Bathing-Related Ischemic Stroke: Association between Stroke Subtype and Cerebral Small Vessel Disease.

IF 3 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of atherosclerosis and thrombosis Pub Date : 2024-06-01 DOI:10.5551/jat.64933

Takahiro Ishikawa, Takeo Sato, Motohiro Okumura, Tatsushi Kokubu, Junichiro Takahashi, Tomomichi Kitagawa, Maki Tanabe, Hiroki Takatsu, Asako Onda, Teppei Komatsu, Kenichi Sakuta, Kenichiro Sakai, Tadashi Umehara, Hidetaka Mitsumura, Yasuyuki Iguchi

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Abstract

Aims: Bathing-related ischemic stroke (BIS) is sometimes fatal. However, its mechanisms and risk factors remain unclear. We aimed to identify the incidence of stroke subtypes in BIS, and clarify the impact of cerebral small vessel disease (CSVD) on BIS.

Methods: Consecutive patients with ischemic stroke between October 2012 and February 2022 were retrospectively screened. The inclusion criteria were: 1) onset-to-door time within 7 days; and 2) availability of the results of MRI evaluation of CSVD markers during hospitalization. BIS was defined as an ischemic stroke that occurred while or shortly after bathing. We investigated the incidence of the stroke subtype and the correlation between CSVD markers and BIS.

Results: 1,753 ischemic stroke patients (1,241 [71%] male, median age 69 years) were included. 57 patients (3%) were included in the BIS group. A higher frequency of large artery atherosclerosis (LAA) (prevalence ratio [PR] 2.069, 95% confidence interval [CI] 1.089 to 3.931, p=0.026) and lower frequency of cardio-embolism (CES) (PR 0.362, 95% CI 0.132 to 0.991, p=0.048) in BIS cases were identified. Moreover, lower periventricular hyperintensity (PVH) Fazekas grade (PR 0.671, 95% CI 0.472 to 0.956, p=0.027) and fewer cerebral microbleeds (CMBs) in deep brain region (PR 0.810, 95%CI 0.657 to 0.999, p=0.049) were associated with BIS cases.

Conclusions: The BIS group was more likely to develop LAA and less likely to develop CES. Lower PVH grade and fewer CMBs in deep brain region were associated with the development of BIS.

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洗澡导致的缺血性中风：中风亚型与脑小血管病之间的关系

目的：沐浴相关缺血性中风（BIS）有时是致命的。然而，其发病机制和风险因素仍不清楚。我们旨在确定 BIS 中风亚型的发生率，并阐明脑小血管疾病（CSVD）对 BIS 的影响：方法：回顾性筛选了 2012 年 10 月至 2022 年 2 月间的连续缺血性卒中患者。纳入标准为1）发病至出院时间在 7 天内；2）住院期间有 CSVD 标记的 MRI 评估结果。BIS 被定义为洗澡时或洗澡后不久发生的缺血性脑卒中。我们调查了中风亚型的发生率以及 CSVD 标志物与 BIS 之间的相关性：共纳入 1,753 名缺血性中风患者（1,241 名[71%]男性，中位年龄 69 岁）。57 名患者（3%）被纳入 BIS 组。结果发现，BIS 组患者中，大动脉粥样硬化（LAA）发生率较高（患病率比 [PR] 2.069，95% 置信区间 [CI] 1.089 至 3.931，P=0.026），心脏栓塞（CES）发生率较低（患病率比 [PR] 0.362，95% 置信区间 [CI] 0.132 至 0.991，P=0.048）。此外，BIS 病例的脑室周围高密度（PVH）法泽卡斯分级较低（PR 0.671，95%CI 0.472 至 0.956，P=0.027），脑深部微出血（CMB）较少（PR 0.810，95%CI 0.657 至 0.999，P=0.049）：结论：BIS 组更有可能发展为 LAA，而较少可能发展为 CES。结论：BIS 组更有可能发展为 LAA，而发展为 CES 的可能性较低。

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