Methamphetamine Abuse Presenting as Stroke Related to the Cardiac Thrombus: A Case Report

Methamphetamine has become a drug of widespread use in young abusers in Iran. It may induce hypertension, vasospasm, and direct vascular toxicity. Harmful consequences are common, including cardiac and cerebrovascular accidents. This is a report of a 37-year-old man with a 3-year history of drug use that presented to the emergency department within 30 min of the onset of syncope followed by speech difficulty and right-sided weakness. The patient had an extensive ischemic stroke because of left ventricular apical thrombus without any other significant risk factors such as hypertension, alcohol abuse, or ischemic heart disease.

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Predictor Naïve Temporal Baseline Hazard of Recurrent Ischemic Stroke

10.21203/rs.3.rs-1181102/v1 ◽

2022 ◽

Author(s):

Marwa Elsaeed Elhefnawy ◽

Siti Maisharah Sheikh Ghadzi ◽

Orwa Albitar ◽

Balamurugan Tangiisuran ◽

Hadzliana Zainal ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Significant Risk ◽

Likelihood Estimation ◽

Preventive Treatment ◽

Hazard Models ◽

Baseline Hazard ◽

Time Points ◽

History Of

Abstract There are established correlation between risk factors and the recurrence of ischemic stroke (IS), however does the hazard of recurrent IS change although without the influence of established risk factors? This study aimed to quantify the hazard of recurrent IS at different time points after the index IS. This was a population cohort study extracted data of 7697 patients with a history of first IS attack registered with National Neurology Registry of Malaysia. A repeated time to recurrent IS model was developed using NONMEM version 7.5. Three baseline hazard models were fitted into the data. The best model was selected using maximum likelihood estimation, clinical plausibility and visual predictive checks. Three hundred and thirty-three (4.32%) patients developed at least one recurrent IS within the maximum 7.37 years follow-up. In the absence of significant risk factors, the hazard of recurrent IS was predicted to be 0.71 within the first month after the index IS and reduced to 0.022 between the first to third months after the index attack. The hazard of IS recurrence accelerated with the presence of typical risk factors such as hyperlipidaemia (HR, 2.64 [2.10-3.33]), hypertension (HR, 1.97 [1.43-2.72], and ischemic heart disease (HR, 2.21 [1.69-2.87]). In conclusion, the absence of significant risk factors, predicted hazard of recurrent IS was prominent in the first month after the index IS and was non-zero even three months after the index IS or later. Optimal secondary preventive treatment should incorporate the ‘nature risk’ IS recurrence.

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Aortic Valve Surgery After Neonatal Balloon Aortic Valvuloplasty in Congenital Aortic Stenosis

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.009933 ◽

2021 ◽

Author(s):

Takashi Kido ◽

Alvise Guariento ◽

Ilias P. Doulamis ◽

Diego Porras ◽

Christopher W. Baird ◽

...

Keyword(s):

Risk Factors ◽

Significant Risk ◽

Left Ventricular ◽

Endocardial Fibroelastosis ◽

Balloon Aortic Valvuloplasty ◽

Congenital Aortic Stenosis ◽

Cutoff Value ◽

Aortic Valvuloplasty ◽

History Of ◽

Annulus Diameter

Background: We sought to identify predictive factors for aortic valve (AoV) surgery after neonatal balloon aortic valvuloplasty (BAV) and characterize clinical outcomes of AoV surgery after neonatal BAV. Methods: Time-to-event analysis identified predictors for AoV surgery after neonatal BAV. Clinical outcomes of AoV surgery following neonatal BAV were examined. Results: This study included 96 consecutive patients who underwent neonatal BAV for congenital aortic stenosis between 1998 and 2018, in 26 of whom a fetal BAV had been performed. Fifty-six patients underwent AoV surgery at a median age of 2.0 years. Significant risk factors for AoV surgery in univariate Cox regression (result presented as hazard ratio [HR], [95% CI]; P value) were a history of fetal BAV (HR, 4.05 [95% CI, 2.19–7.40]; P <0.001), AoV annulus diameter Z score (HR, 0.56 [95% CI, 0.43–0.75]; P =0.001), the presence of endocardial fibroelastosis (HR, 2.61 [95% CI, 1.48–4.51]; P =0.001), severe left ventricular dysfunction before neonatal BAV (HR, 1.75 [95% CI, 1.03–2.97]; P =0.04), and recent era (HR, 3.08 [95% CI, 1.68–5.91]; P =0.0002) in the entire cohort. Area under the receiver operating characteristic curve and Youden J index analysis identified a cutoff value for AoV annulus diameter Z score of −2.6 in patients without fetal BAV. In 24 patients with midterm cardiac catheterization data, univariate linear regression analysis (result presented as B coefficient [95% CI]; P ) showed that the presence of greater-than-moderate aortic regurgitation immediately after BAV (B coefficient, 4.8 [95% CI, 1.0–8.6]; P =0.018) and before AoV surgery (B coefficient, 6.1 [95% CI, 2.2–10.0]; P =0.004) were significant risk factors for elevated left ventricular end-diastolic pressure after AoV surgery, while concomitant endocardial fibroelastosis resection at AoV surgery had a protective effect (B coefficient, −3.8 [95% CI, −7.6 to −0.06]; P =0.05). Conclusions: A small AoV annulus diameter Z score with a cutoff value of −2.6 and a history of fetal BAV were significantly associated with AoV surgery after neonatal BAV. Concomitant endocardial fibroelastosis resection is recommended at AoV surgery following neonatal BAV to improve left ventricular diastolic function.

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Acute Cerebrovascular Events in Hospitalized COVID-19 Patients

Stroke ◽

10.1161/strokeaha.120.030995 ◽

2020 ◽

Vol 51 (9) ◽

Cited By ~ 19

Author(s):

Aaron Rothstein ◽

Olivia Oldridge ◽

Hannah Schwennesen ◽

David Do ◽

Brett L. Cucchiara

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Significant Risk ◽

The United States ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Stroke Incidence ◽

Cerebrovascular Events ◽

History Of

Background and Purpose: Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States. Methods: We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals. Results: We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation. Conclusions: We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.

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Relations between coagulation profiles, lipid profiles, and other risk factors with risk of first-ever ischemic stroke: a novel case-control study

Stroke ◽

10.1161/str.32.suppl_1.367-b ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 367-367

Author(s):

Chyi-Huey Bai ◽

Jiunn-Rong Chen ◽

C. Kate Hsiao ◽

Hou-Chang Chiu ◽

Wen-Harn Pan

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Carotid Plaque ◽

Left Ventricular ◽

Significance Level ◽

Glucose Levels ◽

Hemostatic Factors ◽

History Of ◽

Lipid Parameters

P156 Background and objectives: Several hemostatic factors and lipid parameters are associated with risk of coronary heart disease. Few studies have investigated the relations between these factors and risk of ischemic stroke. The major aim of this study was to estimate the risks of hypercoagulability, hyperlipidemia, hypertension, and hyperglycemia in acquiring first-ever ischemic stroke. An ancillary aim was to observe changes including biochemical and coagulation profiles in first-ever ischemic stroke inpatients from admission to 3 months later. Methods: One hundred and forty-four first-ever ischemic stroke inpatients and two types of controls (including 142 stable ischemic stroke outpatients and 181 non-stroke outpatients) were recruited from 1996 to 1999. Uric acid and glucose levels, status of hypertension, diabetes, left ventricular hypertrophy (LVH), and atrial fibrillation (AF), and coagulation (clotting times, fibrinogen, factor VIIc, and factor VIIIc) and lipid (cholesterol, triglyceride, HDL-C and LDL-C) profiles were obtained. Results: The proportions of cases with elevated fibrinogen and factor VIIIc from admission to 3 months later were significantly higher than those of non-stroke controls, either with or without anticoagulants. The proportions of cases with decreased HDL-C and hyperglycemia were also significantly higher than those of non-stroke controls. After adjusting for multiple cardiovascular risk factors, elevated fibrinogen (OR=3.21; p=0.0071), hyperglycemia (OR=2.65; p=0.0076), hypertension (OR=1.97; p=0.0424), history of LVH (OR=3.15; p=0.0010), and carotid plaque states (OR=2.27; p=0.0185) were significantly associated with risk of first-ever ischemic stroke. Elevated factor VIIIc was at borderline significance level (OR=2.12; p=0.0722). Conclusion: Hypertension, hyperglycemia, LVH and positive carotid plaque were associated with risk of first-ever ischemic stroke. Elevated fibrinogen and factor VIIIc were also associated with first-ever ischemic stroke, indicating a role of coagulation profiles in the pathogenesis of ischemic stroke.

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Quantifying the Contribution of Risk Factors for Ischemic Stroke in Patients with a History of TIA

ISRN Stroke ◽

10.5402/2012/976045 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7

Author(s):

Duncan C. Ramsey ◽

Mark G. Burnett ◽

Matthew C. Cowperthwaite

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Patient Population ◽

Stroke Risk ◽

Significant Risk ◽

Individual Risk ◽

Readmission Rates ◽

Cardiovascular Comorbidities ◽

History Of ◽

Ischemic Attack

Background. Patients with a history of transient ischemic attack (TIA) are known to be at higher risk for a stroke. We sought to investigate predictors of individual risk for an ischemic stroke within 30 days of a TIA. Methods and Results. A retrospective analysis of 57,585 TIA admissions was collected from 155 United States hospitals. Data describing each admission included demographic and clinical data, and information about the admitting hospital. Cerebrovascular disease was the primary readmission reason (19% of readmissions) in the TIA patient population. The prevalence of 30-day ischemic stroke readmissions was 11 per 1,000 TIA admissions; however, 53% of stroke readmissions occurred within one week. Hierarchal regression models suggested that peripheral vascular disease and hypertensive chronic kidney disease were significant individual stroke risk factors, whereas history of myocardial infarction, essential hypertension, and diabetes mellitus was not associated with significant stroke risk. Certified stroke centers were not associated with significantly lower stroke readmission rates. Conclusions. The results suggest that cardiovascular comorbidities confer the most significant risk for an ischemic stroke within 30 days of a TIA. Interestingly, certified stroke centers do not appear to be associated with significantly lower stroke-readmission rates, highlighting the challenges managing this patient population.

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Similarities and Differences in Epidemiology and Risk Factors of Cerebral and Myocardial Ischemic Disease

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2017-0045 ◽

2017 ◽

Vol 18 (s1) ◽

pp. 75-80

Author(s):

Angelina Stevanovic ◽

Danijela Tasic ◽

Nebojsa Tasic ◽

Dalibor Dragisic ◽

Miroslav Mitrovic ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Myocardial Infarction ◽

Blood Pressure ◽

Ischemic Stroke ◽

Alcohol Consumption ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

History Of

Abstract Ischemic heart disease and cerebral ischemia represent the leading causes of mortality worldwide. Both entities share risk factors, pathophisiology and etiologic aspects by means of a main common mechanism, atherosclerosis. The autors aimed to investigate differences and similarities in epidemiology and risk factors that could be found between both entities. In a retrospective sudy 403 patients were included and divided into two groups: group of 289 patients with history of myocardial infarction (AMI), and group of 114 patients with history of ischemic stroke (IS). All patients were evaluated for nonmodifiable risk faktors, which included age and sex, and modifiable, such as hypertension, dyslipidemia, diabetes, obesity, physical activity and smoking. Diff erences in some epidemiological aspects were also considered: occupation, marital status, alcohol consumption, exposure to stress. Patients with history of IS were significantly older then AMI patients (64.0 ± 9.9 vs 64.0 ± 9.9, p=0,028), with higher diastolic blood pressure (87,1 ± 10,2 vs 83,6 ± 10,4, p=0,003) and higher Sokolow-Lyon index in ECG, an also index of left ventricular hypertrophy (19,2 ± 9,1 vs 14,7 ± 6,5). Th ere were no significant differences between groups in the estimated body mass index and waist circumference. Differences between groups in stress exposure, occupation, alcohol consumption or physical activity were no significant. Patients in AMI group were more frequently male (199 (69%) vs 59 (52%), p=0,001), married (252 (87%) vs 88 (77%), p=0,037), smokers (162 (56%) vs 50 (44%), p=0,018) and with higher incidence od dyslipidemia (217 (75%) vs 73 (64%), p=0,019) compared with IS group. Incidence of arterial hypertension and diabetes was similar in both groups. Both entities share similar pathophysiological mechanisms and, consequently, main traditional risk factors. However, incidence of myocardial infarction increases with male sex, dyslipidemia, smoking and marital status, while incidense of ischemic stroke increases with age, higher diastolic blood pressure and also with ECG signs of left ventricular hypertrophy.

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Mortality and Conversion Rate to Below Knee or Above Knee Amputation Following Transmetatarsal Amputation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00112 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0011

Author(s):

D. Anthony Barcel ◽

Susan M. Odum ◽

Taylor Rowe ◽

Jefferson B. Sabatini ◽

Samuel E. Ford ◽

...

Keyword(s):

Risk Factors ◽

Conversion Rate ◽

Significant Risk ◽

High Rate ◽

Administrative Database ◽

Categorical Variables ◽

Diabetic Patients ◽

Knee Amputation ◽

History Of ◽

Transmetatarsal Amputation

Category: Midfoot/Forefoot; Diabetes; Other Introduction/Purpose: Non-traumatic lower extremity amputations (LEA), especially those performed in dysvascular and diabetic patients, are known to have poor long-term prognosis. Perioperative mortality has been reported at between 4 and 10%, and the 1 and 5 year mortality rates range between 22-33% and 39-69%, respectively. While poor outcomes in these patients have been described, there is no consensus as to the predictors of mortality. The purpose of the study is to determine the percentage of patients who had a complication following transmetatarsal amputation (TMA) and identify associated risk factors for complications and mortality. Methods: We queried our institution’s administrative database to identify 247 TMA procedures performed in 229 patients between January, 2002 and December, 2016. Electronic health records were reviewed to document complications defined as reoperation, amputation and mortality. Mortality was also verified using the National Death Index. Additionally, we recorded risk factors including diabetes, A1c level, end stage renal disease (ESRD), cardiovascular disease (CVD), peripheral vascular disease (PVD), history of revascularization, contralateral amputation, and neuropathy. The majority of the study patients were males (157, 69%) and the average age was 57 years (range 24-91). The median BMI was 28 (range 16-58) and 29% of the study patients were obese with a BMI ≥ 30. Fishers Exact tests were used to compare categorical variables. Kruskal-Wallis and Independent T-tests were used to compare numeric data. All data were analyzed using SAS/STAT software version 9.4 (Carey, NC) and a 0.05 level of significance was defined apriori. Results: The conversion rate to below (BKA) or above knee amputation (AKA) was 26% (64 of 247). Males (p=.0274), diabetics (p=.0139), patients in ESRD (p=.019), and patients with a history of CVD (p=.0247) or perioperative revascularization (p=.022) were more likely to undergo further amputation following an index TMA. BMI was significantly higher in patients requiring BKA/AKA (p=.0305). There were no significant differences in age (p=.2723) or A1c levels (p=.4219). The overall mortality rate was 35% (84 of 229). Diabetes (p=.0272), ESRD (p=.0031), history of CVD (p<.0001) or PVD (p=.0179) were all significantly associated with mortality. Patients who died were significantly older (p=.0006) and had significantly higher A1c levels (p=.0373). BMI was not significantly associated with mortality. Twenty-two patients who had 23 further amputations subsequently died. Conclusion: In our series of patients undergoing TMA, 26% underwent further amputation and 35% of patients died. Conversion rate to BKA or AKA occurred at a high rate regardless of preoperative revascularization or the use of tendo-achilles or gastrocnemius lengthening procedures. Male sex, diabetes, ESRD, history of CVD or revascularization are significant risk factors for further amputation. ESRD, diabetes, history of CVD or PVD, older age and higher A1c levels are significant risk factors for mortality. These data provide useful insight into risk factors to be emphasized when counseling patients and their families to establish realistic postoperative expectations.

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The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Reviews in the Neurosciences ◽

10.1515/revneuro-2020-0131 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Alcivan Batista de Morais Filho ◽

Thiago Luis de Holanda Rego ◽

Letícia de Lima Mendonça ◽

Sulyanne Saraiva de Almeida ◽

Mariana Lima da Nóbrega ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Natural History ◽

Hemorrhagic Stroke ◽

Recent Literature ◽

Clinical Manifestations ◽

The Road ◽

History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

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Stroke prediction in patients presenting with isolated dizziness in the emergency department

Scientific Reports ◽

10.1038/s41598-021-85725-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

June-sung Kim ◽

Hong Jun Bae ◽

Muyeol Kim ◽

Shin Ahn ◽

Chang Hwan Sohn ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Multivariate Analysis ◽

Acute Stroke ◽

Neurological Deficits ◽

Cerebrovascular Injury ◽

Risk Patients ◽

History Of ◽

Independent Risk Factors ◽

Record Review

AbstractDiagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

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Association between infection with Campylobacter species, poor oral health and environmental risk factors on esophageal cancer: a hospital-based case–control study in Thailand

European Journal of Medical Research ◽

10.1186/s40001-021-00561-3 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Arisara Poosari ◽

Thitima Nutravong ◽

Prakasit Sa-ngiamwibool ◽

Wises Namwat ◽

Supaporn Chatrchaiwiwatana ◽

...

Keyword(s):

Risk Factors ◽

Esophageal Cancer ◽

Oral Hygiene ◽

Case Control Study ◽

Significant Risk ◽

Case Control ◽

Poor Oral Hygiene ◽

History Of ◽

Control Study ◽

History Of Cancer

Abstract Background Previous studies have shown the association between Campylobacter species infection and that environmental factors, poor oral hygiene in particular, are linked to an increased risk of esophageal cancer (EC). However, no study has reported on these factors in Thailand. Thus, this study’s objective was to evaluate the impact of the relationship between Campylobacter infection and environmental factors on EC incidence in the population of Thailand. Methods Data from a case–control study were collected from 105 newly diagnosed EC cases and 105 controls recruited from 2007 to 2017. Infection with Campylobacter spp. was detected in the formalin-fixed paraffin-embedded (FFPE) tissue of EC taken from gastroesophageal biopsy specimens obtained from the participants, and evaluated using TaqMan® real-time PCR. Multivariable logistic regression was performed to calculate the odds ratios (ORs) and perform data analysis. Results Smoking, alcohol use, a family history of cancer, history of gastroesophageal reflux disease, poor oral hygiene and Campylobacter spp. infection were shown to be significant risk factors for EC (p < 0.05). The combination of poor oral hygiene and infection with Campylobacter spp. constituted significant risk for EC (p < 0.001). In addition, the risk of EC in subjects co-infected with C. rectus and C. concisus that practiced poor oral hygiene was even higher and was significant (ORadj = 4.7; 95% CI 2.41–9.98; p = 0.003). Conclusions In Thailand, the major risk factors for EC are smoking status, alcohol drinking, family history of cancer, GERD, poor oral hygiene and Campylobacter spp. infection. This study found Campylobacter spp. prevalence to be associated with EC and appears to be enhanced by poor oral hygiene, suggesting that a combination of poor oral hygiene and Campylobacter species infection may together act as an important etiological risk factor for EC.

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