From the Stroke Units and Department of Neurology (T.R., N.L., C.D.), Hôpital Bicêtre, Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University; Department of Neurology (Y.B.), University Région Bourgogne, Hôpital de Dijon; Pediatric Neurology Unit (C.B.), Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; Stroke Units and Department of Neurology (B.L.), Hôpital Foch, Suresnes; Department of Neurology (E.J.), Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (F.P.), Hôpital Andre Mignot, Versailles; Department of Neurology (D.S.), Hôpital Sud Francilien, Evry; Department of Neurology (M.Z.), Hôpital Saint Joseph, Paris; Department of Neurology (S.C.), Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris; Department of Neurology (C.L.), Hôpital Sainte Anne, Paris; Interventional Neuroradiology (L.S.), NEURI Centre, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre; French National Health Insurance (P.T.); and Pediatric Neurology Unit (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, France.
Neurology. 2020 Jan 14;94(2):e158-e169. doi: 10.1212/WNL.0000000000008783. Epub 2019 Dec 12.
Adolescence represents a transition period between childhood and adulthood, and only limited information exists about stroke characteristics in this population. Our aim was to describe the clinical and neuroradiologic features, etiologies, initial management, and outcome of ischemic stroke in adolescents.
This retrospective cohort study evaluated all consecutive patients 10 to 18 years with a first-ever ischemic stroke hospitalized between 2007 and 2017 in 10 French academic centers representing a population of ≈10 million. Extracted data from the national database served as validation.
A total of 60 patients were included (53% male, median age 15.2 years). Diagnosis at first medical contact was misevaluated in 36%, more frequently in posterior than anterior circulation strokes (55% vs 20% respectively, odds ratio 4.8, 95% confidence interval 1.41-16.40, = 0.01). Recanalization treatment rate was high (n = 19, 32%): IV thrombolysis (17%), endovascular therapy (11.7%), or both IV and intra-arterial thrombolysis (3.3%); safety was good (only 1 asymptomatic hemorrhagic transformation). Despite thorough etiologic workup, 50% of strokes remained cryptogenic. The most common determined etiologies were cardioembolism (15%), vasculitis and autoimmune disorders (12%, occurring exclusively in female patients), and arterial dissections (10%, exclusively in male patients). Recurrent ischemic cerebrovascular events occurred in 12% (median follow-up 19 months). Recurrence rate was 50% in patients with identified vasculopathy but 0% after cryptogenic stroke. Functional outcome was favorable (Rankin Scale score 0-2 at day 90) in 80% of cases.
Ischemic strokes in adolescents harbor both pediatric and adult features, emphasizing the need for multidisciplinary collaboration in their management. Recanalization treatments appear feasible and safe.
青春期是儿童期向成年期过渡的阶段，目前关于该人群中风特征的信息有限。本研究旨在描述青少年首次缺血性中风的临床和神经影像学特征、病因、初始治疗和结局。
本回顾性队列研究评估了 2007 年至 2017 年间法国 10 个学术中心连续收治的 10-18 岁首次发生缺血性中风的所有患者（约 1000 万人口）。从国家数据库中提取的数据作为验证。
共纳入 60 例患者（53%为男性，中位年龄为 15.2 岁）。在首次医疗接触时，有 36%的患者诊断被错误评估，后循环卒中较前循环卒中更为常见（分别为 55%和 20%，优势比 4.8，95%置信区间 1.41-16.40， = 0.01）。再通治疗率较高（n = 19，32%）：静脉溶栓（17%）、血管内治疗（11.7%）或静脉和动脉内溶栓（3.3%）；安全性良好（仅 1 例无症状性出血转化）。尽管进行了全面的病因学检查，但 50%的中风仍为隐源性。最常见的确定病因是心源性栓塞（15%）、血管炎和自身免疫性疾病（12%，仅发生于女性患者）和动脉夹层（10%，仅发生于男性患者）。12%的患者发生复发性缺血性脑血管事件（中位随访时间为 19 个月）。在有明确血管病变的患者中，复发率为 50%，而在隐源性中风患者中为 0%。80%的患者在 90 天时的功能结局良好（Rankin 量表评分为 0-2 分）。
青少年缺血性中风具有儿科和成人的特征，强调在其治疗中需要多学科合作。再通治疗似乎是可行和安全的。
