Abstract WP252: Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Vaelan Molian ◽  
Amir Shaban ◽  
Aayushi Garg ◽  
Kaustubh Limaye ◽  
Kanika Sharma ◽  
...  
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Small Vessel Disease ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Diagnostic Studies ◽  
Stroke In Young Adults ◽  
Chi Squared ◽  
Comprehensive Stroke Center

Introduction: Because acute ischemic stroke (AIS) in young adults is not rare, understanding trends in etiology may help decisions about evaluation and secondary stroke prevention. This study describes probable causes of AIS in a cohort of young adults and identifies changes in etiologies and diagnostic studies compared to 20 years ago. Methods: We retrospectively reviewed all patients aged 15-45 admitted to our comprehensive stroke center between 1/2010-11/2016 with AIS. Diagnostic studies and stroke etiologies for each patient were reviewed. We then compared our results to a historic sample of young patients who presented to our center in 1977-1993 using univariate chi-squared comparison for each etiology. Results: We identified 333 young adults, 169 (50.8%) were women. The mean age was 36.4±7.1 years. Vessel imaging was performed in 305 (91.3%) cases vs. 68.9% in the historic sample. Of these, 247 (81.0%) had magnetic resonance angiography (MRA). Transthoracic echocardiography (TTE) was performed in 101 (30.3%) and transesophageal echocardiography (TEE) was performed in 171 (51.4%) cases compared to 67.1% who underwent TTE in the historic sample. Etiologic comparisons to the historic sample yielded significant decline in small vessel disease ( P = .029) and a major increase in stroke of other identified cause ( P = .024). Other TOAST etiologies illustrated in Figure 1. The most common etiology for stroke in our sample was arterial dissection 84 (25.2%), whereas this was found in only 6.0% of patients in the historic sample ( P< .001). Conclusions: Using the TOAST classification, the most common subtype in young adults was stroke of other identified cause; a rate that reflects a marked increase in the diagnosis of dissection. Despite advancement in diagnostic studies, cryptogenic stroke remains a common category in young adults.

scholarly journals Return to work after ischemic stroke in young adults

Neurology ◽  
2018 ◽  
Vol 91 (20) ◽  
pp. e1909-e1917 ◽  
Author(s):  
Karoliina Aarnio ◽  
Jorge Rodríguez-Pardo ◽  
Bob Siegerink ◽  
Juliane Hardt ◽  
Jenna Broman ◽  
...  
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Scale Score ◽  
Young Patients ◽  
Large Artery ◽  
Stroke Registry ◽  
Factors Associated ◽  
Stroke In Young Adults ◽  
Risk Sources ◽  
Returning To Work

ObjectiveWe aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW.MethodsPatients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994–2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were included. Data on periods of payment came from the Finnish Centre for Pensions, and death data from Statistics Finland. Multivariate logistic regression analyses assessed factors associated with NRTW 1 year after IS, and lasagna plots visualized the proportion of patients returning to work over time.ResultsWe included a total of 769 patients, of whom 289 (37.6%) were not working at 1 year, 323 (42.0%) at 2 years, and 361 (46.9%) at 5 years from IS. When adjusted for age, sex, socioeconomic status, and NIH Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.ConclusionsNRTW is a frequent adverse outcome after IS in young adults with mild to moderate IS. Clinical variables available during acute hospitalization may allow prediction of NRTW.

scholarly journals Acute ischemic stroke in young adults with tuberculous meningitis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Liming Zhang ◽  
Xiaoyu Zhang ◽  
Huaqiang Li ◽  
Gang Chen ◽  
Meijia Zhu
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Tuberculous Meningitis ◽  
Stroke In Young Adults ◽  
Stroke In Young

Secular Trends for Etiologies of Acute Ischemic Stroke in Young Adults

2020 ◽  
Vol 29 (12) ◽  
pp. 105270
Author(s):  
Amir Shaban ◽  
Vaelan Molian ◽  
Aayushi Garg ◽  
Kaustubh Limaye ◽  
Enrique C. Leira ◽  
...  
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Secular Trends ◽  
Stroke In Young Adults ◽  
Stroke In Young

scholarly journals Ipsilateral internal carotid artery web and acute ischemic stroke: A cohort study, systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257697
Author(s):  
Brian Mac Grory ◽  
Erez Nossek ◽  
Michael E. Reznik ◽  
Matthew Schrag ◽  
Mahesh Jayaraman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Carotid Bifurcation ◽  
Stroke Patients

Introduction The carotid web is a compelling potential mechanism of embolic ischemic stroke. In this study, we aim to determine the prevalence of ipsilateral carotid web in a cohort of ischemic stroke patients and to perform a systematic review and meta-analysis of similar cohorts. Patients & methods We performed a retrospective, observational, cohort study of acute ischemic stroke patients admitted to a comprehensive stroke center from June 2012 to September 2017. Carotid web was defined on computed tomography angiography (CTA) as a thin shelf of non-calcified tissue immediately distal to the carotid bifurcation. We described the prevalence of carotid artery webs in our cohort, then performed a systematic review and meta-analysis of similar cohorts in the published literature. Results We identified 1,435 potentially eligible patients of whom 879 met criteria for inclusion in our analysis. An ipsilateral carotid web was detected in 4 out of 879 (0.45%) patients, of which 4/4 (1.6%) were in 244 patients with cryptogenic stroke and 3/4 were in 66 (4.5%) patients <60 years old with cryptogenic stroke. Our systematic review yielded 3,192 patients. On meta-analysis, the pooled prevalence of ipsilateral carotid web in cryptogenic stroke patients <60 was 13% (95% CI: 7%-22%; I2 = 66.1%). The relative risk (RR) of ipsilateral versus contralateral carotid web in all patients was 2.5 (95% CI 1.5–4.2, p = 0.0009) whereas in patients less than 60 with cryptogenic stroke it was 3.0 (95% CI 1.6–5.8, p = 0.0011). Discussion Carotid webs are more common in young patients with cryptogenic stroke than in other stroke subtypes. Future studies concerning the diagnosis and secondary prevention of stroke associated with carotid web should focus on this population.

scholarly journals COVID-19-Related Acute Ischemic Stroke in Young Adults: What Is the Optimal Antithrombotic Regimen for Secondary Prevention?

2020 ◽  
Vol 10 (5) ◽  
pp. 203-206 ◽  
Author(s):  
Fahimeh Vahabizad ◽  
Maryam Sharifian Dorche ◽  
Pegah Mohammadi ◽  
Kasra Khatibi ◽  
Ashkan Mowla
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Acute Ischemic Stroke ◽  
Stroke In Young Adults ◽  
Stroke In Young

scholarly journals Stroke in young adults

2018 ◽  
Vol 8 (6) ◽  
pp. 501-506 ◽  
Author(s):  
Nirav Bhatt ◽  
Amer M. Malik ◽  
Seemant Chaturvedi
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Management Strategies ◽  
Cryptogenic Stroke ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke In Young Adults ◽  
New Information ◽  
Traditional Risk Factors ◽  
Stroke In Young

Purpose of reviewThe incidence of stroke in young adults is increasing, mainly driven by an increasing incidence of ischemic stroke in this population. We provide new information that has been recently presented regarding the risk factor prevalence, some specific etiologic causes, and management strategies in ischemic stroke in this population.Recent findingsRecent studies indicate a rapid increase in traditional risk factors in young adults. New information regarding the management of patent foramen ovale in cryptogenic stroke and cervical artery dissection is available.SummaryStroke in young adults is a rapidly growing problem with deep public health implications. There are many areas in this field, which require further research.

Abstract 2736: Is Treatment Of Young Ischemic Stroke Patients Improving? Insights From The Nationwide Inpatient Sample

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amit Kansara ◽  
Seemant Chaturvedi ◽  
Pratik Bhattacharya
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Nationwide Inpatient Sample ◽  
Mechanical Thrombectomy ◽  
Young Patients ◽  
International Classification Of Diseases ◽  
Discharge Data ◽  
Time Period ◽  
Young Ischemic Stroke

Background and purpose: Recent studies have shown a trend for increasing use of thrombolysis among acute ischemic stroke (AIS) patients. However, data is lacking for use of thrombolysis among young (19-44 years) AIS patients. It is important to follow the trend as costs and burden of stroke related disability can be significantly higher in young adults as they are more likely to live longer than elderly people with stroke. Method: Discharge data were obtained from Nationwide Inpatient Sample from 2001 to 2009. AIS were defined by discharge diagnosis codes from International Classification of Diseases ICD 9 revision (433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91, and 436). For thrombolysis treatment ICD 9 code 99.10 was used. For mechanical thrombectomy, code 39.74 was used for year 2006 to 2009. Cochran Armitage test was used for trend analysis. Result: From 2001 through 2009, there were an estimated 4,917,217 admissions for acute ischemic stroke. Out of that, 204,703 (4.16%) were young patients with AIS. Numbers of AIS among young adults increased from 19293(3.30% of total AIS) in 2001 to 24816 (4.57%) in 2009 (p<0.0001). 51.4% patients were female in 2001 and 49.3% in 2009. Thrombolysis in young ischemic stroke increased from 354 (1.84% of young AIS) in 2001 to 1237 (4.97%) in 2009 (p<0.0001). Thrombolysis among all AIS increased from 1.00% to 3.84% (p<0.0001) in the same time period. Number of mechanical thrombectomy increased from 53 (0.14%) in 2006 to 527 (0.82%) in 2009 (p<0.0001) in young AIS. In the same time period, mechanical thrombectomy rate in all AIS patients increased from 0.05% to 0.48% (p<0.0001). Conclusion: Thrombolysis rate among young AIS significantly increased from 2001 to 2009. Thrombolysis rate was higher in young AIS than all AIS for all the years from 2001 to 2009. Mechanical thrombectomy rate also significantly increased from 2006 to 2009 among young AIS and it was almost twice the rate all AIS patients. Data on outcomes of young AIS treated with thrombolysis or mechanical thrombectomy are needed.

Abstract TP215: Clinical Utility of Hypercoagulability Screening in Young Adults With Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Setareh Salehi Omran ◽  
Michael P Lerario ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Antonio Moya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Clinical Management ◽  
Medical Center ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Hypercoagulable State ◽  
Secondary Outcome ◽  
Stroke Subtype

Introduction: We aimed to evaluate the ability of current genetic and serological testing to diagnose clinically relevant thrombophilic states in young adults with ischemic stroke. Methods: We performed a retrospective cohort study of patients aged 18 to 65 years who presented to Weill Cornell Medical Center between 2011 and 2014 with an ischemic stroke and had laboratory testing for a hypercoagulable state within six months of the index stroke. A hypercoagulable state was diagnosed by the criteria listed in Table 1. The primary outcome was any positive thrombophilia test. The secondary outcome was a change in clinical management based on the thrombophilia testing, defined as a change in antithrombotic selection or patent foramen ovale (PFO) closure. Using Fisher’s exact or Mann-Whitney U tests, we assessed whether the following prespecified risk factors were associated with our outcomes: age, sex, prior venous thromboembolism, family history of stroke, stroke subtype, and presence of PFO. Results: Of 146 ischemic stroke patients who met inclusion criteria, the mean age was 47 (±10) years and 47% were women. Of these patients, 61 (42.0%, 95% CI 33.7-49.9%) had at least one positive thrombophilia test and 8 (5.5%, 95% CI 1.7-9.2%) had a resultant change in management. A cryptogenic stroke subtype was documented in 87 patients, of whom 40 (46.0%, 95% CI 35.3-56.7%) had an abnormal hypercoagulability screen and 5 (5.7%, 95% CI 0.8-10.7%) had a change in management. There was no association between cryptogenic stroke subtype and a positive hypercoagulability test (p=0.2). No prespecified risk factors were associated with a positive hypercoagulability screen or a change in clinical management. Conclusions: Hypercoagulability screening among young patients with cryptogenic stroke changed clinical management in roughly one of every twenty patients tested. Cryptogenic stroke subtype and other clinical factors were not associated with a positive hypercoagulable screen.

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