scholarly journals Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans

Neurology ◽  
2020 ◽  
Vol 94 (10) ◽  
pp. e998-e1012 ◽  
Author(s):  
Fred S. Sarfo ◽  
Bruce Ovbiagele ◽  
Mulugeta Gebregziabher ◽  
Onoja Akpa ◽  
Albert Akpalu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Conditional Logistic Regression ◽  
Population Level ◽  
Amyloid Angiopathy ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Level Control ◽  
Factors Associated ◽  
West Africans ◽  
Population Attributable Risks

ObjectiveTo characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.MethodsThe Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.ResultsOf 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78–213.72); dyslipidemia, 2.95 (1.84–4.74); meat consumption, 1.55 (1.01–2.38); family history of CVD, 2.22 (1.41–3.50); nonconsumption of green vegetables, 3.61 (2.07–6.31); diabetes mellitus, 2.11 (1.29–3.46); stress, 1.68 (1.03–2.77); and current tobacco use, 14.27 (2.09–97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43–2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00–1.01); presence of midline shift, 1.54 (1.11–2.13); lobar ICH, 1.72 (1.16–2.55); and supratentorial bleeds, 2.17 (1.06–4.46).ConclusionsPopulation-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.

Population level risk factors associated with childhood obesity

2019 ◽  
Author(s):  
Claire Beynon ◽  
Nora Pashyan ◽  
Elizabeth Fisher ◽  
Dougal Hargreaves ◽  
Linda Bailey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Childhood Obesity ◽  
Population Level ◽  
Factors Associated

Abstract W MP54: Risk Factors for Nosocomial Infections after Intracerebral Hemorrhage and Their Impact on Outcome: The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Aaron S Lord ◽  
Mitchell S Elkind ◽  
Carl D Langefeld ◽  
Charles J Moomaw ◽  
Neeraj Badjatia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Pulmonary Edema ◽  
Nosocomial Infections ◽  
Fold Increase ◽  
Cns Infection ◽  
Neurosurgical Procedures ◽  
Chi Square ◽  
Factors Associated ◽  
Ct Data

Background: Risk factors for nosocomial infections and their impact on ICH outcomes are unclear. We hypothesized that factors present on admission are associated with developing infection, and patients who develop infections have worse outcomes. Methods: We determined prevalence of infections among patients in ERICH, a multicenter, triethnic case-control study of ICH. Exclusion criteria specific to this analysis were incomplete CT data and death/withdrawal of care <72 hours after admission. Patients with infection <two weeks before ICH were excluded from risk factor analyses, but included for outcomes assessments. We compared prevalence of risk factors for infections using chi-square and non-parametric tests, and performed multivariate logistic regression for risk of infection. Results: We enrolled 1397 individuals, 144 of whom died/had withdrawal of care within 72 hours and 210 with incomplete CT data, leaving 1043 patients. Nosocomial infections occurred in 300 patients (29%). Factors associated with presence of infections included ICH volume (13mL vs. 7mL, p <0.0001), GCS on admission (13 vs. 15, p <0.0001), WBC > 10 (42% vs. 32%), and higher CRP levels (4.9 vs. 1.8, p=0.01). Blacks had higher infection rates versus whites and Hispanics (33% vs. 27% and 24%, p=0.06). Procedural factors associated with infection included ventriculostomy, intrathecal-tPA, and intubation, while major neurosurgical procedures were associated with a 10-fold increase in CNS infection (all p <0.001). Infections were associated with bowel-bladder dysfunction, CHF/pulmonary edema, decubiti, DVT, dysphagia requiring PEG, and MI. Patients with infection were more likely to have DNR/DNI orders or to be dead at discharge (12.3% vs. 6.5%, p=0.0017). In a multivariate model for factors associated with infection, ICH volume, HIV history, intubation, CHF/pulmonary edema, and dysphagia requiring PEG were all associated with infection. Conclusion: There are identifiable risk factors associated with nosocomial infection after ICH, and infections are associated with mortality. Identification of patients at risk for infections may improve outcomes after ICH.

Abstract WP227: Risk Factors for Pathophysiologic Subtypes of Ischemic Stroke Among West Africans: Findings From the SIREN Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Fred S Sarfo ◽  
Bruce Ovbiagele ◽  
Onoja M Akpa ◽  
Rufus Akinyemi ◽  
Albert Akpalu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Vegetable Consumption ◽  
Conditional Logistic Regression ◽  
Meat Consumption ◽  
Small Vessel ◽  
Large Artery ◽  
Green Vegetable ◽  
Catchment Areas ◽  
West Africans

Background: The risk factors associated with the occurrence of the distinct pathophysiologic subtypes of ischemic stroke are unknown among indigenous Africans. Objective: To identify and quantify the contributions of risk factors for occurrence of ischemic stroke and its etiologic subtypes among West Africans. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Nigeria and Ghana. Cases included adults aged >18 years with CT/MRI confirmed stroke and ischemic strokes were etiologically subtyped using the TOAST protocol. Controls were age-and-gender matched stroke-free adults recruited from the communities in catchment areas of cases. Comprehensive evaluation for vascular, lifestyle and psychosocial factors was performed using standard instruments. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: There were 1,721 ischemic stroke cases with a mean age of 62.19 ± 14.03 vs 60.86 ± 13.71 for controls. Using the TOAST etiologic scheme, 867 (50.3%) were small vessel occlusions, 425(24.7%) were large-artery atherosclerotic, 181(10.5%) were cardio-embolic, 204(11.9%) were undetermined and 44(2.6%) were of other determined etiology. The 7 dominant risk factors for ischemic strokes aOR (95%CI) were hypertension 10.76(7.15-16.20), dyslipidemia 5.30(3.86-7.29), diabetes 3.61(2.72-4.80), psychosocial stress 1.68(1.20-2.35), cardiac disease 1.94 (1.25-3.02), meat consumption 2.02(1.54-2.65), green vegetable consumption 0.44(0.33-0.59). Hypertension, dyslipidemia, diabetes, meat consumption and green vegetable intake were confluent factors shared by small-vessel, large-vessel and cardio-embolic ischemic stroke subtypes. Conclusion: We provide empiric evidence of risk factors to be targeted for stroke prevention. Our findings open a vista into future studies aimed at elucidating the genetic factors linked with pathophysiologic subtypes of stroke among Africans.

Risk Factors for Spontaneous Intracerebral Hemorrhage

Stroke ◽  
1995 ◽  
Vol 26 (9) ◽  
pp. 1558-1564 ◽  
Author(s):  
Seppo Juvela ◽  
Matti Hillbom ◽  
Heikki Palomäki
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage

scholarly journals Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nan Zhang ◽  
Lin Zhang ◽  
Qiu Wang ◽  
Jingwei Zhao ◽  
Jia Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Retrospective Case ◽  
Factors Associated ◽  
Control Study

Abstract Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.

Oxidative markers in spontaneous intracerebral hemorrhage: leukocyte 8-hydroxy-2′-deoxyguanosine as an independent predictor of the 30-day outcome

2011 ◽  
Vol 115 (6) ◽  
pp. 1184-1190 ◽  
Author(s):  
Yi-Chun Chen ◽  
Chiung-Mei Chen ◽  
Jun-Liang Liu ◽  
Sien-Tsong Chen ◽  
Mei-Ling Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Vitamin E ◽  
Vitamin A ◽  
Intracerebral Hemorrhage ◽  
Redox Status ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Oxidative Markers ◽  
Traditional Risk Factors ◽  
Gpx Activity

Object Oxidative stress may play a role in spontaneous intracerebral hemorrhage (ICH), but data on oxidative burden in cerebral hemorrhage are limited, and it is not clear whether oxidative markers add predictive power regarding ICH outcome beyond that of traditional factors. The authors therefore examined redox status and traditional factors in ICH patients within 3 days of hemorrhage onset to delineate redox status in ICH and investigate the predictive value with respect to 30-day functional outcome. Methods Sixty-four patients with ICH and 114 controls were prospectively enrolled in this study. Blood samples were collected within 3 days of ICH onset and processed for isolation of plasma, erythrocytes, and leukocytes. The authors evaluated levels or activities of leukocyte 8-hydroxy-2′-deoxyguanosine (8-OHdG), erythrocyte glucose-6-phosphate dehydrogenase (G6PD), erythrocyte glutathione peroxidase (GPx), plasma malondialdehyde (MDA), vitamin E, and vitamin A, as well as traditional factors including the presence of hypertension or diabetes mellitus, total cholesterol level, and measures of liver function. A general linear model and multivariable logistic regression were used for analyses where appropriate. Results After adjustment for age and sex and traditional risk factors, ICH was significantly associated with an increased level of 8-OHdG (p < 0.0001), decreased GPx activity (p = 0.0002), and a decreased level of vitamin E (p = 0.003). There was no association of ICH risk with G6PD activity or MDA or vitamin A level. Considering all the oxidative markers and traditional risk factors together, logistic regression showed an independent association of ICH with 8-OHdG (OR 2.7, 95% CI 1.7–4.2, p < 0.0001). The association between increased 8-OHdG level and lower 30-day Barthel Index was also independent of the effects of age, sex, hemorrhage location and size, and traditional factors (p = 0.026). Unfavorable outcome (modified Rankin Scale score ≥ 3) at 30 days after ICH onset was not significantly associated with any of the examined oxidative markers. Conclusions Increased leukocyte 8-OHdG levels, as well as decreased GPx activity and vitamin E levels, were found during acute ICH. Only 8-OHdG was associated with ICH and the 30-day outcome independently from the other oxidative markers and traditional factors. Leukocyte 8-OHdG may add power beyond the traditional factors in predicting ICH outcome and thus may be used as an independent surrogate for clinical ICH study.

Intracerebral Hemorrhage and Epileptic Seizures: Frequency, Localization and Seizures Types

2017 ◽  
Vol 71 (2) ◽  
pp. 119-122
Author(s):  
Dragana Petrovska Cvetkovska ◽  
Arben Taravari ◽  
Natalija Dolnenec Baneva ◽  
Dijana Nikodijevik ◽  
Coskun Kerala ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Arterial Hypertension ◽  
Computer Tomography ◽  
Large Volume ◽  
Epileptic Seizures ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Generalized Seizures ◽  
Study Population ◽  
Cortical Involvement

Abstract Introduction. Among 2.8-18.7% of the patients that suffered from spontaneous intracerebral hemorrhage (ICH) develop seizures. Previous studies suggest that most important contributors to developing subsequent seizures are: volume and localization of hematoma, cortical involvement and age. Aims: To determine the occurrence of new epileptic seizures in patients with spontaneous intracerebral hemorrhage and to analyze it with respect to the patient’s age, gender, presence of premorbid risk factors, localization of the hematoma and the type of the seizures. Methods. This study is retrospective in design, with study population of 308 patients with spontaneous intracerebral hemorrhage admitted to our clinic in the period between 2008 and 2014. Analyzed premorbid risk factors for ICH are: hypertension, smoking, alcohol uptake. According to the computer tomography (CT) of brain findings the patients was divided in two groups: lobar and thalamic (deep). By the time of presents of seizures, they were classified as early (within 1 week of ICH) or late (more than 1 week after ICH). Also we analyzed the seizures type and we divided them in four groups: simple partial, partial complex, secondary generalized and tonic clonic generalized seizures. Results. Arterial hypertension was revealed in 78% of the patients with spontaneous supratentorial ICH. Epileptic seizures developed in 8.2% of analyzed patients, most of them in the first week of brain bleeding. Lobar ICH had 78.6% of the patients, with frontal localization was 44% of patients with lobar ICH, and most of them had simple partial and partial complex seizures. Conclusion. Cortical involvement, large volume of hematoma, may be a factor for provoked seizures, especially in the first days of brain bleeding.

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