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IschemicStrokeinYoungadultDefinition：16-45y/oDistribution：3-4%ofallstrokeEtiology,clinicalmanifestation,andprognosisaredifferentfromelderlyItisimportanttofindtheetiologicfactorandtreatthemadequatelyforpreventingtherecurrence
OrvHetil2001Mar25;142(12):607-10IschemicStrokeinYoungadult1EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM2EpidemiologyTable1.AverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994From:
Kristensen:Stroke,Volume28(9).September1997.1702-1709Epidemiology3EpidemiologyTable1.AgesofYoungMenandWomenWithIschemicStrokeArchNeurol.1995;52:491-495Epidemiology4EtiologyAtherosclerosis
isthemaincauseofstrokein
elderly,while
emboligenouscardiopathy
istheoneofthemaincauseof
youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism
wasthemostcommoncauseofstrokeinp’t
youngerthan40
Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%
ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe5EtiologyAtherosclerosis33.3%,Prothromboticstate15.5%,Cardiogenic9.5%
OrvHetil2001Mar25;142(12):607-10Atherosclerosis29.8%,Cardioembolism19.5%,Hematologic5.8%
ArchNeurol.1995;52:491-495SocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsCausearediverseEtiologyAtherosclerosis33.3%,6EtiologyEtiology7EtiologyEtiology8EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:9EtiologyEmbolism:
a.Cardiogenic:1.Valvular:RH,prosthetic,endocarditis,MVP2.Arrhythmia:Af,sicksinussyndrome3.AMI/LVaneurysm:4.LVmyxoma:5.Cardiomyopathy:EtiologyEmbolism:10EtiologyEmbolism:b.Non-cardiogenic:1.PulmonaryAVM:Osler-Weber-Rendusyndrome2.ASD/VSDorPOFwithshunt:3.Pulmonaryembolism:EtiologyEmbolism:11Hepersensitivearteritis:Churg-straussdisease3/10000013.Pulmonaryembolism:AgesofYoungMenandWomenWithIschemicStrokeAtherosclerosiswas38.Hematologicaldisorder:HistoryofHTNandDMsupportsDxProteinC/SdeficiencyEpidemiologyCardiacembolismwasthemostcommoncauseofstrokeinp’tyoungerthan40Casefatalityrate：5.Neurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.AdvisedClinicalStudyembolismLargearteryb.7%(within28days)4.PulmonaryAVM:Osler-Weber-RendusyndromeDramaticincreasedafter45inotherreportdeterioratDramaticincreasedafter45inotherreportEtiologyNon-atherosclerosisarteriopathy:a.Inflammatory:1.Takayasu’sdisease:=Granulomatousarteritis,mono,無脈症2.Hepersensitivearteritis:Churg-straussdisease3.Infectious:Syphiliticarteritis,TB,HIV-associated4.Drugrelated:heroin,amphetamine5.Systemicdisease:SLE,RA,polyarteritisnodosaHepersensitivearteritis:Chur12EtiologyNon-atherosclerosisarteriopathy:
a.Non-inflammatory:1.Moyamoyadisease:2.Arterydissection:3.Irradiationvasculopathy:4.Fibromusculardysplasia:5.Firinoidvasculopathy:EtiologyNon-atherosclerosisar13EtiologyHematologicaldisorder:a.Viscosity:1.MDS:CML,polycythemiavera,essentialthrombocythemia2.Multiplemyeloma:3.Leukemiab.Coagulopathy:
EtiologyHematologicaldisorder14EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder15EtiologyOthers:1.Migraine2.Pregnancy3.TraumaEtiologyOthers:16青年缺血性卒中课件17RiskFactorStroke,Volume28(9).September1997.1702-1709
RiskFactor18RiskfactorAgreedbymostreportersare:1.Cigarettesmoking2.Hypertension3.Hyperlipidemia
OrvHetil2001Mar25;142(12):607-10Postgraduatemedicine.81(5):141-4,149-511987Apr.
ActaNeurologicaScandinavica.101(1):19-24,Jan2000
RiskfactorAgreedbymostrepo19ClinicalPresentationEmbolism:1.Suddenonsetofcorticalimpairment2.Heartconditionpredisposingtoembolism3.Maybefluctuated,andmayrecoverordeterioratClinicalPresentationEmbolism:20ClinicalPresentationLargearteryatherosclerosis:1.Cerebralcorticalimpairment:aphasia,apraxia,anopia,agnosia,restrictedmotorinvolvement2.Historyofintermittentclaudication,TIA
ClinicalPresentationLargeart21ClinicalPresentationSmallarteryocclusion(lacunae)1.Traditionalclinicallacunarsyndromea.Puremotorhemiparesisb.Puresensorystrokec.Ataxiahemiparalysisd.Dysarthria-clumsyhande.Sensorymotorstroke2.HistoryofHTNandDMsupportsDxClinicalPresentationSmallart228%,Cardioembolism19.AnnaliItalianidiMedicinaInterna.AverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994Firinoidvasculopathy:b.3/10000013.ProteinC/SdeficiencyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.HistoryofHTNandDMsupportsDxHematologicaldisorder:30(11):2320-5,1999Nov.Hemologicaldisorder:Hematologicaldisorder:3/10000013.Agreedbymostreportersare:Stroke.Hemologicaldisorder:Smallarteryocclusion(lacunae)Recurrenceriskislow:1.embolismPrognosisFirst28daysmortality:4.8/5.7%Neurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.1/3;6moAlthoughinfarctsizeusuallybigger(>3cm)Recurrenceriskislow:1.1-1.2annuallyOverall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.8%,Cardioembolism19.Prognosi23AdvisedClinicalStudyCT/MRI/angiography12leadEKGEchocardiogram/TEEDupplex(carotidandICdoppler)BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…AdvisedClinicalStudyCT/MRI/a24ConclusionIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.
AnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarConclusionIschemiastrokeiny25EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM26EtiologyAtherosclerosis
isthemaincauseofstrokein
elderly,while
emboligenouscardiopathy
istheoneofthemaincauseof
youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism
wasthemostcommoncauseofstrokeinp’t
youngerthan40
Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%
ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe27EtiologyEtiology28EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:29EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder30From:
Kristensen:Stroke,Volume28(9).Non-atherosclerosisarteriopathy:7%(within28days)4.Agreedbymostreportersare:Agreedbymostreportersare:Viscosityb.Stroke.Hematologicaldisorder:EpidermiologyNeurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.AntithrombinIIIdeficiency3/10000013.CT/MRI/angiography3%,Prothromboticstate15.Non-cardiogenic:3/10000013.ProteinC/SdeficiencyFirst28daysmortality:4.AMI/LVaneurysm:Largearteryb.1995;52:491-495Casefatalityrate：5.September1997.2%andcardioembolismwas18.From:
Kristensen:Stroke,Volume28(9).ClinicalPresentationb.BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…ProteinC/SdeficiencySystemicdisease:SLE,RA,polyarteritisnodosaAgreedbymostreportersare:ProteinC/Sdeficiency30(11):2320-5,1999Nov.Postgraduatemedicine.From:
Kristensen:Stroke,Volume28(9).Casefatalityrate：5.e.Non-cardiogenicPostgraduatemedicine.Heartconditionpredisposingtoapraxia,anopia,agnosia,restrictedmotorEpidemiologyAnti-phospholipidantibodyIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.CoagulopathyAdvisedClinicalStudyRiskFactorAnti-phospholipidantibodyAdvisedClinicalStudyNon-cardiogenic:IschemicStrokeinYoungadultFrom:
Kristensen:Stroke,Volume28(9).Hemologicaldisorder:Firinoidvasculopathy:2%andcardioembolismwas18.NorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.Distribution：3-4%ofallstrokeNon-atherosclerosisarteriopathy:Hepersensitivearteritis:Churg-straussdiseaseStroke.Hematologicaldisorder:apraxia,anopia,agnosia,restrictedmotorHemoglobindisorderNeurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.TraditionalclinicallacunarsyndromeFirst28daysmortality:4.Hemologicaldisorder:CT/MRI/angiographyHematologicaldisorder:2%andcardioembolismwas18.NorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.HistoryofHTNandDMsupportsDxIncreasedwithage：especiallyafter35y/oNon-inflammatoryBCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…Cardiomyopathy:Atherosclerosis:Hepersensitivearteritis:Churg-straussdiseaseAdvisedClinicalStudyDramaticincreasedafter45inotherreportFrom:
Kristensen:Stroke,Volume28(9).TraditionalclinicallacunarsyndromeAtherosclerosiswas38.Firinoidvasculopathy:HeartconditionpredisposingtoAtherosclerosisisthemaincauseofstrokeinelderly,whileemboligenouscardiopathyistheoneofthemaincauseofyoungadultCasefatalityrate：5.Fibromusculardysplasia:Anti-phospholipidantibody2%andcardioembolismwas18.1995;52:491-495apraxia,anopia,agnosia,restrictedmotor3/10000013.7%(within28days)4.From:
Kristensen:Stroke,Volume28(9).Postgraduatemedicine.a.Casefatalityrate：5.AntithrombinIIIdeficiency3/10000013.AdvisedClinicalStudyAnnaliItalianidiMedicinaInterna.From:
Kristensen:Stroke,Volume28(9).AdvisedClinicalStudyCT/MRI/angiography12leadEKGEchocardiogram/TEEDupplex(carotidandICdoppler)BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…From:
Kristensen:Stroke,Vo31IschemicStrokeinYoungadultDefinition：16-45y/oDistribution：3-4%ofallstrokeEtiology,clinicalmanifestation,andprognosisaredifferentfromelderlyItisimportanttofindtheetiologicfactorandtreatthemadequatelyforpreventingtherecurrence
OrvHetil2001Mar25;142(12):607-10IschemicStrokeinYoungadult32EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM33EpidemiologyTable1.AverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994From:
Kristensen:Stroke,Volume28(9).September1997.1702-1709Epidemiology34EpidemiologyTable1.AgesofYoungMenandWomenWithIschemicStrokeArchNeurol.1995;52:491-495Epidemiology35EtiologyAtherosclerosis
isthemaincauseofstrokein
elderly,while
emboligenouscardiopathy
istheoneofthemaincauseof
youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism
wasthemostcommoncauseofstrokeinp’t
youngerthan40
Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%
ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe36EtiologyAtherosclerosis33.3%,Prothromboticstate15.5%,Cardiogenic9.5%
OrvHetil2001Mar25;142(12):607-10Atherosclerosis29.8%,Cardioembolism19.5%,Hematologic5.8%
ArchNeurol.1995;52:491-495SocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsCausearediverseEtiologyAtherosclerosis33.3%,37EtiologyEtiology38EtiologyEtiology39EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:40EtiologyEmbolism:
a.Cardiogenic:1.Valvular:RH,prosthetic,endocarditis,MVP2.Arrhythmia:Af,sicksinussyndrome3.AMI/LVaneurysm:4.LVmyxoma:5.Cardiomyopathy:EtiologyEmbolism:41EtiologyEmbolism:b.Non-cardiogenic:1.PulmonaryAVM:Osler-Weber-Rendusyndrome2.ASD/VSDorPOFwithshunt:3.Pulmonaryembolism:EtiologyEmbolism:42Hepersensitivearteritis:Churg-straussdisease3/10000013.Pulmonaryembolism:AgesofYoungMenandWomenWithIschemicStrokeAtherosclerosiswas38.Hematologicaldisorder:HistoryofHTNandDMsupportsDxProteinC/SdeficiencyEpidemiologyCardiacembolismwasthemostcommoncauseofstrokeinp’tyoungerthan40Casefatalityrate：5.Neurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.AdvisedClinicalStudyembolismLargearteryb.7%(within28days)4.PulmonaryAVM:Osler-Weber-RendusyndromeDramaticincreasedafter45inotherreportdeterioratDramaticincreasedafter45inotherreportEtiologyNon-atherosclerosisarteriopathy:a.Inflammatory:1.Takayasu’sdisease:=Granulomatousarteritis,mono,無脈症2.Hepersensitivearteritis:Churg-straussdisease3.Infectious:Syphiliticarteritis,TB,HIV-associated4.Drugrelated:heroin,amphetamine5.Systemicdisease:SLE,RA,polyarteritisnodosaHepersensitivearteritis:Chur43EtiologyNon-atherosclerosisarteriopathy:
a.Non-inflammatory:1.Moyamoyadisease:2.Arterydissection:3.Irradiationvasculopathy:4.Fibromusculardysplasia:5.Firinoidvasculopathy:EtiologyNon-atherosclerosisar44EtiologyHematologicaldisorder:a.Viscosity:1.MDS:CML,polycythemiavera,essentialthrombocythemia2.Multiplemyeloma:3.Leukemiab.Coagulopathy:
EtiologyHematologicaldisorder45EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder46EtiologyOthers:1.Migraine2.Pregnancy3.TraumaEtiologyOthers:47青年缺血性卒中课件48RiskFactorStroke,Volume28(9).September1997.1702-1709
RiskFactor49RiskfactorAgreedbymostreportersare:1.Cigarettesmoking2.Hypertension3.Hyperlipidemia
OrvHetil2001Mar25;142(12):607-10Postgraduatemedicine.81(5):141-4,149-511987Apr.
ActaNeurologicaScandinavica.101(1):19-24,Jan2000
RiskfactorAgreedbymostrepo50ClinicalPresentationEmbolism:1.Suddenonsetofcorticalimpairment2.Heartconditionpredisposingtoembolism3.Maybefluctuated,andmayrecoverordeterioratClinicalPresentationEmbolism:51ClinicalPresentationLargearteryatherosclerosis:1.Cerebralcorticalimpairment:aphasia,apraxia,anopia,agnosia,restrictedmotorinvolvement2.Historyofintermittentclaudication,TIA
ClinicalPresentationLargeart52ClinicalPresentationSmallarteryocclusion(lacunae)1.Traditionalclinicallacunarsyndromea.Puremotorhemiparesisb.Puresensorystrokec.Ataxiahemiparalysisd.Dysarthria-clumsyhande.Sensorymotorstroke2.HistoryofHTNandDMsupportsDxClinicalPresentationSmallart538%,Cardioembolism19.AnnaliItalianidiMedicinaInterna.AverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994Firinoidvasculopathy:b.3/10000013.ProteinC/SdeficiencyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.HistoryofHTNandDMsupportsDxHematologicaldisorder:30(11):2320-5,1999Nov.Hemologicaldisorder:Hematologicaldisorder:3/10000013.Agreedbymostreportersare:Stroke.Hemologicaldisorder:Smallarteryocclusion(lacunae)Recurrenceriskislow:1.embolismPrognosisFirst28daysmortality:4.8/5.7%Neurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.1/3;6moAlthoughinfarctsizeusuallybigger(>3cm)Recurrenceriskislow:1.1-1.2annuallyOverall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.8%,Cardioembolism19.Prognosi54AdvisedClinicalStudyCT/MRI/angiography12leadEKGEchocardiogram/TEEDupplex(carotidandICdoppler)BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…AdvisedClinicalStudyCT/MRI/a55ConclusionIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.
AnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarConclusionIschemiastrokeiny56EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM57EtiologyAtherosclerosis
isthemaincauseofstrokein
elderly,while
emboligenouscardiopathy
istheoneofthemaincauseof
youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism
wasthemostcommoncauseofstrokeinp’t
youngerthan40
Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%
ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe58EtiologyEtiology59EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:60EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder61From:
Kristensen:Stroke,Volume28(9).Non-atherosclerosisarteriopathy:7%(within28days)4.Agreedbymostreportersare:Agreedbymostreportersare:Viscosityb.Stroke.Hematologicaldisorder:EpidermiologyNeurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.AntithrombinIIIdeficiency3/10000013.CT/MRI/angiography3%,Prothromboticstate15.Non-cardiogenic:3/10000013.ProteinC/SdeficiencyFirst28daysmortality:4.AMI/LVaneurysm:Largearteryb.1995;52:491-495Casefatalityrate：5.September1997.2%andcardioembolismwas18.From:
Kristensen:Stroke,Volume28(9).ClinicalPresentationb.BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…ProteinC/SdeficiencySystemicdisease:SLE,RA,polyarteritisnodosaAgreedbymostreportersare:ProteinC/Sdeficiency30(11):2320-5,1999Nov.Postgraduatemedicine.From:
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