Williams L S, Garg B P, Cohen M, Fleck J D, Biller J
Department of Neurology, Indiana University School of Medicine, Indianapolis 46202, USA.
Neurology. 1997 Dec;49(6):1541-5. doi: 10.1212/wnl.49.6.1541.
Specific strategies for primary and secondary stroke prevention in children and young adults can only be recommended once the causes of stroke in these age groups are well described. ICD-9 codes were used to identify children aged 1 to 18 years with acute ischemic stroke. Young adults aged > 18 to 45 years were identified from the Indiana University and Northwestern University Young Adults Stroke Registries. Validated criteria were used to subtype ischemic stroke as atherothrombotic (AT), cardioembolic (CE), small-vessel (SV), other determined cause, or unknown cause. Ninety-two children and 116 young adults were identified. Stroke subtypes in children/young adults (percentages) were as follows: AT 0/16 (p < 0.001), CE 15/14 (p = 1.0), SV 0/3 (p = 0.26), other 49/44 (p = 0.40), and unknown 36/23 (p = 0.04). Children had more prothrombotic causes (25% versus 14%, p = 0.03), and young adults had more dissections (3% versus 15%, p = 0.005). Children aged 15 to 18 years had causes of ischemic stroke more similar to those in young adults. The cause of ischemic stroke is less often identified in children than it is in young adults. Children have more prothrombotic causes of stroke, and adults have more atherothrombotic causes and dissections. Lacunar strokes are rare in both children and young adults. The age of 15 years should be used to separate childhood from young-adult ischemic stroke.
只有在充分描述儿童和青年人群中卒中的病因之后，才能推荐针对这些人群进行一级和二级卒中预防的具体策略。使用国际疾病分类第九版（ICD - 9）编码来识别1至18岁患有急性缺血性卒中的儿童。年龄大于18至45岁的青年人群来自印第安纳大学和西北大学青年卒中登记处。采用经过验证的标准将缺血性卒中分为动脉粥样硬化血栓形成性（AT）、心源性栓塞性（CE）、小血管性（SV）、其他明确病因或病因不明几类。共识别出92名儿童和116名青年。儿童/青年人群中卒中亚型（百分比）如下：AT 0/16（p < 0.001），CE 15/14（p = 1.0），SV 0/3（p = 0.26），其他49/44（p = 0.40），不明36/23（p = 0.04）。儿童有更多的促血栓形成病因（25% 对14%，p = 0.03），青年有更多的动脉夹层（3% 对15%，p = 0.005）。15至18岁的儿童缺血性卒中病因与青年人群更相似。儿童缺血性卒中的病因比青年人群更不易确定。儿童卒中的促血栓形成病因更多，而成年人动脉粥样硬化血栓形成病因和动脉夹层更多。腔隙性卒中在儿童和青年人群中均罕见。15岁应作为区分儿童与青年缺血性卒中的年龄界限。
