Association of obesity with recurrent stroke and cardiovascular events.

BACKGROUND AND PURPOSE: The relation between obesity and stroke recurrence is still under debate. In this study, we investigated whether initial obesity was associated with recurrent stroke and major cardiovascular events over a long period of time. MATERIALS AND METHODS: Five-years follow-up data of the Ege Stroke Registry for stroke recurrence and cardiovascular events related to obesity were analyzed. Data include age, gender, stroke severity, neuroimaging studies, cardiovascular risk factors. Within the inclusion period, all of the included patients were followed until censoring (10th of December 2011) or readmission because of recurrent stroke, cardiovascular event or death, whichever came first. The Kaplan-Meier method was used for survival analysis. Cox proportional hazard model was applied to identify predictors of stroke and all major vascular events. RESULTS: Of 9285 eligible patients for evaluation, 5158 (56%) were male and 3068 (33%) with a prior stroke were obese at baseline. Among 2198 patients with recurrent stroke, 843 (38%) had obesity while 2229 (62%) had no obesity (HR, 1.36; 95% CI, 1.23-1.50; P<0.001). Overall major vascular events (recurrent stroke, cardiovascular events, and death) occurred in 1464 obese patients (48%) and in 2182 non-obese patients (35%) (HR, 1.69; 95%CI, 1.55-1.84). Cox hazard model showed that being obese was associated with increased recurrent stroke risk compared with those without obesity (HR, 0.85; 95%CI, 0.76-0.94; P<0.001), being obese was not associated with cardiovascular events (HR, 1.09; 95%CI, 0.95-1.26; P=0.22). CONCLUSIONS: Our results showed that obesity is a significant risk factor for recurrent stroke, although obesity was not associated significantly with myocardial infarction and death after 5-years of first stroke. Further clinical goal-directed weight reduction outcome trials in this area will be critical to validate the most effective approaches and, ultimately, to guide policy is certainly needed.

Limb shaking transient ischemic attacks: A follow-up of 28 patients.

BACKGROUND: Limb shaking transient ischemic attack (LSTIA) is an uncommon picture of carotid-occlusive disease. The symptoms are a seizure like activity and misdiagnosed as partial motor seizures. We here present a series of patients in our registry who had limb-shaking activities and their long-term outcome after treatment of their disease. METHODS: A total of 28 patients with limb shaking symptoms were recruited among 798 patients with TIA in our stroke registry. Risk factors and etiology of LSTIA were examined within hospitalization. After the initiaition of treatment patients were followed for a median of 6months. RESULTS: Limb-shaking was observed mainly on the hand-arms (46%), and secondly on the legs (39%). We found five different DWI lesion patterns in patients with LSTIA, including unilateral or bilateral either cortical or borderzone ischemic hyperintensities. Carotid endarterectomy was performed in 9 (32%) patients and carotid angioplasty-stent (CAS) in 10 (36%), and after 6-months of follow-up none of the patients had LSTIA. Limb shaking continued only in a patient with chronic carotid occlusion who received only conservative treatment. CONCLUSIONS: Limb shaking TIA point to carotid artery disease in the majority of patients and vertebrobasilar artery disease in one third. Fast and timely treatment with either surgical or CAS eliminates the attacks and also reduce their risk of stroke.