Height loss caused by bent posture: A risk factor for stroke from ENT clinic – is it time to reconsider the physical examination?

Figures & data

Figure 1. Top: actual bent-posture in an 84-year-old female.(yellow dots). Lower: three-dimensional computed tomography (CT) showing aberration of the internal carotid artery on both sides. Aberrant carotid arteries in the mouth. A submucosal swelling pulsates in synchrony with the patient's heartbeat. Aberration of the internal carotid artery. Reproduced with permission from Tsunoda K et al. Ann Intern Med 2003;139:W-56 [8].

Table I. Risk for ischemic stroke without established factors.

Variable	Adjusted ORs (95% CI)	p value
Categorical risk factors
Gender	0.25 (0.09–0.75)	<0.05
Neck anteflexion	16.20 (2.54–103.33)	<0.001
Height loss (≥3 cm)	19.49 (3.07–123.48)	<0.001
Abnormal head/neck carotid arteries	23.39 (4.78–114.44)	<0.001
Numerical risk factors
Diastolic blood pressure	0.99 (0.94–1.05)	NS
Systolic blood pressure	1.02 (0.99–1.05)	NS
HDL-cholesterol level	0.98 (0.95–1.01)	NS

Figure 2. Stroke prediction based on possible risk factors. (a) Rates of discriminated stroke (orange) and normal (without stroke) (green) in control (upper) and case (lower) patients using all significant risk factors. (b) Based on ICA/CCA aberration alone. (c) Based on height loss (≥3 cm) alone.

Table II. Laterality in association between site of aberration of head/neck carotid arteries and brain infarction.

Laterality	Hemisphere of brain infarction
	Left (%)	Bilateral (%)	Right (%)	Subtotal (%)	LI*
Left side alone	5 (6.9)	4 (5.6)	2 (2.8)	11 (15.3)	+0.27
Both sides	7 (9.7)	18 (25.0)	7 (9.7)	32 (44.4)	0
Right side alone	0 (0.0)	3 (4.2)	17 (23.6)	20 (27.8)	–0.85
None	5 (6.9)	2 (2.8)	2 (2.8)	9 (12.5)	+0.33
Total	17 (23.5)	27 (37.6)	28 (38.9)	72 (100)	–0.15

*LI (laterality index) = ([left brain infarction] – [right brain infarction])/[subtotal].

Tsunoda K, Sakai Y, Kikkawa YS, Aikawa J, Murakami R. Bent (head-down) posture and aberrant internal carotid artery in the mouth. A new risk factor for stroke? Ann Intern Med 2003;139:W–56.

 PubMedGoogle Scholar