Abstract P612: Iron Deficiency Anemia and Ischemic Stroke in Patients With Pulmonary Arteriovenous Fistulas

Introduction: Pulmonary-arteriovenous-fistulas (PAVFs) are pathologic right-to-left shunts resulting in paradoxical embolism causing acute-ischemic-stroke (AIS). Recent single-center studies have identified that in patients with AIS associated with PAVF (AIS-P), traditional stroke risk-factors are not prominent and instead stroke-risk is associated with low serum iron. Single-centre studies have the risk of introducing a selection bias, while multicentre trials are challenging since PAVF still remains a rare and under-recognised entity. We thus seek epidemiological validation of such stroke predictors in patients with PAVF. Methods: We conducted a retrospective analysis of all AIS-admissions within the Nationwide-Inpatient-Sample (NIS) database (2005-2014). Baseline characteristics were compared across AIS populations [AIS-P (with PAVF) and R(routine)-AIS (without PAVF)]. We also compared morbidity, mortality and management trends of AIS in patients with and without PAVF. Results: Of 4,271,910 patients admitted with AIS, 822 (0.02%) were diagnosed with a PAVF. Over this decade the prevalence of PAVF per million AIS-admissions, rose from 197 to 368 (P trend =0.026). Patients with PAVF were younger with a median age (IQR) of 57.5 (42.2 -70.4) years vs. 72.5 (60.8-82.1) years (p<0.001); but had comparable age-adjusted inpatient morbidity (χ 2 p=0.71) and all-cause mortality (χ 2 p=0.26). On multivariate analyses, the odds ratios (95% confidence-interval) favouring PAVF as the cause for AIS were 9.0 (6.79-11.94) for hypoxemia, 4.64 (3.84-5.60) for patent-foramen-ovale, 4.52 (3.42-5.97) for pulmonary hypertension, 4.07(2.23-7.44) for epistaxis, and 2.12 (1.60-2.82) for iron deficiency anaemia [all p-values <0.001]. Conclusion: Pulmonary-arteriovenous-fistula related AIS represents a significantly younger demographic, which suffers inpatient morbidity and mortality comparable to routine ischemic-stroke. They carry a unique set of stroke-risk markers, including treatable conditions such as iron deficiency anemia. Further studies are needed to examine a causal role for such markers on ischemic-stroke risk in this cohort.

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Ischemic Stroke in Patients With Pulmonary Arteriovenous Fistulas

Stroke ◽

10.1161/strokeaha.120.032073 ◽

2021 ◽

Author(s):

Karan K. Topiwala ◽

Smit D. Patel ◽

Mubashir Pervez ◽

Claire L. Shovlin ◽

Mark J. Alberts

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Hereditary Hemorrhagic Telangiectasia ◽

Case Fatality ◽

The United States ◽

Deficiency Anemia ◽

Risk Markers ◽

Arteriovenous Fistulas ◽

Pulmonary Arteriovenous Fistulas

Background and Purpose: Pulmonary arteriovenous fistulas (PAVFs) are a treatable cause of acute ischemic stroke (AIS), not mentioned in current American Heart/Stroke Association guidelines. PAVFs are recognized as an important complication of hereditary hemorrhagic telangiectasia. Methods: The prevalence of PAVF and hereditary hemorrhagic telangiectasia among patients admitted with AIS in the United States (2005–2014) was retrospectively studied, utilizing the Nationwide Inpatient Sample database. Clinical factors, morbidity, mortality, and management were compared in AIS patients with and without PAVF/hereditary hemorrhagic telangiectasia. Results: Of 4 271 910 patients admitted with AIS, 822 (0.02%) were diagnosed with PAVF. Among them, 106 of 822 (12.9%) were diagnosed with hereditary hemorrhagic telangiectasia. The prevalence of PAVF per million AIS admissions rose from 197 in 2005 to 368 in 2014 ( P trend , 0.026). Patients with PAVF were younger than AIS patients without PAVF (median age, 57.5 versus 72.5 years), had lower age-adjusted inpatient morbidity (defined as any discharge other than home; 39.6% versus 46.9%), and had lower in-hospital case fatality rates (1.8% versus 5.1%). Multivariate analyses identified the following as independent risk markers (odds ratio [95% CI]) for AIS in patients with PAVF: hypoxemia (8.4 [6.3–11.2]), pulmonary hemorrhage (7.9 [4.1–15.1]), pulmonary hypertension (4.3 [4.1–15.1]), patent foramen ovale (4.2 [3.5–5.1]), epistaxis (3.7 [2.1–6.8]), venous thrombosis (2.6 [1.9–3.6]), and iron deficiency anemia (2 [1.5–2.7]). Patients with and without PAVF received intravenous thrombolytics at a similar rate (5.9% versus 5.8%), but those with PAVF did not receive mechanical thrombectomy (0% versus 0.7%). Conclusions: Pulmonary arteriovenous fistula–related ischemic stroke represents an important younger demographic with a unique set of stroke risk markers, including treatable conditions such as causal PAVFs and iron deficiency anemia.

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Association of Iron Deficiency Anemia with Stroke Severity in patients with Acute Ischemic Stroke

10.53350/pjmhs2115113004 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3004-3006

Author(s):

Rabia Rathore ◽

Nasir Farooq Butt ◽

Adil Iqbal ◽

Hina Latif ◽

Mariam Azeem ◽

...

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Descriptive Study ◽

World Health ◽

Deficiency Anemia ◽

P Value ◽

Stroke Severity ◽

Cross Sectional

Aim: To study the relationship of Iron Deficiency anemia (IDA) with severity of acute ischemic stroke. Study Design: A cross-sectional descriptive study. Place & Duration of Study: Department of Medicine, Mayo Hospital, Lahore from March 2020 to February 2021 Methods: A descriptive study of cross-sectional type was done on 200 individuals who had acute ischemic stroke (AIS) and were hospitalized at Mayo Hospital Lahore. Consecutive non-probability convenience sampling method was used to gather the data. Severity of stroke was assessed at the time of admission using the National Institute of Health Stroke Scale, (NIHSS) at the same time blood complete examination along with peripheral blood film was done to diagnose anemia in these patients. Iron studies were done to diagnose iron deficiency anemia (IDA). P-value less than 0.05 was taken as significant. Results: About 200individuals presenting with AIS were enrolled in the research work. Anemia according to World Health Organization was seen in 80(40%) and was not present in 120(60%) patients. Among the subjects who had anemia, 16(20%) had a minor AIS, 23(28.75%) had a moderately severe AIS, and 41(51.25%) reported with a severe AIS, according to NIHSS criteria. A notable relationship was found to exist between anemia and stroke severity, (P-value 0.000). Conclusion: Anemia was a commonly found in individuals with acute stroke due to ischemia and had direct relation with severity of stroke. Keywords: Iron deficiency Anemia, severity, ischemic stroke.

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A Case of Acute Ischemic Stroke Associated with Hookworm Anemia.

10.21203/rs.3.rs-198581/v1 ◽

2021 ◽

Author(s):

Jiang-qiong Ke ◽

Huicong Huang ◽

Guangyao Zhou ◽

Yan Li ◽

Shengmin Shao ◽

...

Keyword(s):

Bone Marrow ◽

Ischemic Stroke ◽

Iron Deficiency ◽

Cerebral Infarction ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Deficiency Anemia ◽

Cerebral Stroke ◽

Parasitic Diseases ◽

Normal Brain

Abstract Background: Hookworm disease discovered in a patient presenting with cerebral infarction due to severe iron-deficiency anemia and confirmed by gastroduodenoscopy has not been reported especially with negative stool routine. Case presentation: We report a male patient who presented himself to us with acute cerebral stroke verified as hookworm disease. Routine laboratory tests revealed low Hemoglobin (Hb) concentration but stool routine and occult blood test were normal. Brain magnetic resonance imaging (MRI) showed left-sided parietal-occipital lobe and centrum semiovale (“watershed”) infarction verified the diagnosis of acute ischemic stroke. Bone marrow aspiration showed proliferative bone marrow image with obvious red system hyperplasia. Gastroduodenoscopy discovered adult hematophagic hookworms in the bulb and descending part of duodenum of the patient. A series of conservative drug treatment was initiated and the patient was subsequently treated with albendazole after the gastroduodenoscopy. Twenty-five days later, the patient's physical function improved gradually and he was discharged without neurological deficit. Conclusion: Hookworm disease could be manifest in acute ischemic stroke. It was concluded that patients with severe iron-deficiency anemia should also be examined for rare intestinal parasitic diseases. Screening for these intestinal parasitic diseases in patients presenting with cerebral infarction and anemia could effectively avoid misdiagnosis and make increase the efficacy of treatment.

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655: A CASE OF ACUTE ISCHEMIC STROKE IN A TODDLER WITH SEVERE IRON DEFICIENCY ANEMIA

Critical Care Medicine ◽

10.1097/01.ccm.0000808944.11216.91 ◽

2021 ◽

Vol 50 (1) ◽

pp. 320-320

Author(s):

Yezan Abderrahman ◽

Niranjan Vijayakumar ◽

Aditya Badheka ◽

Madhuradhar Chegondi

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Deficiency Anemia

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Caso clínico: Acidente Vascular Cerebral Isquêmico em lobo frontal à esquerda associado a anemia ferropriva idiopática / Clinical case: Ischemic Stroke in The Left frontal lobe associated with idiopathic iron deficiency anemia

Brazilian Journal of Development ◽

10.34117/bjdv7n12-523 ◽

2021 ◽

Vol 7 (12) ◽

pp. 118067-118071

Author(s):

Gabriela Roriz De Deus ◽

Flávia Borges Carapina Santos ◽

Carla Soares Alves ◽

Claudia Soares Alves ◽

Jordanna de Paula Felipe Mendes ◽

...

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Frontal Lobe ◽

Iron Deficiency Anemia ◽

Clinical Case ◽

Deficiency Anemia ◽

Left Frontal Lobe

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Abstract P604: Incidentally-Discovered Asymptomatic Ischemic Lesions Identified Using Natural Language Processing Are Strong Risk Markers for Future Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p604 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

David M Kent ◽

Lester Y Leung ◽

Yichen Zhou ◽

Patrick H Luetmer ◽

David F Kallmes ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Natural Language Processing ◽

Natural Language ◽

Language Processing ◽

Stroke Risk ◽

Risk Markers ◽

Stroke Risk Factors ◽

Over Time ◽

Major Stroke

Background: White matter disease (WMD) and silent brain infarction (SBI) are known to be risk markers for stroke. Nevertheless, the predictive value of these changes when seen incidentally on routinely-obtained neuroimages is unknown. Methods: In this retrospective cohort study, Kaiser Permanente-Southern California health plan enrollees aged ≥ 50 years old with a brain CT or MRI scan between 2009-2019 and without a prior history of ischemic stroke, transient ischemic attack, or dementia were identified. Natural language processing (NLP) was used to identify patients with SBI and WMD on the index neuroimaging report. We used Cox proportional hazards to estimate the risk of future ischemic stroke associated with the presence of SBI and of WMD, controlling for major stroke risk factors. Results: Among 262,875 individuals receiving brain neuroimaging, 13,154 (5.0%) and 78,330 (29.8%) had SBI and WMD, respectively. The Table below summarizes the crude stroke incidence rates. The crude hazard ratio (HR) was 3.40 (95% CI 3.25-3.56) for SBI and 2.63 (95% CI 2.54-2.71) for WMD. In the multivariable model controlling for all major stroke risk factors, the effect of SBI was found to be stronger in younger versus older patients and for MRI- versus CT-discovered lesions. With MRI, the average adjusted HR over time was 2.95 (95% CI 2.53-3.44) for those < age 65 and 2.15 (95% CI 1.91-2.41) for those ≥ age 65. With CT scan, the average adjusted HR over time was 2.48 (95%CI 2.19-2.81) for those < age 65 and 1.81 (95% CI 1.71-1.91) for those ≥ age 65. The adjusted HR associated with a finding of WMD was 1.76 (95% CI 1.69-1.82) and was not modified by age or imaging modality. The effect of SBI decreased gradually over time, while the effect of WMD remained constant. Conclusion: Incidentally-discovered SBI and WMD are common in patients ≥ age 50 and are associated with substantial increases in the risk of subsequent symptomatic stroke. The findings may represent an opportunity for stroke prevention.

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Acute Ischemic Stroke Secondary to Iron Deficiency Anemia: A Case Report

Case Reports in Neurological Medicine ◽

10.1155/2012/487080 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Preema J. Mehta ◽

Sherita Chapman ◽

Annapurni Jayam-Trouth ◽

Mohankumar Kurukumbi

Keyword(s):

Ischemic Stroke ◽

Iron Deficiency ◽

Acute Ischemic Stroke ◽

Iron Deficiency Anemia ◽

Thrombus Formation ◽

Deficiency Anemia ◽

Low Oxygen ◽

Hypoxic Conditions ◽

Stroke In Young Adults ◽

The Brain

A rare case of acute ischemic stroke in a young patient with iron deficiency anemia (IDA) is reported. IDA has been suggested to have an association with stroke, but few cases have proven it thus far. Three physiological mechanisms explaining IDA to ischemic stroke include a hypercoagulable state secondary to IDA, thrombocytosis secondary to IDA, and anemic hypoxia induced by IDA. Our paper shows an example of a hypoxia-induced stroke secondary to IDA in a young woman with menorrhagia. Thrombus formation was ruled out as the Magnetic Resonance Angiogram (MRA) showed no evidence. As all other known causes for stroke were ruled out, the patient's IDA is a reasonable cause for her stroke. Iron deficiency decreases the amount of hemoglobin, which consequently decreases the amount of oxygen in the blood resulting in low-oxygen delivery to the brain. This causes hypoxic conditions in the brain, leading to death of brain tissue. Thus, we suggest a possible relationship between IDA and ischemic stroke in young adults. Considering IDA as one of the risk factors for ischemic stroke and treating with timely transfusions would be an important step one can take to prevent stroke.

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