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  • 1
    Online Resource
    Online Resource
    Periodontal Disease as a Risk Factor for Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Stroke Vol. 35, No. 2 ( 2004-02), p. 496-501
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 2 ( 2004-02), p. 496-501
    Abstract: Background and Purpose— Chronic infectious diseases may increase the risk of stroke. We investigated whether periodontal disease, including periodontitis and gingivitis, is a risk factor for cerebral ischemia. Methods— We performed a case-control study with 303 patients examined within 7 days after acute ischemic stroke or transient ischemic attack, 300 population controls, and 168 hospital controls with nonvascular and noninflammatory neurological diseases. All subjects received a complete clinical and radiographic dental examination. The individual mean clinical attachment loss measured at 4 sites per tooth served as the main indicator for periodontitis. Results— Patients had higher clinical attachment loss than population ( P 〈 0.001) and hospital ( P =0.010) controls. After adjustment for age, sex, number of teeth, vascular risk factors and diseases, childhood and adult socioeconomic conditions, and lifestyle factors, the risk of cerebral ischemia increased with more severe periodontitis. Subjects with severe periodontitis (mean clinical attachment loss 〉 6 mm) had a 4.3-times-higher (95% confidence interval, 1.85 to 10.2) risk of cerebral ischemia than subjects with mild or without periodontitis (≤3 mm). Severe periodontitis was a risk factor in men but not women and in younger ( 〈 60 years) but not older subjects. Periodontitis increased the risk of cerebral ischemia caused by large-artery atherosclerosis, cardioembolism, and cryptogenic etiology. Gingivitis and severe radiologic bone loss were also independently associated with the risk of cerebral ischemia, whereas caries was not. Conclusions— Our study indicates that periodontal disease, a treatable condition, is an independent risk factor for cerebral ischemia in men and younger subjects.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000110789.20526.9D
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
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  • 2
    Online Resource
    Online Resource
    Stroke Recurrence in Patients with Patent Foramen Ovale after Cerebral Ischemia
    Ovid Technologies (Wolters Kluwer Health) ; 2001
    In:  Stroke Vol. 32, No. suppl_1 ( 2001-01), p. 377-377
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. suppl_1 ( 2001-01), p. 377-377
    Abstract: P207 Paradoxical embolism through a patent foramen ovale (PFO) is a potential cause for ischemic stroke, particularly in younger patients. Longterm data concerning stroke recurrence in patients with PFO is scarce. We performed a longterm follow-up in patients with PFO, diagnosed in association with cerebral ischemia in our department from 1991 to 1997. We performed telephone interviews with a standardized questionnaire and neurologic examinations. PFO-size was assessed semiquantitatively as described before ( 〈 10; 10–99; 〉 99). Univariate and multivariate tests were performed for all potential risk factors of stroke recurrence in patients with PFO. We examined 281 patients with a mean age of 48 years and a mean follow-up interval of 39 months. Recurrent cerebral ischemia occured in 59 patients. Recurrence rate was 6.9% per year. In patients on warfarin, recurrence rate was significantly lower than in patients on aspirin or without therapy (4.2% per year, p= 0.001). In patients without therapy, stroke recurrence rate was significantly higher than in patients on warfarin or aspirin (13% per year, p= 0.002). Recurrence was not associated with PFO-size and spontaneous shunt. Ventricular septum aneurysm (VSA) was not more frequent in patients with recurrent stroke. Recurrence rate was significantly higher in patients with concurrent etiologies (p= 0.001). Stroke recurrence rate in patients with PFO after cerebral ischemia is higher in this large series than in some smaller previous series. Warfarin significantly lowers stroke recurrence rate. Surprisingly, recurrence rate was not associated with PFO-size, spontaneous shunt or VSA. Thererfore, no subgroups could be identified, which are at higher risk. Anticoagulation seems the treatment of choice for secondary prevention, independent from PFO-size or spontaneous shunt.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.32.suppl_1.377-a
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2001
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  • 3
    Online Resource
    Online Resource
    Lack of association between polymorphisms of the toll-like receptor 4 gene and cerebral ischemia
    Springer Science and Business Media LLC ; 2004
    In:  Journal of Neurology Vol. 251, No. 7 ( 2004-7)
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 251, No. 7 ( 2004-7)
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s00415-004-0447-7
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2004
    detail.hit.zdb_id: 1421299-7
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  • 4
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    Leukocyte Count as an Independent Predictor of Recurrent Ischemic Events
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Stroke Vol. 35, No. 5 ( 2004-05), p. 1147-1152
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 5 ( 2004-05), p. 1147-1152
    Abstract: Background and Purpose— Inflammatory markers predict first-time ischemic events. We investigated whether leukocyte and differential counts predict recurrent events and ischemic events in high-risk populations, and whether such events are preceded by acutely exacerbated inflammation. Methods— We studied 18 558 patients with ischemic stroke, myocardial infarction, or peripheral arterial disease who participated in the trial of Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE), a study that compared the occurrence of ischemic stroke, myocardial infarction, or vascular death under randomized treatment with aspirin or clopidogrel. Leukocyte counts were frequently assessed during followup. Results— Compared with the quartile with lowest leukocyte counts at baseline ( 〈 5.9×10 9 /L), patients in the top quartile ( 〉 8.2×10 9 /L) had higher risks for ischemic stroke (relative risk 1.30; P =0.007), myocardial infarction (relative risk 1.56, P 〈 0.001), and vascular death (relative risk 1.51; P 〈 0.001) after adjustment for other risk factors. Neutrophil counts contributed most to increased risk. Assessments of regression dilution effects based on replicate measurements show that these risk associations may underestimate the real associations by 30 to 50%. Treatment with aspirin or clopidogrel did not influence predictive effects by leukocytes. In the week before a recurrent event, but not at earlier time points, the leukocyte count was significantly increased over baseline levels (n=211; mean difference +0.46×10 9 /L; P =0.005). Conclusions— Leukocyte counts and mainly neutrophil counts are independently associated with ischemic events in these high-risk populations. An increase of leukocyte counts over baseline levels heralds a period of increased risk lasting about one week.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000124122.71702.64
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
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  • 5
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    Online Resource
    Editorial Comment: Stroke and the CD40-CD40 Ligand System: At the Hinge Between Inflammation and Thrombosis
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 6 ( 2003-06), p. 1417-1418
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 6 ( 2003-06), p. 1417-1418
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000076520.37414.91
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
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  • 6
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    Online Resource
    Association Between Cerebral Ischemia and Cytotoxin-Associated Gene-A–Bearing Strains of Helicobacter pylori
    Ovid Technologies (Wolters Kluwer Health) ; 2004
    In:  Stroke Vol. 35, No. 8 ( 2004-08), p. 1800-1804
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 35, No. 8 ( 2004-08), p. 1800-1804
    Abstract: Background and Purpose— Studies on Helicobacter pylori infection and risk of ischemic stroke yielded variable results. Infection with more virulent H. pylori strains, such as cytotoxin-associated gene-A (CagA)–bearing strains, may be of particular relevance for ischemic diseases. We investigated whether H. pylori and CagA seropositivity are independent risk factors for cerebral ischemia or its etiologic subtypes. Methods— We determined IgG antibodies against H. pylori and CagA protein (enzyme immunoassays) in 190 patients with acute cerebral ischemia and in 229 age- and sex-matched control subjects selected randomly from the general population. Results— CagA seropositivity was more common in patients (114/190; 60.0%) than in control subjects (99/229; 43.2%; odds ratio, 1.97; 95% CI, 1.33 to 2.91; P 〈 0.001). This result remained significant after adjustment for age, sex, vascular risk factors and diseases, and childhood and adult social status (odds ratio, 1.84; 95% CI, 1.13 to 3.00; P =0.015). Subgroup analyses yielded similar results in all etiologic stroke subtypes. In contrast, H. pylori seropositivity in general was not associated with increased risk of stroke or its etiologic subtypes. Conclusions— Our results support the hypothesis of an association between infection with CagA-positive H. pylori strains and acute cerebral ischemia.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000131751.35926.48
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2004
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  • 7
    Online Resource
    Online Resource
    New Method of Embolus Preparation for Standardized Embolic Stroke in Rabbits
    Ovid Technologies (Wolters Kluwer Health) ; 2002
    In:  Stroke Vol. 33, No. 9 ( 2002-09), p. 2329-2333
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 9 ( 2002-09), p. 2329-2333
    Abstract: Background and Purpose— Although thromboembolic stroke is caused by red, white, or mixed clots, the emboli previously used in animal studies on thrombolysis were more often red than white. Because this might be one of the reasons why thrombolysis is less effective in patients than in experimental stroke, we developed a new method of preparing highly standardized red and fibrin-rich white emboli. Methods— The middle cerebral artery of 20 rabbits was embolized with either red or fibrin-rich white autologous emboli. Cerebral perfusion was monitored by MRI. Results— Red emboli consisted of closely packed erythrocytes within a sparse fibrin net and white emboli of a dense mass of fibrin with only few other blood cells. Infarct volumes were 26±4% (mean±SD) of the ischemic hemisphere with red and 27±6% with white emboli. The relative regional cerebral blood volume dropped below 50% 90 minutes after vascular occlusion with either type of embolus. Late spontaneous lysis and hemorrhagic complications occurred in 37.5% of red but not in white embolus cases. Conclusions— Emboli prepared by our technique result in standardized cerebral infarctions. Size and composition of the emboli continuously can be adjusted according to the experimental requirements.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000027436.82700.73
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2002
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  • 8
    Online Resource
    Online Resource
    Platelet Function Under Aspirin, Clopidogrel, and Both After Ischemic Stroke : A Case-Crossover Study
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 4 ( 2003-04), p. 849-854
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 4 ( 2003-04), p. 849-854
    Abstract: Background and Purpose— Combined antiplatelet agents may offer additive protection over single drugs after stroke. We investigated whether platelet activation is reduced under combined aspirin and clopidogrel compared with each drug alone. Methods— In a case-crossover study, 31 patients with previous atherothrombotic or lacunar stroke who were treated with aspirin (100 to 300 mg/d) received clopidogrel (75 mg/d) and both aspirin and clopidogrel for 4 weeks. Platelet function in whole blood was studied after each treatment period and in healthy control subjects to assess activation-dependent antigens CD62p and CD63 by flow cytometry and collagen/epinephrine (CEPI-CT) and collagen/ADP (CADP-CT) closure times with the platelet function analyzer PFA-100, which investigates platelet-related function under shear stress. Results— CD62p expression and CD63 expression were not different under the 3 treatment regimens. CD63 but not CD62p expression was lower in control subjects than in stroke patients regardless of the antiplatelet treatment ( P 〈 0.05). CEPI-CT was prolonged under aspirin and aspirin plus clopidogrel compared with clopidogrel monotherapy ( P 〈 0.0001). CADP-CT was longer under combination therapy than under aspirin ( P =0.0009) or clopidogrel ( P =0.0074) or in control subjects ( P =0.0010), mainly because of strong prolongation in a patient subgroup (28%). Conclusions— CD63 expression reflecting the release of platelet lysosomes is consistently increased after stroke and incompletely suppressed by treatment with aspirin, clopidogrel, or both. The strong prolongation of CADP-CT under combined aspirin and clopidogrel in a patient subgroup may indicate a lower risk of thrombosis but also a higher risk of hemorrhage. The predictive value of platelet activation parameters requires investigation in prospective studies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000064326.65899.AC
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
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  • 9
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    Online Resource
    Lack of Evidence for Pulmonary Venous Thrombosis in Cryptogenic Stroke : A Magnetic Resonance Angiography Study
    Ovid Technologies (Wolters Kluwer Health) ; 2002
    In:  Stroke Vol. 33, No. 5 ( 2002-05), p. 1416-1419
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 5 ( 2002-05), p. 1416-1419
    Abstract: Background — Even after extensive evaluation, the etiology of ischemic stroke remains undefined in a considerable proportion of cases, suggesting that causes of stroke may exist that have not yet been established. We tested the hypothesis that pulmonary venous thrombosis (PVT) is a potential source of brain embolism in patients with cryptogenic stroke. Summary of Report — Within 7 days after mild to moderately severe ischemic stroke or transient ischemic attack, 18 patients (9 women, 9 men; mean age, 48 years) were studied in whom the etiology remained undefined despite complete workup. All patients received high-resolution pulmonary venography with the use of multiple-bolus, multiphase, 3-dimensional, gadolinium-enhanced MR angiography (MRA). Overall quality of the MRA was good in 14 and insufficient in 4 patients, mainly as a result of breathing artifacts. Visualization of the main and segmental veins and evaluability of their patency were good for most right pulmonary veins but often inadequate for left pulmonary veins, particularly for those in the left lower lobe. There was no evidence for PVT in any of the sufficiently visualized pulmonary veins. Conclusions — The results do not support the hypothesis of PVT as a contributor to the etiology of ischemic stroke. However, the study was limited regarding scan volume, spatial discrimination, patient selection, and delay between ischemia and MRA. Therefore, further investigations, including postmortem studies, are needed to resolve the question of whether PVT may contribute to ischemic stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000013665.55200.73
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2002
    detail.hit.zdb_id: 1467823-8
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