title: Cerebrovascular injury as a risk factor for amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  To use an unbiased method to test a previously reported association between cerebral arteriovenous malformation (AVM) embolisation and the subsequent development of amyotrophic lateral sclerosis (ALS).
  
  
  METHODS
  A hospital record linkage database was used to create cohorts of individuals coded as having cerebral and peripheral vessel AVMs, stroke (separately for haemorrhagic and ischaemic), transient ischaemic attack (TIA) and subarachnoid haemorrhage (SAH). The rate ratio for subsequent ALS was compared to a reference cohort.
  
  
  RESULTS
  An increased rate ratio for ALS was found in relation to prior AVM (2.69; p=0.005), all strokes (1.38; p<0.001), and TIA (1.47; p<0.001).
  
  
  CONCLUSIONS
  Cerebrovascular injury from a variety of causes, rather than the presence of AVM or the associated embolisation procedure per se, may be a risk factor for ALS within the context of a more complex multiple-hit model of pathogenesis.
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Turner
authors.affiliation: Nuffield Department of Population Health, Oxford University, Oxford, UK.
authors.forename: Raph
authors.initials: R
authors.lastname: Goldacre
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Talbot
authors.affiliation: Nuffield Department of Population Health, Oxford University, Oxford, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldacre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology*; D016022:Case-Control Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology*; D055815:Young Adult
keywords: ALS; CEREBROVASCULAR; EPIDEMIOLOGY; MOTOR NEURON DISEASE