Ischemic Stroke in Young Adults Caused by Cervical Artery Dissection—A Retrospective Study

Abstract

Background Ischemic stroke is one of the most common causes of death and disability. The most common independent cause is cervical artery dissection, which represents around 20% of all cases of ischemic stroke in young adults. Risk factors for dissection include male gender, migraine (particularly with aura), hyperhomocysteinemia, recent infection, recent history of minor cervical trauma, young age, current smoking status, increased leucocyte count, and shortened activated partial thromboplastin time, whereas hypercholesterolemia and being overweight appear protective. Patients and Methods This retrospective study was based on data of all patients aged 18 to 49 who were hospitalized in the University Medical Centre Maribor for ischemic stroke between 2010 and 2019 inclusive. The results of the research were analyzed by IBM SPSS Statistics 28 software. For statistical significance, a cut-off value of p < 0.05 was used. Results The study includes 196 patients with 198 events of ischemic stroke. Dissection of cervical arteries was presented in 16 (8.2%) cases. The presence of arterial hypertension proved to have a relation with the presence of a dissection; patients with dissection are less likely to suffer from arterial hypertension. Duration of hospitalization in the group with dissection lasted significantly longer than in the group without dissection. Conclusions Dissection of cervical or intracranial artery is an important cause of ischemic stroke, especially in young adults. Therefore, it should be considered in young adults with presentation of stroke who lack traditional and modifiable risk factors.

Initial clinical experience with Xpert-Pro peripheral self-expanding stent system for internal carotid artery dissection: Two case reports

“…ICAD is the leading risk factor for ischemic stroke in younger patients. 2 Previous studies have demonstrated that thromboembolism is a potentially dangerous factor for ischemic strokes secondary to ICAD. 6 Therefore, for selected patients with ICAD, treatment with anticoagulative or antiplatelet agents as the primary treatment is effective.…”

“…However, ICAD accounts for more than 10% of strokes in younger patients. 1 , 2 , 3 Although the mechanism of ICAD remains elusive, studies have shown that it is a multifactorial process linked to potential risk factors, such as trauma and genetic predisposition. 4 Current therapeutic strategies for ICAD include intravenous and intra-arterial thrombolysis, antiplatelet medications, anticoagulation, and surgical repair.…”

Exploring the Nexus: A Systematic Review on the Interplay of the Methylenetetrahydrofolate Reductase (MTHFR) Gene C677T Genotype, Hyperhomocysteinemia, and Spontaneous Cervical/Vertebral Artery Dissection in Young Adults

“…We reviewed 11 research papers comprising a total of 4,840 patients. From these finalised studies, we identified two case-control studies [ 2 , 5 ], three case reports [ 6 , 13 , 14 ], three narrative reviews [ 3 , 4 , 9 ], one retrospective observational study [ 1 ], one cohort study [ 12 ], and one experimental study [ 15 ]. All the studies include young patients presenting to the hospital with either TIA or stroke, evaluated to identify HHCY and further MTHFR gene C677T polymorphism, or patients with cervical/vertebral artery dissections, presenting with cervicogenic headache, which were often initially misdiagnosed as migraine with aura, until later returning with more serious outcomes.…”

“…Constituting 71% of all strokes, ischemic stroke (IS) is a leading cause of both mortality and disability. Among young adults, aged 18-45 years or 18-50 years, IS accounts for 10 to 18% of all reported cases [ 1 ]. Hence, it is crucial to enhance our comprehension of the risks, causes, and treatment options for IS.…”

“…Although traditional risk factors for stroke, such as diabetes and hypertension, alongside pathological conditions like small vessel disease, extensive intracranial and extracranial atherosclerosis and atrial fibrillation, wield significant influence in older patients, their occurrence is notably less frequent among young adults. The primary clinical challenge in managing stroke in young adults lies in identifying its cause, with a considerable proportion (35% to 42%) remaining undetermined [ 1 , 3 ]. In numerous instances, the underlying causes are related to genetics, and despite dedicated research endeavors, the genomic origins of IS continue to elude our understanding [ 2 , 3 ].…”