Etiopathogenesis and prognosis of cerebral ischemia in young adults.

Lanzino, Giuseppe; Andreoli, A.; Pasquale, Giuseppe Di; Urbinati, Stefano; Limoni, P.; Serracchioli, A.; Lusa, Anna Maria; Pinelli, G; Testa, Claudio; Tognetti, Francesco

doi:10.1111/j.1600-0404.1991.tb04962.x

Cited by 41 publications

(29 citation statements)

References 27 publications

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“…1) and a high percentage of undetermined cause (36%) [3, 5, 6, 12,21,22,23,24] (table 3). Uncertain etiology is a very heterogeneous subtype of stroke that involves cases where the cause cannot be determined with any degree of confidence, including those with more than one potential cause identified.…”

Section: Discussionmentioning

confidence: 99%

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Varona¹,

Guerra²,

Bermejo

et al. 2007

Eur Neurol

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Background: Causes of ischemic stroke in young adults (15–45 years) are diverse, but undetermined etiology is common in a majority of studies. Aims: The present series study aims to evaluate causes and changes in the etiological diagnosis of ischemic stroke in young adult patients admitted to a tertiary medical center over a period of 27 years. Methods: We retrospectively reviewed the records of patients with a first-ever stroke in the age range of 15–45 years who were admitted to the ‘12 de Octubre’ University Hospital between 1974 and 2002. Results: 272 young adults with ischemic stroke were identified. The etiological diagnoses were: undetermined in 36% of patients, large-artery atherosclerosis in 21%, cardioembolism in 17%, non-atherosclerotic vasculopathy in 17%, and other specific etiologies in 9%. While in the first study period (1974–1988) 45% of patients were diagnosed with uncertain etiology, in the last period (1989–2002) only 26% were diagnosed with cryptogenic stroke (45% with two or more potential etiologies identified; 45% with no identified cause despite complete evaluation, and 10% with incomplete evaluation). Conclusions: The etiological diagnosis of stroke in young adults has changed over time as a result of improvements in diagnostic workup. While cryptogenic stroke was the most frequent diagnosis in the past, today specific causes (non-atherosclerotic vasculopathy, large-artery atherosclerosis, cardioembolism and hematological disorder) are identified in the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Varona¹,

Guerra²,

Bermejo

et al. 2007

Eur Neurol

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“…Ischemic stroke in the young originates limitations in the quality of life and occupational status [9,12,20,21,40,44]. Series have reported that between 50%-70% of young adults with stroke return to work, with a time period ranging from several days after stroke to 40 months, with a mean of 8 months.…”

Section: Occupational Statusmentioning

confidence: 99%

“…Stroke associated with migraine, stroke due to extracranial artery dissection, and patients with an unknown etiology have been associated with lower risk of recurrence [2,12,13,20,32,33].…”

Section: Recurrencementioning

confidence: 99%

“…Thus, prognosis of stroke in young as a whole has been described as favorable in most of the series [12,[17][18][19][20][21], but the long-term prognosis is notably worse when compared with the general population of the same age, with higher death rate, higher risk of cardiovascular events, and significant limitations in quality of life [12]. Moreover, in our series (with a mean followup of almost 12 years and mean age of 36 years old), only 57% of the patients followed for more than 3 years are alive, free of significant disability, stroke recurrence or other vascular event [12].…”

Section: Introductionmentioning

confidence: 99%

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Long-term prognosis of ischemic stroke in young adults

et al. 2004

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There is limited information about long-term prognosis of ischemic stroke in young adults. Giving the potentially negative impact in physical, social, and emotional aspects of an ischemic stroke in young people, providing early accurate long-term prognostic information is very important in this clinical setting. Moreover, detection of factors associated with bad outcomes (death, recurrence, moderate-to-severe disability) help physicians in optimizing secondary prevention strategies. The present paper reviews the most relevant published information concerning long-term prognosis and predictors of unfavorable outcomes of ischemic stroke affecting young adults. As a summary, we can conclude that, in the long term, stroke in the young adult increases slightly the risk of mortality, implies higher risk of future cardiovascular events, and determines functional limitations in a significant percentage of patients. Nevertheless, in every individual case the prognosis has to be considered depending on several factors (stroke subtype, initial severity, cardiovascular risk factors) that determine the long-term outcomes.

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“…The major predictor of independence was the severity of the initial stroke measured by the Rankin Scale at discharge. Figures on disability ( 12 or the categories of disability and dependency are not uniformly defined. The percentage of disabled survivors ranges from 2% to 38% and of dependents from 0% to 17% in different series.…”

Section: Total N(%)mentioning

confidence: 99%

Prognosis after transient ischemic attack and ischemic stroke in young adults.

Ferro

Crespo

1994

Stroke

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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 died from cancer. Seven transient ischemic attacks and eight strokes (two hemorrhagic) occurred during follow-up. Patients with strokes of unknown cause experienced no recurrent strokes, contrasting with two deaths and eight strokes in those whose stroke cause was identified (difference between proportions: 8%; 95% confidence interval, 3 to 13). Eighty-eight patients had a complete recovery, and only 21 were disabled (Rankin grades 4 or 5). Logistic regression analysis identified the severity of the initial stroke (Rankin grade > 3) as the only significant predictor of disability (odds ratio, 10.7; 95% confidence interval, 3.7 to 30.6). Of the survivors, 73% were working, and only 18% were retired. Disability at follow-up was the best (but nonsignificant) predictor of retirement (odds ratio, 1.6; 95% confidence interval, 0.8 to 3.4). Ischemic stroke in young adults has a low acute mortality and few recurrences, more so if the cause is not identified. The majority of patients return to an active professional life. Severity of the initial stroke is the major predictor of independence. The relation between disability and return to work or retirement is less clear.

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Etiopathogenesis and prognosis of cerebral ischemia in young adults.

Cited by 41 publications

References 27 publications

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Long-term prognosis of ischemic stroke in young adults

Prognosis after transient ischemic attack and ischemic stroke in young adults.

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