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Nejvíce citované: 18984948

2 citací v PubMed Filtry

Nejvíce citovaný článek - PubMed ID 18984948

Záznam nenalezen v Medvik. Navštivte PubMed 18984948

Článek

Sex Differences in Diagnosis and Diagnostic Revision of Suspected Minor Cerebral Ischemic Events

Yu, Amy Y X
Autor Yu, Amy Y X ORCID From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada. amyyx.yu@utoronto.ca
Hill, Michael D
Autor Hill, Michael D ORCID From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Asdaghi, Negar
Autor Asdaghi, Negar From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Boulanger, Jean-Martin
Autor Boulanger, Jean-Martin From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Camden, Marie-Christine
Autor Camden, Marie-Christine From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Campbell, Bruce C V
Autor Campbell, Bruce C V ORCID From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Demchuk, Andrew M
Autor Demchuk, Andrew M From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Field, Thalia S
Autor Field, Thalia S ORCID From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Goyal, Mayank
Autor Goyal, Mayank From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
Krause, Martin
Autor Krause, Martin From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada

Neurology. 2021 Feb 02 ; 96 (5) : e732-e739. [epub] 20201112

ISSN 1526-632X | 0028-3878
Zdroj

OBJECTIVE: To describe sex differences in the presentation, diagnosis, and revision of diagnosis after early brain MRI in patients who present with acute transient or minor neurologic events. METHODS: We performed a secondary analysis of a prospective multicenter cohort study of patients referred to neurology between 2010 and 2016 with a possible cerebrovascular event and evaluated with brain MRI within 8 days of symptom onset. Investigators documented the characteristics of the event, initial diagnosis, and final diagnosis. We used multivariable logistic regression analyses to evaluate the association between sex and outcomes. RESULTS: Among 1,028 patients (51% women, median age 63 years), more women than men reported headaches and fewer reported chest pain, but there were no sex differences in other accompanying symptoms. Women were more likely than men to be initially diagnosed with stroke mimic (54% of women vs 42% of men, adjusted odds ratio (OR) 1.60, 95% confidence interval [CI] 1.24-2.07), and women were overall less likely to have ischemia on MRI (10% vs 17%, OR 0.52, 95% CI 0.36-0.76). Among 496 patients initially diagnosed with mimic, women were less likely than men to have their diagnosis revised to minor stroke or TIA (13% vs 20%, OR 0.53, 95% CI 0.32-0.88) but were equally likely to have acute ischemia on MRI (5% vs 8%, OR 0.56, 95% CI 0.26-1.21). CONCLUSIONS: Stroke mimic was more frequently diagnosed in women than men, but diagnostic revisions were common in both. Early brain MRI is a useful addition to clinical evaluation in diagnosing transient or minor neurologic events.

Článek

Rate and Prognosis of Brain Ischemia in Patients With Lower-Risk Transient or Persistent Minor Neurologic Events

JAMA neurology. 2019 Dec 01 ; 76 (12) : 1439-1445.

JAMA Neurol
ISSN 2168-6157 | 2168-6149
Zdroj

IMPORTANCE: Early treatment of patients with transient ischemic attack (TIA) reduces the risk of stroke. However, many patients present with symptoms that have an uncertain diagnosis. Patients with motor, speech, or prolonged symptoms are at the highest risk for recurrent stroke and the most likely to undergo comprehensive investigations. Lower-risk patients are much more likely to be cursorily investigated. OBJECTIVE: To establish the frequency of acute infarct defined by diffusion restriction detected on diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) scan (DWI positive). DESIGN, SETTING, AND PARTICIPANTS: The Diagnosis of Uncertain-Origin Benign Transient Neurological Symptoms (DOUBT) study was a prospective, observational, international, multicenter cohort study of 1028 patients with low-risk transient or minor symptoms referred to neurology within 8 days of symptom onset. Patients were enrolled between June 1, 2010, and October 31, 2016. Included patients were 40 years or older and had experienced nonmotor or nonspeech minor focal neurologic events of any duration or motor or speech symptoms of short duration (≤5 minutes), with no previous stroke. EXPOSURES: Patients underwent a detailed neurologic assessment prior to undergoing a brain MRI within 8 days of symptom onset. MAIN OUTCOMES AND MEASURES: The primary outcome was restricted diffusion on a brain MRI scan (acute stroke). RESULTS: A total of 1028 patients (522 women and 506 men; mean [SD] age, 63.0 [11.6] years) were enrolled. A total of 139 patients (13.5%) had an acute stroke as defined by diffusion restriction detected on MRI scans (DWI positive). The final diagnosis was revised in 308 patients (30.0%) after undergoing brain MRI. There were 7 (0.7%) recurrent strokes at 1 year. A DWI-positive brain MRI scan was associated with an increased risk of recurrent stroke (relative risk, 6.4; 95% CI, 2.4-16.8) at 1 year. Absence of a DWI-positive lesion on a brain MRI scan had a 99.8% negative predictive value for recurrent stroke. Factors associated with MRI evidence of stroke in multivariable modeling were older age (odds ratio [OR], 1.02; 95% CI, 1.00-1.04), male sex (OR, 2.03; 95% CI, 1.39-2.96), motor or speech symptoms (OR, 2.12; 95% CI, 1.37-3.29), ongoing symptoms at assessment (OR, 1.97; 95% CI, 1.29-3.02), no prior identical symptomatic event (OR, 1.87; 95% CI, 1.12-3.11), and abnormal results of initial neurologic examination (OR, 1.71; 95% CI, 1.11-2.65). CONCLUSIONS AND RELEVANCE: This study suggested that patients with transient ischemic attack and symptoms traditionally considered low risk carry a substantive risk of acute stroke as defined by diffusion restriction (DWI positive) on a brain MRI scan. Early MRI is required to make a definitive diagnosis.

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