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Cervical artery dissection in patients ≥60 years: Often painless, few mechanical triggers
Christopher Traenka1, Daphne Dougoud2, Barbara Goeggel Simonetti2
1From 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. christopher.traenka@usb.ch.
Insights
Older adults (≥60) with cervical artery dissection (CeAD) often lack typical pain symptoms, making diagnosis challenging. This group also experiences more risk factors like hypertension and poorer outcomes.
Area of Science:
- Neurology
- Vascular Medicine
- Geriatrics
Background:
- Cervical artery dissection (CeAD) is a significant cause of stroke, particularly in younger adults.
- Understanding CeAD characteristics in older populations is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine the proportion of patients aged ≥60 years diagnosed with CeAD.
- To compare clinical characteristics, risk factors, and outcomes between older (≥60) and younger (<60) CeAD patients.
Main Methods:
- Pooled individual patient data from three large CeAD cohorts (Cervical Artery Dissection and Ischemic Stroke Patients-Plus consortium).
- Dichotomized patients into age groups ≥60 and <60 years.
- Compared clinical features, risk factors, vascular aspects, and 3-month outcomes using multivariable adjusted analyses.
Main Results:
- Out of 2,391 CeAD patients, 7.4% (177) were aged ≥60 years.
- Older patients had less frequent cervical pain, headache, mechanical triggers, and migraine.
- Older patients showed higher frequencies of hypercholesterolemia and hypertension.
- Favorable outcomes (modified Rankin Scale score 0-2) were less frequent in the older group (ORadjusted 0.45 [0.25, 0.83]).
Conclusions:
- Approximately 1 in 14 CeAD patients are aged ≥60 years.
- The absence of typical pain and mechanical triggers in older CeAD patients may complicate diagnosis.
- Delayed diagnosis in older adults may contribute to poorer outcomes.
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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