Cerebral Infarction in PeopleUnder 40 Years	I

Barinagarrementería, Fernando; Figueroa, Tatiana; Huebe, J; Cantú, Carlos

doi:10.1159/000108001

Cited by 36 publications

(10 citation statements)

References 30 publications

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“…21 Two of the most common risk factors included hypocholesterolemia and hypertension. Recent attention has focused on the association of hypocholesterolemia and an increased incidence of ICH.…”

Section: Discussionmentioning

confidence: 99%

Intracerebral Hemorrhage in Young People

Ruiz-Sandoval

Cantú

Barinagarrementería

1999

Stroke

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206

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Background and Purpose-The frequency of intracerebral hemorrhages (ICHs) in people aged Յ40 years has been poorly studied. We investigated the incidence, causes, locations, and prognosis of ICH in young patients. Methods-We evaluated all consecutive patients with neuroimaging evidence or pathological confirmation of symptomatic ICH. We excluded patients with primary subarachnoid or traumatic hemorrhage, past evidence of vascular malformation, or brain tumor. We analyzed the risk factors, number, locations, and causes of ICH, and final outcome measured by the modified Glasgow Outcome Scale. Results-We retrospectively evaluated 200 patients (mean age, 27 years; range, 15 to 40 years). The most frequent risk factors were tobacco use (20%), hypocholesterolemia (35%), hypertension, (13%), and alcohol use (10%). The locations of ICH were lobar (55%), basal ganglia/internal capsule (22%), and others (24%). The most common causes of ICH were vascular malformations (49%), including cavernous angioma, and hypertension (11%). Cryptogenic ICH was considered in 15%. Other causes included cerebral venous thrombosis (5%) and sympathomimetic drug use (4%). The majority of patients with ICH that resulted from hypertension were aged Ͼ31 years (odds ratio, 3.48), and those with ICH that resulted from arteriovenous malformations were aged Ͻ20 years (odds ratio, 2.80). The final outcome was considered favorable in 60%. Conclusions-ICHs

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Section: Discussionmentioning

confidence: 99%

Intracerebral Hemorrhage in Young People

Ruiz-Sandoval

Cantú

Barinagarrementería

1999

Stroke

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206

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“…Dissection of the cervical arteries (DCA) is a common cause of stroke before 45 years of age [1] and represents one of the main etiologies of stroke in Mexico [2]. Antithrombotics and anticoagulation have been used in the treatment of DCA since the 1970s [3,4,5,6]; however, their effectiveness has not been determined in controlled clinical trials and there are no evidence-based guidelines for the medical management of DCA.…”

Section: Introductionmentioning

confidence: 99%

Dissection of Cervical Arteries: Long-Term Follow-Up Study of 130 Consecutive Cases

Araúz

Hoyos

Espinoza³

et al. 2006

Cerebrovasc Dis

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115

103

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Background and Purpose: We describe the natural history, functional prognosis and long-term recurrences of patients with dissection of cervical arteries (DCA) in a sequential observational study. Methods: We describe 130 patients with angiographically-proven DCA admitted to the Neurology Institute in Mexico City (Mexico), and analyzed clinical and neuroimaging data, treatment and outcome. Treatment with either anticoagulation or aspirin was decided by the primary physician. Primary outcome measures were recurrence (stroke and death) and clinical outcome at 6 months. Follow-up studies were performed to determine recanalization. Results: Mean age was 35.4 years; 4 patients died (3%) and 126 were followed for 3,906 person/years; 17 patients (13%) had a heralding ischemic cerebral event (6 strokes, 11 TIAS) about 8 days before the diagnosis of DCA. After diagnosis, recurrent ischemic stroke occurred in 6 patients (4.8%) within the 2 first weeks (1.5 persons/1,000 follow-up years). No significant differences were found between aspirin and anticoagulation. Recanalization was more frequent in vertebral dissections. Complete recanalization of vertebral dissections was associated with a favorable prognosis [OR 3.2 (95% CI 1.1–8.8; p = 0.02)]. Conclusions: In Mexico, DCA affects young adults and may present with a heralding stroke or TIA. We found rare, early ischemic recurrences. Vertebral territory dissections had better prognosis than carotid ones, particularly in patients with demonstrated complete recanalization.

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“…Spontaneous cervical arterial dissection (sCAD) is a common cause of stroke before 45 years of age [1, 2] and represents one of the main etiologies of stroke in Mexico [3, 4]. The pathophysiological basis of sCAD remains poorly understood, although numerous risk factors have been postulated [1, 2, 5].…”

Section: Introductionmentioning

confidence: 99%

Mild Hyperhomocysteinemia and Low Folate Concentrations as Risk Factors for Cervical Arterial Dissection

et al. 2007

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Background and Purpose: Elevated homocysteine (Hcy) plasma levels are associated with an increased risk of spontaneous cervical artery dissection (sCAD). We examined the potential association between Hcy, folate, vitamin B₁₂ levels and 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphisms in patients with cerebral infarct caused by sCAD. Patients and Methods: 39 patients who survived a cerebral infarct caused by sCAD [20 (51%) women; 24 (61.5%) vertebral and 15 (38.5%) internal carotid arteries], and 76 healthy control subjects were included. Hcy plasma levels (fasting and after methionine load), folate and vitamin B₁₂ levels were measured. We also performed polymorphisms of MTHFR. Hcy, vitamin B₁₂, folates and polymorphisms of MTHFR were assessed and any associations were analyzed using multivariate statistics. Results: Mean plasma fasting Hcy level was 9.81 µmol/l for cases and 6.38 for controls (p = 0.001). The occurrence of sCAD was associated with elevated fasting Hcy levels (>95th percentile over the control group) with an adjusted odds ratio of 7.9 (95% CI 1.66–35). The association between low plasma folate values (<5th percentile) and the presence of CAD was 7.9 (95% CI 1.6–31) after adjusting for confounding variables. The distribution of the MTHFR genotype showed a higher TT mutant frequency among CAD patients (p = 0.034). Conclusions: High plasma concentrations of Hcy and low plasma levels of folate were associated with an increased risk of sCAD in the sample studied. We conclude that deficiencies in nutritional status may contribute to the relatively high incidence of CAD in Mexico.

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Cerebral Infarction in PeopleUnder 40 Years I

Cited by 36 publications

References 30 publications

Intracerebral Hemorrhage in Young People

Intracerebral Hemorrhage in Young People

Dissection of Cervical Arteries: Long-Term Follow-Up Study of 130 Consecutive Cases

Mild Hyperhomocysteinemia and Low Folate Concentrations as Risk Factors for Cervical Arterial Dissection

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