13 results for Anderson, NE

  • Incidence of Transient Ischemic Attack in Auckland, New Zealand, in 2011-2012

    Barber, Peter; Krishnamurthi, R; Parag, V; Anderson, NE; Ranta, A; Kilfoyle, D; Wong, E; Green, G; Arroll, Bruce; Bennett, DA; Witt, E; Rush, E; Suh, FM; Theadom, A; Rathnasabapathy, Y; Te Ao, B; Parmar, P; Feigin, VL (2016-09)

    Journal article
    The University of Auckland Library

    Background and Purpose—There have been few recent population-based studies reporting the incidence (first ever) and attack rates (incident and recurrent) of transient ischemic attack (TIA). Methods—The fourth Auckland Regional Community Stroke study (ARCOS IV) used multiple overlapping case ascertainment methods to identify all hospitalized and nonhospitalized cases of TIA that occurred in people ≥16 years of age usually resident in Auckland (population ≥16 years of age is 1.12 million), during the 12 months from March 1, 2011. All first-ever and recurrent new TIAs (any new TIA 28 days after the index event) during the study period were recorded. Results—There were 785 people with TIA (402 [51.2%] women, mean [SD] age 71.5 [13.8] years); 614 (78%) of European origin, 84 (11%) Māori/Pacific, and 75 (10%) Asian/Other. The annual incidence of TIA was 40 (95% confidence interval, 36–43), and attack rate was 63 (95% confidence interval, 59–68), per 100 000 people, age standardized to the World Health Organization world population. Approximately two thirds of people were known to be hypertensive or were being treated with blood pressure–lowering agents, half were taking antiplatelet agents and just under half were taking lipid-lowering therapy before the index TIA. Two hundred ten (27%) people were known to have atrial fibrillation at the time of the TIA, of whom only 61 (29%) were taking anticoagulant therapy, suggesting a failure to identify or treat atrial fibrillation. Conclusions—This study describes the burden of TIA in an era of aggressive primary and secondary vascular risk factor management. Education programs for medical practitioners and patients around the identification and management of atrial fibrillation are required.

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  • Cerebral amyloid angiopathy-related inflammation (CAA-I): three case reports and a review

    Chung, KK; Anderson, NE; Hutchinson, D; Synek, B; Barber, Peter (2011)

    Journal article
    The University of Auckland Library

    Cerebral amyloid angiopathy related inflammation (CAA-I), previously described under various names, is a treatable encephalopathy usually occurring in older adults. Here, three patients are described with histopathologically confirmed CAA-I, and summarised data from the published literature are presented. CAA-I has a characteristic combination of clinical and radiological features. Definite diagnosis requires brain and leptomeningeal biopsy. A favourable response to immunosuppressive therapy is common and treatment without brain biopsy may be considered in selected patients. Diagnostic criteria for CAA-I are proposed.

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  • Inadequacy of clinical scoring systems to differentiate stroke subtypes in population-based studies

    Hawkins, GC; Bonita, R; Broad, Joanna; Anderson, NE (1995)

    Journal article
    The University of Auckland Library

    Background and Purpose: We undertook to examine the usefulness for epidemiological studies of two well-known validated clinical scoring methods, the Guys' Hospital Stroke score and the Siriraj Hospital Stroke score, to classify strokes into the two main types, hemorrhagic and ischemic, in epidemiological studies. Methods: Patients from a population-based stroke register who received either a CT scan or an autopsy were retrospectively scored using the two clinical scoring methods. The scores were then compared with the CT scan and autopsy results to determine the sensitivity, specificity, and positive predictive value for intracranial hemorrhage (primary intracerebral and subarachnoid hemorrhage) and ischemic stroke. Results: Over a 12-month period, 554 patients from a population-based study underwent CT scanning. Films or autopsy reports were available for 521 patients, and of these, sufficient clinical information to calculate the Guys' Hospital Stroke score and the Siriraj Hospital Stroke score was available for 464 and 475 patients, respectively. For the Guys' Hospital Stroke score, the sensitivity and specificity for intracranial hemorrhage were 31% and 95%, respectively; the positive predictive value was 73%. The sensitivity and specificity for ischemic stroke were 78% and 70%, respectively, and the positive predictive value was 86%. For the Siriraj Hospital Stroke score, the sensitivity and the specificity for intracranial hemorrhage were 48% and 85%, respectively; the positive, predictive value was 59%. The sensitivity and specificity for ischemic stroke were 61% and 74%, respectively, and the positive predictive value was 84%. Conclusions: This validation study suggests that both clinical scores lack sufficient validity to be used in epidemiological studies for classification of stroke types and should probably not be used in the randomization of patients into treatment trials rising thrombolytic or antithrombotic drugs in the absence of diagnostic information based on neuroimaging techniques.

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  • Adverse Cardiovascular, Cerebrovascular, and Peripheral Vascular Effects of Marijuana: What cardiologists need to know

    Barber, Peter; Roberts, S; Spriggs, DA; Anderson, NE (2014-03)

    Journal article
    The University of Auckland Library

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  • Intravenous thrombolysis is unsafe in stroke due to infective endocarditis

    Brownlee, WJ; Anderson, NE; Barber, Peter (2014-02)

    Journal article
    The University of Auckland Library

    Embolic stroke is the most common neurological complication of infective endocarditis and a major source of morbidity and mortality. Septic embolism is considered a contraindication to intravenous thrombolysis in patients with ischaemic stroke because of concerns over an increased risk of intracranial haemorrhage. We describe a patient with occult endocarditis who was treated with thrombolysis for acute stroke and review other cases reported in the literature.

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  • Not all patients with atrial fibrillation-associated ischemic stroke can be started on anticoagulant therapy

    Pereira, Jennifer; Barber, Peter; Anderson, NE; Kumar, A; Spriggs, D; Charleston, A; Bennett, P; Baker, Y; Ross, L (2006)

    Journal article
    The University of Auckland Library

    Ischemic stroke patients in atrial fibrillation (AF) have a 10% to 20% risk of recurrent stroke. Warfarin reduces this risk by two thirds. However, warfarin is underutilized in this patient group. We performed a prospective study to determine the reasons why warfarin is not started in these patients

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  • Changing attitudes to the management of ischaemic stroke between 1997 and 2004: a survey of New Zealand physicians

    Pereira, Jennifer; Barber, Peter; Anderson, NE; Spriggs, D; Charleston, A; Bennett, P (2006)

    Journal article
    The University of Auckland Library

    Aim: In 1997, a survey of New Zealand physicians’ opinions on the management of stroke was carried out. Since then, there have been a number of advances in stroke therapy. We have repeated the 1997 survey to assess changes in physicians’ opinions on stroke management. Methods: A questionnaire was sent to 293 physicians responsible for patients admitted with acute stroke to hospitals throughout New Zealand. It included questions on the management of acute stroke and secondary prevention and was based on the 1997 questionnaire. Results: Responses were received from 211 physicians of whom 174 (82%) managed patients with an acute stroke. The number of respondents who thought that stroke units were efficacious has increased (57% in 1997 to 89%, P < 0.001). The use of aspirin acutely (P < 0.001) and intravenous tissue plasminogen activator (P = 0.006) has also increased. In 2004, antihypertensive therapy for secondary stroke prevention would be commenced if the blood pressure was 150/90 by 98% of respondents and 140/90 by 70% of respondents. In 2004, a statin would be commenced if the total cholesterol level was 4.0 mmol/L by 56% of respondents and 5.0 mmol/L by 91% of respondents. Conclusions: This survey has shown important changes in the management of ischaemic stroke over the past 7 years.

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  • Cannabis, Ischemic Stroke, and Transient Ischemic Attack: A Case-Control Study

    Barber, Peter; Pridmore, HM; Krishnamurthy, V; Roberts, S; Spriggs, DA; Carter, KN; Anderson, NE (2013-08)

    Journal article
    The University of Auckland Library

    Background and Purpose—There is a temporal relationship between cannabis use and stroke in case series and population-based studies. Methods—Consecutive stroke patients, aged 18 to 55 years, who had urine screens for cannabis were compared with a cohort of control patients admitted to hospital without cardiovascular or neurological diagnoses. Results—One hundred sixty of 218 (73%) ischemic stroke/transient ischemic attack patients had urine drug screens (100 men; mean [SD] age, 44.8 [8.7] years). Twenty-five (15.6%) patients had positive cannabis drug screens. These patients were more likely to be men (84% versus 59%; χ2: P=0.016) and tobacco smokers (88% versus 28%; χ2: P<0.001). Control urine samples were obtained from 160 patients matched for age, sex, and ethnicity. Thirteen (8.1%) control participants tested positive for cannabis. In a logistic regression analysis adjusted for age, sex, and ethnicity, cannabis use was associated with increased risk of ischemic stroke/transient ischemic attack (odds ratio, 2.30; 95% confidence interval, 1.08–5.08). However after adjusting for tobacco use, an association independent of tobacco could not be confirmed (odds ratio, 1.59; 95% confidence interval, 0.71–3.70). Conclusions—This study provides evidence of an association between a cannabis lifestyle that includes tobacco and ischemic stroke. Further research is required to clarify whether there is an association between cannabis and stroke independent of tobacco.

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  • Reversible cerebral vasoconstriction in Guillain–Barré syndrome syndrome

    Wei, DY; Kao, J; Wu, TY; Pereira, Jennifer; Anderson, NE; Barber, Peter (2015)

    Journal article
    The University of Auckland Library

    We present a 51-year-old woman with clinical and neurophysiological evidence of Guillain–Barré syndrome (GBS) who developed a generalised headache and autonomic dysfunction with sinus tachycardia, hypertension, gastrointestinal motility symptoms and urinary retention. MRI/MRA demonstrated cerebral vasoconstriction and a small convexity subarachnoid haemorrhage which resolved after 3 months. Reversible cerebral vasoconstriction syndrome (RCVS) is characterised by headache, focal neurological deficits or seizures, and reversible cerebral vasoconstriction. To our knowledge, this is the first reported case of RCVS complicating autonomic dysfunction in GBS. This case depicts a rare complication of a common condition and also sheds light on the potential mechanism of RCVS. Neurologists should be aware that autonomic dysfunction can lead to RCVS in GBS.

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  • Spice, Pot, and Stroke

    Barber, Peter; Anderson, NE (2014-08)

    Journal article
    The University of Auckland Library

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  • Stroke incidence and case fatality in Australasia: A comparison of the Auckland and Perth population-based stroke registers

    Bonita, R; Broad, Joanna; Anderson, CS; Jamrozik, KD; Stewart-Wynne, EG; Anderson, NE (1994-03)

    Journal article
    The University of Auckland Library

    Background and Purpose: Population-based studies are crucial for identifying explanations for the decline in mortality from stroke and for generating strategies for public health policy. However, they present particular methodological difficulties, and comparability between them is generally poor. In this article we compare the incidence and case fatality of stroke as assessed by two independent well-designed incidence studies. Methods: Two registers of acute cerebrovascular events were compiled in the geographically defined metropolitan areas of Auckland, New Zealand (population 945 369), during 1991-1992 for 12 months and Perth, Australia (population 138 708), during 1989-1990 for 18 months. The protocols for each register included prospective ascertainment of cases using multiple overlapping sources and the application of standardized definitions and criteria for stroke and case fatality. Results: In Auckland, 1803 events occurred in 1761 residents, 73% of which were first-ever strokes. The corresponding figures for Perth were 536 events in 492 residents, 69% of which were first-ever strokes. Both studies identified a substantial proportion of nonfatal strokes managed solely outside the hospital system: 28% in Auckland and 22% in Perth of all patients registered. The age- standardized annual incidence of stroke (all events) was 27% higher among men in Perth compared with Auckland (odds ratio, 1.27; P=.016): women tended to have higher rates in Auckland, although these differences were not statistically significant. In both centers approximately a quarter of all patients died within the first month after a stroke. There were significant differences in the prevalence of hypertension among first-ever strokes. Conclusions: These two studies emphasize the importance of identifying all patients with stroke, both hospitalized and nonhospitalized, in order to measure the incidence of stroke accurately. The incidence and case fatality of stroke were remarkably similar in Auckland and Perth in the early 1990s. However, there are differences in the sex-specific rates that correspond to differences in the pattern of risk factors.

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  • Neurological complications of carotid revascularisation.

    Wu, TY; Anderson, NE; Barber, Peter (2012)

    Journal article
    The University of Auckland Library

    This article has been accepted for publication in Journal of Neurology, Neurosurgery and Psychiatry Online:8 pages Dec 2011 following peer review and can also be viewed on the journal’s website at www. jnnp.bmj.com Carotid endarterectomy (CEA) is an effective treatment for patients with recently symptomatic severe carotid stenosis and in selected patients with symptomatic moderate carotid stenosis. Carotid artery angioplasty and stenting (CAS) is emerging as an alternative to CEA, and randomised controlled trials suggest comparable efficacy to CEA in prevention of non-perioperative stroke. Neurovascular complications can result from both procedures, usually from thromboembolism from the operated vessel, cerebral hypoperfusion causing ischaemia and, rarely, intracerebral haemorrhage. The overall incidence of perioperative strokes complicating CEA and CAS is approximately 4% and 6%, respectively, and represents a devastating outcome that the procedure was designed to prevent. Other neurological sequelae complicating carotid revascularisation include cerebral hyperperfusion syndrome, cranial and peripheral nerve injuries, and contrast encephalopathy in patients undergoing CAS. In this review, we analyse the incidence, mechanisms and perioperative management of neurological complications for patients undergoing carotid revascularisation.

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  • Limbic encephalitis - a review

    Anderson, NE; Barber, Peter (2008)

    Journal article
    The University of Auckland Library

    The clinical features of limbic encephalitis are diverse and early diagnosis of the disorder is frequently difficult. Four patients with limbic encephalitis are described. An antineuronal antibody was identified in three of these patients. Antibodies directed against voltage-gated potassium channels, the N-methyl-D-aspartate receptor and an unidentified neuropil antigen were each found in one patient. The fourth patient had multifocal paraneoplastic encephalitis associated with small cell lung cancer. The clinical and imaging findings associated with these antibodies and the other antineuronal antibodies described in patients with limbic encephalitis are reviewed. An approach to the diagnosis and management of limbic encephalitis is presented.

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