Review of long-term mortality and vascular morbidity amongst young adults with cerebral infarction

The incidence of cerebral infarction amongst patients <45 years ranges from 3.4 to 11.3 per 100 000. Aetiology of cerebral infarction is more heterogeneous amongst young patients than amongst older patients including frequent dissection of neck vessels. Because of longer expected survival, prognosis is of special importance amongst younger patients. Average annual long-term mortality rate after the first year of cerebral infarction ranges from 0.6% to 1.8% and is about 10 times higher than amongst matched controls. Long-term mortality is associated with cardiac embolism and atherosclerosis, whilst dissection of neck vessels is associated with low long-term mortality. Average annual long-term recurrence rate of cerebral infarction ranges from 0.3% to 1.7% after the first year. Recurrence of cerebral infarction and other vascular events is highly associated with traditional risk factors including smoking, diabetes mellitus and symptomatic atherosclerosis. Dissection of neck vessel is associated with low long-term mortality rate and low recurrence rate of cerebral infarction. Tailoring secondary preventive treatment according to aetiology and risk factors suggests better prognosis.     

Etiology of and risk factors for cerebral infarction in young adults in western Norway: a population-based case-control study

We sought to study the etiology of and risk factors for cerebral infarction in young adults in Hordaland County, Norway. All patients aged 15-49 years living in Hordaland County with a first-ever cerebral infarction during 1988-97 were included. Etiology was analyzed in subgroups defined by sex, age (<40 years versus >/=40 years), circulation territory (anterior versus posterior circulation) and short-term functional outcome [modified Rankin score (mRS) 2]. A questionnaire was used to evaluate possible risk factors amongst the patients compared with an age- and sex-matched control group. The distribution of etiology was significantly different in all subgroups. Atherosclerosis was frequent amongst men (22.8% vs. 4.2%) and patients >/= 40 years (20.8% vs. 2.7%). All patients with microangiopathy had favorable short-term outcome. Significant risk factors were smoking more than 15 cigarettes per day (P < 0.001), hypertension (P = 0.001), and myocardial infarction (P = 0.035). Modifiable risk factors were frequent.     

青年脑梗死患者远期认知功能障碍的相关因素分析

目的筛选青年脑梗死患者远期认知功能障碍的相关因素。方法选择2008年1月至2013年6月在我院就诊的青年脑梗死患者58例,根据远期随访蒙特利尔认知量表(Mo CA)评分分为认知功能正常组和认知功能障碍组,比较两组患者的人口学、病情资料和活动功能,从中筛选出青年脑梗死患者远期认知功能障碍的危险因素。结果共有42例患者完成随访,平均随访时间为5.5年(3.3~7.1年),总体Mo CA评分(27.4±3.7)分。认知功能正常组18例,认知功能损害组24例,两组在性别、教育程度、TOAST分型、伴随疾病及嗜好、是否接受溶栓治疗进行组间比较,差异无统计学意义(P0.05)。认知功能障碍组的发病时年龄、美国国立卫生研究院卒中量表(NIHSS)评分大于认知功能正常组;左前循环梗死、出院时Rankin修订量表评分(mRS)2、复诊时工具性日常生活活动能力量表(IADL)8比例均高于认知功能正常组(P0.05)。经多因素Logistic回归分析得出,入院时NIHSS评分、左前循环梗死、出院时mRS2、复诊时IADL8均为认知功能障碍的独立危险因素(OR=1.039,4.329,5.143,12.800,21.333;P0.05)。结论入院时NIHSS评分左前循环梗死、出院时mRS2、复诊时IADL8是青年脑梗死患者远期认知功能障碍的危险因素;而认知功能与入院时NIHSS评分呈负相关。     

Long-term outcome of cerebral infarction in young adults

OBJECTIVES: We analysed the long-term outcome of 232 young adults aged 15-49 years with first-ever cerebral infarction in 1988-1997 in western Norway. MATERIAL AND METHODS: Mortality, recurrence, epilepsy, functional state as evaluated by modified Rankin scale (mRS), and employment were analysed at follow-up (mean time 5.7 years). RESULTS: Twenty-three (9.9%) patients had died. Recurrence occurred in 9.9%, and post-stroke seizures developed in 10.5%. Recurrence was associated with diabetes mellitus (P = 0.005). Favourable functional outcome (mRS = 2) was found in 77.9%. The functional outcome was better in posterior than anterior circulation infarctions (P = 0.011). Unfavourable functional outcome (mRS > 2) was associated with diabetes mellitus (P = 0.001) and severity of neurological deficits on admission for the index stroke (P < 0.001). Only 58.3% were employed at follow-up. CONCLUSION: This population-based study shows that, although the majority had favourable functional outcome, cerebral infarction had major long-term impact on young adults as evaluated by mortality, recurrence and employment status.     

青年隐源性脑梗死的临床特点

目的 对临床诊断为隐源性脑梗死的29例年龄在45岁以下的患者进行临床特点分析.方法 回顾性分析29例青年隐源性脑卒中患者的临床特点,包括性别组成,首发症状,影像学所见,治疗后转归及并发症,并进行为期3 a随访.结果 青年隐源性脑卒中多以单个病灶为主,累及基底节和皮层多见; 1 a复发1例(3.4%),2 a复发3例(1...     

Fatigue at long-term follow-up in young adults with cerebral infarction

BACKGROUND: To study the impact of fatigue in young ischaemic stroke patients. METHODS: The Fatigue Severity Scale score was obtained in 192 patients (mean time 6.0 years after the stroke) and 212 controls. RESULTS: Fatigue was associated with cerebral infarction in a multivariate analysis of patients and controls (p = 0.002). Fatigue was independently associated with unfavourable functional outcome (p = 0.001), depression (p < 0.001), and basilar artery infarction through interaction with the modified Rankin Scale score (p = 0.047) in patients. CONCLUSION: Fatigue is frequent in young adults with cerebral infarction. Stroke-related factors independently associated with fatigue include functional outcome. Stroke location may influence fatigue.     

Social outcomes of young adults with cerebral palsy

Abstract

Background Functional abilities and social outcomes of young adults with cerebral palsy (CP) are relatively underresearched. Improvements in paediatric care have extended the expectation of achieving adulthood to 90%.

Method Young adults aged 20–30 years with CP (n = 335) were compared to a population-based control group (n = 2,152) of the same age. Motor function, self-care abilities, educational level, and social outcomes were determined by questionnaire.

Results Half the study group walked independently, but only 35.5% were independent in self-care. In comparison to their peers without disability, the study group's highest educational level was lower (p < .0001), as were rates of employment (36.3% compared with 80%), they were more likely to be living with parents (80% compared with 21%), to be single, and to have limited financial resources.

Conclusion Young adults with CP are functionally and socially disadvantaged in contrast with their peers without disability. Self-care dependence, intellectual disability, and communication impairments contribute to these outcomes but are not solely responsible.     

Recurrence after first cerebral infarction in young adults

OBJECTIVE: We have investigated recurrence of stroke in a consecutive series of young adults, aged 16 to 45 years, after a first cerebral infarction. METHODS: From January 1, 1988 to December 31, 1996 we submitted those patients to a diagnostic protocol including angiographic, cardiological, and haematological investigations. The patients were followed at 6 month intervals up to December 31, 1998. RESULTS: We have evaluated and followed-up 135 patients, 71 men and 64 women, who were 3.99% of all the admitted stroke patients. At 12 months after stroke, 83 patients had returned to work, 40 patients were mildly to moderately handicapped, 4 were using a wheel-chair, and 8 had died. Follow-up was 26 to 123 months (mean 68.8). Recurrence of stroke, always of ischaemic nature, was seen in 15 patients (11.1%), 3 to 76 months after the first stroke (mean 27.4), for an annual incidence of 2.26%. Recurrence was significantly associated with Partial Anterior Circulation Syndrome and Haematological subtype of first stroke (respectively, P = 0.0209 and P = 0.0135, chi2 test), but not with age (< or = or > 35 years) or risk factors. Repetition of stroke was never fatal, but it caused heavy disability in 13 patients, 8 of whom had completely or nearly completely recovered after the first event. CONCLUSIONS: Our data suggest that recurrence of stroke is a major clinical problem also for the patients aged less than 45 years and that it might be more frequent with specific clinical syndromes and etiologic subtypes of first stroke.     

左心室舒张功能减低是青年高血压病患者罹患脑梗死的独立预测因素——一项回顾性调查研究

目的探讨左心室舒张功能减低与青年高血压病患者急性脑梗死的相关性。方法收集2014年10月~2018年2月宝鸡市第二中医医院神经内科收治的青年急性脑梗死同时患有高血压病的患者92例(观察组),同时选取同期患有高血压病的青年体检患者98例(对照组)。对两组患者都进行心脏彩色多普勒检查,观察患者的左心室舒张功能,并分析左心室舒张功能减低与急性脑梗死的关系。结果 190例青年高血压病患者中,左心室舒张功能正常者18例,占9. 47%,左心室舒张功能减低者172例,占90. 53%,其中127例为左心室舒张功能减低1级,占66. 84%(127/190),55例为左心室舒张功能2级,占28. 95%(55/190),8例为左心室舒张功能3级,占4. 21%(8/190)。观察组患者IVRT、Ea/Aa及A’值分别为(114. 97±10. 16)、(0. 79±0. 11)和(5. 21±1. 03),对照组分别为(72. 86±8. 75)、(1. 3±0. 25)和(5. 02±0. 82),差异有统计学意义(P 0. 05)。观察组患者左心室舒张功能减低IVRT、Ea/Aa及A’值和急性脑梗死发生之间有相关关系(r=0. 53,r=0. 61,r=-0. 59)。结论青年左心室舒张功能减低与高血压病有关,左室舒张功能减低可能是青年高血压病患者罹患急性脑梗死的独立预测因素。     

Etiopathogenesis and prognosis of cerebral ischemia in young adults.

Etiology and long-term prognosis were prospectively investigated in 155 consecutive patients (96 men and 59 women), aged 16 to 45 years, referred to our Neurosurgical Unit with cerebral transient ischemic attacks or infarction during the period 1978-1988. All patients underwent neurological and medical-cardiological evaluation, cerebral computerized tomography scanning, electrocardiogram, and laboratory tests. Two-dimensional echocardiography was performed in 123 cases (79%), cerebral angiography in 147 (95%). Atherosclerosis was the leading etiology occurring in 48 patients (31%). A cardioembolic disorder was considered the probable cause of ischemia in 8 cases (5.1%). Further possible etiologies were contraceptive pill assumption (5.8% of the total, but 15.3% within the female group), spontaneous arterial dissection (4.5%), migraine (4%), puerperium (2.6%), cervical trauma (2.6%), and other, more uncommon conditions. Despite extensive evaluation, the cause of cerebral ischemia remained unknown in 40% of cases. All patients received antiplatelet medication and 16 underwent surgery. The long-term outcome at a mean follow-up of 5.8 years was favorable: 91% of subjects resumed their work on a full or part-time basis.     

中青年脑梗死120例临床分析

目的探讨中青年脑梗死的病因及临床特点。方法回顾120例中青年脑梗死的临床资料及影像学改变。结果120例病人中,痊愈39例,明显好转45例,恢复较差33例,死亡3例。结论高血压病和早发性动脉粥样硬化是导致中青年脑梗死的主要原因,临床上以颈内动脉系统腔隙性梗死常见,其临床预后并非均为良性过程,积极控制高血压病及健康的饮食习惯是降低中青年脑梗死的重要措施。     

61例青年脑梗死病因及危险因素的分析

目的 发现青年人脑梗死可能存在的不同病因及危险因素。方法 将61例15～40岁脑梗死患者按年龄分成两组(15～29岁一组。30～40岁一组)。再根据TOAST病因分类。将患者分成5组(ATR，CEMB。LAC，OTH，UND)。结果 61名脑梗死患者中。男39例．女22例。根据TOAST病因分类。ATR5例(8．2％)，LAC23例(37．7Vo)．CEMB10例(16．4％)．OTH17例(27．9％)。UND6例(9．8％)。结论 青年脑梗死发病原因有其特殊性，应引起临床注意。15～29岁组以其它原因所致脑梗死(OTH)和女性为主；LAC和ATR均多见于30～40岁组．且男性为多；两组心源性栓塞无明显差异。高血压、高血糖、高胆固醇血症、吸烟、饮酒作为引发青年人脑梗死的重要危险因素应积极预防和治疗。     

青中年脑梗死患者颈动脉超声的研究

目的探讨青中年脑梗死与颈动脉粥样硬化的关系。方法对78例青中年脑梗死患者及30名健康对照者作颈动脉超声检查。结果(1)脑梗死组42.3%患者颈动脉内膜-中层厚度增厚(>0.8mm)与健康对照组(仅2例7.4%)比较差异有显著性(P<0.05);(2)脑梗死组动脉硬化斑块检出率为52.94%(36/68),不稳定斑块(软斑和溃疡斑)的检出率为42.03%(29/69),明显高于健康对照组(未检出);(3)多为轻度颈动脉粥样硬化(斑块积分为0.42±0.71);(4)颈动脉管腔狭窄率明显增高,以轻、中度狭窄为主(7.79%)(6/77);(5)<40岁、40~45岁、>45岁斑块发生率分别为0、33.3%和61.8%,随年龄增长,逐渐增加。结论颈动脉粥样硬化与青中年脑梗死之间存在密切关系。     

伴有抑郁的脑梗死患者生存质量

目的：探讨急性期脑梗死患者抑郁心理对其特异性生存质量的影响。方法：急性期脑梗死患者142例,经Zung抑郁自评量表（SDS）评分后分为无抑郁组50例,轻度抑郁组36例和中度抑郁组56例。运用脑卒中影响量表（SIS）评定3组患者的生存质量。结果：在SIS的8个维度中,轻度抑郁组在体力,记忆/思维,情绪,日常活动能力,社会参与等维度的评分低于无抑郁组（P〈0.05）。中度抑郁组在体力,记忆/思维,日常活动能力,行动能力,社会参与等维度的评分低于轻度抑郁组（P〈0.05或P〈0.001）。中度抑郁组除手功能外的其他各维度评分明显低于无抑郁组（P〈0.05或P〈0.001）。结论：脑梗死患者抑郁程度与其生存质量密切相关,抑郁程度重者生存质量较差。     

Construction and validation of the fatigue impact and severity self-assessment for youth and young adults with cerebral palsy

Purpose: The Fatigue Impact and Severity Self-Assessment (FISSA) was created to assess the impact, severity, and self-management of fatigue for individuals with cerebral palsy (CP) aged 14–31 years. Methods: Items were generated from a review of measures and interviews with individuals with CP. Focus groups with health-care professionals were used for item reduction. A mailed survey was conducted (n=163/367) to assess the factor structure, known-groups validity, and test–retest reliability. Results: The final measure contained 31 items in two factors and discriminated between individuals expected to have different levels of fatigue. Individuals with more functional abilities reported less fatigue (p < 0.002) and those with higher pain reported higher fatigue (p < 0.001). The FISSA was shown to have adequate test–retest reliability, intraclass correlation coefficient (ICC)(3,1)=0.74 (95% confidence interval [CI] 0.53–0.87). Conclusions: The FISSA valid and reliable for individuals with CP. It allows for identification of the activities that may be compromised by fatigue to enhance collaborative goal setting and intervention planning.     

中青年脑梗死120例临床分析

目的探讨中青年脑梗死的病因及临床特点。方法回顾120例中青年脑梗死的临床资料及影像学改变。结果120例病人中，痊愈39例，明显好转45例，恢复较差33例，死亡3例．结论高血压病和早发性动脉粥样硬化是导致中青年脑梗死的三要原因，临床上以颈内动脉系统腔隙性梗死常见，其临床预后并非均为起性过程，积极控制高血压病及健康的饮食习惯是降低中青年脑梗死的重要措施。     

A follow-up study of platelet-rich plasma serotonin in clinical subtypes of cerebral infarction

Summary The serotonin concentration in the platelet-rich plasma of 32 patients with single and multiple stroke type cerebral infarction was investigated at various stages. Serotonin levels were decreased in the acute period. The incidence of serotonin abnormality was higher in multiple types than in the single type. Serotonin levels were significantly decreased in treated hypertensive patients compared with untreated patients. Serotonin levels, therefore, varied according to the type and stage of cerebral infarction.     

Birth factors and common mental health problems in young adults

Background Birth-related factors have been associated with adult chronic disease. Whilst the potential association between these factors and depression in adulthood was been described rather less is known about the role of these exposures in the development of anxiety. Method Cross-sectional population-based survey recruited adults aged 18–25 years. Participants were classified on the basis of responses to the Hospital Anxiety and Depression Scale. Birth-related exposures were determined by hospital medical record review. A proportional odds model was used to assess associations between birth factors and anxiety and depression. Results No significant associations were found between birth factors and anxiety. Significant associations were found between depression with low birth weight (odds ratio 2.88, 95% confidence interval 1.26–6.59) and neonatal admission to ITU (3.12, 1.25, 7.78). Conclusion Low birth weight and neonatal intensive care unit admission are significantly associated with depression in adults. Other birth related variables were not significantly associated with either depression or anxiety.     

Correlating cognitive impairment with carotid atherosclerosis and carotid artery stenosis in patients with acute cerebral infarction*★

BACKGROUND：Studies have demonstrated that carotid atherosclerosis and carotid artery stenosis are closely associated with cognitive impairment in patients with and without clinically evident cerebrovascular disease. OBJECTIVE： To investigate the correlation between the degree of pathological changes in carotid atherosclerosis, carotid artery stenosis, and cognitive impairment in patients with acute cerebral infarction through the use of color Doppler imaging. DESIGN, TIME AND SETTING： The present concurrent, non-randomized, controlled experiment was performed at the Departments of Neurology and Ultrasound, Affiliated Hospital of North Sichuan Medical College between November 2006 and August 2007. PARTICIPANTS： Fifty-five patients with cerebral infarction, consisting of 35 males and 20 females, aged 50–82 years, were admitted to the hospital between November 2006 and August 2007 and recruited for this study. An additional 30 subjects consisting of 18 males and 12 females, aged 47–78 years, that concurrently received a health examination at the same hospital, were also included as normal controls. METHODS： Intima-media thickness （IMT）, plaque shape, size, and echo intensity of all subjects were detected by color Doppler flow imaging. Assessment criteria： IMT 〉 1.0 mm was considered to be intimal thickening, and IMT 〉 1.2 mm was determined to be formed atherosclerotic plaques. In the position of the largest plaque, the degree of carotid artery stenosis was determined by the following formula： （1-cross-sectional area of residual vascular luminal area/vascular cross-sectional area） × 100%. Less than 30% exhibited mild stenosis, 30%-40% moderate stenosis, and 〉 50% severe stenosis. MAIN OUTCOME MEASURES： IMT and the degree of carotid artery stenosis were evaluated by color Doppler flow imaging. The Mini-Mental State Examination （MMSE）, as well as the clinical memory scale, was compared between patients with cerebral infarction and normal controls. RESULTS： In the cerebral infarc