An assessment of diagnosis and prognostication in cardioembolic transient ischaemic attack and ischaemic stroke

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dc.contributor.advisor Sweeney, Brian en
dc.contributor.advisor Rothwell, Peter M. en Lyons, Shane M. 2019-05-28T11:41:58Z 2019-05-28T11:41:58Z 2019 2019
dc.identifier.citation Lyons, S. M. 2019. An assessment of diagnosis and prognostication in cardioembolic transient ischaemic attack and ischaemic stroke. MD Thesis, University College Cork. en
dc.description.abstract Transient ischaemic attack (TIA) and ischaemic stroke is a heterogeneous disease with more than 150 known causes with different profiles of vascular risk factors and recurrence risk. Cardioembolic events account for approximately a third of incident stroke. The aim of my thesis has been to assess current methods of identifying cardioembolic source of TIA and stroke, examine the prevalence of atrial fibrillation as the most important cause of cardioembolic neurovascular events as well as the predictors and risk factors of AF in this population. I aimed to test strategies for targeting cardiac investigations using clinical, imaging and echocardiographic parameters, evaluate the clinical significance of cardiac monitoring results, and improve prognostication in cardioembolic events to facilitate optimal treatment. I have collected, collated and analysed data from the Oxford Vascular Study (OXVASC), which is an ongoing prospective, population-based, incidence study of vascular disease in all territories in Oxfordshire, UK. The study population comprises approximately 92,728 individuals registered with nine general practices and uses multiple overlapping “hot” and “cold” methods to identify all patients with acute vascular events. There are several clinically relevant findings in this thesis which address areas of investigation and management of cardioembolic events. First, I have assessed the role of cardiac monitoring following TIA and minor stroke, establishing the prevalence of occult AF in the OXVASC population and evaluating the yield of different monitoring duration in the published literature. Second, I found that a score, the ABC2 score, derived from well established risk factors could improve the yield of cardiac monitoring. Third, I have demonstrated a low risk of recurrent neurovascular and systemic embolic events in patients with brief paroxysms of AF on monitoring in the study population. Fourth, I have shown that copeptin can identify subgroup of patient at particularly high risk of recurrent cardioembolic neurovascular events and that this risk is ameliorated by oral anticoagulant treatment. Fifth, I have demonstrated that the risk of progression of brief paroxysms of AF, while still significant, is lower than previously suspected. Finally, there is a significant incidence of AF during medium-term follow-up after stroke and TIA, suggesting that screening targeted at this population may be of use in risk modification. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2019, Shane M. Lyons. en
dc.rights.uri en
dc.subject Stroke en
dc.subject Cardioembolism en
dc.title An assessment of diagnosis and prognostication in cardioembolic transient ischaemic attack and ischaemic stroke en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname MD en
dc.internal.availability Full text not available en Not applicable en
dc.description.version Accepted Version
dc.description.status Not peer reviewed en Medicine en
dc.check.type No Embargo Required
dc.check.reason This thesis is due for publication or the author is actively seeking to publish this material en
dc.check.opt-out Yes en
dc.thesis.opt-out true
dc.check.embargoformat Embargo not applicable (If you have not submitted an e-thesis or do not want to request an embargo) en
dc.internal.conferring Summer 2019 en

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© 2019, Shane M. Lyons. Except where otherwise noted, this item's license is described as © 2019, Shane M. Lyons.
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