Ischemic Stroke in the Young

Abstract

The purpose of this article is to address several challenging questions in the management of young patients (those age 60 and under) who present with ischemic stroke. Do genetic thrombophilic states, strongly associated with venous thrombosis, independently cause arterial events in adults? Should cases of patent foramen ovale be closed with mechanical devices in patients with cryptogenic stroke? What are the optimal treatments for cerebral vein thrombosis, carotid artery dissection, and antiphospholipid syndrome and are DOACs acceptable treatment for these indications? What is the mechanism underlying large vessel stroke in patients with COVID-19? This is a narrative review. We searched PubMed and Embase and American College of physicians Journal club database for English language articles since 2000 looking mainly at randomized clinical trials, Meta analyses, Cochran reviews as well as some research articles viewed to be cutting edge regarding anticoagulation and cerebrovascular disease. Searches were done entering cerebral vein thrombosis, carotid dissection, anticoagulation therapy and stroke, antiphospholipid antibody and stroke, stroke in young adults, cryptogenic stroke and anticoagulation, patent foramen ovale and cryptogenic stroke, COVID-19 and stroke.

Block Copolymer Nanomicelle-Encapsulated Curcumin Attenuates Cerebral Ischemia Injury and Affects Stem Cell Marker Expression by Inhibiting lncRNA GAS5

“…Stroke has become the most common cause of death in China [1] of which IS accounts for the vast majority, reaching 70% to 80% [2]. At present, the effective treatment methods for IS are mainly to open arteries and restore blood flow as soon as possible [3,4] including intravenous thrombolysis and mechanical clot thrombectomy.…”

Etiologic reclassification of cryptogenic stroke after implantable cardiac monitoring and computed tomography angiography re-assessment

“…Probably, other sources of cardioembolism might be recognized as a possible cause in a percentage of these patients, although our echocardiographic data (left atrial structural parameters being within normal limits in most of our patients) suggest that the so-called atrial cardiopathy does not play a major role in these patients’ stroke pathophysiology. Some studies have hypothesized mechanisms other than atherosclerosis and cardioembolism, such as hypercoagulable states (e.g., in case of covert malignancies), artery dissection, and vasculitis that might be rather prevalent in young stroke patients [ 31 ], which is not however the case of our sample. We think that longitudinal studies are needed to evaluate the risk profile, in terms of stroke relapse, cardiovascular events, and mortality, of patients with true cryptogenic stroke compared to patients having a possible stroke etiology.…”

Quantitative and Qualitative Characteristics of Atherosclerotic Plaques on Carotid Arteries in Patients with Antiphospholipid Syndrome: The Role of MDCT Angiography

“…The control group contained 13 predominantly calcified lesions with a %DS greater than 50% (6/13) or 70% (7/13). While these values may seem of lesser importance, we must emphasise that the early detection of carotid artery stenosis increases the probability of successful management [ 21 , 22 , 23 ].…”