Chlamydia pneumoniae infection in young stroke patients: a case–control study

Retrospective and cross-sectional studies have suggested that both bacterial and viral infections may be risk factors for atherosclerosis, ischemic stroke and acute coronary events. The correlation between Chlamydia pneumoniae and atherosclerosis remains a source of controversy. Our case-control study is aimed at evaluating the frequency of C. pneumoniae infection in a cohort of young adults with recent cerebrovascular disease and in particular etiologic stroke subtypes. Chlamydia pneumoniae IgG, IgM and IgA antibodies were evaluated by microimmunofluorescence method and antibody titers to both recombinant antigens chlamydial outer protein 2 and 60-kDa chlamydial heat shock protein (HSP60) by ELISA. The two groups differed with regard to the prevalence of C. pneumoniae IgA (P < 0.001) and IgG (P < 0.0001), as well as the titer of anti-R-HSP60 IgG (P < 0.001). We found an increase in IgA titers, suggestive of persistent, chronic active infection, in 16 patients in whom the etiology of the cerebral ischemic event was large-vessel atherothrombosis. Persistent, active C. pneumoniae infection may be an additional risk factor for ischemic stroke mainly of atherotrombotic origin in young subjects. However, a large-scale prospective confirmation of our findings is required.     

Association between seropositivity to Chlamydia pneumoniae and acute ischaemic stroke

Recent studies suggest an association between Chlamydia pneumoniae infection with atherosclerosis, including cerebrovascular disease. We investigated the prevalence of Chlamydial seropositivity in patients with acute ischaemic stroke syndrome compared with age- and sex-matched control subjects. Specific antibodies (IgA) to C. pneumoniae were measured by microimmunofluorescence in both the clinical group (n=91) and the control group (n=112). Forty patients (43.9%) and 34 controls (30.3%) had positive IgA titres (P < 0.05). The pooled data from this and previous series yielded 45% of seropositivity in cerebrovascular patients vs. 19% in control subjects (P < 0.001). In conclusion, we suggest an association between chronic infection by C. pneumoniae and acute ischaemic stroke.     

Evidence of an association between Chlamydia pneumoniae and cerebrovascular accidents

The authors report results of a retrospective pilot study showing a strong association between patients with stroke/TIA and the presence of circulating IgG and IgA antibodies to Chlamydia pneumoniae. These results support the hypothesis that chronic active or persistent infection may play a role in the mechanism of thrombosis. The risk for stroke associated with Chlamydial circulating antibodies appeared to be independent of other risk factors such as diabetes and hypercholesterolemia.     

缺血性脑卒中患者的IL-18表达水平及其基因105A/C多态性与肺炎衣原体感染的相关性研究

目的探讨缺血性脑卒中患者体内IL-18表达水平的变化及其基因105A/C多态性与缺血性脑卒中疾病的相关性。方法选择55例缺血性脑卒中患者为实验组,55例健康体检人群为对照组,收集全血标本后用ELISA检测试剂盒分别测定标本的血浆中Cpn IgA、Cpn IgG抗体水平及IL-18表达水平。应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)技术对IL-18基因105位点进行基因分型。结果 AIS组Cpn IgA阳性率明显高于健康对照组(χ~2=18.18,P0.05),而Cpn IgG阳性率二者无显著性差异。AIS组的IL-18表达水平明显高于健康对照组,且Cpn IgA阳性的AIS患者的IL-18表达水平高于Cpn IgA阴性患者,但其基因105A/C基因多态性比较无统计学意义。结论缺血性脑卒中的发生、发展与肺炎衣原体慢性感染和IL-18水平有关,和IL-18的105A/C基因多态性无明显相关,但具体作用机制还有待进一步研究。     

Cocaine use and cerebrovascular disease: two cases of ischemic stroke in young adults

We report two cases of ischemic stroke in young adult cocaine abusers occurring shortly after drug use. We review the literature and discuss the possible pathogenetic mechanisms.

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Sommario Gli Autori riferiscono di due casi di ictus cerebrale ischemico in soggetti dediti alla cocaina, nei quali l'evento cerebrovascolare è seguito poco tempo dopo l'assunzione della droga. è rivista la letteratura e sono discussi i possibili meccanismi patogenetici.

     

Relevance of the genetic polymorphism of NOD1 in Chlamydia pneumoniae seropositive stroke patients

Background and purpose:  Chronic infections with certain pathogens, such as Chlamydia pneumoniae , and genetic parameters that influence inflammatory reactions have been suggested to contribute to ischaemic stroke. NOD1 is a potent cytosolic receptor for C. pneumoniae. The aim of this study was to investigate the genetic polymorphism of NOD1 from the aspect of the development of stroke.
Materials and methods:  A total of 280 patients with ischaemic stroke were enrolled in the study; 150 healthy blood donors served as controls. The G796A (E266K) NOD1 polymorphism was determined by restriction fragment length polymorphism. Chlamydia pneumoniae seropositivity was tested by ELISA.
Results:  There was a significant difference in NOD1 G796A genotype distribution between the controls and the stroke patients with C. pneumoniae seropositivity. The AA homozygote and GA heterozygote mutant variants were detected in 16% (25 of 152) and in 50% (77 of 152) of the C. pneumoniae- positive stroke patients, as compared with 8% (6 of 84), and 28% (24 of 84), respectively, in the C. pneumoniae- positive healthy controls. (OR = 2.559; 95% CI = 1.105–6.517, P  = 0.04 and OR = 2.567; 95% CI = 1.451–4.540 P  < 0.001, respectively). The stroke patients with the large vessel pathology exhibited the highest frequency of the mutant allele A (51%). In contrast, amongst the C. pneumoniae- negative subjects, no difference in genotype frequency was observed between the stroke patients and the controls.
Conclusion:  Polymorphism in NOD1 G796A alone did not prove to be a risk factor for stroke in general, but in association with C. pneumoniae infection it appeared to be accompanied by an increased risk of the development of stroke.     

急性缺血性脑血管病患者肺炎衣原体感染与血清C反应蛋白的关系

目的:探讨肺炎衣原体感染在急性缺血性脑血管病炎症反应中的作用。方法:检测30例急性缺血性脑血管病患者和30例正常对照者血清中肺炎衣原体特异性抗体IgG和IgM,以及血清C反应蛋白水平。结果:缺血性脑血管病患者血清C反应蛋白水平高于对照者(P<0.01)。血清肺炎衣原体IgG抗体阳性脑血管病患者血清C反应蛋白水平(0.57±0.56mg/dl)高于IgG抗体阴性脑血管病患者(0.42±0.21mg/dl)(P>0.05)。血清肺炎衣原体IgM抗体阳性脑血管病患者血清C反应蛋白水平(0.67±0.73mg/dl)高于IgM抗体阴性脑血管病患者(0.47±0.35mg/dl)(P>0.05)。结论:肺炎衣原体急性和慢性感染均参与急性缺血性脑血管病的炎症反应过程,并与其它卒中因素共同引起血清C反应蛋白水平升高。     

青年缺血性脑卒中患者脑血管病变的特点

目的 应用数字减影血管造影（DSA）了解青年缺血性脑卒中脑血管病变的特点。方法 选择连续行主动脉弓＋全脑血管造影检查的青年（年龄15～44岁）缺血性脑卒中患者136例，并分成15～30岁、31～44岁2组，分析血管病变的类型、数目和部位。结果 136例患者中有68．4％异常，38．8％患者存在2支或2支以上的血管病变，且在30～44岁组中常见（2组比较P＜0．05）；61．2%患者为单支血管病变，后者主要分布在颅内血管，但2组无差异（P＞0．05）；血管病变的部位依次为颈内动脉颅外段、大脑中动脉、椎动脉、颈内动脉颅内段、大脑前动脉等。同时发现MoyaMoya病8例，动脉夹层5例，动脉发育不良4例。结论 青年人缺血性脑卒中的血管病变异常率高，颅内、颅外段大血管狭窄均较常见，动脉夹层和变异也是缺血性脑卒中的原因之一。     

Stroke phenotype in cannabis users among young adults with ischemic stroke

Background and purpose

Incidence of ischemic stroke in young adults has been steadily increasing over the past 20 years. One hypothesis to explain this phenomenon is the increase in the use of illicit drugs, including cannabis. However, the mechanisms and the clinical presentation of ischemic stroke associated with cannabis use are unclear. The objective of this study was to describe the phenotype of ischemic stroke in cannabis users compared to nonusers among a population of young adults with a first-ever ischemic stroke.

Methods

Patients aged 18–54 years consecutively hospitalized in a university department of neurology for a first-ever ischemic stroke from January 2017 to July 2021 were included. Drug use over the past year was assessed by a semistructured interview, and the stroke phenotype was described using the ASCOD classification.

Results

A total of 691 patients, including 78 of 691 (11.3%) cannabis users, were included. Cannabis use was independently associated with potential A1 (odds ratio [OR] = 3.30, 95% confidence interval [CI] = 1.45–7.5, p = 0.004) and uncertain A2 (OR = 13.1, 95% CI = 2.89–59.4, p < 0.001) atherosclerotic cause of stroke after adjustment for vascular risk factors including tobacco and other drug use. Moreover, the association of atherosclerosis and cannabis use was significant for frequent (OR = 3.13, 95% CI = 1.07–8.6, p = 0.030) and daily cannabis use (OR = 4.43, 95% CI = 1.40–13.4, p = 0.008), but not for occasional use.

Conclusions

We found a significant, independent, and graded association of cannabis use with the atherosclerotic stroke phenotype.     

Long-term prognosis of ischemic stroke in young adults

Abstract Background There have been few studies of the long-term prognosis of young adults with ischemic stroke. The present study aimed to evaluate the long-term clinical outcome in a large series of young adults with ischemic stroke admitted to a tertiary medical center over the last 27 years, and to identify possible predictors for mortality, stroke recurrence and poor functional recovery. Methods We retrospectively reviewed 272 young adults (15–45 years) with a first-ever ischemic stroke admitted to the Neurology Department of University Hospital 12 de Octubre between 1974 and 2001. Follow-up assessments were performed by review of medical records and telephone interviews. Results Nine patients (3 %) died as the result of their initial stroke and follow-up information about the status of 23 (8%) patients was not available. The remaining 240 patients (89%) were followed. Two hundred and ten of them (88%) were alive with a mean follow-up of 12.3 years and 30 (12%) died during follow-up. The average annual mortality rate was 1.4%, being notably higher during the first (4.9%) than in the subsequent years (0.9 %) after the initial stroke. Ninety per cent of the followed patients were independent and 53% returned to work, although adjustments were necessary for 23% of them. The annual stroke recurrence rate during the first year was 3.6% dropping to 1.7 % in subsequent years. Age over 35 years, male gender, the presence of cardiovascular risk factors and large-artery atherosclerosis in the carotid territory were predictors of negative long-term outcome after the initial stroke. Conclusions The long-term prognosis for the ischemic stroke in the young is better than in the elderly, but the risk of mortality in young adults with ischemic stroke is much higher than in the general population of the same age. A bad prognosis is associated with an atherosclerotic risk profile, with a higher mortality and recurrent stroke rates and poorer functional recovery. The main functional limitation in the young survivors of their initial ischemic stroke occurs in work activity, since most patients are independent but almost half of them do not return to work.     

Incidence and etiology of ischemic stroke in Persian young adults

BACKGROUND: Stroke in young adults causes morbidity in this socioeconomically active age group. The etiologic frequency of ischemic stroke in young adults differs around the world. METHODS: The study population consisted of 314,000 'young adult' residents in Southern Khorasan province in Iran. All patients with stroke are routinely admitted to the Valie Asr tertiary care hospital. Data on patients demographics, clinical presentation and investigations of consecutive patients aged 15-45 years with ischemic stroke are registered in Southern Khorasan stroke data bank for the period March 2000 to March 2005. All patients underwent a standard battery of diagnostic investigations by a stroke neurologist. The etiologic classification of stroke in the patients was made based on the trial of ORG 10172 in acute stroke treatment (TOAST) criteria. RESULTS: One hundred and twenty-four patients (60 female, 64 male) were prospectively investigated during a 5-year period. The incidence of ischemic stroke in young adults was eight cases per 100,000 people per year. Cardioembolic mechanism comprised 54% of stroke etiology in young adults. Rheumatic valvular disease was present in 32% of the patients and caused 2.5 preventable stroke cases per 100,000 'young adults' per year. CONCLUSION: Rheumatic valvular disease is the most common cause and a preventable etiology of stroke in Persian young adults.     

Antithrombin, protein C and protein S levels in 127 consecutive young adults with ischemic stroke

Objectives - The aim of our study was to evaluate the prevalence of antithrombin, protein C and protein S deficiencies in consecutive ischemic stroke patients under 45. Material and methods - We studied 127 consecutive patients with a mean age of 34.4 years admitted for an ischemic stroke, over a 2-year period, after exclusion of those with arterial dissection. Antithrombin, protein C and protein S levels were measured in all patients at the acute stage of the ischemic stroke and measurements were repeated in case of abnormality. Results - We found abnormal levels in 9 patients. Seven had an acquired cause of deficiency (pregnancy, oestrogen, acute inflammation). Two had no obvious acquired cause of deficiency but further controls were normal. Conclusions - Hereditary deficiencies of coagulation inhibitors are rare in ischemic stroke patients under 45 and their systematic detection seems to be of poor interest.     

青年缺血性脑卒中患者病因及相关危险因素分析

目的探讨青年缺血性卒中患者病因及危险因素。方法收集71例青年缺血卒中患者及80例中老年缺血性卒中患者的临床资料,同时选取140例青年健康体检自然人群作为对照,进行病因及相关危险因素分析。结果青年缺血组TOAST病因分型按比例依次为大动脉粥样硬化型（LAA）40.8%、小动脉闭塞型（SAO）28.2%、不明原因型（UND）15.5%、其它原因型（OTH）9.9%、心源性栓塞型（CE）5.6%。与中老年缺血组比较,其UND型比例明显增高（P〈0.05）。青年缺血性脑卒中易患因素依次为吸烟、高脂血症、高血压病、糖尿病、心脏病。与中老年缺血性组相比,青年缺血组中男性患者比例显著增高（P〈0.05）。结论青年缺血性卒中以LAA型最常见;其发病为多因素共同作用结果。     

青年缺血性脑卒中TOAST分型的临床意义

目的采用TOAST分型法研究青年缺血性脑卒中的特征。方法收集64例15～45岁急性缺血性脑卒中患者,并经头部CT或MRI证实;所有患者均行胸部X线、心电图、血常规、血糖、血脂、凝血功能及血管炎方面的检查,多数患者做了血管方面的检查;脑卒中依据TOAST标准分型。结果青年缺血性脑卒中男性患者所占比例较女性患者明显增高,脑卒中亚型;大动脉粥样硬化性脑卒中占21.9%,小动物闭塞脑卒中占32.8%,心源性脑栓塞占18.8%,其他原因引发的缺血性脑卒中占15.6%,原因不明的缺血性脑卒中占10.9%。15～35岁患者心源性脑栓塞和其他原因引发的缺血性脑卒中占相对高的比例;35岁以上患者大动脉粥样硬化性脑卒中及小动脉闭塞性脑卒中占相对高的比例。吸烟、酗酒的男性患者比例较女性患者显著增高,女性患者高血压病的比例较男性患者增多。结论根据TOAST分型及危险因素的研究结果,对不同年龄层次的青年缺血性脑卒中患者有不同的临床意义。     

Sexual dysfunction in stroke patients

Objectives – A marked decline in sexual activity has been reported in stroke patients. Little information, however, is available on clinical correlates of sexual dysfunction, changes in the sexual life of spouses of stroke patients, and abnormalities of nocturnal penile erections. Material and methods – In this prospective 6-month follow-up study, we assessed the impact of stroke on libido, sexual arousal, coital frequency and satisfaction with sexual life in 50 stroke patients (38 men, 12 women, aged 32 to 65 years) and in their spouses. We also measured nocturnal penile erections of the male patients using a strain gauge attached around the penis. Results – All the analyzed aspects of sexuality, i.e., libido, coital frequency, erection, ejaculation, vaginal lubrication, orgasm and satisfaction with sexual life, were commonly decreased as a consequence of stroke both in the patients and in their spouses. Fourteen (28%) patients at 2 months post-stroke and 6 (14%) patients at 6 months had ceased having sexual intercourse. Nocturnal erections at 2 months post-stroke were normal in 17 (45%) of the 38 male patients and impaired in 21 (55%) patients, but all of the patients had some nocturnal erections. Sexual dysfunction correlated significantly ( P <0.05) with the presence of the sensory hemisyndrome. Conclusions – Sexual dysfunction and dissatisfaction with sexual life seems to be common both in male and female stroke patients and in their spouses. Decreased libido, sexual arousal and satisfaction are related particularly to the presence of the hemisensory syndrome. The etiology for sexual dysfunction after stroke is multifactorial including both organic and psychosocial factors.     

青年缺血性卒中病因与危险因素的研究进展

传统认为，缺血性卒中（IS）在青年较少见。但是，随着人们生活习惯改变、节奏加快以及影像检查技术的进步，IS发病的年轻化趋势日益明显。青年IS患者与老年人相比，病因和危险因素有相似之处，但较老年人更加多样化。对于青年IS，只有识别其病因与危险因素，才能有效预防与治疗。     

A diagnostic approach to ischemic stroke in young and middle-aged adults

We prospectively studied 160 patients (18–47 years of age) with TIA (18) or ischemic stroke (142). Eighty-five subjects were under the age of 40. All patients underwent noninvasive ultrasound studies (transcranial doppler and echocardiography), plus a battery of laboratory studies including coagulation and antibodies tests and blood lactate-pyruvate. Angiographic studies were performed in 42% of patients (33% with DSA and 9% with MRA). The most common etiologies were found to be cardioembolic (more common in the 18–39 age group) and atherothromboticic (more common in the 40–47 age group). Autoimmune conditions affected 12.5% of patients, while arterial dissections affected 11%. In 10% of patients the etiology of the cerebral ischemic event could not be determined, in spite of an extensive and expensive workout Hence, a set of guidelines aimed at optimizing, in terms of cost-benefit, a protocol of investigations in young adults with ischemic stroke is tentatively proposed.     

Previously unknown thyroid dysfunction in patients with acute ischemic stroke

Bengtsson D, Brudin L, Wanby P, Carlsson M. Previously unknown thyroid dysfunction in patients with acute ischemic stroke.
Acta Neurol Scand: 2012: 126: 98–102
© 2011 John Wiley & Sons A/S. Objectives – Opinions differ regarding the clinical significance of subclinical thyroid disorders. The aim of the present study was to evaluate the prevalence and influence of previously unknown overt or subclinical thyroid dysfunction in patients with acute ischemic stroke and to look for differences between cardio‐embolic and non‐embolic ischemic stroke. Material and methods – A total of 153 Swedish patients diagnosed with first‐time acute ischemic stroke were included in the study and categorized for suspected cardio‐embolic (n = 30) or non‐embolic (n = 123) ischemic stroke depending on the presence of atrial fibrillation (AF). Blood samples were taken 48 h or earlier after onset of stroke symptoms. Results – Previously, unknown overt or subclinical thyroid dysfunction was found in 12%. Previously, unknown overt or subclinical hyperthyroidism was more common in the AF group (13%) compared to the non‐AF group (3%), P = 0.048. Patients with AF had slightly higher concentrations of free T4 (15 vs 14 pm ; P < 0.001), but there was no significant difference in concentrations of S‐TSH or prevalence of thyroperoxidase (TPO) antibodies between the groups. Conclusions – In patients with first‐time acute ischemic stroke, unknown thyroid dysfunction is common, and unknown overt or subclinical hyperthyroidism is associated with cardio‐embolic stroke.