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Long-term morbidities can develop after traumatic brain injury (TBI). Some studies have suggested that the risk of stroke is higher after TBI, but the association between concussion and stroke remains unclear. Using a national cohort, the authors analyzed the incidence of both hemorrhagic and ischemic strokes in patients with previous concussion. A representative cohort of approximately one million people was followed up for four years. Patients with new-onset concussion were identified ( n = 13,652) as the concussion group. Subsequently, the incidence rates of later stroke events in the concussion group were compared to a sex-, age- and propensity score-matched comparison group ( n = 13,652). The overall incidence rate of stroke in the concussion group was higher than that of the comparison group (9.63 versus 6.52 per 1000 person-years, p < 0.001). Significantly higher stroke risk was observed in the concussion group than in the comparison group (crude hazard ratio 1.48, p < 0.001; adjusted HR 1.65, p < 0.001). In the concussion group, the cumulative incidence rates of both ischemic stroke and hemorrhagic stroke were higher than those of the comparison group (8.9% vs. 5.8% and 2.7% vs. 1.6%, respectively, both p < 0.001). Concussion is an independent risk factor for both ischemic and hemorrhagic strokes. Prevention and monitoring strategies of stroke are therefore suggested for patients who have experienced concussion.

Objectives: This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke., Methods: Using the National Health Insurance Research Database (NHIRD), a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD) in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439) who received spinal fusion surgery, and the control group (n = 2124) who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups., Results: During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years) was significantly lower than that of the control group (20.89 per 1000 person-years, p < 0.001). Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p < 0.001; adjusted HR 1.28, p < 0.001, by a propensity score matched model)., Conclusions: In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke in adult patients with spinal deformity.

The association between osteoporosis and cardiovascular diseases has been demonstrated. Higher cardiovascular risk has also been correlated with vertebral fractures. However, the association between osteoporotic vertebral fracture and the possibly higher risk of stroke remains uncertain. This study aimed to evaluate the incidence, risk, and type of stroke in patients with osteoporotic vertebral fracture. Patients with osteoporotic vertebral fracture were identified (n = 380) and 10 age- and sex-matched controls per case (comparison group, n = 3795) were chosen from a nationwide representative cohort of 999,997 people from 1998 to 2005. Both groups were followed-up for stroke events for 3 years, matched by propensity scores with adjustments for covariates such as comorbidities (ie, hypertension, diabetes, arrhythmia, or coronary heart diseases) and exposure to medications (ie, aspirin, lipid lowering drug, or nitrates), and assessed by Kaplan-Meier and Cox regression analyses. The incidence rate of stroke in the osteoporotic vertebral fracture group (37.5 per 1000 person-years; 95% confidence interval [CI], 27.5-51.2) was significantly higher than in the comparison group (14.0 per 1000 person-years; 95% CI, 12.0-16.4, p < 0.001). Stroke was more likely to occur in the osteoporotic vertebral fracture patients than in the normal controls (crude hazard ratio [HR] 2.68, 95% CI 1.89-3.79, p < 0.001; adjusted HR 2.71, 95% CI 1.90-3.86, p < 0.001). In conclusion, patients with osteoporotic vertebral fracture have a higher risk of stroke (ie, both ischemic and hemorrhagic) and require stroke prevention strategies., (Copyright © 2013 American Society for Bone and Mineral Research.)

Purpose: To investigate the incidence and risk of stroke after lumbar spinal fusion surgery., Method: Study subjects were identified from a nationwide cohort of 1 million people from 2000 to 2005 and were divided into the lumbar spinal fusion group (n = 2,015), who received posterior lumbar spinal fusion surgery, and the comparison group (n = 16,120) composed of age-, sex-, and propensity score-matched control subjects. The matching process was intended to adjust for demographics, comorbidities, and other immeasurable covariates to minimize selection bias. All subjects were followed up for 3 years for stroke, including hemorrhagic and ischemic strokes. Kaplan-Meier and Cox regression analyses were performed., Results: The overall incidence rate of stroke in the cohort was 9.99 per 1,000 person-year. The lumbar spinal fusion group was less likely to have any stroke (adjusted hazard ratio (HR) = 0.83, p = 0.293), hemorrhagic stroke (adjusted HR = 0.74, p = 0.739) and ischemic stroke (adjusted HR = 0.81, p = 0.250) than the comparison group, but without significance., Conclusions: Three years post-operatively, patients who received lumbar spinal fusion had stroke incidence rates similar to those without surgery. Posterior lumbar spinal fusion surgery is not associated with increased risks for any kind of stroke.

Background Context: Postoperative stroke is a rare complication of spinal fusion surgery, but its relevant risk and incidence remain unclear., Purpose: To investigate the incidence and risk of stroke after spinal fusion surgery., Study Design: Cohort study., Patient Sample: All study subjects were extracted from a nationwide representative cohort of one million people from 2000 to 2005., Outcome Measures: Stroke, including hemorrhagic and ischemic, during the study period., Methods: An exposure group of 2,249 subjects who received spinal fusion surgery during the study period was compared with 2,203 control subjects matched by age, sex, and propensity score. All were followed up for 3 years for all kinds of stroke. Demographics, comorbidities, and nonmeasurable covariates were matched between the two groups. Kaplan-Meier analyses were performed, with adjustments by Cox regression model., Results: There were 4,452 subjects, including 2,249 spinal fusion patients and 2,203 controls, who were followed up for 12,967 person-years. The incidence rates of any, hemorrhagic, and ischemic strokes were 9.95, 1.21, and 8.86, respectively, per 1,000 person-years in the spinal fusion group and 11.5, 1.69, and 9.93, respectively, in the comparison group. Patients who received spinal fusion surgery were less likely to have any stroke (crude hazard ratio [HR]=0.87, p=.393), hemorrhagic stroke (HR=0.72, p=.473), and ischemic stroke (HR=0.89, p=.582) than the comparison group but without statistical significance. After adjusting for demographics, comorbidities, and medications, there were still no significant differences for risks of any, hemorrhagic, and ischemic strokes (adjusted HR=0.89, 1.36, and 0.87; p=.522, .553, and .477, respectively) in the spinal fusion group., Conclusions: Patients receiving spinal fusion surgery have similar incidence rates of having a stroke within 3 years postoperation as those without surgery. Risks of any postoperative stroke are similar or insignificantly lower in the spinal fusion group., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: Spinal cord injury (SCI) is associated with a higher risk of cardiovascular diseases but whether or not the risk of cerebrovascular disease also increases remains unclear. This study aimed to evaluate the incidence of stroke in patients with disability caused by SCI., Methods: Study subjects were identified from a nationwide cohort of 18,690,066 people from 1998 to 2002 that was divided into an SCI group (n = 2,806), who were disabled from SCI, and a comparison group (n = 28,060), composed of age-, sex-, and propensity score- matched control subjects. Every subject was followed up for 4 years, unless they died or had a stroke by December 31, 2006. Kaplan-Meier and Cox regression analyses were performed., Results: The incidence rate of stroke in the SCI group (5.96 per 1,000 person-years) was higher than that of the comparison group (p < 0.001). Stroke was more likely to occur in the SCI group than in the comparison group (crude hazard ratio 2.93, p < 0.001; adjusted hazard ratio 2.85, p < 0.001). In the SCI group, the incidence of ischemic stroke was higher than that of hemorrhagic stroke (incidence rate ratio 3.42, p < 0.001)., Conclusions: SCI patients with disability are at a higher risk of stroke, especially the ischemic type. Strategies to prevent stroke are therefore suggested for them.

Purpose: To investigate the incidence and risk of stroke after percutaneous vertebroplasty in patients with osteoporosis., Methods: A group of 334 patients with osteoporosis, and who underwent percutaneous vertebroplasty during the study period, was compared to 1,655 age-, sex- and propensity score-matched patients who did not undergo vertebroplasty. All demographic covariates and co-morbidities were deliberately matched between the two groups to avoid selection bias. Every subject was followed-up for up to five years for stroke. Adjustments using a Cox regression model and Kaplan-Meier analyses were conducted., Results: A total of 1,989 osteoporotic patients were followed up for 3,760.13 person-years. Overall, the incidence rates of any stroke, hemorrhagic stroke and ischemic stroke were 22.6, 4.2 and 19.6 per 1,000 person-years, respectively. Patients who underwent vertebroplasty were not more likely to have any stroke (crude hazard ratio = 1.13, p = 0.693), hemorrhagic stroke (HR = 2.21, p = 0.170), or ischemic stroke (HR = 0.96, p = 0.90). After adjusting for demographics, co-morbidities and medications, the vertebroplasty group had no significant difference with the comparison group in terms of any, hemorrhagic and ischemic strokes (adjusted HR = 1.22, 3.17, and 0.96, p = 0.518, 0.055, and 0.91, respectively)., Conclusions: Osteoporotic patients who undergo percutaneous vertebroplasty are not at higher risk of any stroke in the next five years after the procedure.

Background and Purpose: Infections have been hypothesized to play a role in vascular disease. The association between Mycoplasma pneumoniae (MP) infection and ischemic stroke remained undetermined., Methods: A total of 1094 patients with MP infection were enrolled as the study group and compared with 5168 sex-, age-, and comorbidity-matched subjects without MP, to be followed up prospectively from January 2003 to December 2007 for development of ischemic stroke., Results: During a maximum 5-year follow-up period, 49 patients with ischemic stroke were identified. Subjects with MP infection were significantly associated with increased risk of ischemic stroke compared with controls (1.10% versus 0.72%, respectively; P=0.01). The logrank test showed that patients with MP had significantly higher incidence of stroke development than did those without MP (P=0.046). After Cox model adjustment for risk factors and comorbidities, MP infection was still independently associated with increased risk of stroke (hazard ratio [HR], 2.07; 95% CI, 1.05-4.03)., Conclusions: We conclude that MP infection is independently associated with risk of subsequent ischemic stroke development.

Background Atrial fibrillation (AF) is associated with an increased risk of dementia. However, limited data are available on the predictors of dementia in patients with AF. This study aimed to evaluate whether the CHADS 2 score could be a useful tool for risk stratification with regard to dementia occurrence among patients with AF. Methods AF patients were identified from the National Health Insurance sampling database, which has accumulated a total of 1,000,000 participants since 2000. After excluding patients diagnosed with dementia prior to the index day of enrollment, CHADS 2 score was measured to investigate its association with the occurrence of dementia, including vascular dementia and Alzheimer's disease. Results During the mean follow-up period of 3.71 ± 2.78 years, 1135 dementia cases (7.36%) were identified, including 241 cases of vascular dementia and 894 cases of Alzheimer's disease. In multivariate analysis, an increase of 1 point in the CHADS2 score was independently associated with a 54% increase in the risk of vascular dementia (hazard ratio = 1.54; 95% confidence interval, 1.41–1.69; p < 0.001) and a 40% increase in Alzheimer's disease (hazard ratio = 1.40; 95% confidence interval, 1.34–1.46; p < 0.001). Conclusion CHADS 2 score is a useful predictor for the development of vascular dementia as well as Alzheimer's disease in patients with AF. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cataract is a common and correctable ophthalmological condition that is associated with a poor quality of life and shortened life expectancy in older people. However, little is known regarding the use of cataract surgery in stroke patients after the incident event. Methods: A national cohort of 5462 patients who had experienced an acute stroke event without severe physical disability between 2000 and 2003, and 26,434 randomly selected age- and sex-matched controls were obtained from a random population-based sample of the National Health Insurance database in Taiwan. Multivariate Cox proportional hazard regression analysis was used to assess the association between stroke events and cataract surgery. Results: After a 5-year follow-up, 482 stroke patients (8.8%) and 1897 controls (7.2%) had received cataract surgery after the index dates of their stroke. The incidence of subsequent cataract surgery following acute stroke was 27% higher than that in the comparison group (crude hazard ratio 1.27; p < 0.001). Adjusted for age, sex, co-morbid medical diseases, use of systemic steroids, exposure to radiation during computed tomography, and socioeconomic status, the incidence of cataract surgery in the stroke patients was 30% higher than that in the comparison group (adjusted hazard ratio 1.30; p < 0.001). Conclusion: A 30% increase in the use of cataract surgery was noted among the survivors of acute stroke with mild-to-moderate disabilities, which may result from the increased need for better vision after stroke. [Copyright &y& Elsevier]

Abstract: Background: The beneficial effects of statins in patients undergoing hemodialysis are controversial. Our study aimed to investigate the use of statins and the subsequent risk of cardiovascular morbidity and mortality in patients undergoing hemodialysis. Methods: We conducted a cohort study using data from the Taiwan National Health Insurance Research Database. Cox regressions were performed to determine the hazard ratio (HR) of cardiovascular morbidity and mortality in the HD patients taking statins (statin cohort) compared with a propensity-matched comparison cohort. Results: The statin cohort included a total of 4074 patients who received statin treatment while also undergoing hemodialysis (mean age 53.3±13.5years, male 34.9%). The comparison cohort included 8148 propensity-matched hemodialysis patients who were not using statins. During the three years of follow-up, the statin cohort had lower incidence of ischemic stroke (p <0.001), hospitalizations due to unstable angina (p <0.001), deep vein thrombosis (p <0.001), cardiovascular mortality (p <0.001), and all-cause mortality (p <0.001). After Cox regression analysis, statin use was independently associated with lower risk of future ischemic stroke (HR, 0.49; 95% confidence interval [CI], 0.39–0.63), hospitalization for unstable angina (HR, 0.57; 95% CI, 0.47–0.70), deep vein thrombosis (HR, 0.11; 95% CI, 0.05–0.27), cardiovascular mortality (HR, 0.29; 95% CI, 0.18–0.46), and all-cause mortality (HR, 0.49; 95% CI, 0.41–0.58). Conclusion: Statin use was associated with a lower incidence of cardiovascular morbidity and mortality in patients undergoing hemodialysis. [Copyright &y& Elsevier]