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ABSTRACT: To develop a simple prognostic model to predict outcome at 1 month after acute basilar artery occlusion (BAO) with readily available predictors.
The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational, international registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO. We considered predictors available at hospital admission in multivariable logistic regression models to predict poor outcome (modified Rankin Scale [mRS] score 4-5 or death) at 1 month. We used receiver operator characteristic curves to assess the discriminatory performance of the models.
Of the 619 patients, 429 (69%) had a poor outcome at 1 month: 74 (12%) had a mRS score of 4, 115 (19%) had a mRS score of 5, and 240 (39%) had died. The main predictors of poor outcome were older age, absence of hyperlipidemia, presence of prodromal minor stroke, higher NIH Stroke Scale (NIHSS) score, and longer time to treatment. A prognostic model that combined demographic data and stroke risk factors had an area under the receiver operating characteristic curve (AUC) of 0.64. This performance improved by including findings from the neurologic examination (AUC 0.79) and CT imaging (AUC 0.80). A risk chart showed predictions of poor outcome at 1 month varying from 25 to 96%.
Poor outcome after BAO can be reliably predicted by a simple model that includes older age, absence of hyperlipidemia, presence of prodromal minor stroke, higher NIHSS score, and longer time to treatment.
Neurology 03/2012; 78(14):1058-63. · 8.31 Impact Factor
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ABSTRACT: Migraine with aura (MA) is associated with cardiac right-to-left shunt. We prospectively studied the association between pulmonary arteriovenous malformations (PAVMs) and MA in hereditary haemorrhagic telangiectasia (HHT). All 220 consecutive HHT patients who underwent high-resolution chest computed tomography for PAVM screening were included prospectively. Prior to screening, a structured validated headache questionnaire was completed by 196 patients (57% female; mean+/-sd age 44.6+/-15.2 yrs). Two neurologists diagnosed migraine according to the International Headache Society Criteria. A PAVM was present in 70 (36%) patients. The prevalence of MA was 24% in the presence of a PAVM compared with 6% in the absence of a PAVM (OR 4.6, 95% CI 1.84-11.2; p = 0.001), and MA was an independent predictor for the presence of PAVM using multivariate analysis (OR 3.6, 95% CI 1.21-10.5; p = 0.02). A PAVM was present in 68% of the patients with MA compared with 32% in the non-migraine controls (OR 4.6, 95% CI 1.84-11.2; p = 0.001), and a PAVM was an independent predictor for MA using multivariate analysis (OR 3.0, 95% CI 1.00-9.20; p = 0.05). In conclusion, PAVMs are associated with MA in HHT patients.
European Respiratory Journal 04/2009; 34(4):882-7. · 5.89 Impact Factor
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ABSTRACT: Migraine is a common neurological disorder with a great impact on the quality of life and social activities. Pulmonary arteriovenous malformations (PAVMs) are mostly congenital, with a prevalence of 5-50% in patients with hereditary hemorrhagic telangiectasia (HHT). A high prevalence of PAVMs is found in patients with HHT and migraine. Embolization of PAVMs seems to decrease the prevalence of migraine. Different pathophysiological hypotheses have been proposed to explain the association between migraine and the different right-to-left shunts. This review article describes the association between a pulmonary right-to-left shunt and the occurrence of migraine.
Respiration 06/2008; 76(2):228-33. · 2.26 Impact Factor
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ABSTRACT: To determine if embolization of pulmonary arteriovenous malformations (PAVMs) decreases the occurrence of migraine.
All 105 patients with hereditary hemorrhagic telangiectasia (HHT), minimum age 16 years, who underwent an embolization of PAVM in our hospital between June 1995 and April 2004, were included in this study. A structured headache questionnaire was sent to all patients and focused on two periods: 1 year before and at least 6 months after embolization. Two independent neurologists diagnosed migraine according to the International Headache Society criteria.
Eighty-four patients (80%) sent back the questionnaire (mean age 47.8 +/- 15.1 years, 51 female). Median follow-up time was 48 months (first quartile: 23 months; third quartile: 66 months). The overall prevalence of migraine decreased from 45.2% before to 34.5% after embolization (p = 0.01). The prevalence of migraine with aura decreased from 33.3% before to 19.0% after embolization (p = 0.002). The severity of headache attacks decreased in patients who still had migraine (p = 0.15) or migraine with aura after embolization (p = 0.11).
Embolization of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia seems to be related to a decrease in prevalence of migraine, suggesting that the presence of a right-to-left shunt rather than the localization of this shunt plays a causative role in the pathogenesis of migraine.
Neurology 02/2006; 66(2):202-5. · 8.31 Impact Factor
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ABSTRACT: Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intra-arterial thrombolysis. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case series of highly selected patients.
To provide more data on the outcome of conventional treatment.
Data were analysed on patients from three centres with symptomatic basilar artery occlusion treated conventionally. Conventional therapy was defined as treatment with antiplatelets, anticoagulation, or both.
Data were available on 82 patients. The case fatality was 40%. Among survivors, 65% remained dependent (Rankin score 4-5). Patients younger than 60 years (odds ratio = 3.1 (95% confidence interval, 1.0 to 9.5)) and those with a minor stroke (OR = 3.1 (1.0 to 9.6)) were more likely to have a good outcome (Rankin score 0-3). Patients with a progressive stroke were less likely to have a good outcome (OR = 0.3 (0.08 to 1.2)) than patients with a maximum deficit at onset or fluctuating symptoms at presentation.
Conventional treatment of symptomatic basilar artery occlusion is associated with a poor outcome in almost 80% of patients, which emphasises the importance of the search for a more effective treatment approach.
Journal of Neurology Neurosurgery & Psychiatry 10/2005; 76(9):1238-41. · 4.76 Impact Factor
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W J Schonewille
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ABSTRACT: Caffeine dependence is a frequent cause of chronic daily headache. This condition was diagnosed in three men aged 33, 35 and 26 years, respectively, and two women aged 67 and 44 years, respectively. As little as 100 mg caffeine may be enough to cause the headache, i.e. the equivalent of one cup of coffee, one bar of dark chocolate, 2 cups of tea or 2 tablets of an analgesic-coffee combination preparation. The therapy consists of discontinuing the caffeine consumption. Assessment of caffeine use is an important part of the headache anamnesis, especially in the case of morning or weekend headaches, unexplained increase in frequency and duration of episodes, a decreased response to headache medication or chronic daily headache.
Nederlands tijdschrift voor geneeskunde 11/2002; 146(40):1861-3.
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ABSTRACT: Migraine is a common neurological disorder with a great impact on the quality of life and social activities. Pulmonary arteriovenous malformations (PAVMs) are mostly congenital, with a prevalence of 5–50% in patients with hereditary hemorrhagic telangiectasia (HHT). A high prevalence of PAVMs is found in patients with HHT and migraine. Embolization of PAVMs seems to decrease the prevalence of migraine. Different pathophysiological hypotheses have been proposed to explain the association between migraine and the different right-to-left shunts. This review article describes the association between a pulmonary right-to-left shunt and the occurrence of migraine.
Respiration 08/1970; 76(2):228-233. · 2.26 Impact Factor
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M Arnold,
U Fischer,
A Compter,
J Gralla,
O Findling,
H P Mattle,
L.J. Kappelle,
D. Tanne,
A. Algra,
x BASICS study group, W.J. Schonewille
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W.J. Schonewille,
C.A.C. Wijman,
P Michel,
C.M. Rueckert,
C. Weimar,
H P Mattle,
S T Engelter,
D. Tanne,
K.W. Muir,
CA Molina,
V Thijs,
H. Audebert,
T. Pfefferkorn,
K. Szabo,
P.J. Lindsberg,
G. Freitas,
L.J. Kappelle,
BASICS study group,
A. Algra
