青年缺血性卒中

1、Ischemic Stroke in Young Adult,2001/08/13,Ischemic Stroke in Young adult,Definition：16-45 y/o Distribution：3-4% of all stroke Etiology, clinical manifestation, and prognosis are different from elderly It is important to find the etiologic factor and treat them adequately for preventing the recurrence Orv Hetil 2001 Mar 25;142(12):607-10,Epidermiology,Northern Sweden Monica, 13 third level and local hospital, age 18-44 y/o, from Jan.1991-May 1996, totally 88 cases Annual incidence：11.3/100000 13.

2、6 m vs 8.9 w Case fatality rate：5.7% (within 28 days) 4.8 in Neuro Neurochir pol 2000Nov-Dec; Increased with age：especially after 35 y/o Dramatic increased after 45 in other report Kristensen: Stroke, Volume 28(9).September 1997.1702-1709,Epidemiology,Table 1. Average Annual Age- and Sex-Specific Incidence Rates of First Ischemic Stroke in Young Adults in Northern Sweden, 1991 to 1994 From: Kristensen: Stroke, Volume 28(9).September 1997.1702-1709,Epidemiology,Table 1. Ages of Young Men and Wome

3、n With Ischemic Stroke Arch Neurol. 1995;52:491-495,Etiology,Atherosclerosis is the main cause of stroke in elderly, while emboligenous cardiopathy is the one of the main cause of young adult Annali Italiani di Medicina Interna. 11(1):33-8,1996 Jan-Mar Cardiac embolism was the most common cause of stroke in pt younger than 40 Stroke. 30(11):2320-5, 1999 Nov. 20018350 Atherosclerosis was 38.2% and cardioembolism was 18.1% Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000.,Etiology,Atheroscler

4、osis 33.3%, Prothrombotic state 15.5%, Cardiogenic 9.5% Orv Hetil 2001 Mar 25;142(12):607-10 Atherosclerosis 29.8%, Cardioembolism 19.5%, Hematologic 5.8% Arch Neurol. 1995;52:491-495 So cardioembolism and atherosclerosis are tow major cause of stroke in young adults Cause are diverse,Etiology,Etiology,Etiology,Atherosclerosis: a.Large artery b.Small artery Embolism: a.Cardiogenic b.Non-cardiogenic Non-Atherosclerosis artriopathy: a.Inflammatory b.Non-inflammatory Hemological disorder: a.Viscosi

5、ty b.Coagulopathy Others:,Etiology,Embolism: a.Cardiogenic: 1.Valvular: RH, prosthetic, endocarditis, MVP 2.Arrhythmia: Af, sick sinus syndrome 3.AMI/LV aneurysm: 4.LV myxoma: 5.Cardiomyopathy:,Etiology,Embolism: b.Non-cardiogenic: 1.Pulmonary AVM: Osler-Weber-Rendu syndrome 2.ASD/VSD or POF with shunt: 3.Pulmonary embolism:,Etiology,Non-atherosclerosis arteriopathy: a.Inflammatory: 1.Takayasus disease:=Granulomatous arteritis,mono,無脈症 2.Hepersensitive arteritis: Churg-strauss disease 3.Infectio

6、us: Syphilitic arteritis, TB, HIV-associated 4.Drug related: heroin, amphetamine 5.Systemic disease: SLE, RA, polyarteritis nodosa,Etiology,Non-atherosclerosis arteriopathy: a.Non-inflammatory: 1.Moya moya disease: 2.Artery dissection: 3.Irradiation vasculopathy: 4.Fibromuscular dysplasia: 5.Firinoid vasculopathy:,Etiology,Hematological disorder: a.Viscosity: 1.MDS: CML, polycythemia vera, essential thrombocythemia 2.Multiple myeloma: 3.Leukemia b.Coagulopathy:,Etiology,Hematological disorder: b

7、.Coagulopathy: 1.Hemoglobin disorder 2.Protein C/S deficiency 3.Antithrombin III deficiency 4.DIC 5.Anti-phospholipid antibody,Etiology,Others: 1.Migraine 2.Pregnancy 3.Trauma,Risk Factor,Stroke, Volume 28(9).September 1997.1702-1709,Risk factor,Agreed by most reporters are : 1.Cigarette smoking 2.Hypertension 3.Hyperlipidemia Orv Hetil 2001 Mar 25;142(12):607-10 Postgraduate medicine.81(5):141-4,149-51 1987 Apr. Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000,Clinical Presentation,Embolis

8、m: 1. Sudden onset of cortical impairment 2. Heart condition predisposing to embolism 3. May be fluctuated,and may recover or deteriorat,Clinical Presentation,Large artery atherosclerosis: 1. Cerebral cortical impairment: aphasia, apraxia, anopia, agnosia, restricted motor involvement 2.History of intermittent claudication,TIA,Clinical Presentation,Small artery occlusion (lacunae) 1.Traditional clinical lacunar syndrome a. Pure motor hemiparesis b. Pure sensory stroke c. Ataxia hemiparalysis d.

9、Dysarthria-clumsy hand e. Sensory motor stroke 2.History of HTN and DM supports Dx,Prognosis,First 28 days mortality: 4.8/5.7% Neurological deficit(Canadian neurological scale) and handicap severity(Rankin classification, Barthel index) are all much better than elderly. 1/3; 6mo Although infarct size usually bigger (3cm) Recurrence risk is low :1.1-1.2 annually Over all, prognosis is much better, so aggressive treatment intervention is important.,Advised Clinical Study,CT/MRI/angiography 12 lead EKG Echocardiogram/TEE Dupplex( carotid and IC doppler) BCS, rheumatic profile, autoimmune profile, coagulation profile,Conclusion,Ischemia stroke in young adults must be studied with a different protocol from that used for the elderly, due to the difference of the etiology and the prognosis. Annali Italiani di Medicina Interna. 11(1):33-8,1996 Jan-Mar,

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