Tuberculosis and the Risk of Ischemic Stroke

Abstract

Background and Purpose-The aim of this study is to estimate the risk of ischemic stroke during a 3-year follow-up period after a tuberculosis diagnosis using a nationwide, population-based study and a retrospective cohort design. Method-The study cohort comprised 2283 patients who had received treatment for tuberculosis, except tuberculosis of the meninges and central nervous system, between 2000 and 2003; 6849 randomly selected subjects comprised the comparison cohort. Cox proportional hazard regressions were performed as a means of comparing the 3-year ischemic stroke-free survival rate between these 2 cohorts. Results-Of the 9132 sampled patients, 392 (4.3%) experienced ischemic stroke during the 3-year follow-up period, including 136 (6.0% of the tuberculosis patients) from the study cohort and 256 (3.7%) from the comparison cohort. After adjusting for patient age, gender, hypertension, diabetes, coronary heart disease, hyperlipidemia, malignancy, monthly income, and the geographical region and urbanization level of the community in which the patient resided, the hazard ratio of ischemic stroke for tuberculosis patients was 1.52-times (95% CI, 1.21-1.91; PϽ0.001) higher than for comparison patients. Conclusion-We conclude that patients with a tuberculosis diagnosis are at an increased risk for ischemic stroke but not hemorrhagic stroke in the next 3 years. Further research is necessary to investigate these findings in tuberculosisendemic areas. (Stroke. 2010;41:244-249.)

Stroke in tuberculous meningitis

“…In a longitudinal study, 6% of non CNS tuberculosis patients and 3.7% of controls developed stroke. The hazard ratio of ischemic stroke for tubercular patients in a 3 year follow up was 1.52 times higher compared to nontubercular patients [9]. In this study the patients with TBM were excluded.…”

“…In the year 2007, the worldwide estimate of tuberculosis was 9.27 million new cases and 1.78 million deaths [7]. A link between tuberculosis, atherosclerosis and stroke has been suggested which sometimes correspond with central nervous system (CNS) tuberculosis [8,9]. In a longitudinal study, 6% of non CNS tuberculosis patients and 3.7% of controls developed stroke.…”

“…The greater proportion of infarcts in treated compared to untreated TBM is due to increase survival resulting in more sequelae. Stroke not only occurs during the early period of antitubercular therapy but also has been reported in the late stage of TBM [9].…”

Do que morrem os pacientes com tuberculose: causas múltiplas de morte de uma coorte de casos notificados e uma proposta de investigação de causas presumíveis

“…Esse fato pode ocorrer pelo possível agravamento das doenças do aparelho circulatório pela TB 19 . Apesar de reconhecida a associação entre TB e diabetes, pelo agravamento da TB por este agravo ou vice-versa 20,21 , não se observou relação na análise aqui realizada.…”

Increased Risk of Stroke in Patients with Isolated Third, Fourth, or Sixth Cranial Nerve Palsies: A Nationwide Cohort Study

“…In the subgroup analyses performed in the present study, isolated OCNP was identified as an independent risk factor for stroke even after adjusting for patient age and the presence of common cardiovascular risk factors such as HTN, diabetes, etc. Other possible mechanisms have been proposed, and these include roles for inflammation, infectious processes and hypercoagulability [6,8,25,26,27]. These factors were not evaluated in the present study, but would be factors to consider in future studies.…”