Stroke in systemic lupus erythematosus: epidemiology, mechanism, and long-term outcome.
Lupus
; 29(5): 437-445, 2020 Apr.
Article
em En
| MEDLINE
| ID: mdl-32151182
ABSTRACT
OBJECTIVE:
To determine stroke prevalence, mechanisms, and long-term outcome in a cohort of Hispanic patients with systemic lupus erythematosus (SLE).METHODS:
We analyzed demographical data, the timing between SLE diagnosis and stroke onset, stroke type, recurrence, and outcomes from an institutional database of 4451 patients with SLE followed from 1993 to 2018.RESULTS:
We observed 139 strokes (3.1%), for an incidence rate of 1.25 per 1000 person-years 81 (58.3%) acute ischemic stroke (AIS), 19 (13.7%) subarachnoid hemorrhage (SAH), 17 (12.2%) cerebral venous thrombosis, 13 (9.4%) intracerebral hemorrhage (ICH), and 9 (6.5%) transient ischemic attack. Median time from SLE diagnosis to acute stroke was 60 months (interquartile range 12-132 months). AIS had a bimodal presentation with 26% occurring within the first year and 30% >10 years after SLE diagnosis. In contrast, 75% of ICH cases occurred >3 years (and 34% >10 years) after SLE diagnosis. The most important cause of AIS was secondary antiphospholipid syndrome (48%). Hypertension was associated with 69% of ICH cases, while aneurysmal rupture was observed in 78% of SAH cases. Excellent recovery at hospital discharge was observed in 65%. Stroke recurrence was observed in 7%. The long-term all-cause fatality rate was 8%.CONCLUSIONS:
The prevalence of stroke in this cohort was 3.1%. Ischemic strokes had a bimodal presentation, occurring either early after SLE diagnosis or after a several-year delay. Half of the hemorrhagic strokes occurred >10 years after the diagnosis of SLE. Clinical outcome was usually good with a relatively low recurrence rate.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Hemorragia Subaracnóidea
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Síndrome Antifosfolipídica
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Acidente Vascular Cerebral
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Lúpus Eritematoso Sistêmico
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Adult
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Female
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Humans
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Male
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Middle aged
País como assunto:
Mexico
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article