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1. Determinants and outcome of multiple and early recurrent cervical artery dissections

Author

Compter, A, Schilling, S, Vaineau, C, Goeggel-Simonetti, B, Metso, T, Southerland, A, Pezzini, A, Kloss, M, Touzé, E, Worrall, B, Thijs, V, Bejot, Y, Reiner, P, Grond-Ginsbach, C, Bersano, A, Brandt, T, Caso, V, Lyrer, P, Traenka, C, Lichy, C, Martin, J, Leys, D, Sarikaya, H, Baumgartner, R, Jung, S, Fischer, U, Engelter, S, Dallongeville, J, Chabriat, H, Tatlisumak, T, Bousser, M, Arnold, M, Debette, S, Abboud, S, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Leder, S, Léger, A, Deltour, S, Crozier, S, Méresse, I, Canaple, S, Godefroy, O, Giroud, M, Decavel, P, Medeiros, E, Montiel, P, Moulin, T, Vuillier, F, Amouyel, P, Metso, A, Werner, I, Santos, M, Dichgans, M, Thomas-Feles, C, Weber, R, De Giuli, V, Caria, F, Poli, L, Padovani, A, Lanfranconi, S, Beretta, S, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Bonati, L, Gensicke, H, Amort, M, Altintas, A, Markus, H, Majersik, J, Cole, J, Kittner, S, Buffon, F, Heldner, M, Mattle, H, Kurmann, R, Gralla, J, Compter, Annette, Schilling, Sabrina, Vaineau, Cloé Juliette, Goeggel-Simonetti, Barbara, Metso, Tiina M., Southerland, Andrew, Pezzini, Alessandro, Kloss, Manja, Touzé, Emmanuel, Worrall, Bradford B., Thijs, Vincent, Bejot, Yannick, Reiner, Peggy, Grond-Ginsbach, Caspar, Bersano, Anna, Brandt, Tobias, Caso, Valeria, Lyrer, Philippe A., Traenka, Christopher, Lichy, Christoph, Martin, Juan José, Leys, Didier, Sarikaya, Hakan, Baumgartner, Ralph W., Jung, Simon, Fischer, Urs, Engelter, Stefan T., Dallongeville, Jean, Chabriat, Hugues, Tatlisumak, Turgut, Bousser, Marie-Germaine, Arnold, Marcel, Debette, Stéphanie, Abboud S, Pandolfo M, Bodenant M, Louillet F, Mas JL, Leder S, Léger A, Deltour S, Crozier S, Méresse I, Canaple S, Godefroy O, Giroud M, Decavel P, Medeiros E, Montiel P, Moulin T, Vuillier F, Amouyel P, Metso AJ, Werner I, Arnold ML, Santos MD, Dichgans M, Thomas-Feles C, Weber R, De Giuli V, Caria F, Poli L, Padovani A, Lanfranconi S, Beretta S, Ferrarese C, Giacolone G, Paolucci S, Fluri F, Hatz F, Gisler D, Bonati L, Gensicke H, Amort M, Altintas A, Markus H, Majersik J, Cole J, Kittner S, Buffon F, Heldner MR, Mattle HP, Kurmann R, Gralla J., Compter, A, Schilling, S, Vaineau, C, Goeggel-Simonetti, B, Metso, T, Southerland, A, Pezzini, A, Kloss, M, Touzé, E, Worrall, B, Thijs, V, Bejot, Y, Reiner, P, Grond-Ginsbach, C, Bersano, A, Brandt, T, Caso, V, Lyrer, P, Traenka, C, Lichy, C, Martin, J, Leys, D, Sarikaya, H, Baumgartner, R, Jung, S, Fischer, U, Engelter, S, Dallongeville, J, Chabriat, H, Tatlisumak, T, Bousser, M, Arnold, M, Debette, S, Abboud, S, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Leder, S, Léger, A, Deltour, S, Crozier, S, Méresse, I, Canaple, S, Godefroy, O, Giroud, M, Decavel, P, Medeiros, E, Montiel, P, Moulin, T, Vuillier, F, Amouyel, P, Metso, A, Werner, I, Santos, M, Dichgans, M, Thomas-Feles, C, Weber, R, De Giuli, V, Caria, F, Poli, L, Padovani, A, Lanfranconi, S, Beretta, S, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Bonati, L, Gensicke, H, Amort, M, Altintas, A, Markus, H, Majersik, J, Cole, J, Kittner, S, Buffon, F, Heldner, M, Mattle, H, Kurmann, R, Gralla, J, Compter, Annette, Schilling, Sabrina, Vaineau, Cloé Juliette, Goeggel-Simonetti, Barbara, Metso, Tiina M., Southerland, Andrew, Pezzini, Alessandro, Kloss, Manja, Touzé, Emmanuel, Worrall, Bradford B., Thijs, Vincent, Bejot, Yannick, Reiner, Peggy, Grond-Ginsbach, Caspar, Bersano, Anna, Brandt, Tobias, Caso, Valeria, Lyrer, Philippe A., Traenka, Christopher, Lichy, Christoph, Martin, Juan José, Leys, Didier, Sarikaya, Hakan, Baumgartner, Ralph W., Jung, Simon, Fischer, Urs, Engelter, Stefan T., Dallongeville, Jean, Chabriat, Hugues, Tatlisumak, Turgut, Bousser, Marie-Germaine, Arnold, Marcel, Debette, Stéphanie, Abboud S, Pandolfo M, Bodenant M, Louillet F, Mas JL, Leder S, Léger A, Deltour S, Crozier S, Méresse I, Canaple S, Godefroy O, Giroud M, Decavel P, Medeiros E, Montiel P, Moulin T, Vuillier F, Amouyel P, Metso AJ, Werner I, Arnold ML, Santos MD, Dichgans M, Thomas-Feles C, Weber R, De Giuli V, Caria F, Poli L, Padovani A, Lanfranconi S, Beretta S, Ferrarese C, Giacolone G, Paolucci S, Fluri F, Hatz F, Gisler D, Bonati L, Gensicke H, Amort M, Altintas A, Markus H, Majersik J, Cole J, Kittner S, Buffon F, Heldner MR, Mattle HP, Kurmann R, and Gralla J.

Abstract

Objective To assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD). Methods We combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed. Results Of 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) hadmultiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29-2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34-2.46), family history of stroke (OR 1.55, 95% CI 1.06-2.25), cervical pain (OR 1.36, 95% CI 1.01-1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01-8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients withmultiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49-5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD. Conclusion Patients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.

Published
2018

2. Neurology

Author

Compter, Annette, Schilling, Sabrina, Vaineau, Cloé Juliette, Goeggel-Simonetti, Barbara, Metso, Tiina M., Southerland, Andrew, Pezzini, Alessandro, Kloss, Manja, Touzé, Emmanuel, Worrall, Bradford B., Thijs, Vincent, Bejot, Yannick, Reiner, Peggy, Grond-Ginsbach, Caspar, Bersano, Anna, Brandt, Tobias, Caso, Valeria, Lyrer, Philippe A., Traenka, Christopher, Lichy, Christoph, Martin, Juan José, Leys, Didier, Sarikaya, Hakan, Baumgartner, Ralph W., Jung, Simon, Fischer, Urs, Engelter, Stefan T., Dallongeville, Jean, Chabriat, Hugues, Tatlisumak, Turgut, Bousser, Marie-Germaine, Arnold, Marcel, Debette, Stéphanie, in CADIPS-Group, C. Ferrarese Collaborators (51): Abboud S, Pandolfo M, Bodenant M, Louillet F, Mas JL, Leder S, Léger A, Deltour S, Crozier S, Méresse I, Canaple S, Godefroy O, Giroud M, Decavel P, Medeiros E, Montiel P, Moulin T, Vuillier F, Amouyel P, Metso AJ, Werner I, Arnold ML, Santos MD, Dichgans M, Thomas-Feles C, Weber R, De Giuli V, Caria F, Poli L, Padovani A, Lanfranconi S, Beretta S, Ferrarese C, Giacolone G, Paolucci S, Fluri F, Hatz F, Gisler D, Bonati L, Gensicke H, Amort M, Altintas A, Markus H, Majersik J, Cole J, Kittner S, Buffon F, Heldner MR, Mattle HP, Kurmann R, Gralla J., Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Compter, A, Schilling, S, Vaineau, C, Goeggel-Simonetti, B, Metso, T, Southerland, A, Pezzini, A, Kloss, M, Touzé, E, Worrall, B, Thijs, V, Bejot, Y, Reiner, P, Grond-Ginsbach, C, Bersano, A, Brandt, T, Caso, V, Lyrer, P, Traenka, C, Lichy, C, Martin, J, Leys, D, Sarikaya, H, Baumgartner, R, Jung, S, Fischer, U, Engelter, S, Dallongeville, J, Chabriat, H, Tatlisumak, T, Bousser, M, Arnold, M, Debette, S, In, C, C., F, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Leder, S, Léger, A, Deltour, S, Crozier, S, Méresse, I, Canaple, S, Godefroy, O, Giroud, M, Decavel, P, Medeiros, E, Montiel, P, Moulin, T, Vuillier, F, Amouyel, P, Metso, A, Werner, I, Santos, M, Dichgans, M, Thomas-Feles, C, Weber, R, De Giuli, V, Caria, F, Poli, L, Padovani, A, Lanfranconi, S, Beretta, S, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Bonati, L, Gensicke, H, Amort, M, Altintas, A, Markus, H, Majersik, J, Cole, J, Kittner, S, Buffon, F, Heldner, M, Mattle, H, Kurmann, R, and Gralla, J

Subjects
Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Vertebral artery dissection, International Cooperation, 030204 cardiovascular system & hematology, Ribosomal Protein S6 Kinases, 90-kDa, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Risk Factors, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, Thrombolytic Therapy, Family history, Stroke, Vertebral Artery Dissection, business.industry, Hazard ratio, Odds ratio, Middle Aged, medicine.disease, Magnetic Resonance Imaging, 3. Good health, Logistic Models, Treatment Outcome, VINTAGE, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery, Fibrinolytic agent, Cohort study
Abstract

ObjectiveTo assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD).MethodsWe combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed.ResultsOf 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) had multiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29–2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34–2.46), family history of stroke (OR 1.55, 95% CI 1.06–2.25), cervical pain (OR 1.36, 95% CI 1.01–1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01–8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients with multiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49–5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD.ConclusionPatients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.

Published
2018

3. Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers

Author

Traenka, C, Dougoud, D, Simonetti, B, Metso, T, Debette, S, Pezzini, A, Kloss, M, Grond Ginsbach, C, Majersik, J, Worrall, B, Leys, D, Baumgartner, R, Caso, V, Béjot, Y, Compter, A, Reiner, P, Thijs, V, Southerland, A, Bersano, A, Brandt, T, Gensicke, H, Touzé, E, Martin, J, Chabriat, H, Tatlisumak, T, Lyrer, P, Arnold, M, Engelter, S, Abboud, S, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Leder, S, Léger, A, Deltour, S, Crozier, S, Méresse, I, Canaple, S, Godefroy, O, Giroud, M, Decavel, P, Medeiros, E, Montiel, P, Moulin, T, Vuillier, F, Amouyel, P, Wiest, T, Werner, I, Santos, M, Dichgans, M, Thomas Feles, C, Weber, R, Del Zotto, E, Giossi, A, Volonghi, I, Padovani, A, Poli, L, Morotti, A, Lanfranconi, S, Baron, P, Beretta, S, Ferrarese, C, Giacolone, G, Fluri, F, Hatz, F, Gisler, D, Bonati, Amort, M, Markus, H, Meschia, J, Cole, J, Kittner, S, Buffon, F, Mawet, J, Heldner, M, Mattle, H, Gralla, J, Engelter, ST, Abboud S, Pandolfo M, Bodenant M, Louillet F, Mas JL, Leder S, Léger A, Deltour S, Crozier S, Méresse I, Canaple S, Godefroy O, Giroud M, Decavel P, Medeiros E, Montiel P, Moulin T, Vuillier F, Amouyel P, Wiest T, Werner I, Arnold ML, Santos MD, Dichgans M, Thomas Feles C, Weber R, Del Zotto E, Giossi A, Volonghi I, Padovani A, Poli L, Morotti A, Lanfranconi S, Baron P, Beretta S, Giacolone G, Fluri F, Hatz F, Gisler D, Amort M, Markus H, Meschia JF, Cole J, Kittner S, Buffon F, Mawet J, Heldner MR, Mattle HP, Gralla J., FERRARESE, CARLO, Traenka, C, Dougoud, D, Simonetti, B, Metso, T, Debette, S, Pezzini, A, Kloss, M, Grond Ginsbach, C, Majersik, J, Worrall, B, Leys, D, Baumgartner, R, Caso, V, Béjot, Y, Compter, A, Reiner, P, Thijs, V, Southerland, A, Bersano, A, Brandt, T, Gensicke, H, Touzé, E, Martin, J, Chabriat, H, Tatlisumak, T, Lyrer, P, Arnold, M, Engelter, S, Abboud, S, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Leder, S, Léger, A, Deltour, S, Crozier, S, Méresse, I, Canaple, S, Godefroy, O, Giroud, M, Decavel, P, Medeiros, E, Montiel, P, Moulin, T, Vuillier, F, Amouyel, P, Wiest, T, Werner, I, Santos, M, Dichgans, M, Thomas Feles, C, Weber, R, Del Zotto, E, Giossi, A, Volonghi, I, Padovani, A, Poli, L, Morotti, A, Lanfranconi, S, Baron, P, Beretta, S, Ferrarese, C, Giacolone, G, Fluri, F, Hatz, F, Gisler, D, Bonati, Amort, M, Markus, H, Meschia, J, Cole, J, Kittner, S, Buffon, F, Mawet, J, Heldner, M, Mattle, H, Gralla, J, Engelter, ST, Abboud S, Pandolfo M, Bodenant M, Louillet F, Mas JL, Leder S, Léger A, Deltour S, Crozier S, Méresse I, Canaple S, Godefroy O, Giroud M, Decavel P, Medeiros E, Montiel P, Moulin T, Vuillier F, Amouyel P, Wiest T, Werner I, Arnold ML, Santos MD, Dichgans M, Thomas Feles C, Weber R, Del Zotto E, Giossi A, Volonghi I, Padovani A, Poli L, Morotti A, Lanfranconi S, Baron P, Beretta S, Giacolone G, Fluri F, Hatz F, Gisler D, Amort M, Markus H, Meschia JF, Cole J, Kittner S, Buffon F, Mawet J, Heldner MR, Mattle HP, Gralla J., and FERRARESE, CARLO

Abstract

Objective: In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥ 60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged ,60 vs ≥ 60 years. Methods: We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients-Plus consortium). We dichotomized cases into 2 groups, age ≥ 60 and ,60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated. Results: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥ 60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 3.08 [2.25-4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0-2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]). Conclusion: In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥ 60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.

Published
2017

4. Stroke in first-degree relatives of patients with cervical artery dissection

Author

Kloss, M, Grond Ginsbach, C, Pezzini, A, Metso, T, Metso, A, Debette, S, Leys, D, Dallongeville, J, Caso, V, Thijs, V, Bersano, A, Touzé, E, Bonati, L, Tatlisumak, T, Arnold, M, Lyrer, P, Engelter, S, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Deltour, S, Anne Léger, N, Canaple, S, Godefroy, O, Yannick Béjot, N, Moulin, T, Vuillier, F, Santos, M, Malik, R, Hausser, I, Brandt, T, Thomas Feles, C, Weber, R, Giossi, A, Volonghi, I, Padovani, A, Lanfranconi, S, Baron, P, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Amort, M, Bevan, S, Altintas, A., FERRARESE, CARLO, Kloss, M, Grond Ginsbach, C, Pezzini, A, Metso, T, Metso, A, Debette, S, Leys, D, Dallongeville, J, Caso, V, Thijs, V, Bersano, A, Touzé, E, Bonati, L, Tatlisumak, T, Arnold, M, Lyrer, P, Engelter, S, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Deltour, S, Anne Léger, N, Canaple, S, Godefroy, O, Yannick Béjot, N, Moulin, T, Vuillier, F, Santos, M, Malik, R, Hausser, I, Brandt, T, Thomas Feles, C, Weber, R, Giossi, A, Volonghi, I, Padovani, A, Lanfranconi, S, Baron, P, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Amort, M, Bevan, S, and Altintas, A

Subjects
Adult, Male, medicine.medical_specialty, Vertebral artery dissection, Young stroke, Brain Ischemia, Nuclear Family, Family history of stroke (FHS), Risk Factors, Internal medicine, medicine, Humans, First-degree relatives, Family history, Young adult, Stroke, Vertebral Artery Dissection, business.industry, Risk Factor, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Surgery, Neurology, Female, Neurology (clinical), business, Cervical artery dissection (CeAD), Body mass index, Human
Abstract

Background and purpose Patients with ischaemic stroke (IS) caused by a spontaneous cervical artery dissection (CeAD) worry about an increased risk for stroke in their families. The occurrence of stroke in relatives of patients with CeAD and in those with ischaemic stroke attributable to other (non-CeAD) causes were compared. Methods The frequency of stroke in first-degree relatives (family history of stroke, FHS) was studied in IS patients (CeAD patients and age- and sex-matched non-CeAD 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 CeAD and non-CeAD 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 CeAD patients (15/598 = 2.5%) than in non-CeAD 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 CeAD patients had fewer strokes at a young age than relatives of non-CeAD IS stroke patients.

Published
2014

5. Prognostic significance of pulsatile tinnitus in cervical artery dissection

Author

Kellert, L, Kloss, M, Pezzini, A, Debette, S, Leys, D, Caso, V, Thijs, V, Bersano, A, Touzé, E, Tatlisumak, T, Traenka, C, Lyrer, P, Engelter, S, Metso, T, Grond Ginsbach, C, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Deltour, S, Léger, A, Canaple, S, Godefroy, O, Béjot, Y, Moulin, T, Vuillier, F, Dos Santos, M, Malik, R, Hausser, I, Brandt, T, Thomas Feles, C, Weber, R, Costa, P, Poli, L, Morotti, A, Padovani, A, Lanfranconi, S, Baron, P, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Amort, M, Bevan, S, Altintas, A, Altintas, A., FERRARESE, CARLO, Kellert, L, Kloss, M, Pezzini, A, Debette, S, Leys, D, Caso, V, Thijs, V, Bersano, A, Touzé, E, Tatlisumak, T, Traenka, C, Lyrer, P, Engelter, S, Metso, T, Grond Ginsbach, C, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Deltour, S, Léger, A, Canaple, S, Godefroy, O, Béjot, Y, Moulin, T, Vuillier, F, Dos Santos, M, Malik, R, Hausser, I, Brandt, T, Thomas Feles, C, Weber, R, Costa, P, Poli, L, Morotti, A, Padovani, A, Lanfranconi, S, Baron, P, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Amort, M, Bevan, S, Altintas, A, Altintas, A., and FERRARESE, CARLO

Abstract

Background and purpose: Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance. Methods: All CeAD 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 CeAD. Conclusion: The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.

Published
2016

6. Anemia in young patients with ischaemic stroke

Author

Kellert, L, Kloss, M, Pezzini, A, Metso, T, Metso, A, Debette, S, Leys, D, Caso, V, Thijs, V, Bersano, A, Touzé, E, Tatlisumak, T, Gensicke, H, Lyrer, P, Bösel, J, Engelter, S, Grond-Ginsbach, C, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Deltour, S, Léger, A, Canaple, S, Godefroy, O, Béjot, Y, Moulin, T, Vuillier, F, Dos Santos, M, Malik, R, Hausser, I, Brandt, T, Thomas-Feles, C, Weber, R, Poli, L, Morotti, A, Padovani, A, Lanfranconi, S, Baron, P, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Amort, M, Bevan, S, Altintas, A, Mas, JL, Kellert, L, Kloss, M, Pezzini, A, Metso, T, Metso, A, Debette, S, Leys, D, Caso, V, Thijs, V, Bersano, A, Touzé, E, Tatlisumak, T, Gensicke, H, Lyrer, P, Bösel, J, Engelter, S, Grond-Ginsbach, C, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Deltour, S, Léger, A, Canaple, S, Godefroy, O, Béjot, Y, Moulin, T, Vuillier, F, Dos Santos, M, Malik, R, Hausser, I, Brandt, T, Thomas-Feles, C, Weber, R, Poli, L, Morotti, A, Padovani, A, Lanfranconi, S, Baron, P, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Amort, M, Bevan, S, Altintas, A, and Mas, JL

Abstract

Background and purpose: To investigate the association of anemia on admission with ischaemic stroke (IS), stroke severity and early functional outcome in patients with cervical artery dissection (CeAD) or with IS of other causes (non-CeAD-IS patients). Methods: The study sample comprised all patients from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) study without pre-existing disability and with documentation of stroke severity and hemoglobin (Hb) concentration on admission. Anemia was classified as mild (Hb < 12 g/dl in women and Hb < 13 g/dl in men) or moderate to severe (Hb < 10 g/dl in women and Hb < 11 g/dl in men). Stroke severity on admission was assessed with the National Institutes of Health Stroke Scale (NIHSS). Outcome after 3 months was assessed with the modified Rankin Scale (mRS-3mo). Unfavorable outcome was defined as mRS-3mo ≥ 3. Results: Amongst 1206 study patients (691 CeAD and 515 non-CeAD), 87 (7.2%) had anemia, which was moderate to severe in 18 (1.5%) patients. Anemia was associated with female sex in both study samples, but no further associations with risk factors or comorbidities were observed. In CeAD patients, anemia was associated with occurrence of stroke (P = 0.042). In both study samples, anemic patients had more severe strokes (CeAD, P = 0.023; non-CeAD, P = 0.005). Functional outcome was not associated with anemia in general, but moderate to severe anemia was significantly associated with unfavorable outcome (P = 0.004). Conclusion: Anemia on admission was associated with stroke in CeAD patients and with more severe strokes in both study samples. Moderate to severe anemia may predict unfavorable outcome.

Published
2015

8. Prognostic significance of pulsatile tinnitus in cervical artery dissection

Author

Kellert, L., Kloss, M., Pezzini, Alessandro, Debette, S., Leys, D., Caso, V., Thijs, V. N., Bersano, A., Touzé, E., Tatlisumak, T., Traenka, C., Lyrer, P. A., Engelter, S. T., Metso, T. M., Grond Ginsbach, C., Pandolfo, Massimo, Bodenant, Marie, Louillet, Fabien, Mas, Jean Louis, Deltour, Sandrine, Léger, Anne, Canaple, Sandrine, Godefroy, Olivier, Béjot, Yannick, Moulin, Thierry, Vuillier, Fabrice, Dos Santos, Michael, Malik, Rainer, Hausser, Ingrid, Brandt, Tobias, Thomas Feles, Constanze, Weber, Ralf, Costa, Paolo, Poli, Loris, Morotti, Andrea, Padovani, Alessandro, Lanfranconi, Silvia, Baron, Pierluigi, Ferrarese, Carlo, Giacolone, Giacomo, Paolucci, Stefano, Fluri, Felix, Hatz, Florian, Gisler, Dominique, Amort, Margareth, Bevan, Steve, Altintas, Ayse, Heidelberg University Hospital [Heidelberg], Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Troubles cognitifs dégénératifs et vasculaires - U 1171 (TCDV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Università degli Studi di Perugia = University of Perugia (UNIPG), University Hospitals Leuven [Leuven], Physiopathologie et imagerie des troubles neurologiques (PhIND), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie [CHU Caen], Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), CHU Amiens-Picardie, Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study group, Kellert, L, Kloss, M, Pezzini, A, Debette, S, Leys, D, Caso, V, Thijs, V, Bersano, A, Touzé, E, Tatlisumak, T, Traenka, C, Lyrer, P, Engelter, S, Metso, T, Grond Ginsbach, C, Pandolfo, M, Bodenant, M, Louillet, F, Mas, J, Deltour, S, Léger, A, Canaple, S, Godefroy, O, Béjot, Y, Moulin, T, Vuillier, F, Dos Santos, M, Malik, R, Hausser, I, Brandt, T, Thomas Feles, C, Weber, R, Costa, P, Poli, L, Morotti, A, Padovani, A, Lanfranconi, S, Baron, P, Ferrarese, C, Giacolone, G, Paolucci, S, Fluri, F, Hatz, F, Gisler, D, Amort, M, Bevan, S, and Altintas, A

Subjects
Adult, Male, medicine.medical_specialty, Cervical Artery, Vertebral artery dissection, acute ischaemic stroke, cervical artery dissection, outcome, pulsatile tinnitus, Neurology (clinical), Neurology, Dissection (medical), 030204 cardiovascular system & hematology, Brain Ischemia, Tinnitus, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Modified Rankin Scale, medicine.artery, Internal medicine, medicine, Humans, Stroke, Vertebral Artery Dissection, business.industry, Odds ratio, Middle Aged, Prognosis, medicine.disease, Confidence interval, Surgery, Cardiology, Female, Internal carotid artery, business, pulsatile tinnitu, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Background and purpose Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance. Methods All CeAD 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 CeAD. Conclusion The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.

Published
2016

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