A rare case of non-conventional risk factors for ischemic stroke: A long pathogenic sequence, neurointervention combined with IV acetylsalicylic acid and secondary prevention

Abstract Platelets are pivotal to the process of arterial thrombosis resulting in ischemic stroke. Occlusive thrombosis is initiated by the interaction of von Willebrand factor (vWf) and platelet glycoprotein (GP) Ibα. Three polymorphisms have been described in GP Ibα (Kozak T/C polymorphism, variable number of tandem repeats [VNTR], and the human platelet antigen 2a [HPA-2a] [Thr] or HPA-2b [Met] at position 145), each of which may enhance the vWf and GP Ibα interaction. This study investigated whether these polymorphisms are candidate genes for first-ever ischemic stroke. A hospital-based case-control study was conducted of 219 cases of first-ever ischemic stroke and 205 community controls randomly selected from the electoral roll and stratified by age, sex, and postal code. The subtypes of stroke were classified, the prevalence of conventional risk factors was recorded, and blood was collected to perform genotyping analysis for Kozak C or T alleles, VNTR, and HPA-2a/b. It was found that the Kozak T/C genotype was over-represented in the stroke group (32.2%) compared with controls (22.8%) (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.03-2.54; P < .03), and the association was still present even after adjusting for conventional risk factors. There was a trend in the increased prevalence of HPA-2a/b in stroke patients (15%) compared with controls (9.9%) (adjusted OR, 1.8; 95% CI, 0.94-3.4; P = .07). No associations were seen with the VNTR polymorphism or with any of the polymorphisms with stroke subtype. It was concluded that the Kozak T/C polymorphism, which is associated with an increase in platelet GP Ibα surface expression, is an independent risk factor for first-ever ischemic stroke.

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Case Report: Migrainous Infarct without Aura

Case Reports in Neurology ◽

10.1159/000481281 ◽

2017 ◽

Vol 9 (3) ◽

pp. 241-251

Author(s):

Kamesh Gupta ◽

Anurag Rohatgi ◽

Shivani Handa

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Case Report ◽

Rare Case ◽

Case Presentation ◽

The Past ◽

Need To Evaluate ◽

History Of ◽

Complicated Migraine ◽

Full Investigation

Background: Stroke in a migraine with aura has been documented in several cases, even deserving the merit of a classification as complicated migraine. Herein, we present a rare case of migrainous infarct without aura. The diagnosis was challenging due to lack of risk factors. The patient was unique in not having any other comorbidities. Case Presentation: The case is of a 21-year-old female presenting with right-sided hemiplegia and facial drooping. She had had an index presentation of throbbing headaches for the past 2 years, typical of a migraine but not preceded by any aura symptoms. However, in the current episode, the pain became excessively severe and accompanied by right-sided hemiplegia and facial drooping. A full investigation workup using MRI revealed evidence of infarct in the left temporoparietal and basal ganglion region. Conclusion: Our case highlights the need to evaluate silent ischemic stroke in case of prolonged headache with a history of migraine as well as the need for precaution to avoid the use of triptans or opioids in such a case. It also highlights the conditions that need to be excluded before labeling it as a migrainous infarct.

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Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Journal of Stroke ◽

10.5853/jos.2020.03391 ◽

2021 ◽

Vol 23 (1) ◽

pp. 51-60

Author(s):

Yuesong Pan ◽

Zixiao Li ◽

Jiejie Li ◽

Aoming Jin ◽

Jinxi Lin ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Secondary Prevention ◽

Acute Ischemic Stroke ◽

Stroke Prevention ◽

Recurrent Stroke ◽

Antihypertensive Agents ◽

Residual Risk ◽

Stroke Recurrence ◽

Secondary Stroke Prevention

Background and Purpose Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.Methods Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.Results Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.Conclusions There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

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ANTIPLATELET AGENTS IN THE TREATMENT AND SECONDARY PREVENTION OF PEDIATRIC ARTERIAL ISCHEMIC STROKE: THE STATE OF THE PROBLEM

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-5-151-159 ◽

2021 ◽

Vol 100 (5) ◽

pp. 151-159

Author(s):

I.B. Komarova ◽

Keyword(s):

Ischemic Stroke ◽

Clinical Practice ◽

Secondary Prevention ◽

Acetylsalicylic Acid ◽

Antiplatelet Agents ◽

First Year ◽

Evidence Based ◽

Arterial Ischemic Stroke ◽

Level Of Evidence ◽

Low Level

Arterial ischemic stroke (AIS) in children is a potentially disabling disease with cumulative rates of relapse in the first year of 12–16%, necessitating secondary prevention of the disease. Both in adults and in pediatric clinical practice, acetylsalicylic acid is most commonly used, much less often – clopidogrel. However, the validity of the use of antiplatelet agents in children with ischemic stroke is still controversial, due to the low level of evidence-based studies and the paucity of publications. The article analyzes and summarizes data on the possibilities and limitations of the use of antiplatelet agents for secondary prevention of AIS in children.

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Het nut van antiaggregantia en anticoagulantia na een embolische beroerte van ongekende oorsprong

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.20.174 ◽

2021 ◽

Author(s):

T. GERMEYS ◽

R. LEMMENS ◽

T. VANASSCHE ◽

R. WILLEMS

Keyword(s):

Risk Factors ◽

Secondary Prevention ◽

Acetylsalicylic Acid ◽

Oral Anticoagulants ◽

Unknown Origin ◽

Antiplatelet Agents ◽

Embolic Stroke ◽

Current Evidence ◽

Risk Of Bleeding ◽

Possible Cause

The use of antiplatelet agents and anticoagulants after embolic stroke of undetermined source “Embolic stroke of undetermined source” (ESUS) was introduced in 2014 to classify a population with ischemic stroke, caused by an embolism of unknown origin. Atrial fibrillation (AF) is a possible cause for this embolism. As detection of AF implies secondary prevention with anticoagulants rather than acetylsalicylic acid, the hypothesis arose that anticoagulants are superior to antiplatelet therapy in secondary prevention after ESUS. This article summarizes the current evidence about the use of anticoagulants in secondary prevention after ESUS. Rivaroxaban and dabigatran were not superior to acetylsalicylic acid in secondary prevention of stroke in patients with ESUS and were even associated with a higher risk of bleeding. Ongoing trials compare apixaban with acetylsalicylic acid in secondary prevention of stroke in patients with diagnosed ESUS and concomitant risk factors for AF. Currently, there is no evidence to support the routine use of oral anticoagulants in secondary prevention of stroke after ESUS.

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