Christopher Traenka1, Daphne Dougoud2, Barbara Goeggel Simonetti2, Tiina M Metso2, Stéphanie Debette2, Alessandro Pezzini2, Manja Kloss2, Caspar Grond-Ginsbach2, Jennifer J Majersik2, Bradford B Worrall2, Didier Leys2, Ralf Baumgartner2, Valeria Caso2, Yannick Béjot2, Annette Compter2, Peggy Reiner2, Vincent Thijs2, Andrew M Southerland2, Anna Bersano2, Tobias Brandt2, Henrik Gensicke2, Emmanuel Touzé2, Juan J Martin2, Hugues Chabriat2, Turgut Tatlisumak2, Philippe Lyrer2, Marcel Arnold2, Stefan T Engelter2. 1. From the Department of Neurology and Stroke Center (C.T., H.G., P.L., S.T.E.), University Hospital Basel and University of Basel; Department of Neurology (D.D., B.G.S., M.A.), University Hospital Berne; Ospedale San Giovanni (B.G.S.), Bellinzona, Switzerland; Department of Neurology (T.M.M., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (S.D.), Bordeaux University Hospital; Inserm U1219 (S.D.), Bordeaux; Bordeaux University (S.D.), France; Department of Neurology (S.D.), Boston University School of Medicine, MA; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology (M.K., C.G.-G.), Heidelberg University Hospital, Germany; Department of Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Public Health Sciences (B.B.W., A.M.S.), University of Virginia Health System, Charlottesville; Univ Lille 2 (D.L.), INSERM U 1171, CHU Lille, France; Neuro Center (R.B.), Clinic Hirslanden, Zurich, Switzerland; Stroke Unit and Division of Internal and Cardiovascular Medicine (V.C.), University of Perugia, Italy; Centre Hospitalier Universitaire Le Bocage (Y.B.), Dijon, France; Department of Neurology and Neurosurgery (A.C.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands; Department of Neurology (P.R., H.C.), Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, France; Florey Institute of Neuroscience and Mental Health (V.T.); Department of Neurology (V.T.), Austin Health, Heidelberg, Australia; Cerebrovascular Unit (A.B.), IRCCS Foundation C. Besta Neurological Institute, Milan, Italy; Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany; Normandie Univ (E.T.), UNICAEN, Inserm U919, Department of Neurology, CHU Caen; Department of Neurology (E.T.), CH Sainte-Anne, University Paris Descartes, France; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Department of Neurology (T.T.), Sahlgrenska University Hospital and Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland. christopher.traenka@usb.ch. 2. From the Department of Neurology and Stroke Center (C.T., H.G., P.L., S.T.E.), University Hospital Basel and University of Basel; Department of Neurology (D.D., B.G.S., M.A.), University Hospital Berne; Ospedale San Giovanni (B.G.S.), Bellinzona, Switzerland; Department of Neurology (T.M.M., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (S.D.), Bordeaux University Hospital; Inserm U1219 (S.D.), Bordeaux; Bordeaux University (S.D.), France; Department of Neurology (S.D.), Boston University School of Medicine, MA; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology (M.K., C.G.-G.), Heidelberg University Hospital, Germany; Department of Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Public Health Sciences (B.B.W., A.M.S.), University of Virginia Health System, Charlottesville; Univ Lille 2 (D.L.), INSERM U 1171, CHU Lille, France; Neuro Center (R.B.), Clinic Hirslanden, Zurich, Switzerland; Stroke Unit and Division of Internal and Cardiovascular Medicine (V.C.), University of Perugia, Italy; Centre Hospitalier Universitaire Le Bocage (Y.B.), Dijon, France; Department of Neurology and Neurosurgery (A.C.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands; Department of Neurology (P.R., H.C.), Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, France; Florey Institute of Neuroscience and Mental Health (V.T.); Department of Neurology (V.T.), Austin Health, Heidelberg, Australia; Cerebrovascular Unit (A.B.), IRCCS Foundation C. Besta Neurological Institute, Milan, Italy; Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany; Normandie Univ (E.T.), UNICAEN, Inserm U919, Department of Neurology, CHU Caen; Department of Neurology (E.T.), CH Sainte-Anne, University Paris Descartes, France; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Department of Neurology (T.T.), Sahlgrenska University Hospital and Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland.
Abstract
OBJECTIVE: In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years. METHODS: We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients-Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated. RESULTS: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 3.08 [2.25-4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0-2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]). CONCLUSION: In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
OBJECTIVE: In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years. METHODS: We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic StrokePatients-Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated. RESULTS: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 3.08 [2.25-4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0-2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]). CONCLUSION: In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
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
Authors: Lukas Mayer; Christian Boehme; Thomas Toell; Benjamin Dejakum; Johann Willeit; Christoph Schmidauer; Klaus Berek; Christian Siedentopf; Elke Ruth Gizewski; Gudrun Ratzinger; Stefan Kiechl; Michael Knoflach Journal: J Stroke Date: 2019-01-31 Impact factor: 6.967
Authors: Yahya B Atalay; Pirouz Piran; Abhinaba Chatterjee; Santosh Murthy; Babak B Navi; Ava L Liberman; Joseph Dardick; Cenai Zhang; Hooman Kamel; Alexander E Merkler Journal: Neurology Date: 2021-01-04 Impact factor: 9.910