Cervical artery dissection in patients ≥ 60 years

Christopher Traenka (1, 2) , Daphne Dougoud , Barbara Goeggel Simonetti , Tiina Metso (3) , Stéphanie Debette (4) , Alessandro Pezzini (5) , Manja Kloss (6) , Caspar Grond-Ginsbach (7, 2) , Jennifer Majersik , Bradford Worrall , Didier Leys (8) , Ralf Baumgartner , Valeria Caso (9) , Yannick Béjot (10) , Annette Compter , Peggy Reiner (11) , Vincent Thijs (12, 13) , Andrew Southerland , Anna Bersano (14) , Tobias Brandt (15) , Henrik Gensicke , Emmanuel Touzé , Juan Martin , Hugues Chabriat , Turgut Tatlisumak , Philippe Lyrer , Marcel Arnold , Stefan Engelter , Sandrine Canaple (16, 17, 18) , Olivier Godefroy (18, 16, 17)

1 Unibas - University of Basel
2 Felix Splatter Hospital [Bâle]
3 HUCH - Helsinki University Central Hospital [Finland]
4 Troubles cognitifs vasculaires et dégénératifs
5 UniBs - Università degli Studi di Brescia = University of Brescia
6 Department of Neurology
7 Heidelberg University Hospital [Heidelberg]
8 TCDV - Troubles cognitifs dégénératifs et vasculaires - U 1171
9 UNIPG - Università degli Studi di Perugia = University of Perugia
10 PEC2 - Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon]
11 Hôpital Lariboisière
12 University Hospitals Leuven [Leuven]
13 VIB-KU-CCB - Leuven Center for Cancer Biology
14 Fondazione IRCCS Istituto Neurologico "Carlo Besta"
15 MPIBP - Max-Planck-Institut für Biophysik - Max Planck Institute of Biophysics
16 LNFP - Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559
17 CHU Amiens-Picardie
18 Service de neurologie [Amiens]

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 (OR adjusted 0.47 [0.33–0.66]), headache (OR adjusted 0.58 [0.42–0.79]), mechanical trigger events (OR adjusted 0.53 [0.36–0.77]), and migraine (OR adjusted 0.58 [0.39–0.85]) were less frequent than in younger patients. In turn, hypercholesterolemia (OR adjusted 1.52 [1.1–2.10]) and hypertension (OR adjusted 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 adjusted 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.

Domaines: Médecine humaine et pathologie

Christopher Traenka, Daphne Dougoud, Barbara Goeggel Simonetti, Tiina Metso, Stéphanie Debette, et al.. Cervical artery dissection in patients ≥ 60 years: Often painless, few mechanical triggers. Neurology, 2017, 88 (14), pp.1313-1320. ⟨10.1212/WNL.0000000000003788⟩. ⟨hal-04066708⟩