Abstract WMP70: Yield of Screening Tests for Systemic Vasculitis in Ischemic Stroke in Young Adults

Abstract

Background and Purpose: The causes of ischemic stroke in young adults are more heterogeneous than in the elderly. Sometimes ischemic stroke in young adults is complicated by a systemic vasculitis, which can involve the brain. Therefore, a panel for systemic vasculitis could be considered as one of the etiological work-up of ischemic stroke in young adults. However, little is known about the yield of screening tests for systemic vasculitis in young ischemic stroke patients. Methods: Consecutive patients aged 18 to 45 years with ischemic stroke between January 2011 and June 2017 were included. They all underwent screening tests for systemic vasculitis including rheumatoid factor (RF), antinuclear antibody (ANA), antineutrophil cytoplasmic antibodies (ANCAs), anticardiolipin antibody, lupus anticoagulant, antiphospholipid antibody, anti-DNA antibody, and anti-Ro/SSA and La/SSB antibodies. Results: Among consecutive 2,938 acute ischemic stroke patients during study period, 177 patients (6.0%) were aged 18-45 years. The mean age was 39.0 years. Vasculitis panel screening results were positive in three patients (1.7%). They all had other symptoms or signs of systemic vasculitis. Two female patients with positive ANA and anti-DNA antibody were finally diagnosed as systemic lupus erythematosus (SLE). One patient was compatible with the diagnosis of anti-phospholipid antibody syndrome, and the other patient’s stroke was thought to be related to SLE vasculitis. They all had clinical symptoms of SLE including malar rash and Raynaud phenomenon. One male patient showed positive pANCA. A year previously, he was diagnosed with asthma. Inflammation markers in peripheral blood exams were elevated (CRP 8.21 mg/dl, leukocyte count 17.7/nl), the rate of eosinophilic cells increased (42%). He fulfilled the criteria for the diagnosis of Churg-Strauss syndrome. Conclusions: In the absence of systemic symptoms or signs of vasculitis, vasculitis panel screening in young ischemic stroke patients has a low yield. It’s better to consider individual clinical features and cost effectiveness before screening tests for systemic vasculitis in ischemic stroke in young adults.