scholarly journals Morbidity After Symptomatic Hemorrhage of Cerebral Cavernous Malformation

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 2997-3006
Author(s):  
Li Ma ◽  
Shuo Zhang ◽  
Zongze Li ◽  
Chun-Xue Wu ◽  
Zhaozhao Wang ◽  
...  
Keyword(s):  
Calibration Curve ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Cavernous Malformation ◽  
Cerebral Cavernous Malformation ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Discriminative Ability ◽  
Increased Risk

Background and Purpose: Symptomatic hemorrhage contributes to an increased risk of repeated bleeding and morbidity in cerebral cavernous malformation (CCM). A better understanding of morbidity after CCM hemorrhage would be helpful to identify patients of higher risk for unfavorable outcome and tailor individualized management. Methods: We identified 282 consecutive patients who referred to our institute from 2014 to 2018 for CCM with symptomatic hemorrhage and had an untreated follow-up period over 6 months after the first hemorrhage. The morbidity after hemorrhage was described in CCM of different features. Nomogram to predict morbidity was formulated based on the multivariable model of risk factors. The predictive accuracy and discriminative ability of nomogram were determined with concordance index (C-index) and calibration curve, and further validated in an independent CCM cohort of a prospective multicenter study from 2019 to 2020. Results: The overall morbidity of CCM was 26.2% after a mean follow-up of 1.9 years (range 0.5–3.5 years) since the first hemorrhage. The morbidity during untreated follow-up was associated with hemorrhage ictus (adjusted odds ratio per ictus increase, 4.17 [95% CI, 1.86–9.33]), modified Rankin Scale score at initial hemorrhage (adjusted odds ratio per point increase, 2.57 [95% CI, 1.82–3.63]), brainstem location (adjusted odds ratio, 2.93 [95% CI, 1.28–6.68]), and associated developmental venous anomaly (adjusted odds ratio, 2.21 [95% CI, 1.01–4.83]). Subgroup analysis revealed similar findings in brainstem and non-brainstem CCM. Nomogram was contracted based on these features. The calibration curve showed good agreement between nomogram prediction and actual observation. The C-index of nomogram predicting morbidity was 0.83 (95% CI, 0.77–0.88). In validation cohort, the nomogram maintained the discriminative ability (C-index, 0.87 [95% CI, 0.78–0.96]). Conclusions: Multiple symptomatic hemorrhages, initial neurological function after hemorrhage, brainstem location, and associated developmental venous anomaly were associated with morbidity of CCM hemorrhage. The nomogram represented a practical approach to provide individualized risk assessment for CCM patients. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04076449.

A rare combination of a developmental venous anomaly with a varix

2008 ◽  
Vol 1 (2) ◽  
pp. 156-159 ◽  
Author(s):  
Sait Sirin ◽  
Serdar Kahraman ◽  
Selcuk Gocmen ◽  
Ersin Erdogan
Keyword(s):  
Surgical Intervention ◽  
Cavernous Malformation ◽  
Vascular Anomaly ◽  
Venous Drainage ◽  
Magnetic Resonance Images ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Computed Tomography Scans ◽  
The Brain

✓The most common vascular anomaly associated with a developmental venous anomaly (DVA) is a cavernous malformation. A cerebral DVA is a rare vascular malformation of the brain when it is associated with a varix. The authors report on a 13-year-old girl who presented with 2 brief episodes of nonresponsiveness that mimicked absence seizures. The computed tomography scans, magnetic resonance images, and cerebral angiograms showed a left temporal DVA in combination with a sylvian fissure varix. To maintain normal parenchymal venous drainage, no surgical intervention was performed. Radiological and clinical follow-up was planned. This case report expands the present knowledge of the rare association of a cerebral DVA with a varix and emphasizes the need for meticulous neuroimaging to avoid unnecessary surgery.

Natural course of mild cognitive impairment in Parkinson disease

Neurology ◽  
2017 ◽  
Vol 88 (8) ◽  
pp. 767-774 ◽  
Author(s):  
Kenn Freddy Pedersen ◽  
Jan Petter Larsen ◽  
Ole-Bjørn Tysnes ◽  
Guido Alves
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Confidence Interval ◽  
Parkinson Disease ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Neuropsychological Testing ◽  
Increased Risk ◽  
Normal Cognition

Objective:To examine the incidence, progression, and reversion of mild cognitive impairment in patients with Parkinson disease (PD-MCI) over 5 years.Methods:A population-based cohort of patients with incident PD underwent repeated neuropsychological testing of attention, executive function, memory, and visuospatial abilities at baseline (n = 178), 1 year (n = 175), 3 years (n = 163), and 5 years (n = 150). Patients were classified as PD-MCI and diagnosed with dementia according to published criteria.Results:Thirty-six patients (20.2%) fulfilled criteria for PD-MCI at baseline. Among those with normal cognition at baseline (n = 142), the cumulative incidence of PD-MCI was 9.9% after 1 year, 23.2% after 3 years, and 28.9% after 5 years of follow-up. Overall, 39.1% of patients with baseline or incident PD-MCI progressed to dementia during the 5-year study period. The conversion rate to dementia was 59.1% in patients with persistent PD-MCI at 1 year vs 7.2% in those with normal cognition during the first year (adjusted odds ratio 16.6, 95% confidence interval 5.1–54.7, p < 0.001). A total of 27.8% of patients with baseline PD-MCI and 24.2% of those with incident PD-MCI had reverted to normal cognition at study end, but the reversion rate decreased to 9.4% in those with persistent PD-MCI at 2 consecutive visits. Compared with cognitively normal patients, PD-MCI reverters within the first 3 years of follow-up were at increased risk of subsequently developing dementia (adjusted odds ratio 10.7, 95% confidence interval 1.5–78.5, p = 0.019).Conclusions:Early PD-MCI, regardless of persistence or reversion to normal cognition, has prognostic value for predicting dementia in patients with PD.

Seizure Incidence Rates in Children and Adults With Familial Cerebral Cavernous Malformations

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012569
Author(s):  
Christine K. Fox ◽  
Jeffrey Nelson ◽  
Charles E. McCulloch ◽  
Shantel Weinsheimer ◽  
Ludmila Pawlikowska ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Cavernous Malformation ◽  
Incidence Rates ◽  
Cerebral Cavernous Malformation ◽  
Care Utilization ◽  
Study Cohort ◽  
Cavernous Malformations ◽  
Increased Risk ◽  
Unit Increase

Background and Objectives:Seizure incidence rates related to Familial Cerebral Cavernous Malformation (FCCM) are not well described, especially for children. To measure the seizure incidence rate, examine seizure predictors and characterize epilepsy severity, we studied a cohort of children and adults with FCCM enrolled in the Brain Vascular Malformation Consortium (BVMC).Methods:Seizure data were collected from participants with FCCM in the BVMC at enrollment and during follow-up. We estimated seizure probability by age, and tested whether cerebral cavernous malformation (CCM) counts or genotype were associated with earlier seizure onset.Results:The study cohort included 479 FCCM cases. Median age at enrollment was 42.5 years (Interquartile Range [IQR] 22.5-55.0) and 19% were children (<18 years old). Median large CCM count was 3 (IQR: 1-5). Among 393 with genotyping, mutations were: CCM1-Common Hispanic Mutations (88%), another CCM1 mutation (5%), CCM2 mutations (5%), and CCM3 mutations (2%). Prior to or during the study, 202 (42%) had a seizure. The cumulative incidence of a childhood seizure was 20.3% (95% CI 17.0 – 23.4) and by age 80 years was 60.4% (95% CI 54.2-65.7). More total CCMs (Hazard Ratio [HR] 1.24 per SD unit increase, 95% CI 1.1 – 1.4) or more large CCMs (HR=1.5 per SD unit increase, 95% CI 1.2-1.9) than expected for age and sex increased seizure risk. A CCM3 mutation also increased risk compared to other mutations (HR 3.11, 95% CI 1.15-8.45). Individuals with a seizure prior to enrollment had increased hospitalization rates during follow-up (Incidence Rate Ratio 10.9, 95% CI 2.41 – 49.32) compared to patients without a seizure history.Discussion:Individuals with FCCM have a high seizure incidence, and those with more CCMs or CCM3 genotype are at greater risk. Seizures increase health care utilization in FCCM.

De Novo Cavernous Malformation Associated with a Pre-existing Developmental Venous Anomaly

2019 ◽  
Vol 30 (1) ◽  
pp. 181-184
Author(s):  
Daniel García-Pérez ◽  
Irene Panero ◽  
Alfonso Lagares ◽  
Pedro González
Keyword(s):  
De Novo ◽  
Cavernous Malformation ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly

scholarly journals Sex modulates the association of radial artery augmentation index with renal function decline in individuals without chronic kidney disease

2021 ◽  
Author(s):  
Qiao Qin ◽  
Fangfang Fan ◽  
Jia Jia ◽  
Yan Zhang ◽  
Bo Zheng
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Augmentation Index ◽  
Renal Function Decline

Abstract Purpose An increase in arterial stiffness is associated with rapid renal function decline (RFD) in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether the radial augmentation index (rAI), a surrogate marker of arterial stiffness, affects RFD in individuals without CKD. Methods A total of 3165 Chinese participants from an atherosclerosis cohort with estimated glomerular filtration rates (eGFR) of ≥ 60 mL/min/1.73 m2 were included in this study. The baseline rAI normalized to a heart rate of 75 beats/min (rAIp75) was obtained using an arterial applanation tonometry probe. The eGFRs at both baseline and follow-up were calculated using the equation derived from the Chronic Kidney Disease Epidemiology Collaboration. The association of the rAIp75 with RFD (defined as a drop in the eGFR category accompanied by a ≥ 25% drop in eGFR from baseline or a sustained decline in eGFR of > 5 mL/min/1.73 m2/year) was evaluated using the multivariate regression model. Results During the 2.35-year follow-up, the incidence of RFD was 7.30%. The rAIp75 had no statistically independent association with RFD after adjustment for possible confounders (adjusted odds ratio = 1.12, 95% confidence interval: 0.99–1.27, p = 0.074). When stratified according to sex, the rAIp75 was significantly associated with RFD in women, but not in men (adjusted odds ratio and 95% confidence interval: 1.23[1.06–1.43], p = 0.007 for women, 0.94[0.76–1.16], p = 0.542 for men; p for interaction = 0.038). Conclusion The rAI might help screen for those at high risk of early rapid RFD in women without CKD.

scholarly journals Time to First Cigarette and Self-Reported Health Among US Adult Smokers

2019 ◽  
Vol 12 ◽  
pp. 1179173X1882526 ◽  
Author(s):  
Baksun Sung
Keyword(s):  
United States ◽  
Propensity Score ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Smoking Behavior ◽  
The United States ◽  
Elevated Risk ◽  
Poor Health ◽  
Increased Risk ◽  
Reported Health

Background: Numerous studies have reported that shorter time to first cigarette (TTFC) is linked to elevated risk for smoking-related morbidity. However, little is known about the influence of early TTFC on self-reported health among current smokers. Hence, the objective of this study was to examine the association between TTFC and self-reported health among US adult smokers. Methods: Data came from the 2012-2013 National Adult Tobacco Survey (NATS). Current smokers aged 18 years and older (N = 3323) were categorized into 2 groups based on TTFC: ≤ 5 minutes (n = 1066) and >5 minutes (n = 2257). Propensity score matching (PSM) was used to control selection bias. Results: After adjusting for sociodemographic and smoking behavior factors, current smokers with early TTFC had higher odds for poor health in comparison with current smokers with late TTFC in the prematching (adjusted odds ratio [AOR] = 1.65; 95% confidence interval [CI] = 1.31-2.08) and postmatching (AOR = 1.60; 95% CI = 1.22-2.09) samples. Conclusions: In conclusion, smokers with early TTFC were associated with increased risk of poor health in the United States. To reduce early TTFC, elaborate efforts are needed to educate people about harms of early TTFC and benefits of stopping early TTFC.

Abstract WP200: Post-operative Infection Does not Increase Risk of Post-operative Stroke: Analysis From a Nationwide Quality Initiative Program

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Benjamin R Kummer ◽  
Rebecca Hazan ◽  
Hooman Kamel ◽  
Alexander E Merkler ◽  
Joshua Z Willey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Odds Ratio ◽  
Postoperative Infection ◽  
Adjusted Odds Ratio ◽  
Risk Of Infection ◽  
Postoperative Stroke ◽  
Increased Risk ◽  
Increase Risk ◽  
Initiative Program ◽  
The Relationship

Introduction: Infection has been described as a trigger for acute ischemic stroke, but the relationship between postoperative infection and the risk of postoperative stroke is unclear. We investigated the association between postoperative infection and stroke using the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) database. Hypothesis: Postoperative infection is associated with an increased risk of postoperative stroke. Methods: We used the NSQIP database to identify all patients who underwent surgery between the years of 2000 and 2010 and developed a postoperative stroke within 30 days of surgery. The group was further stratified according to the presence of infection preceding stroke. Using a logistic regression model adjusted for age, race, sex, medical comorbidities, surgical type, and dichotomized functional status, we compared the risk of stroke in patients with and without preceding infections, and investigated the risk of infection following stroke. Results: 729,886 surgical patients were identified, of whom 2,703 (0.3%) developed postoperative stroke. 848 (0.12%) patients developed both postoperative stroke and infection. Among patients who had postoperative stroke, 100 (3.7%) had developed an infection prior to developing a stroke. Patients with infection prior to stroke had a lower risk of stroke than patients who did not develop infection prior to stroke (adjusted odds ratio [OR] 0.25, 95%CI 0.20-0.32). 748 patients (0.1%) developed an infection after having a postoperative stroke. These patients had a higher risk of infection (incidence rate ratio 2.76, 95%CI 2.57-2.97) and a higher odds of infection (adjusted odds ratio [OR] 3.47, 95%CI 3.18-3.78) than patients who did not have a stroke. Conclusions: We found that the presence of a preceding infection was associated with a low risk of postoperative stroke in a large surgical inpatient sample. Although the total number of strokes may have been under-reported, these results conflict with other studies that report that infection is a trigger for ischemic stroke. Further analyses using more granular data are needed to investigate the relationship between postoperative infection and the risk of postoperative stroke.

Stereotactic radiosurgery for cerebral cavernous malformation: comparison of hemorrhage rates before and after stereotactic radiosurgery

2021 ◽  
pp. 1-7
Author(s):  
Burak Karaaslan ◽  
Beste Gülsuna ◽  
Gökberk Erol ◽  
Özlem Dağli ◽  
Hakan Emmez ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Seizure Control ◽  
Cavernous Malformation ◽  
Cerebral Cavernous Malformation ◽  
Vascular Pathology ◽  
Lesion Volume ◽  
Developmental Venous Anomaly ◽  
Effective Treatment Modality ◽  
Radiological Data ◽  
Before And After

OBJECTIVE Cerebral cavernous malformation (CM) is an angiographically occult vascular pathology. Although microsurgery is the gold standard treatment to control the symptoms of CM, resection carries high risk in some situations, especially eloquent areas. The objective was to evaluate annual hemorrhage rates (AHRs) before and after stereotactic radiosurgery (SRS) treatment of cerebral CM in different locations. METHODS A total of 195 patients (119 women and 76 men) with CM treated at the Gazi University Gamma Knife Center between April 2005 and June 2017 were analyzed. The mean ± SD follow-up period was 67.4 ± 31.1 months (range 12 days to 170 months). AHR before SRS, AHR after SRS, morbidity associated with radiation, seizure control rate after SRS, lesion volume, coexistence with developmental venous anomaly, and SRS treatment parameters were analyzed, with evaluation of radiological data and clinical charts performed retrospectively. The seizure control rate was assessed using the Engel outcome scale. RESULTS The AHR before SRS was 15.3%. Application of SRS to these patients significantly reduced the AHR rates to 2.6% during the first 2 years after treatment and to 1.4% thereafter. Favorable seizure control (Engel class I and II) after radiosurgery was achieved in 23 patients (88.5%) with epilepsy. Radiation-related temporary complications occurred in 15.4% of patients, and permanent morbidity occurred in 4.6%. CONCLUSIONS SRS is a safe and effective treatment modality for reducing the hemorrhage risk of CM. The authors suggest that SRS should be considered for the treatment of patients with CM, high surgical risks, and hemorrhage history, instead of a using a wait-and-see policy.

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