Cerebral Infarction In Young Patients Research Articles

Неатеросклеротическая васкулопатия как причина инфаркта головного мозга в молодом возрасте

Представлен аналитический обзор литературы по проблеме инфаркта головного мозга у лиц молодого возраста (18–45 лет). Показана актуальность диагностики и лечения инфаркта мозга у пациентов молодого возраста в Беларуси, Украине и Российской Федерации. В соответствии с общепризнанной концепцией гетерогенности инфаркта мозга рассмотрены некоторые редкие причины развития инсульта у лиц молодого возраста. Инфаркт мозга у данной категории пациентов отличается этиологическим полиморфизмом, имеет особенности течения и прогноза. Подробно рассмотрены неатеросклеротические васкулопатии, которые включают большую группу заболеваний с различными основными механизмами — иммунологические, инфекционные, патологию соединительной ткани. Большое внимание уделено диссекции сосудов головного мозга, причинам ее возникновения, особенностям клинических проявлений. Приведены результаты международных исследований, посвященных новым подходам к диагностике и лечению пациентов со спонтанной диссекцией, васкулитами, фибромускулярной дисплазией. Широкое внедрение в практику методов нейровизуализации головного мозга и улучшение качества неинвазивных ангиографических изображений способствовали более точной и своевременной диагностике и дифференциации васкулопатий, что имеет большое значение для дальнейшей тактики лечения. Вместе с тем наши исследования по изучению патогенетических характеристик инфаркта мозга у пациентов молодого возраста продолжаются и требуют дальнейшего уточнения.

Left ventricular diastolic dysfunction is associated with cerebral infarction in young hypertensive patients: A retrospective case-control study.

Studies have indicated that hypertension is associated with the occurrence of acute cerebral infarction (CI) in young patients (18-45 years). However, the association between CI and left ventricular diastolic (LVD) dysfunction in young patients with hypertension has rarely been reported. The purpose of the present study was to investigate the association between LVD dysfunction and acute CI in young patients with hypertension. A total of 92 patients with acute CI who had hypertension were selected as the study group (CI group) and 98 young patients with only hypertension were selected as the control group (non-CI group). Blood pressure measurements, LVD functional assessment and cerebral MRI were performed. The χ² test was used to compare the left ventricular diastolic function between the CI and non-CI groups. The results indicated that LVD function of young patients was associated with hypertension and there was a correlation between the decrease in LVD function and the occurrence of acute CI in young patients with hypertension. The incidence of acute CI was higher in patients with decreased LVD function than in those with normal LVD function. In conclusion, hypertension in the young is associated with decreased LVD function and is a risk factor for diastolic dysfunction of the left ventricle. LVD function may be an independent predictor of acute CI in young patients with hypertension and should be considered by clinicians. By predicting the risk of acute CI in young patients with hypertension, LVD testing may aid in the primary prevention of CI or guide early treatment.

Relationship between levels of homocysteine and serum uric acid and stability of carotid atherosclerotic plaque in young patients with cerebral infarction

Objective To investigate the relationship between levels of homocysteine （ Hcy ） and serum uric acid（ UA） and stability of carotid atherosclerotic plaque in young patients with cerebral infarction .Methods 150 cases of cerebral infarction in young patients carried the carotid ultrasonography were divided into the non -plaque group （ n=37）,stable plaque group（n=52） and unstable plaque group（n=61） according to the results.The levels of Hcy and UA in the three groups of patients were detected and analyzed statistically .Results The stable plaque group′s Hcy and UA levels were （15.92 ±2.52）μmol/L and （294.85 ±25.52）μmol/L,which were significantly higher than those of the non-plaque group（t=7.33,6.89,all P〈0.05）;The unstable plaque group′s Hcy and UA levels were （23.17 ±3.82 ）μmol/L and （ 388.57 ±26.61 ）μmol/L, which were significantly higher than those of the the non-plaque group and stable plaque group（t=9.82,10.02,6.90,7.12,all P〈0.05）.Conclusion There is a close correlation between the stability of carotid artery plaque and the levels of Hcy and UA . Key words: Brain infarction; Cysteine; Uric acid; Atherosclerosis carotid

The potent different risk factors for cerebral infarction in young patients with and without type 2 diabetes: Subanalysis of the Young Cerebral Infarction Study (YCIS)

BackgroundTo compare risk factors, stroke characteristics, and short-term prognosis between diabetic and nondiabetic young ischemic stroke patients to provide information for patient management, counseling, and future research in these patient groups. MethodsAll consecutive patients between the ages of 18 and 45 years with first-ever cerebral infarction during 2001–2010 were recruited to participate in the study. Using multivariate logistic regression modeling, demographic characteristics, cerebrovascular risk factors, clinical events, stroke subtypes, and outcome in ischemic stroke patients with and without diabetes were compared. ResultsLogistic regression analysis adjusted for confounders confirmed the following independent susceptibility markers: in a substudy of young patients with and without diabetes, the predictors of short-term outcome were more likely to be TOAST subtype, initial stroke severity and serum uric acid, and age at onset, dyslipidemia, initial stroke severity and serum fibron levels correlate with a higher risk for incident stroke in young with diabetes. ConclusionOur findings suggest that diabetic and nondiabetic ischemic stroke patients exhibit a distinct risk-factor and etiologic profile and may help clinicians to assess prognosis more accurately.

Sex differences in risk factors, etiology, and short-term outcome of cerebral infarction in young patients

Investigations to date have demonstrated that the underlying etiology, causes and burden of stroke may be different for women and men. However, data regarding sex differences among young cerebral ischemic stroke patients remains scarce. We conducted this study in 669 young Chinese adults with acute ischemic stroke as determined by the modified Rankin Scale at discharge. Stepwise multiple logistic regression analysis confirmed that NIHSS score (OR 1.277; 95% CI 1.179–1.383, p=0.000), diabetes mellitus (OR 0.121; 95% CI 0.0209–0.718, p=0.020) and serum glucose levels on admission (OR 1.135; 95% CI 0.997–1.293, p=0.046) independently predict short-term outcomes at discharge in young female patients with acute stroke, but the significant variables related to male patients appeared to be Apo A1 (OR 0.165; 95% CI 0.035–0.776, p=0.023) and NIHSS score on admission (OR 1.458; 95% CI 1.325–1.605, p=0.000). In our series, our data suggest that there are several sex differences for risk of cerebral infarction in young patients, which have important implications for the diagnosis, management and prognosis of stroke in young adults.

Aspirina frente a anticoagulación en pacientes jóvenes con infarto cerebral secundario a síndrome antifosfolípido primario

The primary antiphospholipid syndrome (PAS) is an independent risk factor for cerebral infarction. AIM. To evaluate the risk of recurrence, to compare different treatments and determine the risk factors associated with recurrence and hemorrhagic complications in patients with cerebral infarction and PAS. Prospectively collected data from 92 patients under 45 years (71% female, mean age 33.8 ± 8.9 years) with confirmed diagnoses of cerebral infarction and PAS, treated with anticoagulants (n = 54) or aspirin (n = 38) were retrospectively analyzed. Clinical follow-up was obtained by neurological examination every 6 to 12 months. Outcome measures were: recurrence of CI, symptomatic intracerebral hemorrhage, and minor bleeding. During a median follow-up of 54 months (range: 12-240 months), there were 8 (9%) recurrent cerebral infarctions, with no difference between treatment with aspirin (n = 0) or anticoagulants (n = 8). The annual rate of recurrence was 0,014 person-years of follow-up. The history of previous thrombosis and spontaneous abortions were more frequent in patients with recurrence. Aspirin-treated patients more frequently came from rural areas. Four anticoagulated patients developed bleeding complications, two minor bleeding and two subdural hematomas. 76% of the cases evolved with good outcome (modified Rankin scale: 0-2). With the limitations of a nonrandomized study, our data suggest that the risk of recurrent arterial cerebral infarction in young patients with cerebral infarction secondary to PAS is low, probably non-uniform and independent of the type of antithrombotic.

Multiple spontane Dissektionen der hirnversorgenden Arterien bei Ehlers-Danlos-artiger Bindegewebserkrankung Typ III mit atypischer klinischer Manifestation

We report on a patient with spontaneous bilateral dissections of the carotid arteries and dissections of the right vertebral and basilar artery who developed cerebral infarction in the bilateral capsula interna, basal ganglia and border zones following global hypoperfusion. The patient presented atypically with psychomotoric slowing. Headache was the only symptom leading to the diagnosis of spontaneous carotid dissections. Electron microscopy of a skin biopsy sample revealed an Ehlers-Danlos-like connective tissue disease Type III, although the patient showed no typical habitus with hyperextensible skin and hypermobile joints. Spontaneous dissection of cerebral arteries is a leading cause for cerebral infarction in young patients. They can present without ischaemic symptoms and should therefore be considered in patients with atypical symptoms. Even in patients without typical habitus, connective tissue disease can be the underlying aetiology. In our case, neurological symptoms progressed in spite of sufficient anticoagulation. Stent-assisted angioplasty could not be performed due to the anatomical situation of the carotid arteries. In general, however, stent-assisted angioplasty might be an option, if anticoagulation therapy fails to prevent progression of the disease.

Abstracts of Literature

Abstracts of Literature

Human immunodeficiency virus infection and stroke in young patients.

To determine the association between human immunodeficiency virus (HIV) infection and stroke among young persons. Retrospective case-control study. Large, inner-city public hospital. All patients aged 19 to 44 years with a diagnosis of stroke, whose HIV status was determined, admitted from January 1990 through June 1994. Controls matched for age and sex were selected from patients who were admitted during the same period for status asthmaticus whose HIV status was known. The associations of HIV infection with all strokes and with cerebral infarction, after adjustment for other cerebrovascular risk factors, were evaluated by Mantel-Haenszel stratified analyses. The subtypes and causes of stroke in HIV-infected patients were compared with HIV-seronegative patients. The HIV infection was associated with stroke (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0-5.3) and cerebral infarction (OR, 3.4; 95% CI, 1.1-8.9), after adjustment for other cerebrovascular risk factors. Among patients with stroke, cerebral infarction was more frequent in HIV-infected patients than in HIV-seronegative patients (20 [80%] of 25 vs 48 [56%] of 88, P = .04). The frequency of cerebral infarctions associated with meningitis (P < .001) and protein S deficiency (P = .06) was higher in HIV-infected patients than in seronegative patients. Our study suggests that HIV infection is associated with an increased risk of stroke, particularly cerebral infarction in young patients. This risk is probably mediated by increased susceptibility of HIV-infected patients to meningitis and protein S deficiency.

Floating Thrombus in the Innominate Artery as a Cause of Cerebral Infarction in Young Adults

Intraluminal thrombi in the carotid circulation are uncommonly reported as a cause of stroke in young adults. We report two young women who suffered an embolic cerebral infarction from a floating thrombus in the innominate artery, without clotting abnormalities. Intraluminal thrombus at that level may have been previously overlooked as a cause of embolic cerebral infarction in young patients, because of the lack of a systematic assessment of the aortic arch and its proximal branches. Taking into account the fact that the evolution may be rapidly fatal, this possibility should be considered early in young patients without a clear etiology of stroke.