Introduction:An inverse association between serum cholesterol and the risk of hemorrhagic stroke has been noted in epidemiological studies. We performed a case–control study to assess the relationship between primary intracerebral hemorrhage (ICH) and low serum cholesterol.Materials and Methods:Prospectively recruited fully evaluated patients with ICH were compared with a control group based in a primary care practice, i.e. age- and sex-matched individuals attending the routine preventive health check-up. Low cholesterol was defined by the sex-specific lowest quintile of the population.Results:The proportion of ICH patients with low cholesterol was significantly higher than the controls (68% vs. 43%). Mean total cholesterol was also signficantly low in ICH patients compared with controls (177 mg/dL vs. 200 mg/dl; P-value = 0.0006). Low-density lipoprotein cholesterol (LDL-c) and triglycerides were also significantly low in ICH patients compared with controls. Mean LDL-C in the ICH patient group was 114 mg/dL, whereas it was 128.5 mg/dL in the control group (P-value = 0.016). There was no significant difference in the high-density lipoprotein (HDL) levels in both groups. In a subgroup analysis, both men and women in the ICH group had a significantly low mean cholesterol compared with the control group. Although lower mean cholesterol was seen in both young and older individuals in the ICH group than in controls, the difference was significant only in the older group (age >45 years). In multivariate analysis, presence of low cholesterol remained a significant predictor of hemorrhage. The odds ratio of low cholesterol in the hemorrhage cases was 2.75 (95% CI = 1.44–5.49) unadjusted and 2.15 (1.13–4.70) adjusted for age and hypertension.Conclusions:This study confirms an increased risk of primary ICH associated with low cholesterol both in men and women, especially in older individuals.
Introduction Mechanism of acute ischemic stroke in young adults due to acute carotid dissection can be due to cocaine sniffing, as it is sympathomimetic for cranial circulation. Methods A 24-year-old female presented with acute onset of right-sided neck pain and transient left hemiparesis lasting for 15 minutes after sniffing of cocaine. She had another episode of left hemiparesis with dysarthria (with National Institutes of Health Stroke Scale [NIHSS] score 7), which did not recover after second sniffing of cocaine. Her urgent magnetic resonance imaging of the brain and computed tomography angiography showed acute ischemic stroke in the right middle cerebral artery territory with acute right proximal carotid dissection with thrombus. She was having high blood pressure during presentation, which was optimized with labetalol, and was started on low-molecular-weight heparin and antiplatelet and statins. She improved gradually and her NIHSS score at discharge was 4. Discussion Cocaine, due to its sympathomimetic properties, causes sudden vasoconstriction; acute surge in blood pressure shortly after intake of cocaine may increase shear stress in the aortic wall, leading to a disruption of the intimal layer and a dissection with an intramural hematoma that subsequently may rupture into the lumen and cause acute ischemic stroke. In our case clinical history was unique in that episodes of cocaine sniffing caused progressive carotid dissection and subsequent stroke. Treatment needs optimal control of blood pressure and anticoagulation and antiplatelet medication. Conclusion Cocaine sniffing is one of the rare causes of acute ischemic stroke in young adults, and the mechanism can be acute carotid dissection.
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