Berlit P, Endemann B, Vetter P
Neurologische Klinik im Klinikum Mannheim, Universität Heidelberg.
Fortschr Neurol Psychiatr. 1991 Aug;59(8):322-7. doi: 10.1055/s-2007-1000706.
An overview is given over etiology and prognosis of cerebral ischemias until the age of 40. In a time period of 19 years, 168 patients were diagnosed with cerebral ischemia until the age of 40 (91 females, 77 males). The most frequent etiology is premature atherosclerosis in patients with vascular risk factors (up to 50%). Cardiogenic embolism is responsible for 1 to 34% of the cases: cardiac valve diseases and endocarditis being the most frequent sources. In 2 to 19% a vasculitis is diagnosed. While infectious arteritis is especially frequent in countries of the third world, immunovasculitides are common in Europe and the USA. Noninflammatory vasculopathies include spontaneous or traumatic dissection, fibromuscular dysplasia and vascular malformations. A migrainous stroke is especially frequent in female smokers with intake of oral contraceptives. During pregnancy both sinus thrombosis and arterial ischemia occur. Hematologic causes for ischemia are polycythemia, thrombocytosis and genetic diseases (sickle cell anemia, AT3-deficiency). Cerebral ischemia may occur in connection with the ingestion of ergot-derivates. The prognosis of cerebral ischemia in young adults is better than in older stroke-patients.
本文概述了40岁以下人群脑缺血的病因和预后情况。在19年的时间里，共诊断出168例40岁以下的脑缺血患者（女性91例，男性77例）。最常见的病因是有血管危险因素患者的过早动脉粥样硬化（高达50%）。心源性栓塞占病例的1%至34%：心脏瓣膜病和心内膜炎是最常见的栓子来源。2%至19%的病例被诊断为血管炎。感染性动脉炎在第三世界国家尤为常见，而免疫性血管炎在欧洲和美国较为普遍。非炎症性血管病变包括自发性或外伤性夹层、纤维肌发育不良和血管畸形。偏头痛性卒中在服用口服避孕药的女性吸烟者中尤为常见。怀孕期间会发生窦血栓形成和动脉缺血。缺血的血液学原因包括红细胞增多症、血小板增多症和遗传性疾病（镰状细胞贫血、抗凝血酶Ⅲ缺乏症）。年轻人脑缺血的预后优于老年卒中患者。
