cover image European Journal of Neurology

European Journal of Neurology

2013 - Volume 20
Issue 8 | August 2013
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Short Communication

Background and purpose

Microembolic signals (MES) are detectable in the middle cerebral artery by transcranial ultrasound downstream to atherosclerotic lesions of the internal carotid artery (ICA) in patients with stroke or transient ischaemic attack. The occurrence of MES predicts future risk of stroke in patients with symptomatic and asymptomatic carotid stenosis. The detection of intra‐plaque neo‐vascularization by contrast‐enhanced ultrasound (CEUS) in atherosclerotic plaques of the ICA is associated with future cardiovascular/cerebrovascular events. We investigated whether there is an association between both surrogate markers of future vascular events.

Methods

Forty‐one patients with symptomatic atherosclerotic plaques underwent ipsilateral transcranial ultrasound MES detection for 30 min followed by a CEUS investigation of the plaque. The occurrence and number of MES was documented, and the degree of intra‐plaque neo‐vascularization was measured semi‐quantitatively.

Results

During the 30 min investigation, 17 patients had MES and nine of them showed neo‐vascularization of the atherosclerotic plaque. The remaining 24 patients did not have MES, and only in four patients of this group could plaque neo‐vascularization be demonstrated (= 0.020).

Conclusions

We found an association between the occurrence of MES and the presence of neo‐vascularization in patients with symptomatic atherosclerotic carotid plaque. Therefore, plaque neo‐vascularization might also be a surrogate marker of future stroke risk.

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Authors:
M. A. Ritter, K. Theismann, M. Schmiedel, E. B. Ringelstein and R. Dittrich
Article first published online:
20 Nov 2012 | DOI: 10.1111/ene.12030

Original Article

Background and purpose

Enzogenol, a flavonoid‐rich extract from bark with antioxidant and anti‐inflammatory properties has been shown to improve working memory in healthy adults. In traumatic brain injury (TBI), oxidation and inflammation have been linked to poorer cognitive outcomes. Hence, this phase II, randomized controlled trial investigated safety, compliance and efficacy of Enzogenol for improving cognitive functioning in people following mild TBI.

Methods

Sixty adults, who sustained a mild TBI, 3–12 months prior to recruitment, and who were experiencing persistent cognitive difficulties [Cognitive Failures Questionnaire (CFQ) score > 38], were randomized to receive Enzogenol (1000 mg/day) or matching placebo for 6 weeks. Subsequently, all participants received Enzogenol for a further 6 weeks, followed by placebo for 4 weeks. Compliance, side‐effects, cognitive failures, working and episodic memory, post‐concussive symptoms and mood were assessed at baseline, 6, 12 and 16 weeks. Simultaneous estimation of treatment effect and breakpoint was effected, with confidence intervals (CIs) obtained through a treatment–placebo balance‐preserving bootstrap procedure.

Results

Enzogenol was found to be safe and well tolerated. Trend and breakpoint analyses showed a significant reduction in cognitive failures after 6 weeks [mean CFQ score, 95% CI, Enzogenol versus placebo −6.9 (−10.8 to −4.1)]. Improvements in the frequency of self‐reported cognitive failures were estimated to continue until week 11 before stabilizing. Other outcome measures showed some positive trends but no significant treatment effects.

Conclusions

Enzogenol supplementation is safe and well tolerated in people after mild TBI, and may improve cognitive functioning in this patient population. This study provides Class IIB evidence that Enzogenol is well tolerated and may reduce self‐perceived cognitive failures in patients 3–12 months post‐mild TBI.

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Authors:
A. Theadom, S. Mahon, S. Barker‐Collo, K. McPherson, E. Rush, A. C. Vandal and V. L. Feigin
Article first published online:
05 Feb 2013 | DOI: 10.1111/ene.12099

CME Article

Background and purpose

Experimental studies support a link between stress and development of parkinsonian symptoms, but prospective population studies are lacking. The aim of the current study is to determine the effects of several psychosocial factors on the risk of Parkinson's disease (PD), as well as to identify potential pre‐motor symptoms for PD in a large prospective cohort study.

Methods

In 1991–1993, a total of 9955 women and men free of PD from the Copenhagen City Heart Study were asked about major life events, economic hardship, social network, impaired sleep and vital exhaustion. The participants were followed for first‐time hospitalization with PD in nationwide registers until 2011.

Results

Vital exhaustion was associated with a higher risk of PD hospitalization in an exposure‐dependent manner (= 0.001), with high vs. low vital exhaustion being associated with a hazard ratio of 2.50 [95% confidence interval (CI): 1.28–4.89]. A slightly higher risk of PD hospitalization (hazard ratio = 1.49; 95% CI: 0.87–2.56) was suggested in participants with impaired sleep at baseline. No more than weak associations were observed for economic hardship, major life events or inadequate social network in the current study.

Conclusions

Overall, the hypothesis that psychosocial risk factors affect the risk of PD is not supported. The results, however, suggest that vital exhaustion may be a pre‐motor marker of the neurodegenerative process eventually leading to motor symptoms and clinical PD. Vital exhaustion may be useful for screening aimed at early detection and when considering disease‐modifying therapies in people at high risk of clinical PD.

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Authors:
A. J. Clark, B. Ritz, E. Prescott and N. H. Rod
Article first published online:
23 Feb 2013 | DOI: 10.1111/ene.12117

Original Article

Background and purpose

Hemorrhagic transformation (HT) is one of the most problematic complications to arise from intravenous thrombolysis (IVT). This study was conducted to assess whether micro‐ and macroalbuminuria could be associated with HT after IVT in patients with acute ischaemic stroke, and to investigate whether the value of urinary albumin‐to‐creatinine ratios would correlate with the degree of HT.

Methods

This was a retrospective study of stroke patients who had undergone IVT within 3 h of symptom onset. Albuminuria assessment was based on random morning spot urine collection with patients in a fasting state, the first morning after IVT. Multiple logistic regression analysis was used to evaluate whether the presence of micro‐ and macroalbuminuria might be independent predictors of HT.

Results

One‐hundred and fifty‐four patients were included in the study. Fifty‐one patients had HT. The presence of micro‐ or macroalbuminuria was associated with HT after adjustment for variables with clinical significance (adjusting for age, atrial fibrillation, platelet counts, baseline National Institutes of Health Stroke Scale score, hypertension and diabetes mellitus; odds ratio, 2.542; 95% confidence interval, 1.106–5.841; = 0.028). There were significant relationships between the presence of micro‐ and macroalbuminuria and types of HT.

Conclusion

In conclusion, the results of this study suggest that the presence of micro‐ and macroalbuminuria after IVT could be a predictor of severe HT in patients with acute ischaemic stroke.

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Authors:
B.‐H. Cho, J.‐T. Kim, J. Chang, K.‐H. Choi, M.‐S. Park and K.‐H. Cho
Article first published online:
14 Apr 2013 | DOI: 10.1111/ene.12127

Original Article

Background and purpose

Multiple sclerosis (MS) patients are at increased infection risk. Here the influences of susceptibility, severity and surveillance bias on infection‐related hospital admission are assessed.

Methods

Swedish registers identified 20 276 patients with MS, matched with 203 951 people from the general population without MS. Risk of first hospital admission for infection and mortality over 36 years was estimated by Poisson regression.

Results

Multiple sclerosis was associated with an increased hospital admission risk for all infections, with an adjusted relative risk (and 95% confidence interval) of 4.26 (4.13–4.40). A proportion of this raised risk was probably due to surveillance and referral bias, although a raised risk remained when MS was compared with other immune‐mediated diseases. The 1‐month mortality rate following hospital admission for infection was higher in MS patients than in the comparison cohort, with a relative risk of 4.69 (4.21–5.22). There was no clear temporal trend in the results, and risks were higher in males and varied by MS phenotype.

Conclusions

Higher hospital admission rates among MS patients for infection are likely to be due to a combination of surveillance bias, cautious medical management and greater susceptibility to severe infections. MS‐related functional limitations may increase infection risk and this should be considered in MS management.

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Authors:
S. Montgomery, J. Hillert and S. Bahmanyar
Article first published online:
16 Mar 2013 | DOI: 10.1111/ene.12130

Review Article

Abstract

Subarachnoid hemorrhage (SAH) is a devastating disease associated with death and poor functional outcome. Despite decades of intense research and improvements in clinical management, delayed cerebral ischaemia (DCI) remains the most important cause of morbidity and mortality after SAH. The key role of angiographic cerebral vasospasm, thought to be the main cause of DCI, has been questioned. Emerging evidence suggests that DCI is likely to have a multifactorial etiology. Over the last few years, spreading depolarization (SD) has been identified as a potential pathophysiological mechanism contributing to DCI. The presence of cortical spreading ischaemia, due to an inverse hemodynamic response to SD, offers a possible explanation for DCI and requires more intensive research. Understanding the role of SD as another mechanism inducing DCI and its relationship with other pathological factors could instigate the development of new approaches to the diagnosis and treatment of DCI in order to improve the clinical outcome.

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Authors:
R. Sánchez‐Porras, Z. Zheng, E. Santos, M. Schöll, A. W. Unterberg and O. W. Sakowitz
Article first published online:
29 Mar 2013 | DOI: 10.1111/ene.12139

Original Article

Background and purpose

We investigated the effect of celecoxib, a selective inhibitor of cyclo‐oxygenase 2, in patients with intracerebral hemorrhage (ICH).

Methods

We conducted a multicenter, randomized, controlled, and open with blinded end‐point trial of 44 Korean patients 18 years or older with ICH within 24 h of onset. The intervention group (= 20) received celecoxib (400 mg twice a day) for 14 days. The control group (= 24) received the standard medical treatment for ICH. The primary end‐point was the number of patients with a change in the volume of perihematomal edema (PHE) from the 1st to the 7th ± 1 day (cut‐off value, 20%).

Results

The time from onset to computed tomography scan slightly differed between groups (177 ± 160 min for control vs. 297 ± 305 min for the celecoxib group; = 0.10). In the primary end‐point analysis using cut‐off values, there was a significant shift to reduced expansion of PHE in the celecoxib group (= 0.005). With respect to the secondary end‐points, there was also a significant shift to reduced expansion of ICH in the celecoxib group (= 0.046). In addition, the expansion rate of PHE at follow‐up tended to be higher in the control group than in the celecoxib group (90.6 ± 91.7% vs. 44.4 ± 64.9%; = 0.058).

Conclusions

In our small, pilot trial, administration of celecoxib in the acute stage of ICH was associated with a smaller expansion of PHE than that observed in controls.

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Authors:
S.‐H. Lee, H.‐K. Park, W.‐S. Ryu, J.‐S. Lee, H.‐J. Bae, M.‐K. Han, Y.‐S. Lee, H.‐M. Kwon, C. K. Kim, E.‐S. Park, J.‐W. Chung, K.‐H. Jung and J.‐K. Roh
Article first published online:
29 Mar 2013 | DOI: 10.1111/ene.12140

Original Article

Background and purpose

In recent years a possible non‐motor involvement of the nervous system in amyotrophic lateral sclerosis (ALS) has come into the focus of research and has been investigated by numerous techniques. Optical coherence tomography (OCT) – with its potential to reveal neuroaxonal retinal damage – may be an appropriate tool to investigate whether the anterior visual pathway is involved. Our aim was to determine whether OCT‐based measures of retinal nerve fiber layer, ganglion cell layer, inner nuclear layer and outer nuclear layer thickness are abnormal in ALS, or correlated with disease severity.

Methods

Seventy‐six ALS patients (144 eyes) and 54 healthy controls (108 eyes; HCs) were examined with OCT, including automated intraretinal macular segmentation. ALS disease severity was determined with the Amyotrophic Lateral Sclerosis Functional Rating Scale – Revised.

Results

There was no significant difference between ALS patients and HCs in any of the examined OCT measures. Moreover, OCT parameters showed no correlation with clinical measures of disease severity.

Conclusions

These findings indicate that involvement of the anterior visual pathway is not one of the non‐motor manifestations of ALS.

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Authors:
N. M. Roth, S. Saidha, H. Zimmermann, A. U. Brandt, T. Oberwahrenbrock, N. J. Maragakis, H. Tumani, A. C. Ludolph, T. Meyer, P. A. Calabresi and F. Paul
Article first published online:
14 Apr 2013 | DOI: 10.1111/ene.12146

Original Article

Background and purpose

Suffering a stroke during the weekend is associated with a poorer prognosis. The impact of implementing a dedicated stroke care network in Dijon, France, in 2003 on 30‐day mortality in strokes/transient ischaemic attacks (TIA) occurring during weekends/bank holidays was evaluated.

Methods

All cases of stroke and TIA from 1985 to 2010 were identified from a population‐based registry, using multiple overlapping sources of information. Demographics and clinical data were recorded. Cox regression models were used to evaluate associations between day of onset (weekdays versus weekends/bank holidays) and 30‐day all‐cause mortality. Data were stratified according to time periods [before (1985–2003) and after (2004–2010) implementation of the stroke network] and stroke subtypes (ischaemic stroke and intracerebral hemorrhage).

Results

Of the 5864 recorded patients, 1465 (25%) had their event during weekends/bank holidays. Patients with stroke/TIA during weekdays were comparable with those with stroke/TIA during weekends/bank holidays for baseline characteristics. Excess mortality was observed in patients with stroke/TIA during weekends/bank holidays during 1985–2003 (18.2% vs. 14.0%,  < 0.01) but not during 2004–2010 (8.4% vs. 8.3%,  = 0.74). Onset during weekends/bank holidays was associated with a higher risk of 30‐day mortality during 1985–2003 (adjusted hazard ratio 1.26; 95% CI 1.06–1.51,  = 0.01), but not during 2004–2010 (adjusted hazard ratio 0.99; 95% CI 0.69–1.43,  = 0.97).

Conclusion

The deleterious effect of weekends/bank holidays on early stroke mortality disappeared after the organization of a dedicated stroke care network in our community. Our findings provide strong support for the implementation of quality improvement initiatives in order to attenuate inequalities in the management of stroke patients.

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Authors:
Y. Béjot, C. Aboa‐Eboulé, A. Jacquin, O. Troisgros, M. Hervieu, J. Durier, G.‐V. Osseby and M. Giroud
Article first published online:
03 Apr 2013 | DOI: 10.1111/ene.12154

Original Article

Background and purpose

Recurrence of migraine headaches after treatment is common. The evidence regarding steroids for preventing migraine headache recurrence is controversial. This meta‐analysis examined the effectiveness of steroids for prevention of recurrent headaches.

Methods

Databases (PubMed, Embase and the Cochrane Library) and conference proceedings were searched for randomized controlled trials comparing steroids and placebo in the treatment of migraine headaches. Two independent reviewers assessed studies and extracted data. Relative risks (RRs) of headache recurrence and adverse events were calculated and reported with 95% confidence intervals (95% CIs).

Results

Eight studies with 905 patients were included. Pooled analysis showed that when steroids were added to standard abortive therapy they reduced the rate of moderate or severe headache recurrence after 24–72 h of follow‐up evaluation (RR = 0.71; 95% CI = 0.59–0.86). There was no significant benefit of steroids compared with placebo in the proportion of totally resolved migraines (RR = 1.11; 95% CI = 0.94–1.32). The side effects of steroids are mild and not significant except for dizziness. Subgroup meta‐analysis showed that parenteral dexamethasone tends to be more effective in reducing moderate or severe recurrent headaches (RR = 0.68; 95% CI = 0.55–0.84). However, no significant differences were found between oral administration and parenteral administration of steroids ( = 0.37).

Conclusion

When steroids are added to standard abortive therapy for migraine headaches, they are effective and safe for preventing moderate or severe headache recurrence.

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Authors:
Y. Huang, X. Cai, X. Song, H. Tang, Y. Huang, S. Xie and Y. Hu
Article first published online:
11 Apr 2013 | DOI: 10.1111/ene.12155

Original Article

Background and purpose

Elevated plasma total homocysteine level (tHcy) is associated with increased risk of dementia via increased white matter changes or reduction in cortical volume. Whether tHcy has an independent impact on regional perfusion and if it can predict a more rapid cognitive decline in mild Alzheimer dementia (AD) warrants investigation.

Methods

Eighty AD patients with a clinical dementia rating of 1 were enrolled. Their Cognitive Ability Screening Instrument (CASI) scores on enrolment and after 1 year of follow‐up as well as their perfusion index (PI) from single photon emission computed tomography upon enrolment were analyzed.

Results

In cross‐sectional analysis, elevated tHcy was associated with lower frontal PI independent of cerebrovascular risk factors ( = −0.35, =0.009). The CASI scores correlated with temporo‐parietal PI (Pearson range 0.3–0.39, <0.01) but not with tHcy or frontal PI. By longitudinal analysis, only tHcy level was related to a more rapid cognitive decline (odds ratio for executive function score 1.82; odds ratio for total CASI score 1.74).

Conclusions

Cognitive performance in mild AD can be reflected by hypo‐perfusion of the temporo‐parietal region while frontal hypo‐perfusion may be mediated by tHcy. tHcy level is an independent risk factor for rapid cognitive decline, especially in the executive function.

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Authors:
C.‐W. Huang, W.‐N. Chang, S.‐H. Huang, C.‐C. Lui, N.‐C. Chen, Y.‐T. Chang, C.‐C. Lee, C.‐C. Chang and A. Y. W. Chang
Article first published online:
14 Apr 2013 | DOI: 10.1111/ene.12159

Original Article

Background and purpose

The lack of appropriate measures has hindered the research on anxiety syndromes in Parkinson's disease (PD). The objective of the present cross‐sectional, international study was to identify shared elements and grouping of components from anxiety scales as a basis for designing a new scale for use in PD.

Methods

For this purpose, 342 consecutive PD patients were assessed by means of the Mini International Neuropsychiatric Inventory (depression and anxiety sections), the Clinical Global Impression of severity of the anxiety symptoms, the Hamilton Anxiety Rating Scale (HARS), the Neuropsychiatric Inventory (section E), the Beck Anxiety Inventory (BAI) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS‐A).

Results

As the HADS‐A showed a weak correlation with the HARS and BAI, it was not considered for more analyses. HARS and BAI exploratory factor analysis identified nine factors (62% of the variance), with only two of them combining items from both scales. Therefore, a canonical correlation model (a method to identify relations between components of two groups of variables) was built and it showed four factors grouping items from both scales: the first factor corresponded to ‘generalized anxiety’; the second factor included muscular, sensory and autonomic ‘non‐specific somatic symptoms’; the third factor was dominated by ‘respiratory symptoms’; and the fourth factor included ‘cardiovascular symptoms’.

Conclusions

BAI is heavily focused on panic symptoms, whilst HARS is more focused towards generalized anxiety symptoms. The new scale should include additional components in order to assess both episodic and persistent anxiety as well as items for evaluation of avoidance behaviour.

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Authors:
P. Martinez‐Martin, J. M. Rojo‐Abuin, K. Dujardin, G. M. Pontone, D. Weintraub, M. J. Forjaz, S. Starkstein and A. F. G. Leentjens
Article first published online:
14 Apr 2013 | DOI: 10.1111/ene.12160

Original Article

Background and purpose

To identify adverse events (AEs) significantly associated with perampanel treatment in double‐blind clinical studies (RCTs). Serious AEs, study withdrawals due to AEs and dose–effect responses of individual AEs were also investigated.

Methods

All placebo controlled, double‐blind RCTs investigating therapeutic effects of oral perampanel were searched. AEs were assessed for their association with perampanel after exclusion of synonyms, rare AEs and non‐assessable AEs. Risk difference (RD) was used to evaluate the association of any AE (99% confidence intervals) and withdrawals or serious AEs (95% confidence intervals) with perampanel.

Results

Nine RCTs (five in pharmacoresistant epilepsy and four in Parkinson's disease) were included in our study. Almost 4000 patients had been recruited, 2627 of whom were randomized to perampanel and treated with drug doses of 0.5 mg/day ( = 68), 1 mg/day ( = 65), 2 mg/day ( = 753), 4 mg/day ( = 1017), 8 mg/day ( = 431) or 12 mg/day ( = 293). Serious AEs were not significantly associated with perampanel treatment. The experimental drug was significantly associated with an increased risk of AE‐related study withdrawals at 4 mg/day [RD (95% confidence interval) 0.03 (0.00, 0.06)] and 12 mg/day [RD (95% confidence interval) 0.13 (0.07, 0.18)]. Of 15 identified AEs, five (dizziness, ataxia, somnolence, irritability and weight increase) were found to be significantly associated with perampanel and one (seizure worsening) was significantly associated with placebo.

Conclusions

Vestibulocerebellar AEs (dizziness, ataxia), sedative effects (somnolence), irritability and weight increase were significantly associated with perampanel treatment.

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Authors:
G. Zaccara, F. Giovannelli, M. Cincotta, A. Verrotti and E. Grillo
Article first published online:
23 Apr 2013 | DOI: 10.1111/ene.12170

EFNS Forum

Three important steps to European neurology harmonization: core curriculum, visitation program, European board examination

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Authors:
W. Struhal, S. I. Mellgren and W. Grisold
Article first published online:
05 Jul 2013 | DOI: 10.1111/ene.12177

Original Article

Background and purpose

Patients with transient ischaemic attack (TIA) with a high risk of imminent stroke can be identified with the ABCD score and findings on MRI and CT angiography. The predictive value of transcranial color‐coded sonography (TCCS) has not been evaluated in this setting.

Methods

A retrospective analysis was conducted of patients consecutively treated for TIA or minor stroke in a TIA clinic within 24 h of symptom onset. Agreement between TCCS and MRI three‐dimensional time‐of‐flight images for the diagnosis of proximal (internal carotid artery, vertebral artery, basilar artery, circle of Willis and main stem of the middle cerebral artery) >50% stenosis or occlusion of the intracranial symptomatic artery was evaluated. The sensitivity, specificity, predictive values and likelihood ratio of TCCS for predicting recurrent TIA/stroke at 7 days were calculated.

Results

Of 159 patients with a TIA or minor stroke within the last 24 h, 142 had a readable acoustic temporal bone window (89.3%). TCCS and MRI were performed within 4 h of each other in 116 patients. MRI showed a symptomatic proximal intracranial steno‐occlusive lesion in six patients. Agreement between MRI and TCCS was perfect (κ coefficient = 1). Recurrent TIA/stroke occurred in 10 patients (eight TIA and two minor strokes). All recurrences occurred within 24 h of symptom onset. A symptomatic proximal intracranial steno‐occlusive lesion was found on TCCS in 4/10 patients with recurrence and 3/132 patients without recurrence [sensitivity 40%; specificity 97.7%; likelihood ratio 18.1; odds ratio (95% CI) adjusted for ABCD score 31.5 (4.5–218.6)].

Conclusion

Our study shows that TCCS can be used to guide triage of patients with TIA.

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Authors:
N. Nasr, G. Ssi‐Yan‐Kai, B. Guidolin, F. Bonneville and V. Larrue
Article first published online:
06 May 2013 | DOI: 10.1111/ene.12178

Letter to the Editor

Anticardiolipin antibodies‐associated stroke in primary CMV infection

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Authors:
B. Lioger, S. Debiais, M. A. Lauvin, I. Bonnaud, F. Maillot and N. Ferreira‐Maldent
Article first published online:
05 Jul 2013 | DOI: 10.1111/ene.12179

Letter to the Editor

Clinical diagnostic tricks for detecting psychogenic gaze paralysis

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Authors:
E. Bruno, G. Mostile, V. Dibilio, L. Raciti, A. Nicoletti and M. Zappia
Article first published online:
05 Jul 2013 | DOI: 10.1111/ene.12181

Letter to the Editor

Rebound of disease activity during pregnancy after withdrawal of fingolimod

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Authors:
A. P. Sempere, L. Berenguer‐Ruiz and E. Feliu‐Rey
Article first published online:
05 Jul 2013 | DOI: 10.1111/ene.12195

Miscellaneous

Calendar

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Authors:
Article first published online:
05 Jul 2013 | DOI: 10.1111/ene.12223

Original Article

Background and purpose

Anticoagulant and antiplatelets for prevention of ischaemic stroke and cardiovascular diseases may increase the risk of intracerebral hemorrhage (ICH). This study aimed to investigate the influence of pre‐ICH use of anticoagulant and antiplatelets on ICH patients.

Methods

Consecutive patients with acute spontaneous ICH registered in a single‐center stroke registry during 2001 to 2010 were analyzed and categorized according to their pre‐ICH use of warfarin (Group I), antiplatelets (Group II), or neither (Group III). Survival analysis and the Cox proportional hazard model were used to compare between the three groups and the predictors.

Results

Of 2021 ICH patients (male, 63.3%; mean age, 62.6 ± 14.4 years) included, there were 94 (4.7%) in Group I, 232 (11.4%) in Group II, and 1695 (83.9%) in Group III. Warfarin users had larger hematoma volume, more intraventricular extension, higher frequencies of lobar ICH, and higher case fatality than non‐warfarin users (Groups II and III). The Cox proportional hazard model showed increased 6‐month case fatality in pre‐ICH warfarin users (adjusted hazard ratio 2.75, 95% confidence interval 2.04–3.72, <0.001), but not in pre‐ICH antiplatelet users (adjusted hazard ratio 0.95, 95% confidence interval 0.72–1.26).

Conclusions

Intracerebral hemorrhage patients with prior warfarin use, but not antiplatelet use, had significantly higher case fatality at 6 months.

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Authors:
Y.‐W. Chen, S.‐C. Tang, L.‐K. Tsai, S.‐J. Yeh, H.‐Y. Chiou, P.‐K. Yip and J.‐S. Jeng
Article first published online:
17 Aug 2012 | DOI: 10.1111/j.1468-1331.2012.03847.x

Editorial

Abstract

Click to view the accompanying paper in this issue.

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Authors:
M. Hillbom
Article first published online:
06 Aug 2012 | DOI: 10.1111/j.1468-1331.2012.03848.x