ABSTRACT
We aimed to characterize spontaneous cervical artery dissection (CeAD) patients with and without stroke and describe risk factors for cerebrovascular complications in a Chilean prospective cohort. METHODS: Consecutive CeAD patients admitted to a Chilean center confirmed by neuroimaging. Logistic regression was used. RESULTS: 168 patients were included, median follow-up time was 157 days. Stroke occurred in 49 (29.2%) cases, 4 (2%) patients died, all of whom had a stroke, and 10 (6%) presented CeAD recurrence. In univariate analyses, men (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.97-8.00, P < 0.001), internal carotid artery CeAD (OR 2.82, 95% CI 1.38-5.78, Pâ¯=â¯0.005) and vessel occlusion (OR 4.45, 95% CI 1.38-14.38, Pâ¯=â¯0.035) increased stroke risk. Conversely, vertebral artery dissection (OR 0.35, 95% CI 0.16-0.74, Pâ¯=â¯0.006) and longer symptom onset to admission (O-A) time (OR 0.79, 95% CI 0.70-0.90, P < 0.001) were associated to decreased stroke risk. After multivariate analysis, men (OR 2.88, 95% CI 1.32-6.27, Pâ¯=â¯0.008) and O-A time (OR 0.80, 95% CI 0.69-0.92, Pâ¯=â¯0.002) remained independently associated with stroke. CONCLUSION: CeAD presented commonly as a non-stroke entity, with favorable prognosis. Albeit to a higher frequency of CeAD in women, stroke occurred predominantly in men, who were admitted earlier.
Subject(s)
Stroke/epidemiology , Vertebral Artery Dissection/epidemiology , Adult , Cause of Death , Chile/epidemiology , Disability Evaluation , Female , Humans , Male , Middle Aged , Patient Admission , Prognosis , Prospective Studies , Recurrence , Risk Assessment , Risk Factors , Sex Factors , Stroke/diagnosis , Stroke/mortality , Stroke/therapy , Time Factors , Time-to-Treatment , Vertebral Artery Dissection/diagnostic imaging , Vertebral Artery Dissection/mortality , Vertebral Artery Dissection/therapyABSTRACT
BACKGROUND: The NIH Stroke Scale (NIHSS) is used to assess acute ischemic stroke severity and outcome. High NIHSS scores are usually associated with arterial occlusion but it is unknown what the effect of time to clinical evaluation (TTCE) in this association is. We tested the NIHSS scores as an instrument to determine vessel occlusion (VO) at different time points from symptom onset. METHODS: Patients were selected from our prospective stroke database if they had admission NIHSS scores and intracranial vessel neuroimaging studies. We dichotomized patients according to VO and TTCE. Receiver operating curves, c statistics, and odds ratios were calculated to study the validity of the NIHSS score. RESULTS: Among 463 patients (mean age 70.2 years, 53.1% male, median NIHSS 4, median TTCE 3.3 hours), 22.5% had arterial occlusion. Median NIHSS scores were higher in patients with VO, 10.5 (interquartile range 5-18) vs 3 (2-7), p<0.001, and in those with TTCE<6 hours, 15 (interquartile range 7-19) vs 4 (2-8) if ≥6 hours, p<0.001. Receiver operating characteristic curves showed that the validity of NIHSS in predicting VO was higher in patients with TTCE<6 hours, p=0.03. The best cutoff point in patients evaluated before 6 hours was an NIHSS of 7 (76.2% sensitivity, specificity 70.1%), while in patients evaluated after 6 hours the best cutoff point was 4 (sensitivity 65.4%, specificity 62.0%). CONCLUSIONS: Our study shows that the validity of NIHSS scores in predicting arterial occlusion is time-dependent, decreasing with increasing time from symptom onset to clinical evaluation.