Cerebral infarction in young adults

Kittner, Steven J.; Stern, Barney J.; Wozniak, Marcella A.; Buchholz, David W.; Earley, Christopher J.; Feeser, B. R.; Johnson, Constance J.; Macko, Richard F.; McCarter, Robert; Price, Thomas R.; Sherwin, Roger; Sloan, Michael A.; Wityk, Robert J.

doi:10.1212/wnl.50.4.890

Cited by 229 publications

(169 citation statements)

References 17 publications

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“…We found that younger patients were at relatively increased odds of stroke after ILI compared to older patients; for every decade younger age, the odds increased by almost 10%. While the absolute risk of stroke is greater in older adults, approximately 10–14% of all strokes occur in people 18–45 years old, with the incidence and prevalence of stroke in the young increasing 4, 28, 29, 30, 31, 32, 33, 34. This increasing prevalence, moreover, coupled with greater heterogeneity in stroke etiology within the younger age group than in the older stroke population, presents a unique and vulnerable patient population where risk reduction efforts are of increasing importance.…”

Section: Discussionmentioning

confidence: 99%

Influenza‐like illness as a trigger for ischemic stroke

Boehme

Luna

Kulick

et al. 2018

Ann Clin Transl Neurol

122

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ObjectiveWe hypothesized that ILI is associated with risk of incident stroke, and that the risk would be highest closest in time to the event.MethodsThis case‐crossover analysis utilized data obtained from the California State Inpatient Database of the Healthcare Cost and Utilization Project (HCUP). The outcome of interest was ischemic stroke. Exposure was defined as a visit to the emergency department or hospitalization for influenza‐like illness (ILI) 365, 180, 90, 30, or 15 days before stroke (risk period) or similar time intervals exactly 1 or 2 years before stroke (control period). Conditional logistic regression was used to calculate the odds ratio and 95% confidence interval (OR, 95% CI).ResultsIn 2009, 36,975 hospitalized ischemic strokes met inclusion criteria, and of these strokes, 554 (1.5%) had at least 1 episode of ILI in the 365‐day risk period prior to their stroke. Using non‐overlapping time intervals from ILI to stroke, the odds of ischemic stroke was greatest in the first 15 days post ILI (OR: 2.88, 95% CI: 1.86–4.47). The strength of the relationship decreased as the time from ILI increased, and was no longer significant after 60 days. There was a significant interaction (P = 0.017) with age and ILI; the odds of stroke associated increased 7% with each 10‐year decrease in age (OR per 10‐year age decrease 1.07, 95% CI: 1.03–1.35).InterpretationWe found that ILI increases short‐term risk of stroke, particularly in people under the age of 45, and therefore may be considered to act as a trigger for stroke.

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Section: Discussionmentioning

confidence: 99%

Influenza‐like illness as a trigger for ischemic stroke

Boehme

Luna

Kulick

et al. 2018

Ann Clin Transl Neurol

122

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“…Approximately 15% of all ischemic strokes (IS) occur in young adults and adolescents. [1][2][3][4][5][6][7][8] Compared with stroke in older adults, stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. To date, only limited prior public health and research efforts have specifically addressed stroke in the young.…”

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confidence: 99%

Recognition and management of stroke in young adults and adolescents

et al. 2013

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Approximately 15% of all ischemic strokes (IS) occur in young adults and adolescents. To date, only limited prior public health and research efforts have specifically addressed stroke in the young. Early diagnosis remains challenging because of the lack of awareness and the relative infrequency of stroke compared with stroke mimics. Moreover, the causes of IS in the young are heterogeneous and can be relatively uncommon, resulting in uncertainties about diagnostic evaluation and causespecific management. Emerging data have raised public health concerns about the increasing prevalence of traditional vascular risk factors in young individuals, and their potential role in increasing the risk of IS, stroke recurrence, and poststroke mortality. These issues make it important to formulate and enact strategies to increase both awareness and access to resources for young stroke patients, their caregivers and families, and health care professionals. The American Academy of Neurology recently convened an expert panel to develop a consensus document concerning the recognition, evaluation, and management of IS in young adults and adolescents. The report of the consensus panel is presented herein. Approximately 15% of all ischemic strokes (IS) occur in young adults and adolescents. [1][2][3][4][5][6][7][8] Compared with stroke in older adults, stroke in the young has a disproportionately large economic impact by leaving victims disabled before their most productive years. To date, only limited prior public health and research efforts have specifically addressed stroke in the young. Early diagnosis remains challenging because of the lack of awareness and the relative infrequency of stroke compared with stroke mimics. Moreover, the causes of IS in the young are heterogeneous and relatively uncommon, 3,8,9 resulting in uncertainties about diagnostic evaluation and cause-specific management. Emerging data have raised public health concerns about the increasing prevalence of traditional vascular risk factors in young individuals, and their potential role in increasing the risk of IS, stroke recurrence, and poststroke mortality. [5][6][7][8]10,11 These issues make it important to formulate and enact strategies to increase both awareness and access to resources for young stroke patients, their caregivers, and health care professionals. The American Academy of Neurology convened an expert panel to develop a consensus document concerning IS in young adults and adolescents. Given the relative lack of high-level scientific evidence concerning stroke in young individuals, an evidence-based management guideline was considered unfeasible. The report of the consensus panel is presented herein.EPIDEMIOLOGY As young adults approach middle age, stroke prevalence increases 5,7 (table 1). Based on selfreport, 532,000 12 to 852,000 13 persons aged 18 to 44 years in the United States have had a stroke. For comparison, among adults aged 17 to 44 years, the self-reported prevalence of stroke is more than twice that of

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“…23,41,47) Although pregnancy and the period shortly after pregnancy are widely believed to be associated with increased risk of stroke, the age-and race-adjusted relative risk (RR) is reported to be 0.7 (95% confidence interval 0.3-1.6). 23) Among 1,051,113 residents recruited in the Baltimore-Washington Cooperative Young Stroke Study, 24) 17 cerebral infarctions occurred during 8,011,852 woman-weeks of exposure, whereas 175 cerebral infarctions occurred during 101,303,016 non-exposed woman-weeks. On the other hand, the RR increased to 5.4 (95% confidence interval 2.9-10.0) during the postpartum period (after live birth or stillbirth).…”

Section: Incidence Of Ischemic Stroke During Pregnancymentioning

confidence: 99%

Acute Revascularization Therapy in Pregnant Patients

Hirano

2013

Neurol. Med. Chir.(Tokyo)

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Ischemic stroke is uncommon during pregnancy, but decision making for acute revascularization therapy including intravenous recombinant tissue plasminogen activator (rt-PA) is difficult. The use of rt-PA remains controversial, but a systematic review of 16 patients (mean age 31.7 years) showed good results for both maternal (77.8%) and fetal (56.3%) outcomes. Pregnancy alone is not a solid contraindication for acute revascularization therapy including rt-PA. An endovascular approach might be beneficial for reducing the hemorrhagic complication; however, the treatment strategy should be considered based on the available treatment facility. Close cooperation with obstetrics is essential for the successful management of saving the lives of both the mother and the fetus.

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Cerebral infarction in young adults

Cited by 229 publications

References 17 publications

Influenza‐like illness as a trigger for ischemic stroke

Influenza‐like illness as a trigger for ischemic stroke

Recognition and management of stroke in young adults and adolescents

Acute Revascularization Therapy in Pregnant Patients

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