Antti Metso - Academia.edu (original) (raw)

Papers by Antti Metso

Circulation, Apr 12, 2011

Background-Little is known about the risk factors for cervical artery dissection (CEAD), a major ... more Background-Little is known about the risk factors for cervical artery dissection (CEAD), a major cause of ischemic stroke (IS) in young adults. Hypertension, diabetes mellitus, smoking, hypercholesterolemia, and obesity are important risk factors for IS. However, their specific role in CEAD is poorly investigated. Our aim was to compare the prevalence of vascular risk factors in CEAD patients versus referents and patients who suffered an IS of a cause other than CEAD (non-CEAD IS) in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study. Methods and Results-The study sample comprised 690 CEAD patients (mean age, 44.2Ϯ9.9 years; 43.9% women), 556 patients with a non-CEAD IS (44.7Ϯ10.5 years; 39.9% women), and 1170 referents (45.9Ϯ8.1 years; 44.1% women). We compared the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, smoking, and obesity (body mass index Ն30 kg/m 2) or overweightness (body mass index Ն25 kg/m 2 and Ͻ30 kg/m 2) between the 3 groups using a multinomial logistic regression adjusted for country of inclusion, age, and gender. Compared with referents, CEAD patients had a lower prevalence of hypercholesterolemia (odds ratio 0.55; 95% confidence interval, 0.42 to 0.71; PϽ0.

Clinical Neurophysiology, 2008

To gather the required sample size to compare compound nerve conduction velocities (CV) to cutane... more To gather the required sample size to compare compound nerve conduction velocities (CV) to cutaneous sensory CVs and motor CVs to find out if there are statistically significant differences between these nerve fibre populations. We report age, height, and temperature standardized CVs for cutaneous sensory, motor, and compound nerve fibres measured by electroneuromyography (ENMG) for 109 median nerves in 74 people from different age groups with no known neuropathy (age 50.4, median 49, range 21-87). In the region of the forearm, mean CVs were 63.6m/s (CI=62.6-64.7) for compound nerve fibres, 61.3m/s (CI=60.1-62.5) for cutaneous sensory fibres, and 56.3m/s (CI=55.1-57.6) for motor fibres (for all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Age explained most of the variation of CVs (Pearson&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s coefficients -0.394, -0,538, and -0.443, respectively, for all p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=0.002), but also height and temperature displayed minor explanatory effects in multivariate analysis. It appears that compound nerve CVs are faster than cutaneous sensory and motor CVs. Compound nerve CV may represent muscle spindle afferents. These data contribute to an understanding of the neurophysiological mechanisms that are involved in normal function of the human peripheral nervous system.

Stroke, Jun 1, 2009

Background and Purpose-No exclusive systematic data exist on the safety and outcomes of thromboly... more Background and Purpose-No exclusive systematic data exist on the safety and outcomes of thrombolytic treatment in young patients with ischemic stroke. Methods-We evaluated all 48 patients aged 16 to 49 years with hemispheric ischemic stroke treated with intravenous alteplase in Helsinki University Central Hospital from 1994 to 2007. For comparison of outcome, we selected, blinded to outcome data, 96 control subjects (1:2) with ischemic stroke not treated with alteplase matched by age, gender, and admission stroke severity (National Institutes of Health Stroke Scale). We selected similarly 96 older alteplase-treated gender and arrival National Institutes of Health Stroke Scale score-matched patients (aged, 50 to 79 years) for comparison of outcome and hemorrhage rate. A 3-month favorable outcome was defined as modified Rankin Scale score of 0 to 1. Symptomatic intracerebral hemorrhage was defined according to the Safe Implementation of Thrombolysis in Stroke Monitor Study. Results-Young alteplase-treated patients (67% males; mean age, 38.8Ϯ9.1 years) more often recovered completely (27% versus 10%, Pϭ0.010) and achieved a favorable outcome (40% versus 22%, Pϭ0.025) compared with their age-matched control subjects not treated with alteplase. In alteplase-treated patients, unfavorable outcome was more frequent in males and in those with carotid artery dissection. We observed no difference in outcome between cases and older control subjects treated with alteplase. However, none of the cases had symptomatic intracerebral hemorrhage versus 3 (3%) in the older control group (Pϭ0.551). Mortality rate was 2% (Pϭ0.552) in age-matched control subjects and 7% (Pϭ0.095) among older control subjects, whereas none of the case patients died during the 3-month follow-up. Conclusions-Young adults with acute hemispheric ischemic stroke benefited from intravenous thrombolysis with good safety.

PLOS ONE, Sep 5, 2013

Objective: To compare the effects of antiplatelets and anticoagulants on stroke and death in pati... more Objective: To compare the effects of antiplatelets and anticoagulants on stroke and death in patients with acute cervical artery dissection. Design: Systematic review with Bayesian meta-analysis. Data Sources: The reviewers searched MEDLINE and EMBASE from inception to November 2012, checked reference lists, and contacted authors. Study Selection: Studies were eligible if they were randomised, quasi-randomised or observational comparisons of antiplatelets and anticoagulants in patients with cervical artery dissection. Data Extraction: Data were extracted by one reviewer and checked by another. Bayesian techniques were used to appropriately account for studies with scarce event data and imbalances in the size of comparison groups. Data Synthesis: Thirty-seven studies (1991 patients) were included. We found no randomised trial. The primary analysis revealed a large treatment effect in favour of antiplatelets for preventing the primary composite outcome of ischaemic stroke, intracranial haemorrhage or death within the first 3 months after treatment initiation (relative risk 0.32, 95% credibility interval 0.12 to 0.63), while the degree of between-study heterogeneity was moderate (t 2 = 0.18). In an analysis restricted to studies of higher methodological quality, the possible advantage of antiplatelets over anticoagulants was less obvious than in the main analysis (relative risk 0.73, 95% credibility interval 0.17 to 2.30). Conclusion: In view of these results and the safety advantages, easier usage and lower cost of antiplatelets, we conclude that antiplatelets should be given precedence over anticoagulants as a first line treatment in patients with cervical artery dissection unless results of an adequately powered randomised trial suggest the opposite.

Cerebrovascular Diseases, 2010

men, migraine 27 vs. 16% (OR 2.02; 95% CI 1.23-3.31), MA 16 vs. 10% (OR 2.21; 95% CI 1.19-4.11). ... more men, migraine 27 vs. 16% (OR 2.02; 95% CI 1.23-3.31), MA 16 vs. 10% (OR 2.21; 95% CI 1.19-4.11). Over 60% of the CAD patients with still active migraine at the time of dissection reported later alleviation of migraine activity. Conclusion: Our observations suggest that patients with CAD are a significant link between ischemic stroke and migraine. This connection may represent a common pathophysiological or genetic background, or both. Migraine activity appears to be alleviated by CAD.

European Journal of Neurology, Mar 26, 2012

To examine whether thrombolysis for stroke attributable to cervical artery dissection (CeAD Strok... more To examine whether thrombolysis for stroke attributable to cervical artery dissection (CeAD Stroke) affects outcome and major haemorrhage rates. Methods: We used a multicentre CeAD Stroke database to compare CeAD Stroke patients treated with and without thrombolysis. Main outcome measures were favourable 3-month outcome (modified Rankin Scale 0-2) and Ômajor haemorrhageÕ [any intracranial haemorrhage (ICH) and major extracranial haemorrhage]. Adjusted odds ratios [OR (95% confidence intervals)] were calculated on the whole database and on propensity-matched groups. Results: Among 616 CeAD Stroke patients, 68 (11.0%) received thrombolysis; which was used in 55 (81%) intravenously. Thrombolyzed patients had more severe strokes (median NIHSS score 16 vs. 3; P < 0.001) and more often occlusion of the dissected artery (66.2% vs. 39.4%; P < 0.001). After adjustment for stroke severity and vessel occlusion, the likelihood for favourable outcome did not differ between the treatment groups [OR adjusted 0.95 (95% CI 0.45-2.00)]. The propensity matching score model showed that the odds to recover favourably were virtually identical for 64 thrombolyzed and 64 non-thrombolyzed-matched CeAD Stroke patients [OR 1.00 (0.49-2.00)]. Haemorrhages occurred in 4 (5.9%) thrombolyzed patients, all being asymptomatic ICHs. In the non-thrombolysis group, 3 (0.6%) patients had major haemorrhages [asymptomatic ICH (n = 2) and major extracranial haemorrhage (n = 1)]. Conclusion: As thrombolysis was neither independently associated with unfavourable outcome nor with an excess of symptomatic bleedings, our findings suggest thrombolysis should not be withheld in CeAD Stroke patients. However, the lack of any trend towards a benefit of thrombolysis may indicate the legitimacy to search for more efficient treatment options including mechanical revascularization strategies.

Annals of Neurology, Oct 29, 2010

Objective::Data on recurrence of vascular events and their prognostic factors in young (<5... more Objective::Data on recurrence of vascular events and their prognostic factors in young (<50 years of age) stroke patients are not well defined.Methods::We assessed the occurrence of arterial thrombotic events in consecutive first‐ever ischemic stroke patients aged 15 to 49 years entered into the Helsinki Young Stroke Registry (January 1994–October 2004) within 5‐year follow‐up. Follow‐up was conducted with a structured telephone interview or letter, and review of all patient records; mortality data came from Statistics Finland. Primary outcomes were (1) nonfatal or fatal recurrent ischemic stroke; (2) nonfatal or fatal myocardial infarct, other arterial thrombotic event, or revascularization procedure; and (3) any combination of these, whichever occurred first (composite endpoint). We used Kaplan‐Meier analysis to estimate cumulative risks and Cox proportional hazard model—adjusted for age, gender, relevant risk factors, and stroke subtype—for identifying predictors of recurrence.Results::In the 807 patients followed (mean age, 41.5 ± 7.4 years; 62.9% male), cumulative 5‐year recurrence rate was 9.4% (95% confidence interval [CI], 7.3–11.5%) for nonfatal or fatal ischemic stroke, 2.4% (95% CI, 1.3‐3.5%) for nonfatal or fatal myocardial infarct or other arterial endpoint, and 11.5% (95% CI, 9.2‐13.7%) for the composite endpoint. Independent predictors of the composite endpoint were type 1 diabetes mellitus (hazard ratio [HR], 4.39; 95% CI, 2.28‐8.45), large‐artery atherosclerosis underlying the index stroke (HR, 2.82; 95% CI, 1.36‐5.83), heart failure (HR, 2.96; 95% CI, 1.17‐7.50), previous transient ischemic attack (HR, 2.33; 95% CI, 1.40‐3.88), and increasing age (HR, 1.05; 95% CI, 1.01‐1.10).Interpretation::Despite their young age, these individuals were at marked risk of recurrent arterial events, predicted by mostly modifiable baseline factors.ANN NEUROL 2010;68:661–671

Journal of Biological Chemistry, Jun 1, 2000

Isolated human plasma low density lipoprotein (LDL) was observed to possess sphingomyelinase acti... more Isolated human plasma low density lipoprotein (LDL) was observed to possess sphingomyelinase activity. Accordingly, the formation of ceramide was catalyzed by LDL at 37°C using tertiary liposomes composed of sphingomyelin (mole fraction (x) ‫؍‬ 0.2), 1-palmitoyl-2oleoyl-sn-glycero-3-phosphocholine (x ‫؍‬ 0.7), 1,2-dimyristoyl-sn-glycero-3-phospho-rac-glycerol (x ‫؍‬ 0.1), and either the fluorescent sphingomyelin analog Bodipysphingomyelin or [ 14 C]sphingomyelin as substrates. However, this activity was not present in either very low density lipoprotein or the high density lipoprotein subfractions HDL 2 and HDL 3. Oxidation of LDL abrogated its sphingomyelinase activity. Aggregation of the liposomes upon incubation with LDL was evident from the light scattering measurements. Microinjection of LDL to the surface of giant liposomes composed of 1-stearoyl-2oleoyl-sn-glycero-3-phosphocholine (SOPC), N-palmitoyl-D-sphingomyelin (C16:0-sphingomyelin), and Bodipy-sphingomyelin as a fluorescent tracer (0.75:-0.20:0.05, respectively) revealed the induction of vectorial budding of vesicles, resembling endocytosis. The occlusion of blood vessels due to atherosclerosis, resulting from the formation of cholesterol-rich lipid plaques in the arterial walls, is one of the most common causes of death in industrial countries (1, 2). High blood levels of cholesterol correlate with atherosclerosis, and the former is further related to the contents of cholesterol and saturated fat in the diet. Most of the plasma cholesterol is present in low density lipoproteins (LDL), 1 an essential component of the plasma lipid transport system. The metabolism of LDL involves recognition of its protein moiety apolipoprotein B-100 (apoB-100) by specific re

The goal of this work was to explore age- dependent differences in cervical artery dissection (Ce... more The goal of this work was to explore age- dependent differences in cervical artery dissection (CeAD). This study is based on the Cervical Artery Dissection and Ischemic Stroke Patients population comprising 983 con- secutive CeAD patients and 658 control patients with a non-CeAD ischemic stroke (IS), frequency-matched for age and gender. Patients were divided into three age cat- egories: B33 (for CeAD, n = 150), 34-54 (n = 688), and C55 (n = 145) years, and the youngest and oldest groups were compared. The youngest patients were mostly women and the oldest men. The frequency of internal carotid artery dissection (ICAD) versus vertebral artery dissection (VAD) increased with age from 44 to 75 %. This age-related shift remained significant after adjustment for sex. The fre- quency of a transient ischemic event as the CeAD symptom declined from 33 % in the youngest age group, to 19 % in the oldest. Vascular risk factors increased in frequency with advancing age in both groups, but for ...

European journal of neurology : the official journal of the European Federation of Neurological Societies, Jan 24, 2015

To investigate the association of anemia on admission with ischaemic stroke (IS), stroke severity... more To investigate the association of anemia on admission with ischaemic stroke (IS), stroke severity and early functional outcome in patients with cervical artery dissection (CeAD) or with IS of other causes (non-CeAD-IS patients). The study sample comprised all patients from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) study without pre-existing disability and with documentation of stroke severity and hemoglobin (Hb) concentration on admission. Anemia was classified as mild…

Neurology, 2011

Objective: To examine whether risk factor profile, baseline features, and outcome of cervical art... more Objective: To examine whether risk factor profile, baseline features, and outcome of cervical artery dissection (CEAD) differ according to the dissection site. Methods: We analyzed 982 consecutive patients with CEAD included in the Cervical Artery Dissection and Ischemic Stroke Patients observational study (n ϭ 619 with internal carotid artery dissection [ICAD], n ϭ 327 with vertebral artery dissection [VAD], n ϭ 36 with ICAD and VAD). Results: Patients with ICAD were older (p Ͻ 0.0001), more often men (p ϭ 0.006), more frequently had a recent infection (odds ratio [OR] ϭ 1.59 [95% confidence interval (CI) 1.09-2.31]), and tended to report less often a minor neck trauma in the previous month (OR ϭ 0.75 [0.56-1.007]) compared to patients with VAD. Clinically, patients with ICAD more often presented with headache at admission (OR ϭ 1.36 [1.01-1.84]) but less frequently complained of cervical pain (OR ϭ 0.36 [0.27-0.48]) or had cerebral ischemia (OR ϭ 0.32 [0.21-0.49]) than patients with VAD. Among patients with CEAD who sustained an ischemic stroke, the NIH Stroke Scale (NIHSS) score at admission was higher in patients with ICAD than patients with VAD (OR ϭ 1.17 [1.12-1.22]). Aneurysmal dilatation was more common (OR ϭ 1.80 [1.13-2.87]) and bilateral dissection less frequent (OR ϭ 0.63 [0.42-0.95]) in patients with ICAD. Multiple concomitant dissections tended to cluster on the same artery type rather than involving both a vertebral and carotid artery. Patients with ICAD had a less favorable 3-month functional outcome (modified Rankin Scale score Ͼ2, OR ϭ 3.99 [2.32-6.88]), but this was no longer significant after adjusting for baseline NIHSS score. Conclusion: In the largest published series of patients with CEAD, we observed significant differences between VAD and ICAD in terms of risk factors, baseline features, and functional outcome.

Neurology, 2012

Objective: Several small to medium-sized studies indicated a link between cervical artery dissect... more Objective: Several small to medium-sized studies indicated a link between cervical artery dissection (CeAD) and migraine. Migrainous CeAD patients were suggested to have different clinical characteristics compared to nonmigraine CeAD patients. We tested these hypotheses in the large Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) population. Methods: A total of 968 CeAD patients and 653 patients with an ischemic stroke of a cause other than CeAD (non-CeAD IS) were recruited. CeAD patients with stroke (CeAD stroke , n ϭ 635) were compared with non-CeAD IS patients regarding migraine, clinical characteristics, and outcome. CeAD patients with and without migraine were compared in terms of clinical characteristics and outcome. Results: Migraine was more common among CeAD stroke patients compared to non-CeAD IS patients (35.7 vs 27.4%, p ϭ 0.003). The difference was mainly due to migraine without aura (20.2 vs 11.2%, p Ͻ 0.001). There were no differences in prevalence of strokes, arterial distribution, or other clinical or prognostic features between migrainous and nonmigrainous CeAD patients. Conclusion: Migraine without aura is more common among CeAD stroke patients compared to non-CeAD IS patients. The mechanisms and possible causative link remain to be proved. Although CeAD is often complicated by stroke, our data do not support increased risk of stroke in migrainous CeAD patients.

Neurology, 2014

Objective: To study the prognostic importance of Horner syndrome (HS) in patients with internal c... more Objective: To study the prognostic importance of Horner syndrome (HS) in patients with internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD). Methods: In this observational study, characteristics and outcome of patients with ICAD or VAD from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) database were analyzed. The presence of HS was systematically assessed using a standardized questionnaire. Patients with HS (HS1) were compared with HS2 patients. Crude odds ratios (ORs) with 95% confidence intervals and ORs adjusted for age, sex, center, arterial occlusion, bilateral dissection, stroke severity, and type of antithrombotic treatment were calculated. Results: We analyzed 765 patients (n 5 496 with ICAD, n 5 269 with VAD, n 5 303 prospective, n 5 462 retrospective). HS was present in 191 (38.5%) of the patients with ICAD and 36 (13.4%) of the patients with VAD (p , 0.001). HS1 ICAD patients presented less often with stroke or TIA (p , 0.001), less often had bilateral (p 5 0.019) or occlusive (p 5 0.001) dissections, and had fewer severe strokes (p 5 0.041) than HS2 ICAD patients. HS1 ICAD patients had a better functional 3-month outcome than those without HS (OR crude 5 4.0 [2.4-6.7]), and also after adjustment for outcome-relevant covariates (OR adjusted 5 2.0 [1.1-4.0]). HS1 ICAD patients were less likely to have new strokes than HS2 ICAD patients (p 5 0.039). HS1 VAD patients more often had vessel occlusion (p 5 0.014) than HS2 patients but did not differ in any of the other aforementioned variables. Conclusion: In patients with ICAD, HS is an easily assessable marker that might indicate a more benign clinical course. HS had no prognostic meaning in patients with VAD. Neurology ® 2014;82:1653-1659 GLOSSARY CADISP 5 Cervical Artery Dissection and Ischemic Stroke Patients; CeAD 5 cervical artery dissection; CI 5 confidence interval; HS 5 Horner syndrome; ICAD 5 internal carotid artery dissection; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio; VAD 5 vertebral artery dissection.

Neurology, 2013

To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection ... more To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection (CeAD). In this observational study, the presence of and the type of PCT were systematically ascertained in CeAD patients using 2 different populations for comparisons: 1) age- and sex-matched patients with ischemic stroke attributable to a cause other than CeAD (non-CeAD-IS), and 2) healthy subjects participating in the Cervical Artery Dissection and Ischemic Stroke Patients Study. The presence of PCT within 1 month was assessed using a standardized questionnaire. Crude odds ratios (ORs) with 95% confidence intervals (CIs) and ORs adjusted for age, sex, and center were calculated. We analyzed 1,897 participants (n = 966 with CeAD, n = 651 with non-CeAD-IS, n = 280 healthy subjects). CeAD patients had PCT in 40.5% (38.2%-44.5%) of cases, with 88% (344 of 392) classified as mild. PCT was more common in CeAD patients than in non-CeAD-IS patients (ORcrude 5.6 [95% CI 4.20-7.37], p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001; ORadjusted 7.6 [95% CI 5.60-10.20], p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) or healthy subjects (ORcrude 2.8 [95% CI 2.03-3.68], p…

Journal of Neurology, 2012

The goal of this work was to explore agedependent differences in cervical artery dissection (CeAD... more The goal of this work was to explore agedependent differences in cervical artery dissection (CeAD). This study is based on the Cervical Artery Dissection and Ischemic Stroke Patients population comprising 983 consecutive CeAD patients and 658 control patients with a non-CeAD ischemic stroke (IS), frequency-matched for age and gender. Patients were divided into three age categories: B33 (for CeAD, n = 150), 34-54 (n = 688), and C55 (n = 145) years, and the youngest and oldest groups were compared. The youngest patients were mostly women and the oldest men. The frequency of internal carotid artery dissection (ICAD) versus vertebral artery dissection (VAD) increased with age from 44 to 75 %. This age-related shift remained significant after adjustment for sex. The frequency of a transient ischemic event as the CeAD symptom declined from 33 % in the youngest age group, to 19 % in the oldest. Vascular risk factors increased in frequency with advancing age in both groups, but for hypertension the increase was steeper for non-CeAD IS patients. For CeAD patients, but not for patients with non-CeAD IS, preceding infection was more common in the oldest group. The youngest non-CeAD IS patients had better functional outcome (modified Rankin Scale 0-1) than the oldest, while the similar trend was not statistically significant among CeAD patients. Younger age seems to be associated with VAD and female gender, and older age with ICAD and male gender. Age-related changes in the frequencies of hypertension and recent infection were different between the CeAD and non-CeAD IS groups. Age does not seem to be an important outcome predictor in CeAD strokes. For the CADISP group. See supplemental appendix for a complete list of CADISP Investigators.

International Journal of Stroke, 2012

Background Stroke in patients with acute cervical artery dissection may be anticipated by initial... more Background Stroke in patients with acute cervical artery dissection may be anticipated by initial transient ischemic or nonischemic symptoms. Aim Identifying risk factors for delayed stroke upon cervical artery dissection. Methods Cervical artery dissection patients from the multicenter Cervical Artery Dissection and Ischemic Stroke Patients study were classified as patients without stroke ( n = 339), with stroke preceded by nonstroke symptoms (delayed stroke, n = 244), and with stroke at onset ( n = 382). Demographics, clinical, and vascular findings were compared between the three groups. Results Patients with delayed stroke were more likely to present with occlusive cervical artery dissection ( P < 0·001), multiple cervical artery dissection ( P = 0·031), and vertebral artery dissection ( P < 0·001) than patients without stroke. No differences were observed in age, smoking, arterial hypertension, hypercholesterolemia, migraine, body mass index, infections during the last we...

European Journal of Neurology, 2014

Background and purposePatients with ischaemic stroke (IS) caused by a spontaneous cervical artery... more Background and purposePatients with ischaemic stroke (IS) caused by a spontaneous cervical artery dissection (CeAD) worry about an increased risk for stroke in their families. The occurrence of stroke in relatives of patients with CeAD and in those with ischaemic stroke attributable to other (non‐CeAD) causes were compared.MethodsThe frequency of stroke in first‐degree relatives (family history of stroke, FHS) was studied in IS patients (CeAD patients and age‐ and sex‐matched non‐CeAD patients) from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) database. FHS ≤ 50 and FHS > 50 were defined as having relatives who suffered stroke at the age of ≤50 or >50 years. FHS ≤ 50 and FHS > 50 were studied in CeAD and non‐CeAD IS patients and related to age, sex, number of siblings, hypertension, hypercholesterolemia, smoking and body mass index (BMI).ResultsIn all, 1225 patients were analyzed. FHS ≤ 50 was less frequent in CeAD patients (15/598 = 2.5%) than in no...

European Journal of Neurology, 2012

European Journal of Neurology, 2013

Background and purposeIt has been suggested that inflammation may play a role in the development ... more Background and purposeIt has been suggested that inflammation may play a role in the development of cervical artery dissection (CeAD), but evidence remains scarce.MethodsA total of 172 patients were included with acute (< 24 h) CeAD and 348 patients with acute ischaemic stroke (IS) of other (non‐CeAD) causes from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study, and 223 age‐ and sex‐matched healthy control subjects. White blood cell (WBC) counts collected at admission were compared across the three groups.ResultsCompared with healthy control subjects, CeAD patients and non‐CeAD stroke patients had higher WBC counts (P < 0.001). Patients with CeAD had higher WBC counts and were more likely to have WBC > 10 000/μl than non‐CeAD stroke patients (38.4% vs. 23.0%, P < 0.001) and healthy controls (38.4% vs. 8.5%, P < 0.001). WBC counts were higher in CeAD (9.4 ± 3.3) than in IS of other causes (large artery atherosclerosis, 8.7 ± 2.3; cardioembolis...