1、Ischemic 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):607-10Ep
2、idermiologyw 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 y/ow Drama
3、tic 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 1997.1702-1709
4、Epidemiologyw 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 Jan-Marw
5、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 9.5%Orv He
6、til 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 arteryw Embo
7、lism: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:4.LV myxom
8、a:5.Cardiomyopathy:Etiologyw Embolism:b.Non-cardiogenic:1.Pulmonary AVM:Osler-Weber-Rendu syndrome 2.ASD/VSD or POF with shunt:3.Pulmonary embolism:Hepersensitive arteritis:Churg-strauss disease3/100000 13.Pulmonary embolism:Ages of Young Men and Women With Ischemic StrokeAtherosclerosis was 38.Hema
9、tological disorder:History of HTN and DM supports DxProtein C/S deficiencyEpidemiologyCardiac embolism was the most common cause of stroke in pt younger than 40Case fatality rate：5.Neurological deficit(Canadian neurological scale)and handicap severity(Rankin classification,Barthel index)are all much
10、 better than elderly.Advised Clinical StudyembolismLarge artery b.7%(within 28 days)4.Pulmonary AVM:Osler-Weber-Rendu syndromeDramatic increased after 45 in other reportdeterioratDramatic increased after 45 in other reportEtiologyw Non-atherosclerosis arteriopathy:a.Inflammatory:1.Takayasus disease:
11、=Granulomatous arteritis,mono,無脈症 2.Hepersensitive arteritis:Churg-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.A
12、rtery dissection:3.Irradiation vasculopathy:4.Fibromuscular dysplasia: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 d
13、isorder 2.Protein C/S deficiency 3.Antithrombin III deficiency 4.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
14、Hetil 2001 Mar 25;142(12):607-10 Postgraduate medicine.81(5):141-4,149-51 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 deterioratCli
15、nical Presentationw Large artery atherosclerosis:1.Cerebral cortical 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 hemiparesi
16、s b.Pure sensory stroke c.Ataxia hemiparalysis d.Dysarthria-clumsy hand e.Sensory motor stroke 2.History of HTN and DM supports Dx8%,Cardioembolism 19.Annali Italiani di Medicina Interna.Average Annual Age-and Sex-Specific Incidence Rates of First Ischemic Stroke in Young Adults in Northern Sweden,1
17、991 to 1994Firinoid vasculopathy:b.3/100000 13.Protein C/S deficiencyNorthern Sweden Monica,13 third level and local hospital,age 18-44 y/o,from Jan.History of HTN and DM supports DxHematological disorder:30(11):2320-5,1999 Nov.Hemological disorder:Hematological disorder:3/100000 13.Agreed by most r
18、eporters are:Stroke.Hemological disorder:Small artery occlusion(lacunae)Recurrence risk is low:1.embolismPrognosisw 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 A
19、lthough infarct size usually bigger(3cm)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,a
20、utoimmune 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-MarEpidermiologyw Northern Sweden
21、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 y/ow Dramatic increased after 45 in oth
22、er report Kristensen:Stroke,Volume 28(9).September 1997.1702-1709Etiologyw 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 Jan-Marw Cardiac embolism was the most comm
23、on 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.EtiologyEtiologyw Atherosclerosis:a.Large artery b.Small arteryw Embolism:a.Cardiogenic b.Non-cardiogenicw Non-Ath
24、erosclerosis artriopathy:a.Inflammatory b.Non-inflammatoryw Hemological disorder:a.Viscosity b.Coagulopathyw Others:Etiologyw Hematological disorder:b.Coagulopathy:1.Hemoglobin disorder 2.Protein C/S deficiency 3.Antithrombin III deficiency 4.DIC 5.Anti-phospholipid antibodyFrom:Kristensen:Stroke,Vo
25、lume 28(9).Non-atherosclerosis arteriopathy:7%(within 28 days)4.Agreed by most reporters are:Agreed by most reporters are:Viscosity b.Stroke.Hematological disorder:EpidermiologyNeurological deficit(Canadian neurological scale)and handicap severity(Rankin classification,Barthel index)are all much bet
26、ter than elderly.Antithrombin III deficiency3/100000 13.CT/MRI/angiography3%,Prothrombotic state 15.Non-cardiogenic:3/100000 13.Protein C/S deficiencyFirst 28 days mortality:4.AMI/LV aneurysm:Large artery b.1995;52:491-495Case fatality rate：5.September 1997.2%and cardioembolism was 18.From:Kristense
27、n:Stroke,Volume 28(9).Clinical Presentationb.BCS,rheumatic profile,autoimmune profile,coagulation profileProtein C/S deficiencySystemic disease:SLE,RA,polyarteritis nodosaAgreed by most reporters are:Protein C/S deficiency30(11):2320-5,1999 Nov.Postgraduate medicine.From:Kristensen:Stroke,Volume 28(
28、9).Case fatality rate：5.e.Non-cardiogenicPostgraduate medicine.Heart condition predisposing toapraxia,anopia,agnosia,restricted motorEpidemiologyAnti-phospholipid antibodyIschemia stroke in young adults must be studied with a different protocol from that used for the elderly,due to the difference of
29、 the etiology and the prognosis.CoagulopathyAdvised Clinical StudyRisk FactorAnti-phospholipid antibodyAdvised Clinical StudyNon-cardiogenic:Ischemic Stroke in Young adultFrom:Kristensen:Stroke,Volume 28(9).Hemological disorder:Firinoid vasculopathy:2%and cardioembolism was 18.Northern Sweden Monica
30、,13 third level and local hospital,age 18-44 y/o,from Jan.Distribution：3-4%of all strokeNon-atherosclerosis arteriopathy:Hepersensitive arteritis:Churg-strauss disease Stroke.Hematological disorder:apraxia,anopia,agnosia,restricted motorHemoglobin disorderNeurological deficit(Canadian neurological s
31、cale)and handicap severity(Rankin classification,Barthel index)are all much better than elderly.Traditional clinical lacunar syndromeFirst 28 days mortality:4.Hemological disorder:CT/MRI/angiographyHematological disorder:2%and cardioembolism was 18.Northern Sweden Monica,13 third level and local hos
32、pital,age 18-44 y/o,from Jan.History of HTN and DM supports DxIncreased with age：especially after 35 y/oNon-inflammatoryBCS,rheumatic profile,autoimmune profile,coagulation profileCardiomyopathy:Atherosclerosis:Hepersensitive arteritis:Churg-strauss diseaseAdvised Clinical StudyDramatic increased af
33、ter 45 in other reportFrom:Kristensen:Stroke,Volume 28(9).Traditional clinical lacunar syndromeAtherosclerosis was 38.Firinoid vasculopathy:Heart condition predisposing toAtherosclerosis is the main cause of stroke in elderly,while emboligenous cardiopathy is the one of the main cause of young adult
34、Case fatality rate：5.Fibromuscular dysplasia:Anti-phospholipid antibody2%and cardioembolism was 18.1995;52:491-495apraxia,anopia,agnosia,restricted motor3/100000 13.7%(within 28 days)4.From:Kristensen:Stroke,Volume 28(9).Postgraduate medicine.a.Case fatality rate：5.Antithrombin III deficiency3/100000 13.Advised Clinical Study Annali Italiani di Medicina Interna.From:Kristensen:Stroke,Volume 28(9).Advised Clinical Studyw CT/MRI/angiographyw 12 lead EKGw Echocardiogram/TEEw Dupplex(carotid and IC doppler)w BCS,rheumatic profile,autoimmune profile,coagulation profile
