Clinical - imaging features of the institutional cohort of young patients with stroke
Keywords:stroke, younger adults, risk factors
Stroke in younger adults is a less common event in comparison to older ones, but there have been registered a negative trend and an earlier onset of stroke in the past decades. Stroke in younger adults represents an emerging public health issue that needs strengthening, prevention, early diagnosis, and management. The aim of the present research is to investigate the clinical features, risk factors and other diagnostic findings of the young population that developed stroke.
Materials and methods: A multidirectional analysis of patients from the “Diomid Gherman” Institute of Neurology and Neurosurgery, included patients aged 18-49 years with a confirmed clinical diagnosis of stroke during the 2019-2021 period. The clinical, paraclinical, and social profiles of the patients were analyzed applying descriptive statistics.
Results: Primary stroke counted for 67,6% of the analyzed group, most of them being ischemic in the middle cerebral artery. The risk factors were cardiac rhythm dysfunctions - 83 %, hypertension - 73,2 %, obesity - 19,6 %, and diabetes - 14%. It is notable that less than half of the patients took treatment for their risk factors. Clinical features are dominated by motor deficits – 69,6 %, speech disorders - 35,7 %, and less common manifestations included alteration of consciousness or seizures. Computer tomography was used in most of the patients (87,5 %) additionally completed by magnetic resonance in 36,7%, and doppler in 78,8 to fulfill diagnostic requirements. There is a wide range of comorbidities that included hematological disorders, cancers, infections, and valvular disorders that contributed to the development of stroke in younger adults.
Conclusion: While in most cases stroke at a younger age has similar characteristics to the classic one, there are some specific trends that should be assessed during the management of the young population. The prevention of risk factors is essential for all groups of stroke patients. Specific algorithms of diagnosis and treatment would help clinicians to enhance outcomes related to stroke in younger adults.
Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015 Feb 24; 11:157-64. doi: 10.2147/VHRM.S53203.
Boot E, Ekker MS, Putaala J, et al Ischaemic stroke in young adults: a global perspective. Journal of Neurology, Neurosurgery & Psychiatry 2020;91:411-417
Singhal AB, Biller J, Elkind MS, Fullerton HJ, Jauch EC, Kittner SJ, Levine DA, Levine SR. Recognition and management of stroke in young adults and adolescents. Neurology. 2013 Sep 17; 81(12):1089-97. doi: 10.1212/WNL.0b013e3182a4a451. Epub 2013 Aug 14. PMID: 23946297; PMCID: PMC3795593.)
George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995–2008. Ann Neurol 2011; 70:713–721
Carmine Marini, Tommasina Russo, Giorgio Felzani, “Incidence of Stroke in Young Adults: A Review”, Stroke Research and Treatment, vol. 2011, Article ID 535672, 5 pages, 2011. https://doi.org/10.4061/2011/535672.
Khan SU, et al. Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017. Mayo Clin Proc Innov Qual Outcomes. 2021 Apr 8;5(2):431-441. doi: 10.1016/j. mayocpiqo.2021.01.015. PMID: 33997639; PMCID: PMC8105541
Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke the Helsinki young stroke registry. Stroke. 2009;40(4):1195–1203
Agustiyaningsih, T., Nur Rohmah, A. I., & Azizah, L. (2022). Factors Affecting the Incidence of Stroke at a Young Age: A Philosophical Perspective. Cold Spring Harbor Laboratory. https://doi.org/10.1101/2022.07.14.22277618
Gillman MW. Primordial prevention of cardiovascular disease. Circulation. 2015 Feb 17;131(7):599-601. doi: 10.1161/CIRCULATIONAHA.115.014849. Epub 2015 Jan 20. PMID: 25605661; PMCID: PMC4349501.
Aigner, A., Grittner, U., Rolfs, A., Norrving, B., Siegerink, B., & Busch, M. A. (2017). Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults. In Stroke (Vol. 48, Issue 7, pp. 1744–1751). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/strokeaha.117.016599
Griffiths D, Sturm J. Epidemiology and etiology of young stroke. Stroke Res Treat. 2011; 2011:209370. doi: 10.4061/2011/209370. Epub 2011 Jul 18. PMID: 21789269; PMCID: PMC3140048.
Edlow JA, Selim MH. Atypical presentations of acute cerebrovascular syndromes. Lancet Neurol 2011; 10:550–560
Bhat, Dr. Vinayak, et al. Clinical Presentation and Radiological Profile of Patients Presented with Stroke between the Ages of 15-45 Years. International Journal of Advanced Research in Medicine, vol. 4, no. 1, AkiNik Publications, 1 Jan. 2022, pp. 18–20. Crossref, doi:10.22271/27069567.2022.v4.i1a.314
McCarty, J. L., Leung, L. Y., Peterson, R. B., Sitton, C. W., Sarraj, A., Riascos, R. F., & Brinjikji, W. (2019). Ischemic Infarction in Young Adults: A Review for Radiologists. In RadioGraphics (Vol. 39, Issue 6, pp. 1629–1648). Radiological Society of North America (RSNA). https://doi.org/10.1148/rg.2019190033
Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible Cerebral Vasoconstriction Syndrome. II. Diagnostic Work-Up, Imaging Evaluation, and Differential Diagnosis. AJNR Am J Neuroradiol 2015; 36(9):1580–1588
Xu W, Zhang X, Chen H, Zhao Z, Zhu M. Prevalence and outcome of young stroke patients with middle cerebral artery stenosis. BMC Neurol. 2021 Mar 4;21(1):99. doi: 10.1186/s12883-021-02125-8. PMID: 33663425; PMCID: PMC7931598
Jayaraj, R. L., Azimullah, S., Beiram, R., Jalal, F. Y., & Rosenberg, G. A. (2019). Neuroinflammation: friend and foe for ischemic stroke. In Journal of Neuroinflammation (Vol. 16, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12974-019-1516-2
Bergman, E-M, Henriksson, KM, Åsberg, S, Farahmand, B, Terént, A. National registry-based case–control study: comorbidity and stroke in young adults. Acta Neurol Scand 2015: 131:394–399. 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd..
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