From the Departments of Diagnostic and Interventional Imaging (J.L.M., C.W.S., R.F.R.) and Neurology (A.S.), University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030; Department of Neurology, Tufts Medical Center, Boston, Mass (L.Y.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.B.P.); and Departments of Radiology and Neurosurgery, Mayo Clinic, Rochester, Minn (W.B.).
Radiographics. 2019 Oct;39(6):1629-1648. doi: 10.1148/rg.2019190033.
Ischemic strokes in young adults are devastatingly debilitating and increasingly frequent. Stroke remains the leading cause of serious disability in the United States. The consequences of this familiar disease in this atypical age group are especially detrimental and long lasting. Ischemic stroke in young adults is now emerging as a public health issue, one in which radiologists can play a key role. The incidence of ischemic infarction in young adults has risen over the past couple of decades. Increased public awareness, increased use of MRI and angiography, and more accurate diagnosis may in part explain the increased detection of stroke in young adults. The increased prevalence of stroke risk factors in young adults (especially sedentary lifestyle and hypertension) may also contribute. However, compared with older adults, young adults have fewer ischemic infarcts related to the standard cardiovascular risk factors and large- or small-vessel disease. Instead, their infarcts most commonly result from cardioembolic disease and other demonstrated causes (ie, dissection). Thus, radiologists must expand their differential diagnoses to appropriately diagnose ischemic strokes and identify their causes in the young adult population. From the more frequent cardioembolism and dissection to the less common vasculitis, drug-related, CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), moyamoya, and hypercoagulable state-related infarcts, this article covers a wide breadth of causes and imaging findings of ischemic stroke in young adults. RSNA, 2019.
年轻人的缺血性中风是毁灭性的致残性的，而且越来越常见。中风仍然是美国导致严重残疾的主要原因。这种在非典型年龄段的常见疾病的后果尤其不利且持久。年轻人的缺血性中风现在已经成为一个公共卫生问题，放射科医生可以在其中发挥关键作用。在过去几十年中，年轻人的缺血性梗死发病率有所上升。公众意识的提高、MRI 和血管造影的广泛应用以及更准确的诊断可能在一定程度上解释了年轻人中风检测的增加。年轻人中风危险因素的患病率增加（尤其是久坐的生活方式和高血压）也可能是一个原因。然而，与老年人相比，年轻人与标准心血管危险因素和大血管或小血管疾病相关的缺血性梗死较少。相反，他们的梗死最常见于心源性栓塞性疾病和其他已证实的原因（即夹层）。因此，放射科医生必须扩大鉴别诊断范围，以适当诊断年轻人的缺血性中风并确定其病因。从更常见的心源性栓塞和夹层到不那么常见的血管炎、药物相关、CADASIL（伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病）、烟雾病和高凝状态相关的梗死，本文涵盖了广泛的年轻人缺血性中风的病因和影像学表现。RSNA，2019 年。
