Abstract:
OBJECTIVE:Seizure at onset (SaO) has been considered a relative contraindication for intravenous thrombolysis (IVT) in patients with acute ischemic stroke, although this appraisal is not evidence based. Here, we investigated the prognostic significance of SaO in patients treated with IVT for suspected ischemic stroke. METHODS:In this multicenter, IVT-registry-based study we assessed the association between SaO and symptomatic intracranial hemorrhage (sICH, European Cooperative Acute Stroke Study II definition), 3-month mortality, and 3-month functional outcome on the modified Rankin Scale (mRS) using unadjusted and adjusted logistic regression, coarsened exact matching, and inverse probability weighted analyses. RESULTS:Among 10,074 IVT-treated patients, 146 (1.5%) had SaO. SaO patients had significantly higher National Institutes of Health Stroke Scale score and glucose on admission, and more often female sex, prior stroke, and prior functional dependence than non-SaO patients. In unadjusted analysis, they had generally less favorable outcomes. After controlling for confounders in adjusted, matched, and weighted analyses, all associations between SaO and any of the outcomes disappeared, including sICH (odds ratio [OR]unadjusted = 1.53 [95% confidence interval (CI) = 0.74-3.14], ORadjusted = 0.52 [95% CI = 0.13-2.16], ORmatched = 0.68 [95% CI = 0.15-3.03], ORweighted = 0.95 [95% CI = 0.39-2.32]), mortality (ORunadjusted = 1.49 [95% CI = 1.00-2.24], ORadjusted = 0.98 [95% CI = 0.5-1.92], ORmatched = 1.13 [95% CI = 0.55-2.33], ORweighted = 1.17 [95% CI = 0.73-1.88]), and functional outcome (mRS ≥ 3/ordinal mRS: ORunadjusted = 1.33 [95% CI = 0.96-1.84]/1.35 [95% CI = 1.01-1.81], ORadjusted = 0.78 [95% CI = 0.45-1.32]/0.78 [95% CI = 0.52-1.16], ORmatched = 0.75 [95% CI = 0.43-1.32]/0.45 [95% CI = 0.10-2.06], ORweighted = 0.87 [95% CI = 0.57-1.34]/1.00 [95% CI = 0.66-1.52]). These results were consistent regardless of whether patients had an eventual diagnosis of ischemic stroke (89/146) or stroke mimic (57/146 SaO patients). INTERPRETATION:SaO was not an independent predictor of poor prognosis. Withholding IVT from patients with assumed ischemic stroke presenting with SaO seems unjustified. ANN NEUROL 2019;86:770-779.
journal_name
Ann Neuroljournal_title
Annals of neurologyauthors
Polymeris AA,Curtze S,Erdur H,Hametner C,Heldner MR,Groot AE,Zini A,Béjot Y,Dietrich A,Martinez-Majander N,von Rennenberg R,Gumbinger C,Schaedelin S,De Marchis GM,Thilemann S,Traenka C,Lyrer PA,Bonati LH,Wegener S,Rdoi
10.1002/ana.25582subject
Has Abstractpub_date
2019-11-01 00:00:00pages
770-779issue
5eissn
0364-5134issn
1531-8249journal_volume
86pub_type
杂志文章,多中心研究abstract:OBJECTIVE:We tested the premise that cholinesterase inhibitor therapy should target butyrylcholinesterase (BuChE) in Alzheimer's disease (AD), not acetylcholinesterase (AChE) alone, because both enzymes hydrolyze acetylcholine, and BuChE is increased in AD cerebral cortex. METHODS:To examine this issue in vivo, we qua...
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abstract::An infant presented with massive hyperchylomicronemia and a severe encephalopathy. MRI showed marked lipid deposition throughout the brain. Despite the normalization of the biochemistry, there was little clinical improvement, and at 18 months of age she has severe developmental delay, a strikingly abnormal MRI. Apolip...
journal_title:Annals of neurology
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doi:10.1002/ana.10598
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journal_title:Annals of neurology
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journal_title:Annals of neurology
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doi:10.1002/ana.410130106
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pub_type: 杂志文章,评审
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journal_title:Annals of neurology
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doi:10.1002/ana.410060119
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journal_title:Annals of neurology
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doi:10.1002/ana.410220412
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journal_title:Annals of neurology
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更新日期:2004-10-01 00:00:00
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journal_title:Annals of neurology
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doi:10.1002/ana.410240618
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journal_title:Annals of neurology
pub_type: 杂志文章
doi:10.1002/ana.410260603
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doi:10.1002/ana.22631
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journal_title:Annals of neurology
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doi:10.1002/ana.410330307
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doi:10.1002/ana.24081
更新日期:2014-02-01 00:00:00
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journal_title:Annals of neurology
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doi:10.1002/ana.410160509
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journal_title:Annals of neurology
pub_type: 杂志文章
doi:10.1002/ana.410200407
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journal_title:Annals of neurology
pub_type: 杂志文章
doi:10.1002/ana.410160102
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pub_type: 杂志文章
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pub_type: 杂志文章,meta分析
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doi:10.1002/ana.24749
更新日期:2016-10-01 00:00:00
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doi:10.1002/ana.410060614
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journal_title:Annals of neurology
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journal_title:Annals of neurology
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更新日期:1990-12-01 00:00:00
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更新日期:2013-08-01 00:00:00