Traditional and rare causes of ischemic stroke in 18 to 50-year old persons

The article discusses the epidemiological data on the incidence of ischemic stroke (IS) in persons aged 18–50 years, the frequency of various subtypes of IS, depending on the region according to the TOAST classification. Based on recent studies, the frequency of the main traditional risk factors for IS in young people is given, as well as our own data on the frequency of detection of various subtypes of IS on admission and the main risk factors in 145 people aged 18–45 years. The article describes other, moderate causes of stroke at a young age, taking into account modern diagnostic capabilities.

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Distribution of risk factors of ischemic stroke in Chinese young adults and its correlation with prognosis

BMC Neurology ◽

10.1186/s12883-022-02552-1 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Xiaoke Wu ◽

Yutian Zou ◽

Shoujiang You ◽

Yanlin Zhang

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Young People ◽

Poor Prognosis ◽

Sinus Thrombosis ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Definition Of ◽

Toast Classification ◽

Stroke In Young

Abstract Background The risk factors for ischemic stroke in young people are complex, varied and closely related to prognosis. This study aims to analyze the risk factors for ischemic stroke in Chinese young people and to explore the main factors influencing the prognosis. Method A total of 444 patients aged 16 to 45 years with ischemic stroke admitted to Suzhou tertiary hospital from 2011 to 2019 were retrospectively analyzed. Risk factors were identified according to the IPSS definition of pediatric stroke and the TOAST classification. All patients were followed up, and the modified Rankin score was used to evaluate the prognosis. Logistic regression analysis was used to explore the influencing factors of poor prognosis. Results Among the patients, 12 risk factors were found according to the IPSS definition of pediatric stroke, and 5 types of stroke were found according to the TOAST classification. A total of 299 patients had a good prognosis. Anemia, venous sinus thrombosis, isolated large-vessel occlusion, and high baseline NIHSS score were significant risk factors. Conclusion The IPSS definition enables patients to be classified on the basis of more risk factors than other classification methods. The prognosis of ischemic stroke in young people is generally good in the 5 years following the event. Anemia, venous sinus thrombosis, isolated large-vessel occlusion and high baseline NIHSS score were associated with poor prognosis.

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Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.15448 ◽

2021 ◽

Author(s):

Lamia M’barek ◽

Salma Sakka ◽

Fatma Megdiche ◽

Nouha Farhat ◽

Khadija Maalla ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Genetic Markers ◽

Traditional Risk Factors

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TOAST classification and risk factors of ischemic stroke in Lebanon

Acta Neurologica Scandinavica ◽

10.1111/ane.13201 ◽

2019 ◽

Vol 141 (4) ◽

pp. 294-300

Author(s):

Elia G. Malek ◽

Martine Elbejjani ◽

Rawad Abbas ◽

Mary Abed Al Ahad ◽

Hussein Isma'eel ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Toast Classification

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Cardioembolic Sources in Stroke Patients in South of Brazil

Thrombosis ◽

10.1155/2014/753780 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Luiz Carlos Porcello Marrone ◽

João Pedro Farina Brunelli ◽

Ricardo Lutzky Saute ◽

Gustavo Henrique Tomasi ◽

Bianca Cecchele Madeira ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Coronary Artery ◽

Valvular Heart Disease ◽

Oral Anticoagulants ◽

Artery Disease ◽

South Of Brazil ◽

Toast Classification

Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.

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Accident vasculaire cérébral chez les sujets jeunes : à propos d'une jeune femme

Batna Journal of Medical Sciences (BJMS) ◽

10.48087/bjmscr.2020.7115 ◽

2020 ◽

Vol 7 (1) ◽

pp. 59-60

Author(s):

Amrous Amine ◽

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Stroke ◽

Clinical Case ◽

Cerebral Arteries ◽

Epidemiological Data ◽

Common Type ◽

Young Subjects ◽

Embolic Risk ◽

Stroke In Young

According to epidemiological data, stroke’s incidence is clearly growing, especially in young people under 45. Ischemic stroke is the most common type (80%). Many risk factors have been identified, including hypertension, tobacco, dyslipidemia, diabetes, alcohol, and oestroprogestogenic contraceptive pill. The main mechanisms are atheroma of large arterial trunks, occlusion of small cerebral arteries unrelated to atherosclerosis, and cardio-embolic causes. The aim of our study is to present a clinical case of ischemic stroke in young subjects caused by heart disease at high embolic risk.

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Young Ischemic Stroke in South Asia: A review

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v2i1.7636 ◽

2013 ◽

Vol 2 (1) ◽

pp. 27-33 ◽

Cited By ~ 1

Author(s):

Rajeev Ojha ◽

Dongya Huang ◽

Hedi An ◽

Lian Zuo ◽

Wenxia Zhu

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

South Asia ◽

Rural Areas ◽

Young Stroke ◽

Stroke In Young Adults ◽

Incidence Risk ◽

Young Ischemic Stroke ◽

Traditional Risk Factors ◽

Undetermined Etiology

Stroke in young adults may have early impact on quality of life in survivors. Uncontrolled stroke risk factors, lack of treatment facilities and a dense population has made its special significance in South Asia. The main aim of this study is to evaluate incidence, risk factors, etiology and clinical characteristics of young ischemic stroke in South Asia. Incidence of young stroke is more common in South Asian countries than developed western countries and has higher prevalence in rural areas. Traditional risk factors, such as hypertension, smoking, hyperlipidemia and diabetes are associated with majority of cases. Cardioembolism and undetermined etiology contribute to a large proportion of stroke etiology. Appropriate stepwise investigations are suggested to diagnose stroke of other determined etiology. Regular intake of drugs to control risk factors, cessation of smoking, and promote physical activity is suggested to reduce the burden of young stroke. Journal of Advances in Internal Medicine 2013;02(01):27-33 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7636

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Metabolomic Profiles Associated With Incident Ischemic Stroke

Neurology ◽

10.1212/wnl.0000000000013129 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013129

Author(s):

Raji Balasubramanian ◽

Jie Hu ◽

Marta Guasch-Ferre ◽

Jun Li ◽

Farzaneh Sorond ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Risk Prediction ◽

Methionine Sulfoxide ◽

Health Study ◽

Plasma Metabolites ◽

Q Value ◽

Logistic Regression Models ◽

Increased Risk ◽

Traditional Risk Factors

Background:Women have higher lifetime risk of stroke than men, and metabolic factors seem more strongly associated with stroke for women than men. However, few studies in either men or women have evaluated metabolomic profiles and incident stroke.Methods:We applied liquid chromatography-tandem mass spectrometry to measure 519 plasma metabolites in a discovery set of women in the Nurses’ Health Study ([NHS], 454 incident ischemic stroke cases, 454 controls) with validation in two independent, prospective cohorts: Prevención con Dieta Mediterránea ([PREDIMED], 118 stroke cases, 791 controls), and Nurses’ Health Study 2 ([NHS2], 49 ischemic stroke cases, 49 controls). We applied logistic regression models with stroke as the outcome to adjust for multiple risk factors; the false discovery rate (FDR) was controlled through the q value method.Results:Twenty-three metabolites were significantly associated with incident stroke in NHS after adjustment for traditional risk factors (q value <0.05). Of these, 14 metabolites were available in PREDIMED and 3 were significantly associated with incident stroke: methionine sulfoxide, N6-acetyllysine, and sucrose (q value<0.05). In NHS2, one of the 23 metabolites (glucuronate) was significantly associated with incident stroke (q value <0.05). For all four metabolites, higher levels were associated with increased risk. These four metabolites were used to create a stroke metabolite score (SMS) in the NHS and tested in PREDIMED. Per unit of standard deviation of SMS, the odds ratio for incident stroke was 4.12 (95% CI: 2.26 – 7.51) in PREDIMED, after adjustment for risk factors. In PREDIMED, the area under the ROC curve (AUC) for the model including SMS and traditional risk factors was 0.70 (95% CI: 0.75-0.79) versus the AUC for the model including the traditional risk factors only of 0.65 (95% CI: 0.70-75), corresponding to a 5% improvement in risk prediction with SMS (p < 0.005).Discussion:Metabolites associated with stroke included two amino acids, a carboxylic acid and sucrose. A composite SMS including these metabolites was associated with ischemic stroke and showed improvement in risk prediction beyond traditional risk factors.Classification of Evidence:This study provides Class II evidence that a stroke metabolic score accurately predicts incident ischemic stroke risk.

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TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital, Indonesia

Stroke Research and Treatment ◽

10.1155/2018/9589831 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Salim Harris ◽

Saleha Sungkar ◽

Al Rasyid ◽

Mohammad Kurniawan ◽

Taufik Mesiano ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Risk Factor ◽

Ischemic Stroke ◽

Significant Risk ◽

Large Artery ◽

Stroke Risk Factor ◽

Stroke Subtypes ◽

Undetermined Etiology ◽

Toast Classification

Background and Purpose. Stroke is a leading cause of death and disability, with ischemic stroke as the highest prevalent cases in Indonesia. Ischemic stroke can be classified further into five subtypes according to TOAST classification. Numerous studies have revealed that stroke risk factor has variable correlation with different stroke subtype. Currently, there is no data regarding this phenomenon in Indonesia. The aim of study is to identify characteristic of ischemic stroke subtypes and the risk factors in TOAST classification. Methods. A retrospective, cross-sectional study of patients diagnosed with ischemic stroke at Cipto Mangunkusumo Hospital from January till December 2016. Demographic data, ischemic stroke subtypes, risk factors, and other relevant data were documented. Bivariate and multivariate analysis was done using SPSS 23. Results. 235 recorded data patients were included. Large artery atherosclerosis (LAA) was the most prevalent stroke subtypes at 59,6%, followed with small vessel disease (SVD) at 26,7%, undetermined etiology at 9,8%, cardioembolism (CE) at 2,1%, and other determined etiology at 0,9%. Hypertension was the most common vascular risk factor. However, it was only significant in SVD (p=0,023) and undetermined etiology subtypes (p<0,001). Significant risk factor in LAA was diabetes (55%; p=0,016) while in CE subtypes was atrial fibrillation (60%;p<0,001). In multivariate analyses, hypertension (OR 3; 95% CI 1,12-8,05) was the only variable that was related to SVD while in CE it was atrial fibrillation (OR 113,5; 95% CI 13,6-946,5). Conclusion. LAA was the most common stroke ischemic subtypes. Associated risk factor in LAA was diabetes while in SVD and undetermined etiology subtypes it was hypertension. Atrial fibrillation was associated with cardioembolism.

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Diabetes type 2 in young people. Clinical case from the practice of endocrinologist

Clinical review for general practice ◽

10.47407/kr2021.2.1.00028 ◽

2021 ◽

Vol 2 (1) ◽

pp. 18-21

Author(s):

Galina A. Batrak ◽

◽

Maria V. Zhaburina ◽

Keyword(s):

Risk Factors ◽

Insulin Resistance ◽

Type 2 Diabetes ◽

Family History ◽

Young People ◽

Young Patients ◽

Overweight And Obesity ◽

Young Age ◽

History Of

In recent decades, type 2 diabetes is increasingly recorded in young people, adolescents and children. The most significant risk factors for type 2 diabetes in young patients are family history of the disease, overweight and obesity, and the presence of insulin resistance. The main diagnostic criteria for type 2 diabetes mellitus in young patients, in addition to the traditional ones (hyperglycemia and glycosylated hemoglobin), are a high level of C-peptide and insulin resistance in the absence of antibodies to ICA, insulin, GAD. In connection with the projected increase in the incidence of type 2 diabetes at a young age, it is necessary to pay attention to the implementation of preventive measures and timely clinical examination among groups of children and adolescents with the presence of abdominal obesity, burdened with a family history of obesity and type 2 diabetes, in order to prevent or delay the early development of disorders carbohydrate metabolism among this group at an earlier age. Given the predominance of insulin resistance in the pathogenesis of type 2 diabetes in young people, it is necessary to give priority to drugs from the metformin group when prescribing treatment. Thus, the global growth of type 2 diabetes, the tendency to "rejuvenate" diabetes, insufficient information on the prevalence, risk factors and clinical manifestations of the disease at a young age emphasize the urgency of studying this problem.

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Abstract TP375: Using Characteristics of Secondary Ischemic Stroke Events to Improve Stroke Education Initiatives

Stroke ◽

10.1161/str.51.suppl_1.tp375 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Amanda Dirickson ◽

Suzanne Stone

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Stroke Prevention ◽

Small Vessel Disease ◽

Secondary Stroke Prevention ◽

Stroke Treatment ◽

Vessel Disease ◽

Acute Stroke Treatment ◽

Stroke Education ◽

Toast Classification

Purpose: While it is common practice for nursing to perform the duty of stroke education,it is not common to use secondary stroke event data to determine what aspect of stroke education should be emphasized for the greatest impact on secondary stroke prevention. The purpose of this descriptive study is to exam the characteristics of secondary stroke events using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria so future educational initiatives can be customized to the needs of the local high risk population. Methods: The team collected data characteristics on all ischemic stroke admissions with previous admitting diagnosis of acute ischemic stroke. The strokes were further characterized using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification to determine any emerging patterns of both risk factors and etiological types. Conclusions: A total of n=51 admissions were previous adult stroke survivors, (M=30, F=21). Pre-morbid risk factors were as follows: hypertension=78%, type 2 diabetes=39%, hyperlipidemia =54%, smoking=8%, atrial fibrillation=24%. TOAST classification results: Large Vessel Atherosclerosis=14%, Cardioembolic =17%, Small Vessel Disease=3%, Other Known Cause=2%, Cryptogenic=15%. Summary: The results reveal a striking pattern of the presence of premorbid hypertension. While the TOAST classification did not have a single dominant type, but nearly equal distribution of large vessel atherosclerosis, cardioembolic, and small vessel disease etiologies. Not surprising, the decline in stroke mortality is felt to be due to improved blood pressure control, but in discharge stroke education, hypertension is not necessarily emphasized over other perhaps less impactful risk factors. Yet, the most recent acute ischemic stroke clinical guidelines gave providers a first-time recommendation to start or restart antihypertensive therapy in stable patients with BP > 140/90. Nursing has enough encouragement to take the lead on hypertension prevention education in appropriate stable patients ready for discharge. The next goal will be to develop a multimedia educational effort in patient stroke education on hypertension as a risk factor for secondary stroke prevention in this Comprehensive Stroke Center.

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