Long-Term Risk of Stroke After Transient Global Amnesia in Two Prospective Cohorts.

Background and Purpose- Transient global amnesia (TGA) is known as a benign syndrome, but recent data from neuroradiological studies support an ischemic cause in some cases, which might suggest an increased susceptibility to cerebrovascular events. We determined the long-term risk of stroke after a first TGA in 2 independent prospective cohorts. Methods- In 2 independent prospective cohorts of patients with TGA (OXVASC [Oxford Vascular Study], population-based; NU (Northern Umbria) cohort, TGA registry), cardiovascular risk factors and long-term outcomes, including stroke and major cardiovascular events, were identified on follow-up. Cardiovascular risk factors were treated according to primary prevention guidelines. In OXVASC, the age-/sex-adjusted risk of stroke during follow-up was compared with that expected from the rate in the underlying study population. Results- Among 525 patients with TGA (425 NU and 100 OXVASC), mean (SD) age was 65.1 (9.5) years and 42.5% male. Hypertension (58.1%), dyslipidemia (40.4%), and smoking (36.4%) were the most frequent cardiovascular risk factors. The risk of stroke was similar in the 2 cohorts, with a pooled annual risk of 0.6% (95% CI, 0.4-0.9) and a 5-year cumulative risk of 2.7% (1.1-4.3). Moreover, the stroke risk in OXVASC cases was no greater than that expected in the underlying study population (adjusted relative risk=0.73; 0.12-4.54; P=0.74). Conclusions- TGA does not carry an increased risk of stroke, at least when cardiovascular risk factors are treated according to primary prevention guidelines.

Nonmelanoma skin cancer risk awareness in azathioprine-treated myasthenia gravis patients.

OBJECTIVES: Increased rates of NMSC (nonmelanoma skin cancer) have recently been reported in people with MG (myasthenia gravis) receiving azathioprine treatment. Guidelines on azathioprine for patients with dermatological and gastrointestinal disorders stress the importance of NMSC risk awareness and prevention. The aim of this study is to assess whether MG patients are being informed of this risk. METHODS: Clinical records of patients with MG attending a university hospital neurology clinic were reviewed. Data on patient demographics, clinical presentation, diagnostic tests, azathioprine treatment, development of NMSC, and counseling regarding NMSC risk were recorded. RESULTS: Sixty-nine MG cases were identified, median age 58 years (range 20-90). Forty-two (60.9%) had received azathioprine at some point with a mean cumulative dose of 235.5 g (range 9.1-972.8 g). Skin cancer risk and prevention advice provision was documented in 3 (7.1%) azathioprine-treated patients. Five patients developed histologically confirmed NMSC of whom all were treated with azathioprine (incidence rate of 24.9 per 1000, 16 times higher than expected). Documented advice on other safety issues such as regular blood test monitoring was found in 33 (78.8%) azathioprine-treated cases. CONCLUSIONS: Preventative measures such as daily sunscreen use have been shown to reduce the incidence of NMSC in the general population. The results of this study demonstrate a very low rate of advice provision about NMSC risk in azathioprine-treated MG patients and the need for increased awareness among treating neurologists and patients.