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Title: Determinants and outcome of multiple and early recurrent cervical artery dissections.
Austin Authors: Compter, Annette;Schilling, Sabrina;Vaineau, Cloé Juliette;Goeggel-Simonetti, Barbara;Metso, Tiina M;Southerland, Andrew;Pezzini, Alessandro;Kloss, Manja;Touzé, Emmanuel;Worrall, Bradford B;Thijs, Vincent N ;Bejot, Yannick;Reiner, Peggy;Grond-Ginsbach, Caspar;Bersano, Anna;Brandt, Tobias;Caso, Valeria;Lyrer, Philippe A;Traenka, Christopher;Lichy, Christoph;Martin, Juan José;Leys, Didier;Sarikaya, Hakan;Baumgartner, Ralph W;Jung, Simon;Fischer, Urs;Engelter, Stefan T;Dallongeville, Jean;Chabriat, Hugues;Tatlisumak, Turgut;Bousser, Marie-Germaine;Arnold, Marcel;Debette, Stéphanie
Affiliation: Department of Neurology-Memory Clinic, Bordeaux University Hospital, France
Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
and Department of Neurology-Memory Clinic, Bordeaux University Hospital, France
Department of Neuro-oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, the Netherlands
Department of Neurology, MC Slotervaart, Amsterdam, the Netherlands
University of Bordeaux, France
Bordeaux Population Health, INSERM Center U1219, France
Department of Neurology, University Hospital Inselspital and University of Bern, Switzerland
Division of Neuropediatrics, San Giovanni Hospital Bellinzona, Switzerland
Department of Neurology, Helsinki University Central Hospital, Finland
Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville
Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy
Department of Neurology, Heidelberg University Hospital, Germany
Normandie Université , Unicaen, CHU Caen, Inserm U1237, France
Université Paris Descartes, CH Ste Anne, Inserm U894, Paris, France
Stroke Division, Florey Institute for Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Department of Neurology, Dijon University Hospital
Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, France
Cerebrovascular Unit, IRCCS Foundation C. Besta Neurological Institute, Milan, Italy
Suva/Swiss National Accident Insurance Fund, Lucerne, Switzerland
Stroke Unit and Division of Internal and Cardiovascular Medicine, University of Perugia, Italy
Department of Neurology and Stroke Center, Department of Clinical Research, University Hospital and University of Basel, Switzerland
Neurology Clinic, Memmingen Hospital, Germany
Department of Neurology, Sanatorio Allende, Cordoba, Argentina
Department of Neurology, Lille University, INSERM U1171, France
NeuroCentre, Clinic Hirslanden Zürich, Switzerland
Neurorehabilitation Unit), University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, University of Basel, Switzerland
INSERM 1176, Institut Pasteur de Lille, France
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg
Issue Date: 21-Aug-2018 2018
Publication information: Neurology 2018; 91(8): e769-e780
Abstract: To assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD). We combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed. Of 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) had multiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29-2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34-2.46), family history of stroke (OR 1.55, 95% CI 1.06-2.25), cervical pain (OR 1.36, 95% CI 1.01-1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01-8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients with multiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49-5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD. Patients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.
DOI: 10.1212/WNL.0000000000006037
ORCID: 0000-0002-6614-8417
Journal: Neurology
PubMed URL: 30068628
Type: Journal Article
Appears in Collections:Journal articles

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