Risk Factor For Hemorrhagic Stroke Research Articles

Acidente Vascular Cerebral Hemorrágico em Adultos Jovens

Objetivo: O acidente vascular cerebral hemorrágico (AVCH) é um fardo para os jovens devido às suas altas mortalidade e incapacidade. Apesar de incomum, há uma tendência ao aumento na sua incidência, em especial pela alta prevalência de fatores de risco. Esse estudo procura identificar as características epidemiológicas dos adultos jovens acometidos por AVCH. Métodos: Foram analisados 49 pacientes com idade entre 20 e 45 anos e diagnóstico de AVCH, entre julho de 2012 e abril de 2015. Resultados: Foram 37 (75,5%) do sexo masculino e 12 (24,5%) do sexo feminino, com idade média de 39,5 anos. A hipertensão arterial sistêmica (HAS) foi o fator de risco mais prevalente (55,1%). Não foram encontrados casos associados ao tabagismo. AVCH secundário a malformações arteriovenosas (MAV) e ao uso de drogas simpaticomiméticas foram10,2% e 8,1%,respectivamente. A região lobar (46,9%) foi a mais acometida. A taxa de mortalidade foi de 49%, com 24,5% sobrevivendo sem apresentar sequelas. Conclusões: O subdiagnóstico e o baixo controle da HAS no Brasil devem destacá-lo entre os fatores derisco do AVCH. O aumento no consumo de drogas simpaticomiméticas também eleva sua importância. São necessárias medidas de saúde pública para a prevenção do AVCH entre os jovens.

Effect of Adherence to Antihypertensive Medication on the Long-Term Outcome After Hemorrhagic Stroke in Korea.

Hypertension is the single most important risk factor for hemorrhagic stroke, a leading cause of mortality and disability worldwide. Adherence to antihypertensive medication is essential to achieving strict blood pressure control, but poor adherence is common in clinical practice. We evaluated adherence to antihypertensive medication in patients with acute hemorrhagic stroke and its effects on long-term outcome. This was a retrospective cohort study based on a nationwide health insurance claims database in South Korea. We included 1872 hypertensive patients who were admitted with acute hemorrhagic stroke during 2002 to 2013 (1354 cases of intracerebral hemorrhage and 518 cases of subarachnoid hemorrhage). Adherence to antihypertensive medication was calculated using the proportion of days covered by any antihypertensive medication throughout the follow-up period (categorized into poor <40%; intermediate 40%-80%; good >80%) and treated as a time-dependent variable. Primary outcome was defined as a composite of recurrent stroke (hemorrhagic or ischemic), myocardial infarction, or all-cause mortality. Time-dependent Cox proportional hazard regression analyses were performed. During the mean follow-up period of 4.45 years, 634 patients had the primary outcome. The proportion of patients with good adherence to antihypertensive medication was 46.8% at 1 year, 43.2% at 3 years, and 41.7% at 5 years of follow-up. Compared with good adherence, the adjusted hazard ratio (95% confidence interval) for the primary outcome was 1.80 (1.49-2.16) for poor adherence and 1.56 (1.27-1.93) for intermediate adherence.

Clinical Symptoms and Risk Factors Comparison of Ischemic and Hemorrhagic Stroke

Backround: It is very important to know and detect various stroke symptoms because stroke is an emergency condition. Lack of knowledge about stroke symptoms leads to delay on stroke treatment. Objective: The aim of this study is to compare clinical symptoms and risk factors between ischemic and hemorrhagic stroke. Methods: This study was a case control study. The subjects in this study were ischemic and hemorrhagic stroke patients. Subject data were recorded in electronic stroke registry at Bethesda Hospital, Yogyakarta. Results: The most common clinical symptoms in both groups were limb weakness (76.4% vs 71.4%), whereas the rarest was face drooping (2% vs 3.6%). Hypertension was the most common risk factor in both group (48% vs 71.4%), whereas atrial fibrillation was the rarest. This study did not find the specific correlation between any clinical symptoms to ischemic stroke incidence, however, decrease a level of consciousness was significant to hemorrhagic stroke incidence (OR: 2.738, 95% CI: 1.503-4.990, p: 0.001). Previous stroke (OR: 2.413, 95% CI: 1.314-4.433, p: 0.005) and dyslipidemia (OR: 4.862, 95% CI: 2.613-9.045, p: 0.000) were significant increasing risk of ischemic stroke. Hypertension was only the significant increasing risk of hemorrhagic stroke (OR: 3.680, 95% CI: 2.086-6.492, p: 0.000). Conclusion: Decrease level of consciousness has a significant correlation to hemorrhagic stroke incidence, but there is no specific symptom correlate to ischemic stroke incidence. Previous stroke and dyslipidemia are significant risk factors for ischemic stroke, whereas hypertension is the only significant risk factor for hemorrhagic stroke.

Abstract WP327: CHADSVASC and HASBED Scores in Patients With Intracerebral Hemorrhage and Atrial Fibrillation

Background: Patients with intracerebral hemorrhage (ICH) and atrial fibrillation (a-fib) are at risk for having future ischemic events after stopping anticoagulation. Risk calculators (CHA 2 DS 2 -VASc and HAS-BLED) have been validated to assess risk for ischemic stroke and for major bleeding in a-fib patients. We sought to compare the distribution of these scores among ICH patients with a-fib within a large biracial population. Methods: The Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS III) Study included a population-based retrospective chart review of spontaneous ICH among residents of the five-county Greater Cincinnati/Northern Kentucky region between 7/2008 and 12/2012. CHA 2 DS 2 -VASc (risk of ischemic stroke) and HAS-BED (risk of bleeding with anticoagulation; minus “L” because “labile INR” was unavailable) scores were calculated for all ICH patients with a-fib who survived the hospital stay. Published risk coefficients for each score were used to calculate predicted ischemic and bleeding events within one year of onset. Results: Among 1186 cases of spontaneous ICH, 232 had a-fib, of which 123 patients were excluded due to inpatient death or discharge to hospice. Among the remaining 109 cases, 7-8 would be expected to have a major bleeding event (on anticoagulation), and about 6 patients would be expected to have an ischemic stroke within one year (off anticoagulation), with 73 of the 109 patients having higher risk for major bleeding than for ischemic stroke. The correlation between the two scores was weak (Spearman r=.220, p=.021). Discussion: Comparison of CHA 2 DS 2 -VASc and HAS-BED scores suggest a higher CHA 2 DS 2 -VASc threshold for considering anticoagulation is needed for ICH a-fib patients to balance their higher risk of major bleeding. Further evaluation of the consequences of ischemic stroke and major bleeding would be needed to better understand the best treatment strategies for our patients.

Abstract WP345: Pre-Intracerebral Hemorrhage Antiplatelet and Anticoagulant Use and Differences in Hospital Course; A Population-Based Study

Objective: Patients on antiplatelet (AP) or anticoagulant (AC) agents cause more alarm when they develop intracerebral hemorrhage (ICH) compared with non-users. This analysis aimed to quantitatively evaluate the differences in the hospital course of ICH patients based on underlying AP and/or AC use, using a population-based cohort. Methods: Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS III) was a population-based study of spontaneous ICH among residents of the five-county Greater Cincinnati/Northern Kentucky region between July 2008 and December 2012. Baseline demographics, medications, hospital course, and discharge disposition were collected. Initial and subsequent computed tomography (CT) images of the head were reviewed to assess ICH location, volume, and presence of intraventricular hemorrhage (IVH). Change in ICH volume was calculated when repeat CT image was available. Results: There were 1121 cases of ICH during the study period. A higher proportion of white patients were on AP or AC than other races (56.4% vs. 39.7%, p&lt;.0001). The majority of patients with subsequent imaging experienced an increase in ICH size. Patients taking AC pre-ICH had a larger increase in volume despite more frequent use of pro-thrombotic therapy. There was no difference in IVH incidence based on AP or AC use. Length of stay and surgical hematoma evacuation rates were similar among the groups. Inpatient mortality was higher in AC users (44.4% vs. 21.3%, p&lt;.0001), but was virtually the same for AP users as for non-users. Of 272 pre-ICH AP users, 86 (31.6%) were discharged on AP (8 on dual AP). Of 91 pre-ICH AC users, 11 (12%) were discharged on AC. Conclusion: Pre-ICH AC use was associated with greater ICH volume increase and inpatient death. There was no significant difference in number of IVH, rate of surgical treatment, or length of stay. Inpatient mortality did not differ between AP users and non-users.

Abstract 192: Anticoagulation Decision-Making in ICH Patients With Atrial Fibrillation: Quality-Adjusted Decision Model Outcomes

Background: While patients (pts) with atrial fibrillation (AF) face a risk of ischemic events, AF pts with intracerebral hemorrhage (ICH) are at increased risk of bleeding with anticoagulation (AC). Optimal decision-making must weigh the tradeoffs between these competing risks. Our goal was to analyze the impact of AC decisions on projected quality-adjusted life years (QALYs) pts with both ICH and AF within a population. Methods: The Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS III) Study is a population-based evaluation of spontaneous ICH among residents of the five-county Greater Cincinnati/Northern Kentucky study region. The study period was 7/08-12/12. Pts with ICH and AF surviving the hospital stay were included. Medical history and demographics were entered into the Atrial Fibrillation Decision Support Tool, which is a 29-state Markov decision analytic model that projects patient-level QALYs for 7 thromboprophylaxis treatment strategies, using published event rates from CHADSVASC, HAS-B(L)ED, the Friberg ICH prediction model and clinical trials of anticoagulants (including warfarin and direct anticoagulants, DOACs), as well as published rates of outcomes for each possible event. Results: In the study period, there were 1186 cases of spontaneous ICH, 232 with a-fib, of which 123 were excluded because of inpatient death/discharge to hospice. Among the 109 cases, the aggregate net loss for AC was 16.9 QALYs; however there were 10 cases (9%) that gained &gt; 0.1 QALYs with AC. The table displays a heat map showing aggregate gain/loss of QALYs with AC (compared with no treatment) for the cohort, displayed by their CHADSVASC and HASBED scores. Conclusion: We found that 91% of our ICH pts with AF would have either no change or a loss of QALYs with AC. However, given lower bleeding rates with DOACs, anticoagulation may be beneficial in a very select subset of AF pts with ICH. Thresholds for AC treatment should be considered carefully in this population.

Astrocytes and the Warning Signs of Intracerebral Hemorrhagic Stroke.

Two decades into the two thousands, intracerebral hemorrhagic stroke (ICH) continues to reap lives across the globe. In the US, nearly 12,000 people suffer from ICH every year. Half of them survive, but many are left with permanent physical and cognitive disabilities, the severity of which depends on the location and broadness of the brain region affected by the hemorrhage. The ongoing efforts to identify risk factors for hemorrhagic stroke have been instrumental for the development of new medical practices to prevent, aid the recovery and reduce the risk of recurring ICH. Recent efforts approach the study of ICH from a different angle, providing information on how we can limit brain damage by manipulating astrocyte receptors. These results provide a novel understanding of how astrocytes contribute to brain injury and recovery from small ICH. Here, we discuss current knowledge on the risk factors and molecular pathology of ICH and the functional properties of astrocytes and their role in ICH. Last, we discuss candidate astrocyte receptors that may prove to be valuable therapeutic targets to treat ICH. Together, these findings provide basic and clinical scientists useful information for the future development of strategies to improve the detection of small ICH, limit brain damage, and prevent the onset of more severe episodes of brain hemorrhage.

Antiviral therapy reduces risk of haemorrhagic stroke in patients with HCV infection: a nationwide cohort study.

The tendency for haemorrhagic stroke in patients with chronic HCV infection has emerged recently but the finding may be confounded by comorbidities. Proving the causality between HCV infection and haemorrhagic stroke is mandatory. Our study was designed to investigate the incidence of intracranial haemorrhage in HCV-infected patients with and without treatment. In the 11-year and population-based retrospective study, we acquired data from the Taiwan National Health Insurance Research Database. The patients with major comorbidities were excluded and 97,198 HCV-infected patients were included for analysis. Treated and untreated cohorts were matched with propensity score to make the confounding factors in two groups comparable. Cox proportional hazard regression analysis was performed to evaluate the hazard ratio of haemorrhagic stroke in the cohorts. We applied survival analysis to compare the cumulative incidence of outcome events between the two cohorts. After matching, the incidence density (ID) of haemorrhagic stroke in the untreated cohort is significantly higher than in the treated cohort (ID: 1.0 versus 0.6 events per 1,000 person-years; P=0.0014). The adjusted hazard ratio (aHR) of haemorrhagic stroke is significantly reduced in the treated group (P<0.05). Cumulative incidence of haemorrhagic stroke is significantly lower in the treated group than in the untreated group (P=0.013). The study demonstrates that antiviral therapy significantly reduces the events of intracranial haemorrhage in HCV-infected patients and consolidates the novel concept that chronic HCV infection is a risk factor for haemorrhagic stroke.

Relationship Between Bacteremia and Hemorrhagic Stroke in Patients With Continuous-Flow Left Ventricular Assist Device.

Blood stream infection is thought to increase the risk of hemorrhagic stroke, a major adverse event with devastating outcome, in patients with continuous-flow left ventricular assist devices (LVADs). We analyzed the risk factors of hemorrhagic stroke in LVAD patients, as well as the time relationship between systemic bacteremia and hemorrhagic stroke.Methods and Results:We evaluated the incidence of systemic bacteremia and stroke in 164 patients who underwent continuous-flow LVAD implantation between 2005 and 2016. At 1 and 2 years after implantation, the incidence of bacteremia was 29% and 36%, and the incidence of hemorrhagic stroke was 22% and 22% in patients without bacteremia, and 32% and 44% in those with bacteremia, respectively (P=0.035). This higher prevalence of hemorrhagic stroke in patients with bacteremia was notable particularly in the chronic phase (>90 days after implantation). Multivariate analysis revealed that bacteremia was an independent risk factor of hemorrhagic stroke in the chronic phase [hazard ratio, 2.36 (1.02-5.62); P=0.044]. The hazard rate was the highest immediately after the onset of bacteremia, and the risk steadily declined by 90 days after the last episode of bacteremia and flattened thereafter. Bacteremia was an independent risk factor of hemorrhagic stroke in patients in the chronic phase, with the highest risk seen in the early phase following an episode of bacteremia.

Hypertension modifies the short-term effects of temperature on morbidity of hemorrhagic stroke

BackgroundThis study estimated the effects of ambient temperature on hospital admissions for hemorrhagic stroke during 2004–2009 in Jinan, China, and the effect modification of hypertension status. MethodsThe exposure–response relationship between temperature and hemorrhagic stroke was firstly examined, and then the association between daily mean temperature and hemorrhagic stroke was investigated using a generalized additive model. Stratified analyses were conducted to examine the potential effect modification of hypertension. ResultsA total of 1577 hemorrhagic stroke cases were observed between 2004 and 2009, among which, 1058 were hypertensive and 519 were non-hypertensive. We found an approximately linear relationship between ambient temperature and hemorrhagic stroke. Each 1°C decrease in the current day's temperature was associated with 1.63% (95% CI: 0.33%, 2.95%) increase in daily hemorrhagic stroke. The stratified analyses observed that the association was significant among hypertensive hemorrhagic stroke, each 1°C decrease in the current day's temperature was associated with 2.26% (95% CI: 0.57%, 3.98%) increase in daily hypertensive hemorrhagic stroke. While no significant effect was observed for non-hypertensive hemorrhagic stroke. ConclusionsLow temperature might be one risk factor for hemorrhagic stroke and hypertension may be one effect modifier of this association in Jinan, China.

Determinants and Time Trends for Ischaemic and Haemorrhagic Stroke in a Large Chinese Population.

BackgroundThe clinical epidemiology of stroke has been widely investigated in Caucasian populations, but the changes over time in the proportion of ischaemic to haemorrhagic strokes is less clear, especially in the Chinese population.AimsOur objective was to study the determinants and time trends for ischaemic and haemorrhagic stroke, in relation to age, in a large Chinese population cohort.MethodsUsing a medical insurance database in the southwest of China from 2001 to 2012, time trends in age-adjusted ischaemic and haemorrhagic stroke incidence and the contributing risk factors associated with age were investigated.ResultsAmong 425,901 individuals without prior stroke (52.4% male, median age 54), the rate of ischaemic stroke (per 1000 patient-years) decreased between 2002–2007, then remained broadly similar between 2008–2012. The rate of haemorrhagic stroke showed a similar trend, being approximately 1.3–1.9 from 2008–2012. Compared to patients age<65, ischaemic and haemorrhagic stroke incidences (rate, 95% confidential interval, CI) were higher in the elderly population (age <65 versus age ≥65: ischaemic: 3.64, 3.33–4.00, vs 14.33, 14.01–14.60; haemorrhagic: 1.09, 1.00–1.10 vs 2.52,2.40–2.70, respectively, both p<0.001). There were no significant differences in haemorrhagic stroke rates between the elderly and the very elderly population. Ischaemic and haemorrhagic stroke shared similar risk factors (age, hypertension, coronary artery disease (CAD), vascular disease, and diabetes mellitus) (all p<0.05). In subjects age<75 years, CAD (7.17, 4.14–12.37) and diabetes mellitus (3.27, 2.42–4.42) contributed most to the developing of haemorrhagic stroke (all p<0.001). Amongst the very elderly, vascular disease (2.24, 1.49–3.37) was an additional major risk factor for haemorrhagic stroke, together with CAD and diabetes mellitus (all p<0.001).ConclusionIn this large Chinese cohort, there was an increased risk of ischaemic stroke compared to haemorrhagic stroke with ageing. CAD, vascular disease, diabetes mellitus, and hypertension were major contributors to the development of hemorrhagic stroke in the very elderly Chinese population.

Emerging Risk Factors for Stroke: What Have We Learned From Mendelian Randomization Studies?

Establishing new approaches for the prevention and treatment of stroke relies on identifying modifiable risk factors that contribute to the development of this complex disease. Mendelian randomization (MR) studies, analogous to naturally occurring randomized trials, can assess causality of potentially modifiable biomarkers and offer new insights into biological pathways. Stroke is the second leading cause of death worldwide and the chief determinant of long-term disability. Stroke is a heterogeneous disease arising from several distinct underlying pathologies and is typically classified as ischemic or hemorrhagic, and further subclassified using imaging data. Ischemic stroke (IS), including its 3 main subtypes: small vessel disease, large vessel disease, and cardioembolic stroke, accounts for ≈80% of stroke and is the result of an interrupted blood supply, leading to localized areas of ischemia in the brain. Small vessel disease may be a consequence of nonatherosclerotic, as well as atherosclerotic, mechanisms that result in an occlusion of the small perforating arteries, whereas large vessel disease results from occlusions or emboli from plaque rupture in larger vessels, such as a carotid artery. Cardioembolic stroke arises typically from emboli from the heart. By contrast, hemorrhagic stroke is a consequence of intracerebral hemorrhage (bleeding into the brain) or subarachnoid hemorrhage (bleeding into the subarachnoid space). These diverse stroke subtypes have distinct underlying pathologies reflecting different risk factor distributions. MR studies, using genetic variants as instrumental variables, afford a powerful approach to assessing causality of risk factors and avoid biases inherent in observational studies, including confounding and reverse causation. This review considers the contribution of MR studies to stroke epidemiology and their relevance to understanding risk factors and new therapeutic targets for stroke. Meta-analyses of large prospective studies have enhanced our knowledge of classical and emerging risk factors for stroke.1–4 Classical risk factors for stroke include nonmodifiable characteristics, …

Prolonged sleep increases the risk of intracerebral haemorrhage: a nationwide case-control study.

Although abnormal sleep duration is positively associated with increased risk for cardiovascular disease and mortality, the specific impact on intracerebral haemorrhage (ICH) risk remains unclear. The relationship between sleep duration and the risk of ICH was investigated in our study. A nationwide, multicentre matched case-control study was performed to investigate the risk factors for haemorrhagic stroke, using patients from 33 hospitals in Korea. In all, 490 patients with ICH and 980 age- and sex-matched controls were enrolled. Detailed information regarding sleep, sociodemographic factors, lifestyle and medical history before ICH onset was obtained using qualified structured questionnaires. Sleep duration was categorized and the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a conditional logistic regression with 7 h as the reference duration. The number of subjects with long sleep duration, more than 8 h, was significantly greater in the ICH group than in the control group (≥8 h, 30.4% vs. 22.6%, P = 0.002). After controlling for relevant confounding factors, longer sleep duration was found to be independently associated with the risk of ICH in a dose-response manner (8 h, OR 1.57, 95% CI 1.00-2.47; ≥9 h, OR 5.00, 95% CI 2.18-11.47). Our study suggested that long sleep duration is positively associated with an increased ICH risk in a dose-dependent manner. Further studies on the relationship linking long sleep duration with increased risk of ICH are required.

Abstract WP369: Long Sleep Duration as a Risk Factor for Intracerebral Hemorrhage: a Nationwide, Multicenter Case-control Study

Introduction: Sleep duration has been regarded as a potential risk factor for cardiovascular disease and stroke. Short sleep duration is linked with higher stroke incidence, and mortality. Moreover, and paradoxically, long sleep duration is also reported to be positively associated with stroke incidence. However, the impact of sleep duration on the intracerebral hemorrhage (ICH) risk remains unclear. Hypothesis: We assessed the relationship between sleep duration and the risk of ICH. Methods: We performed a nationwide, multicenter matched case-control study to investigate the risk factors for hemorrhagic stroke, using patients from 33 hospitals in Korea. We enrolled a total of 490 patients with ICH and 980 age- and sex-matched controls. We obtained information regarding sleep, sociodemographic factors, lifestyle, and medical history before ICH onset, using qualified structured questionnaires. Sleep duration was categorized as ≤5, 6, 7, 8, and ≥9 hours. We chose sleep duration of 7 h as the reference duration. Results: The included patients were mostly male (58.2%) with a mean age of 57 years. The number of subjects with long sleep duration, more than 8 h, was significantly greater in the ICH group than in the control group (≥8 h, 30.4% vs. 22.6%, P = 0.002). Compared to 7 h, long sleep duration participants tended to be older, be more hypertensive, and be more likely to have blue collar jobs, lower education levels, and poorer marital status (i.e., unmarried or divorced/separated). After controlling for confounding factors, we found that longer sleep duration was independently associated with the risk of ICH in a dose-response manner (8 h: Odds ratio, 1.44; confidence interval, 1.01-2.07; ≥9 h: Odds ratio, 2.60; confidence interval, 1.50–4.49). Conclusions: In conclusion, our study suggested that long sleep duration is positively related to ICH risk in a dose-dependent manner. In this context, our data might suggest that sleep duration is a modifiable risk factor for ICH.

Abstract 87: Selective Serotonin Reuptake Inhibitors and Risk of Intracerebral Hemorrhage

Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in the treatment of psychiatric disorders such as post-stroke depression. Some studies have reported an association between SSRI use and increased bleeding risk, including intracerebral hemorrhage (ICH). We evaluated this association in two large ICH case control studies. We also tested to see whether SSRI use potentiates the bleeding risk associated with warfarin use and prior ischemic stroke. Methods: ICH cases and controls from the Genetic and Environmental Risk Factors for Hemorrhagic Stroke (GERFHS) and Ethnic Racial Variations in ICH (ERICH) studies were combined in an unmatched case-control analysis. SSRI use and variables previously associated with ICH risk were tested in univariate and multivariate analyses. Interaction terms for SSRI use plus warfarin use and SSRI use plus prior ischemic stroke were included. Results: There were 4134 ICH cases with 303 pre-stroke SSRI users (7.3%) and 4945 controls with 419 SSRI users (8.5%). Results of the multivariate analysis are presented in the table. In univariate analysis, SSRI use was protective (OR 0.85, CI 0.73-1.00, p = .05), however in multivariate analysis this became non-significant. Although the combination of an SSRI and warfarin produced a higher point estimate for ICH risk than warfarin alone, the interaction term did not reach significance (p = .09). There was no interaction found for SSRI use plus history of ischemic stroke. Conclusions: In this large case control analysis, SSRI use was not associated with increased risk of ICH. We also failed to confirm an interaction between SSRI use, warfarin use, and ICH risk, although a modest effect cannot be excluded. While a history of ischemic stroke is a risk factor for ICH, SSRI use did not increase that risk.

Clinical Features and Outcomes of Takayasu Arteritis with Neurological Symptoms in China: A Retrospective Study.

To describe the clinical features and longterm outcomes of patients with Takayasu arteritis (TA) in China who experienced neurological symptoms. A retrospective study was undertaken of patients with TA who attended a single study center from 2002 to 2013, who also exhibited neurological symptoms (n = 274). Clinical and imaging features were analyzed, as well as longterm outcomes. The mean age at disease onset was 28.2 ± 11.2 years, with a female-to-male ratio of 4.3:1. The most common neurological manifestation was dizziness (214, 78.1%), the most frequent type of TA was type III (112, 40.9%), and the most common affected artery was the left subclavian (147, 53.6%). Involvement of 3 or 4 branches of the aortic arch was observed in 28% of patients. Among 30 patients experiencing a stroke (10.9%), steno-occlusive lesions of the subclavian artery and common carotid artery were frequently observed in patients with ischemic stroke, while steno-occlusive lesions of the descending aorta, abdominal aorta, and/or renal arteries were more frequently observed with hemorrhagic stroke. Heart failure was the most common cardiovascular event in those who died (n = 6) and in surviving cohorts. Neurological features in patients with TA were variable, and correlated with the number of arteries and the site of artery involvement. Resistant hypertension was one of the most important risk factors for hemorrhagic stroke in patients with TA.

Incidence and Predictors of Hemorrhagic Stroke in Users of Low-Dose Acetylsalicylic Acid

The use of antithrombotic drugs (anticoagulants and antiplatelet drugs) has been reported to increase the risk of hemorrhagic stroke (HS) relative to no treatment. This study was performed to characterize the incidence and predictors of HS in users of acetylsalicylic acid (ASA) for the secondary prevention of cardiovascular events. A cohort of 36,775 ASA users aged 50-84 years in 2000-2007 was identified from The Health Improvement Network database. The incidence of HS was calculated, and a nested case-control analysis, adjusted for potential confounding factors, was performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association of potential risk factors with HS in current users of ASA. The overall incidence of HS was 5.70 cases per 10,000 person-years and increased with age. In current ASA users, the incidence of HS was 4.91 cases per 10,000 person-years. Predictors of HS in patients taking ASA for secondary prevention included a history of HS (OR, 4.84; 95% CI, 1.48-15.88), a history of atrial fibrillation (OR, 4.03; 95% CI, 1.53-10.62), and hypnotic/anxiolytic drug use (OR, 2.67; 95% CI, 1.17-6.05). The small number of patients using warfarin also had an increased risk of HS (OR, 23.42; 95% CI, 4.89-112.10). Physicians should consider additional risk factors for HS, such as a history of HS or atrial fibrillation, and the use of warfarin, before prescribing ASA for the secondary prevention of cardiovascular events.

Statin use and risk of haemorrhagic stroke in a community-based cohort of postmenopausal women: an observational study from the Women's Health Initiative

ObjectivesTo determine whether statin treatment is associated with increased risk of haemorrhagic stroke (HS) in older women. A secondary objective was to evaluate HS risk in users of combined statin...

Migraine and hemorrhagic stroke: data from general practice.

Migraine and hemorrhagic stroke: data from general practice.

E-selectin gene (S128R) polymorphism in hemorrhagic stroke: Comparison with ischemic stroke

Increasing evidence suggests that genetic variation in inflammatory genes plays a pivotal role in pathogenesis of stroke. The aim of the present study was to evaluate the association of E-selectin S128R polymorphism with hemorrhagic stroke and also to evaluate the genotypic and allelic variation with ischemic stroke in a South Indian population from Andhra Pradesh. In this study, we recruited 250 hemorrhagic stroke patients along with 250 age and sex matched controls. The genotypes were determined using PCR-RFLP method and the strength of association between genotypes and hemorrhagic stroke was determined by odds ratio with 95% confidence interval (CI) and chi-square analysis. Allelic and genotypic frequencies of the polymorphism differed significantly between hemorrhagic stroke patients and controls (p<0.001). Significant association was also found following dominant (p<0.001) and co-dominant (p<0.001) models. On comparing the genotypic and allelic frequencies between ischemic and hemorrhagic stroke significant difference was found between the two stroke types (p<0.001). In conclusion, we found the AC genotype to be a significant risk factor for hemorrhagic stroke and we also found significant differences in AC genotype and C allele among the two stroke types. The genotypic and allelic variation between the ischemic and hemorrhagic stroke, suggests that E-selectin S128R mediated amplification of leukocytes onto endothelial cells, leading to secondary damage of brain cells is more pronounced in hemorrhagic stroke.