L Kellert1,2, M Kloss1, A Pezzini3, S Debette4,5,6, D Leys5, V Caso7, V N Thijs8,9, A Bersano10, E Touzé11, T Tatlisumak12,13,14, C Traenka15, P A Lyrer15, S T Engelter15,16, T M Metso12, C Grond-Ginsbach1. 1. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. 2. Department of Neurology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany. 3. Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy. 4. Department of Neurology, Hôpital Lariboisière, Paris, France. 5. Department of Neurology, University Lille Nord de France, INSERM U1171, Lille, France. 6. Department of Epidemiology and Public Health, INSERM U744, Pasteur Institute, Lille, France. 7. Stroke Unit, Perugia University Hospital, Perugia, Italy. 8. Department of Neurosciences, Experimental Neurology - Laboratory of Neurobiology, VIB - Vesalius Research Centre, KU Leuven - University of Leuven, Leuven, Belgium. 9. Neurology, University Hospitals Leuven, Leuven, Belgium. 10. Cerebrovascular Unit, IRCCS Foundation C. Besta Neurological Institute, Milan, Italy. 11. Department of Neurology, University of Caen Basse Normandie, INSERM U919, Caen, France. 12. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. 13. Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. 14. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden. 15. Department of Neurology, Basel University Hospital, Basel, Switzerland. 16. Neurorehabilitation Unit, University Centre for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland.
Abstract
BACKGROUND AND PURPOSE: Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance. METHODS: All CeAD patients from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) study with documentation of PT were analysed. The presence of PT was systematically assessed using a standardized questionnaire. Stroke severity at admission was defined according to the National Institutes of Health Stroke Scale (NIHSS). Excellent outcome after 3 months was defined as a modified Rankin Scale of 0-1. RESULTS: Sixty-three of 778 patients (8.1%) reported PT. PT+ patients presented less often with ischaemic stroke (41.3% vs. 63.9%, P < 0.001), more often with dissection in the internal carotid artery (85.7% vs. 64.2%, P = 0.001), less often with vessel occlusion (19.0% vs. 34.1%, P = 0.017) and more often with excellent outcome at 3 months (92.1% vs. 75.4%, P = 0.002). Logistic regression analysis identified PT as an independent predictor of excellent outcome after 3 months [odds ratio (OR) 3.96, 95% confidence interval (CI) 1.22-12.87] adjusted to significant outcome predictors NIHSS on admission (OR 0.82, 95% CI 0.79-0.86), Horner syndrome (OR 1.95, 95% CI 1.16-3.29) and vessel occlusion (OR 0.62, 95% CI 0.40-0.94) and to non-significant predictors age, sex, pain and location of CeAD. CONCLUSION: The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.
BACKGROUND AND PURPOSE: Our aim was to investigate whether pulsatile tinnitus (PT) in cervical artery dissection (CeAD) has prognostic significance. METHODS: All CeAD patients from the CADISP (Cervical Artery Dissection and Ischemic StrokePatients) study with documentation of PT were analysed. The presence of PT was systematically assessed using a standardized questionnaire. Stroke severity at admission was defined according to the National Institutes of Health Stroke Scale (NIHSS). Excellent outcome after 3 months was defined as a modified Rankin Scale of 0-1. RESULTS: Sixty-three of 778 patients (8.1%) reported PT. PT+ patients presented less often with ischaemic stroke (41.3% vs. 63.9%, P < 0.001), more often with dissection in the internal carotid artery (85.7% vs. 64.2%, P = 0.001), less often with vessel occlusion (19.0% vs. 34.1%, P = 0.017) and more often with excellent outcome at 3 months (92.1% vs. 75.4%, P = 0.002). Logistic regression analysis identified PT as an independent predictor of excellent outcome after 3 months [odds ratio (OR) 3.96, 95% confidence interval (CI) 1.22-12.87] adjusted to significant outcome predictors NIHSS on admission (OR 0.82, 95% CI 0.79-0.86), Horner syndrome (OR 1.95, 95% CI 1.16-3.29) and vessel occlusion (OR 0.62, 95% CI 0.40-0.94) and to non-significant predictors age, sex, pain and location of CeAD. CONCLUSION: The presence of PT in CeAD is associated with a benign clinical course and predicts a favourable outcome.
Authors: Florian Schöberl; Peter Arthur Ringleb; Reza Wakili; Sven Poli; Frank Arne Wollenweber; Lars Kellert Journal: Dtsch Arztebl Int Date: 2017-08-07 Impact factor: 5.594
Authors: Christopher Traenka; Caspar Grond-Ginsbach; Barbara Goeggel Simonetti; Tiina M Metso; Stéphanie Debette; Alessandro Pezzini; Manja Kloss; Jennifer J Majersik; Andrew M Southerland; Didier Leys; Ralf Baumgartner; Valeria Caso; Yannick Béjot; Gian Marco De Marchis; Urs Fischer; Alexandros Polymeris; Hakan Sarikaya; Vincent Thijs; Bradford B Worrall; Anna Bersano; Tobias Brandt; Henrik Gensicke; Leo H Bonati; Emmanuel Touzeé; Juan J Martin; Hugues Chabriat; Turgut Tatlisumak; Marcel Arnold; Stefan T Engelter; Philippe Lyrer Journal: Neurology Date: 2019-11-22 Impact factor: 9.910