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Age-dependent differences in cervical artery dissection

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Abstract

The goal of this work was to explore age-dependent differences in cervical artery dissection (CeAD). This study is based on the Cervical Artery Dissection and Ischemic Stroke Patients population comprising 983 consecutive CeAD patients and 658 control patients with a non-CeAD ischemic stroke (IS), frequency-matched for age and gender. Patients were divided into three age categories: ≤33 (for CeAD, n = 150), 34–54 (n = 688), and ≥55 (n = 145) years, and the youngest and oldest groups were compared. The youngest patients were mostly women and the oldest men. The frequency of internal carotid artery dissection (ICAD) versus vertebral artery dissection (VAD) increased with age from 44 to 75 %. This age-related shift remained significant after adjustment for sex. The frequency of a transient ischemic event as the CeAD symptom declined from 33 % in the youngest age group, to 19 % in the oldest. Vascular risk factors increased in frequency with advancing age in both groups, but for hypertension the increase was steeper for non-CeAD IS patients. For CeAD patients, but not for patients with non-CeAD IS, preceding infection was more common in the oldest group. The youngest non-CeAD IS patients had better functional outcome (modified Rankin Scale 0–1) than the oldest, while the similar trend was not statistically significant among CeAD patients. Younger age seems to be associated with VAD and female gender, and older age with ICAD and male gender. Age-related changes in the frequencies of hypertension and recent infection were different between the CeAD and non-CeAD IS groups. Age does not seem to be an important outcome predictor in CeAD strokes.

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Abbreviations

BMI:

Body mass index

CeAD:

Cervical artery dissection

CADISP:

Cervical Artery Dissection and Ischemic Stroke Patients

ICAD:

Internal carotid artery dissection

IS:

Ischemic stroke

mRS:

Modified Rankin Scale

NA:

Not assessed

NIHSS:

National Institutes of Health Stroke Scale

NS:

Statistically insignificant

TIA:

Transient ischemic attack

TOAST:

Trial of Org 10172 in Acute Stroke Treatment

VAD:

Vertebral artery dissection

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Acknowledgments

The authors thank the staff and participants of all CADISP centers for their contributions: Marja Metso, RN (collection of data and technical assistance), Department of Neurology, Helsinki University Central Hospital, Finland; Laurence Bellengier, MS (data monitoring and technical assistance), Sabrina Schilling, MS (data monitoring and technical assistance), Christian Libersa, MD, PhD (supervision of personnel), and Dominique Deplanque, MD, PhD (supervision of personnel), Centre d’Investigation Clinique, University Hospital of Lille, France; Nathalie Fievet, PhD (technical assistance), INSERM U744, Pasteur Institute, Lille, France; Jean-Christophe Corvol, MD, PhD (supervision of personnel), Sylvie Montel, MS (technical assistance), and Christine Rémy (technical assistance), Centre d’Investigation Clinique, Pitié-Salpêtrière University Hospital, Paris, France; Ana Lopes Da Cruz, PhD (technical assistance), Laboratory of Experimental Neurology, ULB, Brussels, Belgium; Annet Tiemessen, MS (technical assistance), Stroke Team, University Hospital Basel, Switzerland; Dr. Raffaele Palmirotta, MD, PhD (technical assistance), Department of Laboratory Medicine & Advanced Biotechnologies, IRCCS San Raffaele, Rome, Italy; Marie-Luise Arnold, PhD (collection of data and technical assistance), and Inge Werner, MS (technical assistance), Department of Neurology, Heidelberg University Hospital, Germany.

Conflicts of interest

S. Debette, C. Grond-Ginsbach, T. Brandt, A. Pezzini, A. Bersano, M. Kloss, and V. Thijs report no disclosures. T. Metso has received research support from the Finnish Medical Foundation, Helsinki University Medical Foundation, Orion Farmos Research Foundation, Päivikki and Sakari Sohlberg’s Foundation, Maire Taponen Foundation, the Lilly Foundation, Paavo Ilmari Ahvenainen Foundation, Aarne and Aili Turunen Foundation, Aarne Koskelo Foundation, Maud Kuistila Foundation, Emil Aaltonen Foundation, the Finnish Brain Foundation, and the Alfred Kordelin Foundation. S. Engelter has received funding for travel from Boehringer Ingelheim and Shire plc; serves on the editorial board of Stroke; and has received research support from the Käthe-Zingg-Schwichtenberg-Fonds of the Swiss Academy of Medical Sciences, the Swiss Heart Foundation, and Swiss National Funds. D. Leys serves on a scientific advisory board for Bayer Schering Pharma; served as an Associate Editor of the Journal of Neurology, Neurosurgery and Psychiatry, and serves as an editorial board member of Stroke and Cerebrovascular Diseases; serves as a consultant for Allergan, Inc.; and receives research support from PHRC. P. Lyrer served on a scientific advisory board for Bayer Schering Pharma; serves as Co-Editor for Neurologie und Psychiatrie, and on the editorial board of Swiss Archives of Neurology and Psychiatry; and has received research support from the Swiss National Foundation and the Swiss Heart Foundation. T. Tatlisumak serves on scientific advisory boards for Boehringer Ingelheim and Mitsubishi Tanabe Pharma Corporation; has received funding for travel from Boehringer Ingelheim; serves/has served on the editorial board of Stroke, Current Vascular Pharmacology, The Open Pharmacology Journal, Clinics of Turkey, Clinics of Turkey/Neurology, The Open Cardiovascular Medicine Journal, Recent Patents on Biotechnology, Cerebrovascular Diseases, Recent Patents on CNS Drug Discovery, Experimental and Translational Stroke Medicine, Stroke Research and Treatment, BMC Journal of Experimental and Translational Stroke Medicine, and Frontiers in Stroke and was founding Editor-in-chief of Case Reports in Neurology; has filed patents: Stanniocalcin proteins and nucleic acids and methods based thereon, New therapeutic uses (method to prevent brain edema and reperfusion injury), and Thrombolytic compositions (method to prevent postthrombolytic hemorrhage formation); serves as a consultant for Boehringer Ingelheim, PhotoThera, Mitsubishi Tanabe Pharma Corporation, BrainsGate, Schering-Plough Corp., Lundbeck Inc., Sanofi-aventis, Concentric Medical, Inc.; and has received research support from Boehringer Ingelheim, the Academy of Finland, the European Union, Biocentrum Finland, Biocentrum Helsinki, Sigrid Juselius Foundation, Liv och Hälsa, and Maire Taponen Foundation. A. Metso has received research support from the Finnish Medical Foundation and the Alfred Kordelin Foundation.

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Authors and Affiliations

  1. Department of Neurology, Helsinki University Central Hospital, University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland

    Tiina M. Metso, Turgut Tatlisumak & Antti J. Metso

  2. Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Université Lille Nord de France, Lille, France

    Stéphanie Debette

  3. Department of Neurology, EA2691/EA1046, Lille University Hospital, Lille, France

    Stéphanie Debette & Didier Leys

  4. Department of Epidemiology, Paris Ile-de-France Ouest School of Medicine, University of Versailles Saint-Quentin en Yvelines, Paris, France

    Stéphanie Debette

  5. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany

    Caspar Grond-Ginsbach, Tobias Brandt & Manja Kloss

  6. Department of Neurology, Basel University Hospital, Basel, Switzerland

    Stefan T. Engelter & Philippe A. Lyrer

  7. Department of Medical and Surgical Sciences, Neurology Clinic, University of Brescia, Brescia, Italy

    Alessandro Pezzini

  8. U.O Neurologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy

    Anna Bersano

  9. Vesalius Research Center, VIB, and Department of Neurology, Leuven University Hospitals, Leuven, Belgium

    Vincent Thijs

Authors
  1. Tiina M. Metso
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  2. Stéphanie Debette
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  3. Caspar Grond-Ginsbach
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  4. Stefan T. Engelter
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  5. Didier Leys
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  6. Tobias Brandt
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  7. Alessandro Pezzini
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  8. Anna Bersano
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  9. Manja Kloss
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  10. Vincent Thijs
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  11. Philippe A. Lyrer
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  12. Turgut Tatlisumak
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  13. Antti J. Metso
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Corresponding author

Correspondence to Antti J. Metso.

Additional information

For the CADISP group. See supplemental appendix for a complete list of CADISP Investigators.

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Supplementary material 1 (DOC 281 kb)

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Metso, T.M., Debette, S., Grond-Ginsbach, C. et al. Age-dependent differences in cervical artery dissection. J Neurol 259, 2202–2210 (2012). https://doi.org/10.1007/s00415-012-6485-7

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  • DOI: https://doi.org/10.1007/s00415-012-6485-7

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