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Cervical artery dissection in patients >= 60 years Often painless, few mechanical triggers

By Christopher Traenka, Daphne Dougoud, Barbara Goeggel Simonetti, Tiina Maria Metso, Stephanie Debette, Alessandro Pezzini, Manja Kloss, Caspar Grond-Ginsbach, Jennifer J. Majersik, Bradford B. Worrall, Didier Leys, Ralf Baumgartner, Valeria Caso, Yannick Bejot, Annette Compter, Peggy Reiner, Vincent Thijs, Andrew M. Southerland, Anna Bersano, Tobias Brandt, Henrik Gensicke, Emmanuel Touze, Juan J. Martin, Hugues Chabriat, Turgut Tatlisumak, Philippe Lyrer, Marcel Arnold and Stefan T. Engelter

Abstract

Objective: In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged >= 60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged = 60 years. Methods: We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i. e., Cervical Artery Dissection and Ischemic Stroke Patients-Plus consortium). We dichotomized cases into 2 groups, age >= 60 and Results: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged >= 60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 3.08 [2.25-4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i. e., modified Rankin Scale score 0-2) was less frequent in the older age group (ORadjusted 0.45 [0.25, 0.83]). Conclusion: In our study population of patients diagnosed with CeAD, 1 in 14 was aged >= 60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk ofmissed CeAD diagnosis in older patients

Topics: BRAIN-SUPPLYING ARTERIES, ISCHEMIC-STROKE PATIENTS, VASCULAR RISK-FACTORS, VERTEBRAL ARTERY, CAROTID-ARTERY, YOUNG-ADULTS, MIGRAINE, CADISP, PREVALENCE, FEATURES, 3124 Neurology and psychiatry, BRAIN-SUPPLYING ARTERIES, ISCHEMIC-STROKE PATIENTS, VASCULAR RISK-FACTORS, VERTEBRAL ARTERY, CAROTID-ARTERY, YOUNG-ADULTS, MIGRAINE, CADISP, PREVALENCE, FEATURES, 3124 Neurology and psychiatry
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Year: 2017
OAI identifier: oai:helda.helsinki.fi:10138/180297
Journal:

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