Hypertension Before and After Posterior Circulation Infarction: Analysis of Data from the South London Stroke Register

Cates, Matthew; Paton, Julian F. R.; Smeeton, Nigel; Wolfe, Charles D.A.

doi:10.1016/j.jstrokecerebrovasdis.2011.02.004

Cited by 13 publications

(21 citation statements)

References 41 publications

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“…Compared with those studies, sifap1 confirms a higher frequency of small penetrating artery disease and a lower frequency of cardio-embolic stroke aetiology, large vessel disease, and tobacco smoking in young PCS patients than in young ACS patients, which has previously been reported in patients of older ages [1,3,6,7,8,9,10,11,12,13]. We could also confirm a trend towards a higher prevalence of diabetes mellitus in young PCS patients, which has formerly been reported in older patients [6,9,10,11,12].…”

Section: Discussionmentioning

confidence: 48%

“…In Caucasian populations, up to 30% of all strokes occur in the posterior circulation [1,2,3,4,5,6]. Several population- and hospital-based registries in Caucasian and Asian populations consistently showed that compared to anterior circulation strokes (ACS), patients with posterior circulation stroke (PCS) were younger and more commonly male.…”

Section: Introductionmentioning

confidence: 99%

“…Several population- and hospital-based registries in Caucasian and Asian populations consistently showed that compared to anterior circulation strokes (ACS), patients with posterior circulation stroke (PCS) were younger and more commonly male. These patients more frequently had small penetrating artery disease, smoked tobacco and had diabetes mellitus, while they less frequently had cardio-embolic stroke aetiologies, atrial fibrillation, valvular heart disease and hypertension [1,3,6,7,8,9,10,11,12,13]. Large artery disease was more frequent in patients with PCS according to some studies [12,13,14] and less frequent in patients with PCS according to some others [3,11].…”

Section: Introductionmentioning

confidence: 99%

“…Large artery disease was more frequent in patients with PCS according to some studies [12,13,14] and less frequent in patients with PCS according to some others [3,11]. All of these registries included predominantly older patients (between 61 and 72 years) [1,2,3,4,5,6,7,8,9,10,11,12,15]. …”

Section: Introductionmentioning

confidence: 99%

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Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1)

Sarnowski

Rolfs²,

Enzinger³

et al. 2017

Cerebrovasc Dis

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Background: Although 20-30% of all strokes occur in the posterior circulation, few studies have explored the characteristics of patients with strokes in the posterior compared to the anterior circulation so far. Especially data on young patients is missing. Methods: In this secondary analysis of data of the prospective multi-centre European sifap1 study that investigated stroke and transient ischemic attack (TIA) patients aged 18-55 years, we compared vascular risk factors, stroke aetiology, presence of white matter hyperintensities (WMH) and cerebral microbleeds (CMB) between patients with ischaemic posterior circulation stroke (PCS) and those having suffered from anterior circulation stroke (ACS) based on cerebral MRI. Results: We diagnosed PCS in 612 patients (29.1%, 407 men, 205 women) and ACS in 1,489 patients (70.9%). Their age (median 46 vs. 47 years, p = 0.205) and stroke severity (modified Rankin Scale: both 2, p = 0.375, Barthel Index 90 vs. 85, p = 0.412) were similar. PCS was found to be more frequent among the male gender (66.5 vs. 60.1% with ACS, p = 0.003). Vertebral artery (VA) dissection was more often the cause of PCS (16.8%) than was carotid artery dissection of ACS (7.9%, p < 0.001). Likewise, small vessel disease (Trial of Org 10172 in Acute Stroke Treatment [TOAST] = 3, PCS: 14.7%, ACS: 11.8%) and stroke of other determined aetiology (TOAST = 4, PCS: 24.5%, ACS: 16.0%) were more frequent in those with PCS. Furthermore, patent foramen ovale (PFO; PCS: 31.1%, ACS: 25.4%, p = 0.029) was more often detected in patients with PCS. In contrast, large-artery atherosclerosis (TOAST = 1, PCS: 15.4%, ACS: 22.2%) and cardio-embolic stroke (TOAST = 2, PCS: 15.6%, ACS: 18.0%) were less frequent in those with PCS (p < 0.001) as were preceding cerebrovascular events (10.1 vs. 14.1%, p = 0.014), TIA (4.8 vs. 7.7%, p = 0.016) and smoking (53.2 vs. 61.0%, p = 0.001). The presence, extent, and location of WMH and CMB did not differ between the 2 groups. Conclusions: Our data suggested a different pattern of aetiology and risk factors in young patients with PCS compared to those with ACS. These findings especially call for a higher awareness of VA dissection and potentially for more weight of a PFO as a risk factor in young patients with PCS. Clinical trial registration-URL: http://www.clinicaltrials.gov; NCT00414583.

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1)

Sarnowski

Rolfs²,

Enzinger³

et al. 2017

Cerebrovasc Dis

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“…14,15 Brainstem vasculature of patients with hypertension and of animal models of hypertension (eg, spontaneously hypertensive rat [SHR]) is considerably narrower (compared with the respective normotensive counterparts), resulting in high cerebral artery resistance. 16,17 This is not a consequence of hypertension as it occurs prior to its development, at least in the SHR. 16 Thus, the neuronal sympathoexcitatory networks that control the arterial blood pressure have been suggested to be hypoperfused/hypoxic.…”

mentioning

confidence: 99%

Brainstem Hypoxia Contributes to the Development of Hypertension in the Spontaneously Hypertensive Rat

et al. 2015

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Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

et al. 2019

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Objective Posterior circulation ischemic stroke (PCiS) constitutes 20-30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. Methods Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. Results PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04-1.61; male sex, OR = 1.46; 95% CI 1.21-1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. Conclusion Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.

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Hypertension Before and After Posterior Circulation Infarction: Analysis of Data from the South London Stroke Register

Cited by 13 publications

References 41 publications

Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1)

Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1)

Brainstem Hypoxia Contributes to the Development of Hypertension in the Spontaneously Hypertensive Rat

Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

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