Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults: A Registry‐Based Study

Tibæk, Maiken; Dehlendorff, Christian; Jørgensen, Henrik; Forchhammer, Hysse Birgitte; Johnsen, Søren P; Kammersgaard, Lars Peter

doi:10.1161/jaha.115.003158

Cited by 127 publications

(110 citation statements)

References 34 publications

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“…12 These results were corroborated at a 9,14 An increase in IS incidence was also observed in young adults in Denmark and in Sweden. 15,16 The stability of hospitalization rates for HS observed in our study is consistent with results reported in the Danish study and in the Greater Cincinnati and Northern Kentucky study. 8,15 Multiple causes could explain the increase of IS incidence in people aged <65 years.…”

Section: Changes In Hospitalized Patient Ratessupporting

confidence: 91%

“…15,16 The stability of hospitalization rates for HS observed in our study is consistent with results reported in the Danish study and in the Greater Cincinnati and Northern Kentucky study. 8,15 Multiple causes could explain the increase of IS incidence in people aged <65 years. The increase in the prevalence of cardiovascular risk factors in young adults seems to be the best hypothesis in France.…”

Section: Changes In Hospitalized Patient Ratessupporting

confidence: 91%

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National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014

Lecoffre

Peretti

Gabet

et al. 2017

Stroke

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Background and Purpose— Stroke is the leading cause of death in women and the third leading cause in men in France. In young adults (ie, <65 years old), an increase in the incidence of ischemic stroke was observed at a local scale between 1985 and 2011. After the implementation of the 2010 to 2014 National Stroke Action Plan, this study investigates national trends in patients hospitalized by stroke subtypes, in-hospital mortality, and stroke mortality between 2008 and 2014. Methods— Hospitalization data were extracted from the French national hospital discharge databases and mortality data from the French national medical causes of death database. Time trends were tested using a Poisson regression model. Results— From 2008 to 2014, the age-standardized rates of patients hospitalized for ischemic stroke increased by 14.3% in patients <65 years old and decreased by 1.5% in those aged ≥65 years. The rate of patients hospitalized for hemorrhagic stroke was stable (+2.0%), irrespective of age and sex. The proportion of patients hospitalized in stroke units substantially increased. In-hospital mortality decreased by 17.1% in patients with ischemic stroke. From 2008 to 2013, stroke mortality decreased, except for women between 45 and 64 years old and for people aged ≥85 years. Conclusions— An increase in cardiovascular risk factors and improved stroke management may explain the increase in the rates of patients hospitalized for ischemic stroke. The decrease observed for in-hospital stroke mortality may be because of recent improvements in acute-phase management.

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Section: Changes In Hospitalized Patient Ratessupporting

confidence: 91%

Section: Changes In Hospitalized Patient Ratessupporting

confidence: 91%

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014

Lecoffre

Peretti

Gabet

et al. 2017

Stroke

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“…23,24 While ischemic stroke historically has affected predominantly older adults, its frequency in a younger population has been increasing. 25–30 This trend is of particular concern because stroke in younger individuals may lead to disability during the most productive years of life. Risk factors for ischemic stroke in young adults include hypertension, smoking, diabetes mellitus, and obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for ischemic stroke in young adults include hypertension, smoking, diabetes mellitus, and obesity. 30 Stroke in young adults also has other etiologies that are not fully understood but may differ from those of ischemic stroke in individuals of more advanced age, particularly a greater association with cervical artery dissection. 31 While our study suggests mass effect and cervical dissection are associated with AIS onset after TBI, future prospective studies may help better characterize specific mechanisms leading to AIS acutely in these types of brain injuries.…”

Section: Discussionmentioning

confidence: 99%

Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury

Kowalski

Haarbauer‐Krupa

Bell

et al. 2017

Stroke

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Background and Purpose Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. Methods A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. Results Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5%) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95% confidence interval, −16.8 to −9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95% confidence interval, 1.3–2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95% confidence interval, 13.1–23.4; P<0.001). Conclusions Ischemic stroke is observed acutely in 2.5% of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events.

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“…The present study focused on stroke outcomes following PAE in 3-month old young adult animals, since recent epidemiological surveys have identified a sharp increase in stroke in young adults of both sexes (Tibaek et al, 2016, Ramirez et al, 2016), caused perhaps by an increase in metabolic disease in this population. In our studies, stroke due to transient middle cerebral artery occlusion resulted in cortical and striatal infarct after 24 h of reperfusion, comparable to the types of damage observed in human populations (Kaufmann et al, 1999) and in rodent studies (Manwani et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Fetal Alcohol Exposure Alters Blood Flow and Neurological Responses to Transient Cerebral Ischemia in Adult Mice

Bake

Gardner

Tingling

et al. 2016

Alcoholism Clin & Exp Res

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Background Prenatal alcohol exposure can result in physical and neurocognitive deficits that are collectively termed ‘Fetal Alcohol Spectrum Disorders’ (FASD). Though FASD is associated with life-long intellectual disability, the mechanisms mediating the emergence of secondary mental-health and physical disabilities are poorly understood. Based on our previous data showing that maternal ethanol exposure in mice resulted in an immediate reduction in cranially directed fetal blood flow, we hypothesized that such exposure would also result in persistent alterations in cranially directed blood flow in the prenatally alcohol exposed (PAE) adult. We also hypothesized that PAE adults exposed to an acute cerebrovascular insult would exhibit more brain damage and neurobehavioral impairment compared to non-PAE adult controls. Methods Pregnant C57Bl/6 mice were exposed to ethanol, 3g/kg, or water by intra-gastric gavage. Blood flow in carotid, renal and femoral arteries was assessed by ultrasound imaging in PAE and control adults, at 3, 6, and 12 months of age. To mimic ischemic stroke in young adult populations, 3-month-old PAE and control animals were subject to transient middle cerebral artery occlusion (MCAo) and subsequently assessed for behavioral recovery, stroke infarct volume and brain cytokine profiles. Results PAE resulted in a significant age-related decrease in blood acceleration in adult mice, specifically in the carotid artery. A unilateral transient MCAo resulted in equivalent cortico-striatal damage in both PAE and control adults. However, PAE adult mice exhibited significantly decreased post-stroke behavioral recovery compared to controls. Conclusions Our data collectively show that PAE adult mice exhibit a persistent, long-term loss of cranially directed blood flow, and decreased capacity to compensate for brain trauma due to acute onset adult diseases like ischemic stroke.

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Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults: A Registry‐Based Study

Cited by 127 publications

References 34 publications

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014

National Trends in Patients Hospitalized for Stroke and Stroke Mortality in France, 2008 to 2014

Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury

Fetal Alcohol Exposure Alters Blood Flow and Neurological Responses to Transient Cerebral Ischemia in Adult Mice

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