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Biomedical subjects

C Arquizan

Publications and source records attributed to C Arquizan.

10 recordsLinked to original sources
PubMed2003

Early and late seizures after cryptogenic ischemic stroke in young adults.

OBJECTIVES: To assess the incidence and predictive factors of early and late seizures after ischemic stroke in young adults. METHODS: A total of 581 patients (aged 18 to 55 years) with recent cryptogenic ischemic stroke were prospectively enrolled at 30 neurology departments and followed for 37.8 +/- 9.7 months. Early seizures (occurring within 7 days of stroke) were assessed by chart review and late seizures were prospectively recorded at each follow-up visit. Clinical and brain imaging findings were reviewed by two neurologists and two neuroradiologists who were blinded to the occurrence of seizures. RESULTS: Fourteen of the 581 patients (2.4%) developed early seizures, 71% of which occurred within the first 24 hours. Rankin scale >or=3 (odds ratio [OR] 3.9, 95% CI 1.2 to 12.7) and cortical involvement (OR 7.7, 95% CI 1.0 to 61.1) were independently associated with early seizures. Late seizures occurred only in patients with hemispheric stroke (n = 20). The risk of first late seizure was 3.1% (95% CI 1.4 to 4.8) within 1 year and 5.5% (95% CI 3.1 to 7.9) within 3 years. The mean delay between stroke and first late seizure was 12.9 months (0.3 to 33.9). Late seizures were associated with early seizure (hazard ratio [HR] 5.1, 95% CI 1.8 to 14.8), cortical signs (HR 4.5, 95% CI 1.6 to 13.1), and size of infarct superior to one-half hemisphere (HR 9.7, 95% CI 3.1 to 30.8). Eleven of the 20 patients with late seizure experienced recurrences (multiple in eight) on antiepileptic drug treatment. Most of them were seizure free at the end of the follow-up. CONCLUSION: Epilepsy is rarely a major problem in young cryptogenic ischemic stroke survivors. Early seizures are associated with stroke disability and cortical involvement. Early seizures, cortical signs, and large infarct are independent risk factors for late seizures.

Adult↗
PubMed2002

Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm.

BACKGROUND AND PURPOSE: Patent foramen ovale (PFO) has been identified as a potential risk factor for stroke, but the mechanisms of PFO-associated stroke remain unsettled. The aim of our study was to evaluate possible differences in stroke risk factors and stroke patterns between patients with and without PFO that may give clues to the mechanism of PFO-associated stroke. METHODS: This prospective, multicentric study involved 581 young cryptogenic stroke patients. The presence of PFO and atrial septal aneurysm was assessed by transesophageal echocardiography and reviewed independently by 2 experienced sonographers. Clinical, brain, and vascular imaging findings were reviewed by 2 neurologists and 2 neuroradiologists. RESULTS: Of the 581 stroke patients, 267 (45.9%) had PFO. Patients with PFO were younger (OR, 0.95; 95% CI, 0.93 to 0.97) and less likely to have traditional risk factors such as hypertension (OR, 0.49; 95% CI, 0.28 to 0.85), hypercholesterolemia (OR, 0.56; 95% CI, 0.34 to 0.93), or current smoking (OR, 0.67; 95% CI, 0.47 to 0.97). Features suggestive of paradoxical embolism, such as Valsalva-provoking activities or deep vein thrombosis, were not more frequent in patients with PFO. Migraine was more common in patients with PFO (27.3%) than in those without PFO (14.0%). PFO (OR, 1.75; 95% CI, 1.08 to 2.82), particularly when associated with atrial septal aneurysm (OR, 2.71; 95% CI, 1.36 to 5.41), was significantly associated with migraine after adjustment for age and sex. CONCLUSIONS: Differences in stroke risk factors and stroke patterns suggest that different stroke mechanisms occur in patients with and without PFO. PFO is significantly and independently associated with migraine, and this association is even stronger in patients with PFO and atrial septal aneurysm.

Adult↗
PubMed2001

Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both.

BACKGROUND: Patent foramen ovale and atrial septal aneurysm have been identified as potential risk factors for stroke, but information about their effect on the risk of recurrent stroke is limited. We studied the risks of recurrent cerebrovascular events associated with these cardiac abnormalities. METHODS: A total of 581 patients (age, 18 to 55 years) who had had an ischemic stroke of unknown origin within the preceding three months were consecutively enrolled at 30 neurology departments. All patients received aspirin (300 mg per day) for secondary prevention. RESULTS: After four years, the risk of recurrent stroke was 2.3 percent (95 percent confidence interval, 0.3 to 4.3 percent) among the patients with patent foramen ovale alone, 15.2 percent (95 percent confidence interval, 1.8 to 28.6 percent) among the patients with both patent foramen ovale and atrial septal aneurysm, and 4.2 percent (95 percent confidence interval, 1.8 to 6.6 percent) among the patients with neither of these cardiac abnormalities. There were no recurrences among the patients with an atrial septal aneurysm alone. The presence of both cardiac abnormalities was a significant predictor of an increased risk of recurrent stroke (hazard ratio for the comparison with the absence of these abnormalities, 4.17; 95 percent confidence interval, 1.47 to 11.84), whereas isolated patent foramen ovale, whether small or large, was not. CONCLUSIONS: Patients with both patent foramen ovale and atrial septal aneurysm who have had a stroke constitute a subgroup at substantial risk for recurrent stroke, and preventive strategies other than aspirin should be considered.

Adolescent↗
PubMed2001

Aneurysmal forms of cervical artery dissection : associated factors and outcome.

BACKGROUND AND PURPOSE: The natural history of aneurysmal forms of cervical artery dissection (CAD) is ill defined. The aims of this study were to assess (1) clinical and anatomic outcome of aneurysmal forms of extracranial internal carotid artery (ICA) and vertebral artery (VA) dissections and (2) factors associated with aneurysmal forms of CAD. METHODS: Seventy-one consecutive patients with CAD were reviewed. Aneurysmal forms of CAD were identified from all available angiograms by 2 neuroradiologists. The frequency of arterial risk factors, of multiple vessel dissections, and of artery redundancies was compared in patients with and without aneurysm. Patients with aneurysm were invited by mail to undergo a final clinical and radiological evaluation. RESULTS: Of the 71 patients, 35 (49.3%) had a total of 42 aneurysms. Thirty aneurysms were located on a symptomatic artery (ICA, 23; VA, 7) and 12 on an asymptomatic artery (ICA, 10; VA, 2). Patients with aneurysm had multiple dissections of cervical vessels (18/35 versus 7/36; P:=0.005) and arterial redundancies (20/35 versus 11/36; P:=0.02) more frequently than patients without aneurysm. They were also more often migrainous (odds ratio=2.7 [95% CI, 0.8 to 8.5]) and tobacco users (odds ratio=2.2 [95% CI, 0.7 to 6.3]). Clinical and anatomic follow-up information was available for 35 (100%) and 33 patients (94%), respectively. During a mean follow-up of >3 years, no patient had signs of cerebral ischemia, local compression, or rupture. At follow-up, 46% of the aneurysms involving symptomatic ICA were unchanged, 36% had disappeared, and 18% had decreased in size. Resolution was more common for VA than for ICA aneurysms (83% versus 36%). None of the aneurysms located on an asymptomatic ICA had disappeared. CONCLUSIONS: Although aneurysms due to CAD frequently persist, patients carry a very low risk of clinical complications. This favorable clinical outcome should be kept in mind before potential harmful treatment is contemplated.

Adult↗
PubMed2001

Is patent foramen ovale a family trait? A transcranial Doppler sonographic study.

BACKGROUND AND PURPOSE: Patent foramen ovale (PFO) is a frequent finding in young patients with stroke. The aim of this study was to assess whether PFO is a family trait. METHODS: Sixty-two consecutive patients younger than 60 years of age with ischemic stroke and 62 age and gender-matched control siblings were examined by means of contrast transcranial Doppler (TCD) of the middle cerebral artery, using a standardized protocol. The reliability of TCD examination in our laboratory was assessed against transesophageal echocardiography (TEE). All TCD recordings were reviewed by a blinded experienced observer from another center. Disagreements between readers were resolved by unblinded consensus review. RESULTS: Siblings of patients with PFO had a significantly higher prevalence of PFO than had siblings of patients without PFO (61.5% versus 30.6%; OR 3.64 [1.3 to 10.5]; P=0.015). The kappa statistics indicated that agreement of pairs (patients/control siblings) was not due to chance. The strength of the association was sex dependent. In women pairs, prevalence of a PFO was 76.5% in siblings of patients with PFO and 25% in siblings of patients without PFO, giving an OR of 9.8 (95% CI 2 to 47.9; P<0.01). In contrast, in men, no significant difference was observed in the prevalence of PFO between siblings of patients with or without PFO (respectively 33.3% and 35%), giving an OR of 0.9 (95% CI 0.2 to 4.9; P=0.9). CONCLUSIONS: This study suggests that, in women, PFO is a family trait.

Adult↗
PubMed2001

[Endovascular treatment using endoprosthesis and metallic stents for aneurysmal dissection of the intracranial vertebral artery].

Dissecting aneurysms of the intracranial vertebral artery represent a more frequently recognized cause of subarachnoid hemorrhage. The poor natural history of the ruptured dissecting aneurysms indicate a surgical or endovascular treatment. Endovascular treatment usually consists of balloon occlusion of the vertebral artery. This treatment however can lead to hemodynamic complications especially when the treated artery is unique or dominant. We report two cases of ruptured dissecting aneurysms of the intracranial vertebral artery treated by intravascular stent and endosaccular GDC coils. The first patient suffered from bilateral dissection with spontaneous occlusion of the right vertebral artery and development of a pouch on the left side. The second patient suffered from a dissection of the left vertebral artery which was dominant. The stenting-coiling technique was efficient in the two cases. The patients are free of symptoms with a respective follow up of 24 and 8 months. The stenting-coiling association seems to be an interesting therapeutic option in case of intracranial dissecting aneurysms which allows a preservation of the arterial flow and selective occlusion of the aneurysmal pouch.

Adult↗
PubMed1999

Stroke and atrial fibrillation: is stroke prevention treatment appropriate beforehand? SAFE I Study Investigators.

OBJECTIVE: To undertake a pilot study before conducting a large European multicentre prospective study, to determine the proportion of patients with atrial fibrillation who were not receiving antithrombotic treatment before stroke onset, and their characteristics. DESIGN AND PATIENTS: The stroke in atrial fibrillation ensemble (SAFE) I study was an observational study conducted in 213 patients with atrial fibrillation consecutively admitted in 1997 to three European centres for an acute stroke or transient ischaemic attack (TIA). It was determined whether they were receiving prior antithrombotic treatment. RESULTS: Atrial fibrillation was known before stroke in 148 patients (69.5%). Of 213 patients, 34 (16.0%) were receiving anticoagulation treatment before stroke, but only six had an international normalised ratio between 2. 0 and 3.5; 65 (30.5%) were receiving antiplatelet treatment; and three (1.4%) were receiving both anticoagulation and antiplatelet treatment. Of 137 patients eligible for oral anticoagulation, 108 (78.8%) did not receive treatment. Of 142 patients eligible for any antithrombotic treatment, 62 (43.7%) were not treated. The logistic regression analysis, assuming anticoagulation treatment as a dependent variable, found digoxin treatment, absence of arterial hypertension, mitral stenosis, and cardioversion as independent factors. Assuming any antithrombotic treatment as a dependent variable, previously known atrial fibrillation, lower age, being a non-smoker, and absence of arterial hypertension were found to be independent factors. CONCLUSION: More than half of the patients with atrial fibrillation admitted for acute stroke or TIA were not receiving any antithrombotic treatment beforehand. New onset atrial fibrillation and contraindications account for a minority of non-prescriptions; thus, other reasons should be identified to improve stroke prevention in the community.

Adult↗
PubMed1999

Angiitis of the central nervous system.

Angiitis of the central nervous system is a rare disease which may result from numerous causes responsible for the presence of inflammatory lesions of the vascular wall. These inflammatory lesions may sometimes be associated with necrosis. Cerebral vessels of all sizes may be involved. The clinical presentation is highly variable, with focal to diffuse manifestations and acute to chronic evolution. Angiography is the cornerstone diagnostic procedure, showing multiple segmental stenoses of the cerebral arteries sometimes separated by fusiform dilatations. Although suggestive, this angiographical pattern is not unequivocal and other causes must be carefully ruled out. Only cerebral and/or leptomeningeal biopsy can provide a definite diagnosis of cerebral angiitis but this invasive diagnostic procedure is not performed in the majority of cases. Among the numerous causes of cerebral angiitis, one can individualize infectious diseases, primary systemic angiitis with cerebral involvement, angiitis secondary to various systemic diseases and other miscellaneous causes such as drug abuse or neoplasm.

Central Nervous System↗
PubMed1997

[Simultaneous supratentorial multiple cerebral infarctions].

We assessed the frequency, clinical and etiological correlates of acute supratentorial multiple infarcts from a hospital-based prospective stroke registry. Among 383 consecutive patients admitted with acute supratentorial infarcts, 352 had single infarcts and 31 (8.1 p. 100) had multiple infarcts on computed tomography. Multiple infarcts were bilateral in 18 patients and unilateral in 13 patients. In only one third of cases, could the diagnosis of multiple infarcts be suspected clinically before neuroimaging. Compared with patients with acute supratentorial single infarcts, the 18 patients with bilateral acute supratentorial multiple infarcts were younger and had a special etiological profile. Indeed, an unusual definite cause of stroke was identified in 8 of them, including coagulopathy/systemic disorders or rare non-atherosclerotic arteriopathy. Major cardiac sources of embolism were identified in 4, whereas large artery artherosclerosis accounted for only 2 cases. In 3 cases, uncertain causes (abnormalities whose link to stroke could not be clearly established) were found. The etiological workup was entirely negative in one. The 13 patients with unilateral acute supratentorial multiple infarcts did not differ significantly from those with acute supratentorial single infarct, concerning age, gender and risk factor profile. In 7 of them, the infarcts involved the anterior circulation (with or without associated posterior borderzone infarct). Six had ipsilateral ICA disease and one a major cardioembolic source associated with coagulopathy. In the other 6 patients, the infarcts involved the anterior and posterior circulations. Three had a major cardiac source of embolism and one a multifocal intracranial angiopathy. The cause of stroke was uncertain in one patient and the etiological workup was entirely negative in another. In conclusion, acute supratentorial multiple infarcts are not rare (8.1 p. 100). A minority of patients (32 p. 100) had a clinical picture suggesting multiple infarction. Some topographic patterns were associated with etiological correlates: unusual causes of stroke (coagulopathy/systemic disorders) and cardioembolism in bilateral acute supratentorial multiple infarcts; ipsilateral ICA disease in unilateral acute supratentorial multiple infarcts involving the anterior circulation (with or without associated posterior bordezone infarct): cardioembolism in unilateral supratentorial multiple infarcts involving the anterior and posterior circulations.

Cerebral Infarction↗