Young Adult Stroke in Taiwan: etiologies and outcomes

Abstract

Background Early-onset adult stroke has not been fully characterized in Asians. Objectives We investigated the etiologic subtypes, risk factors and 1-year outcomes of early-onset stroke (16 – 55 years of age) in a Taiwanese cohort. Methods We retrospectively reviewed consecutive patients with acute stroke admitted to the Taipei Veterans General Hospital in Taiwan between 2009 and 2017. Patients were classified by age of onset (≤ or > 55) and etiologic subtypes and regularly followed for 1 year. Results Among all stroke patients (n=8155), 17.6% (n=1310) were early-onset, who had slightly more spontaneous hemorrhagic stroke (50.8%) than ischemic stroke (49.2%). The most common etiologic subtypes of hemorrhagic stroke were hypertensive intracerebral hemorrhage (ICH), subarachnoid hemorrhage and undetermined ICH. The most common subtypes of infarction were large artery atherosclerosis, other determined diseases (52.5% arterial dissection) and embolic stroke of undetermined source. Smoking, alcohol overdrink, obesity, ischemic heart disease and family history of stroke were more in the early-onset than the elderly patients. The early-onset patients with familial stroke (n=87, 6.6%) were more males and more commonly had infarction than those without familial stroke. Monogenic diseases accounted for 5.7% of young familial stroke. At 1-year follow-up, the early-onset patients with infarction displayed greater functional improvements but more stroke recurrence than those with ICH. Conclusions Hypertensive hemorrhagic stroke and large artery atherosclerosis or dissection occlusion are characteristically common etiologies of young stroke in Taiwan. Early-onset infarction had higher recurrence yet better 1-year outcomes than early-onset ICH. Patients with familial versus non-familial aggregation had more ischemic infarction and monogenic diseases.

Letter to editor: Uncommon presentation of intracerebral hemorrhage in a young male

“…Stroke incidence in young adults has been rising worldwide possibly due to an increasing incidence of risk factors. In 2019 was proved that hemorrhagic stroke was slightly more common than ischemic stroke in young patients, evaluating stroke in young adults (16-55 years of age) in Taiwan, 3 which has similar results than SIREN study in Stroke Among Young West Africans. 4 In other studies the incidence of ICH in people aged 35 years has been estimated to be 0.3/100 000.…”

“…1 The incidence of intracerebral hemorrhage increased strongly with age, with persons aged 85 years and over having an almost ten-fold increase in yearly risk of intracerebral hemorrhage compared to persons aged 45 to 54 years. 2 Nevertheless, stroke incidence in young adults has been rising worldwide possibly due to an increasing incidence of risk factors, 3 and slightly higher prevalence of hemorrhagic strokes has been reported in young patients. 3,4 Hemorrhagic strokes have a wide spectrum of clinical manifestations, though acute onset headache, vomiting and severe increases in blood pressure are the most prevalent signs and symptoms, that lead to localized neurological signs, developing in a few minutes.…”

“…2 Nevertheless, stroke incidence in young adults has been rising worldwide possibly due to an increasing incidence of risk factors, 3 and slightly higher prevalence of hemorrhagic strokes has been reported in young patients. 3,4 Hemorrhagic strokes have a wide spectrum of clinical manifestations, though acute onset headache, vomiting and severe increases in blood pressure are the most prevalent signs and symptoms, that lead to localized neurological signs, developing in a few minutes. 5 Usually hemorrhagic strokes are accompanied by loose of consciousness and occasionally epileptic seizures.…”