Stroke in Patients With Common Noncancerous Gynecologic Diseases

Autor: Kazuo Yamashiro, Takeo Sato, Chikako Nito, Yuji Ueno, Hiroyuki Kawano, Tetsuya Chiba, Takahito Nishihira, Takafumi Mizuno, Kentaro Ishizuka, Yasuyuki Iguchi, Kazumi Kimura, Kazuo Kitagawa, Masatoshi Koga, Teruyuki Hirano, Tomoaki Kameda, Hidehiro Takekawa, Takao Urabe, Akiyo Taneichi, Hiroyuki Fujiwara, Shigeru Fujimoto, Nobutaka Hattori, Ryota Tanaka
Rok vydání: 2023
Předmět:
Zdroj: Neurology: Clinical Practice. 13:e200165
ISSN: 2163-0933
2163-0402
DOI: 10.1212/cpj.0000000000200165
Popis: Background and ObjectivesGynecologic diseases such as uterine fibroids, endometriosis, and adenomyosis are common in women of reproductive age. Case reports and small case series have reported ischemic stroke in women with such common noncancerous gynecologic diseases, and their cause of stroke is frequently attributed to cryptogenic stroke or unconventional mechanisms related to hypercoagulability. However, stroke etiology and prognosis are not well known. We assessed the prevalence of and stroke mechanisms related to common noncancerous gynecologic diseases using hospital-based clinical data.MethodsWe retrospectively identified consecutive female patients with common noncancerous gynecologic diseases (uterine fibroids, endometriosis, and adenomyosis) diagnosed with ischemic stroke/transient ischemic attack (TIA) between the ages of 20 and 59 years admitted to 10 stroke centers in Japan by reviewing prospectively collected data between 2017 and 2019. The clinical, laboratory, and neuroimaging features were evaluated and compared between patients with conventional stroke mechanisms (CSMs) (large artery atherosclerosis, small vessel occlusion, cardioembolism, and other determined etiology) and non-CSMs (cryptogenic stroke and causes related to hypercoagulability such as nonbacterial thrombotic endocarditis and paradoxical embolism) according to the Trial of Org 10172 in Acute Stroke Treatment criteria.ResultsOf the 470 female patients with ischemic stroke/TIA, 39 (8%) (37 ischemic stroke and 2 TIA) had common noncancerous gynecologic diseases. The most common gynecologic diseases were uterine fibroids in 24 (62%) patients, followed by endometriosis in 9 (23%) and adenomyosis in 6 (15%). Twenty patients (51%) were assigned to the non-CSMs group, and 19 patients (49%) were assigned to the CSMs group. Adenomyosis and endometriosis were more frequent in the non-CSMs group than in the CSMs group. CA125 and D-dimer levels were higher in the non-CSMs group than in the CSMs group. Multiple vascular territory infarcts were frequent in patients with adenomyosis (60%) and endometriosis (43%) in the non-CSMs group. No stroke recurrence or death was observed within 3 months after discharge in both the CSMs and non-CSMs groups. Outcomes at 3 months after discharge were similar in both groups.DiscussionIn patients with common noncancerous gynecologic diseases, hypercoagulopathy may play a role in the pathogenesis of ischemic stroke/TIA without CSMs.
Databáze: OpenAIRE
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