Search

Background and purpose Our aim was to investigate whether pulsatile tinnitus ( PT) in cervical artery dissection (Ce AD) has prognostic significance. Methods All Ce AD patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) study with documentation of PT were analysed. The presence of PT was systematically assessed using a standardized questionnaire. Stroke severity at admission was defined according to the National Institutes of Health Stroke Scale ( NIHSS). Excellent outcome after 3 months was defined as a modified Rankin Scale of 0-1. Results Sixty-three of 778 patients (8.1%) reported PT. PT+ patients presented less often with ischaemic stroke (41.3% vs. 63.9%, P < 0.001), more often with dissection in the internal carotid artery (85.7% vs. 64.2%, P = 0.001), less often with vessel occlusion (19.0% vs. 34.1%, P = 0.017) and more often with excellent outcome at 3 months (92.1% vs. 75.4%, P = 0.002). Logistic regression analysis identified PT as an independent predictor of excellent outcome after 3 months [odds ratio ( OR) 3.96, 95% confidence interval ( CI) 1.22-12.87] adjusted to significant outcome predictors NIHSS on admission ( OR 0.82, 95% CI 0.79-0.86), Horner syndrome ( OR 1.95, 95% CI 1.16-3.29) and vessel occlusion ( OR 0.62, 95% CI 0.40-0.94) and to non-significant predictors age, sex, pain and location of Ce AD. Conclusion The presence of PT in Ce AD is associated with a benign clinical course and predicts a favourable outcome. [ABSTRACT FROM AUTHOR]

Background and purpose Patients with ischaemic stroke ( IS) caused by a spontaneous cervical artery dissection ( Ce AD) worry about an increased risk for stroke in their families. The occurrence of stroke in relatives of patients with Ce AD and in those with ischaemic stroke attributable to other (non- Ce AD) causes were compared. Methods The frequency of stroke in first-degree relatives (family history of stroke, FHS) was studied in IS patients ( Ce AD patients and age- and sex-matched non- Ce AD patients) from the Cervical Artery Dissection and Ischemic Stroke Patients ( CADISP) database. FHS ≤ 50 and FHS > 50 were defined as having relatives who suffered stroke at the age of ≤50 or >50 years. FHS ≤ 50 and FHS > 50 were studied in Ce AD and non-Ce AD IS patients and related to age, sex, number of siblings, hypertension, hypercholesterolemia, smoking and body mass index ( BMI). Results In all, 1225 patients were analyzed. FHS ≤ 50 was less frequent in Ce AD patients (15/598 = 2.5%) than in non-Ce AD IS patients (38/627 = 6.1%) ( P = 0.003; odds ratio 0.40, 95% confidence interval 0.22-0.73), also after adjustment for age, sex and number of siblings ( P = 0.005; odds ratio 0.42, 95% confidence interval 0.23-0.77). The frequency of FHS > 50 was similar in both study groups. Vascular risk factors did not differ between patients with positive or negative FHS ≤ 50. However, patients with FHS > 50 were more likely to have hypertension and higher BMI. Conclusion Relatives of Ce AD patients had fewer strokes at a young age than relatives of non-Ce AD IS stroke patients. [ABSTRACT FROM AUTHOR]

Background and purpose It has been suggested that inflammation may play a role in the development of cervical artery dissection ( Ce AD), but evidence remains scarce. Methods A total of 172 patients were included with acute (< 24 h) Ce AD and 348 patients with acute ischaemic stroke (IS) of other (non- Ce AD) causes from the Cervical Artery Dissection and Ischemic Stroke Patients ( CADISP) study, and 223 age- and sex-matched healthy control subjects. White blood cell ( WBC) counts collected at admission were compared across the three groups. Results Compared with healthy control subjects, Ce AD patients and non- Ce AD stroke patients had higher WBC counts ( P < 0.001). Patients with Ce AD had higher WBC counts and were more likely to have WBC > 10 000/μl than non- Ce AD stroke patients (38.4% vs. 23.0%, P < 0.001) and healthy controls (38.4% vs. 8.5%, P < 0.001). WBC counts were higher in Ce AD (9.4 ± 3.3) than in IS of other causes (large artery atherosclerosis, 8.7 ± 2.3; cardioembolism, 8.2 ± 2.8; small vessel disease, 8.4 ± 2.4; undetermined cause, 8.8 ± 3.1; P = 0.022). After adjustment for age, sex, stroke severity and vascular risk factors in a multiple regression model, elevated WBC count remained associated with Ce AD, as compared with non- Ce AD stroke patients [odds ratio (OR) = 2.56; 95% CI 1.60-4.11; P < 0.001) and healthy controls ( OR = 6.27; 95% CI 3.39-11.61; P < 0.001). Conclusions Acute Ce AD was associated with particularly high WBC counts. Leukocytosis may reflect a pre-existing inflammatory state, supporting the link between inflammation and Ce AD. [ABSTRACT FROM AUTHOR]

Neidert S, Katan M, Schuetz P, Fluri F, Ernst A, Bingisser R, Kappos L, Engelter ST, Steck A, Müller B, Christ-Crain M (University Hospital Basel, Basel, Switzerland; SphingoTec GmbH, Borgsorf, Germany; Kantonsspital Aarau, Aarau, Switzerland) Anterior pituitary axis hormones and outcome in acute ischaemic stroke. J Intern Med 2011; : 420-432. Early and accurate prediction of outcome in acute stroke is important and influences risk-optimized therapeutic strategies. Endocrine alterations of the hypothalamic-pituitary axis are amongst the first measurable alterations after cerebral ischaemia. We therefore evaluated the prognostic value of cortisol, triiodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH) and growth hormone (GH) in patients with an acute ischaemic stroke. In an observational study including 281 patients with ischaemic stroke, anterior pituitary axis hormones (i.e. cortisol, T3, fT4, TSH and GH) were simultaneously assessed to determine their value to predict functional outcome and mortality within 90 days and 1 year. In receiver operating characteristic curve analysis, the prognostic accuracy of cortisol was higher compared to all measured hormones and was in the range of the National Institutes of Health Stroke Scale (NIHSS). Cortisol was an independent prognostic marker of functional outcome and death [odds ratio (OR) 1.0 (1.0-1.01) and 1.62 (1.37-1.92), respectively, P < 0.0002 for both, adjusted for age and the NIHSS] in patients with ischaemic stroke, but added no significant additional predictive value to the clinical NIHSS score. Cortisol is an independent prognostic marker for death and functional outcome within 90 days and 1 year in patients with ischaemic stroke. By contrast, other anterior pituitary axis hormones such as peripheral thyroid hormones and GH are only of minor value to predict outcome in stroke. [ABSTRACT FROM AUTHOR]

Background and purpose: The aim of this study was to determine the prognostic significance of microbleeds in TIA-patients. In patients with a transient ischaemic attack (TIA), the prognostic value of microbleeds is unknown. Methods: In 176 consecutive TIA patients, the number, size, and location of microbleeds with or without acute ischaemic lesions were assessed. We compared microbleed-positive and microbleed-negative patients with regard to the end-point stroke within 3 months. Results: Four of the seven patients with subsequent stroke had microbleeds. Microbleed-positive patients had a higher risk for stroke [odds ratios (OR) 8.91, 95% CI 1.87-42.51, P < 0.01] than those without microbleeds. Microbleed-positive patients with accompanying acute ischaemic lesions had a higher stroke risk than those with neither an acute ischaemia nor a microbleed (OR 6.20, 95% CI 1.10-35.12; P = 0.04). Conclusion: Microbleeds alone or in combination with acute ischaemic lesions may increase the risk for subsequent ischaemic stroke after TIA within 3 months. [ABSTRACT FROM AUTHOR]