青年缺血性卒中课件.ppt

1、2001/08/13Ischemic Stroke in Young adultw Definition：16-45 y/ow Distribution：3-4%of all stroke w Etiology,clinical manifestation,and prognosis are different from elderlyw It is important to find the etiologic factor and treat them adequately for preventing the recurrence Orv Hetil 2001 Mar 25;142(12

2、):607-10Epidermiologyw Northern Sweden Monica,13 third level and local hospital,age 18-44 y/o,from Jan.1991-May 1996,totally 88 casesw Annual incidence：11.3/100000 13.6 m vs 8.9 ww Case fatality rate：5.7%(within 28 days)4.8 in Neuro Neurochir pol 2000Nov-Dec;w Increased with age：especially after 35

3、y/ow Dramatic increased after 45 in other report Kristensen:Stroke,Volume 28(9).September 1997.1702-1709EpidemiologywTable 1.Average Annual Age-and Sex-Specific Incidence Rates of First Ischemic Stroke in Young Adults in Northern Sweden,1991 to 1994 From:Kristensen:Stroke,Volume 28(9).September 1997

4、.1702-1709Epidemiologyw Table 1.Ages of Young Men and Women With Ischemic Stroke Arch Neurol.1995;52:491-495 Etiologyw Atherosclerosis is the main cause of stroke in elderly,while emboligenous cardiopathy is the one of the main cause of young adult Annali Italiani di Medicina Interna.11(1):33-8,1996

5、 Jan-Marw Cardiac embolism was the most common cause of stroke in pt younger than 40 Stroke.30(11):2320-5,1999 Nov.20018350w Atherosclerosis was 38.2%and cardioembolism was 18.1%Acta Neurologica Scandinavica.101(1):19-24,Jan 2000.Etiologyw Atherosclerosis 33.3%,Prothrombotic state 15.5%,Cardiogenic

6、9.5%Orv Hetil 2001 Mar 25;142(12):607-10w Atherosclerosis 29.8%,Cardioembolism 19.5%,Hematologic 5.8%Arch Neurol.1995;52:491-495 w So cardioembolism and atherosclerosis are tow major cause of stroke in young adultsw Cause are diverseEtiologyEtiologyEtiologyw Atherosclerosis:a.Large artery b.Small ar

7、teryw Embolism:a.Cardiogenic b.Non-cardiogenicw Non-Atherosclerosis artriopathy:a.Inflammatory b.Non-inflammatoryw Hemological disorder:a.Viscosity b.Coagulopathyw Others:Etiologyw Embolism:a.Cardiogenic:1.Valvular:RH,prosthetic,endocarditis,MVP 2.Arrhythmia:Af,sick sinus syndrome 3.AMI/LV aneurysm:

8、4.LV myxoma:5.Cardiomyopathy:Etiologyw Embolism:b.Non-cardiogenic:1.Pulmonary AVM:Osler-Weber-Rendu syndrome 2.ASD/VSD or POF with shunt:3.Pulmonary embolism:Etiologyw Non-atherosclerosis arteriopathy:a.Inflammatory:1.Takayasus disease:=Granulomatous arteritis,mono,無脈症 2.Hepersensitive arteritis:Chu

9、rg-strauss disease 3.Infectious:Syphilitic arteritis,TB,HIV-associated 4.Drug related:heroin,amphetamine 5.Systemic disease:SLE,RA,polyarteritis nodosaEtiologyw Non-atherosclerosis arteriopathy:a.Non-inflammatory:1.Moya moya disease:2.Artery dissection:3.Irradiation vasculopathy:4.Fibromuscular dysp

10、lasia:5.Firinoid vasculopathy:Etiologyw Hematological disorder:a.Viscosity:1.MDS:CML,polycythemia vera,essential thrombocythemia 2.Multiple myeloma:3.Leukemia b.Coagulopathy:Etiologyw Hematological disorder:b.Coagulopathy:1.Hemoglobin disorder 2.Protein C/S deficiency 3.Antithrombin III deficiency 4

11、.DIC 5.Anti-phospholipid antibodyEtiologyw Others:1.Migraine 2.Pregnancy 3.TraumaRisk Factor Stroke,Volume 28(9).September 1997.1702-1709 Risk factorw Agreed by most reporters are:1.Cigarette smoking 2.Hypertension 3.Hyperlipidemia Orv Hetil 2001 Mar 25;142(12):607-10 Postgraduate medicine.81(5):141

12、-4,149-51 1987 Apr.Acta Neurologica Scandinavica.101(1):19-24,Jan 2000 Clinical Presentationw Embolism:1.Sudden onset of cortical impairment 2.Heart condition predisposing to embolism 3.May be fluctuated,and may recover or deterioratClinical Presentationw Large artery atherosclerosis:1.Cerebral cort

13、ical impairment:aphasia,apraxia,anopia,agnosia,restricted motor involvement 2.History of intermittent claudication,TIA Clinical Presentationw Small artery occlusion(lacunae)1.Traditional clinical lacunar syndrome a.Pure motor hemiparesis b.Pure sensory stroke c.Ataxia hemiparalysis d.Dysarthria-clum

14、sy hand e.Sensory motor stroke 2.History of HTN and DM supports DxPrognosisw First 28 days mortality:4.8/5.7%w Neurological deficit(Canadian neurological scale)and handicap severity(Rankin classification,Barthel index)are all much better than elderly.1/3;6mow Although infarct size usually bigger(3cm

15、)w Recurrence risk is low:1.1-1.2 annuallyw Over all,prognosis is much better,so aggressive treatment intervention is important.Advised Clinical Studyw CT/MRI/angiographyw 12 lead EKGw Echocardiogram/TEEw Dupplex(carotid and IC doppler)w BCS,rheumatic profile,autoimmune profile,coagulation profileConclusionw Ischemia stroke in young adults must be studied with a different protocol from that used for the elderly,due to the difference of the etiology and the prognosis.Annali Italiani di Medicina Interna.11(1):33-8,1996 Jan-Mar