warfarin and Cerebellar-Diseases

Isolated vertigo is an important symptom of posterior circulation stroke. It has been reported that 11.3% of patients with isolated vertigo have a stroke and that most lesions are located in the cerebellum, particularly in the posterior inferior cerebellar artery. We report the case of a 63-year-old man with multiple atherosclerotic risk factors and atrial fibrillation who showed repeated episodes of isolated vertigo. His repeated vertigo was short-lasting and was often triggered by body position, mimicking benign paroxysmal positional vertigo. Cranial computed tomography on the third hospital day showed left cerebellar infarction within the territory of the posterior inferior cerebellar artery. The vertigo was ameliorated on the fifth hospital day and warfarin was prescribed for secondary prevention. Clinicians should pay special attention to cases in which a patient presents isolated vertigo, even if it shows transient recurrence or is triggered by a positional change, especially in patients with multiple cerebrovascular risk factors.

Topics: Anticoagulants; Brain Infarction; Cerebellar Diseases; Cerebral Angiography; Computed Tomography Angiography; Humans; Male; Middle Aged; Postural Balance; Posture; Recurrence; Secondary Prevention; Treatment Outcome; Vertigo; Warfarin

Despite extensive studies of supratentorial intracerebral hemorrhage (ICH), limited data are available on determinants of hematoma volume in infratentorial ICH. We therefore aimed to identify predictors of infratentorial ICH volume and to evaluate whether location specificity exists when comparing cerebellar to brainstem ICH.. We undertook a retrospective analysis of 139 consecutive infratentorial ICH cases (95 cerebellar and 44 brainstem ICH) prospectively enrolled in a single-center study of ICH. ICH volume was measured on the CT scan obtained upon presentation to the Emergency Department using an established computer-assisted method. We used linear regression to identify determinants of log-transformed ICH volume and logistic regression to evaluate their role in surgical evacuation.. Median ICH volumes for all infratentorial, cerebellar, and brainstem ICH were nine [interquartile range (IQR), 3-23], ten (IQR, 3-25), and eight (IQR, 3-19) milliliters, respectively. Thirty-six patients were on warfarin treatment, 31 underwent surgical evacuation, and 65 died within 90 days. Warfarin was associated with an increase in ICH volume of 86 % [β = 0.86, standard error (SE) = 0.29, p = 0.003] and statin treatment with a decrease of 69 % (β = -69, SE = 0.26, p = 0.008). Among cerebellar ICH subjects, those on warfarin were five times more likely to undergo surgical evacuation (OR = 4.80, 95 % confidence interval 1.63-14.16, p = 0.005).. Warfarin exposure increases ICH volume in infratentorial ICH. Further studies will be necessary to confirm the inverse relation observed between statins and ICH volume.

Topics: Aged; Anticoagulants; Brain Stem Hemorrhage, Traumatic; Cerebellar Diseases; Cerebral Hemorrhage; Female; Hematoma; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Radiography; Retrospective Studies; Treatment Outcome; Warfarin

Topics: Anticoagulants; Articulation Disorders; Cerebellar Diseases; Cerebellum; Female; Frontal Lobe; Functional Laterality; Humans; Infarction, Middle Cerebral Artery; Intracranial Hemorrhages; Middle Aged; Neural Pathways; Neuronal Plasticity; Parietal Lobe; Recovery of Function; Remission, Spontaneous; Speech; Verbal Behavior; Warfarin

Topics: Aged; Anticoagulants; Cerebellar Diseases; Cerebellum; Fatal Outcome; Humans; Intracranial Hemorrhages; Magnetic Resonance Imaging; Male; Warfarin

Topics: Aged; Anticoagulants; Brain Infarction; Cerebellar Diseases; Cerebellum; Cerebral Angiography; Echocardiography, Three-Dimensional; Gait Disorders, Neurologic; Humans; Intracranial Thrombosis; Magnetic Resonance Imaging; Male; Treatment Outcome; Vertebral Artery; Vertebrobasilar Insufficiency; Warfarin

With the recent increase in the use of antithrombotic therapy, intracerebral hemorrhage (ICH) has been found to be a common complication. We determined whether the use of oral antithrombotic therapy and the patients' preexisting comorbidities were predictive of cerebellar hemorrhage (CH; previously reported to be associated with anticoagulants) as compared to other ICH, and whether antithrombotic therapy affected the clinical severity of CH.. A study of 327 consecutive patients hospitalized in our institute within 3 days after the onset of ICH, including 38 patients with a CH.. CH accounted for 12% of all ICH, 75% of which occurred in patients on warfarin therapy with an international normalized ratio (INR) for prothrombin time >2.5 (p < 0.0001), and 33% of which occurred in patients on ticlopidine therapy (p = 0.017). Warfarin therapy with an INR >2.5 and high blood glucose on admission were independently predictive of CH as compared to other ICH. In addition, previous ischemic stroke (p = 0.002) and heart diseases (p = 0.018) were more prevalent in patients with CH than in those with other ICH. The number of major arteriosclerotic comorbidities and risk factors was also independently predictive of CH risk.. We confirmed that warfarin therapy with an INR >2.5 is associated with CH. Patients with CH frequently had arteriosclerotic comorbidities requiring antithrombotic therapy that can complicate their acute management.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulants; Arteriosclerosis; Aspirin; Blood Glucose; Cerebellar Diseases; Female; Fibrinolytic Agents; Heart Diseases; Humans; Intracranial Hemorrhages; Japan; Male; Middle Aged; Odds Ratio; Platelet Aggregation Inhibitors; Predictive Value of Tests; Prospective Studies; Registries; Risk Assessment; Risk Factors; Stroke; Ticlopidine; Time Factors; Warfarin

The characteristics of patients with anticoagulant-associated intracerebral hemorrhage (AAICH) have not been well characterized in a population-based setting.. We attempted to ascertain all patients with ICH in Greater Cincinnati from May 1998 to July 2001 and August 2002 to April 2003 via retrospective review of ICD-9 codes 430-438.9 at all area hospitals and prospective surveillance at tertiary centers. Cases of ICH without coagulopathy and AAICH were compared with multivariate logistic modeling and survival analysis.. AAICH occurred in 190 of 1041 ICH cases (18%). In multivariate analysis, predictors of AAICH were cerebellar location of hemorrhage (p = 0.01) and a history of coronary artery disease (p < 0.001), ischemic stroke (p < 0.001), atrial fibrillation (p < 0.001) and DVT or PE (p < 0.001). Relative to other ICH locations, only cerebellar ICH showed an excess risk of anticoagulant-associated hemorrhage (OR 2.2, 95% CI 1.2 to 4.0). In multivariate modeling the only predictor of cerebellar location of ICH was anticoagulation (p < 0.001). Patients with AAICH were more likely to die than other ICH patients. The difference in morality occurred by day one (mortality 33.2% vs 16.3%, p < 0.001) and remained stable through one year (mortality 66.3% vs 50.3%, p < 0.001).. AAICH preferentially affects the cerebellum. Despite its association with amyloid angiopathy, lobar ICH was no more likely to be anticoagulant-associated than deep cerebral ICH. The excess mortality among AAICH patients accrues within one day of hemorrhage. Patients with AAICH have a high burden of vascular risk factors. New treatments for AAICH with prothrombotic potential should be evaluated in randomized controlled trials before routine use.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Cerebellar Diseases; Cerebral Hemorrhage; Cerebral Infarction; Coronary Disease; Female; Hospital Mortality; Humans; Male; Middle Aged; Multivariate Analysis; Population Surveillance; Prospective Studies; Retrospective Studies; Risk Factors; Survival Rate; Warfarin

Topics: Adult; Anticoagulants; Ataxia; Cerebellar Diseases; Cerebellum; Female; Humans; Indians, North American; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Manipulation, Spinal; Medicine, Traditional; Recovery of Function; Stroke; Vertebral Artery Dissection; Vertigo; Warfarin