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  • 1
    Online Resource
    Online Resource
    Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study
    Elsevier BV ; 2008
    In:  The Lancet Neurology Vol. 7, No. 3 ( 2008-03), p. 223-230
    Details
    In: The Lancet Neurology, Elsevier BV, Vol. 7, No. 3 ( 2008-03), p. 223-230
    Type of Medium: Online Resource
    ISSN: 1474-4422
    URL: Article
    DOI: 10.1016/S1474-4422(08)70026-7
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2008
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  • 2
    Online Resource
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    Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial
    Springer Science and Business Media LLC ; 2015
    In:  Neuroradiology Vol. 57, No. 1 ( 2015-01), p. 1-9
    Details
    In: Neuroradiology, Springer Science and Business Media LLC, Vol. 57, No. 1 ( 2015-01), p. 1-9
    Abstract: CT angiography (CTA) is often used for assessing patients with acute ischaemic stroke. Only limited observer reliability data exist. We tested inter- and intra-observer reliability for the assessment of CTA in acute ischaemic stroke. Methods We selected 15 cases from the Third International Stroke Trial (IST-3, ISRCTN25765518) with various degrees of arterial obstruction in different intracranial locations on CTA. To assess inter-observer reliability, seven members of the IST-3 expert image reading panel ( 〉 5 years experience reading CTA) and seven radiology trainees ( 〈 2 years experience) rated all 15 scans independently and blind to clinical data for: presence (versus absence) of any intracranial arterial abnormality (stenosis or occlusion), severity of arterial abnormality using relevant scales (IST-3 angiography score, Thrombolysis in Cerebral Infarction (TICI) score, Clot Burden Score), collateral supply and visibility of a perfusion defect on CTA source images (CTA-SI). Intra-observer reliability was assessed using independently repeated expert panel scan ratings. We assessed observer agreement with Krippendorff’s-alpha (K-alpha). Results Among experienced observers, inter-observer agreement was substantial for the identification of any angiographic abnormality (K-alpha = 0.70) and with an angiography assessment scale (K-alpha = 0.60–0.66). There was less agreement for grades of collateral supply (K-alpha = 0.56) or for identification of a perfusion defect on CTA-SI (K-alpha = 0.32). Radiology trainees performed as well as expert readers when additional training was undertaken (neuroradiology specialist trainees). Intra-observer agreement among experts provided similar results (K-alpha = 0.33–0.72). Conclusion For most imaging characteristics assessed, CTA has moderate to substantial observer agreement in acute ischaemic stroke. Experienced readers and those with specialist training perform best.
    Type of Medium: Online Resource
    ISSN: 0028-3940 , 1432-1920
    URL: Article
    DOI: 10.1007/s00234-014-1441-0
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 1462953-7
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  • 3
    Online Resource
    Online Resource
    Outcome After Conservative Management or Intervention for Unruptured Brain Arteriovenous Malformations
    American Medical Association (AMA) ; 2014
    In:  JAMA Vol. 311, No. 16 ( 2014-04-23), p. 1661-
    Details
    In: JAMA, American Medical Association (AMA), Vol. 311, No. 16 ( 2014-04-23), p. 1661-
    Type of Medium: Online Resource
    ISSN: 0098-7484
    URL: Article
    DOI: 10.1001/jama.2014.3200
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2014
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 4
    Online Resource
    Online Resource
    Brain Abnormalities Demonstrated by Magnetic Resonance Imaging in Adult IDDM Patients With and Without a History of Recurrent Severe Hypoglycemia
    American Diabetes Association ; 1997
    In:  Diabetes Care Vol. 20, No. 6 ( 1997-06-01), p. 1013-1018
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 20, No. 6 ( 1997-06-01), p. 1013-1018
    Abstract: Previous studies of a cohort of 100 patients with IDDM have shown that a history of recurrent severe hypoglycemia is associated with a modest impairment of cognitive function. The aim of the present study was to determine whether IDDM patients with and without a history of severe hypoglycemia have lesions in the brain that are identifiable by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) and to investigate the putative relationship of any structural brain abnormalities with cognitive function. RESEARCH DESIGN AND METHODS MRI and MRS of the brain were performed in 22 patients from the original cohort. Eleven IDDM patients with no history of severe hypoglycemia (group A) were compared with 11 IDDM patients who had a history of five or more episodes of severe hypoglycemia (group B). RESULTS Nine patients (41%) had abnormal scans. Two types of abnormalities were observed: high-intensity rounded lesions, & gt; 3 mm in diameters, distributed in the periventricular white matter (leukoaraiosis) in four patients; and cortical atrophy in five patients. Five patients in group B had cortical atrophy, whereas no patient in group A demonstrated this feature (P & lt; 0.05). MRS of the frontal and parietal lobes showed no differences in the N-acetyl aspartate/creatine or N-acetyl aspartate/choline ratios between groups A and B. Patients with cortical atrophy showed a nonsignificant trend toward reduced performance on Rapid Visual Information Processing. CONCLUSIONS Brain abnormalities demonstrated by MRI are common in patients with IDDM of long duration and are suggestive of premature aging of the brain. IDDM per se may be an important pathogenic factor, but a significant association was observed between a history of recurrent severe hypoglycemia and cortical atrophy, which may be related to the modest impairment of cognitive function that has been reported previously.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/diacare.20.6.1013
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 1997
    detail.hit.zdb_id: 1490520-6
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  • 5
    Online Resource
    Online Resource
    Scottish Intracranial Vascular Malformation Study (SIVMS) : Evaluation of Methods, ICD-10 Coding, and Potential Sources of Bias in a Prospective, Population-Based Cohort
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 5 ( 2003-05), p. 1156-1162
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 5 ( 2003-05), p. 1156-1162
    Abstract: Background and Purpose— The rarity of intracranial vascular malformations (IVMs) and the infrequency of their outcomes make large, prolonged cohort studies the best means to evaluate their frequency and prognosis. Methods— The Scottish Intracranial Vascular Malformation Study (SIVMS) is a prototype prospective, population-based study of adults resident in Scotland and diagnosed for the first time with an IVM after January 1, 1999. We evaluated the design of SIVMS using 2 complete years of data for adults with arteriovenous malformations (AVMs) of the brain. Results— A collaborative network of clinicians, radiologists, and pathologists, combined with coding of hospital discharge data and death certificates, recruited a cohort distributed in proportion to the Scottish population. Coding (with International Classification of Diseases, 10th Revision [ ICD-10 ] codes Q28.2 and I60.8) had a sensitivity of 72% (95% CI, 61% to 80%) and a positive predictive value of 46% (95% CI, 38% to 55%) for detecting incident brain AVMs. Adults who were detected by coding alone were significantly ( P 〈 0.05) younger, more likely to present with hemorrhage, more frequently investigated with catheter angiography, and more likely to be treated. Adults recruited from tertiary referral centers were significantly more likely to be investigated with catheter angiography and to be treated. Using catheter angiography as a diagnostic requirement for brain AVMs significantly biases the cohort toward younger adults presenting with hemorrhage and receiving treatment. Conclusions— Population-based studies of IVM frequency and prognosis should use multiple overlapping sources of case ascertainment, and such studies of brain AVMs should not require catheter angiography to be the diagnostic standard.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000069012.23858.69
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1467823-8
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  • 6
    Online Resource
    Online Resource
    Prospective, Population-Based Detection of Intracranial Vascular Malformations in Adults : The Scottish Intracranial Vascular Malformation Study (SIVMS)
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Stroke Vol. 34, No. 5 ( 2003-05), p. 1163-1169
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 34, No. 5 ( 2003-05), p. 1163-1169
    Abstract: Background and Purpose— Intracranial vascular malformations (IVMs) are an important cause of intracranial hemorrhage, epilepsy, and long-term disability in adults. There are no published prospective, population-based studies dedicated to the detection of any type of IVM (cavernous malformations, venous malformations, and arteriovenous malformations [AVMs] of the brain or dura). Therefore, we established the Scottish Intracranial Vascular Malformation Study (SIVMS) to monitor detection and long-term prognosis of people with IVMs. Methods— We used multiple overlapping sources of case ascertainment to identify adults (aged ≥16 years) with a first-ever-in-a-lifetime diagnosis of any type of IVM made between January 1, 1999, and December 31, 2000, while resident in Scotland (mid-1999 adult population estimate 4 110 956). Results— Of 418 notifications to SIVMS, 190 adults (45%) were included, 181 (95%) of whom were deemed to harbor a definite IVM after review of diagnostic brain imaging and/or reports of autopsy/surgical excision pathology. The crude detection rate (per 100 000 adults per year) was 2.27 (95% CI, 1.96 to 2.62) for all IVMs, 1.12 (95% CI, 0.90 to 1.37) for brain AVMs, 0.56 (95% CI, 0.41 to 0.75) for cavernous malformations, 0.43 (95% CI, 0.31 to 0.61) for venous malformations, and 0.16 (95% CI, 0.08 to 0.27) for dural AVMs. Conclusions— In addition to providing data on the public health importance and comparative epidemiology of IVMs, continuing recruitment and follow-up of this prospective, population-based cohort will provide estimates of IVM prognosis.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000069018.90456.C9
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Online Resource
    Arterial Obstruction on Computed Tomographic or Magnetic Resonance Angiography and Response to Intravenous Thrombolytics in Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 2 ( 2017-02), p. 353-360
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 2 ( 2017-02), p. 353-360
    Abstract: Computed tomographic angiography and magnetic resonance angiography are used increasingly to assess arterial patency in patients with ischemic stroke. We determined which baseline angiography features predict response to intravenous thrombolytics in ischemic stroke using randomized controlled trial data. Methods— We analyzed angiograms from the IST-3 (Third International Stroke Trial), an international, multicenter, prospective, randomized controlled trial of intravenous alteplase. Readers, masked to clinical, treatment, and outcome data, assessed prerandomization computed tomographic angiography and magnetic resonance angiography for presence, extent, location, and completeness of obstruction and collaterals. We compared angiography findings to 6-month functional outcome (Oxford Handicap Scale) and tested for interactions with alteplase, using ordinal regression in adjusted analyses. We also meta-analyzed all available angiography data from other randomized controlled trials of intravenous thrombolytics. Results— In IST-3, 300 patients had prerandomization angiography (computed tomographic angiography=271 and magnetic resonance angiography=29). On multivariable analysis, more extensive angiographic obstruction and poor collaterals independently predicted poor outcome ( P 〈 0.01). We identified no significant interaction between angiography findings and alteplase effect on Oxford Handicap Scale ( P ≥0.075) in IST-3. In meta-analysis (5 trials of alteplase or desmoteplase, including IST-3, n=591), there was a significantly increased benefit of thrombolytics on outcome (odds ratio 〉 1 indicates benefit) in patients with (odds ratio, 2.07; 95% confidence interval, 1.18–3.64; P =0.011) versus without (odds ratio, 0.88; 95% confidence interval, 0.58–1.35; P =0.566) arterial obstruction ( P for interaction 0.017). Conclusions— Intravenous thrombolytics provide benefit to stroke patients with computed tomographic angiography or magnetic resonance angiography evidence of arterial obstruction, but the sample was underpowered to demonstrate significant treatment benefit or harm among patients with apparently patent arteries. Clinical Trial Registration— URL: http://www.isrctn.com . Unique identifier: ISRCTN25765518.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.015164
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 8
    Online Resource
    Online Resource
    The Presentation and Clinical Course of Intracranial Developmental Venous Anomalies in Adults : A Systematic Review and Prospective, Population-Based Study
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Stroke Vol. 40, No. 6 ( 2009-06), p. 1980-1985
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 40, No. 6 ( 2009-06), p. 1980-1985
    Abstract: Background and Purpose— Reported risks of hemorrhage from intracranial developmental venous anomalies (DVAs) vary, so we investigated this in a systematic review and population-based study. Methods— We systematically reviewed the literature (Ovid Medline and Embase to November 7, 2007) and selected studies of ≥20 participants with ≥1 DVA(s) that described their clinical presentation and/or their clinical course over a specified follow-up period. We also identified every adult first diagnosed with a DVA in Scotland from 1999 to 2003 and followed them in a prospective, population-based study. Results— Of 2068 articles detected by the literature search, 15 met our inclusion criteria and described clinical presentation, 8 of which also described the clinical course of DVAs. In the 15 studies of 714 people first presenting with a DVA, 61% were incidental findings, the mode of presentation was unclear in 23%, 6% presented with nonhemorrhagic focal neurological deficit, 6% had caused symptomatic hemorrhage, 4% were associated with epileptic seizure, and 〈 1% were associated with infarction. In studies of the clinical course of 422 people with a DVA, the hemorrhage rate after first presentation ranged from 0% to 1.28% per year. In the population-based study of 93 adults with DVAs, 98% were incidental, 1% presented with symptomatic hemorrhage, and 1% presented with an infarct, but there were no symptomatic hemorrhages or infarcts in 492 person-years of follow-up (0% per person-year; 95% CI, 0% to 0.7%). Conclusions— Intracranial DVAs have a benign presentation and clinical course.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.108.533034
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Patterns of Brain Arteriovenous Malformation Treatment : Prospective, Population-Based Study
    Ovid Technologies (Wolters Kluwer Health) ; 2008
    In:  Stroke Vol. 39, No. 12 ( 2008-12), p. 3216-3221
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 39, No. 12 ( 2008-12), p. 3216-3221
    Abstract: Background and Purpose— The extent of variation in the interventional treatment of brain arteriovenous malformations (AVMs) is unknown, so we explored patterns of treatment at 4 neuroscience centers in one European country. Methods— We included every participant with an AVM in a prospective, population-based cohort study of adults aged ≥16 years residing in Scotland at the time of AVM diagnosis in 1999 to 2003. Results— Only 11 (5%) of the 229 adults were not managed at a neuroscience center. Adults who received interventional treatment were younger (median, 43 versus 54 years), more likely to have presented with hemorrhage (OR, 2.8; 95% CI, 1.6 to 4.9), and had smaller AVMs (median nidus diameter, 2 cm versus 3 cm; P =0.003) than those who did not. Adults seen at the 4 centers only differed in AVM Spetzler-Martin grade ( P =0.04). The 4 centers did not differ in the proportion of adults with AVMs who received interventional treatment ( P =0.16), but they differed in the Spetzler-Martin grade of the AVMs they treated (Grades III to IV, P =0.01) and the interventional treatments used ( P =0.004). The 2 largest centers differed from each other in the likelihood of surgical resection (OR, 0.2; 95% CI, 0.1 to 0.6) and stereotactic radiosurgery (OR, 2.8; 95% CI, 1.3 to 6.1), and the choice of modality varied within some Spetzler-Martin grades. Conclusions— Patient characteristics and patterns of AVM interventional treatment differ between neuroscience centers in the same population necessitating careful consideration of these factors when comparing one hospital’s outcome with another.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.108.523662
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2008
    detail.hit.zdb_id: 1467823-8
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  • 10
    Online Resource
    Online Resource
    Observer Agreement in the Angiographic Assessment of Arteriovenous Malformations of the Brain
    Ovid Technologies (Wolters Kluwer Health) ; 2002
    In:  Stroke Vol. 33, No. 6 ( 2002-06), p. 1501-1508
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 6 ( 2002-06), p. 1501-1508
    Abstract: Purpose — We aimed to determine intraobserver and interobserver agreement in the characterization of brain arteriovenous malformation (AVM) angioarchitecture on intra-arterial digital subtraction angiograms. Methods — Five experienced interventional neuroradiologists independently reviewed 40 anonymized angiograms obtained at the time of first-ever AVM diagnosis. The allocation of the films to observers was balanced for AVM size and complexity. Every observer was compared with himself and all the others by distributing the films in 2 batches 3 months apart. The observers used standard forms to collect both quantitative and categorized qualitative angiographic data. To measure agreement we used the kappa statistic (κ) for nominal data, weighted κ for ordinal and discrete interval data, and Bland & Altman analysis for continuous data. Results — Intraobserver agreement was generally moderate to substantial, with 95% confidence intervals ranging from fair to almost perfect. However, for every characteristic, interobserver agreement was less than intraobserver agreement. Interobserver agreement was generally slight to moderate, with 95% confidence intervals ranging from less than chance to almost perfect. Conclusion — This study demonstrates the need for robust and generalizeable definitions of AVM angioarchitecture and methods of nidus size measurement—with proof of good intraobserver and interobserver agreement—for future efforts to understand the prognosis and best treatment of AVMs.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/01.STR.0000018318.83802.18
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2002
    detail.hit.zdb_id: 1467823-8
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