Arai Nobuhiko, Yachi Kazunari, Ishihara Ryutaro, Fukushima Takao
Neurosurgery, Takashimadaira Chuo General Hospital, Itabashiku, JPN.
Cureus. 2025 May 8;17(5):e83765. doi: 10.7759/cureus.83765. eCollection 2025 May.
Large vessel occlusion (LVO) in a young patient aged less than 30 years of age is greatly rare. When approaching stroke-like symptoms in younger generations, stroke mimics like epilepsy, chronic subdural hematoma, spinal cord nerve compression due to herniation of disk, or autoimmune neuropathy like Guillain-Barré syndrome or multiple sclerosis are definitely a great hindrance to rapid diagnosis. This condition is likely to increase the difficulty of accurate diagnosis and delay treatment for a stroke in combination with the rarity of strokes in young individuals. What is more, a delayed medical approach for autoimmune neuropathy, like massive steroid injection, could result in a worse prognosis. Oral contraceptives (OC) for migraine without aura are controversial for an increased risk of ischemic stroke. We experienced a highly instructive case of a young LVO patient for whom mechanical thrombectomy was performed. A 26-year-old female patient with a past medical history of migraine or depression had been transferred to the hospital complaining of left upper and lower limb paralysis. Magnetic resonance imaging showed right middle cerebral artery occlusion and cerebral infarction in the basal ganglia. Rapid endovascular thrombectomy was performed and resulted in thrombolysis in cerebral infarction (TICI) 3 by three passes. The patient was discharged without any neurological deficit on the 10 day after admission. She was on OC pills in the last six months before the onset of symptoms. The value of D-dimer on admission was 3.9 mg/dl. We could not acknowledge the other stroke risk factors and suspected the paradoxical embolism as a mechanism of stroke, considering the patient's young age. Transesophageal echocardiography revealed a relatively wide atrial septal defect (ASD). The diagnosis of paradoxical embolism via ASD was made, and a direct oral anticoagulant was started. Closure for ASD was planned. A few months after the ASD closure, the anti-coagulant agent is planned to be ceased. Clinicians have to note that even young people with psychological disorders or migraine can suffer from LVO. More prudent prescription of OC pills for migraine patients is necessary.
30岁以下的年轻患者出现大血管闭塞（LVO）极为罕见。在年轻一代出现类似中风的症状时，癫痫、慢性硬膜下血肿、椎间盘突出导致的脊髓神经受压或吉兰 - 巴雷综合征或多发性硬化症等自身免疫性神经病变等类似中风的病症，无疑会极大地阻碍快速诊断。这种情况可能会增加准确诊断的难度，并因年轻个体中风的罕见性而延误中风治疗。此外，对于自身免疫性神经病变的延迟治疗方法，如大量注射类固醇，可能会导致更差的预后。用于无先兆偏头痛的口服避孕药（OC）因缺血性中风风险增加而存在争议。我们经历了一例极具指导意义的年轻LVO患者，对其进行了机械取栓治疗。一名有偏头痛或抑郁症病史的26岁女性患者因左上肢和下肢瘫痪被转诊至医院。磁共振成像显示右侧大脑中动脉闭塞以及基底节区脑梗死。迅速进行了血管内取栓治疗，经过三次操作实现了脑梗死溶栓（TICI）3级。患者在入院后第10天出院，无任何神经功能缺损。她在症状发作前的最后六个月一直在服用OC药丸。入院时D - 二聚体值为3.9mg/dl。我们未发现其他中风危险因素，考虑到患者年轻，怀疑反常栓塞是中风的机制。经食管超声心动图显示有一个相对较宽的房间隔缺损（ASD）。诊断为通过ASD的反常栓塞，并开始使用直接口服抗凝剂。计划对ASD进行封堵。在ASD封堵几个月后，计划停用抗凝剂。临床医生必须注意，即使是患有心理障碍或偏头痛的年轻人也可能发生LVO。对于偏头痛患者，更谨慎地开具OC药丸处方是必要的。
