The diagnostic tests and functional outcomes of acute ischemic stroke or transient ischemic attack in young adults: A 4-year hospital-based observational study.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
27
02
2023
accepted:
17
09
2023
medline:
2
11
2023
pubmed:
4
10
2023
entrez:
4
10
2023
Statut:
epublish
Résumé
Ischemic strokes in young adults have been a significant concern due to various potential etiologies and had substantial clinical and public health impacts. We aimed to study the diagnostic tests, etiologies, and functional outcomes of acute ischemic stroke (AIS) and transient ischemic attack (TIA) in young adult patients. The data were retrieved from the Chiang Mai University Hospital Stroke Registry between January 2018 and December 2021. Consecutive AIS or TIA patients were included if they were 18-50 years and had no stroke mimics. Study outcomes were proportions of positive diagnostic tests, and 90-day modified Rankin Scale (mRS). Of 244 enrolled patients, 59.0% (n = 144) were male, and 38.1% (n = 93) were aged 18-40, classified as the younger age group. There was a high incidence of diabetes (24.5%) and dyslipidemia (54.3%) among patients aged 41-50, associated with small-vessel occlusion and large-artery atherosclerosis stroke classification in this age group. Patients aged 18-40 years had more other determined etiologies (39.8%), with hypercoagulability (8.2%), arterial dissection (7.8%), and cardiac sources (6.6%) being the first three causes, which were associated with higher anticoagulant treatment. The cerebrovascular study, cardiac evaluation using echocardiography, and antiphospholipid syndrome testing were commonly performed, of which computed tomography angiography provided a high proportion of positive results (80.3%). 76.3% of young adult patients had excellent functional outcomes (mRS 0-1) with a median mRS of 0 (interquartile range 0-1) at 90-day follow-up. Stroke of other determined etiology remained the common cause of stroke in young adults, and most affected individuals had excellent clinical outcomes. Blood tests for arterial hypercoagulability and noninvasive vascular and cardiac evaluations are encouraged in selected patients to determine the stroke etiology and guide for appropriate preventive strategies.
Sections du résumé
BACKGROUND AND OBJECTIVES
Ischemic strokes in young adults have been a significant concern due to various potential etiologies and had substantial clinical and public health impacts. We aimed to study the diagnostic tests, etiologies, and functional outcomes of acute ischemic stroke (AIS) and transient ischemic attack (TIA) in young adult patients.
METHODS
The data were retrieved from the Chiang Mai University Hospital Stroke Registry between January 2018 and December 2021. Consecutive AIS or TIA patients were included if they were 18-50 years and had no stroke mimics. Study outcomes were proportions of positive diagnostic tests, and 90-day modified Rankin Scale (mRS).
RESULTS
Of 244 enrolled patients, 59.0% (n = 144) were male, and 38.1% (n = 93) were aged 18-40, classified as the younger age group. There was a high incidence of diabetes (24.5%) and dyslipidemia (54.3%) among patients aged 41-50, associated with small-vessel occlusion and large-artery atherosclerosis stroke classification in this age group. Patients aged 18-40 years had more other determined etiologies (39.8%), with hypercoagulability (8.2%), arterial dissection (7.8%), and cardiac sources (6.6%) being the first three causes, which were associated with higher anticoagulant treatment. The cerebrovascular study, cardiac evaluation using echocardiography, and antiphospholipid syndrome testing were commonly performed, of which computed tomography angiography provided a high proportion of positive results (80.3%). 76.3% of young adult patients had excellent functional outcomes (mRS 0-1) with a median mRS of 0 (interquartile range 0-1) at 90-day follow-up.
CONCLUSIONS
Stroke of other determined etiology remained the common cause of stroke in young adults, and most affected individuals had excellent clinical outcomes. Blood tests for arterial hypercoagulability and noninvasive vascular and cardiac evaluations are encouraged in selected patients to determine the stroke etiology and guide for appropriate preventive strategies.
Identifiants
pubmed: 37792783
doi: 10.1371/journal.pone.0292274
pii: PONE-D-23-05766
pmc: PMC10550126
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0292274Informations de copyright
Copyright: © 2023 Sakseranee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
JAMA Neurol. 2013 Jan;70(1):51-7
pubmed: 23108720
Vasc Health Risk Manag. 2015 Feb 24;11:157-64
pubmed: 25750539
Stroke. 2013 Jan;44(1):119-25
pubmed: 23150649
N Engl J Med. 2013 Sep 19;369(12):1143-50
pubmed: 24047063
Lancet Neurol. 2018 Sep;17(9):790-801
pubmed: 30129475
Continuum (Minneap Minn). 2020 Apr;26(2):386-414
pubmed: 32224758
Stroke. 2021 Jul;52(7):e364-e467
pubmed: 34024117
J Stroke Cerebrovasc Dis. 2011 May-Jun;20(3):247-50
pubmed: 20580256
Stroke. 2016 Jan;47(1):273-81
pubmed: 26645255
PLoS One. 2022 Jul 13;17(7):e0268481
pubmed: 35830430
Stroke. 1993 Jan;24(1):35-41
pubmed: 7678184
Brain Circ. 2021 May 29;7(2):85-91
pubmed: 34189351
Stroke Vasc Neurol. 2018 Sep 12;3(4):231-236
pubmed: 30637129
N Engl J Med. 2016 May 26;374(21):2065-74
pubmed: 27223148
Eur Neurol. 2018;80(5-6):245-248
pubmed: 30716738
J Neurol Neurosurg Psychiatry. 2005 Feb;76(2):191-5
pubmed: 15654030
Ann Med Surg (Lond). 2022 Sep 22;82:104647
pubmed: 36268321
J Stroke Cerebrovasc Dis. 2009 May-Jun;18(3):178-84
pubmed: 19426886
Stroke. 2003 Jan;34(1):203-5
pubmed: 12511775
Neurology. 2013 Sep 17;81(12):1089-97
pubmed: 23946297
Stroke. 2020 Jan;51(1):331-334
pubmed: 31684848