Prevalence of the Frank’s sign by aetiopathogenic stroke subtype: A prospective analysis

Background and purpose The Frank’s sign is a diagonal earlobe crease running from the tragus to the edge of the auricle at an angle of 45°. Many studies have associated this sign with coronary artery disease and some with cerebrovascular disease. The objective of this study was to analyse the prevalence of the Frank’s sign in patients suffering from acute stroke with a particular focus on its prevalence in each of the five aetiopathogenic stroke subtypes. Special interest is given to embolic stroke of undetermined source (ESUS), correlating the sign with clinical and radiological markers that support an underlying causal profile in this subgroup. Methods Cross-sectional descriptive study including 124 patients admitted consecutively to a stroke unit after suffering an acute stroke. The Frank’s sign was evaluated by the same blinded member of the research team from photographs taken of the patients. The stroke subtype was classified following SSS-TOAST criteria and the aetiological study was performed following the ESO guidelines. Results The Frank’s sign was present in 75 patients and was more prevalent in patients with an ischaemic stroke in comparison with haemorrhagic stroke (63.9 vs. 37.5, p<0.05). A similar prevalence was found in the different ischaemic stroke subtypes. The Frank’s sign was significantly associated with age, particularly in patients older than 70 who had vascular risk factors. Atherosclerotic plaques found in carotid ultrasonography were significantly more frequent in patients with the Frank’s sign (63.6%, p<0.05). Analysing the ESUS, we also found an association with age and a higher prevalence of the Frank’s sign in patients with vascular risk factors and a tendency to a high prevalence of atherosclerosis markers. Conclusion The Frank’s sign is prevalent in all aetiopathogenic ischaemic stroke subtypes, including ESUS, where it could be helpful in suspecting the underlying cardioembolic or atherothrombotic origin and guiding the investigation of atherosclerosis in patients with ESUS and the Frank’s sign.

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Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

Acta Neurologica Scandinavica ◽

10.1111/ane.12446 ◽

2015 ◽

Vol 133 (3) ◽

pp. 202-207 ◽

Cited By ~ 23

Author(s):

A. Nacu ◽

A. Fromm ◽

K. M. Sand ◽

U. Waje‐Andreassen ◽

L. Thomassen ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Vascular Risk Factors ◽

Age Dependency ◽

Vascular Risk ◽

Stroke Subtypes ◽

Western Norway

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Prevalence of stroke and associated risk factors: a population based cross sectional study from northeast China

BMJ Open ◽

10.1136/bmjopen-2016-015758 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015758 ◽

Cited By ~ 20

Author(s):

Fu-Liang Zhang ◽

Zhen-Ni Guo ◽

Yan-Hua Wu ◽

Hao-Yuan Liu ◽

Yun Luo ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Northeast China ◽

Haemorrhagic Stroke ◽

Population Based ◽

Cross Sectional Study ◽

Cross Sectional ◽

Cerebrovascular Risk ◽

Lack Of Exercise ◽

Associated Risk Factors

ObjectivesEpidemiological studies aimed at stroke and its risk factors can help identify persons at higher risk and therefore promote stroke prevention strategies. We aimed to explore the current prevalence of stroke and its associated risk factors in northeast China.DesignPopulation based cross sectional study.SettingData were collected using a structured precoded questionnaire designed by the Stroke Screening and Prevention Programme of the National Health and Family Planning Commission of China, between January and March 2016.Participants4100 permanent residents, aged 40 years or older, who had lived in Dehui City of Jilin Province for more than 6 months volunteered to participate in the survey, with a response rate of 92.2%. For the purpose of the present analysis, 48 subjects were excluded due to missing values, giving a total of 4052 people included in this analysis.Main outcome measureThe questionnaire included demographic characteristics, stroke related behavioural factors, personal and family medical history of stroke, physical examination and laboratory testing.ResultsThe overall prevalence of stroke in Jilin Province was 7.2% (95% CI 6.3% to 8.2%). Of all stroke cases, 91.7% (95% CI 87.4% to 94.6%) were ischaemic stroke and 8.3% (95% CI 5.4% to 12.6%) were haemorrhagic stroke. The prevalence rates of dyslipidaemia, smoking and hypertension were ranked as the top three cerebrovascular risk factors and were 62.1%, 61.8% and 57.3%, respectively. We found that hypertension, dyslipidaemia and lack of exercise were associated with ischaemic stroke. However, only hypertension (OR=4.064, 95% CI 1.358 to 12.160) was significantly associated with haemorrhagic stroke.ConclusionsThe prevalence of stroke, especially ischaemic stroke, and associated cerebrovascular risk factors among adults aged 40 years or older in northeast China were high. A higher regional prevalence of hypertension, dyslipidaemia and lack of exercise may be responsible.

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Vascular risk at younger ages most strongly associates with current and future brain volume

Neurology ◽

10.1212/wnl.0000000000006360 ◽

2018 ◽

Vol 91 (16) ◽

pp. e1479-e1486 ◽

Cited By ~ 14

Author(s):

Matthew P. Pase ◽

Kendra Davis-Plourde ◽

Jayandra J. Himali ◽

Claudia L. Satizabal ◽

Hugo Aparicio ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Brain Volume ◽

Vascular Risk Factor ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Cross Sectional ◽

Strength Of Association ◽

Risk Factor Burden

ObjectiveGiven the potential therapeutic effect of vascular disease control timing to reduce dementia risk, we investigated the age-related influences of vascular risk factor burden on brain structure throughout the lifespan.MethodsWe studied participants from the community-based prospective Framingham Heart Study. Overall vascular risk factor burden was calculated according to the Framingham Stroke Risk Profile, a validated algorithm that predicts stroke risk. Brain volume was estimated by MRI. We used cross-sectional data to examine how the strength of association between vascular risk factor burden and brain volume changed across each age decade from age 45–54 years through to 85–94 years (N = 2,887). Second, we leveraged up to 40 years of longitudinal data to determine how the strength of association between vascular risk factor burden and brain volume changed when vascular risk factors were examined at progressively earlier ages (N = 7,868).ResultsIn both cross-sectional and longitudinal analyses, higher vascular risk factor burden was associated with lower brain volume across each age decade. In the cross-sectional analysis, the strength of this association decreased with each decade of advancing age (p for trend < 0.0001). In longitudinal analysis, the strength of association between vascular risk factor burden and brain volume was stronger when vascular risk factors were measured at younger ages. For example, vascular risk factor burden was most strongly associated with lower brain volume in later life when vascular risk factors were measured at age 45 years.ConclusionVascular risk factors at younger ages appear to have detrimental effects on current and future brain volume.

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Are morphologic features of recent small subcortical infarcts related to specific etiologic aspects?

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286419835716 ◽

2019 ◽

Vol 12 ◽

pp. 175628641983571 ◽

Cited By ~ 3

Author(s):

Sebastian Eppinger ◽

Thomas Gattringer ◽

Lena Nachbaur ◽

Simon Fandler ◽

Lukas Pirpamer ◽

...

Keyword(s):

Risk Factors ◽

Basal Ganglia ◽

Cerebral Circulation ◽

Vascular Risk Factors ◽

Large Artery ◽

Vascular Risk ◽

Mri Features ◽

Artery Disease ◽

Brain Artery ◽

Posterior Cerebral Circulation

Background: Recent small subcortical infarcts (RSSIs) mostly result from the occlusion of a single, small, brain artery due to intrinsic cerebral small-vessel disease (CSVD). Some RSSIs may be attributable to other causes such as cardiac embolism or large-artery disease, and their association with coexisting CSVD and vascular risk factors may vary with morphological magnetic resonance imaging (MRI) features. Methods: We retrospectively identified all inpatients with a single symptomatic MRI-confirmed RSSI between 2008 and 2013. RSSIs were rated for size, shape, location (i.e. anterior: basal ganglia and centrum semiovale posterior cerebral circulation: thalamus and pons) and MRI signs of concomitant CSVD. In a further step, clinical data, including detailed diagnostic workup and vascular risk factors, were analyzed with regard to RSSI features. Results: Among 335 RSSI patients (mean age 71.1 ± 12.1 years), 131 (39%) RSSIs were >15 mm in axial diameter and 66 (20%) were tubular shaped. Atrial fibrillation (AF) was present in 44 (13.1%) and an ipsilateral vessel stenosis > 50% in 30 (9%) patients. Arterial hypertension and CSVD MRI markers were more frequent in patients with anterior-circulation RSSIs, whereas diabetes was more prevalent in posterior-circulation RSSIs. Larger RSSIs occurred more frequently in the basal ganglia and pons, and the latter were associated with signs of large-artery atherosclerosis. Patients with concomitant AF had no specific MRI profile. Conclusion: Our findings suggest the contribution of different pathophysiological mechanisms to the occurrence of RSSIs in the anterior and posterior cerebral circulation. While there appears to be some general association of larger infarcts in the pons with large-artery disease, we found no pattern suggestive of AF in RSSIs.

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Hyperhomocysteinemia: Relationship to vascular risk factors and stroke subtypes

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/s1052-3057(99)80116-5 ◽

1999 ◽

Vol 8 (4) ◽

pp. 280

Author(s):

Abbur Rekha ◽

Souvik Sen ◽

Anand Vaishnav ◽

Mohamed Ibrahim ◽

Piero Verro

Keyword(s):

Risk Factors ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Stroke Subtypes

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Cross-sectional associations of C-reactive protein with vascular risk factors and vascular complications in the DCCT/EDIC cohort

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2007.02.003 ◽

2008 ◽

Vol 22 (3) ◽

pp. 153-163 ◽

Cited By ~ 16

Author(s):

Alicia J. Jenkins ◽

Michelle Rothen ◽

Richard L. Klein ◽

Karina Moller ◽

Leslie Eldridge ◽

...

Keyword(s):

Risk Factors ◽

Vascular Complications ◽

Vascular Risk Factors ◽

Vascular Risk ◽

C Reactive Protein ◽

Cross Sectional ◽

Reactive Protein

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Prevalence of dementia in African–Caribbean compared with UK-born White older people: two-stage cross-sectional study

The British Journal of Psychiatry ◽

10.1192/bjp.bp.110.086405 ◽

2011 ◽

Vol 199 (2) ◽

pp. 119-125 ◽

Cited By ~ 34

Author(s):

Simon Adelman ◽

Martin Blanchard ◽

Greta Rait ◽

Gerard Leavey ◽

Gill Livingston

Keyword(s):

Risk Factors ◽

Older People ◽

Vascular Risk Factors ◽

Country Of Birth ◽

Vascular Risk ◽

Cross Sectional ◽

Caribbean Country ◽

African Caribbean ◽

The Uk ◽

Prevalence Of Dementia

BackgroundPreliminary studies in the UK, all using screening instruments of unknown cultural validity, indicate that there may be an increased prevalence of dementia in African–Caribbean people, possibly related to vascular risk factors and potentially amenable to preventative measures.AimsTo determine the prevalence of dementia in older people of African–Caribbean country of birth compared with their White UK-born counterparts.MethodA total of 218 people of African–Caribbean country of birth and 218 White UK-born people aged ⩾60 years were recruited from five general practices in North London. Those who screened positive for cognitive impairment using a culturally valid instrument were offered a standardised diagnostic interview. Two independent assessors diagnosed dementia according to standard operationalised criteria.ResultsAfrican–Caribbean participants were 2 years younger, and those with dementia nearly 8 years younger than their White counterparts. The prevalence of dementia was significantly higher in the African–Caribbean (9.6%) than the White group (6.9%) after adjustment for the confounders age and socioeconomic status (odds ratio (OR) = 3.1, 95%CI 1.3–7.3, P = 0.012).ConclusionsThere is an increased prevalence of dementia in older people of African–Caribbean country of birth in the UK and at younger ages than in the indigenous White population. These findings have implications for service provision and preventive interventions. Further research is needed to explore the role of vascular risk factors and social adversity in the excess of dementia in this population.

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Computed tomographic pattern of stroke among adult patients in north-eastern Nigeria

Pyramid Journal of Medicine ◽

10.4081/pjm.2021.50 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Yunusa Dahiru M ◽

Umar Umar H ◽

Dahiru Aminu MC ◽

Aminu U Usman ◽

Suleiman T Sa'ad ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Kappa Statistic ◽

Haemorrhagic Stroke ◽

Radiology Department ◽

P Value ◽

Stroke Subtype ◽

Computed Tomographic ◽

The North ◽

North Eastern

Stroke and its complications are major health problems in developing countries including Nigeria. It could be a major cause of death or disability especially when only clinical assessment is relied upon for diagnosis. Computed Tomography (CT) is a valuable tool for the diagnosis of stroke. CT pattern of stroke in the North Eastern Nigeria has not been fully described. This was a prospective descriptive study conducted at the Federal Teaching Hospital, Gombe, Nigeria from June 2016 to December 2016. One hundred and eleven patients who presented with clinical features of stroke and were referred to Radiology department for cranial CT were consecutively selected. Data were analysed using SPSS version 16.0 package. A p-value of ≤ 0.05 and confidence interval of 95% were adapted for statistical analysis. The variables were expressed as range, percentage and mean plus standard deviation. All comparison of variables was done applying kappa statistic and point-biserial correlation coefficient for the correlation analysis. There were 69 (62.2%) males and 42 (37.8%) females aged 18-90 years (mean ± SD of 57.49±13.47 years). Ninety-four (94) patients (84.7%) had ischaemic stroke, while the remaining 17 (15.3%) had haemorrhagic stroke. Lobar location was identified as the most common site of ischaemic stroke while thalamo-ganglionic area was the commonest location for haemorrhagic stroke. Age and hypertension were found to be the commonest risk factors associated with stroke. It is evident from this study that ischaemic stroke is the most prevalent stroke subtype. The middle cerebral artery territory was the commonest vascular territory involved in stroke while hypertension and age are common risk factors for both ischaemic and haemorrhagic stroke.

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Association between excessive premature atrial complexes and cryptogenic stroke: results of a case–control study

BMJ Open ◽

10.1136/bmjopen-2019-029164 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029164 ◽

Cited By ~ 3

Author(s):

Jithin K Sajeev ◽

Anoop N Koshy ◽

Helen Dewey ◽

Jonathan M Kalman ◽

Kevin Rajakariar ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Case Control Study ◽

Cryptogenic Stroke ◽

Case Control ◽

Vascular Risk Factors ◽

Control Group ◽

Prior History ◽

Vascular Risk ◽

Control Study

ObjectiveRecent anticoagulation trials in all-comer cryptogenic stroke patients have yielded equivocal results, reinvigorating the focus on identifying reproducible markers of an atrial myopathy. We investigated the role of excessive premature atrial complexes (PACs) in ischaemic stroke, including cryptogenic stroke and its association with vascular risk factors.Methods and resultsA case–control study was conducted utilising a multicentre institutional stroke database to compare 461 patients with an ischaemic stroke or transient ischaemic attack (TIA) with a control group consisting of age matched patients without prior history of ischaemic stroke/TIA. All patients underwent 24-hour Holter monitoring during the study period and atrial fibrillation was excluded. An excessive PAC burden, defined as ≥200 PACs/24 hours, was present in 25.6% and 14.7% (p<0.01), of stroke/TIA and control patients, respectively. On multivariate regression, excessive PACs (OR 1.97; 95% CI 1.29 to 3.02; p<0.01), smoking (OR 1.58; 95% CI 1.06 to 2.36; p<0.05) and hypertension (OR 1.53; 95% CI 1.07 to 2.17; p<0.05) were independently associated with ischaemic stroke/TIA. Excessive PACs remained the strongest independent risk factor for the cryptogenic stroke subtype (OR 1.95; 95% CI 1.16 to 3.28; p<0.05). Vascular risk factors that promote atrial remodelling, increasing age (≥75 years, OR 3.64; 95% CI 2.08 to 6.36; p<0.01) and hypertension (OR 1.54; 95% CI 1.01 to 2.34; p<0.05) were independently associated with excessive PACs.ConclusionsExcessive PACs are independently associated with cryptogenic stroke and may be a reproducible marker of atrial myopathy. Prospective studies assessing their utility in guiding stroke prevention strategies may be warranted.

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