Role of a Stroke Data Bank in Evaluating Cerebral Infarction Subtypes: Patterns and Outcome of 1,776 Consecutive Patients from the Besançon Stroke Registry

Abstract

The purpose of this study was to estimate the frequency of various risk factors, courses and outcome of infarct subtypes in a large hospital-based stroke registry. Methods: From 1987 to 1994, 1,776 stroke patients with a first-ever infarction were included in the Besançon Stroke Registry. All patients were evaluated by a standard protocol (risk factors, stroke onset, stroke courses, clinical characteristics, neuroimaging, Doppler ultrasonography and cardiac investigations). Outcome was evaluated at 30 days using the Rankin scale. Results: There were 1,012 men (mean age 67.2 ± 13.7 years) and 764 women (mean age 71.4 ± 15.6 years). At least two neuroimaging examinations were performed in 81.4% (n = 1,446) of the patients and an infarct was visible in 80.9% (n = 1,436). The second neuroimaging examination (CT or MRI) was performed after 8.2 ± 1.6 days. 85.4% of patients were admitted on the first day of the stroke: 28.3% within 3 h and 48.4% within 6 h. In addition, stroke severity was well correlated with the short time interval between stroke onset and admission. Past medical history of hypertension was the major risk factor occurring in 57.5% of all types of infarction. While diabetes was more frequently found in small deep infarct, atrial fibrillation and history of heart failure were found in anterior circulation infarcts. The distribution of clinical presentations was conventional. Hemorrhagic transformation was found in 14.9% of the patients, especially in MCA and PCA infarcts. In all patients, logistic regression analysis determined independent predictive factors for death: clinical deterioration at the 48th hour (OR 7.5, 95% CI 4.9–11.3), initial loss of consciousness (OR 3.3, 95% CI 2.1–4.9), age (OR 1.05, 95% CI 1.03–1.06), complete motor deficit (OR 2.6, 95% CI 1.7–3.8), history of heart failure (OR 1.9, 95% CI 1.3–3.0), lacunar syndrome (OR 0.25, 95% CI 0.10–0.60) and regressive stroke onset (OR 0.24, 95% CI 0.10–0.52). However, the outcome was clearly correlated with the infarct location. The in-hospital mortality rate was lowest in patients with small deep infarct (2.9%) or border zone infarcts (3.4%) and the highest in patients with total middle cerebral artery infarct (47.4%) or multiple infarcts (27.6%). Conclusion: Our registry appears to be a useful tool to understand the course and outcome of a large group of nonselected patients with subtypes of infarction. It can also help to analyze the influence of specific stroke management in the different categories of stroke types.

Magnetic Resonance Imaging of the Brain in Diabetes

“…Possibly, these cohorts did not include individuals with the most severe stages of diabetes or with severe sequelae of brain infarcts because they are less likely to attend a health survey. Nonetheless, many previous MRI studies focusing on brain changes caused by small vessel disease presented similar results (3,4,6,9,(11)(12)(13)(14)(15)18,19). A lack of association between diabe- tes and small vessel disease-related cerebral lesions has also been observed in other previous population-based MRI studies (18,19).…”

“…Although it is known that diabetic patients are at increased risk for stroke (2), little is known about the risk for other brain pathology, such as that associated with neurodegeneration or small vessel disease. Previous radiological studies of patients with diabetes were based on highly selective groups of individuals referred to computed tomography or magnetic resonance imaging (MRI) neuroimaging (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Only a few population-based studies assessed the association of diabetes-as one of many cardiovascular disease (CVD) risk factors-to only one specific type of brain lesion (18 -22).…”

“…The reported results are inconsistent. Only 6 (5,6,8,11,16,20) of 19 investigations (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) found diabetes to be a risk factor for small vessel disease-related brain abnormalities, including white matter lesions or lacunes. Three studies found associations with cerebral atrophy (3,7,21).…”

Time Course and Prognostic Value of Plasma Levels of N-Terminal Pro-Brain Natriuretic Peptide in Patients After Ischemic Stroke

“…10,12,13 Additionally, previous studies have shown that heart failure is associated with dependency after stroke 31 and is also an independent predictive factor for mortality after first cerebral infarction. [31][32][33] However, the impact of an increased plasma level of NT-proBNP on clinical outcome after ischemic stroke remains unclear.…”

Acute Ischemic Stroke Management Review for the Hospitalist

“…A recent analysis of an acute ischemic stroke confirmed by diffusion-weighted imaging (DWI) in a large Asian cohort utilizing TOAST classification found large-artery atherosclerosis to be the most common stroke subtype with the middle cerebral artery (MCA) territory most frequently affected (15). However, a non-Asian population determined cardioembolic stroke to be the most common subtype (16). In fact, atrial fibrillation, the prevalence of which is estimated to rise to 12 million in the US by 2030, independently increases stroke risk five-fold across all ages (17,18).…”