Ivana Divjak

Non-atherosclerotic arteriopathy as the cause of ishemic stroke among young adults

The study comprised 100 ischemic stroke patients of both sexes aged 15-45 years who were treated at the Clinic of Neurology of the Clinical Center of Vojvodina in the period January 2001-September 2004. All study subjects were divided into three age groups: 15-25, 26-35 and 36-45 years. Sex, age and risk factors for cerebrovascular disease were determined in all patients. Diagnostic procedures applied in all patients included brain computed tomography and/or magnetic resonance imaging, routine laboratory tests, Doppler imaging of extra and endocranial blood vessels and coagulation tests. Contrast and/or transesophageal echocardiography, immunological blood assays, magnetic resonance angiography and/or computed tomography angiography and/or conventional angiography, thrombophilia markers, antiphospholipid antibodies and toxicological examination, etc. were performed in selected patients. Non-atherosclerotic arteriopathies were found in 8% of all study subjects, and were the most frequent cause of stroke in the age group 15-25. Carotid artery dissection was the most frequent diagnosis overall, found in 6% of all patients. Fibromuscular dysplasia and systemic vasculitis were diagnosed in one patient each. Moyamoya disease, Takayasu disease, infectious and isolated vasculitis of the CNS were not found in our patients.

Association between Apolipoproteins AI and B and Ultrasound Indicators of Carotid Atherosclerosis

BACKGROUND Apolipoproteins A-I and B (apoA-I and apoB) may be better indicators of the risk of cardiovascular and cerebrovascular diseases than conventional risk factors (RFs). The onset of ischemic stroke (IS) may be preceded by the development of atherosclerotic changes in carotid arteries, which can be detected by ultrasound. Only a certain % of patients with IS have an (underlying) carotid etiology. OBJECTIVE The aim of our study was to determine the association between ultrasound indicators of carotid atherosclerosis and the presence of apolipoproteins and other biomarkers in patients with IS. METHODS The study included 120 patients with clinically first, non-cardioembolic ischemic stroke in the carotid circulation. For all patients the following data were recorded: risk factors (hypertension, diabetes, hyperlipoproteinemia, smoking, obesity, metabolic syndrome, (MetS) hyperhomocysteinemia and inflammation), and levels of blood pressure, glucose, glycosylated hemoglobin, lipids, apoA-I and apoB apolipoproteins, body mass index, homocysteine, and C-reactive protein (CRP). Carotid duplex ultrasound was used to measure carotid intima media thickness (cIMT) and determine the presence of an unstable (hypoechogenic) plaque. RESULTS The most significant associations were found between cIMT and older age (β=0.230; p=0.006), lower concentrations of apoA-I (β=-0.244; p=0.008) and a higher apoB/apoA-I ratio (β=0.247; p=0.007). The presence of a hypoechogenic plaque was most significantly associated with increased concentrations of apoB (OR=2.29; 95% CI=4.9-173.5; p<0.0001), the presence of MetS (OR=9.2; 95% CI=2.9-29.2; p<0.0001) and elevated CRP (OR=2.7; 95% CI=1.1-6.9; p = 0.046). CONCLUSION Among RFs and their biomarkers, apoA-I, apoB and the apoB/apoA-I ratio showed strong association with ultrasound indicators of carotid atherosclerosis in IS patients.

EHMTI-0137. Headache as an initial clinical symptom of carotid artery dissection.

Results Average age of patients was 47,4 (28-59) years. From a total of 31 patients, there were 27 with unilateral and 4 with bilateral CAD. Facial and neck pain and Horner’s syndrome were the only presenting symptoms in 6 patients; headache and visual disturbances in 2; headache and tinnitus in 1; facial pain, Horner’s syndrome and contralateral sensorimotor deficit in 7; headache and contralateral sensorimotor deficit in 5; contralateral sensorimotor deficit in 10. CAD was spontaneous in 24 patients while in 7 was triggered by mild trauma. MRI revealed infarction in 22 patients. Between patients without brain infarction, 6 patients presenting with facial and neck pain and Horner’s syndrome, 2 with headache and visual disturbances and 1 with headache and tinnitus. Good outcome (defined as modified Rankin score of 0-2) was seen in 28 patients (90,3%). Conclusion CAD was associated with headache in 21 patients (67,7 %). However, the clinical presentation of CAD is variable and can be similar to other etiology of stroke. No conflict of interest.

Factors predisposing to cervical artery dissection

INTRODUCTION Cervical artery dissection is a major cause of cerebral ischemia in young adults and can lead to various clinical symptoms, some of which are benign (e.g. headache, neck pain, Horners syndrome, and cranial nerve palsy). However, most patients have a stroke or transient ischemic attack. EPIDEMIOLOGY The incidence of cervical artery dissection is low and is estimated to be around 2.6 per 100,000 inhabitants. Mortality and short-term recurrence rates are low: however; they may have been underestimated. PATHOPHYSIOLOGY Although the pathophysiology is still unclear constitutional and partly genetic susceptibility of the arterial wall has been proposed as a causal factor; triggered by infection or minor trauma. PREDISPOSING FACTORS: In addition to the trauma to the neck, other risk fractors have been suggested, such as infection, migraine, hyperhomocisteinamia, and the 67TT genotype of the 5,10-methylene-tetrahydrofolate reductase gene although evidence is sparse. GENETIC FACTORS Cervical artery dissection is now considered a multifactorial disease caused by several genetic abnormalities and environmental factors acting synergistically. CONCLUSION Research aimed at improving our understanding of the environmental and genetic factors predisposing to cervical artery dissection and assessment of long-term outcomes of this disease is needed. Better understanding of the underlying pathophysiology and the natural history of the disease through large prospective multicentre cohorts could also be helpful to improve therapeutic and preventive strategies. Several mutlticentre efforts are already under way to meet these needs.