TY - JOUR
TI - Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin: A Population-Based Study
AU - Tsivgoulis, G.
AU - Kargiotis, O.
AU - Katsanos, A.H.
AU - Patousi, A.
AU - Pikilidou, M.
AU - Birbilis, T.
AU - Mantatzis, M.
AU - Palaiodimou, L.
AU - Triantafyllou, S.
AU - Papanas, N.
AU - Skendros, P.
AU - Terzoudi, A.
AU - Georgiadis, G.S.
AU - Maltezos, E.
AU - Piperidou, C.
AU - Serdari, A.
AU - Theodorou, A.
AU - Ikonomidis, I.
AU - Heliopoulos, I.
AU - Vadikolias, K.
JO - Journal of Neuroimaging
PY - 2019
VL - 29
TODO - 6
SP - 737-742
PB - Blackwell Publishing Inc.
SN - 1051-2284, 1552-6569
TODO - 10.1111/jon.12660
TODO - adult;  age;  aged;  all cause mortality;  Article;  brain edema;  brain hemorrhage;  brain ischemia;  cardioembolic stroke;  cerebrovascular accident;  clinical feature;  clinical outcome;  cohort analysis;  comparative study;  disease registry;  embolic strokes of undetermined source;  female;  follow up;  functional status;  hospital admission;  human;  major clinical study;  male;  mortality rate;  National Institutes of Health Stroke Scale;  neuroimaging;  population research;  prevalence;  Rankin scale;  recurrence risk;  recurrent disease;  sex difference;  stroke patient;  atrial fibrillation;  brain;  brain embolism;  cerebrovascular accident;  diagnostic imaging;  middle aged;  register;  risk factor;  very elderly, Aged;  Aged, 80 and over;  Atrial Fibrillation;  Brain;  Brain Edema;  Female;  Humans;  Intracranial Embolism;  Male;  Middle Aged;  Neuroimaging;  Registries;  Risk Factors;  Stroke
TODO - BACKGROUND AND PURPOSE: Evidence suggests that cardioembolism represents the underlying mechanism in the minority of embolic strokes of undetermined source (ESUS). In this population-based study, we sought to compare the clinical and imaging characteristics as well as outcomes in patients with ESUS and cardioembolic stroke (CE). METHODS: We included consecutive patients with first-ever ischemic stroke (IS) from the previously published population-based Evros-Stroke-Registry identified as ESUS or CE according to standardized criteria. Baseline characteristics, admission NIHSS scores, cerebral edema, hemorrhagic transformation, stroke recurrence, functional outcomes (determined by modified Rankin Scale [mRS] scores), and mortality rates were recorded during the 1-year follow-up period. RESULTS: We identified 21 ESUS (3.7% of IS) and 211 CE (37.1% of IS) cases. Patients with ESUS were younger (median age: 68 years [interquartile range [IQR]: 61-75] vs 80 years [IQR: 75-84]; P <.001), had lower median admission NIHSS scores (4 points [IQR: 2-8] vs 10 points [IQR: 5-17]; P <.001), and lower prevalence of cerebral edema on neuroimaging studies (0 vs. 33.3%, P =.002). Functional outcomes were more favorable in ESUS at 28 (median mRS score: 2 [IQR: 1-3] vs 4 [IQR: 4-5]; P <.001), 90 (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 3-5]; P <.001), and 365 days (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 2-4]; P < 0.001). At 1-year, the mortality rate was lower in ESUS (0% [95% confidence interval [CI]: 0-13.5%] vs 34.6% [95% CI: 28.2-41.0%]; P <.001); the 1-year recurrent rate was also lower numerically (0% [95% CI: 0-13.5%] vs 9.5% [95% CI: 5.5-13.4%]; P =.140) but this difference failed to reach statistical significance due to the small study population. CONCLUSIONS: The clinical and neuroimaging profiles as well as clinical outcomes vary substantially between ESUS and CE indicating different underlying mechanisms. © 2019 by the American Society of Neuroimaging
ER -