Stroke in Young Patients: Etiopathogenesis and Risk Factors in Different Age Classes

Abstract

The aim of our study was to evaluate the etiopathogenesis and the vascular risk factors in a consecutive series of patients with juvenile ischemic stroke. We enrolled 273 patients (158 males and 115 females), aged between 16 and 49 years, with ischemic cerebrovascular events (ICVE), including transient ischemic attack (TIA) or stroke, referred to our neurology ward between January 1994 and December 2001. Our protocol included medical history, cardiac and neurological examinations, assessment of risk factors and laboratory tests. The instrumental assessment included transthoracic echocardiography (70%), transesophageal echocardiography (60%), conventional angiography (30%), MR angiography (30%), cranial computed tomography (100%) and brain MRI (48%). The ICVE was a stroke in 60% of the cases, a reversible ischemic neurologic deficit in 14% and a TIA in 26%. Thirty-three patients were aged less than 29, 59 were aged between 30 and 39 and 181 between 40 and 49. The percentage of females was higher in patients aged less than 29 while males were prevalent in the 4th and 5th decade. The patients were subtyped according to etiopathogenesis. A large-vessel disease (LVD) was diagnosed in 43 patients (16% of the cases), mostly in patients aged more than 40 years (36 cases). A small-vessel disease (SVD) was found in 48 patients (17% of cases), mostly in patients aged more than 40 years (41 cases). A cardioembolic stroke (CE) was diagnosed in 66 patients (24% of the cases). In the majority of the cases, the cardiopathies were at low-uncertain embolic risk: patent foramen ovale (PFO, 39 cases, in 8 patients associated with an atrial septal aneurism), atrial septal aneurism (12 cases) and myxomatous mitral valve prolapse (3 cases). Stroke due to other causes was found in 51 patients (19% of the cases). Arterial dissection, more frequently involving the carotid region, was diagnosed in 35 patients. Coagulopathies and vasculitis were found in 5 and 6 patients, respectively. Stroke of unknown etiology was found in 65 patients (24% of the cases) with a homogeneous distribution among decades. Our study highlights the role of minor cardiac sources of embolism and arterial dissection in the etiology of juvenile ischemic stroke, whereas coagulopathies and vasculitis are less relevant. LVD and SVD were relevant only in the 5th decade.

Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

“…This corresponds to that of other stroke populations 18, 22. However, while some studies have observed higher proportions of large‐artery atherosclerosis earlier in life 23, 24, our population shows that large‐artery atherosclerosis appears in the 3rd decade, but was not a common finding before the 5th decade and thereafter increased until the 8th decade before decreasing again.…”

Influence of transoesophageal echocardiography on therapy and prognosis in young patients with TIA or ischaemic stroke

“…1,2 Embolism of cardiac origin is another main cause of TIA and ischaemic stroke in young patients. It has been estimated that 15 to 30% of all TIAs and ischaemic strokes are due to a cardioembolic source (CES).…”

Simultaneous myocardial infarction and ischaemic stroke secondary to paradoxical emboli through a patent foramen ovale

“…She was transferred urgently to our institution, where bedside trans-thoracic echocardiography revealed apical and anterior left ventricular Joanna Grogono, 1 ST3 cardiology; Samantha J Fitzsimmons, 2 specialist registrar in adult congenital heart disease; Benoy N Shah, 3 clinical research fellow; Dhrubo J Rakhit, 2 consultant cardiologist; Huon H Gray, 2 consultant cardiologist (LV) wall akinesis and overall moderate systolic dysfunction; subsequent cardiac biomarkers were markedly raised (troponin I 71 ug/L and creatine kinase 2049 iu/L). Serum cholesterol was normal (4.0 mmol/L).…”

“…A duplex ultrasound scan showed no evidence of deep venous thrombosis in the legs or pelvis, and blood screening for inherited and sporadic thrombophilia, vasculitis and antiphospholipid lesson of the month (2) Simultaneous myocardial infarction and ischaemic stroke secondary to paradoxical emboli through a patent foramen ovale Myocardial infarction (MI) and stroke are common acute conditions that regularly present as an emergency to hospital. Paradoxical embolism is a recognised complication of patent foramen ovale (PFO), and the literature shows that it can cause ischaemic stroke or, less frequently, acute MI.…”