Chancellor A M, Glasgow G L, Ockelford P A, Johns A, Smith J
Departments of Neurology, Auckland Hospital, New Zealand.
Stroke. 1989 Apr;20(4):477-82. doi: 10.1161/01.str.20.4.477.
We retrospectively evaluated 66 patients younger than 40 years of age who presented with acute nonhemorrhagic cerebral infarction (n = 63) or transient ischemic attacks (n = 3) to determine the possible etiology and long-term outcome at a mean follow-up interval of 3 years after initial presentation. A probable cause for the stroke was identified in 24 patients (36%); this group included one woman with a history of recurrent spontaneous abortions and a positive test for the presence of the lupus anticoagulant. We performed detailed hemostatic investigations at follow-up in 38 (90%) of the remaining 42 patients in whom the cause of the stroke was unknown or uncertain; results of the basic hemostatic screening tests (including that for fibrinogen) were uniformly normal. All 38 patients demonstrated a normal fibrinolytic response as measured by tissue plasminogen activator release to a standard venous occlusion stress test; concentration of the inhibitor of tissue plasminogen activator was not increased. No abnormalities in the concentrations of the inhibitory proteins C or S or antithrombin III were identified, and none of the 38 patients had evidence of a lupus anticoagulant. Neurologic recovery was complete or the residual disability mild in 46 of 59 (78%) patients. Overall prognosis was excellent and independent of whether a precipitating factor for the stroke could be identified.
我们对66例年龄小于40岁的患者进行了回顾性评估，这些患者表现为急性非出血性脑梗死（n = 63）或短暂性脑缺血发作（n = 3），以确定初始就诊后平均3年随访期内可能的病因和长期预后。在24例患者（36%）中确定了可能的卒中病因；该组包括一名有复发性自然流产病史且狼疮抗凝物检测呈阳性的女性。在其余42例卒中病因不明或不确定的患者中，我们对38例（90%）进行了随访时的详细止血检查；基本止血筛查试验（包括纤维蛋白原检测）结果均正常。通过组织纤溶酶原激活物释放对标准静脉闭塞应激试验进行测量，所有38例患者均表现出正常的纤溶反应；组织纤溶酶原激活物抑制剂浓度未升高。未发现抑制蛋白C或S或抗凝血酶III浓度异常，38例患者中无一例有狼疮抗凝物证据。59例患者中有46例（78%）神经功能恢复完全或残留残疾轻微。总体预后良好，且与是否能确定卒中的诱发因素无关。
