Hendrikus J A van Os1, Inge A Mulder2, Irene C van der Schaaf2, L Jaap Kappelle2, Birgitta K Velthuis2, Alexander Broersen2, Jan A Vos2, Gisela M Terwindt2, Wouter Schonewille2, Michel D Ferrari2, Ale Algra2, Marianne A A van Walderveen2, Marieke J H Wermer2. 1. From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands. h.j.a.van_os@lumc.nl. 2. From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.) and Department of Radiology (M.A.A.v.W.), Division of Image Processing (A.B.), Leiden University Medical Center; Departments of Radiology (I.C.v.d.S., B.K.V.) and Neurology (L.J.K.), Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht; and Department of Neurology (J.A.V., W.S.), St Antonius Hospital, Nieuwegein, Netherlands.
Abstract
OBJECTIVE: To investigate the role of large vessel atherosclerosis, blood clot extent, and penumbra volume in relation to headache in ischemic stroke patients. METHODS: In this cross-sectional study, we performed noncontrast CT, CT angiography (CTA), and CT perfusion (CTP) in 284 participants from the Dutch Acute Stroke Study and Leiden Stroke Cohort within 9 hours after ischemic stroke onset. We collected headache characteristics prospectively using a semi-structured questionnaire. Atherosclerosis was assessed by evaluating presence of plaques in extracranial and intracranial vessels and by quantifying intracranial carotid artery calcifications. Clot extent was estimated by the clot burden score on CTA and penumbra volume by CTP. We calculated risk ratios (RRs) with adjustments (aRR) for possible confounders using multivariable Poisson regression. RESULTS: Headache during stroke was reported in 109/284 (38%) participants. Headache was less prevalent in patients with than in patients without atherosclerosis in the extracranial anterior circulation (35% vs 48%; RR 0.72; 95% confidence interval [CI] 0.54-0.97). Atherosclerosis in the intracranial arteries was also associated with less headache, but this association was not statistically significant. Penumbra volume (aRR 1.08; 95% CI 0.63-1.85) and clot extent (aRR 1.02; 95% CI 0.86-1.20) were not related with headache. CONCLUSIONS: Headache in the early phase of ischemic stroke tends to occur less often in patients with atherosclerosis than in patients without atherosclerosis in the large cerebral arteries. This finding lends support to the hypothesis that vessel wall elasticity is a necessary contributing factor in the occurrence of headache during acute ischemic stroke.
OBJECTIVE: To investigate the role of large vessel atherosclerosis, blood clot extent, and penumbra volume in relation to headache in ischemic strokepatients. METHODS: In this cross-sectional study, we performed noncontrast CT, CT angiography (CTA), and CT perfusion (CTP) in 284 participants from the Dutch Acute Stroke Study and Leiden Stroke Cohort within 9 hours after ischemic stroke onset. We collected headache characteristics prospectively using a semi-structured questionnaire. Atherosclerosis was assessed by evaluating presence of plaques in extracranial and intracranial vessels and by quantifying intracranial carotid artery calcifications. Clot extent was estimated by the clot burden score on CTA and penumbra volume by CTP. We calculated risk ratios (RRs) with adjustments (aRR) for possible confounders using multivariable Poisson regression. RESULTS:Headache during stroke was reported in 109/284 (38%) participants. Headache was less prevalent in patients with than in patients without atherosclerosis in the extracranial anterior circulation (35% vs 48%; RR 0.72; 95% confidence interval [CI] 0.54-0.97). Atherosclerosis in the intracranial arteries was also associated with less headache, but this association was not statistically significant. Penumbra volume (aRR 1.08; 95% CI 0.63-1.85) and clot extent (aRR 1.02; 95% CI 0.86-1.20) were not related with headache. CONCLUSIONS:Headache in the early phase of ischemic stroke tends to occur less often in patients with atherosclerosis than in patients without atherosclerosis in the large cerebral arteries. This finding lends support to the hypothesis that vessel wall elasticity is a necessary contributing factor in the occurrence of headache during acute ischemic stroke.
Authors: Mariam Ali; Hendrikus J A van Os; Nelleke van der Weerd; Jan W Schoones; Martijn W Heymans; Nyika D Kruyt; Marieke C Visser; Marieke J H Wermer Journal: Stroke Date: 2021-12-14 Impact factor: 7.914
Authors: S Voigt; Hja van Os; Maa van Walderveen; I C van der Schaaf; L J Kappelle; A Broersen; B K Velthuis; P A de Jong; R Kockelkoren; N D Kruyt; A Algra; Mjh Wermer Journal: Int J Stroke Date: 2020-09-02 Impact factor: 5.266
Authors: Anne van der Meij; Marianne A A van Walderveen; Nyika D Kruyt; Erik W van Zwet; Eric J Liebler; Michel D Ferrari; Marieke J H Wermer Journal: Trials Date: 2020-10-26 Impact factor: 2.279