Stroke In Individuals Research Articles

The role of blood pressure in risk of ischemic and hemorrhagic stroke in type 1 diabetes

BackgroundHypertension is one of the strongest risk factors for stroke in the general population, while systolic blood pressure has been shown to independently increase the risk of stroke in type 1 diabetes. The aim of this study was to elucidate the association between different blood pressure variables and risk of stroke in type 1 diabetes, and to explore potential nonlinearity of this relationship.MethodsWe included 4105 individuals with type 1 diabetes without stroke at baseline, participating in the nationwide Finnish Diabetic Nephropathy Study. Mean age at baseline was 37.4 ± 11.9 years, median duration of diabetes 20.9 (interquartile range 11.5–30.4) years, and 52% were men. Office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. Based on these pulse pressure (PP) and mean arterial pressure (MAP) were calculated. Strokes were classified based on medical and autopsy records, as well as neuroimaging. Cox proportional hazard models were performed to study how the different blood pressure variables affected the risk of stroke and its subtypes.ResultsDuring median follow-up time of 11.9 (9.21–13.9) years, 202 (5%) individuals suffered an incident stroke; 145 (72%) were ischemic and 57 (28%) hemorrhagic. SBP, DBP, PP, and MAP all independently increased the risk of any stroke. SBP, PP, and MAP increased the risk of ischemic stroke, while SBP, DBP, and MAP increased the risk of hemorrhagic stroke. SBP was strongly associated with stroke with a hazard ratio of 1.20 (1.11–1.29)/10 mmHg. When variables were modeled using restricted cubic splines, the risk of stroke increased linearly for SBP, MAP, and PP, and non-linearly for DBP.ConclusionsThe different blood pressure variables are all independently associated with increased risk of stroke in individuals with type 1 diabetes. The risk of stroke, ischemic stroke, and hemorrhagic stroke increases linearly at blood pressure levels less than the current recommended treatment guidelines.

Aspirin for primary prevention of stroke in individuals without cardiovascular disease—A meta-analysis

BackgroundThe benefits of aspirin for primary prevention of stroke are uncertain.MethodsWe performed a cumulative meta-analysis of trials investigating aspirin for primary prevention of cardiovascular disease with a focus on stroke. We assessed the effects of aspirin on non-fatal stroke, hemorrhagic stroke, non-fatal myocardial infarction, all-cause mortality, cardiovascular mortality, major gastrointestinal bleeding, and an analysis of net clinical effect, in populations without a history of clinical or subclinical cardiovascular disease.Summary of review resultsAmong 11 trials (157,054 participants), aspirin was not associated with a statistically significant reduction in non-fatal stroke (odds ratio, 0.94; 95% CI, 0.85 to 1.04) but was associated with an increased risk of hemorrhagic stroke (odds ratio, 1.29; 95% CI, 1.06 to 1.56). Aspirin was not associated with a statistically significant reduction in all-cause mortality (odds ratio, 0.97; 95% CI, 0.92 to 1.03) or cardiovascular mortality (odds ratio, 0.94; 95% CI, 0.85 to 1.03). Aspirin was associated with a reduction in non-fatal myocardial infarction (odds ratio, 0.80; 95% CI, 0.69 to 0.94) and an increased risk of major gastrointestinal bleeding (odds ratio, 1.83; 95% CI, 1.43 to 2.35). Using equal weighting for non-fatal events and major bleeding, we observed no net clinical benefit with aspirin use for primary prevention.ConclusionOur meta-analysis reports no benefit of aspirin for primary stroke prevention.

Year in Review: Applying Top Research to the Practice of PALTC Medicine

Year in Review: Applying Top Research to the Practice of PALTC Medicine

17-LB: Prognostic Value of Gamma-Glutamyl Transferase Variability in Individuals with Diabetes: A Nationwide Population-Based Study

Objective: We investigated whether gamma-glutamyltransferase (GGT) variability can predict the risk of stroke, myocardial infarction (MI), and all-cause mortality in individuals with diabetes. Methods: The study subjects were Koreans with diabetes who had undergone health examinations provided by the Korean National Health Insurance Corporation more than once during 2009-2012 (baseline). After excluding subjects aged <40 years and those with histories of stroke, MI, chronic liver disease, or drinking ≥30g/day of alcohol, a total 698937 individuals were included. As a parameter of variability, we calculated the average successive variability (ASV) of GGT values measured during the five years before the baseline exam. We estimated the risk of stroke, MI, all-cause mortality according to GGT ASV quartiles using multivariate-adjusted Cox analyses, until December 31, 2016. Stroke and MI was defined using ICD-10 codes (I63-I64 and I21-I22) and admission record. Results: During follow-up period, 26119 cases of stroke, 15103 cases of MI, and 39982 cases of death were identified. GGT ASV quartile showed significantly higher risk of stroke and all-cause mortality compared with quartile 1, even after adjustment for age, sex, renal function, obesity, drinking, smoking, exercise, presence of hypertension and dyslipidemia, hemoglobin, income status, glucose and GGT level, duration of diabetes, the number of histories of oral antidiabetic medication, prescription history of insulin, presence of diabetic retinopathy and peripheral artery disease. The fully adjusted HRs (95% CIs) of GGT ASV quartiles 4 were 1.06 (1.03-1.10) and 1.23 (1.20-1.27), respectively. This significance was maintained regardless of baseline GGT quartile in all-cause mortality. Conclusions: GGT variability was associated with the risk of all-cause mortality and stroke. This tendency is most pronounced in all-cause mortality, regardless of baseline GGT levels. Disclosure D. Lee: None. J. Yu: None. K. Han: None. J. Seo: None. N. Kim: None. Funding National Research Foundation of Korea

A Stroke Risk Detection: Improving Hybrid Feature Selection Method.

BackgroundStroke is one of the most common diseases that cause mortality. Detecting the risk of stroke for individuals is critical yet challenging because of a large number of risk factors for stroke.ObjectiveThis study aimed to address the limitation of ineffective feature selection in existing research on stroke risk detection. We have proposed a new feature selection method called weighting- and ranking-based hybrid feature selection (WRHFS) to select important risk factors for detecting ischemic stroke.MethodsWRHFS integrates the strengths of various filter algorithms by following the principle of a wrapper approach. We employed a variety of filter-based feature selection models as the candidate set, including standard deviation, Pearson correlation coefficient, Fisher score, information gain, Relief algorithm, and chi-square test and used sensitivity, specificity, accuracy, and Youden index as performance metrics to evaluate the proposed method.ResultsThis study chose 792 samples from the electronic records of 13,421 patients in a community hospital. Each sample included 28 features (24 blood test features and 4 demographic features). The results of evaluation showed that the proposed method selected 9 important features out of the original 28 features and significantly outperformed baseline methods. Their cumulative contribution was 0.51. The WRHFS method achieved a sensitivity of 82.7% (329/398), specificity of 80.4% (317/394), classification accuracy of 81.5% (645/792), and Youden index of 0.63 using only the top 9 features. We have also presented a chart for visualizing the risk of having ischemic strokes.ConclusionsThis study has proposed, developed, and evaluated a new feature selection method for identifying the most important features for building effective and parsimonious models for stroke risk detection. The findings of this research provide several novel research contributions and practical implications.

SISTEM PENDUKUNG KEPUTUSAN UNTUK DETEKSI DINI RISIKO PENYAKIT STROKE MENGGUNAKAN LEARNING VECTOR QUANTIZATION

Stroke is any sudden neurologic disorder that occurs as a result of restriction or cessation of blood flow through brain arteries supply system. Stroke is the leading cause of death in Indonesia. Services pre-stroke is early detection activities, discovery and monitoring of risk factors for stroke in healthy individuals and at-risk communities that can be performed by physicians, nurses and health workers. Based on the results of the study said that when control stroke risk factors to do with the approach would reduce the number of defects by 60-90%. Works doctor for diagnosis process is not easy because of the many risk factors vary and affect each other, for example Low Density Lipoprotein cholesterol can lead to heart disease can also affect blood pressure, gender can affect the value of uric acid, uric acid can also influence blood pressure and sugar levels can affect blood pressure. Classification method is one solution that is deemed able to handle the process of classifying the status of early detection of the risk of stroke. Mechanical classification using Learning Vector Quantization (LVQ) has excess generating an error value is smaller than other artificial neural networks. Based on the results of research and discussion conducted, algorithms LVQ can recognize patterns and are able to predict the status of early risk of stroke using a variable blood pressure, blood sugar, total cholesterol, Low Density Lipoprotein, age, gender, gout, Blood Urea Nitrogen and creatinine with a total value of up to 82% accuracy.

Abstract P107: Thirty-Year Risk of Incident and Recurrent Ischemic Stroke in Individuals With Sickle Cell Trait and Modification by Midlife Risk Factors: The Atherosclerosis Risk in Communities Study

Introduction: Sickle cell trait (SCT) has been associated with ischemic stroke in some, but not all, epidemiologic cohorts. Heterogeneity of the association may be related to differences in demographic subgroups or midlife risk factors. Methods: The ARIC study is an observational cohort based on 4 US communities. Participation has included 6 clinical visits and ongoing surveillance of acute cardiovascular events. Black participants were genotyped for SCT, excluding any with sickle cell anemia or hemoglobin SC disease. Global genetic ancestry was determined from whole genome variation. Midlife factors were ascertained at ARIC visit 1 (1987-1989), or if missing imputed from visit 2 (1990-1992). Acute ischemic stroke was classified by physician review of the medical record. Associations between SCT and ischemic stroke were analyzed using repeat-events Cox regression with robust estimators, counting all occurrences of ischemic stroke per participant. Models were adjusted for sex, age, global genetic ancestry, and midlife factors (smoking, hypertension, hyperlipidemia, diabetes, chronic kidney disease, and previous myocardial infarction). Effect modification was tested by the multiplicative interaction of SCT with each midlife factor. Results: Our population was composed of 3,827 black adults with complete midlife data (32 [0.8%] excluded). SCT was identified in 255 (7%). The mean age at visit 1 was 53 years; the median follow-up time was 26 years. Most (63%) were women. At midlife, individuals with SCT had a greater prevalence of hyperlipidemia (32% vs. 26%; P =0.04) and chronic kidney disease (20% vs. 13%; P =0.003). From 1987-2016, 579 ischemic strokes occurred in 456 individuals. SCT was more strongly associated with ischemic stroke in participants with chronic kidney disease [HR=2.01 (1.13 - 3.60)] than those without [HR=1.10 (0.77 - 1.57)], P for interaction = 0.05, Figure 1 . Conclusions: The association between SCT and ischemic stroke is heterogeneous and appears to be stronger in those with chronic kidney disease.

Medicare claims can identify post-stroke epilepsy

ObjectiveThere have been no validated Medicare claims-based algorithms available to identify epilepsy by discrete etiology of stroke (e.g., post-stroke epilepsy, PSE) in community-dwelling elderly individuals, despite the increasing availability of large datasets. Our objective was to validate algorithms that detect which patients have true PSE. MethodsWe linked electronic health records (EHR) to Medicare claims from a Medicare Pioneer Accountable Care Organization (ACO) to identify PSE. A neurologist reviewed 01/2012-12/2014 EHR data from a stratified sample of Medicare patients aged 65+ years to adjudicate a reference-standard to develop an algorithm for identifying patients with PSE. Patient sampling strata included those with: A) epilepsy-related claims diagnosis (n = 534 [all]); B) no diagnosis but neurologist visit (n = 500 [randomly sampled from 4346]); C) all others (n = 500 [randomly sampled from 16,065]). We reconstructed the full sample using inverse probability sampling weights; then used half to derive algorithms and assess performance, and the remainder to confirm performance. We evaluated predictive performance across several measures, e.g., specificity, sensitivity, negative and positive predictive values (NPV, PPV). We selected our best performing algorithms based on the greatest specificity and sensitivity. ResultsOf 20,943 patients in the reconstructed sample, 13.6% of patients with epilepsy had reference-standard PSE diagnosis, which represents a 3-year overall prevalence of 0.28% or 28/10,000, and a prevalence within the subpopulation with stroke of 3%. The best algorithm included three conditions: (a) at least one cerebrovascular claim AND one epilepsy-specific anticonvulsant OR (b) at least one cerebrovascular claim AND one electroencephalography claim (specificity 100.0% [95% CI 99.9%–100.0%], NPV 98.8% [98.6%–99.0%], sensitivity 20.6% [95% CI 14.6%–27.9%], PPV 86.5% [95% CI 71.2%–95.5%]). ConclusionMedicare claims can identify elderly Medicare beneficiaries with PSE with high accuracy. Future epidemiological surveillance of epilepsy could incorporate similar algorithms to accurately identify epilepsy by varying etiologies.

Abstract TMP115: Carotid Atherosclerosis Progression and Hippocampal Volume

Background: Carotid atherosclerosis is a known risk factor for stroke and dementia. Carotid atherosclerosis may play a role in neurodegeneration and be a potential target for treatment and preventive efforts for stroke and dementia in asymptomatic individuals. We studied the association of carotid intima media thickness (CIMT) with hippocampal volume (HV) in community-dwelling individuals, and hypothesize that persons with carotid atherosclerosis progression would have a lower HV. Methods: We studied 1,376 Framingham Offspring participants (age 67±8.7 years; 53% women) with two carotid ultrasound measurements (1995-1998 and 2005-2008) and brain MRI scans at or near the second ultrasound, who were stroke, dementia, or other neurological illnesses-free at MRI. We used multivariable linear regression analyses to relate annualized carotid IMT change at internal [ICA] and common carotid [CCA] to HV volume (as a percentage of total cranial volume). Models were adjusted for age, sex, time interval between second carotid duplex and MRI, systolic blood pressure, hypertension treatment (HRx), diabetes, total cholesterol level, smoking, cardiovascular disease and baseline CIMT. We additionally assessed effect modification by HRx and statin use. Results: Mean (±SD) carotid IMT change per year was 0.064±0.082mm in ICA and 0.008±0.008 mm in CCA. Participants with higher ICA IMT progression had significantly lower HV after adjustment for vascular risk factors and baseline IMT (β±SE [standardized beta±standard error]: -0.067±0.027, p= 0.01), but not CCA IMT progression (β±SE: 0.01± 0.0276 p= 0.72). In subgroup analyses, we observed weaker association between ICA IMT change and HV among subjects with HRx (β = -0.047, p=0.19 vs. β =-0.096, p=0.026 in untreated individuals), but HRx by IMT change interaction was not statistically significant (p-interaction=0.39). Effects were similar in statin subgroups and statistically non-significant for CCA IMT progression. Conclusions: Cumulative vascular risk factor exposure, as reflected by ICA IMT progression, are associated with neurodegeneration represented by lower hippocampal volumes. Such changes occur prior to onset of clinical dementia, suggesting that carotid IMT may be a target for preventive efforts.

Abstract TP222: Silent Brain Infarct (SBI) on MRI, Not White Matter Lesions, is Related to 10-year Stroke Risk Prediction in Middle-aged Healthy Japanese Individuals

Background: Periventricular hyperintensity (PVH), deep and subcortical white matter hyperintensity (DSWMH), and silent brain infarct (SBI) have been proposed as subclinical risk markers for future symptomatic stroke onset. However, the differences between PVH, DSWMH, and SBI as markers for eventual development of symptomatic stroke in middle-aged healthy Japanese individuals has not been adequately explored. Methods: We examined 280 Japanese adults (92 female, mean age, 52.9±5 years) with no history of cardio-cerebrovascular disease. PVH, DSWMH, SBI and various vascular risk factors for each subject were assessed, and 10-year stroke risk was predicted using the point-based prediction model provided by the Japan Public Health Center (JPHC) study, which consists of six risk factors that are used to calculated predicted stroke risk, including age, sex, smoking status, body mass index (BMI), blood pressure (BP), and diabetes status. Results: The subjects were divided into four groups based on predicted stroke risk: low, <1%; low-medium, 1- <5%; medium-high, 5-<10%; high, ≥10%. According to the JPHC study risk-prediction algorithm, a PVH grading ≥ 2, a DSWMH grading ≥2, and a SBI number ≥1 were positively correlated with an increase in predicted stroke risk. Age, systolic BP, HbA1c levels, eGFR, hypertension, diabetes mellitus, and family history of cardio-cerebrovascular disease (CCVD) were found to be significantly associated with SBI. The odds ratio (OR) for high predicted stroke risk (10-year risk ≥10%) showed significance for SBI ≥1, even after adjusting for potential confounding factors (OR, 12.45: 95% CI, 3.09-50.84), whereas the ORs for PVH and DSWMH were not significant. Conclusion: The presence of an SBI, not white matter lesions, was significantly correlated with an increased 10-year stroke risk, suggesting that detection of SBI by MRI may be practical for identifying a high risk of stroke for middle-aged Japanese subjects.

Abstract TP236: Cardio-ankle Vascular Index Is Related To The Predicted 10-year Stroke Risk In Middle-aged Japanese Individuals

Background: The cardio-ankle vascular index (CAVI), which is a novel parameter of arterial stiffness has recently been known as a surrogate marker for cardiovascular diseases. However, whether CAVI levels are related to the risk of stroke in the Japanese general individuals remains unclear. Methods: We examined 280 Japanese subjects (92 female, mean age, 52.6 ± 5 years) with no history of cardio-cerebrovascular disease. Each subject’s CAVI level and various risk factors were assessed; the predicted 10-year stroke risk was calculated using the point-based prediction model from the Japan Public Health Center study, which consists of six risk factors (age, sex, smoking status, BMI , BP and DM are used to calculate the predicted risk of stroke. Results: The subjects were divided into four groups based on predicted stroke risk: low, <1%; low-medium, 1- <5%; medium, 5-<10%; medium-high, ≥10%; and high. In a multiple linear regression analysis, sex, age, BMI and systolic BP were significant independent determinants of CAVI levels. When the subjects were divided into four groups based on predicted stroke risk, according to the JPHC study risk prediction algorithm, CAVI levels were significantly higher in the high-predicted risk group than in the medium-low and low-predicted risk groups. A significant odds ratio (OR) for very high predicted stroke risk (10-year risk ≥10%) was noted in the highest quartile of CAVI levels (OR, 13.76; 95% CI, 3.06-61.99), compared with the lowest quartile, after adjusting for potential confounding factors. A significant OR for high-predicted stroke risk was also found for each quartile increase (adjusted OR, 2.85; 95% CI, 1.80-4.53) and 1-point increase (adjusted OR, 2.23; 95% CI, 1.54-3.23) in CAVI level. Conclusion: Elevated CAVI levels were significantly associated with an increased predicted stroke risk, suggesting that measuring CAVI may be useful for identifying Japanese individuals with a high risk of stroke.

Protective effect of influenza vaccination on outcomes in geriatric stroke patients: A nationwide matched cohort study

Background and aimsThe effects of influenza vaccination (IV) on stroke outcomes are unclear. The purpose of this study is to evaluate the outcomes after stroke in elderly individuals who have received an IV. MethodsWe used Taiwan's National Health Insurance Research Database 2000–2009 claims data to conduct a nested stroke cohort study including 148,909 hospitalized stroke patients aged 66 years and older. Using a matching procedure by propensity score, we selected 25,248 stroke patients with IV and 25,248 stroke patients without IV for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs of post-stroke complications and in-hospital mortality associated with IV. ResultsStroke patients with IV had significantly lower risks of post-stroke pneumonia (OR = 0.79; 95% CI, 0.74–0.83), septicemia (OR = 0.78; 95% CI, 0.70–0.86), urinary tract infection (OR = 0.87; 95% CI, 0.83–0.92), and 30-day in-hospital mortality (OR = 0.60; 95% CI, 0.54–0.67) compared with non-IV stroke patients. Vaccinated stroke patients also had shorter hospital stays (p < 0.0001) and less medical expenditures (p < 0.0001) during stroke admission than the control group. Lower rates of post-stroke adverse events in patients with IV were noted in both sexes of all age groups with various types of stroke. ConclusionsStroke patients with IV showed fewer complications and lower mortality compared with non-IV patients. These findings suggest the urgent need to promote IV for this susceptible population of stroke patients.

Lacunar Stroke in Cryptococcal Meningitis: Clinical and Radiographic Features

ObjectiveCryptococcal meningitis carries a high mortality, and survivors are left with considerable neurologic sequelae and marked disability. We lack a clear understanding of the pathogenesis of neurologic sequelae and description of stroke features in this population. We aim to describe clinical and radiographic features and predictors of stroke in a cohort of patients with cryptococcal meningitis. MethodsWe collected key information on patients diagnosed with cryptococcal meningitis at the University of Colorado Hospital between 2000 and 2018 (n = 42). Of those, 32 had neuroimaging studies available. Bivariate and risk ratio estimates regression models were performed to identify predictors of stroke. ResultsWe found a 26% ischemic stroke complication rate in individuals with cryptococcal meningitis. Most strokes were acute (75%), lacunar (100%), multiple (88%), bilateral (63%), and involving the basal ganglia (75%). Presence of malignancy (38% versus 8%, P = .085) was higher in stroke in individuals with cryptococcal meningitis, although not statistically significant. Every unit decrease in hemoglobin and serum sodium were predictors for 1.35 and 1.14 times increase in the risk of ischemic stroke, respectively. The presence of hyponatremia carried a RR of 5.7 (95% confidence interval, 1.7-34, P = .005). Cryptococcal meningitis lead to death in 19% of patients and a considerable rate of neurologic sequela among survivors. ConclusionsCryptococcal meningitis carries a high risk of lacunar stroke, particularly in the basal ganglia. Cryptococcal meningitis-associated stroke is common and frequently associated with neurologic disability among survivors. We need to understand the possible role of malignancy, anemia, and hyponatremia in the onset of ischemic stroke.

Gene polymorphisms of angiotensin-converting enzyme and angiotensinogen and risk of idiopathic ischemic stroke

ObjectiveThe renin-angiotensin system (RAS) is a hormonal signaling mechanism implicated in the atherosclerosis and regulation of blood pressure. Angiotensin-converting enzyme (ACE) a key enzyme in the RAS, plays important roles in vascular remodeling atherosclerosis, and ischemic stroke. The aim of this study was to examine the possible contribution of the I/D in the ACE gene, M235T and T174M in the angiotensinogen (AGT) gene polymorphisms with ischemic stroke in young Mexican population. Materials and methodsA total of 224 patients with diagnosis of idiopathic ischemic stroke ≤45 years of age, and 224 controls matched by age and gender, were recruited from 2006 and 2016. The I/D, M235T and T174M polymorphisms were determined in all participants by PCR-RFLP. ResultsThere was a significant difference in the M235T genotype distribution (p = 0.01) and allele frequency between two groups (p = 0.01). Also, we found a significant difference in the T174M genotype distribution (p = 0.01) and the allele frequency between groups; (p = 0.02). In contrast, in I/D polymorphism, there was a similar genotype distribution; (p = 0.20) and allele distribution (p = 0.20). There were independent factors for ischemic stroke: M235T and T174M polymorphisms, smoking, hypertension, and familial history of atherothrombotic disease. The AGT levels were increased in the group of patients with stroke compared with the control group, but the AGT levels were not influenced by the allele or genotype in each polymorphism. ConclusionsThe M235T and T174M polymorphisms represented an increased risk for stroke in young Mexican individuals. In contrast, the I/D was not associated with in the same group of patients. The AGT levels were higher in the acute phase of stroke, but it was not determined by the polymorphisms.

Vitamin E intake and risk of stroke: a meta-analysis.

Findings from observational studies on the associations between vitamin E intake and stroke risk remain controversial, and the dose-response relationship between vitamin E intake and risk of stroke remains to be determined. We conducted a meta-analysis of prospective studies aiming to clarify the relationships between vitamin E intake and risk of stroke. Relevant studies were identified by searching online databases through to June 2018. We computed summary relative risks (RR) with corresponding 95 % CI. Among 3156 articles retrieved from online databases and relevant bibliographies, nine studies involving 3284 events and 220 371 participants were included in the final analyses. High dietary vitamin E intake was inversely associated with the risk of overall stroke (RR=0·83, 95 % CI 0·73, 0·94), and with the risk of stroke for individuals who were followed-up for <10 (RR=0·84, 95 % CI 0·72, 0·91). There was a non-linear association between dietary vitamin E intake and stroke risk (P=0·0249). Omission of any single study did not alter the summary result. In conclusion, this meta-analysis suggests that there is a significant inverse relationship between dietary vitamin E intake and stroke risk. This meta-analysis provides evidence that a higher dietary vitamin E intake is associated with a lower stroke risk.

Pulmonary arteriovenous malformations.

Pulmonary arteriovenous malformation, a condition most commonly associated with hereditary hemorrhagic telangiectasia, is an abnormal communication between the pulmonary artery and pulmonary vein without an intervening capillary communication. Although asymptomatic in ~ 50% individuals, it can present with the dreaded complications of stroke or intracranial abscess in high-risk individuals including pregnant women, if untreated. The mainstay of treatment is now endovascular embolization of the feeding artery which can alleviate the symptoms and prevent these complications. In this review, we describe the pathophysiology, methods of screening, diagnostic workup and treatment of these vascular lesions with a particular focus on the currently used embolization techniques and their outcomes.

Dose-dependent effect of smoking on risk of coronary heart disease, heart failure and stroke in individuals with type 1 diabetes.

The aim of this study was to assess the potential dose-dependent effects of smoking on the risk of CHD, heart failure and stroke in individuals with type 1 diabetes. The study included 4506 individuals with type 1 diabetes who were participating in the Finnish Diabetic Nephropathy (FinnDiane) study. Intensity of smoking was estimated by packs per day and cumulative smoking by pack-years. Cox regression analyses were used to estimate the risk of incident CHD, heart failure or stroke during follow-up. One pack per day significantly increased the risk of incident CHD in current smokers compared with never smokers (HR 1.45 [95% CI 1.15, 1.84]), after adjustment for age, sex, HbA1c, hypertension, duration of diabetes and BMI. The risk of CHD in former smokers was similar to the risk in never smokers. The risk of incident heart failure was 1.43 (95% CI 1.03, 1.97) in current smokers per one pack per day and 1.37 (95% CI 1.05, 1.77) in former smokers, while the risk of incident stroke was 1.70 (95% CI 1.26, 2.29) and 1.49 (95% CI 1.14, 1.93), respectively. After further adjustments for lipids, however, the difference in the risk of heart failure in current and former smokers was no longer significant. Cumulative smoking data were similar to smoking intensity data. There is a dose-dependent association between smoking and cardiovascular disease in individuals with type 1 diabetes. In men in particular, the risk of incident stroke remains high even after smoking cessation and is increased in current and former smokers independently of other risk factors.

Asymmetries in force matching are related to side of stroke in right-handed individuals

Asymmetries in grasp force matching extend beyond quantifying a single measure of maximum grip strength and advance our application of side-specific treatment interventions. A cross sectional study design investigated grasp-force matching performance in right-handed individuals with a stroke and age-matched healthy controls. A visual representation of the 20% Maximum Voluntary Contraction (MVC) was matched in three conditions in the absence of visual feedback with the same (Ipsilateral Remembered – IR) or opposite hand (Concurrent – CC and Contralateral Remembered – CR). Greater overall relative error (RE) was found in contralateral compared to ipsilateral matching tasks. In the CR condition, post hoc analysis revealed significant differences between control and right hemisphere damage (RHD) group (95% CI [16.41–88.59]; p < 0.01) as well as left hemisphere damage (LHD) group and RHD (95% CI [23.4–95.09]; p < 0.01). Right hand matching relative error was 2.49 times larger in the RHD compared to the LHD group. Within the RHD group, matching errors were greater for the right than left hand in both contralateral conditions (95% CI [34.25–101.07]; p < 0.001).Individuals with RHD showed greater asymmetries in contralateral matching tasks compared to LHD and controls. More specifically, the RHD group had the greatest difficulty matching tasks with their right (non-paretic) than left (paretic) hand. In order to elucidate this asymmetry in the clinic the use of complementary grasp measures may be considered.

The Importance of the Full Blood Count in Cerebral Ischemia: A Review of 609 Consecutive Young Patients with Stroke and Transient Ischemic Attacks

Almost half of ischemic strokes in young individuals are cryptogenic. Thrombophilia testing is routinely sent despite limited evidence linking to arterial cerebrovascular events. A full blood count may identify underlying hematological disorder. We retrospectively reviewed all patients younger than 60 years with stroke and transient ischemic attack (TIA) presenting to a regional hyperacute stroke unit and daily TIA clinic from January 2015 to August 2016. We examined hematocrit level and platelet count, and whether abnormalities were further investigated. We examined if primary hematological disorders associated with stroke were considered, specifically myeloproliferative diseases (MPDs) and thrombotic thrombocytopenic purpura (TTP). Of 609 patients who presented with stroke or TIA, there were 161 abnormalities in hematocrit level or platelet count in 153 patients (25.1%). One hundred sixteen patients had high hematocrit levels (19%), 19 had thrombocytosis (3.1%), 26 had thrombocytopenia (4.3%), and 8 had abnormalities in both lineages (1.3%). A total of 119 patients had repeat testing (74%). Molecular investigations for MPD were warranted in 19 patients (3.1%), performed in 3 patients (.5%) with 2 patients subsequently diagnosed. ADAMTS13 analysis was indicated in 10 patients with thrombocytopenia, performed in 2 patients with 1 diagnosed with TTP thereafter. One quarter of our cohort (n = 153) had abnormalities in hematocrit and/or platelets. MPD or TTP was present in 3 of the 5 patients specifically investigated. At least 22 patients (14%) merited further investigation. Although primary hematological disorders are rare in stroke aetiology, the full blood count is important to exclude known causes of arterial cerebrovascular events in young patients.

Dr. Rossides, et al reply.

We thank Dr. Baicus for his interest1 in our investigation of the mortality and functionality after stroke in individuals with systemic lupus erythematosus (SLE)2. In our article, we reported that the median age at stroke onset in individuals with SLE was 68 years for ischemic stroke and 65 for hemorrhagic stroke … Address correspondence to Dr. M. Rossides, Karolinska Institutet, Department of Medicine Solna, Clinical Epidemiology Division, T2, 171 76 Stockholm, Sweden. E-mail: marios.rossides{at}ki.se