scholarly journals Epidemiology and Etiology of Young Stroke

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Dayna Griffiths ◽  
Jonathan Sturm
Keyword(s):  
Young Patients ◽  
Case Series ◽  
The Elderly ◽  
Population Based ◽  
Stroke Incidence ◽  
Young Stroke ◽  
Underlying Causes ◽  
Stroke In The Young ◽  
The Individual ◽  
Older Populations

Introduction. Stroke in people under 45 years of age is less frequent than in older populations but has a major impact on the individual and society. In this article we provide an overview of the epidemiology and etiology of young stroke.Methods. This paper is based on a review of population-based studies on stroke incidence that have included subgroup analyses for patients under 45 years of age, as well as smaller community-based studies and case-series specifically examining the incidence of stroke in the young. Trends are discussed along with the relative frequencies of various etiologies.Discussion. Stroke in the young requires a different approach to investigation and management than stroke in the elderly given differences in the relative frequencies of possible underlying causes. It remains the case, however, that atherosclerosis contributes to a large proportion of stroke in young patients, thus, conventional risk factors must be targeted aggressively.

scholarly journals Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

2021 ◽  
Author(s):  
Feng Gao ◽  
Jiajian Wang ◽  
Junyi Chen ◽  
Xiaolei Wang ◽  
Yuhong Chen ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Anterior Segment ◽  
Young Patients ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Uncommon Presentation ◽  
Underlying Causes

Abstract Purpose To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. Methods Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts. Results A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan’s syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat’s disease, and neurofibromatosis. Conclusions We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

Abstract 2652: Carotid Revascularization Provides Similar Outcomes in Symptomatic and Asymptomatic Patients with <70 Years

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Paola De Rango ◽  
Fabio Verzini ◽  
Piergiorgio Cao ◽  
Enrico Cieri ◽  
Giuseppe Giordano ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Young Patients ◽  
The Elderly ◽  
Carotid Stenting ◽  
Stroke Incidence ◽  
Perioperative Stroke ◽  
Carotid Revascularization ◽  
Asymptomatic Patients ◽  
Effect Of Age ◽  
Stroke Death

Absolute stroke risk and perioperative stroke risk during carotid revascularization are higher in patients with symptomatic than in those with asymptomatic carotid stenosis. Age is one of the main risk factors for stroke and trials have shown a significant age interaction after carotid stenting (CAS). This study aims to analyze the effect of age on outcomes of carotid revascularization using the 70-year threshold as suggested by CREST. Methods: From 2001 to 2010 patients receiving carotid revascularization, either by CAS or by endarterectomy (CEA) were reviewed. Perioperative stroke-death rates and 72-month survival and late stroke incidence were compared in symptomatic and asymptomatic patients with less and more than 70years. Results: 2196 procedures, 1080 by CAS 1116 by CEA, were reviewed;684 were performed for carotid referable symptoms. Symptomatic patients showed higher perioperative stroke/death risks (3.5% vs 1.9%, p=0.034) and lower 72-months survival (74% vs 82%, p=0.0001) or freedom from late stroke (93% vs 97%, p=0.002) than asymptomatic patients with similar differences detected within CEA or CAS procedure. When only the group of 949 youngsters (≤70y) was analyzed, symptomatic and asymptomatic patients shared similar low perioperative stroke/death risks: 2.1% vs 1.3%, p=0.39. For young symptomatic patients, perioperative stroke/death risk was comparably low in CAS and CEA: 1.8% vs 1.2%. At 72 months, survival (98% vs 97%, p=0.49) and freedom from stroke (89% vs 89%, p=0.33) rates were similarly high in symptomatic and asymptomatic young patients. Comparable risks between the symptomatic and asymptomatic youngsters were found after each CAS (perioperative stroke/death: p=0.64; survival: p=0.10; late stroke: p=0.50) and CEA (perioperative stroke/death: p=0.49; survival: p=0.91; late stroke: p=0.64) procedure. Higher perioperative and late risks were confirmed for symptomatic patients in the elderly (>70y) subgroup (n=1247) regardless of the procedure. Conclusions: Outcomes following carotid revascularization are related to patient age. For younger ages (≤70years) symptomatic and asymptomatic patients may share similarly low perioperative and late risks of stroke and death after carotid revascularization whichever the procedure applied.

Abstract T MP66: Injury to the Head or Neck Increases Risk of Ischemic Stroke Three-fold After Trauma.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Christine K Fox ◽  
Adam L Numis ◽  
Steve Sidney ◽  
Heather J Fullerton
Keyword(s):  
Ischemic Stroke ◽  
Traumatic Injury ◽  
Young Patients ◽  
Risk Groups ◽  
Population Based ◽  
Incidence Rates ◽  
Neck Injury ◽  
Diagnostic Code ◽  
Stroke Incidence ◽  
Diagnostic Codes

Background: Over 2 million people under age 50 are seen in a U.S. emergency room monthly for non-fatal injuries. Our objective was to measure ischemic stroke incidence after traumatic injury in young patients and identify stroke risk factors. Methods: We performed a population-based study of ischemic stroke after trauma among people <50 years old in a Northern Californian integrated health care system. We electronically identified a cohort of patients with diagnostic codes for trauma (ICD-9 800-959.9) in emergency and inpatient encounters from 1997-2011, then identified ischemic stroke outcomes within 4 weeks. To determine stroke, we required an ICD-9 stroke code (433-438) plus a radiology report of brain imaging containing a keyword: stroke, infarct#, thromb#, ischemi#, lacun#, or dissect#. A neurologist reviewed the reports to exclude those inconsistent with ischemic stroke. We obtained clinical data such as injury type from electronic databases to calculate stratified incidence rates and risk ratios. Results: From 1.5 million trauma encounters, we identified 197 ischemic strokes. The 4-week stroke incidence after any traumatic injury was 0.013% (95% CI 0.011, 0.015). Patients with stroke had a mean age of 37.7 years (SD 12.2) versus 24.0 years (SD 13.8) in those without stroke (P<0.0001). Patients with injury to the head or neck were more likely to have a stroke compared to those with other types of injuries (Table). The 4-week stroke incidence after head or neck injury was 0.07% (95% CI 0.05, 0.09) among adults and 0.005% (95% CI 0.001, 0.01) among children (P<0.0001). Of the 197 stroke cases, 16% (95% CI 11, 22) had a diagnostic code for cranio-cervical dissection. Conclusions: A 4-week stroke incidence of 0.013% suggests that 260 young people have an ischemic stroke after a traumatic injury every month in the U.S. Further research is needed to identify the highest risk groups, such as those with head or neck injury, and opportunities for stroke prevention.

scholarly journals Stroke incidence and case fatality: a 9-year prospective population-based study in an elderly population of Bagheria, Italy

2020 ◽  
Author(s):  
Valentina Arnao ◽  
Giuseppe Salemi ◽  
Salvatore Scondotto ◽  
Nicola Casuccio ◽  
Marianna Riolo ◽  
...  
Keyword(s):  
Elderly Population ◽  
Case Fatality ◽  
The Elderly ◽  
Population Based ◽  
Incidence Rates ◽  
World Population ◽  
Italian Population ◽  
Population Based Study ◽  
Stroke Incidence ◽  
Epidemiological Surveys

Abstract Background The incidence of stroke in high-income countries has been on the decline; however, few epidemiological surveys have been conducted in recent years to specifically estimate the incidence along with outcome of stroke, in Italy. This study aimed to examine the incidence and case fatality rates of stroke in an elderly Italian population. Methods A cohort of 2200 people > 65 years was randomly stratified from the total elderly population of Bagheria, Italy. A 9-year prospective population-based study was performed (19,800 person/years). Results We identified 112 first-ever strokes, 53 females and 59 males: 82 (73.1%) ischemic, 13(11.6%) intracerebral haemorrhages, 6 (5.35%) subarachnoid haemorrhages, while 11(9.8%) were classified as undetermined strokes. The crude overall annual incidence was 5.65 per 1000 (95%CI: 4.61 to 6.70) for first-ever stroke. The overall crude incidence rates were 4.74 per 1000 (5.08 for males and 4.46 for females) for ischemic stroke, 0.65 (0.99 for males and 0.37 for females) for intracerebral haemorrhage, and 0.03 for subarachnoid haemorrhage. The incidence rate for first-ever stroke was 5.4 per 1000 (95% CI: 5.36 to 5.45) after adjustment for the 2015 World population and 5.56 (95% CI: 5.52 to 5.61), compared to the 2015 European population. Overall case fatality rates for first-ever stroke was 8.19% at 28 days and 24.1% at 1 year. Conclusion Our study shows that in the elderly population investigated, stroke incidence and case fatality rates resulted being lower, compared to those from Italian and most European populations. Similar to previous studies, these rates increased linearly with age and were higher in males.

scholarly journals 1361. Actinotignum schaalii an Under-recognized Cause of Infections: A Case Series in Calgary from 2012 - 2020

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S766-S767
Author(s):  
Anthony Lieu ◽  
Jordan Mah ◽  
Deirdre Church
Keyword(s):  
Soft Tissue ◽  
Case Series ◽  
The Elderly ◽  
Opportunistic Pathogen ◽  
Invasive Disease ◽  
Population Based ◽  
Invasive Infections ◽  
Phenotypic Methods ◽  
Administrative Health Databases ◽  
Tract Infections

Abstract Background Actinotignum schaalii is a gram-positive rod that is a fastidious commensal of the urogenital tract. Infections with A. schaalii are underdiagnosed previously because phenotypic methods fail to identify it. Both MALDI-TOF mass spectrometry and 16S rRNA sequencing allow definitive identification of this opportunistic emerging pathogen. A. schaalii is an infrequent but important cause of UTIs in the elderly, particularly with urological abnormalities. The spectrum of invasive disease caused by A. schaalii is not well characterized; however, it has been isolated in severe infections including necrotizing skin and soft tissue infections, bacteremia, osteomyelitis, and endocarditis. We used a population-based approach to characterize and describe the clinical and microbiological features of invasive A. schaalii infections in our region. Methods All adult and pediatric cases enrolled had microbiological isolates of Actinotignum schaalii recovered from blood cultures, sterile fluids and tissue cultures from Jan 2012 to Dec 2020 by APL, a regional centralized microbiology laboratory serving the Calgary Zone in Alberta, Canada. Clinical data were retrieved and linked from administrative health databases, chart review and the laboratory information system. Standard descriptive statistics were used. Results We identified 84 unique A. schaalii infections, 35 were from bloodstream, 32 soft tissue, 7 post-operative infections. Median age and Charslon comorbidity score was higher in BSI. 54.3% of patient with BSI had a genitourinary pathology, with 51.4% caused by a complicated urinary infection, while soft and skin tissue infections caused 65.3% of non-BSI. Using EUCAST MIC cut-offs, 48% and 100% of the isolates were resistant to clindamycin and metronidazole, respectively. In contrast, all specimens were susceptible to penicillin. Hospitalization and 90-days mortality were higher in the BSI group. Conclusion A. schaalii is an anaerobic opportunistic pathogen that can cause life-threatening invasive infections, particularly in older adults with underlying genitourinary pathology. BSI were associated with higher rates of hospitalization and mortality. In contrast, patients with A. schaalii isolated from cutaneous sources were younger and had better clinical outcomes. Disclosures All Authors: No reported disclosures

Ischaemic Stroke in the Young

2018 ◽  
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Minor Stroke ◽  
Emergency Setting ◽  
Older Individuals ◽  
Stroke Patients ◽  
Vascular Events ◽  
Stroke Incidence ◽  
Young Stroke ◽  
Stroke In The Young

Stroke in the young is different, complex, and challenging. This book delivers a comprehensive review of the different aspects of young ischaemic stroke. Incidence, risk factors, and aetiology differ notably from those seen in the elderly. There is an increased prevalence of traditional risk factors already at a young age, but the book also focuses on special risk factors in young stroke patients. In many young stroke patients, aetiology remains unclear. The book outlines an extensive diagnostic workup and a stroke subtype classification adapted for young strokes. Gender differences are prevalent in young stroke. The book describes risk factors that are either unique or more prevalent in women and the importance of treating them aggressively. Stroke symptoms in children are comparable to those in adults, but there is a dramatic bystander delay in diagnosing the stroke. The text therefore also deals with rapid stroke recognition and adaption to the special needs in children. Young stroke patients are under-represented in randomized controlled treatment trials. In the emergency setting, unusual clinical findings and off-label situations may be faced and the decision-making process may be challenging. Recommendations for secondary prevention are also mainly extrapolated from studies in older individuals. The authors extrapolate data and draw conclusions on the acute and prophylactic treatment of young stroke. Prognosis after young stroke is poor. Even minor stroke may have devastating life-long consequences for quality of life, education, and working capacity. The book points to the opportunity for lifelong prevention of vascular events.

scholarly journals Risk Factors in Young Stroke

2019 ◽  
Vol 21 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Md Harun Ur Rashid ◽  
MA Kashem ◽  
Sarmistha Biswas ◽  
Mohammad Mahfuzul Hoque
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Young Patients ◽  
The Elderly ◽  
Cross Sectional ◽  
Medical College ◽  
Stroke In Young Adults ◽  
Associated Risk Factors ◽  
The Individual ◽  
Stroke In Young

Background: Stroke in young age is less frequent than in older populations but has a major impact on the individual and society. This study was done to find out aetiological pattern and associated risk factors of stroke in young adults. Methods: This descriptive cross-sectional observational study was conducted in the Department of Medicine and Neurology, Dhaka Medical College, Dhaka, during the period of April to October 2016. We studied consecutive 100 stroke patients between the age of 15-45 years. Results: In this study 62% patients were male and 38% were female, male incidence is 24% higher than female and ratio is 1. 38. Infarction was found in 65% cases. Haemorrhage was in 35% cases. Dyslipidaemia was mostly associated risk factor in both infarction (76. 91%) and in haemorrhage (85. 71%). High prevalence of dyslipidaemia as associated risk factor may indicate premature atherosclerosis. Conclusion: Stroke in young requires a different approach to investigation and management than stroke in the elderly due to differences in the relative frequencies of possible underlying causes. It remains the case, however, that atherosclerosis contributes to a large proportion of stroke in young patients, thus conventional risk factors must be targeted aggressively. J MEDICINE JAN 2020; 21 (1) : 26-30

Abstract 17064: Frailty Predicts Mortality and Hospital Readmission Amongst Elderly Heart Failure (HF) Patients Discharged From Hospital or the Emergency Department (ED)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Penelope Rampersad ◽  
Susan E Bronskill ◽  
Alice Chong ◽  
Peter C Austin ◽  
Jack V Tu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Vital Signs ◽  
The Elderly ◽  
Population Based ◽  
Community Dwelling ◽  
Very Elderly ◽  
Predictors Of Mortality ◽  
Chart Abstraction ◽  
The Individual ◽  
The Impact

Introduction: Frailty is commonly encountered in elderly patients with HF. However, the impact of both frailty and HF on outcomes in the population has not been delineated. There is a need for operationalizable definitions of frailty to explore variations in care among the elderly. Objective: To assess common indicators of frailty as predictors of mortality and rehospitalisation within 1 year in a population-based study of very elderly HF patients. Methods: Community-dwelling HF patients aged >75 yrs discharged from hospital or ED in Ontario, Canada, were studied using the Enhanced Feedback for Effective Cardiac Treatment and Emergency HF Mortality Risk Grade databases. Surrogates of frailty, including dementia, falls, incontinence, immobility, caregiver dependence, and abnormal weight loss, were identified from chart abstraction and linked hospitalization records. Survival analyses were performed using multiple Cox regression, for frail vs non-frail status and for each frailty component. Results: 9964 patients were identified (age 84±5 yrs). After adjustment for age, sex, vital signs, laboratory variables, and comorbidities, presence of any frailty indicator was associated with mortality: adjusted hazard ratio [HR] 1.18 (95%CI; 1.06-1.32, p=0.003). Frailty increased the risk of readmission and the association was more pronounced than for mortality (see Figure ): adjusted HR 1.29 (95%CI; 1.18-1.41, p<.001). Among the individual frailty components, significant predictors of mortality were: dementia (HR 1.49, 95%CI; 1.34-1.64, p<.001) and care provider dependency (HR 1.17, 95%CI; 1.01-1.36, p=0.038). In contrast, other frailty components increased the risk of readmission, specifically: falls (HR 1.17, 95%CI; 1.06-1.29, p=0.003) and incontinence (HR 1.64, 95%CI; 1.18-2.29, p=0.004). Conclusion: Frailty indicators derived from clinical and administrative data sources are associated with death and readmission in a very elderly HF cohort.

NCOG-50. CHARACTERIZING MENINGIOMA IN YOUNG PATIENTS UNDER 40

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi163-vi163
Author(s):  
Moshe Attia ◽  
Yehoshua Mirkin ◽  
Rotem Hershcovitch ◽  
Zvi Cohen ◽  
Zion Zibly ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Young Patients ◽  
Case Series ◽  
Population Level ◽  
Population Based ◽  
Who Grade ◽  
Younger Patients ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND Meningiomas are the most common primary CNS tumor in adults, with a median age at diagnosis of 65 years. Younger patients usually have a genetic background or history of prior radiation exposure. Population-level studies suggest 80-85% of meningiomas are WHO grade I (benign), 15-18% grade II (atypical), and 1-3% grade III (anaplastic). This case series describes a single center experience of meningiomas in patients under 40. METHODS We reviewed the Sheba Medical Center Neurosurgery and radiotherapy databases containing patients operated on for meningioma between 2011-2020. Digital medical records were retrieved, including pathology reports, surgical reports, clinical and radiological data, and use of radiotherapy or medical treatments. RESULTS Of 600 patients in the database, 47 patients under 40 (7.8%) were identified and 54 tumors were reviewed (five patients had multiple operation). 32 patients were female (68%) ; 2 were under 20 years old, 17 were age 20-30 and 28 were age 31-39 at first presentation. Seven patients had received prior radiation therapy for a childhood malignancy. 28 meningiomas were histology confirmed grade I (52%), 22 were grade II (41%), 2 were grade III (4%), and 2 (4%) were grade undetermined. 22 tumors were located in the skull base (41%) and 32 (59%) in the brain convexity. 16 skull base tumors were grade I, five were grade II, and one was grade III. 12 convexity tumors were grade I, 16 were grade II, and two were grade III. Median follow-up was 35 months (range 1 - 98 months). CONCLUSION Our experience with meningioma patients under 40 revealed a different grade segregation than the older population, with younger patients showing a higher incidence of grade II tumors. These tumors are generally more aggressive, and require careful resection and consideration for post-surgical radiotherapy. Further validation with population based databases is required.

Epidemiology

2018 ◽  
Author(s):  
Merel Sanne Ekker ◽  
Frank-Erik de Leeuw
Keyword(s):  
Risk Factors ◽  
Imaging Techniques ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Stroke Incidence ◽  
Young Stroke ◽  
Risk Of Death ◽  
Stroke In Young Adults ◽  
Traditional Risk Factors ◽  
Stroke In Young

Epidemiology can be used to reveal new causes of ischaemic stroke in young adults. Each year, about 2 million patients worldwide suffer a young stroke between the ages of 18 and 49 years. The overall stroke incidence is decreasing; however, an increase in the incidence of young stroke has been witnessed, possibly due to better awareness, new imaging techniques, and the increased prevalence of traditional risk factors already at a young age. Nevertheless, not all young stroke patients have cardiovascular risk factors. The proportion of patients with arterial dissection, cardioembolic stroke, and cryptogenic stroke is higher in young patients than in older patients. This chapter uses sex differences in both incidence and prognosis to provide leads for new risk factors in young men and women. Lastly, prognosis after young stroke is poor. The risk of death is higher than expected from the general population and remains high even years after stroke. Young stroke strikes suddenly, with attendant life-long consequences.

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