Traenka Christopher, Dougoud Daphne, Simonetti Barbara Goeggel, Metso Tiina M, Debette Stéphanie, Pezzini Alessandro, Kloss Manja, Grond-Ginsbach Caspar, Majersik Jennifer J, Worrall Bradford B, Leys Didier, Baumgartner Ralf, Caso Valeria, Béjot Yannick, Compter Annette, Reiner Peggy, Thijs Vincent, Southerland Andrew M, Bersano Anna, Brandt Tobias, Gensicke Henrik, Touzé Emmanuel, Martin Juan J, Chabriat Hugues, Tatlisumak Turgut, Lyrer Philippe, Arnold Marcel, Engelter Stefan T
From the Department of Neurology and Stroke Center (C.T., H.G., P.L., S.T.E.), University Hospital Basel and University of Basel; Department of Neurology (D.D., B.G.S., M.A.), University Hospital Berne; Ospedale San Giovanni (B.G.S.), Bellinzona, Switzerland; Department of Neurology (T.M.M., T.T.), Helsinki University Central Hospital, Finland; Department of Neurology (S.D.), Bordeaux University Hospital; Inserm U1219 (S.D.), Bordeaux; Bordeaux University (S.D.), France; Department of Neurology (S.D.), Boston University School of Medicine, MA; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology (M.K., C.G.-G.), Heidelberg University Hospital, Germany; Department of Neurology (J.J.M.), University of Utah, Salt Lake City; Departments of Neurology and Public Health Sciences (B.B.W., A.M.S.), University of Virginia Health System, Charlottesville; Univ Lille 2 (D.L.), INSERM U 1171, CHU Lille, France; Neuro Center (R.B.), Clinic Hirslanden, Zurich, Switzerland; Stroke Unit and Division of Internal and Cardiovascular Medicine (V.C.), University of Perugia, Italy; Centre Hospitalier Universitaire Le Bocage (Y.B.), Dijon, France; Department of Neurology and Neurosurgery (A.C.), Brain Centre Rudolf Magnus, University Medical Centre Utrecht, the Netherlands; Department of Neurology (P.R., H.C.), Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, France; Florey Institute of Neuroscience and Mental Health (V.T.); Department of Neurology (V.T.), Austin Health, Heidelberg, Australia; Cerebrovascular Unit (A.B.), IRCCS Foundation C. Besta Neurological Institute, Milan, Italy; Clinics for Neurologic Rehabilitation (T.B.), Kliniken Schmieder, Heidelberg, Germany; Normandie Univ (E.T.), UNICAEN, Inserm U919, Department of Neurology, CHU Caen; Department of Neurology (E.T.), CH Sainte-Anne, University Paris Descartes, France; Department of Neurology (J.J.M.), Sanatorio Allende, Cordoba, Argentina; Department of Neurology (T.T.), Sahlgrenska University Hospital and Institute for Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; and Neurorehabilitation Unit (S.T.E.), University of Basel and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital, Basel, Switzerland.
Neurology. 2017 Apr 4;88(14):1313-1320. doi: 10.1212/WNL.0000000000003788. Epub 2017 Mar 3.
In a cohort of patients diagnosed with cervical artery dissection (CeAD), to determine the proportion of patients aged ≥60 years and compare the frequency of characteristics (presenting symptoms, risk factors, and outcome) in patients aged <60 vs ≥60 years.
We combined data from 3 large cohorts of consecutive patients diagnosed with CeAD (i.e., Cervical Artery Dissection and Ischemic Stroke Patients-Plus consortium). We dichotomized cases into 2 groups, age ≥60 and <60 years, and compared clinical characteristics, risk factors, vascular features, and 3-month outcome between the groups. First, we performed a combined analysis of pooled individual patient data. Secondary analyses were done within each cohort and across cohorts. Crude and adjusted odds ratios (OR [95% confidence interval]) were calculated.
Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥60 years. In this age group, cervical pain (OR 0.47 [0.33-0.66]), headache (OR 0.58 [0.42-0.79]), mechanical trigger events (OR 0.53 [0.36-0.77]), and migraine (OR 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (OR 1.52 [1.1-2.10]) and hypertension (OR 3.08 [2.25-4.22]) were more frequent in older patients. Key differences between age groups were confirmed in secondary analyses. In multivariable, adjusted analyses, favorable outcome (i.e., modified Rankin Scale score 0-2) was less frequent in the older age group (OR 0.45 [0.25, 0.83]).
In our study population of patients diagnosed with CeAD, 1 in 14 was aged ≥60 years. In these patients, pain and mechanical triggers might be missing, rendering the diagnosis more challenging and increasing the risk of missed CeAD diagnosis in older patients.
在一组被诊断为颈动脉夹层（CeAD）的患者中，确定年龄≥60岁患者的比例，并比较年龄＜60岁与≥60岁患者的特征（首发症状、危险因素和结局）出现频率。
我们合并了3个连续诊断为CeAD的大型队列患者的数据（即颈动脉夹层与缺血性卒中患者加组联盟）。我们将病例分为两组，年龄≥60岁和＜60岁，并比较两组之间的临床特征、危险因素、血管特征和3个月结局。首先，我们对汇总的个体患者数据进行了综合分析。在每个队列内部和跨队列进行了二次分析。计算了粗比值比和调整比值比（OR[95%置信区间]）。
在2391例被诊断为CeAD的患者中，我们确定了177例（7.4%）年龄≥60岁的患者。在这个年龄组中，颈部疼痛（OR0.47[0.33 - 0.66]）、头痛（OR0.58[0.42 - 0.79]）、机械触发事件（OR0.53[0.36 - 0.77]）和偏头痛（OR0.58[0.39 - 0.85]）的发生频率低于年轻患者。相反，高胆固醇血症（OR1.52[1.1 - 2.10]）和高血压（OR3.08[2.25 - 4.22]）在老年患者中更为常见。年龄组之间的关键差异在二次分析中得到证实。在多变量调整分析中，老年组的良好结局（即改良Rankin量表评分0 - 2）频率较低（OR0.45[0.25, 0.83]）。
在我们诊断为CeAD的研究人群中，14人中有1人年龄≥60岁。在这些患者中，疼痛和机械触发因素可能缺失，这使得诊断更具挑战性，并增加了老年患者漏诊CeAD的风险。
