1.Clinical Course and Recurrence in Transient Global Amnesia:A Study From the TEMPiS Telestroke Network
Shadi TAHERI ; Nils PETERS ; Annaelle ZIETZ ; Berthold ABEL ; Gordian HUBERT ; Filip BARINKA ; Hanni WIESTLER ; Irena KOVACIC ; Ralf LINKER ; Felix SCHLACHETZKI ; Roland BACKHAUS
Journal of Clinical Neurology 2023;19(6):530-538
Background:
and Purpose While the clinical hallmarks of transient global amnesia (TGA) are well defined, its pathophysiological causes are poorly understood. Specifically, risk factors for recurrences are yet to be determined.
Methods:
This retrospective study analyzed TGA cases diagnosed and treated within the TEMPiS telestroke network and a university stroke center in Germany. Demographic and clinical data were assessed and characteristics of TGA episodes were recorded, such as season of occurrence, trigger factors, duration, and concomitant symptoms. Follow-up of the potential recurrence of TGA was performed using a standardized questionnaire.
Results:
Overall 109 patients were included (age 64±8 years [mean±SD], 59.6% female). The most common vascular risk factor was arterial hypertension (60.6%), and other concomitant conditions included migraine (11.9%), hypothyroidism (22.9%), and atrial fibrillation (4.6%). The most frequent concomitant clinical feature accompanying the TGA episode at admission was elevated blood pressure (48.6%). Nineteen patients experienced at least one recurrent TGA episode. Migraine and hypothyroidism were only observed in subjects with a single TGA episode without recurrence (migraine: 14.4% without recurrence vs. none in the recurrence group, p=0.02; hypothyroidism: 27.8% without recurrence vs. none in the recurrence group, p=0.009). In contrast, atrial fibrillation was more common in subjects with TGA recurrence (p<0.001).
Conclusions
Arterial hypertension is prevalent in TGA patients, with elevated blood pressure being the most-frequent concomitant condition. In our cohort, recurrence of TGA occurred in approximately one-fifth of patients. Concomitant conditions such as migraine, hypothyroidism, and atrial fibrillation occurred at different frequencies in the two groups.
2.Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage
Martina B. GOELDLIN ; Achim MUELLER ; Bernhard M. SIEPEN ; Madlaine MUELLER ; Davide STRAMBO ; Patrik MICHEL ; Michael SCHAERER ; Carlo W. CEREDA ; Giovanni BIANCO ; Florian LINDHEIMER ; Christian BERGER ; Friedrich MEDLIN ; Roland BACKHAUS ; Nils PETERS ; Susanne RENAUD ; Loraine FISCH ; Julien NIEDERHAEUSER ; Emmanuel CARRERA ; Elisabeth DIRREN ; Christophe BONVIN ; Rolf STURZENEGGER ; Timo KAHLES ; Krassen NEDELTCHEV ; Georg KAEGI ; Jochen VEHOFF ; Biljana RODIC ; Manuel BOLOGNESE ; Ludwig SCHELOSKY ; Stephan SALMEN ; Marie-Luise MONO ; Alexandros A. POLYMERIS ; Stefan T. ENGELTER ; Philippe LYRER ; Susanne WEGENER ; Andreas R. LUFT ; Werner Z’GRAGGEN ; David BERVINI ; Bastian VOLBERS ; Tomas DOBROCKY ; Johannes KAESMACHER ; Pasquale MORDASINI ; Thomas R. MEINEL ; Marcel ARNOLD ; Javier FANDINO ; Leo H. BONATI ; Urs FISCHER ; David J. SEIFFGE ;
Journal of Stroke 2022;24(2):266-277
Background:
and Purpose Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce.
Methods:
We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). Results We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031).
Conclusions
Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.