Frequency and Patterns of Brain Infarction in Patients With Embolic Stroke of Undetermined Source: NAVIGATE ESUS Trial

Background and Purpose: The spectrum of brain infarction in patients with embolic stroke of undetermined source (ESUS) has not been well characterized. Our objective was to define the frequency and pattern of brain infarcts detected by magnetic resonance imaging (MRI) among patients with recent ESUS participating in a clinical trial. Methods: In the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), an MRI substudy was carried out at 87 sites in 15 countries. Participants underwent an MRI using a specified protocol near randomization. Images were interpreted centrally by those unaware of clinical characteristics. Results: Among the 918 substudy cohort participants, the mean age was 67 years and 60% were men with a median (interquartile range) of 64 (26–115) days between the qualifying ischemic stroke and MRI. On MRI, 855 (93%) had recent or chronic brain infarcts that were multiple in 646 (70%) and involved multiple arterial territories in 62% (401/646). Multiple brain infarcts were present in 68% (510/755) of those without a history of stroke or transient ischemic attack before the qualifying ESUS. Prior stroke/transient ischemic attack ( P <0.001), modified Rankin Scale score >0 ( P <0.001), and current tobacco use ( P =0.01) were associated with multiple infarcts. Topographically, large and/or cortical infarcts were present in 89% (757/855) of patients with infarcts, while in 11% (98/855) infarcts were exclusively small and subcortical. Among those with multiple large and/or cortical infarcts, 57% (251/437) had one or more involving a different vascular territory from the qualifying ESUS. Conclusions: Most patients with ESUS, including those without prior clinical stroke or transient ischemic attack, had multiple large and/or cortical brain infarcts detected by MRI, reflecting a substantial burden of clinical stroke and covert brain infarction. Infarcts most frequently involved multiple vascular territories. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02313909.

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Prevalence and Associations of MRI-Demonstrated Brain Infarcts in Elderly Subjects With a History of Transient Ischemic Attack

Stroke ◽

10.1161/01.str.30.2.383 ◽

1999 ◽

Vol 30 (2) ◽

pp. 383-388 ◽

Cited By ~ 14

Author(s):

Rafeeque A. Bhadelia ◽

Melissa Anderson ◽

Joseph F. Polak ◽

Teri A. Manolio ◽

Norman Beauchamp ◽

...

Keyword(s):

Transient Ischemic Attack ◽

Elderly Subjects ◽

Brain Infarcts ◽

History Of ◽

Ischemic Attack

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Activation Products of the Haemostatic System in Coronary, Cerebrovascular and Peripheral Arterial Disease

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615700 ◽

2001 ◽

Vol 85 (02) ◽

pp. 234-239 ◽

Cited By ~ 32

Author(s):

M. L. Bots ◽

F. Haverkate ◽

P. Meijer ◽

A. Hofman ◽

C. Kluft ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Transient Ischemic Attack ◽

Pressure Ratio ◽

Arterial Disease ◽

Population Based ◽

Control Subjects ◽

History Of ◽

Ischemic Attack ◽

Peripheral Arterial ◽

D Dimer

SummaryTo determine the presence of a ‘hypercoagulable state’ as assessed by indices of thrombin and plasmin generation and of the amount of fibrin that is lysed, in patients with stable coronary, cerebral and peripheral arterial disease a population-based cross-sectional study was performed. From a population-based cohort comprising 7983 men and women aged 55 years and over, we randomly selected 127 subjects with a history of myocardial infarction, 124 with a history of stroke and/or transient ischemic attack, 131 patients with peripheral arterial disease and 263 control subjects in the same age group without arterial disease. Subjects using anticoagulant drugs were not selected. F1+2, TAT, and PAP were not associated with a history of cardiovascular events, nor with peripheral arterial disease. In contrast, positive associations were found for D-Dimer. Mean D-Dimer level was 40 μg/l (95% CI 35,44) in control subjects; 53 μg/l (47, 61) in those with a history of myocar-dial infarction and 51 μg/l (45, 58) in those with a history of stroke and or transient ischemic attack. D-Dimer increased gradually with increasing severity of peripheral atherosclerosis; a decrease in ankle/arm systolic blood pressure ratio of 0.1 was associated with an increase in D-Dimer of 3.9 μg/l (p<0.01). This was more pronounced in subjects with higher F1+2, TAT and PAP concentration. In conclusion, the markers of onset of coagulation F1+2, TAT and PAP are not associated with the presence of arterial disease, but increased levels of these markers are necessary for the positive association between D-Dimer and arterial disease.

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Risk Factors of Stroke in Young and Old Age Group Admitted in a Tertiary Level Hospital, Dhaka - A Comparative Study

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v27i2.17576 ◽

2014 ◽

Vol 27 (2) ◽

pp. 94-100

Author(s):

Md. Nurul Amin Miah ◽

MA Azhar ◽

Aminur Rahman ◽

Durba Halder ◽

Md. Akteruzzaman ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Old Age ◽

Transient Ischemic Attack ◽

Oral Contraceptive Pill ◽

Age Group ◽

Old Patients ◽

History Of ◽

Ischemic Attack ◽

Stroke In Young

Background: Stroke is an important cause of death and disability. Prevalence of stroke in Bangladesh differs with age. The risk factors in young differ in comparison to old age group. In this study risk factors of stroke in young in comparison to old age group were evaluated. Objectives: To compare the risk factors associated with stroke in young adult and to those of old age group. Methodology: This comparative study conducted in the department of Medicine and Neurology, Sir Salimullah Medical College & Mitford Hospital, Dhaka from January 2008 to June 2009. One hundred two stroke patient of above 15 years of age were confirmed by CT scan or MRI of brain those were included in young and old age groups. The risk factors of stroke were defined in terms of hypertension, diabetes mellitus, dyslipidaemia, ischemic heart diseases, valvular heart disease, history of transient ischemic attack or stroke, smoking and oral contraceptive pill. Results: Of total 102 cases 17 were young adults and 85 old patients between 19 to 100 years. Mean age young adult was 39.76 (± 6.379) and old age was 65.06 (± 11.238). 61.7% were male & 38.2% were female and the ratio was 1.6:1. Amongst male 58.8% patients were smoker in each age group and only 2.9% old patients were alcoholic. Only 17.6% had previous history of transient ischemic attack or stroke in each age group. 58.8% of young and 48.2% of old were hypertensive. 7% old patients had history of ischemic heart disease. 5.9% of young and 2.4% of old patients had valvular heart disease but no patient had vasculitis. 16.7% old patients had diabetes mellitus. 4.9% of total patients (young 11.8% and 3.5% old) were oral contraceptive pill user. Out of all patients 24.7% old patients and 5.9% young adult was dyslipidaemic. Among all patients 66.7% patients had the Ischemic stroke and 33.3% patients had the hemorrhagic stroke. 68.2% old patients and 58.8% young patients had Ischemic stroke; 31.8% old patients and 41.2% young patients had hemorrhagic stroke. Conclusion: In young age group smoking, transient ischemic attack or stroke, hypertension, valvular heart disease, oral contraceptive pill and in old age group smoking, transient ischemic attack or stroke, hypertension, Ischemic heart disease, diabetes mellitus and dyslipidaemia were found significant risk factors for development of stroke. So modification of risk factors may reduce the incidence of stroke. Bangladesh Journal of Neuroscience 2011; Vol. 27 (2) : 94-100 DOI: http://dx.doi.org/10.3329/bjn.v27i2.17576

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Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack

10.1002/14651858.cd009938 ◽

2012 ◽

Author(s):

Jie Li ◽

Ming Liu ◽

Shihong Zhang ◽

Zilong Hao ◽

Canfei Zhang ◽

...

Keyword(s):

Medical Therapy ◽

Transient Ischemic Attack ◽

Patent Foramen Ovale ◽

Recurrent Stroke ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

History Of ◽

Ischemic Attack

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Oral Levosimendan Increases Cerebral Blood Flow Velocities in Patients with a History of Stroke or Transient Ischemic Attack: A Pilot Safety Study

Current Therapeutic Research ◽

10.1016/j.curtheres.2015.01.001 ◽

2015 ◽

Vol 77 ◽

pp. 46-51 ◽

Cited By ~ 7

Author(s):

Matti Kivikko ◽

Mikko Kuoppamäki ◽

Lauri Soinne ◽

Stig Sundberg ◽

Pasi Pohjanjousi ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Transient Ischemic Attack ◽

Safety Study ◽

History Of ◽

Blood Flow Velocities ◽

Ischemic Attack ◽

Flow Velocities

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How do we manage emergency department patients diagnosed with transient ischemic attack?

CJEM ◽

10.2310/8000.2011.110533 ◽

2012 ◽

Vol 14 (01) ◽

pp. 20-24 ◽

Cited By ~ 7

Author(s):

Jeffrey J. Perry ◽

Jonathan Kerr ◽

Cheryl Symington ◽

Jane Sutherland

Keyword(s):

Emergency Department ◽

Transient Ischemic Attack ◽

Data Extraction ◽

Tertiary Care ◽

Clinical Findings ◽

Stroke Rate ◽

Historical Cohort ◽

History Of ◽

Emergency Department Patients ◽

Ischemic Attack

ABSTRACTIntroduction:Multiple studies have demonstrated low rates of antithrombotic use, low neuroimaging rates, and high subsequent risk of stroke at 90 days following an emergency department (ED) diagnosis of transient ischemic attack (TIA). This study assessed the use of antithrombotic medications, neuroimaging, and subsequent 90-day stroke rate for patients in a more recent cohort of ED patients discharged home with TIA.Methods:We conducted a 1-year historical cohort study of all patients discharged with a TIA at a tertiary care ED (census 60,000 visits/year), which was one of the four sites participating in one of the aforementioned studies. Data were extracted from paper and electronic records onto standardized data extraction forms. Clinical findings, medications, and tests were recorded.Results:A total of 211 patients were enrolled in the study. The patients had the following characteristics: the mean age was 71.2 years (SD 13.8 years), 56.9% were female, 53.1% had a history of hypertension, 26.5% had a history of ischemic heart disease, and 17.1% had a previous stroke. The most frequent neurologic deficit was unilateral weakness (53.6%), and most deficits lasted for more than 60 minutes (71.6%). Antithrombotic medications were used for 96.7% of patients at ED discharge. Neuroimaging was conducted in 94.3% of patients while in the ED. Our cohort had a 90-day stroke rate of 1.9%.Conclusions:This study established that most TIA patients receive neuroimaging in the ED and are started on or maintained on antithrombotic agents. Clinicians are encouraged to ensure that electrocardiography is done routinely and to involve Neurology in follow-up care.

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Risk Factors of Stroke in Young and Old age Group - A Comparative Study

Journal of Medicine ◽

10.3329/jom.v13i2.12741 ◽

2012 ◽

Vol 13 (2) ◽

pp. 138-142 ◽

Cited By ~ 1

Author(s):

MNA Miah ◽

MA Azhar ◽

A Rahman ◽

D Halder ◽

M Akteruzzaman ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Old Age ◽

Transient Ischemic Attack ◽

Oral Contraceptive Pill ◽

Age Group ◽

Old Patients ◽

History Of ◽

Ischemic Attack ◽

Stroke In Young

Background: Stroke is an important cause of death and disability. Prevalence of stroke in Bangladesh differs with age. The risk factors in young differ in comparison to old age group. In this study risk factors of stroke in young in comparison to old age group were evaluated. Objectives: To compare the risk factors associated with stroke in young adult and to those of old age group. Methodology: This comparative study conducted in the department of Medicine and Neurology, Sir Salimullah Medical College & Mitford Hospital, Dhaka from January 2008 to June 2009. One hundred two stroke patient of above 15 years of age were confirmed by CT scan or MRI of brain those were included in young and old age groups. The risk factors of stroke were defined in terms of hypertension, diabetes mellitus, dyslipidaemia, ischemic heart diseases, valvular heart disease, history of transient ischemic attack or stroke, smoking and oral contraceptive pill. Results: Of total 102 cases 17 were young adults and 85 old patients between 19 to 100 years. Mean age young adult was 39.76 (± 6.379) and old age was 65.06 (± 11.238). 61.7% were male & 38.2% were female and the ratio was 1.6:1. Amongst male 58.8% patients were smoker in each age group and only 2.9% old patients were alcoholic. Only 17.6% had previous history of transient ischemic attack or stroke in each age group. 58.8% of young and 48.2% of old were hypertensive. 7% old patients had history of ischemic heart disease. 5.9% of young and 2.4% of old patients had valvular heart disease but no patient had vasculitis. 16.7% old patients had diabetes mellitus. 4.9% of total patients (young 11.8% and 3.5% old) were oral contraceptive pill user. Out of all patients 24.7% old patients and 5.9% young adult was dyslipidaemic. Among all patients 66.7% patients had the Ischemic stroke and 33.3% patients had the hemorrhagic stroke. 68.2% old patients and 58.8% young patients had Ischemic stroke; 31.8% old patients and 41.2% young patients had hemorrhagic stroke. Conclusion: In young age group smoking, transient ischemic attack or stroke, hypertension, valvular heart disease, oral contraceptive pill and in old age group smoking, transient ischemic attack or stroke, hypertension, Ischemic heart disease, diabetes mellitus and dyslipidaemia were found significant risk factors for development of stroke. So modification of risk factors may reduce the incidence of stroke. DOI: http://dx.doi.org/10.3329/jom.v13i2.12741 J Medicine 2012; 13 : 138-142

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