Background and Purpose— We sought to explore the effect of genetic imbalance on functional outcome after ischemic stroke (IS). Methods— Copy number variation was identified in high-density single-nucleotide polymorphism microarray data of... more
Background and Purpose— We sought to explore the effect of genetic imbalance on functional outcome after ischemic stroke (IS). Methods— Copy number variation was identified in high-density single-nucleotide polymorphism microarray data of IS patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) and SiGN (Stroke Genetics Network)/GISCOME (Genetics of Ischaemic Stroke Functional Outcome) networks. Genetic imbalance, defined as total number of protein-coding genes affected by copy number variations in an individual, was compared between patients with favorable (modified Rankin Scale score of 0–2) and unfavorable (modified Rankin Scale score of ≥3) outcome after 3 months. Subgroup analyses were confined to patients with imbalance affecting ohnologs—a class of dose-sensitive genes, or to those with imbalance not affecting ohnologs. The association of imbalance with outcome was analyzed by logistic regression analysis, adjusted for age, sex, stroke subtype, st...
Research Interests: Medicine, Logistic Regression, Humans, Internal Medicine, Brain Ischemia, and 15 moreIschemic Stroke, Gene Duplication, Gene Dosage, Clinical Sciences, Aged, Middle Aged, Genotype, Adult, Single Nucleotide Polymorphism, Odds ratio, Neurosciences, Severity of Illness Index, Recovery of Function, modified Rankin Scale, and Cardiovascular medicine and haematology
Background and Purpose— Studies on Helicobacter pylori infection and risk of ischemic stroke yielded variable results. Infection with more virulent H. pylori strains, such as cytotoxin-associated gene-A (CagA)–bearing strains, may be of... more
Background and Purpose— Studies on Helicobacter pylori infection and risk of ischemic stroke yielded variable results. Infection with more virulent H. pylori strains, such as cytotoxin-associated gene-A (CagA)–bearing strains, may be of particular relevance for ischemic diseases. We investigated whether H. pylori and CagA seropositivity are independent risk factors for cerebral ischemia or its etiologic subtypes. Methods— We determined IgG antibodies against H. pylori and CagA protein (enzyme immunoassays) in 190 patients with acute cerebral ischemia and in 229 age- and sex-matched control subjects selected randomly from the general population. Results— CagA seropositivity was more common in patients (114/190; 60.0%) than in control subjects (99/229; 43.2%; odds ratio, 1.97; 95% CI, 1.33 to 2.91; P <0.001). This result remained significant after adjustment for age, sex, vascular risk factors and diseases, and childhood and adult social status (odds ratio, 1.84; 95% CI, 1.13 to 3....
Research Interests: Helicobacter pylori, Humans, Internal Medicine, Ischemia, Female, and 15 moreMale, Brain Ischemia, Ischemic Stroke, Clinical Sciences, Aged, Adult, Cerebral Ischemia, Case Control Study, General Population, H Pylori, immunoglobulin G, Case Control Studies, CagA, Enzyme Immunoassay, and Cardiovascular medicine and haematology
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In a large series of patients with cervical artery dissection (CeAD), a major cause of ischemic stroke in young and middle-aged adults, we aimed to examine frequencies and correlates of family history of CeAD and of inherited connective... more
In a large series of patients with cervical artery dissection (CeAD), a major cause of ischemic stroke in young and middle-aged adults, we aimed to examine frequencies and correlates of family history of CeAD and of inherited connective tissue disorders. We combined data from 2 large international multicenter cohorts of consecutive patients with CeAD in 23 neurologic departments participating in the CADISP-plus consortium, following a standardized protocol. Frequency of reported family history of CeAD and of inherited connective tissue disorders was assessed. Putative risk factors, baseline features, and 3-month outcome were compared between groups. Among 1,934 consecutive patients with CeAD, 20 patients (1.0%, 95% confidence interval: 0.6%-1.5%) from 17 families (0.9%, 0.5%-1.3%) had a family history of CeAD. Family history of CeAD was significantly more frequent in patients with carotid location of the dissection and elevated cholesterol levels. Two patients without a family histo...
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Zusammenfassung Eines der entscheidenden Hindernisse für eine flächendeckende Schlaganfallversorgung nach dem „state of the art“, insbesondere in ländlichen Regionen, ist der Mangel an rasch verfügbarer neurologischer Expertise.... more
Zusammenfassung Eines der entscheidenden Hindernisse für eine flächendeckende Schlaganfallversorgung nach dem „state of the art“, insbesondere in ländlichen Regionen, ist der Mangel an rasch verfügbarer neurologischer Expertise. Telemedizinische Anwendungen mit klinisch-neurologischer Untersuchung via Videokonferenz zwischen der Aufnahmeklinik und einem spezialisierten Schlaganfallzentrum sowie teleradiologischer Bewertung der zerebralen Bildgebung können diesen Versorgungsengpass überbrücken. Tatsächlich lassen sich Schlaganfallsyndrome gut durch eine Videountersuchung erfassen. Die
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Background and Purpose— The vitamin K–dependent protein Z (PZ) has been shown to possess anticoagulant as well as procoagulant properties. Plasma levels of PZ show a broad interindividual variation, but it is unknown to which extent this... more
Background and Purpose— The vitamin K–dependent protein Z (PZ) has been shown to possess anticoagulant as well as procoagulant properties. Plasma levels of PZ show a broad interindividual variation, but it is unknown to which extent this variation is under genetic control. Recent clinical studies revealed contradictory results on the association of PZ plasma levels and the risk of ischemic stroke. Methods— We performed a case-control study including 200 patients with cerebral ischemia aged ≤50 years and 199 control subjects from the same South German region. We investigated a possible association of 2 common single nucleotide mutations in the PZ gene with the risk of cerebral ischemia. Furthermore, enzyme-linked immunosorbent assay measurements were done in control subjects without vascular disease to detect a potential association of different genotypes with PZ plasma (antigen) levels. Results— In patients, the frequency of the A allele of the intron F polymorphism G79A was signifi...
Research Interests: Membrane Proteins, Medicine, Germany, Humans, Internal Medicine, and 15 moreFemale, Male, Brain Ischemia, Clinical Sciences, Introns, Genotype, Adult, Cerebral Ischemia, Genetic variation, Allele, Neurosciences, Blood Proteins, Case Control Studies, Gene frequency, and Cardiovascular medicine and haematology
Background and Purpose— Thrombolysis in patients using oral anticoagulants (OAC) and in patients for whom information on OAC status is not available is frequently delayed because the standard coagulation analysis procedure in central... more
Background and Purpose— Thrombolysis in patients using oral anticoagulants (OAC) and in patients for whom information on OAC status is not available is frequently delayed because the standard coagulation analysis procedure in central laboratories (CL) is time-consuming. By using point-of-care (POC) coagumeters, international normalized ratio (INR) values can be measured immediately at the bedside. The accuracy and effectiveness of POC devices for emergency management in acute ischemic stroke has not been tested. Methods— In phase 1, the reliability of emergency INR POC measurements in comparison to CL was determined. In phase 2, patients with ischemic stroke admitted within the time frame for systemic thrombolysis and who were either using OAC or for whom information on OAC status was not available were enrolled. Patients received thrombolysis if POC INR was ≤1.5. Precision and time gain was recorded for INR as measured by POC vs CL. Results— In phase 1 (n=113), Bland-Altman analysi...
Research Interests: Medicine, Stroke, Prospective studies, Humans, Female, and 15 morePoint of Care, Male, Emergency, Brain Ischemia, Anticoagulants, Clinical Sciences, Aged, Middle Aged, Adult, Acute Ischemic Stroke, Neurosciences, Thrombolytic Therapy, Thrombolysis, International normalized ratio, and Cardiovascular medicine and haematology
Background and Purpose— Although thromboembolic stroke is caused by red, white, or mixed clots, the emboli previously used in animal studies on thrombolysis were more often red than white. Because this might be one of the reasons why... more
Background and Purpose— Although thromboembolic stroke is caused by red, white, or mixed clots, the emboli previously used in animal studies on thrombolysis were more often red than white. Because this might be one of the reasons why thrombolysis is less effective in patients than in experimental stroke, we developed a new method of preparing highly standardized red and fibrin-rich white emboli. Methods— The middle cerebral artery of 20 rabbits was embolized with either red or fibrin-rich white autologous emboli. Cerebral perfusion was monitored by MRI. Results— Red emboli consisted of closely packed erythrocytes within a sparse fibrin net and white emboli of a dense mass of fibrin with only few other blood cells. Infarct volumes were 26±4% (mean±SD) of the ischemic hemisphere with red and 27±6% with white emboli. The relative regional cerebral blood volume dropped below 50% 90 minutes after vascular occlusion with either type of embolus. Late spontaneous lysis and hemorrhagic compl...
Research Interests: Animal Studies, Medicine, Fibrin, Stroke, Brain, and 15 moreAnimals, Male, Animal Model, Clinical Sciences, Reproducibility of Results, Rabbits, Erythrocytes, Neurosciences, Embolism, Blood cells, Middle Cerebral Artery, Cerebral Infarction, Cerebral Angiography, Thrombolysis, and Cardiovascular medicine and haematology
Background and Purpose— Leisure-time physical activity protects from stroke. It is insufficiently established whether early lifetime physical activity is independently protective and whether some etiologic stroke subgroups particularly... more
Background and Purpose— Leisure-time physical activity protects from stroke. It is insufficiently established whether early lifetime physical activity is independently protective and whether some etiologic stroke subgroups particularly benefit from physical activity. We tested the hypothesis that both recent and early-adulthood sports activities are associated with reduced odds of stroke and analyzed their effects in stroke subtypes. Methods— We performed a case-control study of 370 patients with acute stroke or transient ischemic attack (TIA) and 370 age- and sex-matched control subjects randomly selected from the population and assessed recent and young adulthood sports activities and their weekly duration in standardized interviews. Results— Recent regular sports activities were less often reported by patients (94/370, 25.4%) than by control subjects (162/370, 43.8%; P <0.0001). After adjustment for vascular risk factors, education, and other factors, recent participation in s...
Research Interests: Adolescent, Medicine, Multivariate Analysis, Germany, Humans, and 15 moreFemale, Male, Brain Ischemia, Clinical Sciences, Aged, Middle Aged, Adult, Odds ratio, Age Factors, Case Control Study, Cerebral Hemorrhage, Neurosciences, Case Control Studies, Motor activity, and Cardiovascular medicine and haematology
Background — Even after extensive evaluation, the etiology of ischemic stroke remains undefined in a considerable proportion of cases, suggesting that causes of stroke may exist that have not yet been established. We tested the hypothesis... more
Background — Even after extensive evaluation, the etiology of ischemic stroke remains undefined in a considerable proportion of cases, suggesting that causes of stroke may exist that have not yet been established. We tested the hypothesis that pulmonary venous thrombosis (PVT) is a potential source of brain embolism in patients with cryptogenic stroke. Summary of Report — Within 7 days after mild to moderately severe ischemic stroke or transient ischemic attack, 18 patients (9 women, 9 men; mean age, 48 years) were studied in whom the etiology remained undefined despite complete workup. All patients received high-resolution pulmonary venography with the use of multiple-bolus, multiphase, 3-dimensional, gadolinium-enhanced MR angiography (MRA). Overall quality of the MRA was good in 14 and insufficient in 4 patients, mainly as a result of breathing artifacts. Visualization of the main and segmental veins and evaluability of their patency were good for most right pulmonary veins but o...
Research Interests: Cardiology, Medicine, Humans, Female, Male, and 15 morecerebral Venous sinus thrombosis, Artifacts, Etiology, Ischemic Stroke, Clinical Sciences, Angiography, Dimensional, Middle Aged, High Resolution, Adult, MR Angiography, Contrast Media, Cerebral Infarction, Magnetic resonance angiography, and Cardiovascular medicine and haematology
Background and Purpose— Herniation attributable to unilateral mass effect is the major cause of death in cerebral venous thrombosis (CVT). Decompressive surgery may be lifesaving in these patients. Methods— Retrospective registry of cases... more
Background and Purpose— Herniation attributable to unilateral mass effect is the major cause of death in cerebral venous thrombosis (CVT). Decompressive surgery may be lifesaving in these patients. Methods— Retrospective registry of cases of acute CVT treated with decompressive surgery (craniectomy or hematoma evacuation) in 22 centers and systematic review of all published cases of CVT treated with decompressive surgery. The primary outcome was the score on the modified Rankin Scale (mRS) score at last follow-up, dichotomized between favorable (mRS score, 0–4) and unfavorable outcome (mRS score, 5 or death). Secondary outcomes were complete recovery (mRS score 0–1), independence (mRS score, 0–2), severe dependence (mRS score, 4–5), and death at last available follow-up. Results— Sixty-nine patients were included and 38 were from the registry. Decompressive craniectomy was performed in 45 patients, hematoma evacuation was performed in 7, and both interventions were performed in 17 p...
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Research Interests: Radiology, Rheumatology, Immunology, Magnetic Resonance Imaging, Adolescent, and 15 moreMedicine, Germany, Stroke, Humans, Female, Male, Follow-up studies, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, European Continental Ancestry Group, Vertebral artery, Arteritis, and Subclavian artery
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Research Interests: Cognitive Science, Neurology, Nonparametric Statistics, Medicine, Observation, and 15 moreProspective studies, Humans, Internal Medicine, Female, Male, Horner syndrome, Clinical Sciences, Middle Aged, Adult, Odds ratio, Retrospective Studies, Neurosciences, Internal Carotid Artery, Vertebral artery, and İcad
The TT genotype of a functional factor XII (FXII) C46T gene polymorphism was shown to be a risk factor for peripheral venous thrombosis. We tested whether this genetic variant also increases the risk for cerebral venous thrombosis (CVT).... more
The TT genotype of a functional factor XII (FXII) C46T gene polymorphism was shown to be a risk factor for peripheral venous thrombosis. We tested whether this genetic variant also increases the risk for cerebral venous thrombosis (CVT). We performed a case-control study including 78 consecutive patients with proven CVT and 201 healthy population controls from South Germany. The FXII C46T genotype was assessed using a PCR technique. The TT genotype of the FXII C46T polymorphism was more common in patients (16.7%) than in controls (5.5%). A strong association of the TT genotype with CVT was found, which was independent of covariables (adjusted odds ratio 4.57; 95% CI 1.55 to 13.41; p = 0.006). The TT genotype of the functional factor XII C46T gene polymorphism may be a new independent risk factor for cerebral venous thrombosis (CVT). Our finding warrants confirmation in an independent study before this genetic variant should be added to the panel of established risk factors for CVT.
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The exposure of tissue factor (TF) to blood flow is the initial step in the coagulation process and plays an important role in thrombogenesis. We investigated the role of genetic polymorphisms and haplotypes of the TF gene in the risk of... more
The exposure of tissue factor (TF) to blood flow is the initial step in the coagulation process and plays an important role in thrombogenesis. We investigated the role of genetic polymorphisms and haplotypes of the TF gene in the risk of ischemic vascular disease. Four hundred and twenty-two Italian patients with juvenile myocardial infarction (MI) and 434 controls, 808 US cases with MI and 1005 controls, 267 Italian cases with juvenile ischemic stroke and 209 controls and 148 German cases with juvenile ischemic stroke and 191 controls were studied. rs1361600, rs3917629 (rs3354 in the US population), rs1324214 and rs3917639 Tag single nucleotide polymorphisms were genotyped. Additionally, a meta-analysis of all previous studies on TF loci and the risk of ischemic coronary disease (ICD) was performed. After multivariable analysis none of the SNPs, major SNP haplotypes or haplotype-pairs showed any consistent association with MI. Pooled meta-analysis of six studies also suggested that TF polymorphisms are not associated with CHD. A significant, independent association between SNP rs1324214 (C/T) and juvenile stroke was found in Italian and German populations (OR for TT homozygotes = 0.47, 95% CI 0.24-0.92, in combined analysis). Pooled analysis also showed a significant association for haplotype H3 (OR = 0.76, 95% CI 0.57-1.00) and haplotype-pair H3-H3 (OR = 0.43, 95% CI 0.20-0.92). TF genetic variations were associated with the risk of ischemic stroke at young age, but did not affect ischemic coronary disease.
Research Interests: Medicine, Multivariate Analysis, Italy, Humans, Internal Medicine, and 15 moreIschemia, Haplotypes, Female, Male, Haemostasis and Thrombosis, Meta Analysis, Clinical Sciences, Middle Aged, Gene Polymorphism, Genotype, Adult, Genetic variation, Haplotype, Case Control Studies, and Cardiovascular medicine and haematology
Spinocerebellar ataxia type 17 (SCA17) is caused by abnormal expansions of CAG/CAA trinucleotides within the TATA-box binding protein gene (TBP). The currently accepted critical threshold of abnormal expansions is ≥43. To investigate the... more
Spinocerebellar ataxia type 17 (SCA17) is caused by abnormal expansions of CAG/CAA trinucleotides within the TATA-box binding protein gene (TBP). The currently accepted critical threshold of abnormal expansions is ≥43. To investigate the minimal CAG/CAA expansion within the TBP in SCA17. 285 patients with autosomal-dominant ataxia were examined, and abnormal or borderline expansions of CAG/CAA within TBP in eight cases were found. Of those, four patients from three families had exactly 42 CAG/CAA trinucleotides, that is, one codon less than the currently accepted critical threshold of 43. The four patients presented with a relatively benign phenotype. All had dysdiadochokinesia and dysarthria. Mild gait ataxia was observed in three of the four patients. The reference definition of at least 43 CAG/CAA codons for pathological SCA17 alleles should be lowered to 42.
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The monocyte receptor for bacterial lipopolysaccharide CD14 is an important mediator of the inflammatory response. Recently, a polymorphism in the promotor of the CD14 gene, C (-260) T, was detected as a risk factor for coronary heart... more
The monocyte receptor for bacterial lipopolysaccharide CD14 is an important mediator of the inflammatory response. Recently, a polymorphism in the promotor of the CD14 gene, C (-260) T, was detected as a risk factor for coronary heart disease. We tested the hypotheses that this polymorphism is a risk factor 1. for cerebral ischemia in general and 2. for cerebral ischemia due to large artery atherosclerosis or microangiopathy in particular. We performed a case control study including 151 consecutive patients with acute cerebral ischemia treated at our university hospital and 149 control subjects. All control subjects were randomly selected from the general population of the same region in South-West Germany. Genotype frequencies of the C(-260) T polymorphism in the promotor of the CD14 gene were examined by restriction length analysis. The TT-genotype was not associated with cerebral ischemia in general either in univariate or in multivariate analysis together with classical vascular risk factors (odds ratio in multivariate analysis: 1.11; 95 %CI, 0.63 to 1.95). In 70 patients with cerebral ischemia due to atherosclerosis of large arteries or microangiopathy, there was a significantly higher prevalence of the TT-genotype than into control subjects (38.6 % vs. 23.5 %; odds ratio in multivariate analysis 2.26; 95 %CI, 1.13 to 4.54). We demonstrated that the TT-genotype of the CD14 C(-260) T polymorphism in a South-German population is not associated with an increased risk of cerebral ischemia in general. However, we found that the TT-genotype is associated with a risk of atherosclerotic or microangiopathic stroke. This finding requires confirmation by future studies in larger populations.
Research Interests: Medicine, German, Lipopolysaccharide, Germany, Humans, and 15 moreInternal Medicine, Female, Male, Brain Ischemia, Clinical Sciences, Aged, Middle Aged, Lipopolysaccharides, Genotype, Coronary heart disease, Cerebral Ischemia, Case Control Study, General Population, Case Control Studies, and Inflammatory response
Background Cervical artery dissection (CAD) is a frequent cause of ischemic stroke, and occasionally death, in young adults. Several lines of evidence suggest a genetic predisposition to CAD. However, previous genetic studies have been... more
Background Cervical artery dissection (CAD) is a frequent cause of ischemic stroke, and occasionally death, in young adults. Several lines of evidence suggest a genetic predisposition to CAD. However, previous genetic studies have been inconclusive mainly due to insufficient numbers of patients. Our hypothesis is that CAD is a multifactorial disease caused by yet largely unidentified genetic variants and environmental factors, which may interact. Our aim is to identify genetic variants associated with an increased risk of CAD and possibly gene-environment interactions. Methods We organized a multinational European network, Cervical Artery Dissection and Ischemic Stroke Patients (CADISP), which aims at increasing our knowledge of the pathophysiological mechanisms of this disease in a large group of patients. Within this network, we are aiming to perform a de novo genetic association analysis using both a genome-wide and a candidate gene approach. For this purpose, DNA from approximat...
Research Interests: Genetics, Research Design, Medicine, Quality Control, DNA, and 15 moreCAD, Humans, Disease, Brain Ischemia, Dissection, Clinical Sciences, Genotype, Adult, European Continental Ancestry Group, Genetic Predisposition, Environment, Neurosciences, Polymorphisms, Cervical Artery Dissection, and Gene frequency
Risk factors for IS in young adults differ between genders and evolve with age, but data on the age- and gender-specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15... more
Risk factors for IS in young adults differ between genders and evolve with age, but data on the age- and gender-specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15 European stroke centers. Stroke etiology was reported in detail for 3331 patients aged 15-49 years with first-ever IS according to Trial of Org in Acute Stroke Treatment (TOAST) criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-vessel occlusion (SVO), other determined etiology, or undetermined etiology. CE was categorized into low- and high-risk sources. Other determined group was divided into dissection and other non-dissection causes. Comparisons were done using logistic regression, adjusting for age, gender, and center heterogeneity. Etiology remained undetermined in 39.6%. Other determined etiology was found in 21.6%, CE in 17.3%, SVO in 12.2%, and LAA in 9.3%. Other determined etiology was more common in females and younger patients, with cervical artery dissection being the single most common etiology (12.8%). CE was more common in younger patients. Within CE, the most frequent high-risk sources were atrial fibrillation/flutter (15.1%) and cardiomyopathy (11.5%). LAA, high-risk sources of CE, and SVO were more common in males. LAA and SVO showed an increasing frequency with age. No significant etiologic distribution differences were found amongst southern, central, or northern Europe. The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.
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Enhanced stimulus-induced release of pro-inflammatory cytokines by leucocytes may contribute to the pathogenesis of ischaemic stroke. We investigated the lipopolysaccharide-induced release of interleukin-1beta (IL-1beta), IL-6, IL-8, and... more
Enhanced stimulus-induced release of pro-inflammatory cytokines by leucocytes may contribute to the pathogenesis of ischaemic stroke. We investigated the lipopolysaccharide-induced release of interleukin-1beta (IL-1beta), IL-6, IL-8, and tumour necrosis factor-alpha (TNF-alpha) in whole blood from 20 patients with a history of ischaemic stroke under the age of 50, 20 patients with a history of cervical artery dissection (CAD) and 21 age- and sex-matched healthy control subjects. Release of IL-8 was higher (P = 0.006) and release of TNF-alpha and IL-6 tended to be higher (P &amp;amp;lt; 0.1) in young stroke patients than in control subjects. No increased release existed in CAD patients. Vascular risk factors or history of infection before stroke did not modify IL-8 production. A common T(250) --&amp;amp;gt; A polymorphism in the IL-8 gene promotor was newly identified but did not correlate with the variability of IL-8 release. The C(260) --&amp;amp;gt; T polymorphism in the gene of the monocytic LPS-receptor CD14--a risk factor for myocardial infarction--was not associated with increased cytokine release. We conclude that high inducible release of IL-8--and possibly of TNF-alpha and IL-6--may contribute to the odds of ischaemic stroke in young adults.
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ABSTRACT
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Background: Paradoxical embolism via persistent foramen ovale (PFO) is suspected to be a frequent cause of stroke in younger patients. We investigated whether the prevalence of the risk factors for venous thrombosis factor V Leiden (FVL)... more
Background: Paradoxical embolism via persistent foramen ovale (PFO) is suspected to be a frequent cause of stroke in younger patients. We investigated whether the prevalence of the risk factors for venous thrombosis factor V Leiden (FVL) and prothrombin G20210A mutation (PT G20210A) is increased in this group of patients. Methods: We examined FVL and PT G20210A mutation in 220 patients (group 1) with cerebral ischemia associated with a PFO and without other etiology, in 196 patients with cerebral ischemia of an etiology other than PFO (group 2), and in 362 healthy subjects (group 3) from the same region in Germany. Results: Heterozygosity for the PT G20210A mutation was more common in group 1 (5.0%) than in group 3 (1.4%; sex- and age-adjusted odds ratio 3.66; 95% CI 1.25–10.75; p = 0.01). By contrast, the mutation was not more common in group 2 (2.6%; odds ratio 1.50; 95% CI 0.42–5.41; p = 0.5). Prevalences of FVL were not different between groups. Conclusions: We identified PT G20...
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Research Interests: Cognitive Science, Neurology, Medicine, Humans, Female, and 15 moreMale, Risk factors, Clinical Sciences, Gene Polymorphism, Genotype, Lysine, Adult, Odds ratio, Risk Factors, Amino Acid Substitution Rates, Neurosciences, Glutamic Acid, Cervical Artery Dissection, Vertebral Artery Dissection, and alleles
Background and Purpose— Although many stroke patients are young or middle-aged, risk factor profiles in these age groups are poorly understood. Methods— The Stroke in Young Fabry Patients (sifap1) study prospectively recruited a large... more
Background and Purpose— Although many stroke patients are young or middle-aged, risk factor profiles in these age groups are poorly understood. Methods— The Stroke in Young Fabry Patients (sifap1) study prospectively recruited a large multinational European cohort of patients with cerebrovascular events aged 18 to 55 years to establish their prevalence of Fabry disease. In a secondary analysis of patients with ischemic stroke or transient ischemic attack, we studied age- and sex-specific prevalences of various risk factors. Results— Among 4467 patients (median age, 47 years; interquartile range, 40–51), the most frequent well-documented and modifiable risk factors were smoking (55.5%), physical inactivity (48.2%), arterial hypertension (46.6%), dyslipidemia (34.9%), and obesity (22.3%). Modifiable less well-documented or potentially modifiable risk factors like high-risk alcohol consumption (33.0%) and short sleep duration (20.6%) were more frequent in men, and migraine (26.5%) was ...
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Research Interests: Ultrasound, Stroke, Humans, Anticoagulants, Sample Size, and 10 moreRecurrence, Clinical Sciences, Randomized Controlled Trial, Neurosciences, Cervical Artery Dissection, Randomized Controlled Trials as Topic, Arteries, Intracranial aneurysm, Platelet Aggregation Inhibitors, and Cardiovascular medicine and haematology
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It has been suggested that inflammation may play a role in the development of cervical artery dissection (CeAD), but evidence remains scarce. A total of 172 patients were included with acute (&amp;amp;amp;amp;amp;amp;amp;amp;lt; 24 h)... more
It has been suggested that inflammation may play a role in the development of cervical artery dissection (CeAD), but evidence remains scarce. A total of 172 patients were included with acute (&amp;amp;amp;amp;amp;amp;amp;amp;lt; 24 h) CeAD and 348 patients with acute ischaemic stroke (IS) of other (non-CeAD) causes from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study, and 223 age- and sex-matched healthy control subjects. White blood cell (WBC) counts collected at admission were compared across the three groups. Compared with healthy control subjects, CeAD patients and non-CeAD stroke patients had higher WBC counts (P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Patients with CeAD had higher WBC counts and were more likely to have WBC &amp;amp;amp;amp;amp;amp;amp;amp;gt; 10 000/μl than non-CeAD stroke patients (38.4% vs. 23.0%, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and healthy controls (38.4% vs. 8.5%, P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). WBC counts were higher in CeAD (9.4 ± 3.3) than in IS of other causes (large artery atherosclerosis, 8.7 ± 2.3; cardioembolism, 8.2 ± 2.8; small vessel disease, 8.4 ± 2.4; undetermined cause, 8.8 ± 3.1; P = 0.022). After adjustment for age, sex, stroke severity and vascular risk factors in a multiple regression model, elevated WBC count remained associated with CeAD, as compared with non-CeAD stroke patients [odds ratio (OR) = 2.56; 95% CI 1.60-4.11; P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and healthy controls (OR = 6.27; 95% CI 3.39-11.61; P &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Acute CeAD was associated with particularly high WBC counts. Leukocytosis may reflect a pre-existing inflammatory state, supporting the link between inflammation and CeAD.