scholarly journals Dolichoectasia and Small Vessel Disease in Young Patients With Transient Ischemic Attack and Stroke

Stroke ◽  
2017 ◽  
Vol 48 (9) ◽  
pp. 2361-2367 ◽  
Author(s):  
Vincent Thijs ◽  
Ulrike Grittner ◽  
Franz Fazekas ◽  
Dominick J.H. McCabe ◽  
Anne-Katrin Giese ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Small Vessel Disease ◽  
Young Patients ◽  
Small Vessel ◽  
Vessel Disease ◽  
Ischemic Attack

scholarly journals Prevalence of Microembolic Signals in Embolic Stroke of Undetermined Source and Other Subtypes of Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 655-658 ◽  
Author(s):  
Eiko Higuchi ◽  
Sono Toi ◽  
Yuka Shirai ◽  
Takao Hoshino ◽  
Kentaro Ishizuka ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Small Vessel Disease ◽  
Univariate Analysis ◽  
Cerebral Small Vessel Disease ◽  
Embolic Stroke ◽  
Small Vessel ◽  
Large Artery ◽  
Vessel Disease ◽  
Ischemic Attack

Background and Purpose— Embolic stroke of undetermined source (ESUS) has been proposed to cause thromboembolic infarction from unknown but potential embolic sources. However, an embolus remains undetected in ESUS. The goal of this study was to characterize the prevalence and risk factors of microembolic signals (MESs) in ESUS. Methods— We examined 108 patients with acute ischemic stroke in the internal carotid artery territory or transient ischemic attack within 14 days of symptom onset and who were admitted to our hospital between April 2017 and March 2019. MESs were monitored in the middle cerebral artery on transcranial Doppler for 60 minutes. We examined the prevalence and number of MES in ESUS and other stroke subtypes, such as cardioembolism, large artery atherosclerosis, cerebral small vessel disease, and transient ischemic attack. The present study was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000031913). Results— MESs were detected in 33 (31%) of 108 patients. ESUS showed the highest proportion (12/24 [50%]), followed by large artery atherosclerosis (8/20 [40%]), cardioembolism (6/18 [33%]), transient ischemic attack (4/24 [17%]), and cerebral small vessel disease (3/21 [14%]). Univariate analysis showed that higher systolic blood pressure, body mass index, hemoglobin A1c, and ESUS were significantly associated with MES. In multiple logistic regression analysis, ESUS remained significantly associated with MES after adjustment for described covariates from univariate analysis (odds ratio, 2.86 [95% CI, 1.01–8.08]). Conclusions— This study demonstrated significant association of ESUS with MES, supporting the embolic nature of this stroke subtype. Registration— URL: https://upload.umin.ac.jp . Unique identifier: UMIN000031913.

scholarly journals Etiological Subtypes of Transient Ischemic Attack and Ischemic Stroke in Chronic Kidney Disease

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2786-2794 ◽  
Author(s):  
Dearbhla M. Kelly ◽  
Linxin Li ◽  
Peter M. Rothwell ◽  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Estimated Glomerular Filtration Rate ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease ◽  
Stroke Subtypes ◽  
Ischemic Attack

Background and Purpose: Chronic kidney disease (CKD) is strongly associated with stroke risk, but the mechanisms underlying this association are unclear and might be informed by subtype-specific analyses. However, few studies have reported stroke subtypes in CKD according to established classification systems, such as the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. We, therefore, aimed to determine which transient ischemic attack and ischemic stroke subtypes using the TOAST classification occur most frequently in patients with CKD. Methods: In a population-based study of all transient ischemic attack and stroke (OXVASC [Oxford Vascular Study]; 2002–2017), all ischemic events were classified by TOAST subtypes (cardioembolism, large artery disease, small vessel disease, undetermined, multiple, other etiology, or incompletely investigated). Logistic regression was used to determine the relationship between CKD (defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m2) and transient ischemic attack/stroke subtypes adjusted for age, sex, and hypertension and then stratified by age and estimated glomerular filtration rate category. Results: Among 3178 patients with transient ischemic attack (n=1167), ischemic stroke (n=1802), and intracerebral hemorrhage (n=209), 1267 (40%) had CKD. Although there was a greater prevalence of cardioembolic events (31.8% versus 21.2%; P <0.001) in patients with CKD, this association was lost after adjustment for age, sex, and hypertension (adjusted odds ratio=1.20 [95% CI, 0.99–1.45]; P =0.07). Similarly, although patients with CKD had a lower prevalence of small vessel disease (8.8% versus 13.6%; P <0.001), undetermined (26.1% versus 39.4%; P <0.001), and other etiology (1.0% versus 3.6%; P <0.001) subtypes, these associations were also lost after adjustment (adjusted odds ratio=0.86 [0.65–1.13]; P =0.27 and 0.73 [0.36–1.43]; P =0.37 for small vessel disease and other defined etiology, respectively) for all but undetermined (adjusted odds ratio=0.81 [0.67–0.98]; P =0.03). Conclusions: There were no independent positive associations between CKD and specific TOAST subtypes, which suggest that renal-specific risk factors are unlikely to play an important role in the etiology of particular subtypes. Future studies of stroke and CKD should report subtype-specific analyses to gain further insights into potential mechanisms.

scholarly journals Case of Small Vessel Disease Associated with COL4A1 Mutations following Trauma

2015 ◽  
Vol 7 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Joao McONeil Plancher ◽  
Robert B. Hufnagel ◽  
Achala Vagal ◽  
Katrina Peariso ◽  
Howard M. Saal ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Head Trauma ◽  
Small Vessel Disease ◽  
Genetic Disorder ◽  
Single Gene ◽  
Young Patients ◽  
Pathogenic Mutation ◽  
Small Vessel ◽  
Vessel Disease ◽  
History Of

With this case report, we would like to heighten the awareness of clinicians about COL4A1 as a single-gene disorder causing cerebral small vessel disease and describe a previously unreported pathogenic missense substitution in COL4A1 (p.Gly990Val) and a new clinical presentation. We identified a heterozygous putatively pathogenic mutation of COL4A1 in a 50-year-old female with a history of congenital cataracts and glaucoma who presented with multiple diffusion-positive infarcts and areas of contrast enhancement following mild head trauma. We believe that this presentation of multiple areas of acute brain and vascular injury in the setting of mild head trauma is a new manifestation of this genetic disorder. Imaging findings of multiple acute infarcts and regions of contrast enhancement with associated asymptomatic old deep microhemorrhages and leukomalacia in adults after head trauma should raise a high suspicion for a COL4A1 genetic disorder. Radiographic patterns of significant leukoaraiosis and deep microhemorrhages can also be seen in patients with long-standing vasculopathy associated with hypertension, which our patient lacked. Our findings demonstrate the utility of genetic screening for COL4A1 mutations in young patients who have small vessel vasculopathy on brain imaging but who do not have significant cardiovascular risk factors.

EXPRESS: Characteristics and Prognosis of Patients with Embolic Stroke of Undetermined Source in China

2021 ◽  
pp. 174749302110280
Author(s):  
Xiaomeng Yang ◽  
Jing Jing ◽  
Xia Meng ◽  
Zixiao Li ◽  
Yuesong Pan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Stroke Recurrence ◽  
Cumulative Probability ◽  
Large Artery ◽  
Stroke Registry ◽  
Vessel Disease ◽  
Ischemic Attack ◽  
Diagnostic Work

Background and purpose: We aimed to explore the frequencies, risk factors, and natural history of ESUS through a national prospective registry in China. Methods: Between August 2015 and March 2018, the Third China National Stroke Registry (CNSR-III) recruited consecutive patients with ischemic stroke or transient ischemic attack (TIA) in China. The baseline characteristics, risks of stroke, and mortality in patients with ESUS were described and compared with that in patients with other causative subtypes. Results: A total of 15166 TIA and ischemic stroke patients were enrolled in CNSR-III. Among 8528 ischemic stroke with standard diagnostic work-up, 2415 (28.3%) patients were diagnosed with ESUS. The mean age was 61 years and 70% of them were male. Compared to patients with cardioembolic strokes and small vessel disease, patients with ESUS had higher prevalence of nonstenosing large artery atherosclerosis (37.93% vs 31.26%, P=0.008 and 37.93% vs 34.40%, P=0.044 respectively). The cumulative probability of stroke recurrence in patients with ESUS at 3 month and 1 year was 5.59% and 8.74%. Compared with ESUS patients (0.70% and 1.99%), patients with the large artery atherosclerosis and cardioembolic strokes had higher cumulative probability of death at 3 month (1.94% and 3.22%) and 1 year (4.17% and 7.39%). Conclusions: ESUS is a common cause of ischemic stroke in Chinese population with a higher stroke recurrence of ESUS than previous reported. It was more likely to have nonstenosing large artery atherosclerosis in patients with ESUS than with cardioembolic strokes and small vessel disease.

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