12 research outputs found

    The presence and severity of cerebral small vessel disease increases the frequency of stroke in a cohort of patients with large artery occlusive disease

    No full text
    <div><p>Background</p><p>Cerebral small vessel disease (SVD) commonly coexists with large artery atherosclerosis (LAA).</p><p>Aim</p><p>We evaluate the effect of SVD on stroke recurrence in patients for ischemic stroke with LAA.</p><p>Methods</p><p>We consecutively collected first-ever ischemic stroke patients who were classified as LAA mechanism between Jan 2010 and Dec 2013. Univariate and multivariate Cox analyses were performed to evaluate the association between the 2-year recurrence and demographic, clinical, and radiological factors. To evaluate the impact of SVD and its components on recurrent stroke, we used the Kaplan-Meier analysis. SVD was defined as the presence of severe white matter hyperintensity (WMH) or old lacunar infarction (OLI) or cerebral microbleeds (CMB). We also compared frequency and burden of SVD among recurrent stroke groups with different mechanisms.</p><p>Results</p><p>Among a total of 956 participants, 92 patients had recurrent events. Recurrence group showed a higher frequency of severe WMH, OLI, asymptomatic territorial infarction, and severe stenosis on the relevant vessel in multivariate analysis. The impact of SVD and its components on recurrent stroke was significant in any ischemic recurrent stroke, and the presence of SVD was continuously important in stroke recurrence regardless of its mechanism, including recurrent LAA stroke, recurrent small vessel occlusion stroke, and even recurrent cardioembolic stroke. Additionally, the recurrence rate increased in dose-response manner with the increased number of SVD components.</p><p>Conclusions</p><p>Cerebral SVD is associated with recurrent stroke in patients with LAA. Additionally, it may affect any mechanisms of recurrent stroke and even with a dose response manner.</p></div

    Acoustic Characteristics of Stridor in Multiple System Atrophy

    No full text
    <div><p>Nocturnal stridor is a breathing disorder prevalent in patients with multiple system atrophy (MSA). An improved understanding of this breathing disorder is essential since nocturnal stridor carries a poor prognosis (an increased risk of sudden death). In this study, we aimed to classify types of stridor by sound analysis and to reveal their clinical significance. Patients who met the criteria for probable MSA and had undergone polysomnography (PSG) were recruited. Patients were then assessed clinically with sleep questionnaires, including the Pittsburgh Sleep Quality Index, and the Hoehn and Yahr scale. Nocturnal stridor and snoring were analyzed with the Multi-Dimensional Voice Program. Nocturnal stridor was recorded in 22 patients and snoring in 18 patients using the PSG. Waveforms of stridors were classified into rhythmic or semirhythmic after analysis of the oscillogram. Formants and harmonics were observed in both types of stridor, but not in snoring. Of the 22 patients diagnosed with stridor during the present study, fifteen have subsequently died, with the time to death after the PSG study being 1.9 ± 1.4 years (range 0.8 to 5.0 years). The rhythmic waveform group presented higher scores on the Hoehn and Yahr scale and the survival outcome of this group was lower compared to the semirhythmic waveform group (p = 0.030, p = 0.014). In the Kaplan Meier’s survival curve, the outcome of patients with rhythmic waveform was significantly less favorable than the outcome of patients with semirhythmic waveform (log-rank test, p < 0.001). Stridor in MSA can be classified into rhythmic and semirhythmic types and the rhythmic component signifies a poorer outcome.</p></div

    Kaplan-Meier analysis of waveform-specific survival rate in patients with MSA stridor.

    No full text
    <p>Patients with rhythmic waveform (n = 9) have a significantly worse prognosis than those with semirhythmic waveform (n = 13) (Log rank test, p<0.001)</p

    Recurrent stroke with the number of components of small vessel disease.

    No full text
    <p>Number of components of small vessel disease showed a dose-response manner with 2-year recurrent stroke both in the Kaplan-Meier analysis (<i>P</i> < 0.001) (A) and univariate Cox regression analysis adjusted by survival time (<i>P</i> < 0.001) (B).</p

    Recurrent stroke between with and without SVD, severe WMH, OLI, or CMB.

    No full text
    <p>Recurrent stroke rate was significantly higher in the group with small vessel disease (A) (<i>P</i> < 0.001), severe white matter hyperintensity (B) (<i>P</i> < 0.001), old lacunar infarction (C) (<i>P</i> < 0.001), or cerebral microbleeds (D) (<i>P</i> < 0.001).</p
    corecore