Carolei A, Marini C, Ferranti E, Frontoni M, Prencipe M, Fieschi C
Clinica Neurologica, Ospedale S. Maria di Collemaggio, Università degli Studi di L'Aquila, Italy.
Stroke. 1993 Mar;24(3):362-7. doi: 10.1161/01.str.24.3.362.
The etiology of stroke in the young is different from that in older patients and remains unknown in almost one third of the cases. To gain further insight into both pathogenic and etiologic determinants, we prospectively studied a large number of consecutive young adults with focal cerebral ischemia.
Three hundred thirty-three patients aged 15-44 years with transient ischemic attack or ischemic stroke within the 8 weeks before hospital admission were recruited and investigated by using a standardized protocol of clinical evaluation, blood tests, electrocardiography, echocardiography, chest roentgenography, and brain computed tomography. Presumed etiology was diagnosed by prospectively applied criteria.
Women predominated (61%) among patients under 35 years of age, mainly due to the frequency of cerebral ischemia related to oral contraceptive use, while men outnumbered women (60%) among patients over that age because of a higher prevalence of atherothrombotic disease. Potential cerebral embolism of cardiac origin was the presumed cause of stroke in 23.7%, but conventional sources of emboli were found only in 7.5% of cases. There was a low prevalence of atrial fibrillation among young patients with cerebral ischemia. Mitral valve prolapse was found in 8.4%, as expected, predominantly (71.4%) among the younger patients. The prevalence of stroke over transient ischemic attack was proportional to the likelihood of cardiac embolism. Acute alcohol intoxication was considered a precipitating factor in only three patients. The percentages of cerebral ischemia attributed to arterial dissection (0.3%), oral contraceptive use in women (8.1%), migraine (1.2%), and other associated medical diseases (1.5%) were lower than reported in recent clinical series.
Two different groups of pathogenic determinants predominate in younger women and in older men, supporting public health measures aimed at strict medical control of the recognized cerebrovascular risk factors.
年轻人中风的病因与老年患者不同，近三分之一的病例病因仍不明确。为了进一步深入了解发病机制和病因决定因素，我们对大量连续性的局灶性脑缺血年轻成年人进行了前瞻性研究。
招募了333例年龄在15 - 44岁之间、入院前8周内发生短暂性脑缺血发作或缺血性中风的患者，并采用标准化的临床评估、血液检查、心电图、超声心动图、胸部X线检查和脑部计算机断层扫描方案进行调查。根据前瞻性应用的标准诊断推测病因。
35岁以下患者中女性占主导（61%），主要是由于与口服避孕药相关的脑缺血发生率较高，而35岁以上患者中男性多于女性（60%），原因是动脉粥样硬化血栓形成疾病的患病率较高。心脏源性潜在脑栓塞被认为是23.7%的中风病因，但仅在7.5%的病例中发现了传统的栓子来源。年轻脑缺血患者中房颤的患病率较低。二尖瓣脱垂的发生率为8.4%，如预期的那样，主要（71.4%）出现在年轻患者中。中风相对于短暂性脑缺血发作的患病率与心脏栓塞的可能性成正比。急性酒精中毒仅在3例患者中被认为是促发因素。归因于动脉夹层（0.3%）、女性口服避孕药使用（8.1%）、偏头痛（1.2%）和其他相关内科疾病（1.5%）的脑缺血百分比低于近期临床系列报道。
年轻女性和老年男性中主要存在两组不同的发病机制决定因素，这支持了旨在严格医学控制已确认的脑血管危险因素的公共卫生措施。
