ISCHEMIC STROKE IN YOUNG-ADULTS - EXPERIENCE IN 329 PATIENTS ENROLLED IN THE IOWA REGISTRY OF STROKE IN YOUNG-ADULTS
ISCHEMIC STROKE IN YOUNG-ADULTS - EXPERIENCE IN 329 PATIENTS ENROLLED IN THE IOWA REGISTRY OF STROKE IN YOUNG-ADULTS
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DOI：
10.1001/archneur.1995.00540290081021
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发表时间：
1995-05-01
影响因子：
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通讯作者：
HEFFNER, M
中科院分区：
文献类型：
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作者：
ADAMS, HP;KAPPELLE, LJ;HEFFNER, M
目的：描述青年人群中缺血性卒中的可能原因，并报告严格算法对该队列中卒中可能原因诊断的影响。设计：从1977年7月1日到1993年1月1日，我们登记了329例缺血性中风的年轻人。诊断研究是在个案基础上选择的。根据临床信息和诊断测试结果确定脑卒中的推定原因。在每个病例中，使用为大型临床试验制定的标准进行第二次病因诊断。环境：患者由爱荷华州和邻近州的医生转诊至爱荷华市爱荷华大学医院和诊所神经内科脑血管病科。患者：329名15 - 45岁缺血性中风的年轻人（182名男性，147名女性）；102人，48男54女，年龄在30岁或以下。结果：颅内动脉造影227例，异常146例。经胸超声心动图显示，221例患者中有82例出现异常。我们确定了大约60种不同的疾病被认为是导致中风的原因。在最初的144名患者和随后的185名患者之间，亚型诊断的频率没有重大变化。使用严格的诊断标准增加了未确定病因的中风病例数（从45例增加到113例），归因于大动脉粥样硬化的病例数从71例减少到32例。结论：青壮年缺血性脑卒中的病因多种多样。由于该组的治疗方案受到假定原因的影响，因此有必要根据具体情况进行评估。我们的经验表明，在大多数情况下，一个可能的原因将被检测出来，可能不需要严格的一系列测试。如果使用严格的诊断标准，不明原因中风的诊断将大大增加。虽然这种严格的标准在测试新干预措施的临床试验中很重要，但将这种方法应用于不寻常人群（如年轻人中风）的价值需要澄清。特别是，当确定了两个或更多可能的原因时，将中风分类为未确定的有用性需要探索。
Objectives: To describe the likely causes of ischemic stroke in a population of young adults and to report the influence of strict algorithms on the diagnosis of the likely cause of stroke in this cohort.Design: Between July 1, 1977, and January 1, 1993, we registered 329 young adults with ischemic stroke in our registry. Diagnostic studies were selected on a case-by-case basis. Presumed causes of stroke were determined using clinical information and the results of diagnostic tests. In each case, a second causative diagnosis was made using the criteria developed for a large clinical trial.Setting: Patients referred to the Division of Cerebrovascular Diseases in the Department of Neurology at the University of Iowa Hospitals and Clinics, Iowa City, by physicians in Iowa and adjacent states.Patients: Three hundred twenty-nine young adults (182 men and 147 women) aged 15 to 45 years with ischemic stroke; 102 persons, 48 men and 54 women, were aged 30 years or younger.Results: Cerebral arteriography was performed in 227 cases, and the findings were abnormal in 146. Transthoracic echocardiography revealed abnormalities in 82 of 221 patients examined. We identified approximately 60 different disorders that were presumed to be the cause of stroke. There were no major changes in the frequency of subtype diagnoses between the first 144 patients and the subsequent 185. Use of strict diagnostic criteria increased the number of cases of stroke of undetermined etiology (from 45 to 113),and the number attributed to large artery atherosclerosis declined from 71 to 32.Conclusions: The causes of ischemic stroke in young adults are numerous. Because treatment options in this group are influenced by a presumed cause, an evaluation on a case-by-case basis is warranted. Our experience suggests that a likely cause will be detected in most cases and that a regimented battery of tests may not be required. If strict diagnostic criteria are used, the diagnosis of stroke of undetermined etiology considerably increases. While such strict criteria are important in clinical trials that test new interventions, the value of the application of such methodologies to an unusual population, such as stroke in young adults, needs clarification. In particular, the usefulness of categorizing a stroke as undetermined when two or more possible causes are identified needs to be explored.