M, Grisendi I, Assenza F, Vandelli G, Napoli M, Moratti C, Valzania F, Pascarella R. Posterior reversible encephalopathy syndrome and acute ischemic stroke: an underreported association. Neurol Sci 2024; 45:1249-1254. [PMID: 38044394 DOI: 10.1007/s10072-023-07223-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Posterior reversible encephalopathy syndrome (PRES) is a rare and complex disorder with variable clinical presentation and a typical magnetic resonance imaging (MRI) pattern of vasogenic edema with typical and atypical locations. It is often triggered by other diseases and drugs and the most prototypical association is with persistently elevated arterial pressure values. Among the potential cerebrovascular complications, intracranial bleeding has been described, but ischemic stroke is uncommonly reported. METHODS We are presenting a case of a male patient with prolonged and sustained arterial hypertension acutely presenting with lacunar ischemic stroke involving the right corona radiata and composite MRI findings with the association of chronic small vessel disease (SVD) markers, acute symptomatic lacunar stroke, and atypical, central variant, posterior fossa dominant PRES. In the MRI follow-up, the white matter hyperintensities in T2-fluid attenuated inversion recovery (FLAIR sequences) due to PRES. DISCUSSION The pathophysiology of PRES is not yet fully known, but the association with markedly increased values of arterial pressure is typical. In this context, ischemic stroke has not been considered in the clinical and neuroradiological manifestations of PRES and it has been only occasionally reported in the literature. In this case, the main hypothesis is that sustained hypertension may have triggered both manifestations, PRES, and ischemic stroke and the last one allowed to diagnose the first one. CONCLUSIONS Atypical variants of PRES are not so rare and it may also occur in typical triggering situations. The association with ischemic stroke is even rarer and it may add some clues to the pathomechanisms of PRES.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Gabriele Vandelli
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy
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Wang S, Kang H, Wang Q, Wang D, Hu L, Kou J, Yang Z. Incidence and influencing factors of urinary incontinence in stroke patients: A meta-analysis. Neurourol Urodyn 2024; 43:680-693. [PMID: 38247371 DOI: 10.1002/nau.25398] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/10/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The incidence of stroke in China ranks first in the world and is the leading cause of death and disability in adults. Urinary incontinence is an independent risk factor leading to poor prognosis of stroke. However, studies on the incidence of urinary incontinence in stroke patients and its influencing factors are different, fluctuate greatly, and there is no unified basis. OBJECTIVE To quantitatively analyze the incidence of urinary incontinence in stroke patients and its related influencing factors, and further make public health strategic decisions to reduce the occurrence of adverse outcomes. METHODS Computer searches were conducted in PubMed, Medline, Web of Science, Cochrane Library, Embase, CLNAHL Complete, China National Knowledge Infrastructure (CNKI), Chinese Biomedical database(CBM), Wan Fang Database, VIP Database, observational studies such as cohort studies, case-control studies or cross-sectional studies on the incidence or influencing factors of urinary incontinence in stroke patients from the establishment of the database to the publication in August 2023. Studies selection, quality evaluation and data extraction were conducted independently by two researchers according to the established search strategy. Stata 14.0 statistical software was used for meta-analysis. RESULTS A total of 21 manuscripts were included, with a cumulative sample size of 7327 cases, including 2887 patients with urinary incontinence. Meta-analysis results showed that the incidence of urinary incontinence in stroke patients was 38% [95% confidence interval (34%, 41%)], including married patients and lacunar infarction were the protective factors for urinary incontinence in stroke patients, while age, chaperone, low educational level, chronic cough, lesion sites (parietal lobe, frontal lobe, and temporal lobe), stroke type (cerebral hemorrhage, subarachnoid hemorrhage and cerebral hemorrhage complicated with subarachnoid hemorrhage), dysfunction (aphasia dyslexia, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, the higher the NIHSS score, the lower the Bachmann index (BI) score, OCSP classification (total anterior circulation infarction) and other 11 items were risk factors for urinary incontinence in stroke patients. CONCLUSION The incidence of urinary incontinence in stroke patients is 38%. Marriage and lacunar infarction are the protective factors of urinary incontinence. Age, carer, low educational level, chronic cough, lesion site (parietal, frontal and temporal lobes), stroke type (cerebral hemorrhage, subarachnoid hemorrhage, cerebral hemorrhage combined with subarachnoid hemorrhage), dysfunction (aphasia and dysarthria syndrome, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, and higher NIHSS score, Lower BI score and OCSP classification (total anterior circulation infarction) were risk factors for urinary incontinence in stroke patients.
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Affiliation(s)
- Shuyao Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hua Kang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qingyuan Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dan Wang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lizi Hu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jiaojiao Kou
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zijiang Yang
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Parodi L, Comeau ME, Georgakis MK, Mayerhofer E, Chung J, Falcone GJ, Malik R, Demel SL, Worrall BB, Koch S, Testai FD, Kittner SJ, McCauley JL, Hall CE, Mayson DJ, Elkind MSV, James ML, Woo D, Rosand J, Langefeld CD, Anderson CD. Deep Resequencing of the 1q22 Locus in Non-Lobar Intracerebral Hemorrhage. Ann Neurol 2024; 95:325-337. [PMID: 37787451 PMCID: PMC10843118 DOI: 10.1002/ana.26814] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/19/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Genome-wide association studies have identified 1q22 as a susceptibility locus for cerebral small vessel diseases, including non-lobar intracerebral hemorrhage (ICH) and lacunar stroke. In the present study, we performed targeted high-depth sequencing of 1q22 in ICH cases and controls to further characterize this locus and prioritize potential causal mechanisms, which remain unknown. METHODS A total of 95,000 base pairs spanning 1q22, including SEMA4A, SLC25A44, and PMF1/PMF1-BGLAP were sequenced in 1,055 spontaneous ICH cases (534 lobar and 521 non-lobar) and 1,078 controls. Firth regression and Rare Variant Influential Filtering Tool analysis were used to analyze common and rare variants, respectively. Chromatin interaction analyses were performed using Hi-C, chromatin immunoprecipitation followed by sequencing, and chromatin interaction analysis with paired-end tag databases. Multivariable Mendelian randomization assessed whether alterations in gene-specific expression relative to regionally co-expressed genes at 1q22 could be causally related to ICH risk. RESULTS Common and rare variant analyses prioritized variants in SEMA4A 5'-UTR and PMF1 intronic regions, overlapping with active promoter and enhancer regions based on ENCODE annotation. Hi-C data analysis determined that 1q22 is spatially organized in a single chromatin loop, and that the genes therein belong to the same topologically associating domain. Chromatin immunoprecipitation followed by sequencing and chromatin interaction analysis with paired-end tag data analysis highlighted the presence of long-range interactions between the SEMA4A-promoter and PMF1-enhancer regions prioritized by association testing. Multivariable Mendelian randomization analyses demonstrated that PMF1 overexpression could be causally related to non-lobar ICH risk. INTERPRETATION Altered promoter-enhancer interactions leading to PMF1 overexpression, potentially dysregulating polyamine catabolism, could explain demonstrated associations with non-lobar ICH risk at 1q22, offering a potential new target for prevention of ICH and cerebral small vessel disease. ANN NEUROL 2024;95:325-337.
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Affiliation(s)
- Livia Parodi
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary E Comeau
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Precision Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Marios K Georgakis
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Ernst Mayerhofer
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jaeyoon Chung
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Guido J Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Rainer Malik
- Institute for Stroke and Dementia Research (ISD), University Hospital, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Stacie L Demel
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Bradford B Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Sebastian Koch
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Fernando D Testai
- Department of Neurology & Neurorehabilitation, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christiana E Hall
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Douglas J Mayson
- Division of Stroke, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Daniel Woo
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Center for Precision Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christopher D Anderson
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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Lee KJ, Kim H, Lee SJ, Duperron MG, Debette S, Bae HJ, Sung J. Causal Effect of the 25-Hydroxyvitamin D Concentration on Cerebral Small Vessel Disease: A Mendelian Randomization Study. Stroke 2023; 54:2338-2346. [PMID: 37465996 PMCID: PMC10453327 DOI: 10.1161/strokeaha.123.042980] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Previous observational studies reported that a lower serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with a higher burden of cerebral small vessel disease (cSVD). The causality of this association is uncertain, but it would be clinically important, given that 25(OH)D can be a target for intervention. We tried to examine the causal effect of 25(OH)D concentration on cSVD-related phenotypes using a Mendelian randomization approach. METHODS Genetic instruments for each serum 25(OH)D concentration and cSVD-related phenotypes (lacunar stroke, white matter hyperintensity, cerebral microbleeds, and perivascular spaces) were derived from large-scale genome-wide association studies. We performed 2-sample Mendelian randomization analyses with multiple post hoc sensitivity analyses. A bidirectional Mendelian randomization approach was also used to explore the possibility of reverse causation. RESULTS We failed to find any significant causal effect of 25(OH)D concentration on cSVD-related phenotypes (odds ratio [95% CI], 1.00 [0.87-1.16], 1.01 [0.96-1.07], 1.06 [0.85-1.33], 1.00 [0.97-1.03], 1.02 [0.99-1.04], 1.01 [0.99-1.04] for lacunar stroke, white matter hyperintensity, cerebral microbleeds, and white matter, basal ganglia, hippocampal perivascular spaces, respectively). These results were reproduced in the sensitivity analyses accounting for genetic pleiotropy. Conversely, when we examined the effects of cSVD phenotypes on 25(OH)D concentration, cerebral microbleeds were negatively associated with 25(OH)D concentration (0.94 [0.92-0.96]). CONCLUSIONS Given the adequate statistical power (>0.8) of the analyses, our findings suggest that the previously reported association between 25(OH)D concentration and cSVD phenotypes might not be causal and partly attributed to reverse causation.
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Affiliation(s)
- Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea (K.-J.L.)
| | - Hakyung Kim
- Genome and Health Big Data Laboratory, Department of Public Health, Graduate School of Public Health (H.K., S.J.L., J.S.), Seoul National University, Republic of Korea
| | - Soo Ji Lee
- Genome and Health Big Data Laboratory, Department of Public Health, Graduate School of Public Health (H.K., S.J.L., J.S.), Seoul National University, Republic of Korea
- Health and Environment Institute (S.J.L., J.S.), Seoul National University, Republic of Korea
| | | | - Stéphanie Debette
- Bordeaux Population Health Research Center, University of Bordeaux, France (M.-G.D., S.D.)
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea (H.-J.B.)
| | - Joohon Sung
- Genome and Health Big Data Laboratory, Department of Public Health, Graduate School of Public Health (H.K., S.J.L., J.S.), Seoul National University, Republic of Korea
- Health and Environment Institute (S.J.L., J.S.), Seoul National University, Republic of Korea
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Mazzacane F, Del Bello B, Ferrari F, Persico A, Rognone E, Pichiecchio A, Padovani A, Cavallini A, Morotti A, Arba F. Intracranial carotid artery calcification morphology differs in patients with lacunar and nonlacunar acute ischemic strokes. Eur J Neurol 2023; 30:963-969. [PMID: 36692888 DOI: 10.1111/ene.15704] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial carotid artery calcifications (ICACs) are a common finding on noncontrast computed tomography (NCCT) and have been associated with an increased risk of ischemic stroke. However, no data are available about the association between ICAC patterns and stroke etiology. We investigated the association between ICAC patterns and etiological subtypes of ischemic stroke. METHODS We retrospectively analyzed a single center cohort of patients admitted for ischemic stroke with known etiology. Each carotid artery was evaluated separately on NCCT scans to define the ICAC pattern (intimal, medial, mixed). The association between ICAC patterns and stroke etiology was investigated using logistic regression models adjusting for relevant confounders. RESULTS A total of 485 patients were included (median age = 78 [interquartile range (IQR) = 70-85] years, 243 [50%] female, median National Institutes of Health Stroke Scale = 6 [IQR = 3-12]). Frequencies of ICAC patterns were: intimal, n = 96 (20%); medial, n = 273 (56%); mixed, n = 51 (11%), indistinct/absent, n = 65 (13%) patients. Intimal pattern was more frequent in lacunar compared with nonlacunar (33% vs. 16%, p < 0.001) stroke etiology, whereas medial pattern was less frequent in lacunar compared with nonlacunar stroke (36% vs. 62%, p < 0.001). After adjustment for confounders, intimal ICAC predominant pattern remained associated with lacunar stroke etiology in two multivariate models (Model 1: adjusted odds ratio [aOR] = 2.08, 95% confidence interval [CI] = 1.20-3.56; Model 2: aOR = 2.01, 95% CI = 1.16-3.46). CONCLUSIONS Our study suggests that intimal ICAC pattern is associated with lacunar stroke and may serve as a marker for lacunar stroke etiology, possibly strengthening the relation between endothelial dysfunction and lacunar stroke.
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Affiliation(s)
- Federico Mazzacane
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Cerebrovascular Disease, Scientific Institute for Research and Health Care Mondino Foundation, Pavia, Italy
| | - Beatrice Del Bello
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Federica Ferrari
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Cerebrovascular Disease, Scientific Institute for Research and Health Care Mondino Foundation, Pavia, Italy
| | - Alessandra Persico
- Department of Cerebrovascular Disease, Scientific Institute for Research and Health Care Mondino Foundation, Pavia, Italy
| | - Elisa Rognone
- Department of Neuroradiology, Scientific Institute for Research and Health Care Mondino Foundation, Pavia, Italy
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Neuroradiology, Scientific Institute for Research and Health Care Mondino Foundation, Pavia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy
| | - Anna Cavallini
- Department of Cerebrovascular Disease, Scientific Institute for Research and Health Care Mondino Foundation, Pavia, Italy
| | - Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy
| | - Francesco Arba
- Stroke Unit, Careggi University Hospital, Florence, Italy
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Kirkham FA, Rankin P, Bunting E, Ali K, Chakravarthi R. Using measures of sarcopenia to predict recurrent cerebrovascular events in stroke and TIA patients. J Stroke Cerebrovasc Dis 2023; 32:106979. [PMID: 36682124 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106979] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Sarcopenia is associated with poor outcomes, and evidence suggests an inverse relationship between skeletal muscle mass and cardiovascular risk. Sarcopenia has been studied after stroke, but its value as a risk factor for stroke has not been examined. This prospective cohort study measured sarcopenia in stroke/TIA patients at baseline to explore its role in predicting recurrent events. METHOD The Arterial Stiffness In lacunar Stroke and TIA (ASIST) study included 96 patients with TIA/lacunar stroke, of which 82 patients (mean age 71.2±10.8 years) had bioimpedance analysis to assess body composition. Skeletal Mass Index (SMI) was calculated and parameters of sarcopenia assessed using Davison (1) and Janssen (2) criteria. Recurrent cerebrovascular events were monitored over 5 years. RESULTS Eighteen patients had recurrent events. On independent samples t test there were significantly more participants with sarcopenia in the recurrent events group (89% vs 56%, p<0.001) using Davison (1) criteria, as well as lower mean SMI, significantly more participants with diabetes and higher arterial stiffness. On binary logistic regression, the only significant predictors of recurrent events were SMI (p=0.036, hazard ratio=0.414, 95% confidence interval 0.195-0.948) and diabetes (p=0.004, hazard ratio=9.06, 95% confidence interval 2.009-40.860) when corrected for age, sex and cardiovascular risk factors. Using Janssen (2) criteria in the regression, severe sarcopenia was a significant predictor of recurrent events (p=0.028). There was a significant association between sarcopenia and recurrent events on Chi square based on Davison (p=0.02) and Janssen (p=0.034) definitions. CONCLUSIONS The presence of baseline sarcopenia in stroke and TIA patients is an independent predictor of recurrent events.
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Affiliation(s)
- Frances A Kirkham
- Department of Geriatric Medicine, University Hospitals Sussex NHS Foundation Trust, East Sussex, UK
| | - Philip Rankin
- Department of Geriatric Medicine, University Hospitals Sussex NHS Foundation Trust, East Sussex, UK
| | - Eva Bunting
- Department of Geriatric Medicine, University Hospitals Sussex NHS Foundation Trust, East Sussex, UK
| | - Khalid Ali
- Department of Geriatric Medicine, University Hospitals Sussex NHS Foundation Trust, East Sussex, UK
| | - Rajkumar Chakravarthi
- Department of Geriatric Medicine, University Hospitals Sussex NHS Foundation Trust, East Sussex, UK; Brighton and Sussex Medical School, University of Sussex, East Sussex, UK.
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Kumar AA, Yeo N, Whittaker M, Attra P, Barrick TR, Bridges LR, Dickson DW, Esiri MM, Farris CW, Graham D, Lin WL, Meijles DN, Pereira AC, Perry G, Rosene DL, Shtaya AB, Van Agtmael T, Zamboni G, Hainsworth AH. Vascular Collagen Type-IV in Hypertension and Cerebral Small Vessel Disease. Stroke 2022; 53:3696-3705. [PMID: 36205142 PMCID: PMC9698121 DOI: 10.1161/strokeaha.122.037761] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral small vessel disease (SVD) is common in older people and causes lacunar stroke and vascular cognitive impairment. Risk factors include old age, hypertension and variants in the genes COL4A1/COL4A2 encoding collagen alpha-1(IV) and alpha-2(IV), here termed collagen-IV, which are core components of the basement membrane. We tested the hypothesis that increased vascular collagen-IV associates with clinical hypertension and with SVD in older persons and with chronic hypertension in young and aged primates and genetically hypertensive rats. METHODS We quantified vascular collagen-IV immunolabeling in small arteries in a cohort of older persons with minimal Alzheimer pathology (N=52; 21F/31M, age 82.8±6.95 years). We also studied archive tissue from young (age range 6.2-8.3 years) and older (17.0-22.7 years) primates (M mulatta) and compared chronically hypertensive animals (18 months aortic stenosis) with normotensives. We also compared genetically hypertensive and normotensive rats (aged 10-12 months). RESULTS Collagen-IV immunolabeling in cerebral small arteries of older persons was negatively associated with radiological SVD severity (ρ: -0.427, P=0.005) but was not related to history of hypertension. General linear models confirmed the negative association of lower collagen-IV with radiological SVD (P<0.017), including age as a covariate and either clinical hypertension (P<0.030) or neuropathological SVD diagnosis (P<0.022) as fixed factors. Reduced vascular collagen-IV was accompanied by accumulation of fibrillar collagens (types I and III) as indicated by immunogold electron microscopy. In young and aged primates, brain collagen-IV was elevated in older normotensive relative to young normotensive animals (P=0.029) but was not associated with hypertension. Genetically hypertensive rats did not differ from normotensive rats in terms of arterial collagen-IV. CONCLUSIONS Our cross-species data provide novel insight into sporadic SVD pathogenesis, supporting insufficient (rather than excessive) arterial collagen-IV in SVD, accompanied by matrix remodeling with elevated fibrillar collagen deposition. They also indicate that hypertension, a major risk factor for SVD, does not act by causing accumulation of brain vascular collagen-IV.
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Affiliation(s)
- Apoorva A. Kumar
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
- Neurology (A.A.K., A.C.P., A.H.H.), St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Natalie Yeo
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
| | - Max Whittaker
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
| | - Priya Attra
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
| | - Thomas R. Barrick
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
| | - Leslie R. Bridges
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
- Cellular Pathology (L.R.B.), St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Dennis W. Dickson
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL (D.W.D., W.L.L.)
| | - Margaret M. Esiri
- Nuffield Department of Clinical Neurosciences, Oxford University, United Kingdom (M.M.E., G.Z.)
| | - Chad W. Farris
- Department of Anatomy and Neurobiology, Boston University School of Medicine, MA (C.W.F., D.L.R.)
| | - Delyth Graham
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.G., T.V.A.)
| | - Wen Lang Lin
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL (D.W.D., W.L.L.)
| | - Daniel N. Meijles
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
| | - Anthony C. Pereira
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
- Neurology (A.A.K., A.C.P., A.H.H.), St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gregory Perry
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
| | - Douglas L. Rosene
- Department of Anatomy and Neurobiology, Boston University School of Medicine, MA (C.W.F., D.L.R.)
| | - Anan B. Shtaya
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
| | - Tom Van Agtmael
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (D.G., T.V.A.)
| | - Giovanna Zamboni
- Nuffield Department of Clinical Neurosciences, Oxford University, United Kingdom (M.M.E., G.Z.)
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Italy (G.Z.)
| | - Atticus H. Hainsworth
- Molecular and Clinical Sciences Research Institute, St George’s University of London, United Kingdom (A.A.K., N.Y., M.W., P.A., T.R.B., L.R.B., D.N.M., A.C.P., G.P., A.B.S., A.H.H.)
- Neurology (A.A.K., A.C.P., A.H.H.), St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
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Choe YM, Baek H, Choi HJ, Byun MS, Yi D, Sohn BK, Sohn CH, Lee DY. Association Between Enlarged Perivascular Spaces and Cognition in a Memory Clinic Population. Neurology 2022; 99:e1414-e1421. [PMID: 35764403 PMCID: PMC9576287 DOI: 10.1212/wnl.0000000000200910] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/11/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although enlarged perivascular spaces (EPVS) have been suggested as an emerging measure of small vessel disease (SVD) in the brain, their association with cognitive impairment is not yet clearly understood. We aimed to examine the relationship between each EPVS in the basal ganglia (BG-EPVS) and centrum semiovale (CSO-EPVS) with cognition in a memory clinic population. METHODS Participants with a diverse cognitive spectrum were recruited from a university hospital memory clinic. They underwent comprehensive clinical and neuropsychological assessments and brain MRI. BG-EPVS and CSO-EPVS were measured on T2-weighted MRI and then dichotomized into low and high degrees for further analyses. Other SVD markers were assessed using validated rating scales. RESULTS A total of 910 participants were included in this study. A high degree of BG-EPVS was significantly associated with poorer scores on the executive function domain, but not with other cognitive domains, when age, sex, education, MRI scanner type, and cognitive diagnosis were controlled as covariates. However, the association between BG-EPVS and executive function was no longer significant after controlling for other markers of SVD, such as lacunar infarcts and periventricular white matter hyperintensities, as additional covariates. CSO-EPVS did not have a significant relationship with any cognitive scores, regardless of the covariates. DISCUSSION Our findings from a large memory clinic population suggest that EPVS, regardless of the topographical location, may not be used as a specific SVD marker for cognitive impairment, although an apparent association was observed between a high degree of BG-EPVS and executive dysfunction before controlling other SVD markers that share a common pathophysiologic process with BG-EPVS.
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Affiliation(s)
- Young Min Choe
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Hyewon Baek
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Hyo Jung Choi
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Min Soo Byun
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Dahyun Yi
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Bo Kyung Sohn
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Chul-Ho Sohn
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea
| | - Dong Young Lee
- From the Department of Neuropsychiatry (Y.M.C.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neuropsychiatry (H.B.), Gyeonggi Provincial Hospital for the Elderly, Yongin; Department of Neuropsychiatry (H.J.C., M.S.B., D.Y.L.), Seoul National University Hospital; Department of Psychiatry (M.S.B., D.Y.L.), Seoul National University College of Medicine; Institute of Human Behavioral Medicine (D.Y., D.Y.L.), Seoul National University Medical Research Center; Department of Psychiatry (B.K.S.), Inje University Sanggye Paik Hospital, Seoul; and Department of Radiology (C.H.S.), Seoul National University Hospital, South Korea.
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Zini A, Pensato U, Forlivesi S. Reader Response: Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. Neurology 2022; 99:219. [PMID: 35914948 DOI: 10.1212/wnl.0000000000200981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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12
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Alpert JN. Reader Response: Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. Neurology 2022; 99:218-219. [PMID: 35914947 DOI: 10.1212/wnl.0000000000200980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Liu Q, Liu X, Zhang X, Zhou C. Diagnostic Value of Hcy Combined with Blood Pressure Variability Index in the Severity of Hypertension Complicated with CSVD and Its Correlation with Cognitive Function and CysC Expression. J Healthc Eng 2022; 2022:9003537. [PMID: 35463682 PMCID: PMC9023186 DOI: 10.1155/2022/9003537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/13/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022]
Abstract
This paper explores the diagnostic value of Hcy combined with the blood pressure variability index in the severity of hypertension complicated with CSVD and its correlation with cognitive function and CysC expression. 200 patients with ischemic small cerebral vessels are selected as the research object. According to the MRI findings, they are divided into 48 cases of white matter lesions (WML), 44 cases of lacunar infarction (LI), 44 cases of enlarged perivascular spaces (EPVs), and 46 cases in the mixed group (referring to two or more types of ischemic cerebrovascular disease on imaging). Different cognitive domains of different types of ischemic cerebrovascular diseases are analyzed. The risk factors of cognitive decline in patients with ischemic cerebrovascular disease are analyzed by univariate analysis and multivariate logistic regression analysis. There is an ancestral correlation between serum Hcy and CSVD, which is an independent risk factor for CSVD.
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Affiliation(s)
- Qiaoling Liu
- Department of Geriatrics, The First People's Hospital of Lianyungang, Lianyungang, China
- Xuzhou Medical University Affiliated the Hospital of Lianyungang, The First Affiliated the Hospital of Kangda College of Nangjing Medical University, Jiangsu 222000, China
| | - Xia Liu
- Department of Geriatrics, The First People's Hospital of Lianyungang, Lianyungang, China
- Xuzhou Medical University Affiliated the Hospital of Lianyungang, The First Affiliated the Hospital of Kangda College of Nangjing Medical University, Jiangsu 222000, China
| | - Xuelian Zhang
- Department of Geriatrics, The First People's Hospital of Lianyungang, Lianyungang, China
- Xuzhou Medical University Affiliated the Hospital of Lianyungang, The First Affiliated the Hospital of Kangda College of Nangjing Medical University, Jiangsu 222000, China
| | - Chen Zhou
- Drug Clinical Experimental Center, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu 210029, China
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Vynckier J, Seiffge DJ, Fischer U. Author Response: Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. Neurology 2022; 98:297. [PMID: 35165157 DOI: 10.1212/wnl.0000000000013257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cao S, Xia M. Reader Response: Early Neurologic Deterioration in Lacunar Stroke: Clinical and Imaging Predictors and Association With Long-term Outcome. Neurology 2022; 98:296-297. [PMID: 35165156 DOI: 10.1212/wnl.0000000000013256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nakamori M, Matsushima H, Tachiyama K, Hayashi Y, Imamura E, Mizoue T, Wakabayashi S. Association of ankle-brachial index with cognitive decline in patients with lacunar infarction. PLoS One 2022; 17:e0263525. [PMID: 35120183 PMCID: PMC8815973 DOI: 10.1371/journal.pone.0263525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/20/2022] [Indexed: 01/04/2023] Open
Abstract
Atherosclerosis is an important risk factor for cognitive decline. This study aimed to investigate the relationship of ankle-brachial pressure index (ABI) and brachial-ankle pulse wave velocity (baPWV) with cognitive function in patients with lacunar infarction. We included records of consecutive patients with their first-ever acute stroke and a diagnosis of lacunar infarction through magnetic resonance imaging (MRI) from July 1, 2011 to December 31, 2018. We excluded patients diagnosed with dementia, including strategic single-infarct dementia, before or after stroke onset. Moreover, we excluded patients with one or more microbleeds, severe white matter lesions, or severe medial temporal atrophy on MRI. For ABI, we used the lower ankle side and divided the results into ABI < 1.0 and ABI ≥ 1.0. For baPWV, we used the higher ankle side and divided the results into two groups based on the median value of the participants. We analyzed 176 patients with stroke (age 72.5 ± 11.4 years, 67 females). The median score on the Mini-Mental State Examination (MMSE) was 27. The number of patients with ABI < 1.0 was 19 (10.8%). Univariate analysis revealed that the MMSE score was associated with age, body mass index, education, chronic kidney disease, periventricular hyperintensity, and ABI < 1.0 (p < 0.10), but not baPWV. Multivariate analysis revealed that body mass index (p = 0.039) and ABI < 1.0 (p = 0.015) were independently associated with the MMSE score. For patients with lacunar infarction, a lower ABI, but not a higher PWV, was associated with cognitive decline.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
- * E-mail:
| | - Hayato Matsushima
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Keisuke Tachiyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
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Lee HN, Subrayan V. I think I have double vision? Or not? Internuclear Ophthalmoplegia following right lacunar infarct. Med J Malaysia 2021; 76:950-952. [PMID: 34806694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Internuclear Ophthalmoplegia (INO) is an inability of the ipsilateral adduction with a contralateral horizontal abducting saccade on attempted gaze to the contra-lesion side. Injury to the medial longitudinal fasciculus (MLF) will obstruct the signalling pathway between the ipsilateral abducens nucleus and the contralateral medial rectus muscle. Infarction accounts for 38% of INO cases with mostly being unilateral (87%), followed by demyelination (34%), which mostly being bilateral (73%). Lacunar infarct is the most common ischemic stroke. INO can be easily missed due to its subtle presentation with no complaints from the patients. A full cranial nerves assessment, includes the extraocular muscles movement, is important. Ischemic and demyelinating INO typically recover. We present here of a case of INO following right lacunar infarct in a 72-year-old Malay woman. She had hypertensive crisis due to missed medications. Her blood pressure was well controlled throughout the hospital admission and finally she was discharged home with continuation of care at her primary facility.
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Affiliation(s)
- H N Lee
- Sultanah Fatimah Specialist Hopsital, Johor, Malaysia.
| | - V Subrayan
- University Malaya Medical Center, Kuala Lumpur, Malaysia
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Wang H, Fu X, Ju J, Meng D, Sun S, Guo C, Jia H, Sun Q. Acupuncture for patients recovering from lacunar infarction: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26413. [PMID: 34160428 PMCID: PMC8238297 DOI: 10.1097/md.0000000000026413] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lacunar infarction (LI) is the mild type in the classification of ischemic stroke, mostly occurs in the middle-aged and elderly, with mild hemiplegia and partial sensory disorder as the main manifestations. In the treatment of LI, acupuncture is often regarded as dominant therapy in the convalescence period. However, acupuncture for treatment of LI in the recovery period lacks high-quality reports and evidence-based medical evidence. Thus, we aim to evaluate the curative effect and safety of acupuncture for LI objectively. METHODS Pubmed, Cochrane Library, Web of Science, EBSCO, Springer, China National Knowledge Infrastructure, Chinese Scientific and Technical Journals Database (VIP), Wan-fang Database, Chinese Biomedical Literature Database, Chinese Science Citation Database, and other electronic databases will be retrieved from the inception to May, 2021. Randomized controlled trials related to this subject will be searched. The inclusion criteria are established and a detailed literature search strategy is designed through discussion. Article retrieval, screening, excluding repetitive studies, assessment of quality, and data processing will be conducted by 2 reviewers independently using EndNote (X9) and Review Manager (5.3.5). The outcome measures include primary outcome measures (total effective rate, National Institute of Health Stroke Scale score, and Fugl-Meyer Assessment score), secondary outcome measures (blood pressure, plasma glucose, and blood lipid), and safety outcome measures. We will perform a meta-analysis, descriptive analysis, and subgroup analysis based on data conditions. RESULTS The study of total effective rate, National Institute of Health Stroke Scale score, Fugl-Meyer Assessment score, blood pressure, plasma glucose, blood lipid, and adverse effects will provide evidenced outcome for high-quality synthesis and descriptive analysis. CONCLUSION This systematic review will kindly provide evidence of whether acupuncture is an effective and safe intervention for LI in the recovery period. INPLASY REGISTRATION NUMBER INPLASY202150060 (DOI:10.37766/inplasy2021.5.0060).
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Affiliation(s)
- Haoran Wang
- Department of Rehabilitation Medicine, The Second Hospital of Shandong University
| | - Xiaoyan Fu
- Department of Endocrinology, Jinan Huaiyin People's Hospital
| | - Jing Ju
- Shandong University of Traditional Chinese Medicine
| | - Dan Meng
- Shandong University of Traditional Chinese Medicine
| | - Shengming Sun
- Department of Traditional Chinese Medicine, Shandong Provincial Public Health Clinical Center
| | - Chenchen Guo
- Neck-Shoulder and Lumbocrural Pain Hospital Affiliated to Shandong First Medical University
| | - Hongling Jia
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qiangsan Sun
- Department of Rehabilitation Medicine, The Second Hospital of Shandong University
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Cukierman-Yaffe T, McClure LA, Risoli T, Bosch J, Sharma M, Gerstein HC, Benavente O. The Relationship Between Glucose Control and Cognitive Function in People With Diabetes After a Lacunar Stroke. J Clin Endocrinol Metab 2021; 106:e1521-e1528. [PMID: 33481011 PMCID: PMC7993572 DOI: 10.1210/clinem/dgab022] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Lacunar strokes and diabetes are risk factors for cognitive dysfunction. Elucidating modifiable risk factors for cognitive dysfunction has great public health implications. One factor may be glycemic status, as measured by glycated hemoglobin (A1c). OBJECTIVE The aim of this study was to assess the relationship between A1c and cognitive function in lacunar stroke patients with diabetes. METHODS The effect of baseline and follow-up A1c on the baseline and the change in Cognitive Assessment Screening Instrument (CASI) score over time among participants with a median of 2 cognitive assessments (range, 1-5) was examined in 942 individuals with diabetes and a lacunar stroke who participated in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (ClinicalTrials.gov No. NCT00059306). RESULTS Every 1% higher baseline A1c was associated with a 0.06 lower standardized CASI z score (95% CI, -0.101 to -0.018). Higher baseline A1c values were associated with lower CASI z scores over time (P for interaction = .037). A 1% increase in A1c over time corresponded with a CASI score decrease of 0.021 (95% CI, -0.0043 to -0.038) during follow-up. All these remained statistically significant after adjustment for age, sex, education, race, depression, hypertension, hyperlipidemia, body mass index, cardiovascular disease, obstructive sleep apnea, diabetic retinopathy, nephropathy insulin use, and white-matter abnormalities. CONCLUSION This analysis of lacunar stroke patients with diabetes demonstrates a relationship between A1c and change in cognitive scores over time. Intervention studies are needed to delineate whether better glucose control could slow the rate of cognitive decline in this high-risk population.
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Affiliation(s)
- Tali Cukierman-Yaffe
- Endocrinology Institute, Gertner Institute Sheba Medical Center, Tel-Aviv, Israel
- Epidemiology Department, Sackler School of Medicine, Herczeg Institute on Aging, Tel-Aviv University, Tel-Aviv, Israel
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
- Correspondence: Tali Cukierman-Yaffe, MD, MSC, Endocrinology Institute, Gertner Institute Sheba Medical Center, 6 Tritsh St, Tel-Aviv, 6986006 Israel.
| | - Leslie A McClure
- Department of Epidemiology & Biostatistics Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Thomas Risoli
- Duke CTSI Biostatistics, Epidemiology and Research Design (BERD) Methods Core Duke University School of Medicine, Durham, North Carolina, USA
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mike Sharma
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Oscar Benavente
- Department of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
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Kwan A, Wei J, Dowling NM, Power MC, Nadareishvili Z. Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death. Cerebrovasc Dis 2021; 50:383-389. [PMID: 33752211 PMCID: PMC8266725 DOI: 10.1159/000514261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/30/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. METHODS We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14-180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death. RESULTS The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04-2.09) and death (hazard ratio, 1.87; 95% CI: 1.25-2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06-2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14-2.67) were associated with an increased risk of death. DISCUSSION/CONCLUSION After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.
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Affiliation(s)
- Abraham Kwan
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jingkai Wei
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - N Maritza Dowling
- Department of Acute and Chronic Care, School of Nursing, George Washington University, Washington, District of Columbia, USA
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Zurab Nadareishvili
- Department of Neurology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA,
- Stroke Center, Virginia Hospital Center, Arlington, Virginia, USA,
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Dunphy L, Rani A, Duodu Y, Behnam Y. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) presenting with stroke in a young man. BMJ Case Rep 2019; 12:e229609. [PMID: 31324668 PMCID: PMC6663233 DOI: 10.1136/bcr-2019-229609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Accepted: 06/08/2019] [Indexed: 11/04/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is caused by mutations in the NOTCH3 gene which maps to the short arm of chromosome 19 and encodes the NOTCH3 receptor protein, predominantly expressed in adults by vascular smooth muscle cells and pericytes. The receptor has a large extracellular domain with 34 epidermal growth factor-like repeats encoded by exons 2-24, the site at which CADASIL mutations are most commonly found. Migraine with aura is often the earliest feature of the disease, with an increased susceptibility to cortical spreading depression suggested as a possible aetiological mechanism. Stroke, acute encephalopathy and cognitive impairment can also occur. Hypertension and smoking are associated with early age of onset of stroke. It diffusely affects white matter, with distinct findings on T2- weighted MRI, involving the external capsule, anterior poles of the temporal lobe and superior frontal gyri, displaying a characteristic pattern of leucoencephalopathy. Affected individuals have a reduced life expectancy. An effective treatment for CADASIL is not available. The authors describe a 35-year-old manwith an unremarkable medical history, presenting to the emergency department with slurred speech and increased confusion 3 days following a fall. He was a smoker and consumed 16 units of alcohol weekly. He was hypertensive and tachycardic. Physical examination confirmed increased tone in his lower limbs and dysarthria. His CT head showed severe cerebral atrophy, multiple small old infarcts and moderate background microvascular disease. Further investigation with an MRI head confirmed multiple white matter abnormalities with microhaemorrhages. The possibility of a hereditary vasculopathy was rendered as the appearances were thought consistent with a diagnosis of CADASIL. Genetic testing identified the NOTCH3 gene thus confirming the diagnosis. This paper provides an overview of the aetiology, clinical presentation, pathogenesis, investigations and management of CADASIL.
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Affiliation(s)
- Louise Dunphy
- Surgery, Milton Keynes University Hospital, Milton Keynes, UK
| | - Amir Rani
- Stroke Medicine, Milton Keynes University Hospital, Milton Keynes, UK
| | - Yaw Duodu
- Stroke Medicine, Milton Keynes University Hospital, Milton Keynes, UK
| | - Yousef Behnam
- Stroke Medicine, Milton Keynes University Hospital, Milton Keynes, UK
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Gao Z, Zhai Y, Zhao X, Wang W, Wu W, Wang Z, Liu R, Wang X. Deep cerebral microbleeds are associated with the severity of lacunar infarcts and hypertension: A retrospective analysis. Medicine (Baltimore) 2018; 97:e11031. [PMID: 29879070 PMCID: PMC5999518 DOI: 10.1097/md.0000000000011031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cerebral microbleeds (CMBs) and lacunar infarcts are common manifestations of cerebral small vessel disease. However, the association between the location of CMBs and lacunar infarcts is unclear. Our study aimed to clarify the relationship between the location of CMBs and lacunar infarcts.This study retrospectively analyzed 166 patients with ischemic stroke or transient ischemic attacks admitted in the Geriatric Neurology Department of Chinese PLA General Hospital between February 2010 and December 2012. We collected clinical characteristics and risk factors of CMBs. The location of CMBs on T2*-weighted angiography was assessed by the Microbleed Anatomical Rating Scale. The number of lacunar infarcts and the severity of white matter hyperintensities were also recorded. The association between the location of CMBs and lacunar infarcts parameters was examined.CMBs were present in 77 (46.4%) patients. The presence [odds ratios (OR), 2.14; 95% confidence interval (CI), 1.02-4.48], number (OR, 1.17; 95% CI, 1.02-1.36 per lesion), severity (OR, 1.61; 95% CI, 1.07-2.42) of lacunar infarcts, and hypertension (OR, 5.76; 95% CI, 2.01-16.55) were independent risk factors for CMBs. Stratified by the location of CMBs, lobar CMBs and infratentorial CMBs did not show significant association with lacunar infarcts. Deep CMBs were significantly associated with the number (OR 1.18, 95% CI 1.03-1.36) and severity (OR 1.71, 95% CI 1.11-2.63) of lacunar infarcts. Moreover, the percentage of deep CMBs increased with the increased severity of lacunar infarcts (P = .003).Deep CMBs rather than lobar and infratentorial CMBs are associated with lacunar infarcts.
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Affiliation(s)
- Zhongbao Gao
- Department of Healthcare, Nanlou Division
- Department of Geriatric Neurology, Nanlou Division
| | | | - Xingli Zhao
- Department of Geriatric Neurology, Nanlou Division
| | - Wei Wang
- Department of Geriatric Neurology, Nanlou Division
| | - Weiping Wu
- Department of Geriatric Neurology, Nanlou Division
| | - Zhenfu Wang
- Department of Geriatric Neurology, Nanlou Division
| | - Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Liu J, Rutten-Jacobs L, Liu M, Markus HS, Traylor M. Causal Impact of Type 2 Diabetes Mellitus on Cerebral Small Vessel Disease: A Mendelian Randomization Analysis. Stroke 2018; 49:1325-1331. [PMID: 29686024 PMCID: PMC5976219 DOI: 10.1161/strokeaha.117.020536] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The relationship between type 2 diabetes mellitus (T2D) and cerebral small vessel disease (CSVD) is unclear. We aimed to examine the causal effect of T2D, fasting glucose levels, and higher insulin resistance on CSVD using Mendelian randomization. METHODS Five CSVD phenotypes were studied; 2 were clinical outcomes associated with CSVD (lacunar stroke: n=2191/27 297 and intracerebral hemorrhage [ICH]: n=2254/8195 [deep and lobar ICH]), whereas 3 were radiological markers of CSVD (white matter hyperintensities: n=8429; fractional anisotropy [FA]: n=8357; and mean diffusivity: n=8357). We applied 2 complementary analyses to evaluate the association of T2D with CSVD. First, we used summarized data from genome-wide association study to calculate the effects of T2D-related variants on CSVD with inverse-variance weighted and weighted median approaches. Second, we performed a genetic risk score approach to test the effects of T2D-associated variants on white matter hyperintensities, FA, and mean diffusivity using individual-level data in UK Biobank. RESULTS T2D was associated with higher risk of lacunar stroke (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.04-1.28; P=0.007) and lower mean FA (OR, 0.78; 95% CI, 0.66-0.92; P=0.004) but not white matter hyperintensities volume (OR, 1.01; 95% CI, 0.97-1.04; P=0.626), higher mean diffusivity (OR, 1.04; 95% CI, 0.89-1.23; P=0.612), ICH (OR, 1.07; 95% CI, 0.95-1.20; P=0.269), lobar ICH (OR, 1.07; 95% CI, 0.89-1.28; P=0.466), or deep ICH (OR, 1.16; 95% CI, 0.99-1.36; P=0.074). Weighted median and penalized median weighted analysis showed similar effect estimates of T2D on lacunar stroke and FA, but with wider CIs, meaning they were not significant. The genetic score on individual-level data was significantly associated with FA (OR, 0.63; 95% CI, 0.45-0.89; P=0.008) after adjusting for potential confounders. CONCLUSIONS Our Mendelian randomization study provides evidence to suggest that T2D may be causally associated with CSVD, in particular with lacunar stroke and FA.
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Affiliation(s)
- Junfeng Liu
- From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China (J.L., M.L.)
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
| | - Loes Rutten-Jacobs
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
- Population Health Sciences, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (L.R.-J.)
| | - Ming Liu
- From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, P. R. China (J.L., M.L.)
| | - Hugh S Markus
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
| | - Matthew Traylor
- Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom (J.L., L.R.-J., H.S.M., M.T.)
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Garcia-Estevez DA, Lopez-Diaz LM, Pardo-Parrado M, Cid-Rodriguez MC, Ozaita-Arteche G. [Isolated dysarthria and dysphagia as the presenting symptoms of simultaneous bilateral acute lagunar ischaemic stroke]. Rev Neurol 2018; 66:33. [PMID: 29251341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Fan H, Yang S, Li Y, Yin J, Qin W, Yang L, Yuan J, Hu W. Assessment of Homocysteine as a Diagnostic and Early Prognostic Biomarker for Patients with Acute Lacunar Infarction. Eur Neurol 2017; 79:54-62. [PMID: 29208848 DOI: 10.1159/000484893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/01/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although increasing evidence has demonstrated that elevated homocysteine (Hcy) levels may be an important contributor for the development of cerebral infarction, rare studies focused on its diagnostic and early prognostic roles in acute lacunar infarction. METHODS A total of 197 patients with acute lacunar infarction and 192 to form the control group were prospectively recruited between January 2013 and February 2017. Early neurological deterioration was defined as an increase of ≥2 points in National Institutes of Health Stroke Scale or the decrease in Barthel index (BI) score at discharge. RESULTS Univariate and multivariate logistic regression analyses revealed that higher levels of fibrinogen and Hcy were independently clinical predictors associated with lacunar infarction. Receiver operating characteristic curves analysis demonstrated that the diagnosis value of Hcy was superior to fibrinogen, with the area under the curve of 0.881 and 0.688 respectively. Using the optimal cutoff value of 15.5 μmol/L of Hcy, a sensitivity of 65% and a specificity of 100% were achieved for predicting lacunar infarction. Hcy was only significantly related with BI reduction in the males (30.5 [15.5-65.5] vs. 18 [15-24], p = 0.034) in the univariate analysis but not in the females and the multivariate analysis. CONCLUSIONS Serum Hcy may be an independent diagnostic and not an early prognostic biomarker for patients with acute lacunar infarction.
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Abstract
Ataxic hemiparesis (AH) is a classic lacunar syndrome associated with localized damage to the pons, internal capsule, thalamus, or corona radiata. A depression of metabolic activity known as crossed cerebellar diaschisis (CCD) is frequently observed in the cerebellar hemisphere contralateral to the site of the lesion in patients with AH. Though small cortical or subcortical lesions may result in AH, such occurrences are rare. The current report details the case of a patient with AH resulting from acute infarction associated with localized lesions of the postcentral gyrus who presented without CCD.
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Affiliation(s)
- Yoshino Kinjo
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yuki Sakamoto
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Seiji Okubo
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan
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Shao L, Wang M, Ge XH, Huang HD, Gao L, Qin JC. The use of susceptibility-weighted imaging to detect cerebral microbleeds after lacunar infarction. Eur Rev Med Pharmacol Sci 2017; 21:3105-3112. [PMID: 28742195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the value of susceptibility-weighted imaging (SWI) technology to detect cerebral microbleeds (CMBs) in senile cerebral lacunar infarction patients; and to evaluate the complicated cerebral hemorrhage risk after patients with CMBs took aspirin, an antiplatelet medication or received anticoagulant therapy. PATIENTS AND METHODS MRI scanning, using GRE-T2*WI, SWI and FSE sequences (T1WI, T2WI, and T2FLAIR), was performed on the three groups: (1) a cerebral lacunar infarction group; (2) cerebral lacunar infarction with cerebral microbleeds (CMBs) group; and (3) a healthy elderly group. A total of 60 cases were in each group (180 total patients). In addition, the lacunar infarction group and lacunar infarction with CMBs groups were both treated with formal antiplatelet or anticoagulant therapy, according to medical guidelines. Patients were followed for 12 months, during which time their cerebral hemorrhages and post-event effects were observed. The relativity of CMBs, antiplatelet therapy, anticoagulant therapy and cerebral hemorrhage transformation was analyzed and defined. The two groups of research patients with lacunar infarctions were scanned with relevant sequences. RESULTS The SWI scanning sequence showed the highest positive rate of CMBs, followed by GRE-T2*WI and other conventional scanning sequences. T1WI, T2WI and T2FLAIR showed a relatively lower positive rate of CMBs. In the cerebral lacunar infarction group and healthy elderly group, 34 cases in the SWI sequence showed 84 positive sites; 18 cases in the GRE-T2*WI sequence showed 40 positive sites; 2 cases in the T1WI sequence showed 4 positive sites; and 6 cases in the T2WI sequence showed 11 positive sites. After a chi-squared test, the differences between the sequences were statistically significant (p < 0.05). In the lacunar infarction group, 26 cases (43.33%) exhibited microbleeding lesions, while the normal control group represented 8 cases (13.33%). The lacunar infarction group exhibited mild, moderate and severe cases, the three types of CMBs. The normal control group only showed mild hemorrhaging. The degree of lacunar infarction was significantly related to the severity of CMBs (p < 0.05). After patients with CMBs had received formal antiplatelet therapy and anticoagulation therapy, one case in the lacunar infarction with microbleeds group showed cerebral hemorrhaging, but this had no statistical significance (p > 0.05). CONCLUSIONS The SWI scanning sequence is more sensitive than the GRE-T2*WI sequence. The GRE-T2*WI sequence is more sensitive than the conventional FSE sequence. SWI is highly sensitive and specific to the diagnosis of CMBs. It is an accurate and effective method for the analysis and diagnosis of CMBs. If patients with CMBs caused by lacunar infarction are treated with antiplatelet and anticoagulant therapy, the risk of cerebral hemorrhagic transformation is relatively smaller within 12 months. However, this needs to be observed further to define possible long-term risks.
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Affiliation(s)
- L Shao
- Internal Medicine-Neurology, Xuzhou First Hospital, Xuzhou, Jiangsu, China.
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Gökcen E, Caltekin İ, Savrun A, Korkmaz H, Savrun ŞT, Yıldırım G. Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. Am J Emerg Med 2017; 35:1607-1611. [PMID: 28473274 DOI: 10.1016/j.ajem.2017.04.073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/19/2016] [Revised: 03/25/2017] [Accepted: 04/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed. METHODS The study included the patients over the age of 18 applying to the emergency department of Malatya State Hospital with the symptoms of stroke between the dates of 1/1/2015 and 1/9/2016. The patients diagnosed with stroke by means of clinical and neuroradiological imaging were examined in 4 subgroups according to Oxfordshire Community Stroke Project. The aim of the study is to predict the intracranial pressure (ICP) levels of the patients through ONSD measurement and CT images. RESULTS In the comparison of the right and left optic nerve sheath diameters of CVD group and control group, the obtained results were found to be statistically significant (p<0.001). When the CVD subgroups were compared with the control group in terms of right and left optic nerve sheath diameters, the highest right-left optic nerve sheath diameter was detected to be in TACI (Total Anterior Circulation Infarction) group (p<0.001). DISCUSSION/CONCLUSION In the early cases of CVD, mortality and morbidity can be decreased through the early diagnosis of the possible existence of ICP increase according to ONSD level.
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Affiliation(s)
- Emre Gökcen
- Emergency Department of Malatya State Hospital, Malatya, Turkey.
| | | | - Atakan Savrun
- Emergency Department of Dr. Nafiz Körez Sincan State Hospital, Sincan, Ankara, Turkey
| | - Hilal Korkmaz
- Physiology Department of Hacettepe University, Ankara, Turkey
| | - Şeyda Tuba Savrun
- Emergency Department of Ankara Atatürk Research and Training Hospital, Ankara, Turkey
| | - Gökhan Yıldırım
- Radiology Department of Malatya State Hospital, Malatya, Turkey
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Yang H, Bai L, Zhou Y, Kang S, Liang P, Wang L, Zhu Y. Increased inter-hemispheric resting-state functional connectivity in acute lacunar stroke patients with aphasia. Exp Brain Res 2016; 235:941-948. [PMID: 27942764 DOI: 10.1007/s00221-016-4851-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 05/23/2016] [Accepted: 11/30/2016] [Indexed: 12/18/2022]
Abstract
Aphasia is a devastating neurological condition affecting a person's ability to communicate and reintegrate into the society. It may occur in 20% or more of patients after stroke. The recovery of language function is accompanied by brain reorganization, and identifying the inter-hemispheric interaction post-stroke will conduce to more targeted treatments. Previous studies suggested that robust homotopic resting-state functional connectivity is a key characteristic of the brain's intrinsic functional architecture, and communication between the left and right cerebral hemispheres is important for language processing. In this study, voxel-mirrored homotopic connectivity (VMHC) was used to examine the inter-hemispheric resting-state functional connectivity (RSFC) differences between 37 patients with acute lacunar stroke in the left hemisphere and 28 healthy controls. Besides, correlation analyses were carried out to investigate the relationship between VMHC values of brain regions showing abnormal inter-hemispheric RSFC and clinical variables [i.e., aphasia quotient (AQ) scores, National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination of patients]. Compared with healthy controls, patients showed significantly increased VMHC in the pars orbitalis of the inferior frontal gyrus, anterior part of the superior temporal gyrus (STG) and lingual gyrus. No brain region showed decreased VMHC in the patient group than in the healthy control group. The AQ scores were negatively correlated with VMHC values in the STG. NIHSS scores were positively correlated with VMHC values in the lingual gyrus. We hope these results could shed new insights into the pathology of aphasia in patients with acute lacunar stroke.
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Affiliation(s)
- Haiqing Yang
- Department of Radiology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Lin Bai
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Yi Zhou
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Shan Kang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Panpan Liang
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China
| | - Lihua Wang
- Department of Blood Purification, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China.
| | - Yifei Zhu
- Department of Neurology, The Second Hospital of Hebei Medical University, No. 215 Heping West Road, Xinhua District, Shijiazhuang, 050000, People's Republic of China.
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Yang S, Cai J, Lu R, Wu J, Zhang M, Zhou X. Association Between Serum Cystatin C Level and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Acute Lacunar Stroke. J Stroke Cerebrovasc Dis 2016; 26:186-191. [PMID: 27727072 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.007] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/24/2016] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is associated with cerebral small vessel disease (cSVD). However, the relationship between serum cystatin C (CysC) level, a highly sensitive marker of impaired kidney function, and cSVD has not been fully understood. This study aimed to investigate the association between serum CysC level and total burden of cSVD on magnetic resonance imaging (MRI) in patients with acute lacunar stroke. MATERIALS AND METHODS A total of 210 patients with first-ever acute lacunar stroke occurring within 1 week after onset were included in this study. Serum CysC level, decreased estimated glomerular filtration rate (eGFR), and proteinuria were used to evaluate kidney function. The combined effect of the markers of cSVD on MRI, including lacunar, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces, were used to evaluate the comprehensive cSVD burden. RESULTS There is a positive association between total cSVD burden and hypertension, low eGFR level, and serum CysC level. After adjustments for potential confounders by ordinal logistic regression, elevated levels of CysC as well as impaired eGFR and the presence of proteinuria were correlated with the burden of total cSVD (odds ratio [OR] 2.633, 95% confidence interval [CI] 1.284-5.403; OR 2.442, 95% CI 1.213-4.918; and OR 2.151, 95% CI 1.162-3.983, respectively). CONCLUSIONS The elevated level of serum CysC is associated with the total burden of cSVD in patients with acute lacunar stroke independent of conventional risk factors.
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Affiliation(s)
- Song Yang
- Department of Neurology, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Jing Cai
- Department of Neuroscience, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Rulan Lu
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China
| | - Jian Wu
- Department of Neurology, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Min Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China
| | - Xianju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China.
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Pavlovic AM, Pekmezovic T, Zidverc Trajkovic J, Svabic Medjedovic T, Veselinovic N, Radojicic A, Mijajlovic M, Tomic G, Jovanovic Z, Norton M, Sternic N. Baseline characteristic of patients presenting with lacunar stroke and cerebral small vessel disease may predict future development of depression. Int J Geriatr Psychiatry 2016; 31:58-65. [PMID: 25821003 DOI: 10.1002/gps.4289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/19/2015] [Accepted: 03/04/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment. METHODS A total of 294 patients with SVD were evaluated 3-5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores. RESULTS On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9 years; p = 0.007), had higher mRS score (2.8 ± 0.7 vs 1.5 ± 0.7; p < 0.0001) and had more severe lesions on MRI scales (p < 0.0001 for all parameters). On follow-up, depressed patients more frequently exhibited cognitive decline (75.2% depressed vs 56.5% non-depressed; p = 0.003). No difference was detected in risk factor frequency between groups. Multivariate Cox regression analysis adjusted by age and gender revealed independent predictors of depression: baseline mRS >2 (HR 2.17, 95%CI 1.74-2.72; p < 0.0001) and tARWMC (HR 1.05, 95%CI 1.02-1.09; p = 0.005), and cognitive decline on follow-up (HR 1.80, 95%CI 1.12-2.89; p = 0.015). CONCLUSIONS Baseline functional status and severity of WMH and development of cognitive decline predict the occurence of late-onset depression in patients with SVD.
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Affiliation(s)
- Aleksandra M Pavlovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jasna Zidverc Trajkovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Tamara Svabic Medjedovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikola Veselinovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Radojicic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milija Mijajlovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Gordana Tomic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Zagorka Jovanovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Melanie Norton
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Sternic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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Zhu S, McClure LA, Lau H, Romero JR, White CL, Babikian V, Nguyen T, Benavente OR, Kase CS, Pikula A. Recurrent vascular events in lacunar stroke patients with metabolic syndrome and/or diabetes. Neurology 2015; 85:935-41. [PMID: 26296518 DOI: 10.1212/wnl.0000000000001933] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES We used a prospective clinical trial to examine the risks conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent strokes in the Secondary Prevention of Small Subcortical Strokes (SPS3) study cohort. METHODS The SPS3 trial enrolled 3,020 patients with lacunar strokes. Participants were stratified into groups of METS only, DM only, both, or neither using American Heart Association/National Heart, Lung, and Blood Institute and World Health Organization guidelines. Annualized event rates of strokes, myocardial infarction (MI), and all-cause mortality were calculated, and hazard ratios (HRs) referencing the “neither” group were computed, controlling for significantly associated baseline characteristics. RESULTS Among 2,999 participants, 25% had METS only, 6% had DM only, 32% had both conditions, and 37%had neither. Over a median of 3.8 years of follow-up, there were 274 recurrent strokes (240 ischemic, 34 hemorrhagic) and 74 MIs; among the 240 ischemic strokes, 134 (56%) were lacunar. The rates of any recurrent stroke (HR 1.7, 95% confidence interval [CI] 1.3–2.3) or lacunar stroke (HR 2.4, 95% CI 1.5–3.7) were significantly higher for those with concurrent METS and DM compared with those who had neither. Risk of incident MI was higher in participants with DM (HR 2.8, 95% CI 1.1–7.0) or concurrent DM and METS (HR 2.6, 95% CI 1.4–4.9). CONCLUSION METS and DM were significant comorbid conditions in lacunar stroke patients and they were associated with stroke recurrence. In patients with lacunar infarcts, a vigilant approach to prevent development of DM in those with METS may be a potential strategy to reduce recurrent strokes.
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Fernandez-Moreno MC, Castilla-Guerra L, Lopez-Chozas JM, Jimenez-Hernandez MD. [Tight control of blood pressure after ischemic stroke is associated with nocturnal hypotension episodes]. Rev Neurol 2015; 61:249-254. [PMID: 26350775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To evaluate whether a tighter blood pressure (BP) control in patients with recent ischemic stroke is associated with the presence of nocturnal hypotension (NHP) episodes. PATIENTS AND METHODS We included one hundred consecutive patients who had been discharged for ischemic stroke in the previous six months. To evaluate adequacy of BP control in these patients office BP and 24-h ambulatory BP monitoring values were used. RESULTS We studied 63 males and 37 females; mean age was 69 ± 11 years. Sixty-eight lacunar and 32 non-lacunar strokes were included. Episodes of NHP were observed in 59 patients. Clinical hypertension was present in 34 patients. An abnormal pattern of circadian rhythm of BP was present in 72 subjects. Only 18 patients had BP within normal limits. Episodes of NHP were more frequent in subjects with good BP control versus patients with bad BP control: 88.8% and 52.4 % respectively (p = 0.007). The presence of NHP episodes was also inversely related to number of BP parameters altered (p = 0.001). CONCLUSIONS Tight control of BP after ischemic stroke is associated with a high frequency of NHP episodes. It is likely that aggressively lowering BP levels within the normal range after an ischemic stroke may be not beneficial, particularly in elderly patients.
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Kilarski LL, Rutten-Jacobs LCA, Bevan S, Baker R, Hassan A, Hughes DA, Markus HS. Prevalence of CADASIL and Fabry Disease in a Cohort of MRI Defined Younger Onset Lacunar Stroke. PLoS One 2015; 10:e0136352. [PMID: 26305465 PMCID: PMC4549151 DOI: 10.1371/journal.pone.0136352] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/01/2015] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), caused by mutations in the NOTCH3 gene, is the most common monogenic disorder causing lacunar stroke and cerebral small vessel disease (SVD). Fabry disease (FD) due to mutations in the GLA gene has been suggested as an underdiagnosed cause of stroke, and one feature is SVD. Previous studies reported varying prevalence of CADASIL and FD in stroke, likely due to varying subtypes studied; no studies have looked at a large cohort of younger onset SVD. We determined the prevalence in a well-defined, MRI-verified cohort of apparently sporadic patients with lacunar infarct. Methods Caucasian patients with lacunar infarction, aged ≤70 years (mean age 56.7 (SD8.6)), were recruited from 72 specialist stroke centres throughout the UK as part of the Young Lacunar Stroke DNA Resource. Patients with a previously confirmed monogenic cause of stroke were excluded. All MRI’s and clinical histories were reviewed centrally. Screening was performed for NOTCH3 and GLA mutations. Results Of 994 subjects five had pathogenic NOTCH3 mutations (R169C, R207C, R587C, C1222G and C323S) all resulting in loss or gain of a cysteine in the NOTCH3 protein. All five patients had confluent leukoaraiosis (Fazekas grade ≥2). CADASIL prevalence overall was 0.5% (95% CI 0.2%-1.1%) and among cases with confluent leukoaraiosis 1.5% (95% CI 0.6%-3.3%). No classic pathogenic FD mutations were found; one patient had a missense mutation (R118C), associated with late-onset FD. Conclusion CADASIL cases are rare and only detected in SVD patients with confluent leukoaraiosis. No definite FD cases were detected.
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Affiliation(s)
- Laura L. Kilarski
- Stroke and Dementia Research Centre, St George’s University of London, London, United Kingdom
| | - Loes C. A. Rutten-Jacobs
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Steve Bevan
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Rob Baker
- Department of Haematology, Lysosomal Storage Disorders Unit, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - Ahamad Hassan
- Department of neurology, Leeds General Infirmary, Leeds, United Kingdom
| | - Derralynn A. Hughes
- Department of Haematology, Lysosomal Storage Disorders Unit, Royal Free Hospital and University College Medical School, London, United Kingdom
| | - Hugh S. Markus
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Hsiao CT, Chen YC, Liu YT, Soong BW, Lee YC. Acute simultaneous multiple lacunar infarcts as the initial presentation of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. J Chin Med Assoc 2015; 78:424-6. [PMID: 25959358 DOI: 10.1016/j.jcma.2015.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an adult-onset, dominantly inherited small-vessel disease of the brain caused by NOTCH3 mutations and characterized by recurrent subcortical infarctions, dementia, migraine with aura, and mood disturbance. We report a patient with unusual presentation of CADASIL with acute simultaneous multiple subcortical lacunar infarcts as the first manifestation. A 69-year-old man developed confusion, drowsiness, right hemiparesis, and slurred speech following orthopedic surgeries. Brain magnetic resonance imaging revealed diffuse leukoencephalopathy and multiple acute subcortical lacunar infarcts. Brain magnetic resonance angiography, echocardiography and 24-hour electrocardiography were unremarkable. The symptoms improved quickly after treatment with fluid hydration and antiplatelet agent, and his consciousness and mentality totally recovered within 3 days. The NOTCH3 genetic testing showed a heterozygous missense mutation, c.1630C>T (p. Arg544Cys). The experience in this case suggests that brain imaging is important in managing postoperative confusion, and any patient with diffuse leukoencephalopathy of unknown etiology may need to be tested for NOTCH3 mutations. Surgery is an important factor of encephalopathy and acute infarction in individuals with NOTCH3 mutations. Comprehensive presurgical evaluations and proactive perioperative precautions to avoid dehydration and anemia are necessary for patients with CADASIL who are about to receive anesthesia and surgery.
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Affiliation(s)
- Cheng-Tsung Hsiao
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Chung Chen
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yo-Tsen Liu
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Bing-Wen Soong
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Chung Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Brain Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
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Xia ZY, Sun QJ, Yang H, Zhang MX, Ban R, Xu GL, Wu YP, Wang LX, Du YF. Effect of Carotid Artery Stenting on Cognitive Function in Patients with Internal Carotid Artery Stenosis and Cerebral Lacunar Infarction: A 3-Year Follow-Up Study in China. PLoS One 2015; 10:e0129917. [PMID: 26067432 PMCID: PMC4466228 DOI: 10.1371/journal.pone.0129917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/14/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Carotid artery stenting (CAS) is an important therapeutic strategy for patients with carotid artery stenosis. However, the potential influence of CAS on cognitive function in patients with carotid artery stenosis and cerebral lacunar infarction has not been determined. This study investigated changes in cognitive function associated with CAS and the factors related to these changes. METHODS This prospective cohort study comprised 579 Chinese patients with cerebral lacunar infarction and carotid artery stenosis for whom CAS was indicated, and a matched control group of 552 healthy individuals. Cognitive function before CAS and at scheduled intervals from 6 months to 3 years was assessed with instruments that included the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scale. Potential factors that might affect cognitive function were analyzed via logistic regression. RESULTS The MMSE and MoCA scores of the patients before CAS were significantly lower than that of the control subjects. These scores were significantly higher 6 months after CAS and sustained or increased throughout the 3-year follow-up. Also significantly improved after CAS from baseline were scores for an alternating trail test, cube copying, clock-drawing, attention, and delayed recall in an auditory-verbal learning test. Logistic regression analyses showed that age greater than 65 y, little education, diabetes, and hypertension were independent risk factors for deteriorated MoCA scores 3 years after CAS. CONCLUSION CAS was associated with significantly improved cognitive function in cerebral lacunar infarction patients with severe stenosis.
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Affiliation(s)
- Zhang Yong Xia
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, PR China
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Qin Jian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, PR China
| | - Hua Yang
- Department of Neurology, the Third People’s Hospital of Liaocheng, Liaocheng, Shandong, 252000, PR China
| | - Ming Xia Zhang
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Ru Ban
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Ge Lin Xu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, 210002, PR China
| | - Ya Ping Wu
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong, 252000, PR China
| | - Le Xin Wang
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW 2678, Australia
| | - Yi Feng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, PR China
- * E-mail:
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Imaizumi T, Inamura S, Nomura T. Contribution of Deep Microbleeds to Stroke Recurrence: Differences between Patients with Past Deep Intracerebral Hemorrhages and Lacunar Infarctions. J Stroke Cerebrovasc Dis 2015; 24:1855-64. [PMID: 25980343 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 11/06/2014] [Revised: 04/09/2015] [Accepted: 04/17/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study investigated the contribution of deep cerebral microbleeds (MBs) to stroke recurrences in patients with histories of deep intracerebral hemorrhages (ICHs) or lacunar infarctions (LIs). METHODS We prospectively analyzed stroke recurrences in patients admitted to our hospital who were treated for deep ICHs or LIs between April 2004 and December 2011. The number of deep MBs was counted on admission. Stroke recurrence-free rate curves were generated with the Kaplan-Meier method using the log-rank test. The odds ratios (ORs) for recurrent strokes were derived using multivariate logistic regression models, based on deep MBs and risk factors. RESULTS We evaluated magnetic resonance images or the recurrences of 231 deep-ICH patients (92 women, 68.0 ± 12.0 years old) and 309 LI patients (140 women, 70.7 ± 11.7 years old). The incidences of deep ICHs (1.5%/year) and LIs (2.1%/year) presenting as stroke recurrences were significantly larger in LI patients with deep MBs than in those without (.01 [P = .0001] and .08%/year [P = .005], respectively). However, there was no significant difference between deep-ICH patients with and without MBs in terms of incidence of recurrences. Multivariate analyses revealed that deep MBs independently and significantly elevated the rate of deep ICHs (OR, 19.0; P = .007) or LIs (OR, 3.62; P = .008) presenting as recurrences in LI patients, but not in deep-ICH patients, when adjusted for stroke risk factors. CONCLUSIONS There may be differences between patients with deep ICHs and those with LIs in terms of the contribution of deep MBs to stroke recurrence.
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Affiliation(s)
- Toshio Imaizumi
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan.
| | - Shigeru Inamura
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
| | - Tatsufumi Nomura
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Hokkaido, Japan
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Tseng WS, Cheng CA. Vertical gaze palsies from unilateral thalamic infarction. Acta Neurol Taiwan 2013; 22:177-178. [PMID: 24458857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Wei-Shih Tseng
- Department of Diving Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chun-An Cheng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Gobron C, Erginay A, Massin P, Lutz G, Tessier N, Vicaut E, Chabriat H. Microvascular retinal abnormalities in acute intracerebral haemorrhage and lacunar infarction. Rev Neurol (Paris) 2013; 170:13-8. [PMID: 24269117 DOI: 10.1016/j.neurol.2013.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 02/04/2013] [Revised: 07/10/2013] [Accepted: 07/18/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retinal microvascular changes have been previously associated with cerebral MRI markers of small vessel disease (SVD). Whether retinal changes differ between patient with intracerebral haemorrhage (ICH) and patients with lacunar infarction (LI) caused by small vessel disease has been poorly investigated. OBJECTIVE The study aims to compare the frequency of retinal changes between patients with LI and patients with ICH at the acute stage of stroke-related SVD. METHODS Microvascular wall signs (arteriolar occlusion, arteriovenous nicking, focal arterial narrowing) and retinopathy lesions (microanevrysms, cotton wool spots, retinal haemorrhages, hard exudates) were assessed by retinography up to three months after stroke onset. RESULTS Forty-eight non-diabetic patients with acute stroke-related to SVD (26 LI, 22 ICH) were recruited prospectively in the study. Retinal wall signs (arteriovenous nicking, and focal arterial narrowing) were found in more than three quarters of subjects and most often bilaterally in both groups. Retinopathy lesions (cotton wool spots, retinal haemorrhages) were found more frequently in ICH patients than in LI patients (22.2% vs. 15.4%, 50% vs. 34% respectively, P>0.005). The frequency of bilateral cotton wool spots and of bilateral retinal haemorrhages was significantly higher in ICH patients than in LI patients (12.5% vs. 0%, P=0.012, 41.2% vs. 7.7%, P=0.029 respectively). CONCLUSION These results confirm the high frequency of microvascular alterations in patients with hypertension-related SVD leading to LI or ICH and suggest that retinal tissue alterations are more frequent in ICH than in LI. Further investigations are needed to investigate the mechanisms underlying this difference.
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Affiliation(s)
- C Gobron
- Physiological department, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Neurology department and stroke unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - A Erginay
- Ophthalmology department, CHU Lariboisiere Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - P Massin
- Ophthalmology department, CHU Lariboisiere Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - G Lutz
- Neurology department and stroke unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - N Tessier
- Clinical research unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré 75475 Paris cedex 10, France
| | - E Vicaut
- Clinical research unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré 75475 Paris cedex 10, France
| | - H Chabriat
- Neurology department and stroke unit, CHU Lariboisière Fernand-Widal, AP-HP, Paris Diderot university, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; Inserm U740, faculty of medicine, university Paris Diderot, Paris, France.
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Yagi Y, Watanabe Y, Yokote H, Amino T, Kamata T. Lacunar thalamic infarction with isolated dysesthesia in contralateral fingers. Acta Neurol Belg 2013; 113:199-200. [PMID: 22837025 DOI: 10.1007/s13760-012-0118-x] [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] [Received: 06/18/2012] [Accepted: 07/12/2012] [Indexed: 11/27/2022]
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Iwasaki Y, Mori K, Ito M, Deguchi A, Tatsumi S, Mimuro M, Yoshida M. [An autopsied case of argyrophilic grain dementia with parkinsonism due to multiple lacunar infarctions]. Brain Nerve 2013; 65:583-587. [PMID: 23667123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A 77-year-old Japanese woman developed parkinsonism and showed tremor in the upper extremities, bradykinesia, and gait disturbance. She was diagnosed with Parkinson's disease. Treatment with L-3,4-dihydroxyphenylalanine (L-DOPA) was ineffective. Two years later, dementia symptoms such as memory disturbance and disorientation gradually manifested and abnormal behaviors including egocentric behavior were observed. No apparent pyramidal tract signs, focal cerebral signs, or cerebellar dysfunction was observed. The patient died at the age of 90 years, and the clinical diagnosis was Parkinson's disease with dementia. The brain weight was 1,110 g. Multiple infarctions were observed in the basal ganglia and thalamus with état criblé. Argyrophilic grains corresponding to Saito's stage III were observed mainly in the limbic system. Neuronal loss with gliosis and tissue rarefaction was detected in the subiculum, parahippocampal gyrus, and amygdala. Oligodendroglial coiled bodies and argyrophilic threads were also observed in the areas in which the grains were abundant. Neurofibrillary tangles and senile plaques corresponding to Braak stage III and Consortium to Establish a Registry for Alzheimer's Disease (CERAD) stage B, respectively, were detected. The number of neurons of the substantia nigra and locus coeruleus was found to be unchanged. Pathological features of Parkinson's disease, including Lewy bodies and α-synuclein-positive abnormal structures, were not observed. On the basis of the pathological features, we made a diagnosis of argyrophilic grain dementia (AGD) with multiple infarctions. The patient's dementia was thought to be due to AGD, and parkinsonism was suspected to be due to multiple infarctions of the basal ganglia. The clinical findings of the patient described in this case study include important findings that will help in clinically discriminating between different dementias such as Alzheimer's disease and AGD.
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Affiliation(s)
- Yasushi Iwasaki
- Department of Neuropathology, Aichi Medical University, Japan
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Chang GY. Acute simultaneous multiple lacunar infarcts: a severe disease entity in small artery disease. Eur Neurol 2012; 68:258. [PMID: 23006658 DOI: 10.1159/000341334] [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] [Received: 05/25/2012] [Accepted: 06/24/2012] [Indexed: 11/19/2022]
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Park JH, Ryoo S, Kim SJ, Kim GM, Chung CS, Lee KH, Bang OY. Differential risk factors for lacunar stroke depending on the MRI (white and red) subtypes of microangiopathy. PLoS One 2012; 7:e44865. [PMID: 23024771 PMCID: PMC3443091 DOI: 10.1371/journal.pone.0044865] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/09/2012] [Indexed: 11/18/2022] Open
Abstract
Background Leukoaraiosis and cerebral microbleeds (CMB), which represent cerebral microangiopathy, commonly coexist in patients with acute lacunar stroke. Since they may have different impacts on stroke prognosis and treatment, it is important to know the factors associated with leukoaraiosis-predominant vs. CMB-predominant microangiopathies. Methods We prospectively recruited 226 patients with acute lacunar infarction and divided them into four groups according to the Fazekas’ score and the presence of CMB: mild, red (predominant CMB), white (predominant leukoaraiosis) and severe microangiopathy groups. For comparison, we also evaluated 50 patients with intracerebral hemorrhage (ICH). We evaluated the clinical and laboratory findings of microangiopathy subtypes in patients with acute lacunar stroke and then compared them with those of primary ICH. Results The risk factor profile was different among the groups. Patients with acute lacunar infarct but mild microangiopathy were younger, predominantly male, less hypertensive, and more frequently had smoking and heavy alcohol habits than other groups. The risk factor profile of red microangiopathy was similar to that of ICH but differed from that of white microangiopathy. The subjects in the white microangiopathy group were older and more frequently had diabetes than those in the red microangiopathy or ICH group. After adjustments for other factors, age [odds ratio (OR) 1.13; 95% confidence interval (CI) 1.08–1.18; p<0.001] and diabetes (OR 2.28; 95% CI 1.02–5.13; p = 0.045) were independently associated with white microangiopathy, and age (OR 1.05; 95% CI 1.01–1.08; p = 0.010) was independent predictor for red microangiopathy compared to mild microangiopathy. Conclusion Patients with acute lacunar infarction have a different risk factor profile depending on microangiopathic findings. Our results indicate that diabetes may be an one of determinants of white (leukoaraiosis-predominant) microangiopathy, whereas smoking and alcohol habits in relatively young people may be a determinants of mild microangiopahic changes in patients with lacunar infarction.
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Affiliation(s)
- Jae-Hyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sookyung Ryoo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk Jae Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Ho Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Abstract
OBJECTIVE Lacunar strokes are a leading cause of cognitive impairment and vascular dementia. However, adequate characterization of cognitive impairment is lacking. The aim of this study was to estimate the prevalence and characterize the neuropsychological impairment in lacunar stroke patients. METHODS All English-speaking participants in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial (National Clinical Trial 00059306) underwent neuropsychological testing at baseline. Raw scores were converted to z scores using published norms. Those with impairment (z ≤ -1.5) in memory and/or nonmemory domains were classified as having mild cognitive impairment (MCI). RESULTS Among the 1,636 participants, average z scores on all tests were < 0, with the largest deficits seen on tests of episodic memory (range of means, -0.65 to -0.92), verbal fluency (mean, -0.89), and motor dexterity (mean, -2.5). Forty-seven percent were classified as having MCI (36% amnestic, 37% amnestic multidomain, 28% nonamnestic). Of those with modified Rankin score 0-1 and Barthel score = 100, 41% had MCI. Younger age (odds ratio [OR] per 10-year increase, 0.87), male sex (OR, 1.3), less education (OR, 0.13-0.66 for higher education levels compared to 0-4 years education), poststroke disability (OR, 1.4), and impaired activities of daily living (OR, 1.8) were independently associated with MCI. INTERPRETATION In this large, well-characterized cohort of lacunar stroke patients, MCI was present in nearly half, including many with minimal or no physical disabilities. Cognitive dysfunction in lacunar stroke patients may commonly be overlooked in clinical practice but may be as important as motor and sensory sequelae.
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Affiliation(s)
- Claudia Jacova
- Division of Neurology, Department of Medicine, Brain Research Center, University of British Columbia, Vancouver, BC, Canada
| | - Lesly A Pearce
- Biostatistical Consultant, 2509 Bel Air Court, Minot, ND, USA
| | - Raymond Costello
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Leslie A McClure
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen L Holliday
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Robert G Hart
- Division of Neurology, Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, ON, Canada
| | - Oscar R Benavente
- Division of Neurology, Department of Medicine, Brain Research Center, University of British Columbia, Vancouver, BC, Canada
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Tazen S, Pawar G. To scan or not to scan. W V Med J 2012; 108:36-37. [PMID: 23098009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Belli H, Akbudak M, Ural C, Kulacaoglu F. Solitary lesion in ponto-mesencephalic area related secondary mania: a case report. Psychiatr Danub 2012; 24:223-5. [PMID: 22706424 DOI: pmid/22706424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hasan Belli
- Department of Psychiatry, Bagcilar Education And Research Hospital, Istanbul, Turkey.
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Benavente O. [Branch atheromatous disease: prognosis and management. The SPS3 experience]. Rinsho Shinkeigaku 2011; 51:883. [PMID: 22277402 DOI: 10.5692/clinicalneurol.51.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Oscar Benavente
- Division of Neurology, University of British Columbia, Canada
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White CL, McClure LA, Wallace PM, Braimah J, Liskay A, Roldan A, Benavente OR. The correlates and course of depression in patients with lacunar stroke: results from the Secondary Prevention of Small Subcortical Strokes (SPS3) study. Cerebrovasc Dis 2011; 32:354-60. [PMID: 21921599 PMCID: PMC3712814 DOI: 10.1159/000330350] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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: 02/15/2011] [Accepted: 06/08/2011] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability. METHODS Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject. RESULTS The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19%. Older age (OR 0.97; 95% CI 0.96-0.99), male gender (OR 0.62; 95% CI 0.48-0.80) and less cognitive impairment (OR 0.99; 95% CI 0.98-1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95% CI 1.3-2.4), living with a spouse/family (OR 1.6; 95% CI 1.1-2.3) and risk factors for stroke (OR 1.2; 95% CI 1.0-1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95% CI 1.06-1.17) for each 1-year increase in time. CONCLUSIONS One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.
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Affiliation(s)
- Carole L White
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
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Abstract
Isolated paresthesia, or paresthesia not accompanied by sensory and/or motor deficits, is an extremely rare manifestation of a cerebrovascular accident. Lacunar pure sensory stroke (PSS) confined to thalamus is characterized by persistent or transient numbness, tingling, pain, burning, or another unpleasant sensation on one side of the body. However, in this condition a sensory loss to all primary modalities in the contralateral face and body is very often encountered. Also previous reported cases of PSS due to lacunar stroke in regions other than thalamus are characterized by the presence of sensory loss together with positive sensory symptoms, none of them reporting isolated paresthesia as the only clinical feature of PSS. We present a case of isolated paresthesia as only clinical manifestation of a lacunar PSS involving both trigeminal and medial lemniscus in dorsal paramedian pontine region. A PSS manifesting with isolated paresthesias may be secondary not only to a thalamic lacunar stroke, but also to a small ischemic lesion confined to both trigeminal and medial lemniscus in dorsal paramedian pontine region.
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Affiliation(s)
- Francesco Brigo
- Dipartimento di Scienze Neurologiche, Neuropsicologiche, Morfologiche e Motorie, Sezione di Neurologia Clinica, Università di Verona, Piazzale L.A. Scuro, 10 - 37134, Verona, Italy.
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Field TS, Benavente OR. Penetrating artery territory pontine infarction. Rev Neurol Dis 2011; 8:30-38. [PMID: 21769069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pontine infarcts account for 25% of lacunar strokes. The primary morphologies are wedge-shaped tegmental, basal, and tegmentobasal infarcts, caused by disease of the paramedian basilar branches, and smaller, circumscribed lacunar infarcts attributed to lipohyalinosis. Roughly 60% of infarcts are paramedian. Both typical and atypical lacunar syndromes are seen with pontine infarcts, pure motor hemiparesis being the most common, followed by sensorimotor stroke and ataxic hemiparesis. Eye movement abnormalities and neuropsychological deficits are also commonly seen. Short-term functional prognosis is usually good with lacunar morphology; rostral, lateral or tegmental locations predict a more favorable prognosis.
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Affiliation(s)
- Thalia S Field
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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