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  • S. Karger AG  (13)
  • 2015-2019  (13)
  • 1
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 43, No. 1-2 ( 2017), p. 82-89
    Kurzfassung: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Dementia and stroke are major causes of disability in the elderly. However, the association between pre-stroke dementia and functional outcome after stoke remains unresolved. We aimed to determine this association in patients with acute ischemic stroke. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Among patients registered in the Fukuoka Stroke Registry from June 2007 to May 2015, 4,237 patients with ischemic stroke within 24 h of onset, who were functionally independent before the onset, were enrolled in this study. Pre-stroke dementia was defined as any type of dementia that was present prior to the index stroke. Primary and secondary study outcomes were poor functional outcome (modified Rankin Scale 3-6) at 3 months after the stroke onset and neurological deterioration (≥2-point increases on the National Institutes of Health Stroke Scale score during hospitalization), respectively. For propensity score (PS)-matched cohort study to control confounding variables for pre-stroke dementia, 318 pairs of patients with and without pre-stroke dementia were also selected on the basis of 1:1 matching. Multivariable logistic regression models and conditional logistic regression analysis were used to quantify associations between pre-stroke dementia and study outcomes. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of all 4,237 participants, 347 (8.2%) had pre-stroke dementia. The frequencies of neurological deterioration and poor functional outcome were significantly higher in patients with pre-stroke dementia than in those without pre-stroke dementia (neurological deterioration, 16.1 vs. 7.1%, 〈 i 〉 p 〈 /i 〉 〈 0.01; poor functional outcome, 63.7 vs. 27.1%, 〈 i 〉 p 〈 /i 〉 〈 0.01). Multivariable analysis showed that pre-stroke dementia was significantly associated with neurological deterioration (OR 1.67; 95% CI 1.14-2.41; 〈 i 〉 p 〈 /i 〉 〈 0.01) and poor functional outcome (OR 2.91; 95% CI 2.17-3.91; 〈 i 〉 p 〈 /i 〉 〈 0.01). In the PS-matched cohort study, the same trends were observed between the pre-stroke dementia and neurological deterioration (OR 2.60; 95% CI 1.17-5.78; 〈 i 〉 p 〈 /i 〉 〈 0.01) and between the dementia and poor functional outcome (OR 3.62; 95% CI 1.89-6.95; 〈 i 〉 p 〈 /i 〉 〈 0.01). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Pre-stroke dementia was significantly associated with higher risks for poor functional outcome at 3 months after stroke onset as well as for neurological deterioration during hospitalization in patients with acute ischemic stroke.
    Materialart: Online-Ressource
    ISSN: 1015-9770 , 1421-9786
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2017
    ZDB Id: 1482069-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    In: Nephron, S. Karger AG, Vol. 139, No. 4 ( 2018), p. 305-312
    Kurzfassung: 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 Hemodialysis (HD) time has been recognized as an important factor in dialysis adequacy. However, few studies have reported on associations between HD time and prognosis among maintenance HD patients. We present some findings from a prospective cohort study, the ­Q-Cohort Study, which was set up to explore risk factors for mortality in Japanese HD patients. We hypothesized that HD ≥5 h was associated with a significant survival advantage compared with HD & #x3c; 5 h. The present study examined association between HD time and mortality in Japanese HD patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 The prospective multicenter Q-Cohort Study was conducted between December 2006 and December 2010, following 3,456 Japanese HD patients for 4 years. We examined the association between HD time and prognosis using Cox proportional hazards modeling. Propensity scores were calculated using logistic regression. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 During follow-up, 566 patients died from any cause. Patients with HD ≥5 h ( 〈 i 〉 n 〈 /i 〉 = 2,141) showed ­significantly lower risk of all-cause death (hazards ratio = 0.82; 95% CI 0.68–0.99) than those with HD & #x3c; 5 h ( 〈 i 〉 n 〈 /i 〉 = 1,315), after adjusting for confounding risk factors. This ­association remained significant using a propensity score-based approach. After stratifying the analysis by patient age in 10-year increments, this finding remained ­significant only in patients who were ≥80 years of age. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Our results suggest that HD ≥5 h has a more favorable effect on mortality than HD & #x3c; 5 h.
    Materialart: Online-Ressource
    ISSN: 1660-8151 , 2235-3186
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2018
    ZDB Id: 2810853-X
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    Online-Ressource
    Online-Ressource
    S. Karger AG ; 2017
    In:  Case Reports in Neurology Vol. 8, No. 3 ( 2017-1-3), p. 276-281
    In: Case Reports in Neurology, S. Karger AG, Vol. 8, No. 3 ( 2017-1-3), p. 276-281
    Kurzfassung: Cerebral venous thrombosis (CVT) has a broad spectrum of clinical presentation compared to arterial etiology. Seizure is one of the common symptoms and is more frequent than in other stroke types. Hence, transient neurological symptoms in CVT patients are usually due to epileptic seizures, while transient repetitive movement disorder is extremely rare except as a complication of epilepsy. We report a case of CVT in the superior sagittal sinus with a 1-year history of paroxysmal kinetic tremor without evident epilepsy.
    Materialart: Online-Ressource
    ISSN: 1662-680X
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2017
    ZDB Id: 2505302-4
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    In: Case Reports in Neurology, S. Karger AG, Vol. 9, No. 3 ( 2017-10-16), p. 234-240
    Kurzfassung: Intravascular lymphoma (IVL) is a rare disease characterized by the proliferation of lymphoma cells in the lumen of the small blood vessels. Although early diagnosis of IVL is important to prolong survival of the patients, its atypical symptoms and clinical course often delay its diagnosis. More than half of the patients are diagnosed at autopsy. We report a 68-year-old man who presented with transient ideomotor apraxia and mildly elevated soluble interleukin-2 receptor levels. He was initially diagnosed with aortogenic embolic stroke. He developed rapidly progressive neurological manifestations with enlargement of brain lesions on brain computed tomography and magnetic resonance imaging and died 3 months after symptom onset. The diagnosis of IVL could not be made by random skin biopsy, but was finally made at autopsy. For the early diagnosis, sufficient random skin biopsy or brain biopsy should be planned when suspected.
    Materialart: Online-Ressource
    ISSN: 1662-680X
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2017
    ZDB Id: 2505302-4
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 5
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 45, No. 3-4 ( 2018), p. 170-179
    Kurzfassung: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 We aimed to clarify associations between pre-admission risk scores (CHADS 〈 sub 〉 2 〈 /sub 〉 , CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc, and HAS-BLED) and 2-year clinical outcomes in ischemic stroke or transient ischemic attack (TIA) patients with non-valvular atrial fibrillation (NVAF) using a prospective, multicenter, observational registry. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 From 18 Japanese stroke centers, ischemic stroke or TIA patients with NVAF hospitalized within 7 days after onset were enrolled. Outcome measures were defined as death/disability (modified Rankin Scale score ≥3) at 2 years, 2-year mortality, and ischemic or hemorrhagic events within 2 years. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 1,192 patients with NVAF (527 women; mean age, 78 ± 10 years), including 1,141 ischemic stroke and 51 TIA, were analyzed. Rates of death/disability, mortality, and ischemic or hemorrhagic events increased significantly with increasing pre-admission CHADS 〈 sub 〉 2 〈 /sub 〉 ( 〈 i 〉 p 〈 /i 〉 for trend & #x3c;0.001 for death/disability and mortality, 〈 i 〉 p 〈 /i 〉 for trend = 0.024 for events), CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc ( 〈 i 〉 p 〈 /i 〉 for trend  & #x3c;0.001 for all), and HAS-BLED ( 〈 i 〉 p 〈 /i 〉 for trend = 0.004 for death/disability, 〈 i 〉 p 〈 /i 〉 for trend & #x3c;0.001 for mortality, 〈 i 〉 p 〈 /i 〉 for trend = 0.024 for events) scores. Pre-admission CHADS 〈 sub 〉 2 〈 /sub 〉 (OR per 1 point, 1.52; 95% CI 1.35–1.71; 〈 i 〉 p 〈 /i 〉 & #x3c;0.001 for death/disability; hazard ratio (HR) per 1 point, 1.23; 95% CI 1.12–1.35; 〈 i 〉 p 〈 /i 〉 & #x3c;0.001 for mortality; HR per 1 point, 1.14; 95% CI 1.02–1.26; 〈 i 〉 p 〈 /i 〉 = 0.016 for events), CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc (1.55, 1.41–1.72, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001; 1.21, 1.12–1.30, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001; 1.17, 1.07–1.27, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001; respectively), and HAS-BLED (1.33, 1.17–1.52, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001; 1.23, 1.10–1.38, 〈 i 〉 p  〈 /i 〉 & #x3c; 0.001; 1.18, 1.05–1.34, 〈 i 〉 p 〈 /i 〉 = 0.008; respectively) scores were independently associated with all outcome measures. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In ischemic stroke or TIA patients with NVAF, all pre-admission risk scores were independently associated with death/disability at 2 years and 2-year mortality, as well as ischemic or hemorrhagic events within 2 years.
    Materialart: Online-Ressource
    ISSN: 1015-9770 , 1421-9786
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2018
    ZDB Id: 1482069-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 6
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 42, No. 3-4 ( 2016), p. 196-204
    Kurzfassung: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Oral anticoagulants (OACs) reduce the incidence of embolic events associated with non-valvular atrial fibrillation (NVAF); however, ischemic stroke can still occur in such patients. Although there are various causes of ischemic stroke in patients with NVAF, their medication status at onset has scarcely been studied. This retrospective study aimed to determine the underlying causes of ischemic stroke in patients with NVAF in relation to pre-stroke anticoagulation. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Among Japanese patients with acute ischemic stroke enrolled in the Fukuoka Stroke Registry from June 2007 to May 2013, 1,302 patients with NVAF who had been hospitalized within 24 h of onset were included in this study, and their backgrounds, pre-stroke use of OACs and prothrombin time-international normalized ratio (PT-INR) on admission were investigated. Strokes were regarded as being non-cardioembolic (CE) type when causes other than NVAF had been identified. The sub-therapeutic range (TR) for warfarin was defined according to Japanese guidelines for pharmacotherapy of atrial fibrillation. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Atrial fibrillation had been diagnosed prior to onset of stroke in 704 of 1,302 patients (54%). However, it had not been detected before or on admission, but identified later during hospitalization in 270 patients (21%). Of the patients who had atrial fibrillation on admission but had not been diagnosed as having it, 108 (8%) had not received any medication before onset of stroke and 220 (17%) had received medications other than OACs. OACs had been administered to 415 (59%) of the patients with known atrial fibrillation. The proportion of pre-stroke CHADS 〈 sub 〉 2 〈 /sub 〉 or CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc scores ≥1 ranged from 93 to 99% depending on whether atrial fibrillation had been diagnosed or anticoagulation therapy administered before stroke onset. The PT-INR was in the sub-TR on admission in 283 of 399 patients (71%) receiving warfarin. Male sex, smoking and previous stroke were more prevalent in patients with values within or over the TR of PT-INR than in those in the sub-TR. Non-CE stroke was more prevalent in patients with values above the lower therapeutic limit of the recommended PT-INR than in those in the sub-TR (p 〈 0.001). The number of CE strokes was much smaller in patients with high admission PT-INR values; this was not observed for non-CE ischemic strokes (p 〈 0.001). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In the clinical setting, under-diagnosis, underuse and sub-therapeutic doses of OACs are major causes of ischemic stroke in patients with NVAF. However, non-CE ischemic strokes may develop in patients receiving therapeutic doses of warfarin.
    Materialart: Online-Ressource
    ISSN: 1015-9770 , 1421-9786
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2016
    ZDB Id: 1482069-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 7
    In: Digestion, S. Karger AG, Vol. 91, No. 1 ( 2015), p. 50-56
    Kurzfassung: 〈 b 〉 〈 i 〉 Background/Aims: 〈 /i 〉 〈 /b 〉 Infliximab (IFX) is an effective treatment for maintaining clinical remission in patients with initially moderate-to-severe Crohn's disease (CD). However, a certain number of patients become unresponsive to IFX, subsequently requiring intensified therapy. The aim of this study was to compare the short- and long-term therapeutic efficacy of intensified regimens in CD patients who fail to respond to IFX. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 The clinical courses of 33 CD patients who failed to respond to treatment with IFX were investigated retrospectively. An intensified regimen involving doubling the dose of IFX was chosen in 13 patients (DD group) versus shortening the IFX interval in 13 patients (SI group) and switching to adalimumab (ADA) in 7 patients (SA group). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The clinical response and rate of clinical remission at 4 weeks were 62 and 54% in the DD group, 77 and 62% in the SI group and 57 and 43% in the SA group, respectively (p = 0.59 for clinical response, p = 0.90 for clinical remission). The rate of sustained remission at 48 weeks was 44% in the DD group, 54% in the SI group and 33% in the SA group (p = 0.88). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The short- and long-term efficacy of doubling the dose of IFX, shortening the interval of IFX or switching to ADA is similar for CD patients who no longer respond to IFX.
    Materialart: Online-Ressource
    ISSN: 0012-2823 , 1421-9867
    RVK:
    RVK:
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2015
    ZDB Id: 1482218-0
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 8
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 48, No. 1-2 ( 2019), p. 53-60
    Kurzfassung: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Prior stroke is a risk factor for stroke and bleeding during anticoagulation in patients with atrial fibrillation (AF). Although rivaroxaban is widely prescribed to reduce their risk of stroke in patients with nonvalvular AF (NVAF), the real-world evidence on rivaroxaban treatment is limited. We aimed to examine the outcomes of rivaroxaban treatment in NVAF patients with prior ischemic stroke/transient ischemic attack (TIA) by using the data of the Xarelto Post-Authorization Safety and Effectiveness Study in Japanese ­Patients with AF, a prospective, single-arm, observational study. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 The clinical outcomes of 9,578 patients who completed the 1-year follow-up were evaluated. Safety and effectiveness outcomes were compared between patients with and without prior ischemic stroke/TIA. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among the patients, 2,153 (22.5%) had prior ischemic stroke/TIA. They were significantly older and had lower body weight, lower creatinine clearance, higher CHADS 〈 sub 〉 2 〈 /sub 〉 , CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc, and modified HAS-BLED scores as compared to those without prior ischemic stroke/TIA. Any bleeding (9.1 vs. 7.2 events per 100 patient-years), major bleeding (2.3 vs. 1.6 events per 100 patient-years), and stroke/non-central nervous system systemic embolism/myocardial infarction (3.4 vs. 1.3 events per 100 patient-years) were more frequent in patients with prior ischemic stroke/TIA. Stepwise regression analysis suggested that body weight of ≤50 kg and diabetes mellitus were predictive of major bleeding in patients with prior ischemic stroke/TIA. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Safety and effectiveness event rates were higher in patients with prior ischemic stroke/TIA than those without. This might be explained by differences in several risk profiles including age, body weight, renal function, and risk scores such as CHADS 〈 sub 〉 2 〈 /sub 〉 between the groups. Clinicaltrials.gov: NCT01582737.
    Materialart: Online-Ressource
    ISSN: 1015-9770 , 1421-9786
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2019
    ZDB Id: 1482069-9
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 9
    In: Case Reports in Neurology, S. Karger AG, Vol. 8, No. 2 ( 2016-7-20), p. 156-160
    Kurzfassung: Rheumatoid meningoencephalitis (RM) is a rare complication of rheumatoid arthritis (RA). This report describes a 63-year-old man with complaints of high-grade fever, headache, and vomiting for several days before admission. Both his serum and cerebrospinal fluid were positive for anti-cyclic citrullinated peptide (CCP) antibody and rheumatoid factor, and contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (MRI) showed abnormal gadolinium enhancement of the meninges and high-intensity lesions in the subarachnoid spaces. The patient was diagnosed with RM despite lack of signs suggesting RA. His symptoms drastically improved with intravenous infusion of high-dose methylprednisolone. Two months later, he developed RA. The findings in this patient suggest that RM could develop prior to the onset of RA. Anti-CCP antibody and MRI findings may be useful for the diagnosis of RM, regardless of RA history.
    Materialart: Online-Ressource
    ISSN: 1662-680X
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2016
    ZDB Id: 2505302-4
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 10
    In: Cerebrovascular Diseases Extra, S. Karger AG, Vol. 9, No. 3 ( 2019-9-20), p. 98-106
    Kurzfassung: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Covert paroxysmal atrial fibrillation (CPAF) is a major cause of embolic stroke of undetermined source (ESUS). However, detecting PAF during hospitalization in these patients is difficult. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 This study aimed to determine whether findings of transesophageal echocardiography (TEE) during hospitalization are associated with later detection of PAF in patients with ESUS. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 We retrospectively studied 348 patients with ESUS who were admitted to our hospital within 1 week of onset. These patients met the criteria of ESUS, underwent TEE during hospitalization, and were followed up for at least 1 year. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We found PAF in 35 (10.0%) patients. In patients with PAF, spontaneous echo contrast (SEC) and low left atrial appendage flow (LAAF) by TEE and enlargement of the left atrial dimension (LAD) by transthoracic echocardiography were identified more frequently compared with those who did not have PAF. In multivariate analysis, SEC and an LAD ≥42 mm were independently associated with later detection of PAF ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.05). An association of LAAF & #x3c;46.9 cm/s and PAF was marginal ( 〈 i 〉 p 〈 /i 〉 = 0.09). The specificity of the combined finding of SEC and/or LAAF with that of LAD increased up to 90%, while that of LAD alone was 70%. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The findings of TEE during hospitalization may be useful for identifying patients at increased risk of CPAF in patients with ESUS.
    Materialart: Online-Ressource
    ISSN: 1664-5456
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2019
    ZDB Id: 2651613-5
    Standort Signatur Einschränkungen Verfügbarkeit
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