January 03, 2023; 100 (1) Research Article
Trigger Factors for Stroke in Young Adults
A Case-Crossover Study
Merel S. Ekker, Jamie I. Verhoeven, Karlijn M.L. Rensink, Mijntje M.I. Schellekens, Esther M. Boot, Mayte E. van Alebeek, Paul J.A.M. Brouwers, Renate M. Arntz, Gert W. van Dijk, Rob A.R. Gons, Inge W.M. van Uden, Tom den Heijer, Paul L.M. de Kort, Karlijn F. de Laat, Anouk G.W. van Norden, Sarah E. Vermeer, Marian van Zagten, Robert J. van Oostenbrugge, Marieke J.H. Wermer, Paul J. Nederkoorn, Henk Kerkhoff, Fergus Rooyer, Frank G. van Rooij, Ido R. van den Wijngaard, Catharina J. M. Klijn, Anil M. Tuladhar, Frank-Erik de Leeuw
First published September 20, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201341
Merel S. Ekker
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Jamie I. Verhoeven
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Karlijn M.L. Rensink
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Mijntje M.I. Schellekens
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Esther M. Boot
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Mayte E. van Alebeek
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Paul J.A.M. Brouwers
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Renate M. Arntz
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Gert W. van Dijk
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Rob A.R. Gons
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Inge W.M. van Uden
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Tom den Heijer
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Paul L.M. de Kort
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Karlijn F. de Laat
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Anouk G.W. van Norden
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Sarah E. Vermeer
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Marian van Zagten
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Robert J. van Oostenbrugge
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Marieke J.H. Wermer
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Paul J. Nederkoorn
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Henk Kerkhoff
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Fergus Rooyer
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Frank G. van Rooij
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Ido R. van den Wijngaard
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Catharina J. M. Klijn
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Anil M. Tuladhar
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Frank-Erik de Leeuw
From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.
Trigger Factors for Stroke in Young Adults
A Case-Crossover Study
Merel S. Ekker, Jamie I. Verhoeven, Karlijn M.L. Rensink, Mijntje M.I. Schellekens, Esther M. Boot, Mayte E. van Alebeek, Paul J.A.M. Brouwers, Renate M. Arntz, Gert W. van Dijk, Rob A.R. Gons, Inge W.M. van Uden, Tom den Heijer, Paul L.M. de Kort, Karlijn F. de Laat, Anouk G.W. van Norden, Sarah E. Vermeer, Marian van Zagten, Robert J. van Oostenbrugge, Marieke J.H. Wermer, Paul J. Nederkoorn, Henk Kerkhoff, Fergus Rooyer, Frank G. van Rooij, Ido R. van den Wijngaard, Catharina J. M. Klijn, Anil M. Tuladhar, Frank-Erik de Leeuw
Neurology Jan 2023, 100 (1) e49-e61; DOI: 10.1212/WNL.0000000000201341
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Abstract
Background and Objectives Causes of stroke in young adults differ from those in the elderly individuals, and in a larger percentage, no cause can be determined. To gain more insight into the etiology of (cryptogenic) stroke in the young population, we investigated whether trigger factors, such as short-lasting exposure to toxins or infection, may play a role.
Methods Patients aged 18–49 years with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) in 17 participating centers in the Netherlands completed a questionnaire about exposure to 9 potential trigger factors in hazard periods and on a regular yearly basis. A case-crossover design was used to assess relative risks (RRs) with 95% confidence intervals (95% CIs) by the Mantel-Haenszel case-crossover method, for any stroke (ischemic stroke and ICH combined) and for different etiologic subgroups of ischemic stroke.
Results One thousand one hundred forty-six patients completed the questionnaire (1,043 patients with an ischemic stroke and 103 with an ICH, median age 44.0 years, 52.6% men). For any stroke, an increased risk emerged within 1 hour of cola consumption (RR 2.0, 95% CI 1.5–2.8) and vigorous physical exercise (RR 2.6, 95% CI 2.2–3.0), within 2 hours after sexual activity (RR 2.4, 95% CI 1.6–3.5), within 4 hours after illicit drug use (RR 2.8, 95% CI 1.7–4.9), and within 24 hours after fever or flu-like disease (RR 14.1, 95% CI 10.5–31.2; RR 13.9, 95% CI 8.9–21.9). Four trigger factors increased the risk of other determined and cryptogenic ischemic stroke, 3 that of cardioembolic stroke, 2 that of large vessel atherosclerosis and likely atherothrombotic stroke combined and stroke with multiple causes, and none that of stroke due to small vessel disease.
Discussion We identified cola consumption, vigorous physical exercise, sexual activity, illicit drug use, fever, and flu-like disease as potential trigger factors for stroke in the young population and found differences in the type and number of trigger factors associated with different etiologic subgroups of ischemic stroke. These findings might help in better understanding the pathophysiologic mechanisms of (cryptogenic) stroke in the young population.
Glossary
- AVM=
- arteriovenous malformation;
- ICH=
- intracerebral hemorrhage;
- LSD=
- lysergic acid diethylamide;
- mRS=
- modified ranking scale;
- MET=
- metabolic equivalent of task;
- NIHSS=
- National Institutes of Health Stroke Scale;
- ODYSSEY=
- Observational Dutch Young Symptomatic StrokE studY;
- RR=
- relative risk;
- PAF=
- population attributable fraction;
- SAH=
- subarachnoid hemorrhage;
- TOAST=
- Trial of Org 10172 in Acute Stroke Treatment;
- TIA=
- transient ischemic attack
Footnotes
↵* These authors contributed equally.
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Brad Worrall, MD, MSc, FAAN.
- Received January 22, 2022.
- Accepted in final form August 17, 2022.
- © 2022 American Academy of Neurology
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