Forame oval patente e acidente vascular cerebral isquêmico em jovens: associação causal ou estatística?

Negrão, Edson Marcio; Brandi, Ivar Viana; Nunes, Simone Vilela; Távora, Daniel Gurgel Fernandes; Nakayama, Mauro; Beraldo, Paulo Sérgio Siebra

doi:10.1590/s0066-782x2007000500003

Cited by 9 publications

(5 citation statements)

References 35 publications

(20 reference statements)

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“…The higher frequency of females observed in this study, confirms the research conducted on national territory 3,6,10 , including a study in the city of Salvador…”

supporting

confidence: 91%

“…Furthermore, the great etiology diversity for stroke in the younger population, diverging from the elderly population in relation to the most important risk factors, topography and most affected vascular territories 9 justifies the need to extend studies on this population. The studies carried out in stroke units are not specifically aimed to this age group of the population, and a few national studies have characterized the population of young adults after stroke, which were performed in ambulatory services 3.6 , one of hospital level 10 or even survey by telephone 11 . Data from a unit specialized in the diagnosis and etiological investigation of stroke can increase knowledge of the behavior of this disease in this specific age group.…”

mentioning

confidence: 99%

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Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Makhoul

Maso²,

Monteiro

et al. 2016

BJMHH

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A B S T R A C T BACKGROUND:Previously referred to as rare among young adults, in the last five years was found a frequency approaching 30 % of young adults between those who have suffered a stroke in Brazil. OBJECTIVE: To identify the sociodemographic, clinical and functional characteristics of young adult patients. METHODS: It was a cross-sectional study, conducted with individuals assisted in a stroke unit with ischemic or hemorrhagic stroke diagnosis and age of 18-50 years old between August 2014 to April 2015. It was used the National Institutes of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS). RESULTS: The study population consisted of 47 individuals, in which 28 (59,6%) were female, with an average age of 39,2 (DP±8,3) years, and brown skin color 21 (44,7%). They presented 8,9 years of formal education. 28 (59,6%) patients were diagnosed with ischemic stroke, 30 (63,8%) had involvement of the anterior circulation, and 23 (48,9%) of the left hemisphere. 26 (55,3%) patients presented hypertension and 36 (76,6%) were sedentary. The stroke severity had a median of 7 ( 0-23 ) points and 30 (63,7%) of patients the functional was capacity 5 in the Rakin Scale. It was found a statistically significant difference for hypertensive etiology of hemorrhagic stroke in men ( p = 0,047) when compared with gender and the occurrence of stroke in the right hemisphere in women (p=0,032). CONCLUSION: The profile of the young adult patients from a stroke unit consists of female, of brown skin color, economically active with moderate stroke severity and severe functional disability. According to the World Health Organization, the stroke is the second leading cause of death in the world, after ischemic heart disease¹. In Brazil and other Latin America countries it is the leading cause of death². The age group most commonly affected by stroke is between 70-80 years old due to the aging of nervous and cardiovascular system³ associated with risk factors such as diabetes, hypertension, smoking, physical inactivity, dyslipidemia, heart diseases², among others. Previously referenced as a rare condition among the young adults, with an incidence of 5 to 10% 4.5 , in Brazil, In the last five years have identified a frequency which is close to 40% of young adults between those who had stroke 6 . In addition to the high mortality rate, it is considered as the most disabling of long-term diseases, impacting not only the patient but also their families 7, and the social security and public system 8 . The growing number of young adults affected by stroke has increased the cost of disability benefits, greatly burdening the public health budget and being responsible for 40% of early retirements 8 . Furthermore, the great etiology diversity for stroke in the younger population, diverging from the elderly population in relation to the most important risk factors, topography and most affected vascular territories 9 justifies the need to extend studies on this population. The studies carried out in stroke units are not specific...

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“…The higher frequency of females observed in this study, confirms the research conducted on national territory 3,6,10 , including a study in the city of Salvador…”

supporting

confidence: 91%

mentioning

confidence: 99%

Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Makhoul

Maso²,

Monteiro

et al. 2016

BJMHH

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“…The etiology of nearly 40% of strokes in patients could not be determined and these are called cryptogenic strokes [2]. Patent foramen ovale (PFO) is a known and important predisposing factor for cryptogenic stroke [3–5]. In the literature, PFO incidence among patients with cryptogenic stroke ranges between 40% and 55% whereas the incidence is 25% in the healthy population [6–9].…”

Section: Introductionmentioning

confidence: 99%

Mean platelet volume is elevated in patients with patent foramen ovale

Demir

Caglar

Ünğan

et al. 2013

aoms

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IntroductionPlatelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review.Material and methodsThirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium.ResultsThere was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively).ConclusionsOur results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms.

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“…A total of 10 studies compared cryptogenic ischemic stroke with: (1) healthy community-convenience controls [35,36]; (2) controls undergoing echocardiography for non-stroke indications [37,38,39], or (3) ischemic stroke of known cause, adjusted for other vascular risk factors [40,41,42,43,44]. When subdivided by a population sampling frame, the pooled ORs for community-convenience and hospital-convenience controls were 1.9 (95% CI 1.2–3.1; I 2 = 39%) and 2.8 (95% CI 2.1–3.6; I 2 = 27%), respectively (fig.…”

Section: Resultsmentioning

confidence: 99%

Patent Foramen Ovale, Ischemic Stroke and Migraine: Systematic Review and Stratified Meta-Analysis of Association Studies

et al. 2012

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Background: Observational data have reported associations between patent foramen ovale (PFO), cryptogenic stroke and migraine. However, randomized trials of PFO closure do not demonstrate a clear benefit either because the underlying association is weaker than previously suggested or because the trials were underpowered. In order to resolve the apparent discrepancy between observational data and randomized trials, we investigated associations between (1) migraine and ischemic stroke, (2) PFO and ischemic stroke, and (3) PFO and migraine. Methods: Eligibility criteria were consistent; including all studies with specifically defined exposures and outcomes unrestricted by language. We focused on studies at lowest risk of bias by stratifying analyses based on methodological design and quantified associations using fixed-effects meta-analysis models. Results: We included 37 studies of 7,686 identified. Compared to reports in the literature as a whole, studies with population-based comparators showed weaker associations between migraine with aura and cryptogenic ischemic stroke in younger women (OR 1.4; 95% CI 0.9–2.0; 1 study), PFO and ischemic stroke (HR 1.6; 95 CI 1.0–2.5; 2 studies; OR 1.3; 95% CI 0.9–1.9; 3 studies), or PFO and migraine (OR 1.0; 95% CI 0.6–1.6; 1 study). It was not possible to look for interactions or effect modifiers. These results are limited by sources of bias within individual studies. Conclusions: The overall pairwise associations between PFO, cryptogenic ischemic stroke and migraine do not strongly suggest a causal role for PFO. Ongoing randomized trials of PFO closure may need larger numbers of participants to detect an overall beneficial effect.

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Forame oval patente e acidente vascular cerebral isquêmico em jovens: associação causal ou estatística?

Cited by 9 publications

References 35 publications

Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Mean platelet volume is elevated in patients with patent foramen ovale

Patent Foramen Ovale, Ischemic Stroke and Migraine: Systematic Review and Stratified Meta-Analysis of Association Studies

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