Τίτλος:
Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin: A Population-Based Study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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
Συγγραφείς:
Tsivgoulis, G.
Kargiotis, O.
Katsanos, A.H.
Patousi, A.
Pikilidou, M.
Birbilis, T.
Mantatzis, M.
Palaiodimou, L.
Triantafyllou, S.
Papanas, N.
Skendros, P.
Terzoudi, A.
Georgiadis, G.S.
Maltezos, E.
Piperidou, C.
Serdari, A.
Theodorou, A.
Ikonomidis, I.
Heliopoulos, I.
Vadikolias, K.
Περιοδικό:
Journal of Neuroimaging
Εκδότης:
Blackwell Publishing Inc.
Λέξεις-κλειδιά:
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
