Young Ischemic Stroke Patients Research Articles

The options for prognosis of the outcome of ischemic stroke in young patients

Objective. To develop criteria for prognosis of the outcome of ischemic stroke, taking into account age, dynamics of state assessment, the Rankin and NIHSS scales readings and the fact of disability in the long-term period. The universal reliable criteria, that allow to predict the outcome of ischemic stroke, have not been developed yet. Material and methods. The study group consisted of 246 patients with ischemic stroke aged 18 to 44 who were observed from 2008 to 2021. Results. It is impossible to predict disability in a long-term period of ischemic stroke reliably. Predicting the outcome of ischemic stroke using the Rankin and NIHSS scales is significant in the acute period and allows to predict the dynamics of recovery in mild and moderate cases. Conclusion. The predictive value of the integrative indicators of the patient's condition, assessed by the Rankin and NIHSS scales, has been established.

A novel NODAL variant in a young embolic stroke patient with visceral heterotaxy

BackgroundIschemic stroke in young adults can be caused by a variety of etiologies including the monogenic disorders. Visceral heterotaxy is a condition caused by abnormal left–right determinations during embryonic development. We aimed to determine the cause of a young ischemic stroke patient with visceral heterotaxy.Case presentationWe performed neurological, radiological, and genetic evaluations in a 17-year-old male patient presenting ischemic stroke and visceral heterotaxy to determine the underlying cause of this rare disease combination. Brain magnetic resonance imaging (MRI) showed evidence of embolic stroke, abdominal computed tomography (CT) showed visceral heterotaxy, and echocardiogram showed cardiac anomaly with right-to-left-shunt (RLS). Whole genome sequencing (WGS) revealed a heterozygous missense variant (NM_018055.5: c.1016 T > C, p.(Met339Val)) in the NODAL gene, which is essential to the determination of the left–right body axis.ConclusionsOur study highlights the importance of evaluating genetic etiology in young ischemic stroke and the need for stroke risk management in visceral heterotaxy patients with RLS. To the best of our knowledge, we report the first genetically-confirmed case of visceral heterotaxy with young embolic stroke reported to date.

Etiologic subtypes of first and recurrent ischemic stroke in young patients using A-S-C-O and TOAST classification criteria: A retrospective follow-up study.

Scarce data exist on the etiology of recurrent ischemic strokes (ISs) among young adults. We analyzed the etiology of first-ever and recurrent events and the differences between them. Patients aged 15-49 years with a first-ever IS in 1994-2007 were included in the Helsinki Young Stroke Registry. In this retrospective cohort study, data on recurrent ISs were identified from Care Register for Health Care until the end of 2017 and Causes of Death Register and from patient records until the end of 2020. All first-ever and recurrent ISs were classified using Atherosclerosis-Small vessel disease-Cardioembolism-Other Cause (A-S-C-O) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classifications. A total of 970 patients were included (median age at index IS 46 years, interquartile range 43-48, 33% women), of which 155 (16.0%) patients had recurrent IS, with 8 (5.2%) fatal cases and 5 (3.2%) unverifiable cases. The median follow-up was 17.4 (IQR 13.9-21.7) years. Median time from the index event to the first recurrent event was 4.5 (interquartile range [IQR] 1.6-10.2) years. Recurrence was more often due to definite cardioembolism (10.7% vs 18.0%, p = 0.013), while the proportion of other definite A-S-C-O subgroups remained the same. With TOAST classification, the proportion of true cryptogenic ISs decreased (16.7% vs 6.7%, p = 0.003), while those with incomplete evaluation increased (9.3% vs 19.3%, p = 0.015). Other TOAST phenotypes remained the same. The proportion of definite cardioembolism increased at recurrence using the A-S-C-O classification and the number of cryptogenic ISs decreased using the TOAST classification, while cases with incomplete evaluation increased. Most etiologies remained the same.

Cognitive impairment and emotional disturbances in young ischaemic stroke patients - scoping review

Cognitive impairment and emotional disturbances in young ischaemic stroke patients - scoping review

Abstract 96: Temporal Trends in Vascular Risk Factor Burden Among Young Adults With Ischemic Stroke: The Florida Stroke Registry

Introduction: While ischemic stroke (IS) in the young (18-55) is thought to have different etiologies than in older patients, a rise in vascular risk factors (VRFs) among young adults may translate to an IS risk profile similar to the older population. We aimed to examine the prevalence of VRFs and temporal trends in VRF burden among young patients presenting with IS. Methods: Data was prospectively collected by Get With the Guidelines-Stroke® hospitals participating in the Florida Stroke Registry between January 2010 and December 2022. Patients aged 18-55 with a diagnosis of IS were included and separated into two age groups: 18-35 and 36-55. VRFs included hypertension, dyslipidemia, obesity, smoking, atrial fibrillation, coronary artery disease, heart failure, diabetes, and sleep apnea. Multimorbidity was defined as having ≥4 VRFs. Results: 47,792 patients with IS were included (43% female, median age 49, 51% white), comprising 4,275 patients aged 18-35 (8.9%) and 43,517 aged 36-55 (91.1%). The prevalence of each VRF was higher among patients aged 36-55 vs 18-35 (all p values <0.001), and only 15.3% of patients aged 36-55 and 40.0% of patients aged 18-35 had 0 VRFs. African American patients with IS had a significantly higher prevalence of multimorbidity than white or non-white Hispanic patients; specifically in those aged 18-35 (6.1% vs 3.5% vs 3.5%, p <0.001), while those aged 36-55 demonstrated a smaller difference (17.6% vs 17.2% vs 15.4% p <0.001).VRF burden worsened across the study period, with an increase in multimorbidity from 11.2% to 21.7% in patients 36-55 (p<0.0001) and from 1.3% to 6.6% in patients 18-35 (p= 0.0006). Conclusions: Increasingly, young stroke patients have traditional VRFs. The prevalence of multimorbidity disproportionately affects African American patients and has significantly increased over the past 12 years. Efforts targeting VRFs reduction must start as early as possible in light of the rise in VRF burden amongst young IS patients.

A cross-sectional analysis of the relationship between ischemic stroke and uric acid in young people in highland areas.

To investigate the relationship between serum uric acid (SUA) levels and ischemic stroke in young patients in the Ganzi Tibetan plateau area. A cross-sectional survey was undertaken from January 2020 to June 2023 involving young patients (age: 15-45 years) diagnosed with ischemic stroke. The survey was conducted at the Department of Internal Medicine of the People's Hospital of Derong County, Ganzi Prefecture. The participants underwent a comprehensive assessment, including questionnaire surveys, physical examinations, laboratory tests, and head computed tomography (CT) examinations. Based on the tertiles of serum uric acid (SUA) levels, the patients were stratified into three groups. Furthermore, stroke severity was classified into mild (1-4 points), moderate (5-15 points), and severe (>15 points) categories using the National Institute of Health Stroke Scale. The severe stroke group exhibited higher levels of age, glucose, systolic blood pressure, serum triglyceride, low-density lipoprotein cholesterol, and serum uric acid (SUA) compared to the mild stroke group (P < 0.05). Furthermore, the likelihood of male sex, advanced age, smoking, and a family history of stroke, diabetes mellitus, and heart disease were significantly elevated in the severe stroke group compared to the moderate stroke group (P < 0.05). Multivariate logistic regression analysis conducted on young adults residing in highland areas revealed a significant association between SUA levels and the risk of stroke. Elevated SUA levels serve as a distinct risk factor for the development of a major stroke in young patients in highland areas. At SUA levels of 320.56 mol/L, the risk of a moderate-to-severe stroke is noticeably elevated.

Recurrent vascular events partially explain association between diabetes and poor prognosis in young ischemic stroke patients

Background and aimsStroke is the second leading cause of death and third leading cause of disability worldwide. There is an increasing incidence of stroke among the young. In this study, we aimed to identify factors associated with poor long-term prognosis in young stroke patients. MethodsIn this longitudinal observational study, we recruited 147 young ischemic stroke patients within one week of ischemic stroke and followed them up for functional outcome (modified Rankin score (mRS)), recurrent vascular events, and recurrent hospitalisation. Poor function was labelled as mRS score of 3 and above. We performed univariate and multivariable logistic regression analyses to determine factors associated with poor long term functional outcome. ResultsAt a median follow-up of 7-years, 32 (22%) of the 147 patients had poor functional outcome. In multivariable analyses, diabetes mellitus (OR = 9.01, CI 3.15 to 26.92), was the only independent predictor of poor function. In analyses stratified by diabetic status, recurrent vascular events (OR = 4.47, CI 1.40 to 14.28) were associated with poor functional outcome within young diabetic patients but not in non-diabetic patients. ConclusionsOur findings suggest that diabetes mellitus affects long-term functional outcome in young ischemic stroke and that its effect is mediated partly by recurrent vascular events. Data access statementData obtained from Multi-Centre Retinal study (MCRS), Singapore site. Data cannot be made publicly available due to potentially identifiable research participant information.

D-dimer levels in young patients with ischemic stroke: A clinical report

Objective: This clinical report investigates the role of D-dimer in young ischemic stroke patients and its association with stroke severity assessed by the National Institutes of Health Stroke Scale (NIHSS) and functional outcomes evaluated using the modified Rankin Scale (mRS). Subject and method: We conducted a prospective study on 35 young patients (aged under 46) diagnosed with acute ischemic stroke at 108 Military Central Hospital in Ha Noi from October 2022 to April 2023. Each patient underwent thorough clinical evaluation, including a detailed medical history, physical examination, and neuroimaging studies. D-dimer levels were measured within 24 hours of admission using standard laboratory assays. The patients were divided into 2 groups according to mRS scores or NIHSS scores evaluated on the first day inhospital. Result: We observed that plasma D-dimer level correlated significantly with the prognosis of acute cerebral infarction (ACI) evaluated based on both mRS scores (1526.58 ± 1462.51ng/mL for poor prognosis versus 348.22 ± 201.14ng/mL for good prognosis, p&lt;0.05) and NIHSS scores (1962.00 ± 1578.50ng/mL for poor prognosis versus 501.93 ± 663.10ng/mL for good prognosis, p&lt;0.05). Conclusion: Our results demonstrated that there is a significant correlation between elevated D-dimer levels and worsened functional outcomes and increased mortality in young patients with acute ischemic stroke.

Recurrent vascular events partially explain association between diabetes and poor prognosis in young ischemic stroke patients

Recurrent vascular events partially explain association between diabetes and poor prognosis in young ischemic stroke patients

Functional brain connectivity in young adults with post-stroke epilepsy.

Approximately 1 in 10 young stroke patients (18-50 years) will develop post-stroke epilepsy, which is associated with cognitive impairment. While previous studies have shown altered brain connectivity in patients with epilepsy, little is however known about the changes in functional brain connectivity in young stroke patients with post-stroke epilepsy and their relationship with cognitive impairment. Therefore, we aimed to investigate whether young ischaemic stroke patients have altered functional networks and whether this alteration is related to cognitive impairment. We included 164 participants with a first-ever cerebral infarction at young age (18-50 years), along with 77 age- and sex-matched controls, from the Follow-Up of Transient Ischemic Attack and Stroke patients and Unelucidated Risk Factor Evaluation study. All participants underwent neuropsychological testing and resting-state functional MRI to generate functional connectivity networks. At follow-up (10.5 years after the index event), 23 participants developed post-stroke epilepsy. Graph theoretical analysis revealed functional network reorganization in participants with post-stroke epilepsy, in whom a weaker (i.e. network strength), less-integrated (i.e. global efficiency) and less-segregated (i.e. clustering coefficient and local efficiency) functional network was observed compared with the participants without post-stroke epilepsy group and the controls (P < 0.05). Regional analysis showed a trend towards decreased clustering coefficient, local efficiency and nodal efficiency in contralesional brain regions, including the caudal anterior cingulate cortex, posterior cingulate cortex, precuneus, superior frontal gyrus and insula in participants with post-stroke epilepsy compared with those without post-stroke epilepsy. Furthermore, participants with post-stroke epilepsy more often had impairment in the processing speed domain than the group without post-stroke epilepsy, in whom the network properties of the precuneus were positively associated with processing speed performance. Our findings suggest that post-stroke epilepsy is associated with functional reorganization of the brain network after stroke that is characterized by a weaker, less-integrated and less-segregated brain network in young ischaemic stroke patients compared with patients without post-stroke epilepsy. The contralesional brain regions, which are mostly considered as hub regions, might be particularly involved in the altered functional network and may contribute to cognitive impairment in post-stroke epilepsy patients. Overall, our findings provide additional evidence for a potential role of disrupted functional network as underlying pathophysiological mechanism for cognitive impairment in patients with post-stroke epilepsy.

Risk factors for stroke recurrence in young patients with first-ever ischemic stroke: A meta-analysis.

At present, the incidence rate of ischemic stroke in young people is increasing yearly, and the age of onset is increasingly young. Therefore, primary and secondary prevention of ischemic stroke in young people, especially secondary prevention, is particularly crucial. We aimed to comprehensively evaluate risk factors for stroke recurrence in first-ever young ischemic stroke (YIS) patients. The meta-analysis was used to quantitatively analyze the research results on risk factors for stroke recurrence in first-ever YIS patients both domestically and internationally. Stata12.0 software was used for heterogeneity testing, publication bias analysis, sensitivity analysis, and the calculation of combined odds ratios and 95% confidence intervals. The odds ratio (OR) values of the relationship between hypertension and hyperlipidemia and recurrence of first-ever YIS were 1.54 (1.05-2.26) and 1.12 (1.00-1.25), respectively. The OR values of male sex, type 2 diabetes, smoking, drinking and YIS recurrence were 1.66 (0.98-2.79), 1.01 (0.64-1.59), 1.21 (0.83-1.76), and 1.28 (0.82-2.53), respectively. The relationship between male sex, type 2 diabetes, smoking, drinking and YIS recurrence was ambiguous. Hypertension and hyperlipidemia are important risk factors for stroke recurrence in first-ever YIS patients, and active intervention should be taken.

Diagnosis of atrial fibrillation in young patients with ischemic stroke: A systematic review and meta-analysis

IntroductionThe recommended cardiac rhythm evaluation to determine the etiology of ischemic stroke (IS) is similar in all patients regardless of their age and includes an electrocardiogram and at least a 24-hour heart rhythm monitoring. However, it is known that the main causes of IS vary according to patients’ age. There is a higher preponderance of arterial dissections and patent foramen ovale in younger patients, while atrial fibrillation (AF) is more common in older patients. AimsTo determine the proportion of AF in young IS reported in the literature and determine if young IS patients found to have AF had known structural cardiac pathology. MethodsSystematic review of the literature searching PubMed and Embase for articles published since their inception to August 2020. Inclusion criteria were studies including at least 10 patients, aged 14-50 years-old, clinical or radiological diagnosis of IS and quantification of patients found to have AF. We conducted a meta-analysis using a random-effects model and calculated pooled proportions with 95% confidence intervals. Results8331 articles were screened, 154 were selected for full-text review. 43 studies were included in our final analysis (902800 patients). The proportion of AF in young IS overall was 3.1% [95%CI 2.4-3.7], I2 93.88%. Sub-analysis revealed a proportion of AF of 3.8% [95% CI 0.3-7.3] in lower-middle-income economies, versus 5.4% [95% CI 3-7.9] in upper-middle-income economies, and 2.2% [95% CI 1.6-2.8] in high-income economies. Only 3 studies mentioned the proportion of patients with AF that had structural cardiac pathology. ConclusionThe proportion of AF in young IS was low. More studies are needed to better understand if young IS patients diagnosed with AF had a priori known structural cardiac pathology that could increase the probability of finding AF. This could lead to a reevaluation of the need for 24 hours cardiac rhythm evaluation in young patients without cardiac pathology.

Risk Factors for Acute Ischaemic Stroke in Young Adults in Armed Forces Medical Institute of Dhaka

Background: Stroke is a leading cause of death and disability in developing countries, afflicting individuals at a young age. The affection of economically productive group adds further to the overall disease burden. The contribution of established vascular risk factors to ischaemic stroke in young adults has not been evaluated systematically in CMH, Dhaka Cantonment. The purpose of the study is to detect the risk factors for acute Ischaemic stroke in adults. Materials and methods: The case-control study was carried out in the department of Neurology and Medicine, CMH Dhaka during October 2019 to August 2020. Consecutive ischemic stroke patients who met the inclusion criteria and were hospitalized in the Department of Neurology and Medicine at CMH Dhaka were included in the study. Results: The mean age of young patients with ischaemic stroke was 40.1 (SD± 6.6) years (Range 17-45 years). There were 40 (59.7%) male and 27 (40.3%) female with ratio of male to female was 1.5:1. Risk of acute ischaemic stroke was 2.7 times higher in smoker [36 (53.7%) vs 20 (29.9%) OR=2.7, 95% of 01=1.34-5.55, p&lt;0.01] 2.4 times higher in diabetic [23 (34.3%) vs 12 (17.9%), OR=2.4, 95% of 01=1.07-5.35, p&lt;0.05], 2.6 times higher in hypertensive patients [27 (40.3%) vs 14 (20.9%), OR=2.6, 95% of 01=1.19-5.49; p&lt;0.05], 4.2 times higher in patients with atrial fibrillation [11 (16.4%) vs 3 (4.5%)]. The mean BMI of the respondents was 21.8 (SD± 3.3) Kg/M2 in stroke patients of young and was 22.3 (SD 2.9) Kg/M2 in control group (p&gt;0.05). Conclusion: Ischemic stroke in young patients has wider risk factors. Hypertension, diabetes mellitus, smoking and atrial fibrillation are the most common risk factors of acute ischemic stroke in young adults. Early identification of risk factors and proper prevention, treatment and life style modification may reduce the morbidity and mortality in young stroke patients. IAHS Medical Journal Vol 5(2), Dec 2022; 52-57

Increased cardiovascular events in young patients with mental disorders: a nationwide cohort study.

It remains unclear whether young patients with mental disorders have a higher risk of cardiovascular diseases than does the general population. Using a nationwide database, we investigated the prognostic association between the risks of myocardial infarction (MI), ischaemic stroke (IS), and mental disorders in young patients. Young patients aged between 20 and 39 years old who underwent nationwide health examinations between 2009 and 2012 were screened. A total of 6 557 727 individuals were identified and subsequently classified according to mental disorders including depressive disorder, bipolar disorder, schizophrenia, insomnia, anxiety disorder, post-traumatic stress disorder, personality disorder, somatoform disorder, eating disorder, and substance use disorder. Patients were then followed up for MI and IS until December 2018. Patients with mental disorders did not show unfavourable lifestyle behaviours or worse metabolic profiles than their counterparts. During the follow-up period (median, 7.6 years; interquartile range, 6.5-8.3), 16 133 cases of MI and 10 509 cases of IS occurred. Patients with mental disorders had higher risks of MI (log-rank P = 0.033 in eating disorder and log-rank P < 0.001 in all other mental disorders). Patients with mental disorders had higher risks of IS except post-traumatic stress disorder (log-rank P = 0.119) and eating disorder (log-rank P = 0.828). After adjusting for covariates, the overall diagnosis and each mental disorder were independently associated with increased cardiovascular endpoints. Mental disorders in young patients may have deleterious effects which increase the incidence of MI and IS. Prevention efforts are needed to prevent MI and IS in young patients with mental disorders.

Lack of Better Functional Outcomes in Young Border Hispanic Patients with Acute Ischemic Stroke after Endovascular Thrombectomy Compared to Older Patients: A Retrospective Chart Review (P8-5.001)

<h3>Objective:</h3> To study the interaction between age and Hispanic status to assess functional outcomes after endovascular thrombectomy in young versus older patients in a predominantly Hispanic population with a high prevalence of diabetes mellitus and obesity. <h3>Background:</h3> Previous data indicates that young acute ischemic stroke patients have better prognosis after endovascular thrombectomy. However, data has also shown that Hispanic patients are associated with poorer outcomes following thrombectomy, yet the combination of these factors is not well characterized. <h3>Design/Methods:</h3> A retrospective chart review of patients with an anterior circulation large vessel occlusion between August 2012 to January 2022 was performed, comparing the data of young patients (18–49 years) and older patients (≥ 50 years). Baseline characteristics and outcomes including Modified Rankin Scale (mRS), Symptomatic Intracerebral Hemorrhage (sICH), Expanded Treatment in Cerebral Infarction score (eTICI), and mortality were studied, adjusting for confounders. <h3>Results:</h3> A total of 811 patients, with 66 (8%) being 18 to 49 years old (33% female) revealed younger patients had lower presenting median National Institute of Health Stroke Scale (NIHSS) scores (9.5 versus 17, P &lt;0.001), and lower presence of co-morbidities. Both groups had a Hispanic predominance (73 versus 74%, P = 0.97). Subset analysis indicated that 90-day mRS score 0–2, sICH, eTICI, and mortality rates did not differ significantly. <h3>Conclusions:</h3> Our Hispanic population demonstrates no differences in sICH, mortality, and functional independence between young and older acute ischemic stroke patients after endovascular thrombectomy, deviating from previous data. The Texas Rio Grande Valley region has uniquely high rates of diabetes and obesity in young patients compared to elsewhere. Our findings demonstrate that Hispanic status and high diabetes rates in young patients may predominate over age-related outcome differences in prior data. Further investigation is needed to elucidate the unique intersection between Hispanic status, diabetes mellitus, obesity, and age in ischemic stroke patients after endovascular thrombectomy. <b>Disclosure:</b> Ms. Ravi has nothing to disclose. Mr. Desai has nothing to disclose. Mr. Ghozy has nothing to disclose. Dr. Tekle has nothing to disclose. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.

Fabry disease screening in young patients with acute ischemic stroke in Korea

Background: Fabry disease is an X-linked lysosomal storage disorder that results from a mutation in the α-galactosidase A (GLA) gene. It shows multiple organ involvement, including cerebrovascular disease. Since Fabry disease has a prevalence of approximately 4% in young patients with cryptogenic stroke, screening for this condition is recommended for young stroke patients. This study aimed to investigate the prevalence of Fabry disease in young acute ischemic stroke patients in Korea, the distribution of GLA gene mutations, and the subtypes of ischemic stroke. Methods: This study included 211 young patients with acute ischemic stroke or transient ischemic attack. To screen for Fabry disease, α-galactosidase A (α-Gal A) enzyme activity was measured and DNA sequencing analysis of the GLA gene was performed. Results: None of the patients exhibited low α-Gal A enzyme activity or had a pathogenic GLA mutation, but 18 nonpathogenic GLA gene variants were detected, including c.-10C&gt;T in 16 patients, c.-33C&gt;T in one patient, and c.196G&gt;C in one patient. The mean α-Gal A enzyme activity in 14 male patients with the c.-10C&gt;T variant was 5.17±1.19, which was significantly lower than that of male patients with the normal genotype (7.47±3.48, P&lt;0.05). The distribution of stroke subtypes in patients with GLA gene polymorphisms was not significantly different from that in patients with a normal genotype.Conclusions: This study demonstrates that Fabry disease is rare in young patients with ischemic stroke or transient ischemic attack in Korea, and we suggest that routine screening for Fabry disease may not be necessary for ischemic stroke patients.

Pulmonary AVM and Stroke: Case Report from Istishari Arab Hospital

Background: Pulmonary arteriovenous malformation (PAVM) is an abnormal communication between pulmonary artery and pulmonary vein which leads to multiple manifestations that range from hypoxia to neurological manifestation such as stroke due paradoxical emboli in young patients. Chest radiography and CT-enhanced studies help in diagnosis with pulmonary angiography which is considered the gold standard study for diagnosis. Management was done with embolization of the feeding artery or arteries. Case: A 31 year old female with no previous history of medical illness, presented with sudden onset left sided weakness and was diagnosed as a case of right sided ischemic stroke. After reviewing her case by multidisciplinary team and multiple imaging studies, pulmonary angiography showed that the patient had large right lower lung lobe PAVM in addition to another right middle lung lobe and left lower lung lobe smaller PAVM. After that, patient underwent embolization of with no complications. Conclusion: PAVM, although it is rare, should be considered in differential diagnosis as the cause of neurological manifestation as ischemic stroke in young patients by paradoxical emboli. Embolization of the feeding artery or arteries is the main treatment of PAVM.

Long Sleep Duration and Dissatisfaction with Sleep Quality Are Associated with Ischemic Stroke in Young Patients

Introduction: Suboptimal sleep duration and poor sleep quality have been proposed to increase stroke risk. However, their significance in young ischemic stroke is unclear. We aimed to investigate the importance of sleep duration and quality on young ischemic stroke patients. Methods: A multicenter matched case-control study was performed to evaluate under-recognized risk factors in young (<45 years) ischemic stroke patients in 8 tertiary hospitals in Korea. A total of 225 patients and 225 age- and sex-matched controls were enrolled in the same period. Detailed information about patients’ demographics, socioeconomic state, and traditional and nontraditional risk factors including sleep-related factors were obtained using structured questionnaires. Risk of ischemic stroke was estimated using conditional logistic regression analysis. Results: Although average sleep duration was similar in patients and controls, patients were more likely to have long (≥9 h) or extremely short (<5 h) sleep durations. In addition, the proportion of subjects with dissatisfaction with sleep quality was higher in patients than controls (66.2 vs. 49.3%, p < 0.001). In multivariable conditional logistic regression analysis, long sleep duration (OR: 11.076, 95% CI: 1.819–67.446, p = 0.009) and dissatisfaction with sleep quality (OR: 2.116, 95% CI: 1.168–3.833, p = 0.013) were independently associated with risk of ischemic stroke. Conclusions: Long sleep duration and dissatisfaction with sleep quality may be associated with increased risk of ischemic stroke in young adults. Improving sleep habit or quality could be important for reducing the risk of ischemic stroke.

Verified Parental Cardiovascular Events for Young and Middle-Aged Ischaemic Stroke Patients and Controls

Introduction. Nonmodifiable cardiovascular risk factors, like age and sex, are easily quantifiable. Due to immense technical progress in diagnostics and medical data storage, the aim of this study was to quantify, verify, and to compare parental cardiovascular events (CVE) as an additional nonmodifiable risk factor for young and middle-aged ischaemic stroke patients and controls. Methods. Information about parental CVE was first obtained by standardized questionnaires answered by 385 acute ischaemic stroke patients (15-60 years of age) and 260 controls. After consent to contact living and include deceased parents, patients and controls provided necessary personal identification of their parents. Thereafter, CVE were verified by standardized questionnaires answered by parents or medical records in case of deceased parents. Results. One hundred-and-nine (14.2%) of 770 patient parents vs. 128 (24.6%) of 520 control parents were not available for verification. Active participation was obtained for 229 (73.9%) of 310 patient parents vs.113 (58.2%) of 194 control parents. Medical record verification was obtained for 192 (54.7%) of 351 deceased patient parents, vs.103 (52.0%) of 198 deceased control parents. This study showed highest death rates of fathers (65.3% patient fathers and 57.6% control fathers) and highest numbers of CVE, especially myocardial infarction among patient fathers of patients aged 50-60 years. Discussion and Conclusion. Obtaining verified parental CVE as a nonmodifiable risk factor is still challenging, despite widely available digital medical information. To attain more accurate information on parental CVE, we recommend active involvement of family members in addition to medical record verification, especially for patients aged &lt;50 years. Trial Registration. This trial is registered with NCT01597453

Polymorphisms and gene expression of metalloproteinases and their inhibitors associated with cerebral ischemic stroke in young patients with sickle cell anemia.

Sickle cell anemia (SCA) is a genetic disease with great clinical heterogeneity and few viable strategies for treatment; hydroxyurea (HU) is the only widely used drug. Thus, the study of single nucleotide polymorphisms (SNPs) and the gene expression of MMPs 1, 2, 9, 7 and TIMPs 1 and 2, which are involved in the regulation of extracellular matrix, inflammation, and neuropathies, may provide further insights into the pathophysiology of the disease and elucidate biomarkers and molecules as potential therapeutic targets for patients with SCA. We evaluated 251 young individuals with SCA from northeastern Brazil. The groups were divided according to vaso-occlusive crisis (VOC) and cerebrovascular disease (CVD), compared to control individuals. SNP detection and gene expression assays were performed by real-time PCR, TaqMan system®. Both the expression levels of MMP1 gene, and the SNP MMP1-1607 1G/2G were associated with the risk of cerebral ischemic stroke (IS), and the expression of MMP1 was also associated with a higher frequency of VOC/year. Expression levels of MMP7, TIMP1, and TIMP2 were increased in patients conditioned to IS. The SNP 372T>C (rs4898) TIMP1 T alleles were more frequent in patients with > 5 VOC events/year. The SNP rs17576 of MMP9 showed differences in gene expression levels; it was increased in the genotypes AG, and AG+GG. The findings of this study, the SNPs, and expression provide initial support for understanding the role of MMPs-TIMPs in the pathophysiology of SCA in young patients.