Risk Factor For Hemorrhagic Stroke Research Articles

Abstract 4143227: Incidence of Hemorrhagic Stroke in Hypertrophic Cardiomyopathy

Background: Individuals with hypertrophic cardiomyopathy (HCM) have an elevated risk of ischemic stroke, primarily driven by the increased risk of atrial fibrillation (AF) development in this patient population. This risk remains elevated regardless of CHADS2VASC score; thus, anticoagulation is recommended for all HCM patients with AF. Given the known association between anticoagulant medications and hemorrhagic events, there is likely an assumed risk of hemorrhagic stroke in these individuals. Currently, the incidence of hemorrhagic stroke in HCM and its relationship to AF and anticoagulation has not been well-established in the literature. The goal of this study was to establish the presence of and risk factors for hemorrhagic stroke in individuals with HCM. Methods: A retrospective review of all HCM patients ages 18 and older in our institution’s health system was performed from 2019-2023. ICD 10 codes were used to identify individuals with hemorrhagic stroke. Patient charts were reviewed for additional data including demographics, comorbid conditions, anticoagulant prescription, and other inciting factors prior to the hemorrhagic event. Results: The study cohort comprised 343 HCM patients, of which 47.1% were female and 72.7% were Caucasian. Concurrently, 30% (n=103) had a diagnosis of AF. The overall incidence of hemorrhagic stroke was 2.9% (5.8%, n=6 in those with AF vs 1.7%, n=4 in those without AF); furthermore, AF was associated with a non-statistically significant increased risk of hemorrhagic stroke (RR = 3.36, 95% CI 0.97-11.7). Anticoagulant use at the time of hemorrhagic event was observed in 4 individuals (67%) with AF and 1 individual (25%) without AF. Head trauma and falls were frequently observed as precipitating events prior to hospital admission for hemorrhagic stroke, occurring in 83% (n = 5) of patients with AF and 50% (n = 2) of those without AF. Conclusions: While ischemic stroke and anticoagulant use are commonly studied in those with HCM, the incidence of hemorrhagic stroke in this population is not negligible. Risk of hemorrhagic events in HCM appears largely influenced by anticoagulant use, particularly in those with concurrent AF, and by head trauma. Given the known benefits of anticoagulation on ischemic stroke risk in the HCM population, appropriate counseling and careful attention to individual patient factors may be warranted in the administration of anticoagulants.

Abstract 116: Increased Collagen I/Collagen III Ratio is Associated With Hemorrhage in Brain Arteriovenous Malformations in Human and Mouse

Background and purpose: Brain arteriovenous malformation (bAVM) is an important risk factor for hemorrhagic stroke in young adults, but the underlying mechanisms are unclear. Increase of Col I/Col III ratio enhances vessel wall stiffness and renders vessel less resistant to changes of blood flow and pressure. Hypothesis: Col I/Col III ratio is increased in bAVM vessels, which is associated with bAVM hemorrhage. Method: Human bAVMs were collected from HHT and sporadic bAVM patients. Temporal lobe specimens from epilepsy patients were used as controls. Three mouse models were used: 1) PdgfbicreER; Alk1 f/f ; 2) PdgfbicreER; Eng f/f ; 3) Alk 1 f/f . Mice in models 1 and 2 have Pdgfb promoter driving, tamoxifen (TM) inducible cre expression in endothelial cells (ECs). BAVMs were induced by intra-brain injection of AAV-VEGF to induce angiogenesis and i.p. injection of TM to delete Alk1 or Eng in ECs. In model 3, bAVMs were by intra-brain injection of AAV-VEGF and an adenoviral vector expressing Cre to delete Alk1 gene focally. Colony stimulating factor receptor inhibitor (PLX5622) was given to Alk1 f/f mice 8 week after model induction when bAVMs have fully developed to transiently deplete microglia. Vascular Col I and Col III levels were analyzed by immunostaining using anti- CD31 and anti-Col I or Col II antibodies. Brain AVM bleeding was detected by Prussian blue staining, and RNA-Sequencing used to study gene profiles. Results: Col I and Col III levels and the Col I/Col III ratio were higher in the vessels of human HHT and sporadic bAVM than controls. Col I/Col III ratio was higher in ruptured than unruptured sporadic bAVM. RNA-seq data shown that Col I and Co III mRNA levels were higher in Eng deficient bAVMs than normal brain angiogenic regions. Col I and Col III levels were higher on Alk1 and Eng deficient bAVMs compared to normal vessels. Col I/Col III ratio was also increased in the Alk1 deficient bAVMs. Depletion of microglia by PLX5622 reduced Col I and Col III levels and reduced microhemorrhage of Alk1 deficient bAVMs. Conclusion: Col I, Col III and Col I/Col III ratio are increased on human and mouse bAVM vessels, which is associated with bAVM hemorrhage. Depletion of microglia reduces Col I and Col III and hemorrhage in bAVMs in mice.

Hemorrhagic stroke in children.

Hemorrhagic stroke (HS) in childhood accounts for almost 50% of childhood strokes, is among the top ten causes of deaths, or determines lifelong disability. These facts form significant socio-economic and demographic problems. The purpose of this review is to analyze current knowledge about HS in children. The data on HS terminology are presented, taking into account the International Classification of Diseases 11 edition. Attention is paid to the epidemiology of HS in children, including the results of individual local studies. The risk factors of HS in children were studied with an analysis of the causal, pathophysiological mechanisms of HS of various etiologies. The ideas about the clinical manifestations of HS in children are described. The analysis of HS treatment in children was carried out with an emphasis on achievements in neurointensive therapy of the acute period of HS. This review also includes information on the outcomes of HS in children.

The causal effects between gut microbiota and hemorrhagic stroke: a bidirectional two-sample Mendelian randomization study.

Recent studies have suggested that the composition of gut microbiota (GM) may change after intracerebral hemorrhage. However, the causal inference of GM and hemorrhagic stroke is unknown. Mendelian Randomization (MR) is an effective research method that removes confounding factors and investigates the causal relationship between exposure and outcome. This study intends to explore the causal relationship between GM and hemorrhagic stroke with the help of MR. Univariable and multivariable MR analyses were performed using summary statistics of the GM (n = 18,340) in the MiBioGen consortium vs. the FinnGen consortium R9 summary statistics (intracerebral hemorrhage, subarachnoid hemorrhage, and nontraumatic intracranial hemorrhage). Causal associations between gut microbiota and hemorrhagic stroke were analyzed using inverse variance weighted, MR-Egger regression, weighted median, weighted mode, simple mode, and MR-PRESSO. Cochran's Q statistic, MR-Egger regression, and leave-one-out analysis were used to test for multiplicity and heterogeneity of instrumental variables. Separate reverse MR analyses were performed for microbiota found to be causally associated with hemorrhagic stroke in the forward MR analysis. Also, multivariate MR analyses were conducted after incorporating common confounders. Based on the results of univariable and multivariate MR analyses, Actinobacteria (phylum) (OR, 0.80; 95%CI, 0.66-0.97; p = 0.025) had a protective effect against hemorrhagic stroke, while Rikenellaceae RC9 gut group (genus) (OR, 0.81; 95%CI, 0.67-0.99; p = 0.039) had a potential protective effect. Furthermore, Dorea (genus) (OR, 1.77; 95%CI, 1.27-2.46; p = 0.001), Eisenbergiella (genus) (OR, 1.24; 95%CI, 1.05-1.48; p = 0.013) and Lachnospiraceae UCG008 (genus) (OR, 1.28; 95%CI, 1.01-1.62; p = 0.041) acted as potential risk factors for hemorrhagic stroke. The abundance of Dorea (genus) (β, 0.05; 95%CI, 0.002 ~ 0.101; p = 0.041) may increase, and that of Eisenbergiella (genus) (β, -0.072; 95%CI, -0.137 ~ -0.007; p = 0.030) decreased after hemorrhagic stroke according to the results of reverse MR analysis. No significant pleiotropy or heterogeneity was detected in any of the MR analyses. There is a significant causal relationship between GM and hemorrhagic stroke. The prevention, monitoring, and treatment of hemorrhagic stroke through GM represent a promising avenue and contribute to a deeper understanding of the mechanisms underlying hemorrhagic stroke.

Association between Hemorrhagic Stroke and Diabetes Mellitus; A Hospital-Based Case-Control Study

Introduction: Stroke is the third leading cause of death in the world. Numerous studies show that diabetes mellitus is one of the risk factors for stroke. In general, stroke is divided into two types: hemorrhagic & ischemic, and approximately 15-25% of strokes are the hemorrhagic type. 
 Objective: As it is claimed that diabetes mellitus is an important risk factor for hemorrhagic stroke, this study attempts to explain the association between diabetes and hemorrhagic stroke.
 Method and Data Collection: According to Epi Info statistic software; 102 participants who were 40≥ years old, and had a hemorrhagic stroke in their brain CT scan or MRI, were selected as cases, and 255 Participants without having a hemorrhagic stroke, including as controls. The proportional distribution of cases and controls in terms of sex and age was considered. Data has been obtained primarily through the design of a questionnaire from admitted patients in the neurosurgery and neurology wards of Aliabad university hospital. 
 Results: Out of 357 participants, 181 (50.7%) participants were female and 176 (49.3%) were male. The study found that 25.5% of the participants in the case group, and 13.3% of the participants in the control group, were exposed to diabetes mellitus. 
 Considering (P-Value = 0.006) and Odds ratio (OR=2.224; 95% CI = 1.253 – 3.945), the association between hemorrhagic Stroke and diabetes mellitus is suggested to be significant.
 Conclusion: As a result of the study, we can claim that among other risk factors, Diabetes Mellitus can also be considered a possible predisposing factor for Hemorrhagic Stroke and there is a significant association between Hemorrhagic stroke and Diabetes mellitus.

Abstract 12039: Association Between Idiopathic Thrombocytopenic Purpura and Risk of Hemorrhagic Stroke: A Nationwide Inpatient Sample Study

Background: Strokes are a major cause of morbidity and mortality worldwide. Low platelet counts are a known risk factor for hemorrhagic stroke, but the association between idiopathic thrombocytopenic purpura (ITP) and different types of strokes remains unclear. Objective: To investigate the impact of ITP on the prevalence of different types of strokes using the Nationwide Inpatient Sample (NIS) database. Methods: We analyzed data from 382,170,108 patients, including 535,602 patients with ITP, from the NIS database. We compared the prevalence of hemorrhagic and non-hemorrhagic strokes between patients with and without ITP. Results: From 2005 to 2014, hemorrhagic stroke occurred in 0.7% to 1.6% of ITP patients compared to 0.4% to 0.6% of patients without ITP. The odds ratio for hemorrhagic stroke in ITP patients was 1.75-2.19, with a statistically significant association in all ten years. Multivariate analysis adjusted for gender, age, race, and hypertension confirmed the positive association between ITP and hemorrhagic stroke across all ten years. Conclusion: Our study provides evidence of a positive association between ITP and hemorrhagic stroke, highlighting the need for increased vigilance in managing patients with ITP. The findings have important implications for clinical practice and suggest the need for further studies to elucidate the mechanisms underlying this association.

Trends in hemorrhagic stroke incidence and mortality in a National Stroke Registry of a multi-ethnic Asian population.

High-quality epidemiological data on hemorrhagic stroke (HS) and its subtypes, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), remains limited in Asian ethnicities. We investigated the trends in HS incidence and 30-day mortality from 2005 to 2019 in a multi-ethnic Asian population from a national registry. Data on all stroke cases from the Singapore Stroke Registry from 2005 to 2019 were collected. Cases were defined using centrally adjudicated review of diagnosis codes. Death outcomes were obtained by linkage with the national death registry. Incidence (per 100,000 people) and 30-day mortality (per 100 people) were measured as crude and age-standardized rates. Trends were analyzed using linear regression. We analyzed 19,017 cases of HS (83.9% ICH; 16.1% SAH). From 2005 to 2019, age-standardized incidence rates (ASIR) for HS remained stable from 34.4 to 34.5. However, age-standardized mortality rates (ASMR) decreased significantly from 29.5 to 21.4 (p < 0.001). For ICH, ASIR remained stable while ASMR decreased from 30.4 to 21.3 (p < 0.001); for SAH, ASIR increased from 2.7 to 6.0 (p = 0.006) while ASMR remained stable. In subgroup analyses, HS incidence increased significantly in persons <65 years (from 18.1 to 19.6) and Malays (from 39.5 to 49.7). From 2005 to 2019, ASIR of HS remained stable while ASMR decreased. Decreasing ASMR reflects improvements in the overall management of HS, consistent with global trends. Population health efforts to address modifiable risk factors for HS in specific demographic subgroups may be warranted to reduce incidence and mortality of HS.

Comparison of risk factors for hemorrhagic stroke and ischemic stroke, a prospective long-term follow-up cohort study

Objective: To analyze and compare the risk factors for hemorrhagic stroke and ischemic stroke and understand the exposure levels in population. Methods: A cohort study of risk factors of stroke was conducted in a rural community in Fengxian District of Shanghai in 2003, and the common risk factors of stroke were investigated at baseline survey, the cerebrovascular hemodynamics indexes were detected, the cerebrovascular function score was calculated according to the unified integral rule, and the incidence of stroke was observed in follow up. The risk factors for hemorrhagic stroke and ischemic stroke were analyzed by cohort study. The risk factors for two subtypes of stroke were compared. Result: A total of 10 565 participants were included in the study, with a mean follow-up period of (11.15±2.26) years, and 103 hemorrhagic stroke cases and 268 ischemic stroke cases were observed during follow-up period. The independent risk factors of hemorrhagic stroke included decreased cerebrovascular function score [hazard ratio (HR)=1.56, 95%CI: 1.23-1.98], history of alcohol consumption (HR=2.46, 95%CI: 1.39-4.34), hypertension (HR=1.75, 95%CI: 1.00-3.07) and older age (HR=1.07, 95%CI: 1.04-1.10). The independent risk factors of ischemic stroke included decreased cerebrovascular function score (HR=1.43, 95%CI: 1.25-1.65), smoking history (HR=1.52, 95%CI: 1.13-2.05), hypertension (HR=1.51, 95%CI: 1.10-2.07), family history of stroke (HR=1.89, 95%CI: 1.13-3.15), left ventricular hypertrophy (HR=1.74, 95%CI: 1.07-2.81) and older age (HR=1.07, 95%CI: 1.05-1.08). Conclusions: Decreased cerebrovascular function score, hypertension, and older age were common independent risk factors of both types of stroke, alcohol consumption history was an independent risk factor of hemorrhagic stroke, and smoking history, and family history of stroke and left ventricular hypertrophy were independent risk factors of ischemic stroke.

ALDH2 rs671 Polymorphism Likely a Risk Factor for Hemorrhagic Stroke: A Hospital-Based Study.

Hypertension is the main risk factor for hemorrhagic stroke. Aldehyde dehydrogenase 2 (ALDH2) may inhibit the occurrence of hypertension by anti-oxidative stress and vascular dilation. The purpose was to investigate the relationship of ALDH2 polymorphisms with hemorrhagic stroke in Hakka Chinese. A total of 329 patients with hemorrhagic stroke and 515 controls were enrolled, and medical records (smoking and drinking history, hypertension, and diabetes) were collected. The genotypes of ALDH2 rs671 of the two groups were detected and analyzed. The proportion of the ALDH2 rs671 G/G, G/A, and A/A genotype in patients with hemorrhagic stroke was 55.9%, 37.4%, and 6.7%, respectively, while those were 65.0%, 30.7%, and 4.3% in controls, respectively. There was statistically significant difference in ALDH2 rs671 genotypes distribution (P=0.021) and alleles distribution (P=0.005) between patients and controls. Among hemorrhagic stroke patients, no statistically significant differences were observed between patients with ALDH2 different genotypes. Logistic regression analysis showed that there was significantly high risk of hemorrhagic stroke in men (male vs female: adjusted OR 1.711, 95% CI 1.154-2.538, P=0.008), the presence of hypertension (with vs without hypertension: adjusted OR 16.095, 95% CI 10.958-23.641, P<0.001), and the presence of ALDH2 rs671 G/A genotype (G/A vs G/G: adjusted OR 1.679, 95% CI 1.151-2.450, P=0.007) or A/A genotype (A/A vs G/G: adjusted OR 2.516, 95% CI 1.132-5.591, P=0.024). ALDH2 rs671 polymorphism likely a risk factor for hemorrhagic stroke.

High Risk of Obstructive Sleep Apnea in Hemorrhagic Stroke Patient

Background: Stroke is one of the biggest causes of mortality and morbidity in the world, about 10% - 20% are caused by hemorrhagic strokes. Obstructive Sleep Apnea (OSA) is a sleep disorder that is often found in 5-15% of the general population and has a high prevalence in patients with cerebrovascular disease. Case summary: A 51 year old female with a sudden loss of consciousness since 1 day ago, while working. The patient has a history of hypertension since 2014. On computerized tomography scan (CT scan) of the head without contrast shows bleeding. During hospitalization, it appears that the patient snoring, easily falls asleep during the day and there are periods of apnea when the patient sleeps. The blood gas analysis was normal. The patient's sleep score shows high risk of OSA. Discussion: Patient with a hemorrhagic stroke and high risk OSA. There are several risk factors that influence the emergence of OSA in this case, obesity and hypertension. The therapy is to prohibit positioning, sleep hygiene, and losing weight. Conclusion: We have reported a case of hemorrhagic stroke with a high risk of OSA that was experienced long before. The high risk of OSA in these patients can be a risk factor for hemorrhagic stroke. Polysomnography examination needs to be done in patients with a high risk of OSA, as the gold standard. Management of these patients apart from giving pharmacological therapy combined with behavioral and positional therapy to treat OSA symptoms. Mandibular enhancement devices and continuous positive airway pressure (CPAP) have not been given to this patient because polysomnography has not been performed and cost constraints. Keywords: hypertension; hemorrhagic stroke; obesity; OSA

Risk factors of Hemorrhagic Stroke- a Case-Control Study in Bangladesh

Background: Spontaneous intracerebral hemorrhage is one of the leading causes of mortality and morbidity. Genetic factors play an important role in this disease. Among the non-genetic causes Hypertension (HTN), IDDM (insulin dependent diabetes mellitus), NIDDM (non-insulin dependent diabetes mellitus), family history of hemorrhagic stroke, smoking, previous history of ischemic stroke, alcohol intake and education level are important. Methods: The aim of the study was to evaluate the association between ICH and non-genetic risk factors. This was a case-control study with 120 participants. The place of the study was in the Neurosurgery department of Sylhet Women’s Medical College Hospital (SWMCH) and the study period was 2 years. Result: Alcohol consumption (RR=3, Odd=3.11) showed highest risk for ICH. Other risk factors of ICH were smoking (RR=2, Odd=2.36), family history (F/H) of ICH (RR=1.3, Odd=1.38), Hypertension (RR=1.1, Odd=1.39) and below 12 class education status (RR=1.08, Odd=1.63). The relative risk of IDDM, NIDDM, previous history (P/H) of ischemic stroke were less than 1. Conclusion: There are few controllable risk factors of hemorrhagic stroke apart from genetic risk factors.

Risk Factors for Hemorrhagic Stroke among Adults in the Democratic Republic of the Congo: A Hospital-Based Study in a Limited Resource Setting.

The prevalence of stroke is increasing in sub-Saharan Africa. The scarcity of hospital-based stroke data in Lubumbashi (in the Democratic Republic of the Congo) led to the study, which was designed to describe the epidemiology of stroke and identify risk factors associated with hemorrhagic stroke among adult patients in Lubumbashi. This was a cross-sectional study of 158 adult patients admitted for stroke in the internal medicine department of Lubumbashi University Clinics from January 2018 to December 2020. Sociodemographic and clinical features, cardiovascular risk factors, and hospital mortality were collected. A logistic regression has determined the risk of developing a hemorrhagic stroke. Of 9,919 hospitalized patients, 158 had a stroke with a hospital prevalence of 1.6%; 86 (54.4%) patients had a hemorrhagic stroke while 72 (45.6%) had an ischemic stroke. Of which 41.1% (65/158) were women. The mean age was 60.8 ± 13.3 years. Main clinical signs were hemiplegia (63.3%), headache (48.7%), speech disorders (38.6%), and dizziness (38.6%). Hypertension (82.9%) and hyperglycemia (53.2%) were the most common risk factors. Inhospital mortality was 22.8%. After logistic regression, independent predictors for developing hemorrhagic stroke were hypertension (aOR = 8.19; 95% CI: 2.72-24.66; p < 0.0001) and atrial fibrillation (aOR = 4.89; 95% CI: 1.41-16.89; p = 0.012). This study highlights the high stroke mortality in a resource-limited hospital and the burden of hypertension in the development of hemorrhagic stroke. It illustrates the need to establish stroke care setting to improve the quality of stroke care.

Risk factors for stroke recurrence in patients with hemorrhagic stroke

The risk factors for recurrence of hemorrhagic or ischemic stroke in patients with intracranial hemorrhage (ICH) are inconclusive. This study was designed to investigate the risk factors for stroke recurrence and the impact of antiplatelet on stroke recurrence in patients with ICH. This population-based case-cohort study analyzed the data obtained from a randomized sample of 2 million subjects in the Taiwan National Health Insurance Research Database. The survival of patients with hemorrhagic stroke from January 1, 2000, to December 31, 2013, was included in the study. During the 5-year follow-up period, the recurrence rate of stroke was 13.1% (7.01% hemorrhagic stroke, and 6.12% ischemic stroke). The recurrence rate of stroke was 13.3% in the without antiplatelet group and 12.6% in the antiplatelet group. The risk factor for hemorrhagic stroke was hypertension (OR 1.87). The risk factors for ischemic stroke were age (OR 2.99), diabetes mellitus (OR 1.28), hypertension (OR 2.68), atrial fibrillation (OR 1.97), cardiovascular disease (OR 1.42), and ischemic stroke history (OR 1.68). Antiplatelet may decrease risk of hemorrhagic stroke (OR 0.53). The risk of stroke recurrence is high in patients with ICH. Hypertension is a risk factor for ischemic and hemorrhagic stroke recurrence. Antiplatelet therapy does not decrease risk of ischemic stroke recurrence but may reduce recurrence of hemorrhagic stroke.

Homocysteine, Vitamins B6, B12, and Folate and the Risk of Ischemic and Hemorrhagic Stroke: A Case-control Study from Northeast India.

Stroke is a major leading global health complication. Identification and management of risk factors associated with stroke can help in prior detection, prevention, and improvement in patient care. To investigate the prevalence of hyperhomocysteinemia (HHcy) and Vitamins B6, B12, and folate deficiency in stroke patients and also to assess other risk factors associated with ischemic and hemorrhagic stroke. Detail history of all the subjects in the study including history of hypertension, anemia, fasting glucose, carotid artery thickness, smoking, alcohol, and dietary intake was recorded. Standard assays for homocysteine (Hcy), Vitamins B6, B12, and folate estimation were done. Lipid and renal profile tests were also performed. The prevalence and odds of having HHcy, Vitamins B6, B12, and folate deficiency, and other risk factors in ischemic and hemorrhagic stroke patients were evaluated. Student's t-tests and chi-square tests were done for statistical validation of the data. Prevalence of HHcy and Vitamins B6, B12, and folate deficiency was not observed in ischemic cases. HHcy and folate deficiency was found to be prevalent in hemorrhagic stroke patients. The odds that a person with HHcy and folate deficiency has hemorrhagic stroke was found to be significantly high. In our study, high Hcy and low folate levels emerged as risk factors for hemorrhagic stroke.

Alzheimer's disease related single nucleotide polymorphisms and correlation with intracerebral hemorrhage incidence.

Apolipoprotein E alleles have been associated with both Alzheimer’s disease (AD) and intracerebral hemorrhage (ICH). In addition, ICH is associated with a markedly high risk of subsequent dementia compared to other subtypes of stroke. We sought to evaluate if other genetic markers for AD were also associated with ICH. We examined whether published AD risk single nucleotide polymorphisms (SNPs) and haplotypes were associated with ICH utilizing genome-wide association study data from 2 independent studies (genetic and environmental risk factors for hemorrhagic stroke [GERFHS] study and genetics of cerebral hemorrhage with anticoagulation [GOCHA]). Analyses included evaluation by location of ICH. GERFHS and GOCHA cohorts contained 745 ICH cases and 536 controls for analysis. The strongest association was on 1q32 near Complement receptor type 1 (CR1), where rs6701713 was associated with all ICH (P = .0074, odds ratio [OR] = 2.07) and lobar ICH (P = .0073, OR = 2.80). The 51 most significant 2-SNP haplotypes associated with lobar ICH were identified within the Clusterin (CLU) gene. We identified that variation within CR1 and CLU, previously identified risk factors for AD, and are associated with an increased risk for ICH driven primarily by lobar ICH. Previous work implicated CR1 and CLU in cerebral amyloid clearance, the innate immune system, and cellular stress response.

A Mendelian randomization-based exploration of red blood cell distribution width and mean corpuscular volume with risk of hemorrhagic strokes.

SummaryRed blood cell distribution width (RCDW) and mean corpuscular volume (MCV) are associated with different risk factors for hemorrhagic stroke. However, whether RCDW and MCV are causally related to hemorrhagic stroke remains poorly understood. Therefore, we explored the causality between RCDW/MCV and nontraumatic hemorrhagic strokes using Mendelian randomization (MR) methods. We extracted exposure and outcome summary statistics from the UK Biobank and FinnGen. We evaluated the causality of RCDW/MCV on four outcomes (subarachnoid hemorrhage [SAH], intracerebral hemorrhage [ICH], nontraumatic intracranial hemorrhage [nITH], and a combination of SAH, cerebral aneurysm, and aneurysm operations) using univariable MR (UMR) and multivariable MR (MVMR). We further performed colocalization and mediation analyses. UMR and MVMR revealed that higher genetically predicted MCV is protective of ICH (UMR: odds ratio [OR] = 0.89 [0.8–0.99], p = 0.036; MVMR: OR = 0.87 [0.78–0.98], p = 0.021) and nITH (UMR: OR = 0.89 [0.82–0.97], p = 0.005; MVMR: OR = 0.88 [0.8–0.96], p = 0.004). There were no strong causal associations between RCDW/MCV and any other outcome. Colocalization analysis revealed a shared causal variant between MCV and ICH; it was not reported to be associated with ICH. Proportion mediated via diastolic blood pressure was 3.1% (0.1%,14.3%) in ICH and 3.4% (0.2%,15.8%) in nITH. The study constitutes the first MR analysis on whether genetically elevated RCDW and MCV affect the risk of hemorrhagic strokes. UMR, MVMR, and mediation analysis revealed that MCV is a protective factor for ICH and nITH, which may inform new insights into the treatments for hemorrhagic strokes.

Passive smoking may be associated with bleeding of cerebral arteriovenous malformation in non-smoking women: a retrospective analysis.

Smoking has been considered to be a risk factor for cardiovascular disease, cancer, depression and other diseases in previous reports, and active smoking is considered to be a risk factor for hemorrhagic stroke. In addition, a retrospective study showed that male smokers were at increased risk of bleeding from arteriovenous malformation (AVM), compared with non-smokers. However, the effect of passive smoking on rupturing of cerebral AVM in non-smoking women has not been addressed. This study aimed to assess the impact of tobacco exposure on AVM bleeding risk in non-smoking women. A total of 393 non-smoking women diagnosed with AVM were included. They were divided into a bleeding group (205 women) and a non-bleeding group (188 women). We conducted univariate and multivariate analysis on these two groups. In univariate analysis, risk factors that might be related to AVM bleeding were analyzed. In multivariate analysis, the relationship between passive smoking and AVM rupture was analyzed by correcting confounding factors. Multivariate analysis showed that the proportion of passive smoking was statistically different between the bleeding group and the non-bleeding group (OR = 1.609; CI = 1.031-2.509; p = 0.036). Passive smoking may increase the risk of AVM bleeding in non-smoking women. This increased risk may be related to the inflammatory response, vascular wall damage, hemodynamic disorders, changes in atherosclerosis and changes in gene expression caused by passive smoking.

Clinical Significance of Intracranial Aneurysms in Adult Moyamoya Disease

We present the relationship between an aneurysm in adult moyamoya disease (MMD) patients and a future stroke event. One hundred forty-seven aneurysms were found in 118 adult MMD patients. To find risk factors for future hemorrhagic and ischemic stroke, Kaplan-Meier and Cox-regression analyses were performed on clinical and radiologic factors. In addition to the anatomical classification method based on the circle of Willis, aneurysms occurring in the collateral pathway were analyzed by reflecting the hemodynamic changes in MMD. The initial clinical presentations are divided into ischemia (n= 53, 44.9%), hemorrhage (n= 51, 43.2%), and asymptomatic (n= 14, 11.9%). The mean size of the aneurysms was 2.9±1.67mm. Thirty-four aneurysms were treated with coil (n= 24) and glue embolization (n= 10). One hundred thirteen aneurysms were conservatively managed. All of aneurysms did not cause recurrent hemorrhagic strokes by aneurysm rupture. The mean follow-up period duration was 78.3±58.9months. The overall estimated rate of hemorrhage was 10.5%/hemisphere at 5years and 18.2%/hemisphere at 10years after the initial angiography. The overall estimated rate of infarction was 2.8%/hemisphere at 5years and 4.5%/hemisphere at 10years after the initial angiography. A Cox regression analysis revealed that a collateral pathway aneurysm is a significant risk factor for hemorrhagic stroke (P= 0.045, hazard ratio=2.366). However, less hemorrhaging occurred in MMD patients with hypertension (P= 0.018, hazard ratio=0.364). The presence of a collateral pathway aneurysm appears to reflect the hemodynamic stress exerted on the cerebral hemispheres of MMD patients, suggesting an increased risk of future hemorrhagic strokes.

Analysis of Risk Factors for Haemorrhagic Stroke Patients in a Tertiary Care Hospital of Bangladesh

Background: Cardiovascular diseases are the leading cause of death worldwide, with stroke coming in second. Controlling risk factors is the best strategy to avoid a stroke. Disability is also a cause of death. For treating and preventing hemorrhagic stroke, understanding the risk factors is critical. The aim of the study: The current study's objective was to determine the risk factors for hemorrhagic stroke. Materials and Methods: This study was a case-control study carried out at Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh from January to June 2021. A total number of 66 subjects of more than 18 years were considered for the study as the study subjects. Among them, 33 were in the study (Case) group and 33 were in the control group. The study population had been selected according to the pre-defined exclusion and inclusion criteria. Results: The risk factors between the groups were evaluated, it was found that the study group had 22 smokers and the control group had 18 smokers. The study group had 11 nonsmokers and the control group had 15. There were 29 non-diabetic patients in the study group and 28 in the control group, according to the findings. The study group had 4 diabetes while the control group had 5. In the smoker vs. non-smoker and diabetics vs. non-diabetics population, there was no statistically significant difference between study and control groups. There were also 8 non-hypertensive patients in the study group and 29 non-hypertensive patients in the control group. The study group consisted of 25 hypertension patients, while the control group consisted of four. Between the study and control groups, there was a statistically significant difference. In terms of hypertension and total serum cholesterol, there were statistically significant differences between the study and control groups. Conclusion: We can conclude from the results of this study that hypertension and low total serum cholesterol are potential risk factors for ............

Human Galectin-7 Gene LGALS7 Promoter Sequence Polymorphisms and Risk of Spontaneous Intracerebral Hemorrhage: A Prospective Study.

Background and purposeDespite evidence for the role of genetic factors in stroke, only a small proportion of strokes have been clearly attributed to monogenic factors, due to phenotypic heterogeneity. The goal of this study was to determine whether a significant relationship exists between human galectin-7 gene LGALS7 promoter region polymorphisms and the risk of stroke due to non-traumatic intracerebral hemorrhage (ICH).MethodsThis two-stage genetic association study included an initial exploratory stage followed by a discovery stage. During the exploratory stage, transgenic galectin-7 mice or transgenic mice with the scrambled sequence of the hairpin structure –silenced down gene LGALS7—were generated and then expressed differentially expressed proteins and galectin-7-interacting proteins were identified through proteomic analysis. During the discovery stage, a single-nucleotide polymorphism (SNP) genotyping approach was used to determine associations between 2 LGALS7 SNPs and ICH stroke risk for a cohort of 24 patients with stroke of the Chinese Han population and 70 controls.ResultsDuring the exploratory phase, LGALS7 expression was found to be decreased in TGLGALS–DOWN mice as compared to its expression in TGLGALS mice. During the discovery phase, analysis of LGALS7 sequences of 24 non-traumatic ICH cases and 70 controls led to the identification of 2 ICH susceptibility loci: a genomic region on 19q13.2 containing two LGALS7 SNPs, rs567785577 and rs138945880, whereby the A allele of rs567785577 and the T allele of rs138945880 were associated with greater risk of contracting ICH [for T and A vs. C and G, unadjusted odds ratio (OR) = 13.5; 95% CI = 2.249–146.5; p = 0.002]. This is the first study to genotype the galectin-7 promoter in patients with hemorrhagic stroke. Genotype and allele association tests and preliminary analysis of patients with stroke revealed that a single locus may be a genetic risk factor for hemorrhagic stroke.ConclusionA and T alleles of two novel SNP loci of 19q13.2, rs567785577 and rs138945880, respectively, were evaluated for associations with susceptibility to ICH. Further studies with expanded case numbers that include subjects of other ethnic populations are needed to elucidate mechanisms underlying associations between these SNPs and ICH risk.