Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers

Christopher Traenka, Daphne Dougoud, Barbara Goeggel Simonetti, Tiina M. Metso, Stéphanie Debette, Alessandro Pezzini, Manja Kloss, Caspar Grond-Ginsbach, Jennifer J. Majersik, Bradford B. Worrall, Didier Leys, Ralf Baumgartner, Valeria Caso, Yannick Béjot, Annette Compter, Peggy Reiner, Vincent Thijs, Andrew M. Southerland, Anna Bersano, Tobias BrandtHenrik Gensicke, Emmanuel Touzé, Juan J. Martin, Hugues Chabriat, Turgut Tatlisumak, Philippe Lyrer, Marcel Arnold, Stefan T. Engelter

Research output: Contribution to journalArticle

Abstract

Objective: 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. Methods: 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. Results: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥ 60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 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 (ORadjusted 0.45 [0.25, 0.83]). Conclusion: 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.

Original languageEnglish
Pages (from-to)1313-1320
Number of pages8
JournalNeurology
Volume88
Issue number14
DOIs
Publication statusPublished - Apr 4 2017

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Dissection
Arteries
Age Groups
Neck Pain
Hypercholesterolemia
Migraine Disorders
Blood Vessels
Headache
Stroke
Odds Ratio
Confidence Intervals
Hypertension
Pain

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Traenka, C., Dougoud, D., Simonetti, B. G., Metso, T. M., Debette, S., Pezzini, A., ... Engelter, S. T. (2017). Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers. Neurology, 88(14), 1313-1320. https://doi.org/10.1212/WNL.0000000000003788

Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers. / 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.

In: Neurology, Vol. 88, No. 14, 04.04.2017, p. 1313-1320.

Research output: Contribution to journalArticle

Traenka, C, Dougoud, D, Simonetti, BG, Metso, TM, Debette, S, Pezzini, A, Kloss, M, Grond-Ginsbach, C, Majersik, JJ, Worrall, BB, Leys, D, Baumgartner, R, Caso, V, Béjot, Y, Compter, A, Reiner, P, Thijs, V, Southerland, AM, Bersano, A, Brandt, T, Gensicke, H, Touzé, E, Martin, JJ, Chabriat, H, Tatlisumak, T, Lyrer, P, Arnold, M & Engelter, ST 2017, 'Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers', Neurology, vol. 88, no. 14, pp. 1313-1320. https://doi.org/10.1212/WNL.0000000000003788
Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A et al. Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers. Neurology. 2017 Apr 4;88(14):1313-1320. https://doi.org/10.1212/WNL.0000000000003788
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. / Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers. In: Neurology. 2017 ; Vol. 88, No. 14. pp. 1313-1320.
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abstract = "Objective: 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. Methods: 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. Results: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4{\%}) aged ≥ 60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 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 (ORadjusted 0.45 [0.25, 0.83]). Conclusion: 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.",
author = "Christopher Traenka and Daphne Dougoud and Simonetti, {Barbara Goeggel} and Metso, {Tiina M.} and St{\'e}phanie Debette and Alessandro Pezzini and Manja Kloss and Caspar Grond-Ginsbach and Majersik, {Jennifer J.} and Worrall, {Bradford B.} and Didier Leys and Ralf Baumgartner and Valeria Caso and Yannick B{\'e}jot and Annette Compter and Peggy Reiner and Vincent Thijs and Southerland, {Andrew M.} and Anna Bersano and Tobias Brandt and Henrik Gensicke and Emmanuel Touz{\'e} and Martin, {Juan J.} and Hugues Chabriat and Turgut Tatlisumak and Philippe Lyrer and Marcel Arnold and Engelter, {Stefan T.}",
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T1 - Cervical artery dissection in patients ≥60 years Often painless, few mechanical triggers

AU - Traenka, Christopher

AU - Dougoud, Daphne

AU - Simonetti, Barbara Goeggel

AU - Metso, Tiina M.

AU - Debette, Stéphanie

AU - Pezzini, Alessandro

AU - Kloss, Manja

AU - Grond-Ginsbach, Caspar

AU - Majersik, Jennifer J.

AU - Worrall, Bradford B.

AU - Leys, Didier

AU - Baumgartner, Ralf

AU - Caso, Valeria

AU - Béjot, Yannick

AU - Compter, Annette

AU - Reiner, Peggy

AU - Thijs, Vincent

AU - Southerland, Andrew M.

AU - Bersano, Anna

AU - Brandt, Tobias

AU - Gensicke, Henrik

AU - Touzé, Emmanuel

AU - Martin, Juan J.

AU - Chabriat, Hugues

AU - Tatlisumak, Turgut

AU - Lyrer, Philippe

AU - Arnold, Marcel

AU - Engelter, Stefan T.

PY - 2017/4/4

Y1 - 2017/4/4

N2 - Objective: 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. Methods: 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. Results: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥ 60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 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 (ORadjusted 0.45 [0.25, 0.83]). Conclusion: 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.

AB - Objective: 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. Methods: 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. Results: Among 2,391 patients diagnosed with CeAD, we identified 177 patients (7.4%) aged ≥ 60 years. In this age group, cervical pain (ORadjusted 0.47 [0.33-0.66]), headache (ORadjusted 0.58 [0.42-0.79]), mechanical trigger events (ORadjusted 0.53 [0.36-0.77]), and migraine (ORadjusted 0.58 [0.39-0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (ORadjusted 1.52 [1.1-2.10]) and hypertension (ORadjusted 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 (ORadjusted 0.45 [0.25, 0.83]). Conclusion: 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.

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