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[PMID]: 28449276 [Au] Autor: Eggers CCJ; Bocksrucker C; Seyfang L; Austrian Stroke Unit Registry Collaborators [Ad] Endereço: Department of Neurology, Hospital Barmherzige Brüder, Linz, Austria. [Ti] Título: The efficacy of thrombolysis in lacunar stroke - evidence from the Austrian Stroke Unit Registry. [So] Source: Eur J Neurol;24(6):780-787, 2017 Jun. [Is] ISSN: 1468-1331 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND AND PURPOSE: Intravenous thrombolysis (ivT) with recombinant tissue plasminogen activator is established in acute ischaemic stroke. Little is known, however, about its efficacy in different stroke subtypes. METHODS: A retrospective analysis of 128 733 patients from the Austrian Stroke Unit Registry was performed. Patients were classified as lacunar (LacS) or non-lacunar ischaemic stroke (nonLacS) by use of the clinical syndrome and technical findings. Outcome parameters were the short term improvement in the stroke unit [the difference of the National Institutes of Health Stroke Scale (NIHSS) score at admission and at discharge] and the modified Rankin Scale (mRS) score at 3 months. Patients were assigned to four groups according to thrombolysis and stroke subtype. To control for confounding, patients were matched for variables identified with impact outcome and for variables of general interest (NIHSS at admission, mRS before stroke and general risk factors). RESULTS: There were four matched groups of 401 cases each. In LacS median short term improvement was 3 [interquartile range (IQR) 2-5] NIHSS points in the thrombolysed patients and 2 (IQR 1-4) in the non-thrombolysed patients (P < 0.001). In the nonLacS groups median short term improvement was 3 (IQR 1-5) in the thrombolysed and 2 (IQR 0-4) in the non-thrombolysed patients (P < 0.001). At 3-month follow-up, ivT was significantly associated with a better functional outcome in LacS (P < 0.001) and nonLacS patients (P < 0.001). Taking magnetic resonance imaging as a requirement for stroke subtyping led to similar results. CONCLUSIONS: Patients with both lacunar and non-lacunar stroke benefitted from ivT. The degree of improvement was similar in both groups. [Mh] Termos MeSH primário: Isquemia Encefálica/tratamento farmacológico Fibrinolíticos/uso terapêutico Acidente Vascular Cerebral Lacunar/tratamento farmacológico Terapia Trombolítica Ativador de Plasminogênio Tecidual/uso terapêutico [Mh] Termos MeSH secundário: Adulto Idoso Idoso de 80 Anos ou mais Áustria Feminino Seres Humanos Masculino Meia-Idade Sistema de Registros Estudos Retrospectivos Fatores de Risco Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Fibrinolytic Agents); EC 3.4.21.68 (Tissue Plasminogen Activator) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180212 [Lr] Data última revisão: 180212 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170428 [St] Status: MEDLINE [do] DOI: 10.1111/ene.13288

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[PMID]: 28991905 [Au] Autor: Nam KW; Kwon HM; Lim JS; Han MK; Nam H; Lee YS [Ad] Endereço: Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. [Ti] Título: The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease. [So] Source: PLoS One;12(10):e0184944, 2017. [Is] ISSN: 1932-6203 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Cerebral small vessel disease (SVD) commonly coexists with large artery atherosclerosis (LAA). AIM: We evaluate the effect of SVD on stroke recurrence in patients for ischemic stroke with LAA. METHODS: We consecutively collected first-ever ischemic stroke patients who were classified as LAA mechanism between Jan 2010 and Dec 2013. Univariate and multivariate Cox analyses were performed to evaluate the association between the 2-year recurrence and demographic, clinical, and radiological factors. To evaluate the impact of SVD and its components on recurrent stroke, we used the Kaplan-Meier analysis. SVD was defined as the presence of severe white matter hyperintensity (WMH) or old lacunar infarction (OLI) or cerebral microbleeds (CMB). We also compared frequency and burden of SVD among recurrent stroke groups with different mechanisms. RESULTS: Among a total of 956 participants, 92 patients had recurrent events. Recurrence group showed a higher frequency of severe WMH, OLI, asymptomatic territorial infarction, and severe stenosis on the relevant vessel in multivariate analysis. The impact of SVD and its components on recurrent stroke was significant in any ischemic recurrent stroke, and the presence of SVD was continuously important in stroke recurrence regardless of its mechanism, including recurrent LAA stroke, recurrent small vessel occlusion stroke, and even recurrent cardioembolic stroke. Additionally, the recurrence rate increased in dose-response manner with the increased number of SVD components. CONCLUSIONS: Cerebral SVD is associated with recurrent stroke in patients with LAA. Additionally, it may affect any mechanisms of recurrent stroke and even with a dose response manner. [Mh] Termos MeSH primário: Aterosclerose/complicações Doenças de Pequenos Vasos Cerebrais/complicações Acidente Vascular Cerebral/etiologia [Mh] Termos MeSH secundário: Idoso Aterosclerose/patologia Doenças de Pequenos Vasos Cerebrais/patologia Estudos de Coortes Feminino Seres Humanos Estimativa de Kaplan-Meier Masculino Meia-Idade Análise Multivariada Recidiva Acidente Vascular Cerebral/patologia Acidente Vascular Cerebral Lacunar/etiologia Acidente Vascular Cerebral Lacunar/patologia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171031 [Lr] Data última revisão: 171031 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171010 [St] Status: MEDLINE [do] DOI: 10.1371/journal.pone.0184944

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[PMID]: 28954878 [Au] Autor: Rannikmäe K; Sivakumaran V; Millar H; Malik R; Anderson CD; Chong M; Dave T; Falcone GJ; Fernandez-Cadenas I; Jimenez-Conde J; Lindgren A; Montaner J; O'Donnell M; Paré G; Radmanesh F; Rost NS; Slowik A; Söderholm M; Traylor M; Pulit SL; Seshadri S; Worrall BB; Woo D; Markus HS; Mitchell BD; Dichgans M; Rosand J; Sudlow CLM; Stroke Genetics Network (SiGN), METASTROKE Collaboration, and International Stroke Genetics Consortium (ISGC) [Ad] Endereço: From the Centre for Clinical Brain Sciences (K.R., C.L.M.S.), College of Medicine and Veterinary Medicine (V.S., H.M.), and Institute for Genetics and Molecular Medicine (C.L.M.S.), University of Edinburgh, UK; Institute for Stroke and Dementia Research (R.M., M.D.), Klinikum der Universität München [Ti] Título: is associated with lacunar ischemic stroke and deep ICH: Meta-analyses among 21,500 cases and 40,600 controls. [So] Source: Neurology;89(17):1829-1839, 2017 Oct 24. [Is] ISSN: 1526-632X [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To determine whether common variants in familial cerebral small vessel disease (SVD) genes confer risk of sporadic cerebral SVD. METHODS: We meta-analyzed genotype data from individuals of European ancestry to determine associations of common single nucleotide polymorphisms (SNPs) in 6 familial cerebral SVD genes ( , , , , , and ) with intracerebral hemorrhage (ICH) (deep, lobar, all; 1,878 cases, 2,830 controls) and ischemic stroke (IS) (lacunar, cardioembolic, large vessel disease, all; 19,569 cases, 37,853 controls). We applied data quality filters and set statistical significance thresholds accounting for linkage disequilibrium and multiple testing. RESULTS: A locus in was associated (significance threshold < 3.5 × 10 ) with both lacunar IS (lead SNP rs9515201: odds ratio [OR] 1.17, 95% confidence interval [CI] 1.11-1.24, = 6.62 × 10 ) and deep ICH (lead SNP rs4771674: OR 1.28, 95% CI 1.13-1.44, = 5.76 × 10 ). A SNP in was associated (significance threshold < 5.5 × 10 ) with lacunar IS (rs79043147: OR 1.23, 95% CI 1.10-1.37, = 1.90 × 10 ) and less robustly with deep ICH. There was no clear evidence for association of common variants in either or with non-SVD strokes or in any of the other genes with any stroke phenotype. CONCLUSIONS: These results provide evidence of shared genetic determinants and suggest common pathophysiologic mechanisms of distinct ischemic and hemorrhagic cerebral SVD stroke phenotypes, offering new insights into the causal mechanisms of cerebral SVD. [Mh] Termos MeSH primário: Hemorragia Cerebral/genética Colágeno Tipo IV/genética Polimorfismo de Nucleotídeo Único/genética Acidente Vascular Cerebral Lacunar/genética [Mh] Termos MeSH secundário: Hemorragia Cerebral/epidemiologia Europa (Continente)/epidemiologia Estudos de Associação Genética Seres Humanos Acidente Vascular Cerebral Lacunar/epidemiologia [Pt] Tipo de publicação: JOURNAL ARTICLE; META-ANALYSIS [Nm] Nome de substância: 0 (COL4A2 protein, human); 0 (Collagen Type IV) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171105 [Lr] Data última revisão: 171105 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170929 [St] Status: MEDLINE [do] DOI: 10.1212/WNL.0000000000004560

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[PMID]: 28765289 [Au] Autor: Rutten-Jacobs LCA; Markus HS; UK Young Lacunar Stroke DNA Study [Ad] Endereço: From the Department of Clinical Neurosciences, Stroke Research Group, University of Cambridge, United Kingdom. lr406@medschl.cam.ac.uk. [Ti] Título: Vascular Risk Factor Profiles Differ Between Magnetic Resonance Imaging-Defined Subtypes of Younger-Onset Lacunar Stroke. [So] Source: Stroke;48(9):2405-2411, 2017 Sep. [Is] ISSN: 1524-4628 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND AND PURPOSE: Differing associations of vascular risk factors with lacunar infarct have been reported, which is likely because of diagnostic differences and possible heterogeneity in the pathogenesis underlying lacunar infarction. In a large magnetic resonance imaging-verified cohort of lacunar infarct patients, we investigated the risk factor profile of lacunar infarction and magnetic resonance imaging characteristics. METHODS: One thousand twenty-three patients with lacunar infarction (mean age, 56.7; SD, 8.5) were recruited from 72 stroke centers throughout the United Kingdom as part of the UK Young Lacunar Stroke DNA Study. Risk factor profiles were compared with 1961 stroke-free population controls with similar age. Furthermore, we tested risk factor profiles of lacunar stroke patients for association with the presence of multiple lacunar infarcts, white matter hyperintensities (WMH), and location of the acute lacunar infarct. RESULTS: Hypertension (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.85-2.64), diabetes mellitus (OR, 2.10; 95% CI, 1.61-2.73), hyperlipidemia (OR, 1.74; 95% CI, 1.46-2.07), and smoking (OR, 1.65; 95% CI, 1.39-1.96) were independently associated in lacunar infarct patients compared with healthy controls. Patients with multiple lacunar infarcts were more likely to be men (OR, 2.53; 95% CI, 1.81-3.53) and have hypertension (OR, 1.54; 95% CI, 1.12-2.04) compared with patients with a single lacunar infarct, independent of other vascular risk factors. The presence of moderate-to-severe WMH versus no or mild WMH was independently associated with increased age (OR, 1.54; 95% CI, 1.12-2.04), hypertension (OR, 2.06; 95% CI, 1.44-2.95), and impaired renal function (OR, 0.90; 95% CI, 0.82-0.98). CONCLUSIONS: In this magnetic resonance imaging-verified lacunar stroke population, we identified a distinct risk factor profile in the group as a whole. However, there were differing risk factor profiles according to the presence of multiple lacunar infarcts and confluent WMH. The association of hypertension, smoking, and renal impairment with the presence of multiple lacunar infarcts and confluent WMH might reflect a diffuse small vessel arteriopathy. [Mh] Termos MeSH primário: Diabetes Mellitus/epidemiologia Hiperlipidemias/epidemiologia Hipertensão/epidemiologia Leucoencefalopatias/epidemiologia Insuficiência Renal Crônica/epidemiologia Fumar/epidemiologia Acidente Vascular Cerebral Lacunar/epidemiologia [Mh] Termos MeSH secundário: Idade de Início Idoso Feminino Seres Humanos Leucoencefalopatias/diagnóstico por imagem Imagem por Ressonância Magnética Masculino Meia-Idade Razão de Chances Fatores de Risco Índice de Gravidade de Doença Fatores Sexuais Acidente Vascular Cerebral Lacunar/diagnóstico por imagem Reino Unido/epidemiologia Substância Branca/diagnóstico por imagem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170926 [Lr] Data última revisão: 170926 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170803 [St] Status: MEDLINE [do] DOI: 10.1161/STROKEAHA.117.017813

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[PMID]: 28681535 [Au] Autor: Shoamanesh A; Pearce LA; Bazan C; Catanese L; McClure LA; Sharma M; Marti-Fabregas J; Anderson DC; Kase CS; Hart RG; Benavente OR; SPS3 Trial Investigators [Ad] Endereço: McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada. [Ti] Título: Microbleeds in the Secondary Prevention of Small Subcortical Strokes Trial: Stroke, mortality, and treatment interactions. [So] Source: Ann Neurol;82(2):196-207, 2017 Aug. [Is] ISSN: 1531-8249 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: OBJECTIVE: To characterize cerebral microbleeds (CMBs) in lacunar stroke patients in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial and to assess their relationship with recurrent stroke and death, and response to assigned treatment. METHODS: SPS3 is a randomized, clinical trial conducted between 2003 and 2011. Patients with recent magnetic resonance imaging (MRI)-documented lacunar infarcts were randomly assigned in a factorial design to target levels of systolic blood pressure (130-149mmHg vs <130mmHg; open label) and to antiplatelet treatment (aspirin/clopidogrel vs aspirin/placebo; double-blinded). The current analysis involves 1,278 trial participants who had a baseline axial T2*-weighted gradient echo MRI sequence allowing for CMB detection. RESULTS: CMBs were present in 30% of 1,278 patients (mean age = 63 years). Male gender (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.3-2.3), history of hypertension (OR = 1.6, 95% CI = 1.2-2.3), increased systolic blood pressure (1.2 per 20mmHg, 95% CI = 1.1-1.4), nondiabetic status (OR = 1.4, 95% CI = 1.1-1.9), multiple old lacunar infarcts (OR = 1.9, 95% CI = 1.5-2.5), and moderate (OR = 1.7, 95% CI = 1.2-2.3) or severe (OR = 4.2, 95% CI = 3.0-5.9) white matter hyperintensities on MRI were independently associated with CMBs. During a mean follow-up of 3.3 years, overall stroke recurrence was 2.5% per patient-year. Patients with CMBs had an adjusted 2-fold increased risk of recurrent stroke (hazard ratio = 2.1, 95% CI = 1.4-3.1). CMBs were not a risk factor for death. There were no statistically significant interactions between CMBs and treatment assignments. INTERPRETATION: Patients with lacunar stroke and CMBs likely harbor a more advanced form of cerebral small vessel disease in need of efficacious therapeutic strategies. Ann Neurol 2017;82:196-207. [Mh] Termos MeSH primário: Aspirina/uso terapêutico Hemorragia Cerebral/mortalidade Hemorragia Cerebral/prevenção & controle Prevenção Secundária/métodos Acidente Vascular Cerebral Lacunar/prevenção & controle Ticlopidina/análogos & derivados [Mh] Termos MeSH secundário: Hemorragia Cerebral/complicações Método Duplo-Cego Feminino Seres Humanos Imagem por Ressonância Magnética Masculino Meia-Idade Inibidores da Agregação de Plaquetas/uso terapêutico Recidiva Fatores de Risco Acidente Vascular Cerebral Lacunar/complicações Acidente Vascular Cerebral Lacunar/diagnóstico por imagem Ticlopidina/uso terapêutico [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Platelet Aggregation Inhibitors); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin) [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170926 [Lr] Data última revisão: 170926 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170707 [St] Status: MEDLINE [do] DOI: 10.1002/ana.24988

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[PMID]: 28596452 [Au] Autor: van Dalen JW; Moll van Charante EP; Caan MWA; Scheltens P; Majoie CBLM; Nederveen AJ; van Gool WA; Richard E [Ad] Endereço: From the Department of Neurology (J.W.v.D., W.A.v.G., E.R.), Department of General Practice (E.P.M.v.C.), and Department of Radiology (M.W.A.C., C.B.L.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology, VU Medical Center, Alzheimer Center, Amsterdam, the Neth [Ti] Título: Effect of Long-Term Vascular Care on Progression of Cerebrovascular Lesions: Magnetic Resonance Imaging Substudy of the PreDIVA Trial (Prevention of Dementia by Intensive Vascular Care). [So] Source: Stroke;48(7):1842-1848, 2017 Jul. [Is] ISSN: 1524-4628 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND AND PURPOSE: This study aimed to evaluate the effect of a nurse-led multidomain cardiovascular intervention on white matter hyperintensity (WMH) progression and incident lacunar infarcts in community-dwelling elderly with hypertension. METHODS: The preDIVA trial (Prevention of Dementia by Intensive Vascular Care) was an open-label, cluster-randomized controlled trial in community-dwelling individuals aged 70 to 78 years. General practices were assigned by computer-generated randomization to 6-year nurse-led, multidomain intensive vascular care or standard care. Of 3526 preDIVA participants, 195 nondemented participants with a systolic blood pressure ≥140 mm Hg were consecutively recruited to undergo magnetic resonance imaging at 2 to 3 and 5 to 6 years after baseline. WMH volumes were measured automatically, lacunar infarcts assessed visually, blinded to treatment allocation. RESULTS: One hundred and twenty-six participants were available for longitudinal analysis (64 intervention and 62 control). Annual WMH volume increase in milliliter was similar for intervention (mean=0.73, SD=0.84) and control (mean=0.70, SD=0.59) participants (adjusted mean difference, -0.08 mL; 95% confidence interval, -0.30 to 0.15; =0.50). Analyses suggested greater intervention effects with increasing baseline WMH volumes ( for interaction=0.03). New lacunar infarcts developed in 6 (9%) intervention and 2 (3%) control participants (odds ratio, 2.2; 95% confidence interval, 0.4-12.1; =0.36). CONCLUSIONS: Nurse-led vascular care in hypertensive community-dwelling older persons did not diminish WMH accumulation over 3 years. However, our results do suggest this type of intervention could be effective in persons with high WMH volumes. There was no effect on lacunar infarcts incidence but numbers were low. CLINICAL TRIAL INFORMATION: URL: http://www.isrctn.com/ISRCTN29711771. Unique identifier: ISRCTN29711771. [Mh] Termos MeSH primário: Demência/diagnóstico por imagem Progressão da Doença Imagem por Ressonância Magnética/tendências Papel do Profissional de Enfermagem Acidente Vascular Cerebral Lacunar/diagnóstico por imagem Substância Branca/diagnóstico por imagem [Mh] Termos MeSH secundário: Idoso Transtornos Cerebrovasculares/diagnóstico por imagem Transtornos Cerebrovasculares/epidemiologia Transtornos Cerebrovasculares/terapia Análise por Conglomerados Demência/epidemiologia Demência/terapia Feminino Seres Humanos Vida Independente/tendências Assistência de Longa Duração/tendências Estudos Longitudinais Masculino Acidente Vascular Cerebral Lacunar/epidemiologia Acidente Vascular Cerebral Lacunar/terapia Resultado do Tratamento [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170829 [Lr] Data última revisão: 170829 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170610 [St] Status: MEDLINE [do] DOI: 10.1161/STROKEAHA.117.017207

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[PMID]: 28566448 [Au] Autor: van Leijsen EMC; de Leeuw FE; Tuladhar AM [Ad] Endereço: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Radboud university medical centre, Nijmegen, the Netherlands. [Ti] Título: Disease progression and regression in sporadic small vessel disease-insights from neuroimaging. [So] Source: Clin Sci (Lond);131(12):1191-1206, 2017 Jun 01. [Is] ISSN: 1470-8736 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: Cerebral small vessel disease (SVD) is considered the most important vascular contributor to the development of dementia. Comprehensive characterization of the time course of disease progression will result in better understanding of aetiology and clinical consequences of SVD. SVD progression has been studied extensively over the years, usually describing change in SVD markers over time using neuroimaging at two time points. As a consequence, SVD is usually seen as a rather linear, continuously progressive process. This assumption of continuous progression of SVD markers was recently challenged by several studies that showed regression of SVD markers. Here, we provide a review on disease progression in sporadic SVD, thereby taking into account both progression and regression of SVD markers with emphasis on white matter hyperintensities (WMH), lacunes and microbleeds. We will elaborate on temporal dynamics of SVD progression and discuss the view of SVD progression as a dynamic process, rather than the traditional view of SVD as a continuous progressive process, that might better fit evidence from longitudinal neuroimaging studies. We will discuss possible mechanisms and clinical implications of a dynamic time course of SVD, with both progression and regression of SVD markers. [Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem Microvasos/diagnóstico por imagem Neuroimagem/métodos [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Doenças de Pequenos Vasos Cerebrais/epidemiologia Progressão da Doença Seres Humanos Incidência Hemorragias Intracranianas/diagnóstico por imagem Leucoencefalopatias/diagnóstico por imagem Meia-Idade Valor Preditivo dos Testes Prognóstico Remissão Espontânea Acidente Vascular Cerebral Lacunar/diagnóstico por imagem Fatores de Tempo [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170828 [Lr] Data última revisão: 170828 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170602 [St] Status: MEDLINE [do] DOI: 10.1042/CS20160384

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[PMID]: 28487471 [Au] Autor: Croall ID; Lohner V; Moynihan B; Khan U; Hassan A; O'Brien JT; Morris RG; Tozer DJ; Cambridge VC; Harkness K; Werring DJ; Blamire AM; Ford GA; Barrick TR; Markus HS [Ad] Endereço: Department of Clinical Neuroscience, Stroke Research Group, University of Cambridge, Cambridge, U.K. [Ti] Título: Using DTI to assess white matter microstructure in cerebral small vessel disease (SVD) in multicentre studies. [So] Source: Clin Sci (Lond);131(12):1361-1373, 2017 Jun 01. [Is] ISSN: 1470-8736 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: Diffusion tensor imaging (DTI) metrics such as fractional anisotropy (FA) and mean diffusivity (MD) have been proposed as clinical trial markers of cerebral small vessel disease (SVD) due to their associations with outcomes such as cognition. However, studies investigating this have been predominantly single-centre. As clinical trials are likely to be multisite, further studies are required to determine whether associations with cognition of similar strengths can be detected in a multicentre setting. One hundred and nine patients (mean age =68 years) with symptomatic lacunar infarction and confluent white matter hyperintensities (WMH) on MRI was recruited across six sites as part of the PRESERVE DTI substudy. After handling missing data, 3T-MRI scanning was available from five sites on five scanner models (Siemens and Philips), alongside neuropsychological and quality of life (QoL) assessments. FA median and MD peak height were extracted from DTI histogram analysis. Multiple linear regressions were performed, including normalized brain volume, WMH lesion load, and n° lacunes as covariates, to investigate the association of FA and MD with cognition and QoL. DTI metrics from all white matter were significantly associated with global cognition (standardized ß =0.268), mental flexibility (ß =0.306), verbal fluency (ß =0.376), and Montreal Cognitive Assessment (MoCA) (ß =0.273). The magnitudes of these associations were comparable with those previously reported from single-centre studies found in a systematic literature review. In this multicentre study, we confirmed associations between DTI parameters and cognition, which were similar in strength to those found in previous single-centre studies. The present study supports the use of DTI metrics as biomarkers of disease progression in multicentre studies. [Mh] Termos MeSH primário: Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem Transtornos Cognitivos/diagnóstico por imagem Imagem de Tensor de Difusão Leucoencefalopatias/diagnóstico por imagem Imagem por Ressonância Magnética Microvasos/diagnóstico por imagem [Mh] Termos MeSH secundário: Idoso Doenças de Pequenos Vasos Cerebrais/fisiopatologia Doenças de Pequenos Vasos Cerebrais/psicologia Cognição Transtornos Cognitivos/fisiopatologia Transtornos Cognitivos/psicologia Progressão da Doença Inglaterra Feminino Seres Humanos Leucoencefalopatias/fisiopatologia Leucoencefalopatias/psicologia Modelos Lineares Masculino Microvasos/fisiopatologia Meia-Idade Testes Neuropsicológicos Valor Preditivo dos Testes Qualidade de Vida Acidente Vascular Cerebral Lacunar/diagnóstico por imagem Acidente Vascular Cerebral Lacunar/fisiopatologia Acidente Vascular Cerebral Lacunar/psicologia Inquéritos e Questionários [Pt] Tipo de publicação: JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170828 [Lr] Data última revisão: 170828 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170511 [St] Status: MEDLINE [do] DOI: 10.1042/CS20170146

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[PMID]: 28473274 [Au] Autor: Gökcen E; Caltekin I; Savrun A; Korkmaz H; Savrun ST; Yildirim G [Ad] Endereço: Emergency Department of Malatya State Hospital, Malatya, Turkey. Electronic address: emregokcenacl@gmail.com. [Ti] Título: Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. [So] Source: Am J Emerg Med;35(11):1607-1611, 2017 Nov. [Is] ISSN: 1532-8171 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed. METHODS: The study included the patients over the age of 18 applying to the emergency department of Malatya State Hospital with the symptoms of stroke between the dates of 1/1/2015 and 1/9/2016. The patients diagnosed with stroke by means of clinical and neuroradiological imaging were examined in 4 subgroups according to Oxfordshire Community Stroke Project. The aim of the study is to predict the intracranial pressure (ICP) levels of the patients through ONSD measurement and CT images. RESULTS: In the comparison of the right and left optic nerve sheath diameters of CVD group and control group, the obtained results were found to be statistically significant (p<0.001). When the CVD subgroups were compared with the control group in terms of right and left optic nerve sheath diameters, the highest right-left optic nerve sheath diameter was detected to be in TACI (Total Anterior Circulation Infarction) group (p<0.001). DISCUSSION/CONCLUSION: In the early cases of CVD, mortality and morbidity can be decreased through the early diagnosis of the possible existence of ICP increase according to ONSD level. [Mh] Termos MeSH primário: Infarto Encefálico/diagnóstico por imagem Hipertensão Intracraniana/diagnóstico por imagem Nervo Óptico/diagnóstico por imagem Acidente Vascular Cerebral Lacunar/diagnóstico por imagem [Mh] Termos MeSH secundário: Idoso Idoso de 80 Anos ou mais Infarto Encefálico/complicações Transtornos Cerebrovasculares/classificação Transtornos Cerebrovasculares/complicações Transtornos Cerebrovasculares/diagnóstico por imagem Serviço Hospitalar de Emergência Feminino Seres Humanos Hipertensão Intracraniana/etiologia Pressão Intracraniana Masculino Meia-Idade Nervo Óptico/patologia Tamanho do Órgão Estudos Retrospectivos Sensibilidade e Especificidade Índice de Gravidade de Doença Acidente Vascular Cerebral/classificação Acidente Vascular Cerebral/complicações Acidente Vascular Cerebral/diagnóstico por imagem Acidente Vascular Cerebral Lacunar/complicações Tomografia Computadorizada por Raios X [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171106 [Lr] Data última revisão: 171106 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170506 [St] Status: MEDLINE

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[PMID]: 28389611 [Au] Autor: Owolabi M; Sarfo F; Howard VJ; Irvin MR; Gebregziabher M; Akinyemi R; Bennett A; Armstrong K; Tiwari HK; Akpalu A; Wahab KW; Owolabi L; Fawale B; Komolafe M; Obiako R; Adebayo P; Manly JM; Ogbole G; Melikam E; Laryea R; Saulson R; Jenkins C; Arnett DK; Lackland DT; Ovbiagele B; Howard G; SIREN-REGARDS Collaboration (Stroke Investigative Research and Educational Network­Reasons for Geographic and Racial Differences in Stroke) [Ad] Endereço: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University o [Ti] Título: Stroke in Indigenous Africans, African Americans, and European Americans: Interplay of Racial and Geographic Factors. [So] Source: Stroke;48(5):1169-1175, 2017 May. [Is] ISSN: 1524-4628 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND AND PURPOSE: The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA). METHODS: SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa-the ancestral home of 71% AA-whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies. RESULTS: There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively ( <0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%; <0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%; <0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%; <0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%; <0.0001). Premorbid sedentary lifestyle was similar in AA (37.7%) and EA (34.0%) but lower frequency in IA (8.0%). CONCLUSIONS: Environmental risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry. [Mh] Termos MeSH primário: Afroamericanos/etnologia Grupo com Ancestrais do Continente Africano/etnologia Isquemia Encefálica/etnologia Hemorragia Cerebral/etnologia Grupo com Ancestrais do Continente Europeu/etnologia Hipertensão/etnologia Estilo de Vida Sedentário/etnologia Acidente Vascular Cerebral/etnologia [Mh] Termos MeSH secundário: África Ocidental/etnologia Idoso Estudos de Casos e Controles Feminino Seres Humanos Masculino Meia-Idade Fatores de Risco Acidente Vascular Cerebral Lacunar/etnologia Estados Unidos/etnologia [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 170630 [Lr] Data última revisão: 170630 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170409 [St] Status: MEDLINE [do] DOI: 10.1161/STROKEAHA.116.015937

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