Young cryptogenic ischemic stroke: A descriptive analysis of clinical and laboratory characteristics, outcomes and stroke recurrence

Divišová, Petra; Šaňák, Daniel; Král, Michal; Bártková, Andrea; Hutyra, Martin; Zapletalová, Jana; Dorňák, Tomáš; Špaček, Miroslav; Franc, David; Polidar, Petr; Veverka, Tomáš; Kaňovský, Petr

doi:10.1016/j.jstrokecerebrovasdis.2020.105046

Cited by 8 publications

(11 citation statements)

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“…The role of obesity in overall stroke risk has probably been underestimated, but there are some young stroke studies providing these data. 4,6,9,20,22 Most of the studies report quite low percentage of obese patients (8-22%), but surprisingly in our cohort it reached 35%. One explanation for this might again be the age-difference between studies.…”

Section: Discussioncontrasting

confidence: 55%

“…The severity of stroke has not been studied in many young stroke cohorts, but available data indicate that median NIHSS score on admission is uniquely three points 2,6,9,26 and was the same in our study. Interestingly, the stroke was significantly more severe among men which could be derived from the high-risk factor burden, higher prevalence of cardioembolic stroke and stroke due to largeartery atherosclerosis.…”

Section: Discussionsupporting

confidence: 54%

“…Previous young stroke studies have used different age cut-off and thus affect comparisons. The Swiss stroke study and the SIFAP1 study included patients up to 55 years of age, other studies have included patients up to 49–50 years of age 1,4–5,9,19–20 or up to 45 years of age. 6–7,21 In addition, most of the published cohorts have been evaluated 10 or more years ago, 1,4–7,21,22 some of them started recruitment already in the 1990s when the standards for diagnostic evaluation were somewhat different.…”

Section: Discussionmentioning

confidence: 99%

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Estonian young stroke registry: High burden of risk factors and high prevalence of cardioembolic and large-artery stroke

Vibo

Schneider

Kõrv

et al. 2021

European Stroke Journal

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Background and aims The aim of the present study was to assess the risk factor burden and stroke etiology of young stroke patients in Estonia and to compare the results with similar cohorts from other countries. Methods This study includes ischemic stroke patients aged 18–54 years from the prospective Estonian Young Stroke Registry between 2013 and 2020. All patients were managed in a stroke unit following a prespecified detailed protocol. Data on stroke risk factors, etiology, and stroke severity were analyzed. Results A total of 437 patients (mean age 44.7 ± 8.3 years; 62% males) were included in the registry during the 8-year study period. A total of 50.2% of patients had ≥ 3 well-documented risk factors (higher for men: odds ratio (OR) 3.8; 95% cardiac index confidence interval (CI) 1.8–8.3; p < .001) and 6.2% of patients had ≥ 3 less well-documented risk factors. While 42% of patients had undetermined cause of stroke (34% of them cryptogenic), the second most frequent etiologies were large-artery atherosclerosis and cardioembolism (both 19%). 60 percent of cardioembolic strokes were due to high-risk causes. Large-artery atherosclerosis was more prevalent in men (OR 1.8; 95% CI 1–3.3; p = .05) and among older patients (OR 6.2; 95% CI 1.8–21.4; p = .008). The median National Institutes of Health Stroke Scale score on admission was 3 (interquartile ranges 2–6), stroke was more severe in men ( p = .05). Conclusions Our study revealed that young patients with stroke in Estonia have higher burden of well-documented risk factors, higher prevalence of high-risk cardioembolic causes and higher prevalence of large-artery stroke compared to other young stroke cohorts.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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Estonian young stroke registry: High burden of risk factors and high prevalence of cardioembolic and large-artery stroke

Vibo

Schneider

Kõrv

et al. 2021

European Stroke Journal

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“…Socioeconomic status (SES) and different lifestyle parameters have impact on recovery after ischaemic stroke (IS) and on risk of recurrent ischaemic stroke (RIS) in elderly patients (1)(2)(3)(4)(5)(6)(7)(8)(9). Although most young patients achieve a good 3-month clinical outcome after IS (10)(11)(12)(13), different factors may have impact on better recovery; especially lower stroke severity and substantially less serious comorbidities (13)(14)(15)(16). Nevertheless, the impact of SES and lifestyle on stroke recovery in young patients remains unclear due to a lack of relevant research.…”

Section: Introductionmentioning

confidence: 99%

“…Specific lifestyle risk factors associated with IS were well identified in elderly patients previously (9,16,24), but in young patients, only limited data are available (13).…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic status and lifestyle in young ischaemic stroke patients: a possible relationship to stroke recovery and risk of recurrent event

Franc

Šaňák

Divišová

et al. 2021

Cent Eur J Public Health

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Objectives: Socioeconomic status (SES) and lifestyle have impact on recovery after ischaemic stroke (IS) and on risk of recurrent ischaemic stroke (RIS) in elderly patients. With regard to currently available limited data on young people, we aimed to assess SES and parameters of lifestyle and evaluate their relationship to stroke recovery and risk of RIS in young patients.Methods: We analysed consecutive young IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischaemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). Data were acquired from structured a self-evaluating multiple-choice questionnaire. Clinical outcome was assessed using the Modified Rankin Scale (MRS) after 3 months with score 0-1 for excellent outcome.Results: Data were obtained from 297 (163 males, mean age 39.6 ± 7.8 years) young patients. Patients with MRS 0-1 (237, 79.8%) did not differ in SES except university education (21.1 vs. 3.3%; p = 0.001), less smoked (16.5 vs. 58.3%; p < 0.001), more of them did regular sport activities (79.1 vs. 51.6%; p = 0.02) and passed regular preventive medical checks (45.6 vs. 24.2%; p = 0.01). Twelve (4%) patients suffered from RIS during a follow-up with median of 25 months. They did not differ in SES but had higher body mass index (31.6 vs. 26.7; p = 0.007), reported less regular sport activities (16.7 vs. 73.0%; p < 0.001) and less regular medical checks (8.3 vs. 40.0%; p = 0.001). Conclusion:In young patients, SES had no relationship to clinical outcome after IS and to risk of RIS except education level. Some parameters of health lifestyle were presented more in patients with excellent outcome and without RIS during the follow-up.

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A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke

Potter

Tannous

Vahidy

2022

Curr Atheroscler Rep

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Purpose of Review Recent data identifies increases in young ischemic and hemorrhagic strokes. We provide a contemporary overview of current literature on stroke among young patients or premature stroke along with directions for future investigation. Recent Findings Strokes in the young are highly heterogenous and often cryptogenic. Sex distribution and risk factors shift from women among the youngest age groups (< 35) to men over the age of 45, with a coinciding rise in traditional vascular risk factors. Incidence is higher in minority and socioeconomically disadvantaged populations, and the impact of stroke among these communities may be exaggerated by disparities in symptom recognition and access to care. Special diagnostic work-up may be needed, and a lower threshold for diagnosis is warranted as potential misdiagnosis is a concern and may preclude necessary triage and management. Summary Although “premature strokes” form a relatively small proportion of total incidence, they vary greatly across subgroups and present an outsized impact on quality of life and productivity.

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Young cryptogenic ischemic stroke: A descriptive analysis of clinical and laboratory characteristics, outcomes and stroke recurrence

Cited by 8 publications

References 50 publications

Estonian young stroke registry: High burden of risk factors and high prevalence of cardioembolic and large-artery stroke

Estonian young stroke registry: High burden of risk factors and high prevalence of cardioembolic and large-artery stroke

Socioeconomic status and lifestyle in young ischaemic stroke patients: a possible relationship to stroke recovery and risk of recurrent event

A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke

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