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University education and cervical artery dissection

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Abstract

Background and purpose

We investigated whether university education is more likely in cervical artery dissection (CeAD)-patients than in age- and sex-matched patients with ischemic stroke (IS) due to other causes (non-CeAD-IS-patients).

Methods

Patients from the Cervical Artery Dissection and Ischemic Stroke Patients study with documented self-reported profession before onset of IS due to CeAD (n = 715) or non-CeAD causes (n = 631) were analyzed. In the reported profession, the absence or presence of university education was assessed. Professions could be rated as academic or non-academic in 518 CeAD and 456 non-CeAD patients. Clinical outcome at 3 months was defined as excellent if modified Rankin Scale was 0–1.

Results

University education was more frequent in CeAD-patients (100 of 518, 19.3%) than in non-CeAD-IS-patients (61 of 456, 13.4%, p = 0.008). CeAD-patients with and without university education differed significantly with regard to smoking (39 vs. 57%, p = 0.001) and excellent outcome (80 vs. 66%, p = 0.004). In logistic regression analysis, university education was associated with excellent outcome in CeAD-patients (OR 2.44, 95% CI 1.37–5.38) independent of other outcome predictors such as age (OR 0.97, 95% CI 0.84–0.99), NIHSS (OR 0.80, 95% CI 0.76–0.84) and local signs (OR 2.77, 95% CI 1.37–5.57).

Conclusion

We observed a higher rate of university education in patients with CeAD compared with non-CeAD patients in our study population. University education was associated with favorable outcome in CeAD-patients. The mechanism behind this association remains unclear.

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Acknowledgements

CADISP (Cervical Artery Dissections and Ischemic Stroke Patients) Co-investigators: Massimo Pandolfo, M.D. Ph.D., Department of Neurology, Erasmus University Hospital, Brussels and Laboratory of Experimental Neurology, ULB, Brussels, Belgium; Marie Bodenant, M.D., Department of Neurology, Lille University Hospital–EA1046, France; Fabien Louillet, M.D. and Jean-Louis Mas, M.D. Ph.D., Department of Neurology, Sainte-Anne University Hospital, Paris, France; Sandrine Deltour, M.D. and Anne Léger, M.D., Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Sandrine Canaple, M.D. and Olivier Godefroy, M.D. Ph.D., Department of Neurology, Amiens University Hospital, France; Yannick Béjot, M.D. Ph.D., Department of Neurology, Dijon University Hospital, France; Thierry Moulin, M.D. Ph.D. and Fabrice Vuillier, M.D., Department of Neurology, Besançon University Hospital, France; Michael Dos Santos, M.D., Department of Neurology, University Hospital of Ludwigshafen, Germany; Ingrid Hausser, Ph.D., Department of Dermatology, Heidelberg University Hospital, Germany; Tobias Brandt M.D. Ph.D., Constanze Thomas-Feles, M.D., Kliniken-Schmieder, Heidelberg, Germany,; Valeria De Giuli M.D., Filomena Caria M.D., Loris Poli M.D., Alessandro Padovani M.D, PhD., Department of Neurology, Brescia University Hospital, Italy; Silvia Lanfranconi, M.D. and Pierluigi Baron, M.D. Ph.D., Department of Neurology, Milan University Hospital, Italy; Carlo Ferrarese, M.D. Ph.D., University of Milano Bicocca, San Gerardo Hospital, Monza, Italy; Giacomo Giacolone, M.D., Milan Scientific Institute San Raffaele University Hospital, Italy; Stefano Paolucci, M.D. Ph.D., Department of Rehabilitation, Santa Lucia Hospital, Rome, Italy; Felix Fluri, M.D., Florian Hatz, M.D., Dominique Gisler, M.D. and Margareth Amort, M.D., Department of Neurology, Basel University Hospital, Switzerland; Steve Bevan, Ph.D., Clinical Neuroscience, St George’s University of London, UK; Ayse Altintas, M.D. Ph.D., Department of Neurology, University Hospital of Istanbul, Turkey; Antti Metso, Ph.D., Marja Metso, Department of Neurology, Helsinki University Central Hospital.

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Correspondence to Lars Kellert.

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Conflicts of interest

LK has received funding for travel and/or speaker honoraria from Bayer Vital, Boehringer Ingelheim, Bristal Myers Squibb, Daiichi Sankyo, and Pfizer. AG, AP, SD, DL, AB, TT, CT, CGG, MK report no disclosures. TMM has received funding from the Finnish Medical Foundation, Helsinki University Central Hospital Research Fund, Helsinki University Medical Foundation, Orion Farmos Research Foundation, Päivikki and Sakari Sohlberg Foundation, Maire Taponen Foundation, the Lilly Foundation, Paavo Ilmari Ahvenainen Foundation, Aarne and Aili Turunen Foundation, Aarne Koskelo Foundation, the Maud Kuistila Memorial Foundation, Emil Aaltonen Foundation, Finnish Brain Foundation, and Alfred Kordelin Foundation. VC has served as speaker for Boehringer Ingelheim, Sanofi, and Pfizer. VNT has received funding for travel or speaker honoraria from Bayer, Boehringer Ingelheim, Pfizer Inc and Medtronic; he has served on scientific advisory boards for Shire, Bayer, Pfizer and Boehringer Ingelheim and on the editorial board of Stroke. He is an associate editor of Acta Neurologica Belgica. He has received honoraria for being on the steering committee of the AX200 trial (SYGNIS). He has received research support from FWO Flanders. AB has received funding for travel and congresses participations from Shire, Boehringer Ingelheim, and Sanofi-aventis. ET has served on scientific advisory boards for Bayer Schering Pharma, Pfizer, BMS, and Shire; has received speaker honoraria from Boehringer Ingelheim, Bayer Schering Pharma, Pfizer, BMS, and Shire; has received funding for travel from Astra Zeneca and BMS; he serves as assistant editor for Stroke; and has received research support from the French Ministry of Health. PAL has served on scientific advisory boards for Bayer Schering Pharma, and Boehringer Ingelheim; has received funding for travel or speaker honoraria from Bayer Schering Pharma, Boehringer Ingelheim, and Shire plc; he serves as Co-Editor for Neurologie und Psychiatrie and on the editorial board of Swiss Archives of Neurology and Psychiatry; and has received research support from AstraZeneca, Boehringer Ingelheim, Sanofi-aventis, PhotoThera, the Swiss National Science Foundation, and the Swiss Heart Foundation. STE has received funding for travel or speaker honoraria from Bayer, Boehringer Ingelheim, Pfizer Inc, Sanofi-aventis, and Shire plc; he has served on scientific advisory boards for Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, and Pfizer and on the editorial board of Stroke. He has received research support from the Kaethe-Zingg-Schwichtenberg-Fonds of the Swiss Academy of Medical Sciences, the Swiss Heart Foundation, and Swiss National Science Foundation.

Ethical standard

The CADISP study protocol (http://clinicaltrials.gov/ct2/show/NCT00657969) was approved by the relevant local authorities of all participating centers and is conducted according to the national rules concerning ethics committee approval and informed consent.

Additional information

CADISP (Cervical Artery Dissections and Ischemic Stroke Patients) Co-investigators are listed in Acknowledgements.

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Kellert, L., Grau, A., Pezzini, A. et al. University education and cervical artery dissection. J Neurol 265, 1065–1070 (2018). https://doi.org/10.1007/s00415-018-8798-7

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