Long-Term Prognosis of Cerebral Ischemia in Young Adults (original) (raw)

2010

https://doi.org/10.1161/01.STR.30.11.2320

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Abstract

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AI

Cerebral ischemia in young adults, though rare, significantly impacts quality of life and socioeconomic conditions. This study investigates long-term prognosis in individuals under 45 years with first-time stroke or transient ischemic attack, revealing varying risk factors and outcomes based on diagnostic groups. Key findings indicate that male gender and older age at entry correlate with a higher risk of recurrent events and mortality.

Prognosis after transient ischemic attack and ischemic stroke in young adults

Stroke, 1994

We undertook this study to describe the risk of stroke recurrence and functional and occupational status in the long-term follow-up of young adults with ischemic strokes and to identify possible predictors for stroke recurrence, disability, and working status. A cohort of 215 patients aged < or = 45 years with ischemic cerebral events (43 transient ischemic attacks, 135 minor strokes, 37 major strokes), evaluated at our institution from May 1985 through March 1992, was followed for a mean of 43.1 months (SD, 39.7 months; range, 1 to 228 months). Information on death and recurrent cerebral vascular events, functional disability (Rankin Scale), retirement, and working status was obtained from direct observation, mail questionnaire, and telephone interviews. Four patients (2%) with major strokes died acutely. Information on stroke recurrence and disability was available for 184 (87%) of the survivors and on retirement and working status for 140 (67%) of the patients. Two patients di...

Exploration of factors affecting prognosis of stroke preceded by transient ischemic attack

Asian Journal of Medical Sciences, 2016

Background: Age is the most important risk factor for stroke. The regional brain affection was not considered in a comparison between different brain locations as a predictor for outcome in those with and without prior TIA.Aims and Objectives: Can transient Ischemic attack predict stroke prognosis?Materials and Methods: Fifty nine patients, aged ≥ 55 years old, with recent ischemic stroke were studied, with (cases, 40.68%) and without (controls) antecedent TIA. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (MRS), and California risk score (CRS) were assessed. A brain computed tomography was done.Results: Older age was a predictor of more severe stroke (P<0.001). Different latencies for TIA were studied. With reference to our controls, better prognosis was found only in cases with TIA ≤ seven days as a predictor for better NIHSS and MRS. In cases, CRS was a significant predictor of shorter latency. Infratentorial ischemic stroke, not supratentorial isch...

AN ETIOLOGICAL STUDY OF ISCHEMIC STROKE IN YOUNG ADULTS

Background:- Ischemic stroke in young adult accounts for up to 12% of all first ever ischemic strokes. Cardioembolic source has been shown to be the most frequent cause of ischemic stroke in young population. Objective:-To determine the different etiologies and risk factors of ischemic stroke in young adults. Patients and methods:-The present descriptive study was performed on 40 patients presented by cerebral ischemic stroke whose age was ranged between 20-42 years. After detailed history and examination, all patients underwent standard diagnostic investigations. The laboratory investigations included complete blood counts (CBC), ESR, urine examination, liver function tests, lipid profile and renal function tests. Thrombophilia screening and protein C&S assay were performed in patients when indicated. Electrocardiogram (ECG), echocardiogram, carotid duplex ultrasound study, imaging studies of brain including CT scan and/or magnetic resonance imaging (MRI), were carried out routinely in all patients. Results:-There was an overall female preponderance (F/M ratio 1.2/1). Cardioembolism was the most frequent cause of young stroke (32.5%), followed by stroke due to large artery athero¬sclerosis (27.5%). Small vessel disease (15%), determined etiology (12.5%) and stroke due to undetermined etiology (12.5%) were least frequent etiologic patterns.Smoking, hypertension and dyslipidemia were statisti-cally significantly associated risk factors in this series of younger stroke patients. Conclusion:-Cardioembolic etiology is the most common treatable subtype of stroke in young adults and traditional risk factors i.e. hypertension, diabetes mellitus, dyslipidemia and cigarette smoking are the most important risk factors associated with ischemic stroke in young adults.

Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke

The New England journal of medicine, 2018

Background After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke and other vascular events is not well known. In this follow-up to a report on 1-year outcomes from a registry of TIA clinics in 21 countries that enrolled 4789 patients with a TIA or minor ischemic stroke from 2009 through 2011, we examined the 5-year risk of stroke and vascular events. Methods We evaluated patients who had had a TIA or minor stroke within 7 days before enrollment in the registry. Among 61 sites that participated in the 1-year outcome study, we selected 42 sites that had follow-up data on more than 50% of their enrolled patients at 5 years. The primary outcome was a composite of stroke, acute coronary syndrome, or death from cardiovascular causes (whichever occurred first), with an emphasis on events that occurred in the second through fifth years. In calculating the cumulative incidence of the primary outcome and secondary outcomes (except death from any cause), we trea...

Stroke in Young Adults in the Community-Based L'Aquila Registry : Incidence and Prognosis

Stroke, 2001

Background and Purpose-Stroke type in the young may influence the outcome and may have a dramatic impact on the quality of life in survivors. This study aimed to evaluate the incidence and prognosis of first-ever stroke in the young and to make comparisons with older patients within a well-defined population. Methods-All first-ever strokes occurring in the L'Aquila district, central Italy, were traced by active monitoring of inpatient and outpatient health services. Incidence rates were standardized to the 1996 European population according to the direct method. Long-term survival was estimated by the Kaplan-Meier method; outcome in survivors was evaluated by the modified Rankin scale. Results-Of 4353 patients who had a first-ever stroke, 89 patients Ͻ45 years of age (55 men and 34 women) (2%) were identified in a 5-year period. Mean ageϮSD was 36.1Ϯ8.1 years. Twenty patients (22.5%) had a subarachnoid hemorrhage, 18 (20.2%) an intracerebral hemorrhage, and 51 (57.3%) a cerebral infarction. The corresponding proportions in patients Ͼ45 years of age were 2.4%, 13.3%, and 83.1%. Neuroimaging studies of the brain detected 14 intracranial aneurysms and 6 arteriovenous malformations in 20 of 38 patients (52.6%) with either subarachnoid (nϭ17) or intracerebral (nϭ3) hemorrhage. The crude annual incidence rate was 10.18/100 000 (95% CI, 8.14 to 12.57) and 10.23/100 000 when standardized to the 1996 European population. The 30-day case-fatality rate was 11.2% (95% CI, 6.2 to 19.4). Patients with subarachnoid hemorrhage had the highest proportion of good recovery (60%), patients with intracerebral hemorrhage had the highest mortality (44%), and patients with cerebral infarction had the highest proportion of severe disability (47%). Conclusions-Stroke patients Ͻ45 years of age showed a disproportionate cumulative high prevalence (42.7%) of subarachnoid and intracerebral hemorrhage with respect to older patients (15.7%), mainly (52.6%) due to aneurysms and arteriovenous malformations. Therefore, screening procedures and preventive strategies in the young should also be addressed to subjects at risk of subarachnoid and intracerebral hemorrhage. (Stroke. 2001;32:52-56.)

Epidemiology, aetiology, and management of ischaemic stroke in young adults

The Lancet Neurology, 2018

Epidemiological evidence suggests that the incidence of ischaemic stroke in young adults (18-50 years) has increased substantially. These patients have a long life expectancy after stroke, and the costs of long-term care pose huge challenges to health-care systems. Although the current recommendations for treatment of young and old (>50 years) patients with stroke are similar, the optimal management of young adult patients with stroke is unknown. They are usually not included in trials, and specific subanalyses limited to young adult patients with stroke are usually not done, owing to lower incidence of stroke and lower prevalence of vascular risk factors in young adults. Progress has been made in identifying patients with a considerable risk of stroke occurrence, such as those with patent foramen ovale. Future prevention studies might result in a decrease in the incidence of stroke and its sequelae in young adults. The development of guidelines specifically devoted to the management of stroke in young adults will be an important step in achieving this aim.

One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

The New England journal of medicine, 2016

Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD(2) score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke...

Very Early Risk of Stroke After a First Transient Ischemic Attack

Stroke, 2003

Background and Purpose-The commonly quoted early risks of stroke after a first transient ischemic attack (TIA)-1% to 2% at 7 days and 2% to 4% at 1 month-are likely to be underestimates because of the delay before inclusion into previous studies and the exclusion of patients who had a stroke during this time. Therefore, it is uncertain how urgently TIA patients should be assessed. We used data from the Oxford Community Stroke Project (OCSP) to estimate the very early stroke risk after a TIA and investigated the potential effects of the delays before specialist assessment. Methods-All OCSP patients who had a first-ever definite TIA during the study period (nϭ209) were included. Three analyses were used to estimate the early stroke risk after a first TIA starting from 3 different dates: assessment by a neurologist, referral to the TIA service, and onset of first TIA. Results-The stroke risk from assessment by a neurologist was 1.9% [95% confidence interval (CI), 0.1 to 3.8] at 7 days and 4.4% (95% CI, 1.6 to 7.2) at 30 days. The 7-and 30-day stroke risks from referral were 2.4% (95% CI, 0.3 to 4.5) and 4.9% (95% CI, 1.9 to 7.8), respectively, and from onset of first-ever TIA were 8.6% (95% CI, 4.8 to 12.4) and 12.0% (95% CI, 7.6 to 16.4), respectively. Conclusions-The early risk of stroke from date of first-ever TIA is likely to be higher than commonly quoted. Public education about the symptoms of TIA is needed so that medical attention is sought more urgently and stroke prevention strategies are implemented sooner. (Stroke. 2003;34:e138-e142.)

Italian multicenter study on reversible cerebral ischemic attacks: angiographic index of atherosclerosis related to age

1984

The influence of age and other risk factors (history of hypertension and diabetes, cigarette smoking, dyslipidemia) on cerebral atherosclerosis was studied in 462 patients with RIA who had cerebral angiography. The degree of atherosclerosis was quantified using extracranial and intracranial cerebrovascular scores (ECS, ICS) based on the number and severity of the lesion in 11 extracranial and 21 intracranial arterial segments. Thirty-six percent of the patients under age 45 had a normal angiogram compared with 17% of the patients over 45. In the subgroup of patients with abnormal angiogram the mean ECS and ICS vascular scores were not significantly different in the two age groups. Cigarette smoking was the only risk factor to show a strong association with the extracranial score, and it was independent of the effect of age and other risk factors. Stroke Vol 15, No 2. 1984 STROKES are not only a problem for the old but also for the young population, as the age-specific incidence for cerebrovascular disease (CVD) is more than 20 per 100,000 per year in the population under age 45.' Atherosclerosis is believed to be the most frequent cause of cerebrovascular disease in middle age and in the elderly, but a less common cause in the young. The reported decline in mortality and incidence of CVD noted in epidemiological studies has benefited the elderly population more than the young. 2-3 Bcause of this difference, a reliable index of cerebral atherosclerosis in vivo derived from angiographic studies was developed and was correlated with risk factors for CVD present in a large population of symptomatic patients, of different age groups. Methods Four hundred and sixty-two patients referred for examination because of carotid or vertebrobasilar ischemic attacks were used in this study. These patients came from six neurological and two neurosurgical centers involved in a multicenter study of stroke in Italy from 1977 to 1981. 4 5 All patients had clinical symptoms suggestive of single or multiple reversible ischemic attacks (RIAs). Only patients who had cerebral angiography were admitted. Twenty-four patients with

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A case series of young stroke in Rome

European Journal of Neurology, 2006

In this hospital case series study we enrolled 394 consecutive ischemic stroke patients aged 14-47 years, all of whom were submitted to a diagnostic protocol. We evaluated the incidence of cerebral ischemia in young adults, as well as the risk factors and the etiopathogenesis of this pathology. Modified diagnostic criteria adopted from the TOAST and Baltimore-Washington Cooperative Young Stroke Study were used for the etiologic classification.The crude annual incidence rate was 8.8/100 000 (95% CI 7.7-9.9), which is in keeping with the rates reported in comparable registries. Risk factors were distributed as follows: smoking in 56% of patients, hypertension in 23%, dyslipidemia in 15%, migraine in 26%, and diabetes mellitus in 2%. Oral contraceptives were being taken by 38% of the women enrolled. The etiology of stroke in the patients was as follows: cardioembolism in 34%, atherothrombosis in 12%, non-atherosclerotic vasculopathies in 14% (including arterial dissection in 12%), other determined causes in 13%, lacunar stroke in 2.5%, migraine in 1%, and undetermined causes in 24%.Despite its biased sampling frame, this large hospital case series, in which risk factor distribution and etiopathogenesis were investigated, stresses the need for an adequate diagnostic approach in young ischemic patients.

A prospective study of cerebral ischemia in the young. Analysis of pathogenic determinants. The National Research Council Study Group

Stroke, 1993

The etiology of stroke in the young is different from that in older patients and remains unknown in almost one third of the cases. To gain further insight into both pathogenic and etiologic determinants, we prospectively studied a large number of consecutive young adults with focal cerebral ischemia. Three hundred thirty-three patients aged 15-44 years with transient ischemic attack or ischemic stroke within the 8 weeks before hospital admission were recruited and investigated by using a standardized protocol of clinical evaluation, blood tests, electrocardiography, echocardiography, chest roentgenography, and brain computed tomography. Presumed etiology was diagnosed by prospectively applied criteria. Women predominated (61%) among patients under 35 years of age, mainly due to the frequency of cerebral ischemia related to oral contraceptive use, while men outnumbered women (60%) among patients over that age because of a higher prevalence of atherothrombotic disease. Potential cerebral embolism of cardiac origin was the presumed cause of stroke in 23.7%, but conventional sources of emboli were found only in 7.5% of cases. There was a low prevalence of atrial fibrillation among young patients with cerebral ischemia. Mitral valve prolapse was found in 8.4%, as expected, predominantly (71.4%) among the younger patients. The prevalence of stroke over transient ischemic attack was proportional to the likelihood of cardiac embolism. Acute alcohol intoxication was considered a precipitating factor in only three patients. The percentages of cerebral ischemia attributed to arterial dissection (0.3%), oral contraceptive use in women (8.1%), migraine (1.2%), and other associated medical diseases (1.5%) were lower than reported in recent clinical series. Two different groups of pathogenic determinants predominate in younger women and in older men, supporting public health measures aimed at strict medical control of the recognized cerebrovascular risk factors.

Ischaemic stroke in young adults: predictors of outcome and recurrence

Journal of Neurology, Neurosurgery & Psychiatry, 2005

Background: There is limited information about predictors of outcome and recurrence of ischaemic stroke affecting young adults. Objective: To assess the predictive value of the presenting characteristics for both outcome and recurrence in young stroke victims. Methods: Clinical and radiological data for 203 patients aged 16 to 45 years were collected prospectively; they comprised 11% of 1809 consecutive patients with ischaemic stroke. The National Institutes of Health stroke scale (NIHSS), the Bamford criteria, and the trial of ORG 10172 in acute stroke treatment (TOAST) classification were used to define stroke severity, subtype, and aetiology. The clinical outcome of 198 patients (98%) was assessed using the modified Rankin scale (mRS) and categorised as favourable (score 0-1) or unfavourable (score 2-6). Results: Stroke was caused by atherosclerotic large artery disease in 4%, cardioembolism in 24%, small vessel disease in 9%, another determined aetiology in 30%, and undetermined aetiology in 33%. Clinical outcome at three months was favourable in 68%, unfavourable in 29%, and lethal in 3%. Thirteen non-fatal stroke, two fatal strokes, and six transient ischaemic attacks (TIA) occurred during a mean (SD) follow up of 26 (17) months. High NIHSS score, total anterior circulation stroke, and diabetes mellitus were independent predictors of unfavourable outcome or death (p,0.0001, p = 0.011, and p = 0.023). History of TIA predicted stroke recurrence (p = 0.02). Conclusions: Severe neurological deficits at presentation, total anterior circulation stroke, and diabetes mellitus predict unfavourable outcome. Previous TIA are associated with increased risk of recurrence.

Analysis of 1008 Consecutive Patients Aged 15 to 49 With First-Ever Ischemic Stroke: The Helsinki Young Stroke Registry

Stroke, 2009

Stroke. The Helsinki Young Stroke Registry Analysis of 1008 Consecutive Patients Aged 15 to 49 With First-Ever Ischemic http://stroke.ahajournals.org located on the World Wide Web at: The online version of this article, along with updated information and services, is http://www.lww.com/reprints Reprints: Information about reprints can be found online at Background and Purpose-To analyze trends in occurrence, risk factors, etiology, and neuroimaging features of ischemic stroke in young adults in a large cohort. Methods-We evaluated all 1008 consecutive ischemic stroke patients aged 15 to 49 admitted to Helsinki University Central Hospital, 1994 to 2007. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria.

Recurrence after first cerebral infarction in young adults

Acta Neurologica Scandinavica, 2000

Objective ± We have investigated recurrence of stroke in a consecutive series of young adults, aged 16 to 45 years, after a ®rst cerebral infarction. Methods ± From January 1, 1988 to December 31, 1996 we submitted those patients to a diagnostic protocol including angiographic, cardiological, and haematological investigations. The patients were followed at 6 month intervals up to December 31, 1998. Results ± We have evaluated and followed-up 135 patients, 71 men and 64 women, who were 3.99% of all the admitted stroke patients. At 12 months after stroke, 83 patients had returned to work, 40 patients were mildly to moderately handicapped, 4 were using a wheel-chair, and 8 had died. Follow-up was 26 to 123 months (mean 68.8). Recurrence of stroke, always of ischaemic nature, was seen in 15 patients (11.1%), 3 to 76 months after the ®rst stroke (mean 27.4), for an annual incidence of 2.26%. Recurrence was signi®cantly associated with Partial Anterior Circulation Syndrome and Haematological subtype of ®rst stroke (respectively, P=0.0209 and P=0.0135, x 2 test), but not with age (j or >35 years) or risk factors. Repetition of stroke was never fatal, but it caused heavy disability in 13 patients, 8 of whom had completely or nearly completely recovered after the ®rst event. Conclusions ± Our data suggest that recurrence of stroke is a major clinical problem also for the patients aged less than 45 years and that it might be more frequent with speci®c clinical syndromes and etiologic subtypes of ®rst stroke.

Predictors of Long-Term Recurrent Vascular Events After Ischemic Stroke at Young Age: The Italian Project on Stroke in Young Adults

Circulation, 2014

Background— Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. Methods and Results— We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%–17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%–17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%–1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphosphol...

Epidemiological Features of Ischemic Brain Stroke; a Cross-Sectional Hospital-Based Study

Archives of Neuroscience

Background: Assessing the prevalence of brain stroke and its clinical patterns across countries and nations could be valuable. It is an important concern for Iran as one of the countries with a high rate of stroke. Objectives: The present study was aimed to assess the epidemiological aspects of ischemic brain stroke. Methods: This cross-sectional study was conducted in Loghman-e-Hakim Hospital, Tehran, Iran from January 2013 to December 2016. The data were gathered by retrospectively reviewing the hospital records. Results: In this study, 2041 cases were admitted that 1145 (56%) cases were male. The mean age of the patients was 66.50 ± 13.49 years. The most common underlying risk factor was hypertension in 73.7% followed by diabetes mellitus in 44.3%. Left carotid stenosis was reported in 17.2% of the cases and right carotid stenosis in 9.5%. Left ventricular ejection fraction < 40% was found in 8.6% of the cases. The most common areas involved in the brain CT scanning were periventricular areas in 20.5%, left middle cerebral artery in 15.4%, and lacunar infarction 8.8% of the cases. In addition, 214 patients died indicating a crude mortality rate of 10.5%. Conclusions: The prevalence of ischemic brain stroke in males is slightly higher than females and the mean age of the patients was estimated to be 66 years. The most common risk factors are comprised of hypertension, diabetes mellitus, and smoking. Carotid stenosis is evident in more than 25% of the patients, and the mortality rate was 10% in the studied population.

Clinical Pattern of Stroke and Distributions According to Age, Gender and Potential Risk Factors

Zenodo (CERN European Organization for Nuclear Research), 2018

Background: Stroke with mortality rate up to 25% is a fatal clinical syndrome. Most common risk factors are Hypertension, smoking, family history of stroke and diabetes mellitus. The objective was to study the pattern of brain strokes, areas and vascular territories of brain affected as per computerized tomography scan (CT scan) findings and risk factors in stroke patients admitted in Allied hospitals of Rawalpindi Medical University, Rawalpindi Methods: This descriptive cross-sectional study was conducted in Allied hospitals of Rawalpindi Medical College (RMC), Rawalpindi from September 2016 to February 2017 after taking ethical approval from Institutional Research Forum (IRF). All diagnosed cases of Stroke (Ischemic stroke or Hemorrhagic stroke) on the basis of Computerized Tomography Scan (CT-Scan) or Magnetic Resonance Imaging (MRI) admitted to Medical Units of Allied Hospitals of RMC were included in the study irrespective of their age and gender. A Structured Questionnaire designed according to the objectives of this study was used for data collection. SPSS (Version-22) for windows was used for analysis through frequencies, percentages and cross tabulations. Result: Out of 200 diagnosed cases of stroke 115 (57.5%) were males and 85 (42.5%) were females. Mean age of patients was 53.73 years. Regarding the types of stroke, predominance of ischemic stroke 121 (60.5%) was seen as compared to hemorrhagic stroke which constitutes of 73 (36.5%) of the cases and the remaining 6 (3%) were the cases where both types of stroke were diagnosed based on CT scan reports. Male predominance 66 (54.54%) was seen in Ischemic stroke as well as in Hemorrhagic stroke 48 (65.75%) as compared to females (Ischemic stroke 55 (45.50%) and Hemorrhagic stroke 25 (34.24%). Most common vascular territory involved in all types of stroke was of middle cerebral artery 115 (57.5%). Among Hemorrhagic stroke subarachnoid hemorrhage 49 (67.1%) was the most common site. In our study most common potential risk factors were Hypertension 115 (57.5%), Smoking 91 (45.5%), Family history of stroke 60 (33 %) and Diabetes 55 (27.5%). Conclusion: Most commonly ischemic stroke, with overall male predominance was seen in our study. Hypertension, smoking and diabetes were the most common modifiable risk factors. Vascular territory of Middle cerebral artery and subarachnoid area were most commonly involved regions of brain in stroke. More than 63 % of patients were above the age of 45 years.

A Four-Year Observational Study regarding the Characteristics and Causes of the Ischemic Stroke in Young Adults: one center study report

Balneo Research Journal, 2020

Introduction. Stroke is the second cause of mortality worldwide, after the ischemic coronary disease, and the first cause of long term-disability. Recent studies report that ischemic stroke (IS) in young patients is increasing in incidence, even though the overall stroke hospitalization rate is decreasing. Stroke in the young, working individuals significantly affects the quality of life (QoL) and also determines an important, negative economic impact by reducing the workforce. Material and method. The aim of this paper is to present the results of a 4-year observational, retrospective study on all patients between 18-49 years, who suffered from acute IS and were admitted and investigated in the Neurology Clinic of Sibiu and the CVASIC Research Center. Clinical evaluations, imaging investigations, and risk factor evaluations were performed on all patients in order to elucidate the etiology and organize according to the TOAST classification. Results and discussions. 114 patients with ischemic stroke were included in the study. 76% of the subjects fall into the 40-49 age class. In respect to the TOAST classification, most cases of IS were of UE (rural<urban), while the fewest cases of IS were represented by SAA in both populations. The most frequent vascular risk factors were hypertension, dyslipidemia, smoking and thrombophilia. Confirmed cervical arteries dissection caused 2/3 of the severe carotid stenosis and 45,5% of the carotid occlusions. Conclusions. Hypertension, dyslipidemia and smoking are the main risk factors for stroke in young patients. The most common TOAST stroke subtype was stroke of undetermined etiology, followed by stroke of other determined etiology (carotid artery dissection and thrombophilia).

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Long-term mortality among young ischemic stroke patients in western Norway

Acta Neurologica Scandinavica, 2007

To obtain data on long-term mortality among young ischemic stroke patients compared with controls in this population-based study. We used Kaplan-Meier survival analysis to compare 232 patients aged 15-49 years with first-ever cerebral infarction in 1988-1997 and 453 controls followed from inclusion to death or 1 August 2005 for 2515 and 5558 person-years respectively. In a subanalysis of 192 patients, we compared risk factor variables using the Kaplan-Meier method and log-rank testing. We applied a Cox proportional hazards model to adjust for multiple risk factors. Forty-five patients and nine controls died during follow-up (P &amp;amp;lt; 0.0005). Independent risk factors for mortality were active tumor disease (P &amp;amp;lt; 0.0005), high consumption of alcohol (P &amp;amp;lt; 0.0005), coronary atherosclerosis (P &amp;amp;lt; 0.001), living alone (P &amp;amp;lt; 0.02), seizures (P &amp;amp;lt; 0.04) and smoking (P = 0.08). Long-term mortality was significantly increased among young stroke patients, mainly due to such lifestyle factors as high consumption of alcohol and tobacco.

Cerebral ischemia in young patients (under 45 years of age): clinical and neuroradiological follow-up

Neurological Sciences, 2011

Ischemic stroke in young patients is a relatively rare event. Few studies have examined the long-term prognosis. The aim of this study was to evaluate the longterm outcome to identify clinical, laboratory and radiologic patterns as possible predictors for mortality, recurrence and functional recovery. We prospectively evaluated 94 patients (42 males and 52 females, aged 14-45 years, mean age 35.5 years, SD 8.4) admitted to our Neurological Department, for first acute ischemic stroke. A 48-month follow-up was performed. The patients were classified according to TOAST and Baltimore classification and Bamford criteria. The severity of the neurological deficit on admission was assessed using the NIHSS. The follow-up included a clinical visit, the modified Ranking scale (mRs) score, Barthel index (BI), and magnetic resonance imaging and intraextracranial vessel Angio MRI. A good functional outcome (mRS 0-1) was found in 74 patients and unfavourable outcome (mRS 2-6) in 20 patients. 16 patients had a recurrent cerebral ischemic event: 5 patients had stroke and 11 patients had TIA. The average incidence annual rate of recurrence was 4.5% and a mortality rate was of 1.06%. Our study does not demonstrate any predictive factor related to clinical outcome. The relevant data of neuroradiological follow-up is the presence of clinically silent lesions in nine patients, considered as a recurrent stroke. To attribute a prognostic role to these lesions, clinical and neuroradiological follow-up needs to be continued.

Validation of the Los Angeles pre-hospital stroke screen (LAPSS) in a Chinese urban emergency medical service population

PloS one, 2013

Early and accurate diagnosis of stroke by emergency medical service (EMS) paramedics is critical for reducing pre-hospital delays. The Los Angeles pre-hospital stroke screen (LAPSS) has been widely used as a validated screening tool for early identifying stroke patients by EMS paramedics. However, validation of LAPSS has never been performed in Chinese stroke population. This study is aimed to verify the LAPSS for early identifying stroke patients in a Chinese urban EMS. 76 paramedics of five urban first aid stations attached to Beijing 120 EMS were involved. The paramedics were trained by professionals to quickly screen patients based on LAPSS. Potential "target stroke" individuals who met the base LAPSS screen criteria were identified. Sensitivity and specificity analyses of the LAPSS were calculated. From June 10, 2009 to June 10, 2010, paramedics transported a total of 50,220 patients. 1550 patients who met the baseline screen criteria were identified as the potential ...

Intravenous Thrombolysis for Acute Ischaemic Stroke in Young Adult Patients

Canadian Journal of Neurological Sciences, 2009

Background: Intravenous tissue plasminogen activator (IV tPA) has been studied primarily in patients over age 50. We sought to describe baseline differences in adult patients <50 years-old taken from a large prospective cohort of acute stroke patients treated with intravenous tPA (IV tPA) and to determine whether outcomes differed for this population. Methods: Data (n = 1120) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study (CASES) were reviewed and patients aged <50 years-old (n=99) were compared with those aged >50 years (n=1021) with regards to baseline characteristics, symptomatic intracerebral haemorrhage (sICH), functional outcome at 90 days and death. Results: Nine percent of patients were <50 years-old. Among patients aged <50 years, 40.4% were women and median age was 42 ± 6.1 years (range 20 to 50). They had significantly more current cigarette use but fewer other vascular risk factors than older patients (p<0.05) and their baseline median NIHSS score was lower (13 versus 15, P=0.001). Although this group was more likely to have a favourable 90-day outcome, multivariable regression confirmed that age <50 years, while independently associated with a decreased risk of death (RR 0.36, 95% CI 0.14 to 0.95), was not itself predictive of favourable 90-day outcome or decreased risk of sICH. Conclusions: Adult patients <50 years-old had fewer medical co-morbidities and a modestly lower baseline median NIHSS score than their older counterparts. Age <50 years was independently associated with a decreased risk of death but not with favourable outcome or risk of sICH. RESUME: Thrombolyse intraveineuse dans l'accident vasculaire cerebral aigu ischemique chez les jeunes adultes. Contexte : L'administration intraveineuse de l'activateur du plasminogene tissulaire (rt-PA IV) a ete etudiee surtout chez les patients de plus de 50 ans. Notre but etait de decrire les caracteristiques de patients adultes de 50 ans et moins faisant partie d'une cohorte prospective importante de patients atteints d'un accident vasculaire cerebral aigu (AVCA) traites par rt-PA IV et de determiner si le resultat therapeutique etait different chez ces patients. Methodes : Nous avons revise les donnees recueillies de facon prospective au cours de l'etude Canadian Alteplase for Stroke Effectiveness Study (CASES) sur 1120 patients et nous avons compare les patients ages de 50 ans et moins (n = 99) a ceux de plus de 50 ans (n = 1021) quant aux caracteristiques initiales, a l'hemorragie intracerebrale symptomatique (HICs), au resultat fonctionnel apres 90 jours et au deces. Resultats : Neuf pour cent des patients etaient ages de 50 ans et moins. Parmi ces patients, 40,4% etaient des femmes et l'age median etait de 42 ± 6,1 ans (ecart de 20 a 50 ans). Le taux de tabagisme actuel etait significativement plus eleve dans ce groupe, mais ces patients presentaient moins d'autres facteurs de risque vasculaire que les patients plus ages (p < 0,05) et leur score median au NIHSS etait plus bas (13 versus 15 ; p = 0,001). Bien que ce groupe soit plus susceptible d'avoir un resultat favorable apres 90 jours, l'analyse de regression multivariee a continue que l'age de 50 ans et moins, bien qu'associe de facon independante a un risque plus faible de deces (RR 0,36, IC a 95% de 0,14 a 0,95), n'etait par en soi predictif d'un resultat favorable a 90 jours ou d'un risque plus faible d'HICs. Conclusions : Les patients adultes de 50 ans et moins avaient moins de co-morbidites medicales et un score median initial NIHSS legerement plus bas que ceux de plus de 50 ans. Etre age de 50 ans et moins etait associe de facon independante a un risque plus faible de deces mais n'etait pas associe a une issue favorable ou au risque d'HICs.