Department of Emergency Medicine, Columbia University Medical Center, New York, NY.
Department of Emergency Medicine, Yale-New Haven Medical Center, New Haven, CT.
Acad Emerg Med. 2018 Jan;25(1):54-64. doi: 10.1111/acem.13243. Epub 2017 Oct 10.
Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting.
A panel of six board-certified emergency physicians, one with fellowship training in stroke and one with training in sex- and sex-based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors.
Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals.
Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.
缺血性脑卒中是全球范围内发病率和死亡率最高的疾病。虽然老年人的发病率最高，但年轻（例如绝经前）女性的缺血性脑卒中发病率一直在迅速上升。在急诊科，由于一系列特定于性别的风险因素和广泛的鉴别诊断，年轻女性缺血性脑卒中的评估和及时诊断存在挑战。本文的目的是总结目前关于年轻女性在急性缺血性脑卒中评估和管理方面的知识。
一个由六名具有急诊医师资格认证的医师组成的小组，其中一名具有中风专业培训，一名具有性别和性别医学培训，以及一名血管神经病学家作为共同作者参与了本文的撰写。每位作者都使用了各种搜索策略（例如 PubMed、PsycINFO 和 Google Scholar）来进行主要研究，并审查了与他们所在部分相关的文章。参考文献经过审查和评估，根据主要作者的审查结果被纳入。
美国绝经前女性缺血性脑卒中的发病率估计为每 100,000 人中 3.65 至 8.9 人。年轻女性存在多种缺血性脑卒中风险因素，包括口服避孕药（OCP）使用和有先兆的偏头痛。妊娠和产后（长达 12 周）也是一个重要的短暂状态，在此期间缺血性卒中和脑出血的风险增加，占 35 岁以下女性中风的 18%。本文还总结了目前关于年轻女性急性缺血性脑卒中管理的证据，包括在妊娠和非妊娠个体中使用溶栓药物（例如组织型纤溶酶原激活剂）。
在评估和诊断年轻女性的缺血性脑卒中时存在独特的挑战。仍有许多机会进行未来的研究，旨在提高对该人群的检测和治疗。
