Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

被引：35

作者：

Frid, Petrea ^{[1
,2
,3
]}

Drake, Mattias ^{[4
,5
]}

Giese, A. K. ^{[6
,7
]}

Wasselius, J. ^{[4
,5
]}

Schirmer, M. D. ^{[6
,8
,9
]}

Donahue, K. L. ^{[6
]}

Cloonan, L. ^{[6
]}

Irie, R. ^{[10
]}

Bouts, M. J. R. J. ^{[10
]}

McIntosh, E. C. ^{[10
]}

Mocking, S. J. T. ^{[10
]}

Dalca, A. V. ^{[8
,10
]}

Sridharan, R. ^{[8
]}

Xu, H. ^{[11
]}

Giralt-Steinhauer, E. ^{[12
]}

Holmegaard, L. ^{[13
,14
]}

Jood, K. ^{[13
,14
]}

Roquer, J. ^{[12
]}

Cole, J. W. ^{[15
,16
]}

McArdle, P. F. ^{[11
]}

Broderick, J. P. ^{[17
]}

Jimenez-Conde, J. ^{[12
]}

Jern, C. ^{[18
]}

Kissela, B. M. ^{[17
]}

Kleindorfer, D. O. ^{[17
]}

Lemmens, R. ^{[19
,20
,21
]}

Meschia, J. F. ^{[22
]}

Rundek, T. ^{[23
,24
]}

Sacco, R. L. ^{[23
,24
]}

Schmidt, R. ^{[25
]}

Sharma, P. ^{[26
,27
]}

Slowik, A. ^{[28
]}

Thijs, V. ^{[29
,30
]}

Woo, D. ^{[17
]}

Worrall, B. B. ^{[31
,32
]}

Kittner, S. J. ^{[15
,16
]}

Mitchell, B. D. ^{[11
,33
]}

Petersson, J. ^{[1
,2
]}

Rosand, J. ^{[6
,7
,10
,34
,35
]}

Golland, P. ^{[8
]}

Wu, O. ^{[10
]}

Rost, N. S. ^{[6
]}

Lindgren, A. ^{[1
,36
]}

机构：

[1] Lund Univ, Dept Clin Sci Lund, Neurol, Lund, Sweden

[2] Skane Univ Hosp, Dept Neurol & Rehabil Med, Neurol, Malmo, Sweden

[3] Skane Univ Hosp, Dept Neurol, Jan Waldenstroms Gata 19, S-20502 Malmo, Sweden

[4] Lund Univ, Dept Clin Sci Lund, Radiol, Lund, Sweden

[5] Skane Univ Hosp, Dept Radiol, Neuroradiol, Lund, Sweden

[6] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, J Philip Kistler Stroke Res Ctr, Boston, MA 02115 USA

[7] Broad Inst MIT & Harvard, Program Med & Populat Genet, Cambridge, MA 02142 USA

[8] MIT, Comp Sci & Artificial Intelligence Lab, Cambridge, MA 02139 USA

[9] German Ctr Neurodegenerat Dis DZNE, Dept Populat Hlth Sci, Bonn, Germany

[10] Harvard Med Sch, Massachusetts Gen Hosp, Athinoula A Martinos Ctr Biomed Imaging, Dept Radiol, Charlestown, MA USA

[11] Univ Maryland, Sch Med, Dept Med, Div Endocrinol Diabet & Nutr, Baltimore, MD 21201 USA

[12] Univ Autonoma Barcelona, IMIM Hosp del Mar, Inst Hosp del Mar Invest Med, Barcelona, Spain

[13] Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Dept Clin Neurosci, Gothenburg, Sweden

[14] Sahlgrens Univ Hosp, Dept Neurol, Gothenburg, Sweden

[15] Univ Maryland, Sch Med, Dept Neurol, Baltimore, MD 21201 USA

[16] Vet Affairs Maryland Hlth Care Syst, Baltimore, MD USA

[17] Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USA

[18] Univ Gothenburg, Sahlgrenska Acad, Inst Biomed, Gothenburg, Sweden

[19] Univ Leuven, KU Leuven, Dept Neurosci, Expt Neurol, Louvain, Belgium

[20] VIB Ctr Brain & Dis Res, Louvain, Belgium

[21] Univ Hosp Leuven, Dept Neurol, Louvain, Belgium

[22] Mayo Clin, Dept Neurol, Jacksonville, FL 32224 USA

[23] Univ Miami, Miller Sch Med, Dept Neurol, Miami, FL 33136 USA

[24] Univ Miami, Miller Sch Med, Evelyn F McKnight Brain Inst, Miami, FL 33136 USA

[25] Med Univ Graz, Dept Neurol, Clin Div Neurogeriatr, Graz, Austria

[26] Royal Holloway Univ London ICR2UL, Inst Cardiovasc Res, Egham, Surrey, England

[27] Ashford & St Peters Hosp, Ashford, Kent, England

[28] Jagiellonian Univ, Coll Med, Dept Neurol, Krakow, Poland

[29] Florey Inst Neurosci & Mental Hlth, Stroke Div, Heidelberg, Vic, Australia

[30] Austin Hlth, Dept Neurol, Heidelberg, Vic, Australia

[31] Univ Virginia, Dept Neurol, Charlottesville, VA USA

[32] Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USA

[33] Vet Adm Med Ctr, Geriatr Res & Educ Clin Ctr, Baltimore, MD 21218 USA

[34] Massachusetts Gen Hosp, Ctr Genom Res, Boston, MA 02114 USA

[35] Massachusetts Gen Hosp, Div Neurocrit Care & Emergency Neurol, Boston, MA 02114 USA

[36] Skane Univ Hosp, Dept Neurol & Rehabil Med, Neurol, Lund, Sweden

来源：

JOURNAL OF NEUROLOGY | 2020年 / 267卷 / 03期

基金：

瑞典研究理事会;

关键词：

Stroke; Posterior circulation brain infarction; Risk factors; Magnetic resonance imaging; Phenotyping; RISK-FACTORS; CAUSATIVE CLASSIFICATION; CONSECUTIVE PATIENTS; CEREBRAL INFARCTION; SUBTYPES; REGISTRY; DISEASE; GLUCOSE; SIGN;

D O I：

10.1007/s00415-019-09613-5

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Objective Posterior circulation ischemic stroke (PCiS) constitutes 20-30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. Methods Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. Results PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04-1.61; male sex, OR = 1.46; 95% CI 1.21-1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. Conclusion Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.

引用

页码：649 / 658

页数：10

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