Papers by Kristina Ryliškienė
Journal of neurology, neurosurgery and psychiatry, Jun 21, 2024
Background The underlying risk factors for young-onset cryptogenic ischaemic stroke (CIS) remain ... more Background The underlying risk factors for young-onset cryptogenic ischaemic stroke (CIS) remain unclear. This multicentre study aimed to explore the association between heavy alcohol consumption and CIS with subgroup analyses stratified by sex and age. Methods Altogether, 540 patients aged 18-49 years (median age 41; 47.2% women) with a recent CIS and 540 sex-matched and age-matched stroke-free controls were included. Heavy alcohol consumption was defined as >7 (women) and >14 (men) units per week or at least an average of two times per month ≥5 (women) and ≥7 (men) units per instance (binge drinking). A conditional logistic regression adjusting for age, sex, education, hypertension, cardiovascular diseases, diabetes, hypercholesterolaemia, current smoking, obesity, diet and physical inactivity was used to assess the independent association between alcohol consumption and CIS. Results Patients were twice as more often heavy alcohol users compared with controls (13.7% vs 6.7%, p<0.001), were more likely to have hypertension and they were more often current smokers, overweight and physically inactive. In the entire study population, heavy alcohol consumption was independently associated with CIS (adjusted OR 2.11; 95% CI 1.22 to 3.63). In sex-specific analysis, heavy alcohol consumption was associated with CIS in men (2.72; 95% CI 1.25 to 5.92), but not in women (1.56; 95% CI 0.71 to 3.41). When exploring the association with binge drinking alone, a significant association was shown in the entire cohort (2.43; 95% CI 1.31 to 4.53) and in men (3.36; 95% CI 1.44 to 7.84), but not in women. Conclusions Heavy alcohol consumption, particularly binge drinking, appears to be an independent risk factor in young men with CIS.
Frontiers in neurology, May 28, 2024
This cross-sectional study aims to investigate migraineurs' preferred complementary and alternati... more This cross-sectional study aims to investigate migraineurs' preferred complementary and alternative medicine (CAM) types and the factors influencing their usage. An anonymous e-survey was distributed to Lithuanian Migraine Association members, and social media migraine support communities. The collected data consisted of demographic, migraine-related questions, personal qualities, CAM habits. Results: 470 respondents were analyzed. 95.96% were women with a median age of 37 (IQR 31, 44). The median duration of migraine was 17.5 years (IQR 10, 25) and the median headache severity was rated 8 (IQR 7, 10) out of 10. 68.90% of participants had one or more headache days per week. 71.49% of respondents were triptan users, 27.66% used medical prophylaxis, and 17.87% used monoclonal antibodies. 52.55% of respondents used CAM in the past 12 months. Physical activity (36.17%), dietary changes/fasting (27.02%), relaxation/meditation (26.60%) were the most used CAM types. Reasons for CAM use included dissatisfaction with conventional treatment effectiveness (42.51%), concerns about safety (48.18%) and adverse effects (37.25%). Factors associated with the decision to explore CAM included longer headache duration (p = 0.017, Mann-Whitney U test), frequent sick leaves (p < 0.001, Mann-Whitney U test), current preventive medication use (p = 0.016, chi-square test), positive views on CAM safety/naturality (p = 0.001/ p < 0.001, Mann-Whitney U test), belief of having a healthy diet (p < 0.001, chi-square test), food-related worries (p = 0.011, Mann-Whitney U test) and Big-five personality trait of openness to experience (p = 0.049, chi-square test). After logistic regression, the frequent need to take sick leaves, having a healthy diet, food-associated fears maintained statistical significance. CAM use was not associated with non-adherence to conventional medicine. 48.99% of CAM consumers disclosed CAM use to their doctors. CAM is explored by a significant proportion of migraineurs, less than half communicate this to their doctors. In our sample, physical activity, dietary changes, and relaxation techniques were the most common. Many patients opted for CAM due to previously experienced side effects/ineffectiveness of conventional migraine treatment or the fear of potential harm from standard medication. Individual factors, such as openness of personality can be an important contributing factor.
European Journal of Medical Research, Dec 17, 2023
International Heart Journal, 2015
The left atrial appendage (LAA) represents one of the major sources of cardiac thrombi responsibl... more The left atrial appendage (LAA) represents one of the major sources of cardiac thrombi responsible for embolic stroke in patients with atrial fibrillation (AF). The aim of the present study was to evaluate LAA structure and functions by transesophageal echocardiography (TEE) in patients with AF to investigate the possible association between the different LAA morphologies and the patients' history of ischemic cerebral stroke. We included 50 patients with non-valvular AF (29 chronic, 21 paroxysmal), 24 patients (13 men) without stroke; and 26 patients (9 men) with a history of ischemic stroke. All patients underwent TEE evaluation of LAA morphology and functions. Compared to patients without stroke, patients with ischemic stroke had significantly higher CHADS2 scores (4.19 ± 0.89 versus 1.67 ± 1.13; P < 0.001) and C-reactive protein levels (8.3 ± 1.6 versus 7.6 ± 0.83 mg/L; P = 0.023), and lower peak filling (21.7 ± 11.3 versus 31.2 ± 9.5 cm/second; P = 0.033) and emptying (22.2 ± 9.7 versus 33.4 ± 13.4 cm/second, P = 0.030) velocities. Triangular LAA morphology had a higher prevalence in patients with stroke (36% versus 12% in non-stroke group); and in half of them an LAA thrombus was present. LAA thrombi were detected in 9 patients (18%) with stroke and in 5 patients (10%) without stroke. On multivariate logistic regression analysis, age (OR = 1.202 [1.042-1.585]; P = 0.041), LAA orifice diameter (OR = 1.275 [1.102-1.748]; P = 0.028), and triangular LAA morphology (OR = 4.53 [1.629-8.381]; P = 0.011) were significantly and independently associated with ischemic stroke in AF patients. LAA morphology evaluated by TEE may be useful for predicting ischemic cerebral stroke in patients with non-valvular AF, especially in those with a low CHADS2 score.
Frontiers in neurology, Feb 9, 2024
This case study describes a 57-year-old woman with a six-year history of recurrent episodes chara... more This case study describes a 57-year-old woman with a six-year history of recurrent episodes characterized by visual, sensory, speech disturbances, hemiparesis and severe one-sided headaches accompanied by fever and altered consciousness. Initially misdiagnosed as a stroke, the atypical disease course and MRI findings led to additional genetic testing which revealed a sodium voltage-gated channel gene mutation (T1174S), confirming a diagnosis of sporadic hemiplegic migraine. The migraine prophylaxis showed some improvement in episode frequency and severity. Despite an initial improvement, the patient underwent severe cognitive decline and developed new permanent neurological symptoms during the subsequent 7 years of follow-up.
Journal of stroke and cerebrovascular diseases, May 1, 2022
OBJECTIVES We examined the association between obesity and early-onset cryptogenic ischemic strok... more OBJECTIVES We examined the association between obesity and early-onset cryptogenic ischemic stroke (CIS) and whether fat distribution or sex altered this association. MATERIALS AND METHODS This prospective, multi-center, case-control study included 345 patients, aged 18-49 years, with first-ever, acute CIS. The control group included 345 age- and sex-matched stroke-free individuals. We measured height, weight, waist circumference, and hip circumference. Obesity metrics analyzed included body mass index (BMI), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), and a body shape index (ABSI). Models were adjusted for age, level of education, vascular risk factors, and migraine with aura. RESULTS After adjusting for demographics, vascular risk factors, and migraine with aura, the highest tertile of WHR was associated with CIS (OR for highest versus lowest WHR tertile 2.81, 95%CI 1.43-5.51; P=0.003). In sex-specific analyses, WHR tertiles were not associated with CIS. However, using WHO WHR cutoff values (>0.85 for women, >0.90 for men), abdominally obese women were at increased risk of CIS (OR 2.09, 95%CI 1.02-4.27; P=0.045). After adjusting for confounders, WC, BMI, WSR, or ABSI were not associated with CIS. CONCLUSIONS Abdominal obesity measured with WHR was an independent risk factor for CIS in young adults after rigorous adjustment for concomitant risk factors.
Atherosclerosis, Dec 1, 2016
Background and aims: We aimed to identify clusters of metabolic syndrome (MetS) components, risky... more Background and aims: We aimed to identify clusters of metabolic syndrome (MetS) components, risky for extremely high intima-media thickness. Methods: We studied 41,513 volunteers (men and women) from eleven cohorts worldwide, participating in the MARE (Metabolic syndrome and Artery REsearch) Consortium. Results: Specific clusters of MetS components-high triglycerides-high blood pressure-abdominal obesity (TBW), low HDL cholesterol-high blood pressure-abdominal obesity (HBW), high glucosehigh blood pressure-abdominal obesity (GBW)-were accompanied by a 50 to 90% significantly greater likelihood of presenting extremely high intima-media thickness (via ultrasound of carotid artery, CCA IMT), after controlling for age, sex, smoking, non-HDL cholesterol, and presence of diabetes mellitus. This likelihood is comparable to the effect of being 7-8 years older or of being a cigarette smoker or of having non-HDL cholesterol 50 mg/dl higher. Conclusions: The consistent association of specific clusters of MetS components with extremely thick (older) large artery cross-culturally suggests that identification of those clusters in clinical practice will facilitate a personalized health care and a better-i.e. more healthy and cost-effective-prevention of major cardiovascular (CV) events .
Clinical Neurology and Neurosurgery, Dec 1, 2017
According to Eurolight project's results, frequency of medication overuse headache in Lithuania i... more According to Eurolight project's results, frequency of medication overuse headache in Lithuania is similar to other European countries. However, data on the characteristics of the disorder is lacking. Objective: The aim was to analyze clinical characteristics and overuse patterns of patients with medication overuse headache. Patients and methods: Retrospective study was conducted in outpatient department of university hospital. 57.0% of the patients were from Vilnius and 43.0% from other cities and districts of Lithuania. Medical histories of patients consulted by headache specialist on private (86.2%) or public basis from 2008 to 2015 were analyzed. Diagnoses prior to 2013 were revised according to ICHD-III beta criteria. Overuse patterns were calculated only for patients with migraine. 2 Results: 87 patients (90.8% female) with mean age of 43.78 years were included in the study and 67 of them had primary diagnosis of migraine. Mean duration of overuse was 4.00 years. Mean headache frequency was 24.11 days per month. Triptans more often were overused by younger patients (p=0.049). 41.8% of migraine patients with MOH overused triptans, 38.8% simple, and 38.8% combinationanalgesics. 1 (1.5%) patient overused ergotamines, 7.5% were poly-overusers and no pure opioid overuse was found. Among patients with migraine most common overused medications were sumatriptan (38.8%), caffeine containing combination-analgesics (35.8%) and ibuprofen (20.9%). Conclusion: Triptans were most commonly overused drugs among patients with migraine. Fairly frequent overuse of combination-analgesics for migraine should raise concern.
Artery Research, 2011
on chest x-ray was correlated with the above mentioned established markers of vascular calcificat... more on chest x-ray was correlated with the above mentioned established markers of vascular calcification. Methods: AAC, AoAC and PWV were measured in 88 patients on RRT who were Danish participants in a European multicenter cross-sectional study. Inclusion criteria were: >18 years of age and >3 months of maintenance haemo-or peritoneal dialysis treatment. AoAC was measured using a semiquantitative method. The cross section of the aortic arch was divided into 16 sectors on a plain frontal chest x-ray. Sectors showing signs of calcified plaques in the form of typically shaped densities were identified. The carotid-femoral PWV was measured using applanation tonometry. Results: 72% had a AoAC score > 0 compared to 81 % with a AAC score > 0. AoAC was significantly positively correlated with AAC (rZ0.69, p<0.001) and PWV (rZ0.35, p<0.001). The positive-and negative predictive values of AoAC with respect to AAC were 98% and 32%, respectively. Conclusion: The presence of calcification on chest x-ray was positively correlated with AAC and PWV. Chest x-ray is inexpensive and frequently obtained in this patient population. We believe it may provide valuable data on calcification and may be used in risk stratification of dialysis patients. Further evaluation is required.
Artery Research, 2015
method of BP measurement was more strongly associated with LVM in a young healthy normotensive po... more method of BP measurement was more strongly associated with LVM in a young healthy normotensive population. Methods: Forty-one adults (23AE4yrs, 27% male) took part in the study. LVM was measured using 2-D echocardiography (Vividq, GE) and indexed to body surface area (LVMi). Both office and 24-hour pSBP and cSBP were measured using the Mobil-O-Graph system (IEM, Germany). cSBP's were calculated using brachial mean and diastolic pressures (MAP-cal). Results: Participants had normal office pSBP (117 AE10 mmHg) and LVMi (79 AE17 g/m 2) values. On average, office cSBP (128 AE19 mmHg) was significantly higher than 24cSBP (123 AE14 mmHg, P<0.05). LVMi was not associated with pSBP (rZ0.275, PZ0.82) and weakly associated with 24pSBP (rZ0.320, PZ0.041). However the strongest associations with LVMi were with cSBP MAP-cal (rZ0.506, PZ0.001) and 24cSBP MAP-cal (rZ0.556, P<0.0001). Conclusion: In the current young normotensive population, both office cSBP and 24cSBP were more closely associated with LVMi than peripheral measures of SBP. These findings may have implications for the progression and potential treatment of hypertension-induced target organ damage.
Artery Research, 2015
Purpose: The Mediterranean diet (Med-Diet) assists cardiovascular disease prevention. Erectile dy... more Purpose: The Mediterranean diet (Med-Diet) assists cardiovascular disease prevention. Erectile dysfunction (ED) reflects functional damage of the small peripheral vessels. Our aim is to investigate whether left ventricular (LV)
Artery Research, 2012
Background: Controversy exists regarding the prognostic relevance of blood pressure variability. ... more Background: Controversy exists regarding the prognostic relevance of blood pressure variability. Recent evidence suggests that variability is involved in the development of atherosclerosis. We therefore investigated
European Journal of Neurology, 2020
BackgroundThe frequent use of medication to treat migraine attacks can lead to an increase in mig... more BackgroundThe frequent use of medication to treat migraine attacks can lead to an increase in migraine frequency and is called medication‐overuse headache (MOH).MethodsBased on the available literature in this guideline, the first step in patient management is education and counselling.ResultsPatients with MOH should be managed by a multidisciplinary team of neurologists or pain specialists and behavioral psychologists. Patients in whom education is not effective should be withdrawn from overused drugs and should receive preventive treatment with drugs of proven efficacy. Patients with MOH in whom preventive treatment is not effective should undergo drug withdrawal. Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan medication. In patients with long‐lasting abuse of opioids, barbiturates or tranquilizers, slow tapering of these drugs is recommended. Withdrawal can be performed on an outpatient basis or in a daycare or inpa...
The American Journal of Medicine, 2017
A running head: Aerobic Training Effect on Arterial Stiffness Clinical Significance In subjects... more A running head: Aerobic Training Effect on Arterial Stiffness Clinical Significance In subjects with metabolic syndrome, the univariate analysis demonstrated that heart rate targeted aerobic exercise training is associated with the decrease in aortic stiffness, which is the surrogate marker of cardiovascular diseases. Heart rate targeted aerobic exercise training was associated with significant decrease in waist circumference, systolic, diastolic and mean blood pressure, and heart rate.
Artery Research, 2015
vs. 26.9AE18.4) and contrast volume (ml) (370.8AE 170.2 vs. 348.3AE156.7) did not differ beetwen ... more vs. 26.9AE18.4) and contrast volume (ml) (370.8AE 170.2 vs. 348.3AE156.7) did not differ beetwen women and men (pZNS for all). Overall succes rate was 86.7%, in women 80.9% and in men 87.9% (pZNS). Conclusion: PCI of CTO remains safe and successful method of revascularization in men and women. However, women were a significant minority. Although women are older, success rate of revascularization and complications were similar compared to men.
Artery Research, 2015
vs. 26.9AE18.4) and contrast volume (ml) (370.8AE 170.2 vs. 348.3AE156.7) did not differ beetwen ... more vs. 26.9AE18.4) and contrast volume (ml) (370.8AE 170.2 vs. 348.3AE156.7) did not differ beetwen women and men (pZNS for all). Overall succes rate was 86.7%, in women 80.9% and in men 87.9% (pZNS). Conclusion: PCI of CTO remains safe and successful method of revascularization in men and women. However, women were a significant minority. Although women are older, success rate of revascularization and complications were similar compared to men.
Artery Research, 2010
echocardiographic findings. Distensibility (D) of forearm large arteries was calculated as a rati... more echocardiographic findings. Distensibility (D) of forearm large arteries was calculated as a ratio between volume pulse amplitude and pulse pressure. Forearm vascular resistance (FVR) was calculated from data on mean arterial pressure and forearm blood flow measured by venous occlusion plethysmography. Results: It was stated that Verapamil significantly reduces systolic (-18,8AE1,9 mmHg), diastolic (-8,7AE1,2 mmHg), mean (-13,7AE1,6 mmHg) and pulse (-12,5AE1,5 mmHg) pressure. D of forearm large arteries in all investigated patients increases by 53AE4%, whereas FVR did not change uniformly. In the case when hypotensive effect was caused by a decrease in CO, FVR did not change, but in the case when hypotensive effect was ensured by a decrease in SVR, the inverse relationship existed between changes in SVR and FVR (r Z-0,6). Conclusions: During effective treatment of essential hypertensives with Verapamil contractile activity of forearm large arteries always decreases, whereas precapillary vessels obviously are involved in counterregulation and this masks direct vasodilator effect of Verapamil on arterial smooth muscles.
Neurologijos seminarai, 2021
Lytinės veiklos sukeltas galvos skausmas (LVS) yra pirminis galvos skausmas, sukeliamas lytinės v... more Lytinės veiklos sukeltas galvos skausmas (LVS) yra pirminis galvos skausmas, sukeliamas lytinės veiklos ar atsirandantis jos metu. Literatūroje nurodomas LVS paplitimas siekia apie 1-1,6 %. Nepaisant to, spėjama, kad ligos dažnis gali būti kur kas didesnis dėl pacientų vengimo išsakyti skundus, susijusius su lytine veikla. LVS pasižymi dideliu komorbidiškumu su kitais pirminiais galvos skausmais. Ligos gydymas susideda iš skausmo priepuolių malšinimo ir priepuolių prevencijos. Šiame straipsnyje apžvelgiama LVS epidemiologija, skausmo charakteristikos, diagnostiniai kriterijai, diferencinė diagnostika ir gydymas. Aptariamas pirminio galvos skausmo ir moterų lytinės disfunkcijos komorbidiškumas bei lytinių santykių poveikis pirminiam galvos skausmui.
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Papers by Kristina Ryliškienė