Varona J F, Bermejo F, Guerra J M, Molina J A
Department of Internal Medicine, University Hospital 12 de Octubre, Avda. Andalucía, km 5.4, 28041-Madrid, Spain.
J Neurol. 2004 Dec;251(12):1507-14. doi: 10.1007/s00415-004-0583-0.
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.
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.
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.
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.
关于青年缺血性卒中患者长期预后的研究较少。本研究旨在评估过去27年在一家三级医疗中心收治的大量青年缺血性卒中患者的长期临床结局，并确定死亡、卒中复发及功能恢复不良的可能预测因素。
我们回顾性分析了1974年至2001年间在“12 de Octubre”大学医院神经科收治的272例首次发生缺血性卒中的青年患者（15 - 45岁）。通过查阅病历和电话访谈进行随访评估。
9例患者（3%）死于首次卒中，23例患者（8%）的随访信息缺失。其余240例患者（89%）接受了随访。其中210例（88%）存活，平均随访12.3年，30例（12%）在随访期间死亡。年平均死亡率为1.4%，首次卒中后的第一年死亡率（4.9%）显著高于随后几年（0.9%）。90%的随访患者生活自理，53%恢复工作，不过其中23%的患者需要进行调整。第一年的年卒中复发率为3.6%，随后几年降至1.7%。年龄超过35岁、男性、存在心血管危险因素以及颈动脉区域的大动脉粥样硬化是首次卒中后长期不良结局的预测因素。
青年缺血性卒中的长期预后优于老年人，但青年缺血性卒中患者的死亡风险远高于同年龄段的普通人群。不良预后与动脉粥样硬化风险特征相关，死亡率和卒中复发率更高，功能恢复更差。青年首次缺血性卒中幸存者的主要功能限制在于工作活动，因为大多数患者生活自理，但几乎一半患者无法恢复工作。
