Abstract 147: Cannabis, Ischemic Stroke and Transient Ischemic Attack: A Case Control Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
P A Barber ◽  
Heidi Pridmore ◽  
Venkatesh Krishnamurthy ◽  
Sally Roberts ◽  
David A Spriggs ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Case Series ◽  
Population Based ◽  
Cannabis Use ◽  
Urine Samples ◽  
Controlled Study ◽  
Increased Risk ◽  
Urine Drug ◽  
Hospital Patients ◽  
Ischemic Attack

Background: Cannabis is the most widely used illicit drug of abuse. A temporal relationship between cannabis use and stroke has been reported in case series and population based studies. To date this relationship has not been confirmed. We performed a case-controlled study on the recent use of cannabis in younger stroke patients. Methods: Consecutive ischemic stroke/TIA patients aged 18-55 years had urine screens for cannabis. A control cohort of age, sex and ethnicity matched hospital patients were screened for cannabis using anonymized urine samples obtained for other indications and which would otherwise be discarded. The study was performed with the approval of the regional Ethics Committee. Results: One hundred and sixty of 218 (73%) ischemic stroke/TIA patients had urine drug screens [100 men, 60 women; mean (SD) age 44.8 (8.7) years], of whom 150 (94%) had ischemic stroke and 10 (6%) had TIA. Fifty-eight patients did not have drug screens, mainly because they were admitted outside office hours or had been discharged early (primarily TIA patients). All of the patients approached to provide a urine sample agreed to do so. Twenty-five (15.6%) patients had positive cannabis drug screens, and these patients were more likely to be male (84% versus 59%, χ 2 p=0.016) and tobacco smokers (88% versus 28%, χ 2 p<0.001). There were no differences in age, stroke mechanism or most vascular risk factors between those with and without positive cannabis tests. Control urine samples were obtained from 160 patients matched for age (t-test, p=0.979), sex (χ 2 p=0.492) and ethnicity (χ 2 p=0.910). Thirteen (8.1%) control participants tested positive for cannabis. In a logistic regression analysis adjusted for age, sex and ethnicity, cannabis use was associated with increased risk of ischemic stroke and TIA (odds ratio 2.30, 95% confidence intervals 1.07-4.95). Conclusions: This study provides the strongest evidence to date of an association between cannabis and stroke, with ischemic stroke and TIA patients twice as to have recently used cannabis likely as control participants. Cannabis is generally perceived as having few serious adverse effects. This study suggests that this may not be the case and that the association between cannabis and stroke warrants further investigation.

scholarly journals Expert opinion paper on cardiac imaging after ischemic stroke

2021 ◽  
Author(s):  
Renate B. Schnabel ◽  
Stephan Camen ◽  
Fabian Knebel ◽  
Andreas Hagendorff ◽  
Udo Bavendiek ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Expert Opinion ◽  
Cardiac Imaging ◽  
Controlled Trial ◽  
Case Series ◽  
Stroke Care ◽  
Imaging Method ◽  
Cardiac Evaluation ◽  
Magnetic Resonance Imaging Mri ◽  
Ischemic Attack

AbstractThis expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the “Heart and Brain” consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.

scholarly journals Increased Risk of Traffic Injury After a Cerebrovascular Event

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 3006-3011
Author(s):  
Amy Y.X. Yu ◽  
Moira K. Kapral ◽  
Jiming Fang ◽  
Donald A. Redelmeier
Keyword(s):  
Transient Ischemic Attack ◽  
Motor Vehicle ◽  
Population Based ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Cerebrovascular Event ◽  
Traffic Injury ◽  
Increased Risk ◽  
Ischemic Attack ◽  
Serious Injuries

Background and Purpose— We aimed to determine the long-term risks of a motor vehicle collision after a cerebrovascular event and whether the risks were similar after left- or right-hemispheric events. Methods— We used a population-based registry to identify patients diagnosed with a transient ischemic attack or stroke (hemorrhagic or ischemic) between 2003 and 2013 in Ontario, Canada. Hemispheric laterality was determined using radiological and clinical findings. We identified subsequent serious injuries involving the patient as a driver using linked administrative data. Secondary outcomes included serious injuries involving the patient as a pedestrian, as a passenger, or other traumatic events (fall, fracture, ankle sprain). We used proportional hazard models accounting for death as a competing risk to test the association of hemispheric laterality and outcomes with and without adjustment for age, sex, discharge modified Rankin Scale score, home location, and prior driving record. Patients were followed through to 2017. Results— Among 26 144 patients with hemispheric cerebrovascular events, 377 subsequent serious traffic injuries as a driver (2.2 per 1000 person-year) were identified over a median follow-up of 6.4 person-years. The rate did not differ by laterality (adjusted hazard ratio, 1.00; 95% CI, 0.82–1.23). The risk of a serious traffic injury as a pedestrian was significantly higher after a right-sided than left-sided event (adjusted hazard ratio, 1.27; 95% CI, 1.02–1.58). Subsequent risks for other traumatic injuries did not differ by laterality of cerebrovascular event. Conclusions— The risk of a serious traffic injury as a pedestrian is substantially higher after a right-hemispheric cerebrovascular event compared with a left-sided event. Walking should be promoted for exercise in survivors of a stroke or transient ischemic attack, but these vulnerable road users may benefit from additional poststroke rehabilitation to optimize safety.

scholarly journals Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis

2018 ◽  
Vol 212 (4) ◽  
pp. 227-233 ◽  
Author(s):  
Antti Mustonen ◽  
Solja Niemelä ◽  
Tanja Nordström ◽  
Graham K. Murray ◽  
Pirjo Mäki ◽  
...  
Keyword(s):  
Substance Use ◽  
General Population ◽  
Birth Cohort ◽  
Psychotic Disorders ◽  
Temporal Order ◽  
Population Based ◽  
Cannabis Use ◽  
Prodromal Symptoms ◽  
Increased Risk ◽  
Icd 10

BackgroundThe association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial.AimsTo examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders.MethodThe sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15–16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers.ResultsThe risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0–13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1–8.0).ConclusionsAdolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use.Declaration of interestNone.

scholarly journals Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study

2017 ◽  
Vol 176 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Olaf M Dekkers ◽  
Erzsébet Horváth-Puhó ◽  
Suzanne C Cannegieter ◽  
Jan P Vandenbroucke ◽  
Henrik Toft Sørensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Arterial Embolism ◽  
Registration System ◽  
Increased Risk ◽  
All Cause Mortality

Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. Design It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. Results The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40–4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33–1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58–8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30–8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. Conclusions We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.

scholarly journals Women With Osteoarthritis Are at Increased Risk of Ischemic Stroke: A Population-Based Cohort Study

2021 ◽  
Author(s):  
Chung-Hsin Yeh ◽  
Wei-Lun Chang ◽  
Po-Chi Chan ◽  
Chih-Hsin Mou ◽  
Ko-Shih Chang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischemic Stroke ◽  
Population Based ◽  
Increased Risk

scholarly journals Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1)

2018 ◽  
Vol 13 (5) ◽  
pp. 454-468 ◽  
Author(s):  
Andreas Charidimou ◽  
Sara Shams ◽  
Jose R Romero ◽  
Jie Ding ◽  
Roland Veltkamp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Meta Analysis ◽  
Population Based ◽  
Cerebral Microbleeds ◽  
Clinical Settings ◽  
Memory Clinic ◽  
Increased Risk ◽  
Stroke Death

Background Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, “high risk” elderly populations, and healthy individuals in population-based studies. Methods Cohorts (with > 100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (≥3 months) were identified. The association between cerebral microbleeds and each of the outcomes (ischemic stroke, intracerebral hemorrhage, death, and dementia) was quantified using random effects models of (a) unadjusted crude odds ratios and (b) covariate-adjusted hazard rations. Results We identified 31 cohorts ( n = 20,368): 19 ischemic stroke/TIA ( n = 7672), 4 memory clinic ( n = 1957), 3 high risk elderly ( n = 1458) and 5 population-based cohorts ( n = 11,722). Cerebral microbleeds were associated with an increased risk of ischemic stroke (OR: 2.14; 95% CI: 1.58–2.89 and adj-HR: 2.09; 95% CI: 1.71–2.57), but the relative increase in future intracerebral hemorrhage risk was greater (OR: 4.65; 95% CI: 2.68–8.08 and adj-HR: 3.93; 95% CI: 2.71–5.69). Cerebral microbleeds were an independent predictor of all-cause mortality (adj-HR: 1.36; 95% CI: 1.24–1.48). In three population-based studies, cerebral microbleeds were independently associated with incident dementia (adj-HR: 1.35; 95% CI: 1.00–1.82). Results were overall consistent in analyses stratified by different populations, but with different degrees of heterogeneity. Conclusions Our meta-analysis shows that cerebral microbleeds predict an increased risk of stroke, death, and dementia and provides up-to-date effect sizes across different clinical settings. These pooled estimates can inform clinical decisions and trials, further supporting cerebral microbleeds role as biomarkers of underlying subclinical brain pathology in research and clinical settings.

scholarly journals Risks of suicide attempts after prescription of zolpidem in people with depression: a nationwide population study in South Korea

SLEEP ◽  
2019 ◽  
Vol 43 (3) ◽  
Author(s):  
Hyewon Kim ◽  
Yuwon Kim ◽  
Woojae Myung ◽  
Maurizio Fava ◽  
David Mischoulon ◽  
...  
Keyword(s):  
Suicide Attempt ◽  
Medical Records ◽  
Suicide Attempts ◽  
Case Series ◽  
Population Based ◽  
Additional Increase ◽  
Series Design ◽  
Increased Risk ◽  
Before And After ◽  
Rate Ratios

Abstract Objectives To investigate the association between zolpidem prescription and suicide attempts in people with depression Methods A nationwide, population-based electronic medical records database from the Health Insurance Review & Assessment Service of South was used to investigate the incidence rate ratios (IRRs) of suicide attempts and probable suicide attempts in people with depression before and after zolpidem prescription using self-controlled case series design. Results In a total of 445 people who attempted suicide and 23 141 people who attempted probable suicide attempt, the IRRs of suicidal behavior during the risk periods before and after zolpidem prescription increased compared with those at the baseline. The IRRs gradually increased and peaked immediately before the prescription of zolpidem. The IRR was 70.06 (95% CI: 25.58–191.90) on day 2 before zolpidem prescription and 63.35 (95% CI: 22.99–174.59) on day 1 after zolpidem prescription in the suicide attempt group. The IRR was 24.07 (95% CI: 20.50–28.26) on the day before zolpidem prescription and 14.96 (95% CI: 12.21–18.34) on the day after zolpidem prescription in the probable suicide attempt group. The ratios declined eventually after zolpidem was prescribed. Conclusions Although zolpidem prescription was associated with an increased risk of suicide attempts in people with depression, the risk increased and peaked immediately before zolpidem prescription. The risk declined gradually thereafter. This result indicates that the risk of suicide attempts increases at the time of zolpidem prescription. However, zolpidem prescription does not contribute to additional increase in the risk of suicide attempts.

Effect of herpes zoster vaccine and antiviral treatment on risk of ischemic stroke

Neurology ◽  
2020 ◽  
Vol 95 (6) ◽  
pp. e708-e717
Author(s):  
Quanhe Yang ◽  
Mary G. George ◽  
Anping Chang ◽  
Xin Tong ◽  
Robert Merritt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Herpes Zoster ◽  
Antiviral Treatment ◽  
Case Series ◽  
Effect Modification ◽  
Fee For Service ◽  
Zoster Vaccine ◽  
Increased Risk ◽  
Group Sex ◽  
Rate Ratios

ObjectiveTo determine whether increased risk of acute ischemic stroke (AIS) following herpes zoster (HZ) might be modified by the status of zoster vaccine live (ZVL) vaccination and antiviral treatment following HZ.MethodsWe included 87,405 Medicare fee-for-service beneficiaries aged ≥66 years diagnosed with HZ and AIS from 2008 to 2017. We used a self-controlled case series design to examine the association between HZ and AIS, and estimated incidence rate ratios (IRRs) by comparing incidence of AIS in risk periods vs control periods. To examine effect modification by ZVL and antiviral treatment, beneficiaries were classified into 4 mutually exclusive groups: (1) no vaccination and no antiviral treatment; (2) vaccination only; (3) antiviral treatment only; and (4) both vaccination and antiviral treatment. We tested for interaction to examine changes in IRRs across 4 groups.ResultsAmong 87,405 beneficiaries with HZ and AIS, 22.0%, 2.0%, 70.1%, and 5.8% were in groups 1 to 4, respectively. IRRs in 0–14, 15–30, 31–90, and 91–180 days following HZ were 1.89 (95% confidence interval [CI], 1.77–2.02), 1.58 (95% CI, 1.47–1.69), 1.36 (95% CI, 1.31–1.42), and 1.19 (95% CI, 1.15–1.23), respectively. There was no evidence of effect modification by ZVL and antiviral treatment on AIS (p = 0.067 for interaction). The pattern of association between HZ and risk for AIS was largely consistent across age group, sex, and race.ConclusionsRisk of AIS increased significantly following HZ, and this increased risk was not modified by ZVL and antiviral treatment. Our findings suggest the importance of following recommended HZ vaccination in prevention of HZ and HZ-associated AIS.

scholarly journals First-Ever Ischemic Stroke and Incident Major Adverse Cardiovascular Events in 93 627 Older Women and Men

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 387-394 ◽  
Author(s):  
Luciano A. Sposato ◽  
Melody Lam ◽  
Britney Allen ◽  
Salimah Z. Shariff ◽  
Gustavo Saposnik ◽  
...  
Keyword(s):  
Sex Differences ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Population Based ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Complications ◽  
Coronary Syndrome ◽  
Cardiovascular Comorbidities ◽  
Increased Risk

Background and Purpose— Stroke risk is sex-specific, but little is known about sex differences of poststroke major adverse cardiovascular events (MACEs). Stroke-related brain damage causes autonomic dysfunction and inflammation, sometimes resulting in cardiac complications. Sex-specific cardiovascular susceptibility to stroke without the confounding effect of preexisting heart disease constitutes an unexplored field because previous studies focusing on sex differences in poststroke MACE have not excluded patients with known cardiovascular comorbidities. We therefore investigated sex-specific risks of incident MACE in a heart disease-free population-based cohort of patients with first-ever ischemic stroke and propensity-matched individuals without stroke. Methods— We included Ontario residents ≥66 years, without known cardiovascular comorbidities, with first-ever ischemic stroke between 2002 and 2012 and propensity-matched individuals without stroke. We investigated the 1-year risk of incident MACE (acute coronary syndrome, myocardial infarction, incident coronary artery disease, coronary revascularization procedures, incident heart failure, or cardiovascular death) separately for females and males. For estimating cause-specific adjusted hazard ratios, we adjusted Cox models for variables with weighted standardized differences >0.10 or those known to influence MACE risk. Results— We included 93 627 subjects without known cardiovascular comorbidities; 21 931 with first-ever ischemic stroke and 71 696 propensity-matched subjects without stroke. Groups were well-balanced on propensity-matching variables. There were 53 476 women (12 421 with and 41 055 without ischemic stroke) and 40 151 men (9510 with and 30 641 without ischemic stroke). First-ever ischemic stroke was associated with increased risk of incident MACE in both sexes. The risk was time-dependent, highest within 30 days (women: adjusted hazard ratio, 25.1 [95% CI, 19.3–32.6]; men: aHR, 23.4 [95% CI, 17.2–31.9]) and decreasing but remaining significant between 31 and 90 days (women: aHR, 4.8 [95% CI, 3.8–6.0]; men: aHR, 4.2 [95% CI, 3.3–5.4]), and 91 to 365 days (aHR, 2.1 [95% CI, 1.8–2.3]; men: aHR, 2.0 [95% CI, 1.7–2.3]). Conclusions— In this large population-based study, ischemic stroke was independently associated with increased risk of incident MACE in both sexes.

scholarly journals Serious complications and risk of re-operation after Dupuytren’s disease surgery: a population-based cohort study of 121,488 patients in England

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Osaid Alser ◽  
Richard S. Craig ◽  
Jennifer C. E. Lane ◽  
Albert Prats-Uribe ◽  
Danielle E. Robinson ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Case Series ◽  
Population Based ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Systemic Complications ◽  
Increased Risk ◽  
Risk Patients ◽  
Limited Fasciectomy

Abstract Dupuytren’s disease (DD) is a common fibro-proliferative disorder of the palm. We estimated the risk of serious local and systemic complications and re-operation after DD surgery. We queried England’s Hospital Episode Statistics database and included all adult DD patients who were surgically treated. A longitudinal cohort study and self-controlled case series were conducted. Between 1 April 2007 and 31 March 2017, 121,488 adults underwent 158,119 operations for DD. The cumulative incidence of 90-day serious local complications was low at 1.2% (95% CI 1.1–1.2). However, the amputation rate for re-operation by limited fasciectomy following dermofasciectomy was 8%. 90-day systemic complications were also uncommon at 0.78% (95% CI 0.74–0.83), however operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications such as myocardial infarction. Re-operation was lower than previous reports (33.7% for percutaneous needle fasciotomy, 19.5% for limited fasciectomy, and 18.2% for dermofasciectomy). Overall, DD surgery performed in England was safe; however, re-operation by after dermofasciectomy carries a high risk of amputation. Furthermore, whilst serious systemic complications were unusual, the data suggest that high-risk patients should undergo treatment under local anaesthesia. These data will inform better shared decision-making regarding this common condition.

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