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[Cerebral arterial ischemic complications in young adults. Etiology and prognosis]
L Milandre1, M Ceccaldi, A Ali Chérif
1Clinique Neurologique; CHU Timone, Marseille.
Insights
This study on young adults with cerebral ischemic attack found common causes like atherosclerosis and cardiopathy, but also uncommon ones such as oral contraceptives and arteriopathies. Recurrent stroke risk was low, with most patients maintaining daily living autonomy.
Area of Science:
- Neurology
- Vascular Medicine
- Epidemiology
Context:
- Cerebral ischemic attacks in young adults (16-45 years) present diagnostic challenges.
- Exclusion of venous thrombosis is critical in evaluating ischemic stroke.
- Understanding diverse etiologies is essential for appropriate patient management.
Purpose:
- To investigate the causes and outcomes of cerebral ischemic attacks in a young adult population.
- To identify common and uncommon etiological factors contributing to stroke in this demographic.
- To assess the long-term prognosis, including recurrence rates and functional recovery.
Summary:
- 100 patients (55 males, 45 females) with cerebral ischemic attack were studied. Common causes included premature atherosclerosis (26%), cardiopathy (20%), and lacunar stroke (3%). Uncommon etiologies comprised nonatherosclerotic arteriopathies (10%), oral contraceptives (14%), migraine (2%), and hematological disorders (10%). Etiology remained undetermined in 13% of cases.
- Four patients experienced acute mortality. Follow-up in 93 survivors (mean 26 months) revealed 4 deaths and 6 recurrent strokes (3% annual recurrence rate).
- Functional outcomes showed 64% with complete autonomy, 13% with mild disability, and 23% with severe handicap.
Impact:
- Highlights the importance of considering diverse etiologies beyond traditional risk factors in young stroke patients.
- Provides crucial data on recurrence rates and long-term functional outcomes in this population.
- Informs clinical practice regarding the workup and management strategies for young adults experiencing ischemic stroke.
Abstract:
The authors investigated 100 patients (55 males and 45 females) aged 16 to 45 years who experienced cerebral ischemic attack, excluding venous thrombosis. Transient ischemic attacks accounted for 12% only. Attacks were related to usual causes of brain ischemia in 49 cases (premature atherosclerosis in 26, cardiopathy in 20 and lacunar stroke in 3). Thirty-eight events were attributed to most uncommon etiologies. Nonatherosclerotic arteriopathies (10 cases) such as spontaneous dissection, dysplasia or megadolichoarteries were easily diagnosed by angiography. Oral contraceptives (14 cases) and migraine (2 cases) were diagnosis of exclusion. Hematological disorders were a possible cause in 10 patients. Etiology remained undetermined in 13 cases. Four patients died acutely. Follow-up data were obtained in 93 survivors with a mean duration of 26 months (range, 6 to 60 months). Four subjects died during follow-up and 6 experienced recurrent stroke (annual recurrence rate: 3%). In activities of daily living, 64% of patients had complete autonomy while 13% had mild residual disability and 23% had severe handicap.