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Extended Computed Tomography Angiography for the Successful Diagnosis of Cardioaortic Thrombus in Acute Ischemic Stroke and TIA: Study Protocol for a Randomized Controlled Trial. 扩展计算机断层扫描血管造影用于成功诊断急性缺血性中风和 TIA 的心主动脉瘤(DAYLIGHT):随机对照试验研究方案》。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-06-26 DOI: 10.1159/000540034
Luciano A Sposato, Diana Ayan, Mobeen Ahmed, Sebastian Fridman, Jennifer L Mandzia, Facundo F Lodol, Maged Elrayes, Sachin Pandey, Rodrigo Bagur

Introduction: Cardiac imaging is one of the main components of the etiological investigation of ischemic strokes. However, basic and advanced cardiac imaging remain underused in most stroke centers globally. Computed tomography angiography (CTA) of the supra-aortic and intracranial arteries is the most frequent imaging modality applied during the evaluation of patients with acute ischemic stroke to identify the presence of a large vessel occlusion. Recent evidence from retrospective observational studies has shown a high detection of cardiac thrombi, ranging from 6.6 to 17.4%, by extending a CTA a few cm below the carina to capture cardiac images. However, this approach has never been prospectively compared against usual care in a randomized controlled trial. The Extended Computed Tomography Angiography for the Successful Screening of Cardioaortic Thrombus in Acute Ischemic Stroke and TIA (DAYLIGHT) prospective, randomized, controlled trial evaluates whether an extended CTA (eCTA) + standard-of-care stroke workup results in higher detection rates of cardiac and aortic source of embolism compared to standard-of-care CTA (sCTA) + standard-of-care stroke workup.

Methods: DAYLIGHT is a single-center, prospective, randomized, open-blinded endpoint trial, aiming to recruit 830 patients with suspected acute ischemic stroke or transient ischemic attack (TIA) being assessed under acute code stroke at the emergency department or at a dedicated urgent stroke prevention clinic. Patients are randomized 1:1 to eCTA versus sCTA. The eCTA expands image acquisition caudally, 6 cm below the carina. All patients receive standard-of-care cardiac imaging and diagnostic stroke workup. The primary efficacy endpoint is the diagnosis of a cardioaortic thrombus after at least 30 days of follow-up. The primary safety endpoint is door-to-CTA completion time. The diagnosis of a qualifying ischemic stroke or TIA is independently adjudicated by a stroke neurologist, blinded to the study arm allocation. Patients without an adjudicated ischemic stroke or TIA are excluded from the analysis. The primary outcome events are adjudicated by a board-certified radiologist with subspecialty training in cardiothoracic radiology and a cardiologist with formal training in cardiac imaging. The primary analysis is performed according to the modified intention-to-diagnose principle and without adjustment by logistic regression models. Results are presented with odds ratios and 95% confidence intervals.

Conclusion: The DAYLIGHT trial will provide evidence on whether extending a CTA to include the heart results in an increased detection of cardioaortic thrombi compared to standard-of-care stroke workup.

导言:心脏成像是缺血性脑卒中病因调查的主要内容之一。然而,全球大多数卒中中心仍未充分利用基础和高级心脏成像技术。主动脉上动脉和颅内动脉计算机断层扫描(CTA)是评估急性缺血性脑卒中患者时最常用的成像方式,可用于确定是否存在大血管闭塞。回顾性观察研究的最新证据显示,通过将 CTA 扩展到心尖下几厘米处以捕捉心脏图像,心脏血栓的检出率很高,从 6.6% 到 17.4% 不等。然而,这种方法从未在随机对照试验中与常规治疗进行过前瞻性比较。DAYLIGHT(急性缺血性中风和 TIA 中成功诊断心主动脉栓塞的扩展计算机断层扫描)前瞻性随机对照试验将评估扩展 CTA(eCTA)+ 标准护理中风检查与标准 CTA(sCTA)+ 标准护理中风检查相比是否能提高心脏和主动脉栓塞源的检出率:DAYLIGHT是一项单中心、前瞻性、随机、开放盲法终点试验,旨在招募830名疑似急性缺血性卒中或短暂性脑缺血发作(TIA)患者,由急诊科或专门的紧急卒中预防门诊根据急性卒中代码进行评估。患者将按 1:1 随机分配到 eCTA 与 sCTA。eCTA 将把图像采集范围扩大到尾部,即心尖下 6 厘米处。所有患者都将接受标准的心脏成像和中风诊断检查。主要疗效终点是随访至少 30 天后诊断出心主动脉血栓。主要安全性终点是完成CTA检查。合格的缺血性中风或 TIA 诊断将由一名中风神经科医生独立裁定,该医生对研究臂的分配情况保密。未确诊缺血性中风或 TIA 的患者将被排除在分析之外。主要结果事件将由一名接受过心胸放射学亚专业培训的注册放射科医师和一名接受过心脏成像正规培训的心脏病医师裁定。主要分析将根据意向诊断原则进行,不使用逻辑回归模型进行调整。结果将以几率比率和95%置信区间表示 结论。DAYLIGHT 试验将提供证据,证明与标准护理卒中检查相比,将 CTA 延长至心窝下 6 厘米是否会增加心主动脉血栓的检出率:NCT05522244。
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引用次数: 0
Neurologists Preferences on Basic and Advanced Cardiac Imaging Utilization in Ischemic Stroke Patients. 神经科医生对缺血性脑卒中患者使用基础和高级心脏成像的偏好。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-06-22 DOI: 10.1159/000539998
Thaís L Secchi, Arthur Pille, Mariana M D da Silva, Sheila C O Martins, Rodrigo Bagur, Luciano A Sposato, Diana Ayan

Introduction: It is unknown how cardiac imaging studies are used by neurologists to investigate cardioembolic sources in ischemic stroke patients.

Methods: Between August 12, 2023, and December 8, 2023, we conducted an international survey among neurologists from Europe, North America, South America, and Asia, to investigate the frequency of utilization of cardiac imaging studies for the detection of cardioembolic sources of ischemic stroke. Questions were structured into deciles of percentage utilization of transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), ECG-gated cardiac computed tomography (G-CCT), and cardiac magnetic resonance imaging (CMRI). We estimated the weighted proportion (x¯) of utilization of each cardiac imaging modality, both globally and by continent. We also investigated the use of head and neck computed tomography angiography (CTA) as an emerging approach to the screening of cardioembolic sources.

Results: A total of 402 neurologists from 64 countries completed the survey. Globally, TTE was the most frequently used cardiac imaging technology (x¯ = 71.2%), followed by TEE (x¯ = 15.8%), G-CCT (x¯ = 10.9%), and CMRI (x¯ = 7.7%). Findings were consistent across all continents. A total of 288 respondents routinely used a CTA in the acute ischemic stroke phase (71.6%), but the CTA included a non-gated CCT in only 15 cases (5.2%).

Conclusions: This survey suggests that basic cardiac imaging is not done in all ischemic stroke patients evaluated in 4 continents. We also found a substantially low utilization of advanced cardiac imaging studies. Easier to adopt screening methods for cardioembolic sources of embolism are needed.

导言:神经科医生如何使用心脏成像检查来调查缺血性卒中患者的心源性栓塞源尚属未知:在 2023 年 8 月 12 日至 2023 年 12 月 8 日期间,我们对来自欧洲、北美、南美和亚洲的神经科医生进行了一次国际调查,以了解他们利用心脏成像检查检测缺血性卒中心源性栓塞源的频率。问题按经胸超声心动图 (TTE)、经食道超声心动图 (TEE)、心电图门控心脏计算机断层扫描 (G-CCT) 和心脏磁共振成像 (CMRI) 的使用百分比分档。我们估算了全球和各大洲使用每种心脏成像方式的加权比例(x ̅)。我们还调查了头颈部计算机断层扫描(CTA)的使用情况,将其作为筛查心源性栓塞的一种新兴方法:共有来自 64 个国家的 402 名神经科医生完成了调查。在全球范围内,TTE 是最常用的心脏成像技术(x ̅=71.2%),其次是 TEE(x ̅=15.8%)、G-CCT(x ̅=10.9%)和 CMRI(x ̅=7.7%)。各大洲的调查结果一致。共有 288 名受访者在急性缺血性卒中阶段常规使用 CTA(71.6%),但只有 15 例(5.2%)的 CTA 包括非门控 CCT:这项调查表明,在四大洲接受评估的缺血性卒中患者中,并非所有患者都进行了基本的心脏成像。我们还发现,高级心脏成像检查的使用率非常低。需要更容易采用的心源性栓子筛查方法。
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引用次数: 0
Association of Cognitive Reserve and Preoperative Cognitive Function in Patients with Adult Moyamoya Disease: A Preliminary Study. 成人 Moyamoya 病患者认知储备与术前认知功能的关系:一项初步研究。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-06-12 DOI: 10.1159/000539694
Young-Ah Choi

Introduction: Many patients with moyamoya disease (MMD) exhibit cognitive decline; however, the link between cognitive reserve (CR) and cognitive function in those who have not undergone revascularization remains unexplored. We aimed to evaluate preoperative cognitive impairment in such patients and to explore the relationship between CR, measured using the Cognitive Reserve Index questionnaire (CRIq), and cognitive abilities across different domains, determined using neuropsychological tests.

Methods: Demographic, clinical, CRIq, and neuropsychological assessment data were gathered from patients with MMD who underwent preoperative cognitive functional assessments at our center during 2021-2023. These patients were categorized according to their Montreal Cognitive Assessment score. Multivariable linear regression was performed to analyze the association between CRIq score and cognitive performance, both globally and in specific domains.

Results: In the MMD cohort of 53 patients, 49% (n = 26) of the patients exhibited a decrease in overall cognitive performance. Individuals with cognitive dysfunction had significantly lower composite CRIq scores than those with intact cognition. Although no association between overall cognitive ability and CR was observed, independent associations emerged between CR and specific cognitive functions - language (β = 0.56, p = 0.002), verbal memory (β = 0.45, p = 0.001), and executive function (β = 0.35, p = 0.03).

Conclusion: This preliminary study revealed that expressive language, verbal memory, and executive function are linked to CR in presurgical patients with MMD, highlighting the role of CR in predicting cognitive outcomes. Further research is warranted to elucidate the combined effects of CR and other risk factors on the cognitive function of patients with MMD.

导言:许多莫亚莫亚病(MMD)患者都会出现认知功能下降;然而,对于那些未接受血管重建手术的患者,认知储备(CR)与认知功能之间的联系仍未得到探讨。我们的目的是评估这类患者术前的认知功能障碍,并探讨认知储备指数问卷(CRIq)测量的认知储备与神经心理学测试确定的不同领域认知能力之间的关系:收集了 2021-2023 年期间在本中心接受术前认知功能评估的 MMD 患者的人口统计学、临床、CRIq 和神经心理学评估数据。这些患者根据其蒙特利尔认知评估得分进行分类。研究人员对CRIq评分和认知能力(包括整体和特定领域)之间的关系进行了多变量线性回归分析:在 53 名 MMD 患者中,49%(n=26)的患者表现出整体认知能力下降。认知功能障碍患者的CRIq综合评分明显低于认知功能完好的患者。虽然总体认知能力与 CR 之间没有关联,但 CR 与特定认知功能--语言(β = 0.56,p = 0.002)、言语记忆(β = 0.45,p = 0.001)和执行功能(β = 0.35,p = 0.03)--之间存在独立关联:这项初步研究表明,MMD 术前患者的语言表达能力、言语记忆力和执行功能与 CR 有关,突出了 CR 在预测认知结果方面的作用。为阐明 CR 和其他风险因素对 MMD 患者认知功能的综合影响,有必要开展进一步研究。
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引用次数: 0
Endovascular Treatment for Cerebral Venous Thrombosis: Applying Lessons Learned from Clinical Trials of Endovascular Treatment in Acute Arterial Ischemic Stroke. 脑静脉血栓形成的血管内治疗:应用急性动脉缺血性中风 EVT 临床试验的经验教训。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-06-06 DOI: 10.1159/000539657
Johanna Maria Ospel, Nishita Singh, Thanh N Nguyen, Shadi Yaghi, Mayank Goyal, Michael D Hill, Thalia S Field

Background: Cerebral venous thrombosis (CVT) is a rare but severely disabling form of stroke. Acute treatment mainly consists of medical management, since there is no robust evidence suggesting the benefit of endovascular treatment for CVT. Given the relative lack of data to guide acute treatment decision-making, CVT treatment decisions are mostly made on a case-by-case basis. In some ways, the current status quo of endovascular treatment for CVT resembles the state of endovascular treatment for acute ischemic stroke before the wave of major positive large vessel occlusion endovascular treatment trials in 2015.

Summary: The current state of evidence with regard to endovascular CVT treatment is summarized, parallels to acute ischemic stroke are drawn, and it is discussed how the lessons learned from the evolution of acute ischemic stroke endovascular treatment (EVT) trials could be applied to designing a trial of endovascular treatment for CVT. The review ends by outlining possible scenarios for the future of endovascular CVT treatment.

Key messages: CVT is a serious disease, affecting young patients and their families, and harbors a considerable social and economic burden. Working toward high-level evidence for the best possible treatment strategy and exploring a possible role for EVT to improve outcomes in CVT needs to remain a high priority in stroke research.

脑静脉血栓(CVT)是一种罕见但严重致残的中风形式。急性期的治疗主要包括药物治疗,因为没有有力的证据表明血管内治疗对 CVT 有益。由于相对缺乏指导急性治疗决策的数据,CVT 的治疗决策大多是根据具体情况做出的。在某些方面,脑静脉血栓形成(CVT)血管内治疗的现状类似于 2015 年大血管闭塞血管内治疗试验浪潮之前急性缺血性卒中血管内治疗的现状。在这篇综述中,我们总结了血管内 CVT 治疗的证据现状,将其与急性缺血性卒中进行了比较,并讨论了如何将从急性缺血性卒中 EVT 试验演变中吸取的经验教训应用于设计 CVT 血管内治疗试验。最后,我们概述了血管内 CVT 治疗未来的可能方案。
{"title":"Endovascular Treatment for Cerebral Venous Thrombosis: Applying Lessons Learned from Clinical Trials of Endovascular Treatment in Acute Arterial Ischemic Stroke.","authors":"Johanna Maria Ospel, Nishita Singh, Thanh N Nguyen, Shadi Yaghi, Mayank Goyal, Michael D Hill, Thalia S Field","doi":"10.1159/000539657","DOIUrl":"10.1159/000539657","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous thrombosis (CVT) is a rare but severely disabling form of stroke. Acute treatment mainly consists of medical management, since there is no robust evidence suggesting the benefit of endovascular treatment for CVT. Given the relative lack of data to guide acute treatment decision-making, CVT treatment decisions are mostly made on a case-by-case basis. In some ways, the current status quo of endovascular treatment for CVT resembles the state of endovascular treatment for acute ischemic stroke before the wave of major positive large vessel occlusion endovascular treatment trials in 2015.</p><p><strong>Summary: </strong>The current state of evidence with regard to endovascular CVT treatment is summarized, parallels to acute ischemic stroke are drawn, and it is discussed how the lessons learned from the evolution of acute ischemic stroke endovascular treatment (EVT) trials could be applied to designing a trial of endovascular treatment for CVT. The review ends by outlining possible scenarios for the future of endovascular CVT treatment.</p><p><strong>Key messages: </strong>CVT is a serious disease, affecting young patients and their families, and harbors a considerable social and economic burden. Working toward high-level evidence for the best possible treatment strategy and exploring a possible role for EVT to improve outcomes in CVT needs to remain a high priority in stroke research.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advancing Post-Stroke Cognitive Assessments: The Potential and Challenges of Integrating Eye Tracking Technology in Clinical Practice. 推进卒中后认知评估:将眼动追踪技术融入临床实践的潜力与挑战》。
IF 2.9 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-30 DOI: 10.1159/000539594
Amanda Cyntia Lima Fonseca Rodrigues, Keun-Hwa Jung
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引用次数: 0
Statistical Analysis Plan for the INTEnsive Ambulance-Delivered Blood Pressure Reduction in Hyper-ACute Stroke Trial. INTEnsive 救护车送药降低超急性期中风患者血压试验 (INTERACT4) 统计分析计划。
IF 2.9 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-30 DOI: 10.1159/000539503
Laurent Billot, Chen Chen, Lili Song, Yapeng Lin, Feifeng Liu, Xiaoying Chen, Hisatomi Arima, Philip M Bath, Gary A Ford, Thompson G Robinson, Else Charlotte Sandset, Jeffrey L Saver, Nikola Sprigg, H Bart van der Worp, Jie Yang, Gang Li, Craig S Anderson

Introduction: Recruitment is complete in the fourth INTEnsive ambulance-delivered blood pressure Reduction in hyper-ACute stroke Trial (INTERACT4), a multicenter, prospective, randomized, open-label, blinded endpoint assessed trial of prehospital blood pressure (BP) lowering initiated in the ambulance for patients with a suspected acute stroke and elevated BP in China. According to the registered and published trial protocol and developed by the blinded trial Steering Committee and Operations team, this manuscript outlines a detailed statistical analysis plan for the trial prior to database lock.

Methods: Patients were randomized (1:1) to intensive (target systolic BP 130-140 mm Hg within 30 min) or guideline-recommended BP management (BP lowering only considered if systolic BP >220 mm Hg) group. Primary outcome is an ordinal analysis of the full range of scores on the modified Rankin scale at 90 days. A modified sample size of 2,320 was estimated to provide 90% power to detect a 22% reduction in the odds (common odds ratio of 0.78) of a worse functional outcome using ordinal logistic regression, on the assumption of 5% patients with missing outcome and 6% patients with a stroke mimic.

Conclusion: The statistical analysis plan for the trial has been developed to ensure transparent, verifiable, and prespecified analysis and to avoid potential bias in the evaluation of the trial intervention.

简介:第四项 INTEnsive 救护车送药降低超急性期中风患者血压试验(INTERACT4)已完成招募:第四届INTEnsive救护车降压治疗超急性脑卒中试验(INTERACT4)是一项多中心、前瞻性、随机、开放标签、盲终点评估的试验,针对中国疑似急性脑卒中且血压升高的患者在救护车上启动院前降压治疗。根据已注册并公布的试验方案,并由盲法试验指导委员会和操作团队制定,本稿件概述了数据库锁定前试验的详细统计分析计划:患者被随机(1:1)分配到强化治疗组(目标收缩压[SBP] 130-140 mmHg,30 分钟内达标)或指南推荐的血压管理组(只有当 SBP >220 mmHg 时才考虑降压)。主要结果是对 90 天时改良兰金量表的全部评分进行序数分析。据估计,修改后的样本量为 2320 个,使用序数逻辑回归法,假设有 5% 的患者结果缺失,6% 的患者为中风模拟患者,则 90% 的力量可以检测到功能结果变差的几率降低了 22%(普通几率比为 0.78):该试验的统计分析计划是为确保透明、可核查和预先指定的分析而制定的,以避免试验干预评估中可能出现的偏差。
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引用次数: 0
Miller Fisher's Rules and Digital Health: The Best of Both Worlds. 米勒-费舍尔规则与数字医疗:两全其美。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-29 DOI: 10.1159/000539323
Joao Brainer Andrade, George Nunes Mendes, Gisele Sampaio Silva

Background: Professor Fisher's legacy, defined by meticulous observation, curiosity, and profound knowledge, has established a foundational cornerstone in medical practice. However, the advent of automated algorithms and artificial intelligence (AI) in medicine raises questions about the applicability of Fisher's principles in this era. Our objective was to propose adaptations to these enduring rules, addressing the challenges and leveraging the opportunities presented by digital health.

Summary: The adapted rules we propose advocate for the harmonious integration of traditional bedside manners with contemporary technological advancements. The judicious use of advanced devices for patient examination, recording, and sharing, while upholding patient confidentiality, is pivotal in modern practice and academic research. Additionally, the strategic employment of AI tools at the bedside, to aid in diagnosis and hypothesis generation, underscores their role as valued complements to clinical reasoning. These adapted rules emphasize the importance of continual learning from experience, literature, and colleagues, and stress the necessity for a critical approach toward AI-derived information, which further consolidates clinical skills. These aspects underscore the perpetual relevance of Professor Fisher's rules, advocating not for their replacement but for their evolution. Thus, a balanced methodology that adeptly utilizes the strengths of AI and digital tools, while steadfastly maintaining the core humanistic values, arises as essential in the modern practice of medicine.

Key messages: A commitment between traditional medical wisdom and modern technological capabilities may enhance medical practice and patient care. This represents the future of medicine - a resolute commitment to progress and technology, while preserving the essence of medical humanities.

背景费舍尔教授以其细致入微的观察、好奇心和渊博的知识为医学实践奠定了基石。然而,医学中自动算法和人工智能的出现,使人们对费雪原则在这个时代的适用性产生了疑问。我们的目标是对这些经久不衰的规则提出调整建议,以应对挑战并利用数字医疗带来的机遇。摘要 我们提出的调整规则主张将传统的床边礼仪与当代的技术进步和谐地结合起来。在维护患者隐私的同时,合理使用先进设备对患者进行检查、记录和共享,这在现代实践和学术研究中至关重要。此外,在床边战略性地使用人工智能工具来辅助诊断和提出假设,也凸显了其作为临床推理的重要补充的作用。这些经过调整的规则强调了从经验、文献和同事那里不断学习的重要性,并强调了对人工智能衍生信息采取批判性方法的必要性,这进一步巩固了临床技能。这些方面都强调了费舍尔教授规则的永恒相关性,不是要取代这些规则,而是要发展这些规则。因此,在现代医学实践中,既要善于利用人工智能和数字工具的优势,又要坚定不移地维护核心人文价值,这样一种平衡的方法至关重要。重要信息 传统医学智慧与现代技术能力之间的结合可以提高医疗实践和患者护理水平。这代表着医学的未来--坚定地致力于进步和技术,同时保留医学人文的精髓。
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引用次数: 0
Age-Related Variations in Patterns of Patent Foramen Ovale-Stroke versus Other Cryptogenic Stroke. 卵圆孔未闭中风与其他隐源性中风模式的年龄相关性变化
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-29 DOI: 10.1159/000539535
Monique Therese S Punsalan, Han-Yeong Jeong, Keun-Hwa Jung, Sue Young Ha, Eung-Joon Lee, Wookjin Yang, Dong-Wan Kang, Jeong-Min Kim, Seung-Hoon Lee

Introduction: Patent foramen ovale (PFO)-stroke, a form of cryptogenic stroke, has certain identifying clinical and imaging features. However, data describing this stroke type remain inconsistent. This study examined the potential variations in PFO-stroke features, depending on age.

Methods: From a hospital registry, cryptogenic stroke patients were retrospectively selected, and PFO-strokes were identified by the presence of >10 microembolic signals on transcranial Doppler saline agitation test. Cryptogenic strokes were grouped according to age (<70 as young, ≥70 as elderly). Clinical and imaging variables of PFO-strokes and non-PFO-strokes were compared, with and without age considered.

Results: Of the 462 cryptogenic patients, 30.5% (141/462) were PFO-strokes, while majority (321/462) had no PFO. When cryptogenic strokes were analyzed by age, the significant difference was noted in the lesion number, pattern, and side. A single (72.8 vs. 57.9%, p = 0.020) and a small single lesion (51.1 vs. 35.5%, p = 0.039) were frequently seen in the younger PFO-strokes than the non-PFO counterpart, while mixed territory lesions identified the elderly PFO-strokes (30.6 vs. 8.9%, p = 0.001). A multivariate logistic regression analysis of PFO-strokes further showed that age was independently associated with lesion side (OR 1.12 [1.05-1.20], p < 0.001) and lesion number (OR 1.06 [1.02-1.10], p = 0.005).

Conclusions: Incorporating age-specific imaging criteria in the identification of PFO-strokes may be of additional value. Further, PFO may remain contributory to the stroke risk in the elderly, in association with vascular risk factors.

导言:卵圆孔未闭(PFO)卒中是隐源性卒中的一种,具有一定的临床和影像学特征。然而,描述这种卒中类型的数据仍不一致。本研究探讨了不同年龄段 PFO 中风特征的潜在差异:方法:从医院登记册中回顾性筛选出隐源性卒中患者,并通过经颅多普勒(TCD)生理盐水激动试验中出现的>10个微栓塞信号(MES)来识别PFO卒中。隐源性脑卒中根据年龄分组(<70 岁为年轻组,>70 岁为老年组)。在考虑和不考虑年龄因素的情况下,比较了PFO脑卒中和非PFO脑卒中的临床和影像学变量:结果:在462名隐源性脑卒中患者中,30.5%(141/462)为PFO脑卒中,而大多数(321/462)患者没有PFO。按年龄对隐源性脑卒中进行分析后发现,病变数量、形态和侧位均存在显著差异。与非 PFO 患者相比,年轻的 PFO 脑卒中患者多见单发病灶(72.8% 对 57.9%,P=0.020)和小单发病灶(51.1% 对 35.5%,P=0.039),而老年 PFO 脑卒中患者多见混合区域病灶(30.6% 对 8.9%,P=0.001)。对PFO脑卒中的多变量逻辑回归分析进一步显示,年龄与病变侧(OR 1.12 (1.05-1.20),p<0.001)和病变数(OR 1.06 (1.02-1.10),p=0.005)独立相关:结论:在识别PFO脑卒中时纳入年龄特异性成像标准可能具有额外价值。此外,PFO 可能与血管风险因素共同导致老年人的中风风险。
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引用次数: 0
Changes in Migraine Symptoms after Ischemic Stroke: A Cohort Study. 缺血性中风后偏头痛症状的变化:一项队列研究。
IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-23 DOI: 10.1159/000539421
Nelleke van der Weerd, Nadine Pelzer, Emma Egberts, Marit Mertens, Willemijn Bakker, Katie M Linstra, Arn M J M van den Maagdenberg, Erik W van Zwet, Antoinette MaassenVanDenBrink, Gisela M Terwindt, Marieke J H Wermer

Introduction: Migraine symptoms are postulated to improve post-stroke. We aimed to determine post-stroke changes in patients with active migraine pre-stroke and explored the relation with stroke location and stroke-preventive medication use.

Methods: Patients with active migraine who had an ischemic stroke were retrieved from three research-cohorts between 2014 and 2021. By an interview, we retrospectively investigated first-year post-stroke changes for those ischemic stroke patients that suffered from migraine pre-stroke. Associations between change in migraine frequency/intensity/aura (decrease, no change, increase), stroke location (posterior location vs. other), and use of secondary stroke preventive medication were assessed by ordinal regression with adjustment for confounders.

Results: We included 78 patients (mean age 48 years, 86% women, 47% with aura). Change in migraine symptomatology was reported by 63 (81%) patients; 51 (81%) noticed a decrease in attack frequency (27 no attacks) and 12 (19%) an increase. Pain intensity change was reported by 18 (35%) patients (50% increase, 50% decrease). Aura symptomatology improved in 4 (11%). Reduced attack frequency was not related to posterior stroke (OR = 1.5, 95% CI: 0.6-3.9), or preventive medication (antiplatelets OR = 1.0, 95% CI: 0.2-3.7; coumarin OR = 2.7, 95% CI: 0.4-20.6).

Conclusions: Most patients with active pre-stroke migraine experience improvement of their symptoms in the first year after ischemic stroke. This change does not seem to be related to secondary stroke preventive medication or posterior stroke location.

导言:偏头痛症状被认为在中风后会有所改善。我们旨在确定中风前活动性偏头痛患者中风后的变化,并探讨其与中风位置和中风预防药物使用的关系。方法 我们从 2014-2021 年间的三个研究队列中选取了发生缺血性中风的活动性偏头痛患者。通过访谈,我们对中风前患有偏头痛的缺血性中风患者中风后第一年的变化进行了回顾性调查。我们通过序数回归评估了偏头痛频率/强度/先兆变化(减少、无变化、增加)、中风位置(后部位置与其他位置)和中风二级预防药物使用之间的关联,并对混杂因素进行了调整。结果 我们纳入了 78 名患者(平均年龄 48 岁,86% 为女性,47% 有先兆)。63名患者(81%)报告了偏头痛症状的变化;51名患者(81%)注意到发作频率下降(27名患者没有发作),12名患者(19%)注意到发作频率上升。18名患者(35%)报告疼痛强度发生了变化(50%增加,50%减少)。4名患者(11%)的先兆症状有所改善。发作频率降低与中风后遗症(OR=1.5,95%CI 0.6-3.9)或预防性药物(抗血小板 OR=1.0,95%CI 0.2-3.7;香豆素 OR=2.7,95%CI 0.4-20.6)无关。结论 大多数卒中前活动性偏头痛患者在缺血性卒中后的第一年症状有所改善。这种变化似乎与二级中风预防药物或中风后的位置无关。
{"title":"Changes in Migraine Symptoms after Ischemic Stroke: A Cohort Study.","authors":"Nelleke van der Weerd, Nadine Pelzer, Emma Egberts, Marit Mertens, Willemijn Bakker, Katie M Linstra, Arn M J M van den Maagdenberg, Erik W van Zwet, Antoinette MaassenVanDenBrink, Gisela M Terwindt, Marieke J H Wermer","doi":"10.1159/000539421","DOIUrl":"10.1159/000539421","url":null,"abstract":"<p><strong>Introduction: </strong>Migraine symptoms are postulated to improve post-stroke. We aimed to determine post-stroke changes in patients with active migraine pre-stroke and explored the relation with stroke location and stroke-preventive medication use.</p><p><strong>Methods: </strong>Patients with active migraine who had an ischemic stroke were retrieved from three research-cohorts between 2014 and 2021. By an interview, we retrospectively investigated first-year post-stroke changes for those ischemic stroke patients that suffered from migraine pre-stroke. Associations between change in migraine frequency/intensity/aura (decrease, no change, increase), stroke location (posterior location vs. other), and use of secondary stroke preventive medication were assessed by ordinal regression with adjustment for confounders.</p><p><strong>Results: </strong>We included 78 patients (mean age 48 years, 86% women, 47% with aura). Change in migraine symptomatology was reported by 63 (81%) patients; 51 (81%) noticed a decrease in attack frequency (27 no attacks) and 12 (19%) an increase. Pain intensity change was reported by 18 (35%) patients (50% increase, 50% decrease). Aura symptomatology improved in 4 (11%). Reduced attack frequency was not related to posterior stroke (OR = 1.5, 95% CI: 0.6-3.9), or preventive medication (antiplatelets OR = 1.0, 95% CI: 0.2-3.7; coumarin OR = 2.7, 95% CI: 0.4-20.6).</p><p><strong>Conclusions: </strong>Most patients with active pre-stroke migraine experience improvement of their symptoms in the first year after ischemic stroke. This change does not seem to be related to secondary stroke preventive medication or posterior stroke location.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-6"},"PeriodicalIF":2.2,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictors of Early versus Delayed Neurological Deterioration after Thrombolysis for Ischemic Stroke. 缺血性脑卒中溶栓治疗后神经功能早期恶化与延迟恶化的预测因素:ENCHANTED研究。
IF 2.9 3区 医学 Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-15 DOI: 10.1159/000539322
Qiao Han, Shoujiang You, Toshiki Maeda, Yanan Wang, Menglu Ouyang, Qiang Li, Lili Song, Yang Zhao, Xinwen Ren, Chen Chen, Candice Delcourt, Zien Zhou, Yongjun Cao, Chun-Feng Liu, Danni Zheng, Hisatomi Arima, Thompson G Robinson, Xiaoying Chen, Richard I Lindley, John Chalmers, Craig S Anderson, Xia Wang

Introduction: We aimed to determine predictors of early (END) and delayed neurological deterioration (DND) and their association with the functional outcome in patients with acute ischemic stroke (AIS) who participated in the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

Methods: END and DND (without END) were defined as scores of a ≥2-point increase on the National Institutes of Health Stroke Scale (NIHSS) or a ≥1-point decrease on the Glasgow coma scale or death, from baseline to 24 h and 24-72 h, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death).

Results: Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p ≤ 0.01) and DND (all p ≤ 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p < 0.001).

Conclusion: We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. Both END and DND predict unfavorable outcomes at 90 days.

背景和目的:我们旨在确定参加国际高血压和溶栓卒中强化控制研究(ENCHANTED)的急性缺血性卒中患者早期(END)和延迟神经功能恶化(DND)的预测因素及其与功能预后的关系:END和DND的定义分别为从基线到24小时和从24小时到72小时美国国立卫生研究院卒中量表(NIHSS)增加≥2分或格拉斯哥昏迷量表减少≥1分或死亡。采用多变量逻辑回归模型确定END和DND的独立预测因素及其与90天预后(改良Rankin量表[mRS]上2-6 vs 0-1和3-6 vs 0-2的二分法评分以及死亡)的关系:在4496名患者中,分别有871名(19.4%)和302名(8.4%)患者经历了END和DND。较高的基线 NIHSS 评分、较高的年龄、明显的动脉粥样硬化导致的大动脉闭塞、心栓塞性卒中亚型、出血性梗死和 24 小时内的实质血肿都是END(所有 P 均≤0.01)和 DND(所有 P 均≤0.024)的独立预测因素。此外,基线收缩压(BP)较高(比值比 [OR] 1.07,95% 置信区间 [CI]1.02-1.12)、24 小时内舒张压变化较大(OR 1.07,95% CI 1.04-1.09)、亚洲患者(OR 1.25,95% CI 1.03-1.52)是END的唯一独立预测因素。然而,亚洲人种与 DND 呈负相关(OR 0.64,95% CI 0.47-0.86)。在所有卒中亚型中,24 小时内出血性梗死和实质性血肿是END 的主要预测因素。END和DND均与90天后功能预后不良有关(均为P<0.001):我们发现了急性缺血性卒中溶栓治疗后END和DND重叠且独特的人口统计学和临床预测因素。END和DND均可预测90天后的不良预后。
{"title":"Predictors of Early versus Delayed Neurological Deterioration after Thrombolysis for Ischemic Stroke.","authors":"Qiao Han, Shoujiang You, Toshiki Maeda, Yanan Wang, Menglu Ouyang, Qiang Li, Lili Song, Yang Zhao, Xinwen Ren, Chen Chen, Candice Delcourt, Zien Zhou, Yongjun Cao, Chun-Feng Liu, Danni Zheng, Hisatomi Arima, Thompson G Robinson, Xiaoying Chen, Richard I Lindley, John Chalmers, Craig S Anderson, Xia Wang","doi":"10.1159/000539322","DOIUrl":"10.1159/000539322","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to determine predictors of early (END) and delayed neurological deterioration (DND) and their association with the functional outcome in patients with acute ischemic stroke (AIS) who participated in the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).</p><p><strong>Methods: </strong>END and DND (without END) were defined as scores of a ≥2-point increase on the National Institutes of Health Stroke Scale (NIHSS) or a ≥1-point decrease on the Glasgow coma scale or death, from baseline to 24 h and 24-72 h, respectively. Multivariable logistic regression models were used to determine independent predictors of END and DND and their association with 90-day outcomes (dichotomous scores on the modified Rankin scale [mRS] of 2-6 vs. 0-1 and 3-6 vs. 0-2 and death).</p><p><strong>Results: </strong>Of 4,496 patients, 871 (19.4%) and 302 (8.4%) patients experienced END and DND, respectively. Higher baseline NIHSS score, older age, large-artery occlusion due to significant atheroma, cardioembolic stroke subtype, hemorrhagic infarction and parenchymatous hematoma within 24 h were all independent predictors for both END (all p ≤ 0.01) and DND (all p ≤ 0.024). Moreover, higher baseline systolic blood pressure (BP) (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12), higher diastolic BP variability within 24 h (OR 1.07, 95% CI 1.04-1.09), patients from Asia (OR 1.25, 95% CI 1.03-1.52) were the only independent predictors for END. However, Asian ethnicity was negatively associated with DND (OR 0.64, 95% CI 0.47-0.86). Hemorrhagic infarction and parenchymatous hematoma within 24 h were the key predictors of END across all stroke subtypes. END and DND were all associated with a poor functional outcome at 90 days (all p &lt; 0.001).</p><p><strong>Conclusion: </strong>We identified overlapping and unique demographic and clinical predictors of END and DND after thrombolysis for AIS. Both END and DND predict unfavorable outcomes at 90 days.</p>","PeriodicalId":9683,"journal":{"name":"Cerebrovascular Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Cerebrovascular Diseases
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