Ischemic Stroke and Transient Ischemic Attack in Young Adults Risk Factors, Diagnostic Yield, Neuroimaging, and Thrombolysis
Ischemic Stroke and Transient Ischemic Attack in Young Adults Risk Factors, Diagnostic Yield, Neuroimaging, and Thrombolysis
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DOI：
10.1001/jamaneurol.2013.575
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发表时间：
2013-01-01
期刊：
影响因子：
29
通讯作者：
Singhal, Aneesh B.
中科院分区：
文献类型：
--
作者：
Ji, Ruijun;Schwamm, Lee H.;Singhal, Aneesh B.
背景：大约10% - 14%的缺血性中风发生在年轻人中。目的：探讨青壮年缺血性脑卒中的诊断检查、神经影像学表现及治疗方法。设计：我们回顾性地回顾了2005年至2010年卒中指南数据库中的数据。单位：大学医院三级脑卒中中心。患者：共215例18 ~ 45岁连续住院的缺血性卒中/短暂性脑缺血发作患者。平均（SD）年龄37.5(7)岁；51%为男性。结果：高血压（20%）、糖尿病（11%）、血脂异常（38%）、吸烟（34%）发生率较高。203例患者中脑血管造影136例出现相关异常，195例患者中心脏超声100例，192例患者中动态心电图2例；189名患者中有30人有高凝血功能。多发性梗死发生率为31%，在年龄小于35岁的人群中更为普遍。相关动脉病变多见于大脑中动脉（23%）、颈内动脉（13%）和椎基底动脉（13%）。心脏栓塞性卒中发生率为47%（其中17%为孤立性卵圆孔未闭），11%的卒中病因不明。美国国立卫生研究院卒中量表得分中位数为3（四分位数范围0-9），81%的患者出院时预后良好。在29例接受溶栓治疗的患者中（美国国立卫生研究院卒中量表评分中位数为14分；四分位数范围为9-17分），55%的患者出院时预后良好，无患者出现症状性脑出血。结论：本研究显示了在三级卒中中心住院的年轻成人缺血性卒中的当代概况。近90%的患者可以通过现代诊断测试确定脑卒中的病因。原因是多方面的；然而，年轻人患传统血管危险因素的比例很高。溶栓似乎是安全的，短期结果是有利的。中华神经科杂志，2013;37(1):51-57。2012年10月29日在线发布。doi: 10.1001 / jamaneurol.2013.575
Background: Approximately 10% to 14% of ischemic strokes occur in young adults.Objective: To investigate the yield of diagnostic tests, neuroimaging findings, and treatment of ischemic strokes in young adults.Design: We retrospectively reviewed data from our Get with the Guidelines-Stroke database from 2005 through 2010.Setting: University hospital tertiary stroke center.Patients: A total of 215 consecutive inpatients aged 18 to 45 years with ischemic stroke/transient ischemic attack. The mean (SD) age was 37.5 (7) years; 51% were male.Results: There were high incidence rates of hypertension (20%), diabetes mellitus (11%), dyslipidemia (38%), and smoking (34%). Relevant abnormalities were shown on cerebral angiography in 136 of 203 patients, on cardiac ultrasonography in 100 of 195, on Holter monitoring in 2 of 192; and on hypercoagulable panel in 30 of 189 patients. Multiple infarcts were observed in 31% and were more prevalent in individuals younger than age 35 years. Relevant arterial lesions were frequently detected in the middle cerebral artery (23%), internal carotid artery (13%), and vertebrobasilar arteries (13%). Cardioembolic stroke occurred in 47% (including 17% with isolated patent foramen ovale), and 11% had undetermined stroke etiology. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 0-9) and 81% had good outcome at hospital discharge. Of the 29 patients receiving thrombolysis (median National Institutes of Health Stroke Scale score, 14; interquartile range, 9-17), 55% had good outcome at hospital discharge and none developed symptomatic brain hemorrhage.Conclusions: This study shows the contemporary profile of ischemic stroke in young adults admitted to a tertiary stroke center. Stroke etiology can be determined in nearly 90% of patients with modern diagnostic tests. The causes are heterogeneous; however, young adults have a high rate of traditional vascular risk factors. Thrombolysis appears safe and short-term outcomes are favorable. JAMA Neurol. 2013;70(1):51-57. Published online October 29, 2012. doi:10.1001/jamaneurol.2013.575