Gynecologic diseases such as uterine fibroids, endometriosis, and adenomyosis are common in women of reproductive age. Case reports and small case series have reported ischemic stroke in women with such common noncancerous gynecologic diseases, and their cause of stroke is frequently attributed to cryptogenic stroke or unconventional mechanisms related to hypercoagulability. However, stroke etiology and prognosis are not well known. We assessed the prevalence of and stroke mechanisms related to common noncancerous gynecologic diseases using hospital-based clinical data.
Methods
We retrospectively identified consecutive female patients with common noncancerous gynecologic diseases (uterine fibroids, endometriosis, and adenomyosis) diagnosed with ischemic stroke/transient ischemic attack (TIA) between the ages of 20 and 59 years admitted to 10 stroke centers in Japan by reviewing prospectively collected data between 2017 and 2019. The clinical, laboratory, and neuroimaging features were evaluated and compared between patients with conventional stroke mechanisms (CSMs) (large artery atherosclerosis, small vessel occlusion, cardioembolism, and other determined etiology) and non-CSMs (cryptogenic stroke and causes related to hypercoagulability such as nonbacterial thrombotic endocarditis and paradoxical embolism) according to the Trial of Org 10172 in Acute Stroke Treatment criteria.
Results
Of the 470 female patients with ischemic stroke/TIA, 39 (8%) (37 ischemic stroke and 2 TIA) had common noncancerous gynecologic diseases. The most common gynecologic diseases were uterine fibroids in 24 (62%) patients, followed by endometriosis in 9 (23%) and adenomyosis in 6 (15%). Twenty patients (51%) were assigned to the non-CSMs group, and 19 patients (49%) were assigned to the CSMs group. Adenomyosis and endometriosis were more frequent in the non-CSMs group than in the CSMs group. CA125 and D-dimer levels were higher in the non-CSMs group than in the CSMs group. Multiple vascular territory infarcts were frequent in patients with adenomyosis (60%) and endometriosis (43%) in the non-CSMs group. No stroke recurrence or death was observed within 3 months after discharge in both the CSMs and non-CSMs groups. Outcomes at 3 months after discharge were similar in both groups.
Discussion
In patients with common noncancerous gynecologic diseases, hypercoagulopathy may play a role in the pathogenesis of ischemic stroke/TIA without CSMs.
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The authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Take-home Points
→ Among female patients with ischemic stroke/TIA, 8% had common noncancerous gynecologic diseases, such as uterine fibroids, endometriosis, and adenomyosis.
→ Half of the patients with ischemic stroke/TIA and common noncancerous gynecologic diseases had non-CSMs that included cryptogenic stroke, NBTE, and paradoxical embolism.
→ Patients with non-CSMs had higher frequencies of adenomyosis and endometriosis, and higher CA125 and D-dimer levels than those with CSMs.
→ Hypercoagulopathy may play a role in the pathogenesis of ischemic stroke/TIA in patients with common noncancerous gynecologic diseases and non-CSMs.
Study Funding
The authors report no targeted funding.
Authors
Affiliations & Disclosures
KazuoYamashiro, MD, PhD
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
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Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
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None
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Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
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Kaneka Corp.
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JSPS KAKENHI Grant-in-Aid for Scientific Research (C) from the Ministry of Education, Culture, Sports, Science, and Technology of Japan, #21K09163, Lead investigator, 2021-2024
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Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
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1.
NONE
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1.
None
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1.
NONE
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1.
NONE
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1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
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1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
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Research Support, Foundations and Societies:
1.
None
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Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
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1.
NONE
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1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
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Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
1) Journal name; Neurosonology, Role; Chief editor, Year; 3 years
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Kazumi Kimura received lecture fees from Bristol-Myers Squibb Co. Ltd., Nippon Boehringer Ingelheim Co. Ltd., Bayer Healthcare Co. Ltd., and Daiichi Sankyo Co.; research funding from Nippon Boehringer Ingelheim Co. Ltd., Daiichi Sankyo Co., Pfizer Japan Inc., Medtronic Co. Ltd., and Teijin Pharma Ltd.
Editorial Boards:
1.
European Neurology
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
(1) Journal of Atherosclerosis and Thrombosis, Associate editor
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
(1) Kyowa Kirin (2) Daiichi-Sankyo
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
(1) Clinical procedure (Neurology and Stroke Center), 50% of effort
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
An editorial board member, Cerebrovascular DiseasesAn editorial board member, Journal of Atherosclerosis and ThrombosisAn editorial board member, Rinsho Shinkeigaku (Clin Neurol) An associate editor, Japanese Journal of Stroke
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
Journal of Medical Ultrasonics, Associate Editor, 4 yearsNeurosonology, Editor-in-chief, 1 year
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None
Editorial Boards:
1.
Movement Disorders-Clinical Practice, Journal of Neural Transmission, Neuroscience Research, JNNP, J of Parkinson's disease
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Hisamitsu Pharmaceutical, Dai-Nippon Sumitomo Pharma Co.,Ltd., Kyowa Hakko Kirin,
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Department of Neurology (KY, YU, NH, RT), Juntendo University School of Medicine, Tokyo; Department of Neurology (KY, TU), Juntendo University Urayasu Hospital, Chiba; Department of Neurology (TS, YI), Jikei University School of Medicine, Tokyo; Department of Neurology (CN, Kazumi Kimura), Nippon Medical School, Tokyo; Department of Neurology (YU), University of Yamanashi; Department of Stroke and Cerebrovascular Medicine (HK, TH), Kyorin University, Tokyo; Department of Cerebrovascular Medicine (TC, MK), National Cerebral and Cardiovascular Center, Suita; Stroke Center (TN, HT), Dokkyo Medical University, Tochigi; Department of Neurology (TM, KI, Kazuo Kitagawa), Tokyo Women's Medical University, Tokyo; Department of Neurology (TK), Shin-Oyama City Hospital, Tochigi; Department of Obstetrics and Gynaecology (AT, HF), Jichi Medical University, Tochigi; and Division of Neurology (SF, RT), Department of Internal Medicine, Jichi Medical University, Tochigi, Japan.
Disclosure
Scientific Advisory Boards:
1.
None
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
R.T. received honoraria for work unrelated to this study from Takeda Pharmaceutical Co.,Ltd., Nippon Boehringer Ingelheim,Co.,Ltd, Dai-Nippon Sumitomo Pharma Co.,Ltd., Bayer Yakuhin, Ltd, Otsuka Pharmaceutical, Co.,Ltd, Pfizer Japan Inc., DAIICHI SANKYO Co.,Ltd., Eisai Co.,Ltd., Bristol-Myers Squibb Co., Stryker Japan K.K., CSL Behring K.K,. and Kowa Co.,Ltd.
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
None
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
Submitted and externally peer reviewed. The handling editor was Associate Editor Amanda Jagolino-Cole, MD, FAAN.
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