Лакунарный инсульт у мужчин молодого возраста

Abstract

Background: ischemic strokes at a young age are one of the urgent problems of modern reality, since they occur in persons of working age. These vascular catastrophes are of great economic importance. Lacunar stroke (LS), or small vessel occlusion, is one of the main ischemic stroke (IS) subtypes with a variety of modifiable risk factors for its development. Aim: to evaluate the main risk factors, the stroke patterns and the endothelial function state in young male patients (18—50 y.o.) with LS. Patients and Methods: 46 male patients aged 18–50 y.o. with LS were included in the study. The NIHSS neurological deficit assessment scale, the Modified Rankin Scale and the Rivermead Mobility Index were used to objectify the severity of existing clinical symptoms and assess the IS severity. The patients underwent brain CT and/or MRI, ultrasound and duplex scanning of neck and head vessels, ECG, ECHO cardioscopy and laboratory examination. Shoulder ultrasound (SU) was used to assess the endothelial vasomotor function. Results: in the examined patients, the main risk factors were hypertension (97.8%), smoking (67.4%), dyslipidemia (41.3%) and obesity (8.7%). At the same time, the combination of hypertension and smoking was noted in 67.4% of cases, the combination of hypertension, smoking and regular alcohol consumption — in 17.4% of cases, atherosclerosis of the major arteries of the head — in 56.5% of cases. Isolated common carotid artery (CCA) stenosis was observed in 22.2% of cases, the degree of which varied from 20 to 35%, in 50% — internal carotid artery (ICA) stenosis (20—40%) and in 33.3% — combined stenoses of the CCA and ICA (25—60%). SU revealed a disorder in the form of a decreased vasomotor reactivity in 20 (58.8%) of the 34 examined patients. Conclusion: in male patients aged 18–50 y.o. with LS, multiple modifiable risk factors were identified. Ultrasound signs of endothelial dysfunction were detected in more than half of the patients. KEYWORDS: lacunar stroke, young age, modifiable risk factors, endothelial dysfunction, shoulder ultrasound. FOR CITATION: Pizov N.A., Baranova N.S., Pizova N.V., Bakucheva M.V. Lacunar stroke in young male patients. Russian Medical Inquiry. 2023;7(10):614–619 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-1.