Etiology and risk factors of intracranial hemorrhage and ischemic stroke in young adults

Abstract

Background: Young stroke incidence has increased worldwide with lifestyle changes. Etiology and risk factors for both ischemic and hemorrhagic stroke in young Asians remain underexplored. Methods: We retrospectively reviewed consecutive acute stroke patients aged 16–45 years admitted to the Taipei Veterans General Hospital between 2009 and 2019 to analyze etiologic subtypes, risk factors, and serial modified Rankin Scale scores for 1 year and compare the age groups of 16–30 and 31–45 years. Results: Among 670 young Taiwanese patients (mean age at onset 37.5 ± 7.0 years; male 65.1%), there were 366 nontraumatic spontaneous hemorrhagic stroke (including 259 intracerebral hemorrhage [ICH] and 107 subarachnoid hemorrhage, SAH), 292 ischemic stroke and 12 cerebral venous thromboses. Notably, ICH was more prevalent in patients aged 16–30 than in those aged 31–45 (54.8% vs 36.8%). Specifically, structural vasculopathy (e.g., arteriovenous malformation, cavernoma) was the most common etiologic subtype in patients aged 16–30 (p < 0.001), whereas hypertensive ICH was the most common subtype in patients aged 31–45 (p < 0.001). On the other hand, the top ischemic subtype for both age groups was other determined diseases (e.g., arterial dissection, autoimmune diseases, moyamoya disease, etc.) rather than large artery atherosclerosis. Hyperlipidemia, diabetes, and cigarette smoking were more common risk factors for infarction than ICH. Familial stroke patients whose first- or second-degree relatives had a stroke by age 80 (n = 104, 15.5%) had more infarctions than those without a familial stroke history. In multivariate analyses, initial stroke severity, and infarction type were important predictors of favorable outcomes after 3 months. At the 1-year follow-up, patients with ICH and SAH had worse functional outcomes and survival rates than those with infarction. Conclusion: An aggressive approach to elucidate the etiology of stroke is indicated because structural vasculopathy-induced ICH and other determined infarction are distinctively prevalent in young adults, particularly those aged 16–30.

To do one and to get more: Part I. Diabetes and bone

“…Since DM is a chronic systemic inflammatory disease and shares the similar pathophysiological disorders of many other chronic diseases or aging process, such as cancers, hereditary diseases, and many others, 4,7,8,10,[12][13][14][15][48][49][50][51] DM is associated with many morbidities. Morbidity from DM is mainly secondary to microvascular damage and dysfunction (hypertension, retinopathy, nephropathy, neuropathy, diabetic foot, and nonalcoholic fatty liver), macrovascular injury and occlusion (hypertension, atherosclerotic cardiovascular disease), and acute complications of life-threatening diseases, including hyperglycemia (hyperglycemia hyperosmolar nonketotic coma and diabetic ketoacidosis) or hypoglycemia.…”

A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke

“…As with older populations, IS typically accounts for the greatest proportion of incident strokes (44-65%) among younger patients, followed by intracerebral hemorrhage (ICH; 17-39%) and subarachnoid hemorrhage (SAH; 16-20%) [6,7]. Rates vary considerably between cohorts, and a meta-analysis reports wide ranges for each subtype [8].…”

Relationship between the stroke mechanism of symptomatic middle cerebral artery atherosclerotic diseases and culprit plaques based on high-resolution vessel wall imaging

“…The incidence rate of the intracranial large atherosclerotic disease has gradually increased in recent years with changes in the social environment, and it is affecting a younger population (6). Therefore, effective methods are needed to clarify the mechanism of ischemic stroke because these mechanisms have potential significance for the clinical treatment and prevention of secondary stroke (7).…”