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