Young Stroke Patients Research Articles

Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study.

SARS-CoV-2 is associated with new-onset neurological and psychiatric conditions. Detailed clinical data, including factors associated with recovery, are lacking, hampering prediction modelling and targeted therapeutic interventions. In a UK-wide cross-sectional surveillance study of adult hospitalized patients during the first COVID-19 wave, with multi-professional input from general and sub-specialty neurologists, psychiatrists, stroke physicians, and intensivists, we captured detailed data on demographics, risk factors, pre-COVID-19 Rockwood frailty score, comorbidities, neurological presentation and outcome. A priori clinical case definitions were used, with cross-specialty independent adjudication for discrepant cases. Multivariable logistic regression was performed using demographic and clinical variables, to determine the factors associated with outcome. A total of 267 cases were included. Cerebrovascular events were most frequently reported (131, 49%), followed by other central disorders (95, 36%) including delirium (28, 11%), central inflammatory (25, 9%), psychiatric (25, 9%), and other encephalopathies (17, 7%), including a severe encephalopathy (n = 13) not meeting delirium criteria; and peripheral nerve disorders (41, 15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared to normative data during the equivalent time period prior to the pandemic, cases of stroke in association with COVID-19 were younger and had a greater number of conventional, modifiable cerebrovascular risk factors. Twenty-seven per cent of strokes occurred in patients <60 years. Relative to those >60 years old, the younger stroke patients presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which were independently associated with a poor outcome. In summary, this study describes the spectrum of neurological and psychiatric conditions associated with COVID-19. In addition, we identify a severe COVID-19 encephalopathy atypical for delirium, and a phenotype of COVID-19 associated stroke in younger adults with a tendency for multiple infarcts and systemic thromboses. These clinical data will be useful to inform mechanistic studies and stratification of patients in clinical trials.

Shorter visual aura characterizes young and middle-aged stroke patients with migraine with aura.

To identify the clinical profile and aura characteristics of patients with Migraine with Aura (MwA) having acute cerebral ischemia, we compared stroke phenotype and risk factors in stroke patients with (S+MwA+) or without (S+MwA-) MwA and aura features in MwA patients with (S+MwA+) or without (S-MwA+) stroke. In this retrospective multicenter case-control study, we reviewed stroke phenotypes and vascular risk factors in S+MwA+ and S+MwA- patients younger than 60years and risk factors and aura type, duration, onset age, and the frequency in the previous year in S+MwA+ patients and S-MwA+ subjects matched for age and disease history, investigated for patent foramen ovale (PFO). 539 stroke (7.7% S+MwA+) and 94 S-MwA + patients were enrolled. S+MwA+ patients were younger (p =.0.004) and more frequently presented PFO [OR 4.89 (95% CI 2.12-11.27)], septal interatrial aneurism [OR 2.69 (95% CI 1.15-6.27)] and cryptogenic ischemic stroke (CIS) [OR 6.80 (95% CI 3.26-14.18)] than S+MwA- subjects. Significant atherosclerosis was not detected in S+MwA+ patients. Compared to S-MwA+, S+MwA+ patients were characterized by visual [OR 3.82 (95% CI 1.36-10.66)] and shorter-lasting (20.0min IQr 13.1 vs 30.0min IQr 25.0; p < 0.001) aura, and PFO [OR 1.26 (95% CI 1.03-1.54)]. Regression analysis evidenced that only shorter aura duration associated with stroke (p = 0.001). High-risk PFO was equally represented in S+MwA-, S+MwA+, S-MwA+ groups. Shorter visual aura and CIS characterize MwA patients with stroke. Although more prevalent, PFO can not be considered the main responsible for the increased stroke risk in MwA patients but as a part of a complex multifactorial condition.

Epidemiology and risk factors for stroke in young individuals: implications for prevention.

Summarize and examine the epidemiology, etiologies, risk factors, and treatment of stroke among young adults and highlight the importance of early recognition, treatment, and primordial prevention of risk factors that lead to stroke. Incidence of stroke, predominantly ischemic, among young adults has increased over the past two decades. This parallels an increase in traditional risk factors such as hypertension, diabetes, and use of tobacco, and use of illicit substances among young stroke patients. Compared to older patients, there is a much higher proportion of intracerebral and subarachnoid hemorrhage in young adults. The cause of ischemic stroke in young adults is also more diverse compared to older adults with 1/3rd classified as stroke of undetermined etiology due to inadequate effort or time spent on investigating these diverse and rare etiologies. Young premature Atherosclerotic Cardiovascular Disease patients have suboptimal secondary prevention care compared to older patients with lower use of antiplatelets and statin therapy and lower adherence to statins. Among young patients, time-critical diagnosis and management remain challenging, due to atypical stroke presentations, vast etiologies, statin hesitancy, and provider clinical inertia. Early recognition and aggressive risk profile modification along with primary and secondary prevention therapy optimization are imperative to reduce the burden of stroke among young adults and save potential disability-adjusted life years.

Establishment of Carotid Artery Dissection and MRI Findings in a Swine Model.

Carotid artery dissection (CAD) is the leading cause of ischemic stroke in young patients; however, the etiology and pathophysiology of CAD remain largely unknown. In our study, two types of dissections (length × width: 1.5 cm × 1/3 circumference of intima, Group I, n = 6; or 1.5 cm × 2/3 circumference of intima, Group II, n = 6) were created between the media and intima. Ultrasound (within 2 h after dissection) showed a dissociated intima in the lumen and obstructed blood flow in the surgical area. Digital subtraction angiography (DSA, 72 h after dissection), magnetic resonance imaging (MRI, 72 h after dissection), and hematoxylin–eosin (H&E, 7 days after dissection) staining confirmed stenosis (33.67 ± 5.66%) in Group I and total occlusion in Group II. In 10 out of 12 swine, the CAD model was established using a detacher and balloon dilation, and morphological outcomes (stenosis or occlusion) after CAD were determined by the size of intimal incision.

Intervention study of Snyder’s hope theory on the stigma of stroke in young and middle-aged patients: a randomised trial

Stigma refers to the sense of discrimination that society has towards a certain group of people, and this part of the group will also have a sense of shame due to their own negative circumstance. Young and middle-aged stroke patients need long-term effective support from their families and society, which can easily produce shame, and have a negative impact on disease treatment. A total of 94 young and middle-aged stroke patients admitted to our hospital from November 2018 to November 2020 were selected and randomly allocated to 2 groups, with 47 cases in each group. The control group received routine intervention, and the observation group received SHT intervention. The stigma, hope level, compliance with functional exercise, National Institute of Health Stroke Scale (NIHSS) score and changes in activities of daily living were compared between the 2 groups before and after intervention. The total scores of social interaction, treatment, ability, and stigma of the observation group were lower than those of the control group after 1 month of intervention (P<0.05). The observation group's positive attitude towards reality and the future, taking positive actions, maintaining close relationships with others, and hope levels after 1 month of intervention were all higher than the control group (P<0.05). The functional exercise compliance of the observation group was higher than that of the control group after 1 month of intervention (P<0.05). The Barthel index score of the observation group was higher than that of the control group after 1 month of intervention, and the NIHSS score was lower than that of the control group (P<0.05). The application of SHT to young and middle-aged stroke patients can reduce stigma, improve hope level and compliance with functional exercise, improve neurological function, and enhance the ability for daily living. Chinese Clinical Trial Registry ChiCTR2100045926.

Information regarding acute stroke associated with COVID-19 in online news

Patients with COVID-19 may present with neurological manifestations, lack of oxygenation, or clotting disorders such as ischemic or hemorrhagic strokes. This has been observed in even young patients with mild symptoms. The aim of this study was to explore current online news coverage of acute stroke associated with COVID-19 in the four-month period from April 2020 to July 2020, a time during which the US found itself in the center of the pandemic. The relevant Google News stories were reviewed for content. The analysis indicated that 118 online news reports covered the topic to varying degrees, including data from reputable sources, references to the neurological symptoms, and to the incidence of stroke in young patients. It is important that health professionals be aware of this risk and convey to the public the possibility of stroke due to COVID-19 so as to increase the probability of early diagnosis and optimal outcomes.

Characteristics and Predictors of Outcome of Pseudoaneurysms Associated With Vertebral Artery Dissections: A 310-Patient Case Series.

Vertebral artery dissections (VADs) are a common cause of stroke in young patients and can result in various secondary effects, including pseudoaneurysm formation. To identify differences in predisposing factors and outcomes for VADs with and without concomitant pseudoaneurysms. We retrospective chart reviewed patients who presented to our institution at the time of VAD with at least a 3-mo clinical follow-up. Demographics, VAD characteristics, treatment, and outcomes represented as modified Rankin scale (mRS) scores were collected. Of 310 patients with a VAD included in this study, 301 patients had an identified pseudoaneurysm status, with 54 pseudoaneurysm-associated VADs and 247 VADs not associated with pseudoaneurysm. VAD patients with associated pseudoaneurysms were more likely to be female (P<.004), have bilateral VADs (P<.001), and have fewer vertebral artery segments affected (P=.018), and less likely to have stroke (P<.008) or occlusion of the vertebral artery (P<.001). There was no difference in the proportion of patients treated with antiplatelet agents (P=.12) or anticoagulants (P=.27) between the groups. VAD patients with associated pseudoaneurysms were more likely to have a higher mRS at 3-mo follow-up (P=.044) but not discharge (P=.18) or last follow-up (P=.05). VAD patients with pseudoaneurysms were equally likely to have resolution of occlusion (P=.40) and stenosis (P=.19). Demographics and clinical and radiological characteristics of VADs associated with pseudoaneurysms are different from those without associated pseudoaneurysms. Vertebral artery dissections with concomitant pseudoaneurysms are neither associated with worse functional nor radiographic outcomes.

The Impact of Sex on Arterial Ischemic Stroke in Young Patients: From Stroke Occurrence to Poststroke Consequences.

The male sex has been suggested to predominate in paediatric patients with arterial ischemic stroke (AIS), especially in newborns. The explanation for this phenomenon remains unsatisfactory since it focuses on the analysis of the potential relationship with trauma and arterial dissection. In turn, in some populations of young adults, men suffer from AIS more frequently than women, which may be related to the protective role of oestrogen. On the other hand, certain data indicate that women dominate over men. Some of the disparities in the frequencies of particular symptoms of AIS and poststroke consequences in both children and young adults have been suggested; however, data are scarce. Unfortunately, the low number of studies on the subject does not allow certain conclusions to be drawn. For adults, more data are available for patients aged over 60 years, the results of which are more obvious. The present literature review aimed to discuss available data on the prevalence of AIS, its clinical presentations, and poststroke consequences in regard to the sex of young patients. We considered young patients to be children from birth up to the age of 19 years of life and young adults to be individuals up to the age of 55 years. The role of sex hormones in AIS and possible gender differences in genetic risk factors for AIS were also discussed briefly.

Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

BackgroundEtiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations.MethodsYoung patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome.ResultsTwo hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome.ConclusionsForty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

Abstract P692: This is Your Brain on Drugs: The Burden and Severity of Stroke Related to Substance Use and Infective Endocarditis

Background: Substance abuse is a major health crisis in the US, with approximately 20 million people suffering from substance use disorders (SUD). The rate of opioid-related overdose deaths in Kentucky has climbrf from 1.3 per 100,000 persons in 1999 to a staggering 23.6 in 2016. SUD is a risk factor for infectious endocarditis (IE), an important cause of stroke in young patients. We previously reported that SUD in stroke is associated with poorer admission NIH stroke scales and longer lengths of stay (LOS) compared to patients without SUD. Objective: To describe the burden of stroke due to endocarditis in a regional population within Kentucky, and to compare outcomes of stroke in patients with SUD with or without evidence of IE. Methods: This is a single center, retrospective chart review of patients with SUD and stroke. Subjects included adults age &gt; 18 years, who received the diagnosis of acute stroke, and were identified as an illicit drug user based on either urine drug testing or provided history in the medical record, admitted between October 2015 and May 2019. Data elements collected included length of stay (LOS), admission/discharge NIH stroke scale scores, drug use history, laboratory data, discharge modified Rankin Scores, intracerebral hemorrhage (ICH) scores, and discharge status. Results: We identified 197 (M=157, 74.6%) SUD/IE-, and 116 (M=81, 69.8%) SUD/IE+ stroke cases. SUD+/IE+ cases were younger with a mean age of 36.53 +/- 8.94, as compared to SUD+/IE-, mean age of 54.94 +/-12.01 (p&lt;0.0001). Ischemic stroke was more common than ICH in both groups. While admission NIHSS scores were similar in the two groups, SUD+/IE+ patients had longer lengths of stay (29.60 +/-25.73 days vs. 11.65 +/-16.95, p&lt;0.0001), and experienced greater mortality, with 38 deaths (32.8% SUD+/IE+) as compared to 20 (10.2%) in the SUD+/IE- group, p&lt;0.0001. An additional 16 (13.8%) patients IE+ were discharged to hospice, compared to 8 (4.1%) in the IE- group, p=0.003. Conclusion: Within our regional population, there is a high burden of SUD-related infective endocarditis and stroke, which is associated with poorer outcomes and increased mortality. Further study is warranted to examine the socioeconomic factors influencing SUD in our population to reduce overall disease burden.

Hornerandrsquo;s Syndrome due to a Spontaneous Internal Carotid Artery Dissection treated with Casper Stent

Horner syndrome is a constellation of neurological findings consisting of ipsilateral ptosis, miosis and anhidrosis. Partial Horner syndrome, comprising ipsilateral ptosis and miosis in the absence of anhidrosis, is a well-documented but uncommon manifestation of internal carotid artery dissection. Internal carotid artery dissection (ICAD) is a rare entity that either results from traumatic injury or can be spontaneously preceded or not by aminor trauma such as sporting activities, is a common cause of ischaemic stroke in young patients. As many as 40 to 50% of patients with carotid dissection will develop an ipsilateral Horner’s sindrome.

Potential Factors for Psychological Symptoms at Three Months in Patients with Young Ischemic Stroke.

Objective Psychological status plays a vital role in the recovery in young ischemic stroke patients. However, few reports on the psychological symptoms in Chinese young ischemic stroke patients have been published. In the present study, we aimed to outline the psychological status of young ischemic stroke patients and its risk factors at three months after their stroke. Methods 364 patients with young ischemic stroke and 384 age-matched healthy controls were consecutively recruited from our study hospitals of the mainland of China between June 2018 and November 2020. Social demographic and clinical data were collected from all enrolled participants in the acute stage of their stroke, and their psychological variables were assessed via the Symptom Checklist 90 Revised (SCL-90-R) at three-month timepoint after their stroke. Multivariable logistic regression analyses were run to identify the independent factors for psychological variables in patients. Results Compared with healthy controls, patients with young ischemic stroke had significantly higher total score of SCL-90-R and all subscale total scores (p < 0.01 or 0.05). 22.3% (81/364 cases) in young ischemic stroke patients had psychological abnormalities. Compared with young ischemic stroke patients without psychological symptoms (n = 283), patients with psychological symptoms (n = 81) had higher rate of married status (p = 0.03), rate of hypertension (p = 0.01), infarct size (p = 0.01), and the family dysfunction (p < 0.01). Multivariate logistic regression analyses revealed that the family dysfunction (odds ratio [OR], 2.50, 95% confidence interval [CI]: 1.71 to 3.54, p < 0.01), having hypertension (OR, 3.27, 95% CI: 1.92 to 4.27, p = 0.02), and ≥20mm3 infarct size (OR, 2.39, 95% CI: 1.53 to 3.45, p < 0.01) were independent factors for having psychological abnormalities in patients with young ischemic stroke at three months after their stroke. Single (OR, 1.23, 95% CI: 1.03 to 1.54, p = 0.01), poor family function (OR, 1.21, 95% CI: 1.05 to 1.45, p = 0.03), and ≥20mm3 infarct size (OR, 1.74, 95% CI: 1.14 to 3.13, p = 0.02) were independent factors for having depression in patents with psychological symptoms. The family dysfunction (OR, 2.32, 95% CI: 1.51 to 2.80, p < 0.01) and hypertension (OR, 2.41, 95% CI: 1.54 to 3.46, p = 0.03) were independent factors for emerging somatization and anxiety in patients with psychological symptoms, respectively. Conclusions At three months after their stroke, young ischemic stroke patients had psychological problems and risk factors for developing them.

Elevated factor VIII levels and arterial stroke: a review of literature with a case report

BackgroundCerebral arterial thromboses or ischemic strokes may be caused by cumulative or independent effects of a variety of risk factors. High factor VIII level is one of those important but less known risk factors for arterial and venous thrombosis. We hereby provide a comprehensive review of the role of high factor VIII levels as a risk factor of arterial thrombosis. Moreover, we present our views on inclusion of factor VIII testing in the etiology workup protocol of young patients with ischemic strokes and their treatment with anticoagulant therapy.Case presentationWe illustrate a case of 32-year-old North Indian female patient with Ischemic stroke whose only identifiable risk factor was revealed to be an elevated factor VIII level. She was treated with oral anticoagulant with an uneventful follow-up of 6 months.ConclusionsElevated factor VIII levels have their independent and additive effects in causation and prognosis of arterial strokes. We herein discuss the mechanism of this association, the feasibility and yield of routine testing, appropriate cut-off levels, and further treatment protocol especially in young stroke patients.

Mutation analysis of the GLA gene in Chinese patients with intracerebral hemorrhage

Fabry disease (FD) is an important underlying condition in young cryptogenic stroke patients and has also been implicated in cerebral small vessel disease. However, the contributions of causative GLA mutations in patients with intracerebral hemorrhage (ICH) remain unclear. In this study, GLA sequences were analyzed in a Chinese ICH cohort comprising 373 patients with computed tomography-confirmed ICH and 563 in-house controls and East Asians from public databases. Only one previously reported mutation, p. Ala15Val, responsible for Fabry disease was identified in a female patient with nonlobar ICH. Therefore, this definitive GLA mutation accounted for 0.27% (1/373) of Chinese patients with ICH. Another functional variant, rs2071225 (c.-10C>T), was present at minor allele frequency (MAF) of 9.1%, indicating no association with ICH, despite a trend of an association for male patients with lobar ICH. In conclusion, our results indicate that the GLA mutation is an uncommon genetic etiology of ICH in China.

CLINICAL PROFILE OF PATIENTS OF YOUNG STROKE.

A study of stroke in young patients has recently become a subject of interest. This is due to a lot of impact on the individual and society. Study of stroke in young patients can lead to therapeutical results affecting both short term and long-term outcomes. Our study is hospital based retrospective study for duration of 1 year. Thi Methods: Results: s study revealed stroke in young in 25.16% of all stroke cases, with cerebral infarction in 56% and followed by intracerebral haemorrhage in 25.64%, and cerebral venous thrombosis in 18%. The most common presenting symptom was hemiparesis. The most prevalent risk factor for stroke in young was hypertension followed by diabetes mellitus, alcohol consumption and smoking. Stroke in young requires a differe Conclusion: nt approach to investigate and treat. This is due to different underlying etilogy as compared to elderly. Although traditional risk factors are associated with stroke, behavioural pattern such as smoking and alcohol may cause and promote development of stroke in young.

Serum metabolomic patterns in young patients with ischemic stroke: a case study.

Ischemic stroke is one of the leading causes of death and adult disability. The incidence of ischemic stroke continues to rise in young adults. This study aimed to provide a comprehensive evaluation of metabolic changes and explore possible mechanisms in young ischemic stroke patients without common risk factors. This study investigated serum metabolomics in 50 young patients with newly suffered ischemic stroke and 50 age-, sex-, and body mass index-matched healthy controls. Liquid chromatography coupled with a Waters Xevo TQ-S mass spectrometer with an electrospray ionization (ESI) source was used to analyze amino acid or bile acid, and free fatty acid or lipid was analyzed by liquid chromatography coupled with a Qtrap5500 mass spectrometer with an ESI source. The metabolomic data were analyzed by performing a multivariate statistical analysis. A total of 197 metabolites, including amino acids, bile acids, free fatty acids, and lipids, were identified in all participants. Multivariate models showed significant differences in serum metabolomic patterns between young patients with ischemic stroke and healthy controls. The stroke patients had increased L-methionine, homocysteine, glutamine, uric acid, GCDCA, and PE (18:0/20:4, 16:0/22:5), and decreased levels of L-citrulline, taurine, PC (16:2/22:6, 16:2/20:5, 15:0/18:2), and SM (d18:1/23:0, d20:0/19:1, d18:1/22:0, d16:0/26:1, d16:0/18:0, d16:0/22:1, d18:1/19:1, d16:0/17:1, d16:1/24:1, d18:1/19:0). Based on the identified metabolites, the metabolic pathways of arginine biosynthesis, glycerophospholipid metabolism, and taurine and hypotaurine metabolism were significantly enriched in the young patients with ischemic stroke. Serum metabolomic patterns were significantly different between young patients with ischemic stroke and healthy controls. Our study is beneficial in providing a further view into the pathophysiology of young patients with ischemic stroke.

Patent Foramen Ovale and Inherited Thrombophilia in the Pathogenesis of Arterial Thrombosis in a Young Patient: A Case Report and Literature Review

Background: A Patent Foramen Ovale (PFO) is frequently associated with cryptogenic stroke in young patients with paradoxical embolism as the presumed mechanism. Moreover, hypercoagulable states that are known in the pathogenesis of venous thrombosis, can sometimes be found in patients with stroke, which can be explained by the PFO, that provides the missing link. The association between PFO and prothrombotic state may hence increase the risk for paradoxical embolism. Yet, the cause-and-effect relationship between these pathologies is not clearly established and the best therapeutic and preventive strategy are unelucidated. Case Report: We report a case associating ischemic stroke, left internal carotid occlusion, and pulmonary embolism with the discovery of a PFO and inherited thrombophilic disorders, in a young woman under combined contraceptives. Conclusion: We believe that this case is important since it shows the importance of searching for a PFO in young patients with arterial events and thrombophilia and also the interest of systematic screening for procoagulant disorders in those with stroke and PFO, and highlights the challenge in the multidisciplinary management of such patients.

Young Stroke Prevention Program for University Lecturers with Risk Factors via Smartphone Application

The major risk factors for young stroke patients were hypertension, diabetes, hyperlipidemia, waist circumference, and body mass index. This study evaluated the effectiveness of a young stroke prevention program for university lecturers via using a smartphone application. Research design was a quasi-experimental research one-group pretest-posttest design with using multistage random sampling. The study population were Kasetsart university lecturers (n = 21) with risk factors for stroke, age between 20 - 45 years old. The 13 weeks program involved sending each subject weekly via a smart phone application information on stroke education, nutrition management and basic knowledge of exercise. Descriptive statistics were used to analyze the general characteristics, Inferential statistics to analyze the average scores pre-test and post-test, with stroke knowledge, weight, waist, body mass index (BMI), blood pressure level, attitude, and risk behavior were determined using a paired t-test statistic. The post-test results from the 21 respondents who participated indicated their knowledge level of stroke education was significantly higher than the pre-exposure, with mean pre-exposure and post-exposure scores of 7.81 and 9.10, respectively. Furthermore, body weight, waist size, systolic blood pressure, diastolic blood pressure and body mass index, were significantly lower by the end of the program. However, no significant differences were found for attitude nor for the subject behavior regarding risk factors of a stroke. This program can act as the guideline to reduce the incidence of young stroke by reducing risk factors and managing stroke prevention for university lecturers with risk factors of stroke.

A study of Relationship Between Mean Corpuscular Volume and Diagnosed Cases of Thrombotic Stroke in Young People

After coronary illness and all malignancies stroke is the third basic reason for death on the planet.study was aimed to determine the possible relationship between mean corpuscular volume and thrombotic stroke in young people. The study was carried out at a tertiary care hospital. The case-control study was done in 50 patients of young thrombotic cerebrovascular disease and 50 healthy age and sex-matched controls. Estimation of MCV levels was done in both the groups and compared. The mean age of cases was 41.56 ± 9.51. total of 50 cases of young stroke, 36 (72%) was male. The mean and SD values of MCV levels for the case group were 96.78±7.54, for the control group were 82.07±7. Out of the 50 young stroke patients, 17 (34%) had MCV levels ≥101fL. In the control group, all the subjects had MCV levels ≤ 100fL. The mean haemoglobin level was 14.29, with SD ± 1.48 in cases, and the control group mean haemoglobin level was 12.41 with SD±1.39. Mean serum haemoglobin levels were higher in cases than controls. The Significant Macrocytosis (MCV≥100fL) can be a new, low cost and early marker in anticipating the risk of developing thrombotic stroke in young adults who may or may not have anaemia.

Who Should Rather Undergo Transesophageal Echocardiography to Determine Stroke Etiology: Young or Elderly Stroke Patients?

Introduction: The indication of transesophageal echocardiography (TEE) in acute stroke is unclear. Thus, we systematically studied the impact of TEE on determining stroke etiology and secondary prevention in patients of different age-groups with cryptogenic stroke.Methods: Four hundred and eighty five consecutive patients with acute retinal or cerebral ischemia were prospectively included and underwent routine stroke workup including TEE. Stroke etiology was identified according to the TOAST classification and patients were divided in those with determined and cryptogenic stroke etiology without TEE results. Then, the frequency of high- and potential-risk sources in TEE was evaluated in <55, 55–74, and ≥75 year-old patients with cryptogenic stroke etiology.Results: Without TEE, stroke etiology was cryptogenic in 329(67.8%) patients and TEE determined possible etiology in 158(48.4%) of them. In patients aged <55, 55–74, ≥75, TEE detected aortic arch plaques ≥4 mm thickness in 2(1.2%), 37(23.0%), and 33(40.2%) and plaques with superimposed thrombi in 0(0.0%), 5(3.1%), and 7(8.5%); left atrial appendage peak emptying flow velocity ≤30cm/s in 0(0.0%), 1(0.6%), and 2(2.4%), spontaneous echo contrast in 0(0.0%), 1(0.6%), and 6(7.3%), endocarditis in 0(0.0%), 0(0.0%), and 1(1.2%) and patent foramen ovale (PFO) plus atrial septum aneurysm (ASA) in 18(20.9%), 32(19.9%), and 14(17.1%), respectively. TEE changed secondary prevention in 16.4% of these patients following guidelines of 2010/11 and still 9.4% when applying the guidelines of 2020.Conclusions: TEE was highly valuable for determining stroke etiology and influenced individual secondary prevention based on available treatment guidelines and expert opinion in most cases. In young patients the impact of TEE was limited to the detection of septal anomalies. By contrast, in older patients TEE detected high numbers of complex aortic atheroma and potential indicators of paroxysmal atrial fibrillation.