Neurology Section, University of Antioquia, Carrera 51D #62-29, Medellín, 050010, Colombia.
School of Medicine, University of Antioquia, Medellín, Colombia.
BMC Neurol. 2022 Sep 22;22(1):363. doi: 10.1186/s12883-022-02895-9.
There is scarce information about ischemic stroke in young patients in Colombia. To get insights about this phenomenon, this study describes the etiologies and risk factors of ischemic stroke in young patients in a third level complexity referral hospital in Medellin, Colombia.
A retrospective observational cross-sectional study was carried out reviewing the medical records of patients between 18 to 49 years old admitted for the first time for ischemic stroke, from January 2009 to December 2019. The sociodemographic characteristics, risk factors, and etiological classification of ischemic stroke according to the Trial of Org 10,172 in Acute Stroke Treatment (TOAST) were described.
Two hundred thirty-seven cases were found. The most frequent risk factors were arterial hypertension (31.7%), smoking (29.5%) and alcohol intake (23.2%). There was a greater number of traditional cardiovascular risk factors at older ages. The TOAST classification was large-artery atherosclerosis (6.8%), cardioembolism (17.7%), small-vessel disease (7.6%), other determined etiology (25.7%) and undetermined (42.2%). Within cardioembolism, the most common high-risk source was valve replacement, and the most common moderate-risk source was patent foramen ovale. Craniocervical arterial dissection (11.4%) and substance abuse (2.9%) were the two most frequent sources within other determined etiologies. The most common compromised vascular territory was the anterior (55.7%).
The high frequency of traditional risk factors in young patients highlights the need to optimize primary and secondary prevention plans. This study provides new insights about the relevance of illicit substance abuse in Colombia as a cause of stroke in young patients, unlike the previous one conducted in Bogotá. Infectious causes were other peculiarities found. It is necessary to investigate the reasons for the high proportion of undetermined causes.
关于哥伦比亚年轻患者的缺血性脑卒中信息很少。为了深入了解这一现象，本研究描述了哥伦比亚麦德林一家三级复杂转诊医院中年轻患者缺血性脑卒中的病因和危险因素。
本研究为回顾性观察性横断面研究，纳入了 2009 年 1 月至 2019 年 12 月期间首次因缺血性脑卒中入院的年龄在 18 至 49 岁之间的患者的病历。描述了患者的社会人口学特征、危险因素以及根据组织溶解治疗急性卒中试验（TOAST）的缺血性脑卒中病因分类。
共发现 237 例病例。最常见的危险因素是动脉高血压（31.7%）、吸烟（29.5%）和饮酒（23.2%）。随着年龄的增长，传统心血管危险因素的数量更多。TOAST 分类为大动脉粥样硬化（6.8%）、心源性栓塞（17.7%）、小血管疾病（7.6%）、其他确定病因（25.7%）和未确定病因（42.2%）。在心源性栓塞中，最常见的高危源是瓣膜置换，最常见的中危源是卵圆孔未闭。颅颈动脉夹层（11.4%）和物质滥用（2.9%）是其他确定病因中最常见的两个病因。最常见的血管受累区域是前循环（55.7%）。
年轻患者中传统危险因素的高频率突显了优化一级和二级预防计划的必要性。本研究提供了新的见解，即了解哥伦比亚物质滥用作为年轻患者脑卒中的一个原因的重要性，这与之前在波哥大进行的研究不同。还发现了感染性病因的其他特点。有必要调查未确定病因比例高的原因。
