青年缺血性卒中课件

1、Ischemic Stroke in Young Adult2001/08/13Ischemic Stroke in Young AdultIschemic Stroke in Young adultDefinition：16-45 y/oDistribution：3-4% of all stroke Etiology, clinical manifestation, and prognosis are different from elderlyIt is important to find the etiologic factor and treat them adequately for

2、 preventing the recurrence Orv Hetil 2001 Mar 25;142(12):607-10Ischemic Stroke in Young adultEpidermiologyNorthern Sweden Monica, 13 third level and local hospital, age 18-44 y/o, from Jan.1991-May 1996, totally 88 casesAnnual incidence：11.3/100000 13.6 m vs 8.9 wCase fatality rate：5.7% (within 28 d

3、ays) 4.8 in Neuro Neurochir pol 2000Nov-Dec;Increased with age：especially after 35 y/oDramatic increased after 45 in other report Kristensen: Stroke, Volume 28(9).September 1997.1702-1709EpidermiologyNorthern Sweden MEpidemiologyTable 1. Average Annual Age- and Sex-Specific Incidence Rates of First

4、Ischemic Stroke in Young Adults in Northern Sweden, 1991 to 1994 From: Kristensen: Stroke, Volume 28(9).September 1997.1702-1709EpidemiologyEpidemiologyTable 1. Ages of Young Men and Women With Ischemic Stroke Arch Neurol. 1995;52:491-495 EpidemiologyEtiologyAtherosclerosis is the main cause of stro

5、ke in elderly, while emboligenous cardiopathy is the one of the main cause of young adult Annali Italiani di Medicina Interna. 11(1):33-8,1996 Jan-MarCardiac embolism was the most common cause of stroke in pt younger than 40 Stroke. 30(11):2320-5, 1999 Nov. 20018350Atherosclerosis was 38.2% and card

6、ioembolism was 18.1% Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000.EtiologyAtherosclerosis is theEtiologyAtherosclerosis 33.3%, Prothrombotic state 15.5%, Cardiogenic 9.5% Orv Hetil 2001 Mar 25;142(12):607-10Atherosclerosis 29.8%, Cardioembolism 19.5%, Hematologic 5.8% Arch Neurol. 1995;52:4

7、91-495 So cardioembolism and atherosclerosis are tow major cause of stroke in young adultsCause are diverseEtiologyAtherosclerosis 33.3%,EtiologyEtiologyEtiologyEtiologyEtiologyAtherosclerosis: a.Large artery b.Small arteryEmbolism: a.Cardiogenic b.Non-cardiogenicNon-Atherosclerosis artriopathy: a.I

8、nflammatory b.Non-inflammatoryHemological disorder: a.Viscosity b.CoagulopathyOthers:EtiologyAtherosclerosis:EtiologyEmbolism: a.Cardiogenic: 1.Valvular: RH, prosthetic, endocarditis, MVP 2.Arrhythmia: Af, sick sinus syndrome 3.AMI/LV aneurysm: 4.LV myxoma: 5.Cardiomyopathy:EtiologyEmbolism:Etiology

9、Embolism: b.Non-cardiogenic: 1.Pulmonary AVM: Osler-Weber-Rendu syndrome 2.ASD/VSD or POF with shunt: 3.Pulmonary embolism:EtiologyEmbolism:EtiologyNon-atherosclerosis arteriopathy: a.Inflammatory: 1.Takayasus disease:=Granulomatous arteritis,mono,無脈症 2.Hepersensitive arteritis: Churg-strauss diseas

10、e 3.Infectious: Syphilitic arteritis, TB, HIV-associated 4.Drug related: heroin, amphetamine 5.Systemic disease: SLE, RA, polyarteritis nodosaEtiologyNon-atherosclerosis arEtiologyNon-atherosclerosis arteriopathy: a.Non-inflammatory: 1.Moya moya disease: 2.Artery dissection: 3.Irradiation vasculopat

11、hy: 4.Fibromuscular dysplasia: 5.Firinoid vasculopathy:EtiologyNon-atherosclerosis arEtiologyHematological disorder: a.Viscosity: 1.MDS: CML, polycythemia vera, essential thrombocythemia 2.Multiple myeloma: 3.Leukemia b.Coagulopathy: EtiologyHematological disorderEtiologyHematological disorder: b.Co

12、agulopathy: 1.Hemoglobin disorder 2.Protein C/S deficiency 3.Antithrombin III deficiency 4.DIC 5.Anti-phospholipid antibodyEtiologyHematological disorderEtiologyOthers: 1.Migraine 2.Pregnancy 3.TraumaEtiologyOthers:青年缺血性卒中课件Risk Factor Stroke, Volume 28(9).September 1997.1702-1709 Risk FactorRisk fa

13、ctorAgreed by most reporters are : 1.Cigarette smoking 2.Hypertension 3.Hyperlipidemia Orv Hetil 2001 Mar 25;142(12):607-10 Postgraduate medicine.81(5):141-4,149-51 1987 Apr. Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000 Risk factorAgreed by most repoClinical PresentationEmbolism: 1. Sudden

14、onset of cortical impairment 2. Heart condition predisposing to embolism 3. May be fluctuated,and may recover or deterioratClinical PresentationEmbolism:Clinical PresentationLarge artery atherosclerosis: 1. Cerebral cortical impairment: aphasia, apraxia, anopia, agnosia, restricted motor involvement

15、 2.History of intermittent claudication,TIA Clinical PresentationLarge artClinical PresentationSmall artery occlusion (lacunae) 1.Traditional clinical lacunar syndrome a. Pure motor hemiparesis b. Pure sensory stroke c. Ataxia hemiparalysis d. Dysarthria-clumsy hand e. Sensory motor stroke 2.History

16、 of HTN and DM supports DxClinical PresentationSmall artPrognosisFirst 28 days mortality: 4.8/5.7%Neurological deficit(Canadian neurological scale) and handicap severity(Rankin classification, Barthel index) are all much better than elderly. 1/3; 6moAlthough infarct size usually bigger (3cm)Recurren

17、ce risk is low :1.1-1.2 annuallyOver all, prognosis is much better, so aggressive treatment intervention is important. PrognosisFirst 28 days mortaliAdvised Clinical StudyCT/MRI/angiography12 lead EKGEchocardiogram/TEEDupplex( carotid and IC doppler)BCS, rheumatic profile, autoimmune profile, coagulation profileAdvised Clinical StudyC