Stroke in young adults: epidemiology

Neurological Sciences - Stroke in the young is rather rare. The absolute proportion of juvenile stroke is strongly linked to the structure of the population. In western European countries, with a...     

Stroke in young adults

Strokes in young adults are uncommon and often a diagnostic challenge. A retrospective study of strokes due to intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction was undertaken. We reviewed the medical records of 113 young patients aged 15-45 years who were admitted to the Medical Center Hospital of Vermont with a diagnosis of stroke between 1982 and 1987. This group comprised 8.5% of patients of all ages admitted for stroke, 2.3 times the proportion observed in the National Survey of Stroke. Nontraumatic intracerebral hemorrhage was diagnosed in 46 young patients (41%); the main causes included aneurysms, arteriovenous malformations, hypertension, and tumors. Subarachnoid hemorrhage was found in 19 young patients (17%); the majority were due to aneurysms. The remaining 48 young patients (42%) had cerebral infarction, the majority due to cardiogenic emboli and premature atherosclerosis. Mitral valve prolapse, the use of oral contraceptives, alcohol drinking, and migraine were infrequent sole causes of cerebral infarction in the absence of other risk factors. The case-fatality rate for this group of young patients with stroke was 20.4% compared with 23.9% for the National Survey of Stroke. Young adults with stroke deserve an extensive but tailored evaluation, which should include angiography and echocardiography.     

Stroke in young adults and children

Data from studies of 337 children and 1606 young adults are summarized to identify the major causes of stroke in these age groups. In children under 15 years of age, stroke occurs in patients with congenital heart disease, nonatherosclerotic vasculopathies, infection, and hematologic defects like sickle cell disease. In patients 15 to 35 years of age, dissection, cardioembolism, nonatheroslerotic vasculopathies, and prothrombotic states cause a significant percentage of strokes. In adults over 35 years of age, traditional atherosclerotic risk factors predominate. Lifestyle choices (eg, cigarette smoking, alcohol consumption, and illicit drug use) can significantly increase the rate of stroke among young adults in a community. Limited access to healthcare may increase the role of infectious disease and peripartum complications.     

Stroke in young adults in Japan]

The details of stroke in young adults remain unknown in Japan. We performed a multicenter survey to establish a stroke data bank for young adults in Japan. We collected clinical data of 7,245 acute stroke patients admitted to 18 hospitals in Japan. In patients admitted within the first 7 days of stroke, patients aged = < 50, = < 45, and = < 40 accounted for 8.9%, 4.2%, and 2.2%, respectively. Hypertension, diabetes mellitus, hypercholesterolemia, and non-valvular atrial fibrillation were significantly more frequent in the non-young than in the young, but smoking habits and patent foramen ovale were more frequent in the young than in the non-young. Brain infarction was the most predominant stroke subtype in the non-young, but not so in the young (62.6% vs. 36.7%, p < 0.01). Brain hemorrhage (20.8% vs. 32.1%, p < 0.01) and subarachnoid hemorrhage (7.3% vs. 26.1%, p < 0.01) were more frequent in the young. Causes of brain infarction and hemorrhage were often atypical in the young (2.8% vs. 25.1%, p < 0.001 and 4.6% vs. 20.2%, p < 0.0001, respectively). Causes of stroke in the young was often atypical, such as cerebral arterial dissection, Moyamoya disease, antiphospholipid syndrome, arteriovenous malformation, et al. Because causes and underlying risk factors of stroke in young adults were quite different from those in older patients, we need to establish the data bank and to explore optimal measures of the diagnosis and management for young stroke patients.     

Stroke in young adults: the role of paradoxical embolism

Stroke in young adults may be devastating and frequently no cause can be found. However, there is ample literature to suggest an association between cryptogenic stroke in young people and paradoxical embolisation via a venous to arterial circulation shunt (v-aCS), commonly due to patent foramen ovale (PFO). Although paradoxical embolisation is assumed to be a rare event, this review suggests that it is an important or even dominant cause of stroke in young people and that a transcranial Doppler (TCD) technique may be the investigation of choice to identify v-aCS.     

Stroke in young adults who abuse amphetamines or cocaine: a population-based study of hospitalized patients

CONTEXT: The abuse of stimulant drugs is increasing in the western United States. Although numerous case reports and animal studies suggest a link with stroke, epidemiologic studies have yielded conflicting results. OBJECTIVE: To test the hypothesis that young adults who abuse amphetamines or cocaine are at a higher risk of stroke. Design, Setting, and PARTICIPANTS: Using a cross-sectional design and from a quality indicators' database of 3 148 165 discharges from Texas hospitals, we estimated the secular trends from January 1, 2000, to December 31, 2003, in the abuse of various drugs and of strokes. We developed separate logistic regression models of risk factors for hemorrhagic (n = 937) and ischemic (n = 998) stroke discharges of persons aged 18 to 44 years in 2003, and for mortality risk in patients with stroke. Main Outcome Measure Incidence of stroke using definitions from the Agency for Healthcare Research and Quality's stroke mortality Inpatient Quality Indicator. RESULTS: From 2000 to 2003, the rate of increase was greatest for abuse of amphetamines, followed by cannabis and cocaine. The rate of strokes also increased, particularly among amphetamine abusers. In 812 247 discharges in 2003, amphetamine abuse was associated with hemorrhagic stroke (adjusted odds ratio [OR], 4.95; 95% confidence interval [CI], 3.24-7.55), but not with ischemic stroke; cocaine abuse was associated with hemorrhagic (OR, 2.33; 95% CI, 1.74-3.11) and ischemic (OR, 2.03; 95% CI, 1.48-2.79) stroke. Amphetamine, but not cocaine, abuse was associated with a higher risk of death after hemorrhagic stroke (OR, 2.63; 95% CI, 1.07-6.50). CONCLUSION: Increases in stimulant drug abuse may increase the rate of hospital admissions for strokes and stroke-related mortality.     

Stroke in Saudi Arabian young adults: a study of 120 cases

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.     

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.     

Stroke in young people: imaging

Neurological Sciences - Stroke in young people is an unexpected event, whose causes are more heterogeneous than in the older population. Moreover, its diagnosis must exclude a large number of other...     

Stroke in young patients: etiopathogenesis and risk factors in different age classes

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.     

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。     

Stroke in young women

In women ages 15-45 years, an additional set of risk factors are important in the pathogenesis of ischemic stroke. Some of these pertain strictly to women, and relate to exogenous hormones and pregnancy. Various other conditions are more common in women, which include migraine with aura, selected vascular disorders and autoimmune conditions. These differences do have implications for management in both the primary and secondary prevention of stroke in this age group.     

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。     

Stroke burden in adults in Armenia

We investigated around 100 patients for one-year and then registered the information about the possible etiology of the stroke, type of disease, treatment, localization of the clot, age, as well as gender distribution of stroke patients' population. This general overview of risk factors, ways of treatment, diagnostics, care and monitoring of the stroke patients in Armenia might serve as a cornerstone work for further highlighting of new avenues for stroke treatment.