Montanaro Vinícius V A, Freitas Denise D S, Ruiz Miguel C M, Cavalcanti Eduardo B U, Marinho Patricia B C, Freitas Maria C D N B, Oliveira Eleonora M J D
SARAH Hospital of Rehabilitation, Asa Sul, Brazil.
Neurologist. 2017 Mar;22(2):61-63. doi: 10.1097/NRL.0000000000000110.
The societal and economic impact of ischemic stroke in young adults is considerable. The etiological investigation of ischemic stroke in this population is also challenging.
To describe the characteristics of young patients with ischemic stroke admitted to a neurological rehabilitation program in Brazil.
This transversal retrospective study analyzed data from the electronic health records of 134 patients aged 18 to 45 years with ischemic stroke admitted from 2008 to 2012.
The average patient age at the time of ictus was 33 years; 56% of the subjects were female, and 29.3% had undetermined etiologies of stroke, on the basis of both TOAST and SSS TOAST criteria. Further, 48.7% of the subjects had a known vascular risk factor, which was arterial hypertension in most cases. The results of thrombophilia testing were positive in 13.7% of patients, but in only 3.7% of patients, thrombophilia was determined to be the causal mechanism of the stroke. There was a significant association between thrombophilia and patent foramen ovale, but no significant association was found between thrombophilia and arterial dissection. Among the patients with artery dissections, 46% had a history of trauma, which was statistically significant.
Etiological diagnosis of stroke in the young is challenging for clinicians. Hence, a more effective classification scheme, better investigative mechanisms, and correct determination of causal associations in ischemic stroke are needed. Thrombophilia screening should be performed in the presence of relevant clinical signs and/or family history.
青年缺血性卒中的社会和经济影响颇为重大。对这一人群缺血性卒中的病因学调查也颇具挑战性。
描述巴西一家神经康复项目收治的青年缺血性卒中患者的特征。
这项横断面回顾性研究分析了2008年至2012年收治的134例年龄在18至45岁之间的缺血性卒中患者电子健康记录中的数据。
发病时患者的平均年龄为33岁；56%的受试者为女性，根据TOAST和SSS TOAST标准，29.3%的患者卒中病因不明。此外，48.7%的受试者有已知的血管危险因素，大多数情况下为动脉高血压。13.7%的患者血栓形成倾向检测结果呈阳性，但只有3.7%的患者血栓形成倾向被确定为卒中的病因机制。血栓形成倾向与卵圆孔未闭之间存在显著关联，但血栓形成倾向与动脉夹层之间未发现显著关联。在动脉夹层患者中，46%有外伤史，具有统计学意义。
对临床医生而言，青年卒中的病因诊断颇具挑战性。因此，需要更有效的分类方案及更好的调查机制，并正确确定缺血性卒中的因果关联。在存在相关临床体征和/或家族史的情况下应进行血栓形成倾向筛查。
