Age-Stratified Risk of Cerebral Venous Sinus Thrombosis After SARS-CoV-2 Vaccination.

2019-nCoV Vaccine mRNA-1273 / adverse effects Ad26COVS1 / adverse effects Adolescent Adult Age Distribution Aged BNT162 Vaccine / adverse effects COVID-19 Vaccines / administration & dosage ChAdOx1 nCoV-19 / adverse effects Humans Middle Aged Risk Assessment Sinus Thrombosis, Intracranial / epidemiology Young Adult

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
15 02 2022
Historique:
received: 24 08 2021
accepted: 23 11 2021
pubmed: 19 12 2021
medline: 12 3 2022
entrez: 18 12 2021
Statut: ppublish

Résumé

Cerebral venous sinus thrombosis (CVST) as a part of the thrombosis and thrombocytopenia syndrome is a rare adverse drug reaction of severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) vaccination. Estimated background rate of CVST with thrombocytopenia is 0.1 per million per month. We assessed the age-stratified risk of CVST with and without thrombocytopenia after SARS-CoV-2 vaccination. We estimated the absolute risk of CVST with and without thrombocytopenia within 28 days of a first dose of 4 SARS-CoV-2 vaccinations using data from the European Medicines Agency's EudraVigilance database (until June 13, 2021). As a denominator, we used data on vaccine delivery from 31 European countries. For 22.8 million adults from 25 countries, we estimated the absolute risk of CVST after the first dose of ChAdOx1 nCov-19 per age category. The absolute risk of CVST within 28 days of first-dose vaccination was 7.5 (95% confidence interval [CI] 6.9-8.3), 0.7 (95% CI 0.2-2.4), 0.6 (95% CI 0.5-0.7), and 0.6 (95% CI 0.3-1.1) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2, and mRNA-1273, respectively. The absolute risk of CVST with thrombocytopenia within 28 days of first dose vaccination was 4.4 (95% CI 3.9-4.9), 0.7 (95% CI 0.2-2.4), 0.0 (95% CI 0.0-0.1), and 0.0 (95% CI 0.0-0.2) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2, and mRNA-1273, respectively. In recipients of ChAdOx1 nCov-19, the absolute risk of CVST, both with and without thrombocytopenia, was the highest in the 18- to 24-year-old group (7.3 per million, 95% CI 2.8-18.8 and 3.7 per million, 95% CI 1.0-13.3, respectively). The risk of CVST with thrombocytopenia in ChAdOx1 nCov-19 recipients was the lowest in the age group ≥70 years (0.2, 95% CI 0.0-1.3). Age <60 years compared to ≥60 years was a predictor for CVST with thrombocytopenia (incidence rate ratio 5.79, 95% CI 2.98-11.24, The risk of CVST with thrombocytopenia within 28 days of first-dose vaccination with ChAdOx1 nCov-19 was higher in younger age groups. The risk of CVST with thrombocytopenia was slightly increased in patients receiving Ad26.COV2.S compared with the estimated background risk. The risk of CVST with thrombocytopenia was not increased in recipients of SARS-CoV-2 mRNA vaccines.

Sections du résumé

BACKGROUND AND OBJECTIVES
Cerebral venous sinus thrombosis (CVST) as a part of the thrombosis and thrombocytopenia syndrome is a rare adverse drug reaction of severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) vaccination. Estimated background rate of CVST with thrombocytopenia is 0.1 per million per month. We assessed the age-stratified risk of CVST with and without thrombocytopenia after SARS-CoV-2 vaccination.
METHODS
We estimated the absolute risk of CVST with and without thrombocytopenia within 28 days of a first dose of 4 SARS-CoV-2 vaccinations using data from the European Medicines Agency's EudraVigilance database (until June 13, 2021). As a denominator, we used data on vaccine delivery from 31 European countries. For 22.8 million adults from 25 countries, we estimated the absolute risk of CVST after the first dose of ChAdOx1 nCov-19 per age category.
RESULTS
The absolute risk of CVST within 28 days of first-dose vaccination was 7.5 (95% confidence interval [CI] 6.9-8.3), 0.7 (95% CI 0.2-2.4), 0.6 (95% CI 0.5-0.7), and 0.6 (95% CI 0.3-1.1) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2, and mRNA-1273, respectively. The absolute risk of CVST with thrombocytopenia within 28 days of first dose vaccination was 4.4 (95% CI 3.9-4.9), 0.7 (95% CI 0.2-2.4), 0.0 (95% CI 0.0-0.1), and 0.0 (95% CI 0.0-0.2) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2, and mRNA-1273, respectively. In recipients of ChAdOx1 nCov-19, the absolute risk of CVST, both with and without thrombocytopenia, was the highest in the 18- to 24-year-old group (7.3 per million, 95% CI 2.8-18.8 and 3.7 per million, 95% CI 1.0-13.3, respectively). The risk of CVST with thrombocytopenia in ChAdOx1 nCov-19 recipients was the lowest in the age group ≥70 years (0.2, 95% CI 0.0-1.3). Age <60 years compared to ≥60 years was a predictor for CVST with thrombocytopenia (incidence rate ratio 5.79, 95% CI 2.98-11.24,
DISCUSSION
The risk of CVST with thrombocytopenia within 28 days of first-dose vaccination with ChAdOx1 nCov-19 was higher in younger age groups. The risk of CVST with thrombocytopenia was slightly increased in patients receiving Ad26.COV2.S compared with the estimated background risk. The risk of CVST with thrombocytopenia was not increased in recipients of SARS-CoV-2 mRNA vaccines.

Identifiants

DOI: 10.1212/WNL.0000000000013148 PMID: 34921101
pubmed: 34921101
pii: WNL.0000000000013148
doi: 10.1212/WNL.0000000000013148
doi:

Substances chimiques

Ad26COVS1 JT2NS6183B
COVID-19 Vaccines 0
ChAdOx1 nCoV-19 B5S3K2V0G8
2019-nCoV Vaccine mRNA-1273 EPK39PL4R4
BNT162 Vaccine N38TVC63NU

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e759-e768

Informations de copyright

© 2021 American Academy of Neurology.

Auteurs

Katarzyna Krzywicka (K)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.
ORCID: 0000-0002-9478-0401

Anita van de Munckhof (A)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Mayte Sánchez van Kammen (M)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Mirjam R Heldner (MR)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Katarina Jood (K)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Erik Lindgren (E)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Turgut Tatlisumak (T)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Jukka Putaala (J)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Johanna A Kremer Hovinga (JA)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Saskia Middeldorp (S)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Marcel M Levi (MM)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Charlotte Cordonnier (C)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Marcel Arnold (M)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Aeilko H Zwinderman (AH)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

José M Ferro (JM)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Jonathan M Coutinho (JM)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal.

Diana Aguiar de Sousa (D)

From the Departments of Neurology (K.K., A.v.d.M., M.S.v.K., J.M.C.) and Vascular Medicine (M.M.L.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Departments of Neurology (M.R.H., M.A.) and Hematology (J.A.K.H.), Inselspital, Bern University Hospital, University of Bern; Department of Neurology (K.J., E.L., T.T.), Sahlgrenska University Hospital; Department of Clinical Neuroscience (K.J., E.L., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology (J.P.), Helsinki University Hospital and University of Helsinki, Finland; Department of Internal Medicine (S.M.) and Radboud Institute of Health Sciences (S.M.), Radboud University Medical Center, Nijmegen, the Netherlands; National Institute for Health Research University College London Hospitals Biomedical Research Centre (M.M.L.), UK; University of Lille (C.C.), Inserm, CHU Lille, U1172-Lille Neuroscience and Cognition, France; Department of Clinical Epidemiology and Biostatistics (A.H.Z.), Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; and Department of Neurosciences and Mental Health (J.M.F., D.A.d.S.), Neurology Service, Hospital de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), University of Lisbon, Portugal. dianasousa@campus.ul.pt.

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