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dc.contributor.authorMEANEY, JAMESen
dc.contributor.authorKENNY, ROSEen
dc.contributor.authorHARBISON, JOSEPHen
dc.contributor.authorMEANEY, JAMESen
dc.contributor.authorHARBISON, JOSEPH AUGUSTINEen
dc.contributor.authorKENNY, ROSE ANNEen
dc.date.accessioned2015-12-09T12:42:34Z
dc.date.available2015-12-09T12:42:34Z
dc.date.issued2015en
dc.date.submitted2015en
dc.identifier.citationRyan DJ, Kenny RA, Christensen S, Meaney JF, Fagan AJ, Harbison J, Ischaemic stroke or TIA in older subjects associated with impaired dynamic blood pressure control in the absence of severe large artery stenosis., Age and ageing, 44, 4, 2015, 655-661en
dc.identifier.otherYen
dc.identifier.urihttp://hdl.handle.net/2262/75243
dc.descriptionPUBLISHEDen
dc.descriptionafv011en
dc.description.abstractBackground: older subjects may require higher baseline blood pressures to maintain cerebral perfusion. We investigated whether episodic hypotension is associated with tissue infarction in subjects with syncopal symptoms at stroke onset. Methods: over 30 months, all acute strokes/TIAs were prospectively screened for symptoms of syncope or presyncope at stroke onset. Subjects with severe large vessel stenosis were excluded, while cases were referred for syncope unit investigation. All underwent 1.5 T MRI acutely, and suspected borderzone infarctions (BZI) were confirmed through Matlab-derived perfusion software. Case–control comparison was derived from stroke controls with no prior syncope history. Results: thirty-eight of 772 stroke patients described presyncope or syncope at stroke onset and had patent large vessels (4.9% of all strokes). Median age was 72 years (IQR 21.4). Twenty-two patients (58%) were prescribed antihypertensive agents at symptom onset. Twenty-six (68.4%) reported focal neurology <24 h in duration. 63.2% (n = 24) of cases reported prior syncope history, compared with 33% (N = 103) of controls, P < 0.001. Cases exhibited greater orthostatic BP drop than controls, P < 0.05 Twenty-four patients were diagnosed with vasovagal syncope through head-up tilt symptom reproduction, 9 with orthostatic hypotension, 4 with cardiac syncope and 1 with carotid sinus syndrome. Nineteen (50%) patients had an acute infarct on MRI, 14 of these were in the arterial borderzone (73.6%). The BZI group were significantly older than the non-BZI group, 79.2yrs versus 63.3 yrs, P = 0.002. Conclusion: subjects reporting hypotensive symptoms at stroke onset have a higher prevalence of borderzone infarction, despite being normotensive or hypertensive at baseline.en
dc.description.sponsorshipThe Study was supported through The Health Research Board Ireland (HRA/2009/208) and through the Lundbeck Neuroscience Bursary 2010en
dc.format.extent655-661en
dc.relation.ispartofseriesAge and ageingen
dc.relation.ispartofseries44en
dc.relation.ispartofseries4en
dc.rightsYen
dc.subjectcerebral perfusionen
dc.subject.lcshcerebral perfusionen
dc.titleIschaemic stroke or TIA in older subjects associated with impaired dynamic blood pressure control in the absence of severe large artery stenosis.en
dc.typeJournal Articleen
dc.contributor.sponsorMercer's Institute for Research on Ageingen
dc.contributor.sponsorHealth Research Board (HRB)en
dc.type.supercollectionscholarly_publicationsen
dc.type.supercollectionrefereed_publicationsen
dc.identifier.peoplefinderurlhttp://people.tcd.ie/jharbisoen
dc.identifier.peoplefinderurlhttp://people.tcd.ie/jmeaneyen
dc.identifier.peoplefinderurlhttp://people.tcd.ie/rkennyen
dc.identifier.rssinternalid102239en
dc.identifier.doihttp://dx.doi.org/10.1093/ageing/afv011en
dc.rights.ecaccessrightsopenAccess
dc.subject.TCDThemeAgeingen
dc.subject.TCDThemeNeuroscienceen
dc.subject.TCDTagAge related diseasesen
dc.subject.TCDTagImaging Techniquesen


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