Ischaemic stroke in young adults: risk factors and long-term consequences

Maaijwee, Noortje A.M.; Rutten-Jacobs, Loes C.A.; Schaapsmeerders, Pauline; Dijk, Ewoud J. van; Leeuw, Frank‐Erik de

doi:10.1038/nrneurol.2014.72

Cited by 299 publications

(313 citation statements)

References 133 publications

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“…Taken together, our study suggests that atherosclerosis is the most common cause of intracranial stenosis in Chinese young patients, similar to the old (20,21). On the other hand, the patients aged 36 to 45 years old had more traditional vascular risk factors and eccentric stenosis than those ≤35 years old, supporting that the rising incidence of traditional vascular risk factors have effects on intracranial artery pathophysiology (17,21,22).…”

Section: Discussionmentioning

confidence: 50%

“…Our results are potentially clinically important. It has been known that the prognosis of young stroke is not as favorable as previously thought, with respect either to mortality, or cardiovascular disease, or to psychosocial consequences (17). Early etiology diagnosis and pathophysiology evaluation of intracranial stenosis are meaningful.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that there is a sharp rise in the prevalence of traditional risk factors over the age of 35 years and "young stroke" increasingly resembles 'old' stroke (17). To address whether this "sharp risk factors rise" is meaningful for intracranial vessel pathophysiology, we further divided patients into two subgroups: patients >35 years old and patients ≤35 years old.…”

Section: Participantsmentioning

confidence: 99%

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Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study

Gao

et al. 2017

Ann. Transl. Med.

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Background: Using high-resolution magnetic resonance imaging (HRMRI), we sought to investigate the underlying etiology of intracranial stenosis in young patients. Methods:We retrospectively studied 122 Chinese young adult patients (from 18 to 45 years old, mean age 36.2±7.5 years) with unilateral middle cerebral artery (MCA) stenosis based on a prospectively established HRMRI database. The eccentricity, degree of stenosis, and remodeling types of MCA lesions were analyzed.The MCA lesions were classified as eccentric (presumed atherosclerosis) or concentric stenosis (presumed non-atherosclerosis). The clinical data and vessel wall properties were compared between the patients >35 years old and the patients ≤35 years old.Results: Eccentric stenosis was observed in 98 (80.3%) patients and concentric stenosis in 24 (19.7%) patients. The patients with eccentric stenosis were older (37.5±6.8 vs. 31.4±8.4 years old, P<0.001) and more likely had atherosclerosis risk factors (56.1% vs. 25.0%, P=0.006). The patients >35 years old had higher prevalence (90.1% vs. 66.7%, P=0.001) of eccentric stenosis and atherosclerosis factors (60.6% vs. 35.3%, P=0.006) than the patients ≤35 years old. Most of the patients with concentric stenosis were ≤35 years old (17/24, 70.8%) and were female (16/24, 66.7%). Binary Logistic analysis suggested smoking (OR =3.171; 95% CI,) and remodeling ratio (OR =1.625; 95% CI, 1.001-2.636) were independent predictive factors for symptomatic stenosis.Conclusions: Atherosclerosis is the most common cause of intracranial stenosis in Chinese young patients.Non-atherosclerosis disease is an important etiology in young female, especially in the patients aged 35 years old or younger.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

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Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study

Gao

et al. 2017

Ann. Transl. Med.

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“…An overview of the risk factors of ischemic stroke in young adults in the last years revealed rising prevalence of “traditional” vascular risk factors in young age groups (Maailjwee et al. 2014). Recent research has shown that heavy consumption of alcohol increases the possibility of dying from stroke (Rantakömi et al.…”

Section: Discussionmentioning

confidence: 99%

Twenty years trends in mortality rates from stroke in Klaipeda

et al. 2016

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BackgroundDuring the past decades, mortality from stroke decreased in many western European countries; however, changes concerning long‐term stroke mortality in eastern European countries are less evident.ObjectiveTo assess age‐ and gender‐specific trends in stroke mortality in Klaipeda (Lithuania) from 1994 to 2013.DesignDescriptive epidemiological study.Setting/subjectsPermanent population of Klaipeda.MethodsData on 2509 permanent residents of Klaipeda aged 35–79 years who died from stroke between 1994 and 2013 were gathered. Directly, age‐standardized (European population) stroke mortality rates were analyzed using joinpoint regression separately for specific age groups (35–64, 65–79, and 35–79 years) and by gender. Annual percentage change (APC) and 95% CIs were presented.ResultsStroke mortality in the 35‐ to 79‐year‐old age group peaked in 1994–1997, it then decreased by −9.9% (95% CI: −18.7, −0.2) yearly up until 2001 and leveled off by −0.2% (−5.1, 4.9) between 2001 and 2013. Among men aged 35–64 years, mortality decreased substantially by 12.8% (−21.5, −3.3) per year from 1994 to 2001 and turned positive by 6.3% (0.8, 12.1) between 2000 and 2013. Among women aged 35–64 years, mortality decreased significantly by 15.5% (−28.1, −0.7) from 1994 to 2000. There was evidence of recent plateauing of trends for 35‐ to 64‐year‐old women between 2000 and 2013. In the 65‐ to 79‐year‐old age group, mortality decreased from 1994 onward yearly by −5.5% (−7.9, −3.0) in women and by −3.3% (−5.6, −0.9) in men.ConclusionsJoinpoint regression revealed steadily decreasing trend in stroke mortality between 1994 and 2001. The decline in death rates flattened out in the recent decade. Mortality rates varied among age groups and were more pronounced in adults aged 35–64 years. It is essential to monitor and manage stroke risk factors, especially among middle‐aged population.

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“…What are the most common causes for stroke in young adults without high-risk factors for CVD? 1 Routine blood test, ECG, heart and carotid ultrasonography, and transcranial Doppler were unremarkable. Further digital subtraction angiography (DSA) revealed a complex pattern of brain blood supply (figure e-2, A and C): (1) irregularity of contrast filling indicating artery dissection formation in the C1 segment of the right internal carotid artery (RICA) with visible active thrombosis and diminished forward flow; (2) Dissection at C1 level of the left internal carotid artery (LICA) without luminal restriction with normal flow (3); intracranial supply of internal carotid artery (ICA) partially compensated by lateral circulation from normal vertebral arteries (VA).…”

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confidence: 99%

Clinical Reasoning: Sudden-onset pulsatile headache in a previously healthy young man

2017

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A previously healthy 41-year-old man presented to the local hospital with a sudden-onset right-sided pulsatile headache, accompanied by vertigo, unstable gait, nausea, and vomiting. On admission, he additionally presented with left central facial paralysis, left-sided hemiparesis, and NIH Stroke Scale score of 2. The patient denied history of hypertension, diabetes, or any other high-risk factors for cerebral vascular diseases (CVD). Diffusion-weighted imaging (DWI) revealed multiple acute focal infarctions in the right frontoparietal lobe consistent with decreased blood supply through the right carotid artery (figure e-1A1 at Neurology.org).

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Ischaemic stroke in young adults: risk factors and long-term consequences

Cited by 299 publications

References 133 publications

Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study

Etiology of intracranial stenosis in young patients: a high-resolution magnetic resonance imaging study

Twenty years trends in mortality rates from stroke in Klaipeda

Clinical Reasoning: Sudden-onset pulsatile headache in a previously healthy young man

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