scholarly journals Risk Factors and Etiologies of Ischemic Stroke in Young Adults: A Hospital-based Study in Bangladesh

2018 ◽  
Vol 8 (2) ◽  
pp. 138-144
Author(s):  
Rumana Habib ◽  
Ikram Hosen ◽  
Rashedul Islam ◽  
Nirmalendu Bikash Bhowmik
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Internal Capsule ◽  
Large Artery ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Stroke In Young Adults ◽  
Subcortical Region ◽  
Associated Risk Factors

Background: Stroke is an important cause of disability among adults and is one of the leading causes of death worldwide. Strokes in young adults can have a significant impact on the affected individuals, their families and societies in general as the affected patients are in the economically productive period of their lives.This study was aimed to find out the demographic profile and explore the associated risk factors of the first-ever ischemic stroke of young adults.Methods: This retrospective study reviewed the records of 64 patients, age 18-49 years, ischemic stroke patients consecutively admitted in the Neurology department, BIRDEM General Hospital during the period January 2016 to June 2017. Study variables included hematological and biochemistry investigations and radiological and imaging findings. Stroke sub-typing was done following to TOAST criteria. Data of follow-up data at 3 month were also included. Data were expressed as number (percent) and managed by SPSS for Windows Version 15.Results: Of the 634 patients diagnosed as acute ischemic stroke 64 (9.90%) were in the 18-49 (yr) age range and the majority (55.4%) were male. Stroke was more common (47 out of 54) among the 31-49 years category as compare with the <30 years category. Stroke patients presented with diabetes mellitus(87.03%),arterial hypertension (44.4%), dyslipidemia (23.5%) and cigarette smoking (31.48%). Family history of stroke was present in 33.5% cases. Ten (6.51%) patients showed hypercoagualable state.Small vessel occlusion (SVO) found in 48.40% cases followed by large artery atherosclerosis (21.86%).Patients with SVO stroke presented with lacunar syndromes and lesions in Basal ganglia(12.1%),Thalamus(6.6%), Subcortical region (0.9%),Internal capsule (20.0%)and brain stem(11.3%). Thrombolysis was not done in any of patients. Most of the patients were on an anti-platelet treatment and majority (85.4%) receiving aspirin alone. Strokes left 48(75.5%)patients with moderate to moderately severe disability on discharge from the hospital.Mortality was lower (6.3%) and had good recovery 35 (54.6%).Conclusion: Ischemic stroke in the young adults accounted for 9.90% of the hospital admission with stroke. Those suffered from ischemic stroke had presence of modifiable risk factors. Predominance of SVO among them not only indicated stroke etiology but also predicted good short term prognosis.Birdem Med J 2018; 8(2): 138-144

scholarly journals Ischemic Stroke in Young Adults: Study of the Subtypes, Risk factors and Predictors of Poor Outcomes

2019 ◽  
Vol 16 (1) ◽  
pp. 29-34
Author(s):  
Reema Rajbhandari ◽  
Parmatma Prajuli ◽  
K K Oli
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Small Scale ◽  
Sudden Increase ◽  
Large Artery ◽  
Stroke Patients ◽  
Aggressive Approach ◽  
Positive Correlation ◽  
Poor Outcomes

The aim of this study is to show the subtype, risk factors and predictors of poor outcomes in young ischemic stroke patients. Materials and Methods: It is a prospective study where only young onset ischemic stroke patients are analyzed. 8% of total ischemic stroke sufferers were young adults; more prevalent in female (57.1%), with risk factors of smoking (47.6%) subtype cardio embolic (42.9%) was common. High NIHSS score was related to new event and correlation to mortality. Three month follow up showed MRS 2.86 ± 1.02. 57.1% of cases had significant disability (defined as MRS ≥ 3). There was a positive correlation of the cardio embolic subtype and the unclassified subtype to all three forms of poor outcomes, along with a positive correlation of the large artery atherothrombotic subtype to new events Recurrence of events (new stroke, sudden increase in symptoms and new TIAs) was observed in 14.3 %. Death was reported in 9.5% of cases.   Etiological diagnosis can be reached in majority of cases if an aggressive approach is maintained. This small scale study has provided an overview of the distribution of subtypes, risk factors and poor outcomes and their predictors. Cardiac diseases (esp. valvular disease) need to be taken more seriously to prevent cardio embolic strokes, while addressing other traditional risk factors to prevent the atherothrombotic subtypes.

Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults: A Worldwide Meta-analysis: The GOAL-Initiative

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013195
Author(s):  
Mina A. Jacob ◽  
Merel S. Ekker ◽  
Youssra Allach ◽  
Mengfei Cai ◽  
Karoliina Aarnio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Regional Differences ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Patient Data ◽  
Stroke Patients ◽  
Stroke In Young Adults ◽  
Stroke In Young

Background and Objectives:There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional healthcare services. To study the global distribution of risk factors, causes and 3-month mortality of young ischemic stroke patients, by performing a patient data meta-analysis form different cohorts worldwide.Methods:We did a pooled analysis of individual patient data from cohort studies which included consecutive ischemic stroke patients aged 18-50 years. We studied differences in prevalence of risk factors and causes between different ethnic and racial groups, geographic regions and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression.Results:We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Blacks (hypertension, 52.1%; diabetes, 20.7%) and Asians (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often cause of stroke in high-income countries (HICs; both p<0.001), whereas ‘’other determined stroke’’ and ‘’undetermined stroke’’ were higher in low and middle-income countries (LMICs; both p<0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (OR 2.49; 95% CI 1.42-4.36).Discussion:The ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial, and regional differences in incidence of ischemic stroke. Our results also visualize the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve healthcare facilities in LMICs.

scholarly journals Ischemic stroke in young adults: an overview of etiological aspects

2012 ◽  
Vol 70 (6) ◽  
pp. 462-466 ◽  
Author(s):  
Fábio Iuji Yamamoto
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Young People ◽  
Chagas Disease ◽  
The Other ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Stroke In Young Adults ◽  
Stroke In Young

Stroke affects mainly people aged over 65 years, and atherosclerosis predominates as the main etiopathogenic factor in ischemic stroke (IS). On the other hand, cardiac embolism and arterial dissection are the most frequent causes of IS in patients aged less than 45 years. However, inappropriate control of traditional vascular risk factors in young people may be causing a significant increase of atherosclerosis-related IS in this population. Furthermore, a variety of etiologies, many of them uncommon, must be investigated. In endemic regions, neurocysticercosis and Chagas' disease deserve consideration. Undetermined cause has been still reported in as many as one third of young stroke patients.

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 Etiology of ischemic stroke among young adults of Serbia

2008 ◽  
Vol 65 (11) ◽  
pp. 803-809 ◽  
Author(s):  
Dejana Jovanovic ◽  
Ljiljana Beslac-Bumbasirevic ◽  
Ranko Raicevic ◽  
Jasna Zidverc-Trajkovic ◽  
Marko Ercegovac
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Heart Diseases ◽  
Developed Countries ◽  
Large Artery ◽  
Stroke Treatment ◽  
Prosthetic Valves ◽  
Number Of Patients ◽  
Coagulation Inhibitors

Background/Aim. Etiology of ischemic stroke (IS) among young adults varies among countries. The aim of the study was to investigate the causes and risk factors of IS in the young adults of Serbia. Methods. A total of 865 patients with IS, aged 15 to 45 years, were treated throughout the period 1989-2005. Etiologic diagnostic tests were performed on the patient by the patient basis and according to their availability at the time of investigation. The most likely cause of stroke was categorized according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Results. There were 486 men and 379 women, with 19% of the patients ? 30 years old. Large artery arteriosclerosis and small artery disease were confirmed in 14% of the patients, and embolism and other determined causes in 20%. Undetermined causes made up 32% of the patients, mostly those (26%) with incomplete investigations. Smoking (37%), hypertension (35%) and hyperlipidemia (35%) were the most common risk factors. Rheumatic heart diseases and prosthetic valves were the most common causes of IS. Arterial dissections and coagulation inhibitors deficiency were detected in a small number of patients. Conclusion. Etiology of IS among Serbian young adults shares characteristics of those in both western and less developed countries.

Abstract WMP53: Traditional Vascular Risk Factors Account for Different Proportions of Ischemic Stroke Within Different Gender and Race Groups

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Elizabeth M Aradine ◽  
Yan Hou ◽  
Kathleen A Ryan ◽  
Prachi Mehndiratta ◽  
Michael S Phipps ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Black Men ◽  
White Men ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Odds Ratios ◽  
Stroke In Young Adults ◽  
Stroke In Young

Introduction: Few studies have compared the proportion of ischemic strokes attributable to traditional vascular risk factors (population-attributable risk percent or PAR%) between genders and races. The PAR% is a function of the population prevalence and strength of association of a risk factor. Methods: A population-based case-control study of ischemic stroke in young adults ages 18-49 in the Baltimore-Washington region was used to study the prevalence, odds ratios, and PAR% of hypertension, diabetes, and smoking among blacks and whites. Logistic regression was used to calculate age-adjusted odds ratios. All analyses were stratified by gender. Results: There were 1044 cases and 1099 controls. Of the cases, 47% were black, 54% were women. Roughly a quarter to a third of all strokes in women were attributable to smoking. Due to the higher prevalence of hypertension and a higher odds ratio for hypertension in black men (OR 3.9, 95% CI 2.6-5.9) compared to white men (OR 1.8, 95% CI 1.3-2.6), there was a much higher PAR% for hypertension among black men than white men. See Table 1 for prevalence and Table 2 for PAR% stratified by gender and race. Conclusion: Traditional vascular risk factors have the potential to explain a high proportion of ischemic stroke in young adults. The high proportion of strokes in women attributable to smoking underscores the need for targeted smoking cessation interventions in this population. Diabetes and, especially, hypertension are important contributors to the excess population burden of ischemic stroke among blacks. These findings support the value of early screening and treatment for hypertension in young blacks.

Abstract 2919: Do Premature Ventricular Contractions Play a Role in the Etiologic Subtypes of Ischemic Stroke?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
JUN LEE ◽  
Na-Young Kim
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
Median Number ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Premature Ventricular Contractions ◽  
Ordinal Logistic Regression Analysis ◽  
The Relationship

Background The relationship between stroke and non-atrial fibrillation cardiac arrhythmias remains unclear. Frequent premature ventricular contractions (PVCs) are associated with impaired ventricular relaxation and may increase the risk of clot formation and subsequent embolization. This study investigated the relationship between frequency of PVCs and etiologic subtypes of ischemic stroke. Methods Consecutive ischemic stroke patients admitted within 7 days of onset who underwent 24-hour Holter monitoring were enrolled (n=451). Subtypes of ischemic stroke were defined according to the SSS-TOAST classification as Large artery atherosclerosis (LAD), cardioembolic stroke (CE), small vessel occlusion (SVO), other causes (OC), and cryptogenic stroke (CS). Risk factors, demographic information, and 24-hour Holter recordings were compared between the subtypes of ischemic stroke. Results There were 182 women and 269 men (191 LAD, 90 CE, 93 SVO, 13 OC, 64 CS), with a mean age of 66 years (median 68). PVCs were seen in 305 patients (67.5%) on 24-hour Holter monitoring (median 3, IQR 0-48). CE had a higher median number of PVCs (median 24, IQR 0-258) than LAD (median 2, p=0.01), SVO (median 1, p<0.001), OC (median 0, p=0.013), and CS (median 4, p=0.2). The proportions of frequent PVCs (>50 in a 24-hour Holter monitoring) were higher in CE (43.3%) compared with the other groups (20.9% in LAD, 15.1% in SVO, 15.4% in OC, and 23.4% in CS; p<0.001). Compared with the SVO, the upper 3 quartiles of PVCs were associated with CE (OR 2.93; 95% CI, 1.69 to 5.06) and CS (OR 1.86; 95% CI, 1.07 to 3.2) in ordinal logistic regression analysis after adjustment for traditional risk factors. Conclusions The number of PVCs detected by 24-hour Holter monitoring is associated with CE and CS. The presence of high frequency of PVC may help in stratifying patients with different stroke subtypes, particularly embolic stroke. The role of these arrhythmias as a risk marker for ischemic stroke deserves further investigation.

scholarly journals Subtypes, Risk Factors and Site of Stenosis of Ischaemic Stroke in a University Hospital in Bangladesh

2021 ◽  
pp. 11
Author(s):  
Mohammad Shahidullah ◽  
Nahid Sultana ◽  
Subash Kanti Dey ◽  
Anis Ahmed
Keyword(s):  
Risk Factors ◽  
Magnetic Resonance ◽  
Ischaemic Stroke ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Large Artery ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Cross Sectional ◽  
Common Cause

Stoke is the second most common cause of death and the most common cause of adult disability. To plan an efficient evaluation and treatment of an individual patient with ischaemic stroke, the clinician should be familiar with the subtyping of ischaemic stroke patients and the risk factors analysis of different aetiology. Eight hundred seventy-seven (877) patients have been selected for this cross-sectional study conducted in a university hospital of Bangladesh from 2014 to 2018, to whom brain imaging [Computed Tomography (CT)/ Magnetic Resonance Imaging (MRI)], vascular imaging [Magnetic Resonance Angiogram (MRA), Digital Subtraction Angiogram (DSA)], ECG and echocardiography have been done. We did subtyping according to TOAST criteria. The mean age of patients was 60.5 ± 11 years. Most patients (29.33%) belonged to the age group 51 – 60, where 70.47% of subjects were male and 29.53% were female. In this study, 43.87% of patients were in the large artery atherosclerosis group, 23.83.% in the small vessel occlusion group, 8.46% in the cardiac embolism group, 19.30% in the undetermined aetiology group and 4.54% in other determined aetiology. Among risk factors hypertension, diabetes mellitus, dyslipidaemia was present in 58.15%, 38.42%, and 38.88% of patients, respectively. In ischaemic stroke patients, large artery atherosclerosis was the most common subtype and hypertension was significant in this group. Extracranial stenosis was more common in ischaemic stroke.

scholarly journals Global Outcome Assessment Life-long after stroke in young adults initiative—the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031144
Author(s):  
Merel Ekker ◽  
Mina Jacob ◽  
Myrna van Dongen ◽  
Karoliina Aarnio ◽  
Arunkar Annamalai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Secondary Prevention ◽  
Stroke Risk ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Stroke Patients ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Stroke In Young

IntroductionWorldwide, 2 million patients aged 18–50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients.Methods and analysisThe Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18–50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Ethics and disseminationEthical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

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