Adams H P, Kappelle L J, Biller J, Gordon D L, Love B B, Gomez F, Heffner M
Department of Neurology, University of Iowa College of Medicine, Iowa City, USA.
Arch Neurol. 1995 May;52(5):491-5. doi: 10.1001/archneur.1995.00540290081021.
To describe the likely causes of ischemic stroke in a population of young adults and to report the influence of strict algorithms on the diagnosis of the likely cause of stroke in this cohort.
Between July 1, 1977, and January 1, 1993, we registered 329 young adults with ischemic stroke in our registry. Diagnostic studies were selected on a case-by-case basis. Presumed causes of stroke were determined using clinical information and the results of diagnostic tests. In each case, a second causative diagnosis was made using the criteria developed for a large clinical trial.
Patients referred to the Division of Cerebrovascular Diseases in the Department of Neurology at the University of Iowa Hospitals and Clinics, Iowa City, by physicians in Iowa and adjacent states.
Three hundred twenty-nine young adults (182 men and 147 women) aged 15 to 45 years with ischemic stroke; 102 persons, 48 men and 54 women, were aged 30 years or younger.
Cerebral arteriography was performed in 227 cases, and the findings were abnormal in 146. Transthoracic echocardiography revealed abnormalities in 82 of 221 patients examined. We identified approximately 60 different disorders that were presumed to be the cause of stroke. There were no major changes in the frequency of subtype diagnoses between the first 144 patients and the subsequent 185. Use of strict diagnostic criteria increased the number of cases of stroke of undetermined etiology (from 45 to 113), and the number attributed to large artery atherosclerosis declined from 71 to 32.
The causes of ischemic stroke in young adults are numerous. Because treatment options in this group are influenced by a presumed cause, an evaluation on a case-by-case basis is warranted. Our experience suggests that a likely cause will be detected in most cases and that a regimented battery of tests may not be required. If strict diagnostic criteria are used, the diagnosis of stroke of undetermined etiology considerably increases. While such strict criteria are important in clinical trials that test new interventions, the value of the application of such methodologies to an unusual population, such as stroke in young adults, needs clarification. In particular, the usefulness of categorizing a stroke as undetermined when two or more possible causes are identified needs to be explored.
描述年轻成年人群体中缺血性卒中的可能病因，并报告严格算法对该队列中卒中可能病因诊断的影响。
在1977年7月1日至1993年1月1日期间，我们在登记处登记了329例年轻成年缺血性卒中患者。诊断研究根据具体病例逐一选择。根据临床信息和诊断测试结果确定卒中的推测病因。在每个病例中，使用为一项大型临床试验制定的标准进行二次病因诊断。
爱荷华州和邻近州的医生将患者转诊至爱荷华市爱荷华大学医院及诊所神经科脑血管病科。
329例年龄在15至45岁之间的年轻成年缺血性卒中患者（182名男性和147名女性）；102人，48名男性和54名女性，年龄在30岁及以下。
227例患者进行了脑血管造影，其中146例结果异常。221例接受检查的患者中，经胸超声心动图显示82例异常。我们确定了约60种不同的疾病被推测为卒中病因。在前144例患者和随后的185例患者之间，亚型诊断的频率没有重大变化。使用严格的诊断标准增加了病因不明的卒中病例数（从45例增加到113例），而归因于大动脉粥样硬化的病例数从71例降至32例。
年轻成年人缺血性卒中的病因众多。由于该群体的治疗选择受推测病因的影响，因此有必要逐案进行评估。我们的经验表明，大多数情况下可以检测到可能的病因，可能不需要一套严格的检查。如果使用严格的诊断标准，病因不明的卒中诊断会大幅增加。虽然此类严格标准在测试新干预措施的临床试验中很重要，但将此类方法应用于不寻常人群（如年轻成年人卒中）的价值需要阐明。特别是，当确定两个或更多可能病因时将卒中归类为病因不明的实用性需要探讨。
