Risk Factor and Etiology Analysis of Ischemic Stroke in Young Adult Patients

Renna, Rosaria; Pilato, Fabio; Profice, Paolo; Marca, Giacomo Della; Broccolini, Aldobrando; Morosetti, Roberta; Frisullo, Giovanni; Rossi, Elena; Stefano, Valerio De; Lazzaro, Vincenzo Di

doi:10.1016/j.jstrokecerebrovasdis.2013.10.008

Cited by 89 publications

(101 citation statements)

References 18 publications

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“…The severity of stroke, as well as the impact on functional capacity may be related to lesions in both hemispheres. In this study the majority of patients at the time of admission showed a moderate stroke severity according to the NIHSS, which is in consonance with Rena et al 9 2014, a study conducted on a stroke unit in Italy, which evaluated 150 patients young adults. When compared the types of stroke, the greater frequency of ischemic stroke in this study corroborates to what has been described in the literature 3,4,18,19,22 , in particular, the proportion of patients diagnosed with hemorrhagic stroke were mostly of hypertensive etiology, reasoning with the findings of previous studies 3,4 .…”

supporting

confidence: 91%

Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Makhoul

Maso²,

Monteiro

et al. 2016

BJMHH

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A B S T R A C T BACKGROUND:Previously referred to as rare among young adults, in the last five years was found a frequency approaching 30 % of young adults between those who have suffered a stroke in Brazil. OBJECTIVE: To identify the sociodemographic, clinical and functional characteristics of young adult patients. METHODS: It was a cross-sectional study, conducted with individuals assisted in a stroke unit with ischemic or hemorrhagic stroke diagnosis and age of 18-50 years old between August 2014 to April 2015. It was used the National Institutes of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS). RESULTS: The study population consisted of 47 individuals, in which 28 (59,6%) were female, with an average age of 39,2 (DP±8,3) years, and brown skin color 21 (44,7%). They presented 8,9 years of formal education. 28 (59,6%) patients were diagnosed with ischemic stroke, 30 (63,8%) had involvement of the anterior circulation, and 23 (48,9%) of the left hemisphere. 26 (55,3%) patients presented hypertension and 36 (76,6%) were sedentary. The stroke severity had a median of 7 ( 0-23 ) points and 30 (63,7%) of patients the functional was capacity 5 in the Rakin Scale. It was found a statistically significant difference for hypertensive etiology of hemorrhagic stroke in men ( p = 0,047) when compared with gender and the occurrence of stroke in the right hemisphere in women (p=0,032). CONCLUSION: The profile of the young adult patients from a stroke unit consists of female, of brown skin color, economically active with moderate stroke severity and severe functional disability. According to the World Health Organization, the stroke is the second leading cause of death in the world, after ischemic heart disease¹. In Brazil and other Latin America countries it is the leading cause of death². The age group most commonly affected by stroke is between 70-80 years old due to the aging of nervous and cardiovascular system³ associated with risk factors such as diabetes, hypertension, smoking, physical inactivity, dyslipidemia, heart diseases², among others. Previously referenced as a rare condition among the young adults, with an incidence of 5 to 10% 4.5 , in Brazil, In the last five years have identified a frequency which is close to 40% of young adults between those who had stroke 6 . In addition to the high mortality rate, it is considered as the most disabling of long-term diseases, impacting not only the patient but also their families 7, and the social security and public system 8 . The growing number of young adults affected by stroke has increased the cost of disability benefits, greatly burdening the public health budget and being responsible for 40% of early retirements 8 . Furthermore, the great etiology diversity for stroke in the younger population, diverging from the elderly population in relation to the most important risk factors, topography and most affected vascular territories 9 justifies the need to extend studies on this population. The studies carried out in stroke units are not specific...

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confidence: 91%

Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Makhoul

Maso²,

Monteiro

et al. 2016

BJMHH

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“…The former is related to deep vein thrombosis and pulmonary thromboembolism. The latter is the cause of systemic thromboembolism, such as cerebral infarction, renal infarction, and mesenteric artery occlusion (22,23). The present patient showed the typical clinical course of leftsided cardiac thrombi.…”

Section: Discussionsupporting

confidence: 51%

Hypertensive Crisis and Left Ventricular Thrombi after an Upper Respiratory Infection during the Long-term Use of Oral Contraceptives

Suzuki

Mizuno

et al. 2016

Intern. Med.

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A 34-year-old woman who had been using oral contraceptives for 10 years developed hypertensive crisis with papilloedema after an upper respiratory infection. Laboratory data showed hyperreninemic hyperaldosteronism and elevated levels of fibrinogen, fibrin, and fibrinogen degradation products. Echocardiography demonstrated two masses (18 mm) in the left ventricle. On the fourth hospital day, cerebral infarction, renal infarction, and upper mesenteric artery occlusion suddenly occurred despite the blood pressure being wellcontrolled using anti-hypertensive drugs. Echocardiography revealed the disappearance of the left ventricular masses, which suggested left ventricular thrombi. Cessation of the contraceptives and administration of heparin, warfarin, and anti-platelets drugs improved her general condition.

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“…En los pacientes con ACV isquémico vimos un bajo porcentaje de factores de riesgo cardiovascular clásicos como la diabetes y la dislipemia; mientras que el tabaquismo y la hipertensión arterial fueron muy prevalentes (HTA 31,2%, DM 3,1%, dislipemia 6,2%, tabaquismo 56,2%) (3,8,11,13) , reafirmando que en los pacientes jóvenes los FRCV clásicos tienen también una gran importancia, sobre todo en los mayores a 35 años.…”

Section: Discussionunclassified

“…Si bien es cierto que en este subtipo de ACV las etiologías son más diversas que en el ACV de los añosos, en los mayores de 35 años las etiologías se van asemejando a las del ACV de la población general (6,11,13) . Así mismo las hemorragias cerebrales presentan más variadas y distintas etiologías en este grupo y aumenta su proporción respecto a los ACV isquémicos (5,6) .…”

Section: Introductionunclassified

“…A pesar de una minuciosa búsqueda etiológica, un 30-35% aproximadamente de los casos de ACV isquémicos en el joven quedan sin etiología aclarada (ACV indeterminados a pesar de estudio completo o criptogénicos) (6,13,14) . Por lo tanto el principal reto para el neurólogo que se enfrenta ante un paciente con ACV en el joven es identificar su causa para lograr un correcto manejo terapéutico y la prevención secundaria adecuada del mismo (5,6,11) .…”

Section: Introductionunclassified

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Análisis de una Cohorte de Pacientes con ACV del Joven. Hospital de Clínicas, Montevideo.

Higgie

Urban

Hackembruch

et al. 2018

Rev. urug. med. interna

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Analysis of a cohort of patients with young man's stroke. Hospital of Clinics, Montevideo.Análise de uma coorte de pacientes com AVC do jovem. Hospital de Clínicas, Montevidéu.Resumen: Introducción. El ataque cerebro-vascular (ACV) es un importante problema de salud pública. Se define ACV en el joven a aquel que se presenta entre los 15-45 años. El objetivo primario de este trabajo es describir las características epidemiológicas, clínicas, imagenológicas, etiopatogénicas y terapéuticas de los pacientes con ACV en el joven. Materiales y Métodos. Se trata de un estudio retrospectivo y descriptivo, acerca de una cohorte de pacientes que presentaron ACV en el joven asistidos en el Hospital de Clínicas de Montevideo en el período comprendido entre junio de 2007 y junio de 2014. Resultados. Se incluyeron 50 pacientes que representaron el 5,6 % de todos los ACV en el período comprendido en el estudio. La media de edad fue de 33 años. En cuanto a la naturaleza, el 64% fueron isquémicos y el 36% hemorrágicos. Según la clasificación TOAST, la etiología más frecuente fue la criptogenética (34%). Respecto a la etiología de las hemorragias intracerebrales la mitad correspondió a malformaciones vasculares. Discusión. El porcentaje de ACV del joven fue algo menor que el descrito en otras comunicaciones. Comparado con el ACV en todas las edades, la hemorragia cerebral aumenta su proporción, si bien la naturaleza isquémica sigue predominando. La causa más frecuente de ACV isquémico del joven fue la criptogenética, seguida de la cardioembolia y las causas inhabituales. Las disecciones arteriales igualaron en prevalencia a la ateromatosis de grandes vasos. Este hecho es similar a lo descrito por la mayoría de los autores. Si bien la etiología más prevalente de hemorragia parenquimatosa fueron las malformaciones vasculares, la cantidad de hematomas hipertensivos no fue despreciable a estas edades.Palabras clave: Unidad ACV, ACV, joven.Abstract: Introduction. Stroke is an important public health issue. Stroke in the young is defined as the one who presents between 15 and 45 years old. The primary objective of this study is to describe the epidemiological, clinical, imaging, etiopathogenic and therapeutic characteristics of stroke in young patients. Materials and Methods. This was a retrospective and descriptive study of a cohort of patients who presented with stroke in the young assisted at the Hospital de Clínicas in Montevideo in the period between June 2007 and June 2014. Results. We have included fifty patients which accounted for 5.6% of all stroke in the period covered by the study. The mean age was 33 yo. As for nature, 64% were ischemic and 36% hemorrhagic. According to the TOAST classification, the most common etiology was cryptogenetic (34%). Regarding the etiology of intracerebral hemorrhages, half corresponded to vascular malformations. Discussion. The proportion of stroke in young people was somewhat lower than that described in other communications. Compared with stroke in all ages, cerebral hemorrhage increases its p...

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Risk Factor and Etiology Analysis of Ischemic Stroke in Young Adult Patients

Cited by 89 publications

References 18 publications

Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Clinical and Functional Characteristics of Young Adult Patients Admitted in a Stroke Unit

Hypertensive Crisis and Left Ventricular Thrombi after an Upper Respiratory Infection during the Long-term Use of Oral Contraceptives

Análisis de una Cohorte de Pacientes con ACV del Joven. Hospital de Clínicas, Montevideo.

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