The incidence of cerebral infarction amongst patients <45 years ranges from 3.4 to 11.3 per 100,000. Aetiology of cerebral infarction is more heterogeneous amongst young patients than amongst older patients including frequent dissection of neck vessels. Because of longer expected survival, prognosis is of special importance amongst younger patients. Average annual long-term mortality rate after the first year of cerebral infarction ranges from 0.6% to 1.8% and is about 10 times higher than amongst matched controls. Long-term mortality is associated with cardiac embolism and atherosclerosis, whilst dissection of neck vessels is associated with low long-term mortality. Average annual long-term recurrence rate of cerebral infarction ranges from 0.3% to 1.7% after the first year. Recurrence of cerebral infarction and other vascular events is highly associated with traditional risk factors including smoking, diabetes mellitus and symptomatic atherosclerosis. Dissection of neck vessel is associated with low long-term mortality rate and low recurrence rate of cerebral infarction. Tailoring secondary preventive treatment according to aetiology and risk factors suggests better prognosis.
". Primary prevention is likely to be the principal strategy to fight stroke in the young. In addition to conventional stroke risk factors, young patients have special risk factors inherent to genetic and environmental elements, such as cardiac abnormalities, thrombophylic states, migraine, the use of oral contraceptives and illicit drugs that should be identified and adequately controlled . The high proportion of subarachnoid and intracerebral hemorrages in patients under 45 years reported by some studies, makes mandatory tailored preventive strategies, mainly focused on early detection and treatment of hypertension and possibly including neuroimaging studies for the screening of aneurysms and arteriovenous malformations in subjects at risk. "
[Show abstract][Hide abstract] ABSTRACT: Introduction. Stroke in the young may have a dramatic impact on the quality of life in survivors. This study was aimed to evaluate incidence of first-ever stroke in the young by means of a systematic review.
Materials and Methods. All papers on incidence of stroke in the young published after 1980, were identified by electronic search of Medline and manual search of reference lists. Only studies recruiting subjects under 44 years of age and with a lower age limit not higher than 20 years were included. Incidence rates were standardized to the 2000 European population according to the direct method. Poisson regression analysis was used to compare studies.
Results. 29 studies including 3548 participants were identified. Incidence rates, after excluding a few outliers, ranged between 8.63 and 19.12 for crude rates and between 8.70 and 21.02 for standardized rates. Heterogeneity among studies was statistically significant but improved after excluding 4 studies. Few studies reported the proportions of stroke subtypes.
Conclusions. Stroke in subjects under 45 years of age is not such a rare disease and requires specific preventive programs.
Stroke Research and Treatment 12/2010; 2011:535672. DOI:10.4061/2011/535672
[Show abstract][Hide abstract] ABSTRACT: The objective of this study is to evaluate characteristics and mortality related to long-term post-stroke pain (PSP). All surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, between February 2006 and July 2009 received a postal questionnaire including the fatigue severity scale (FSS), the hospital anxiety and depression scale (HADSD), the Barthel index (BI), and questions regarding location of pain and pain severity at least 6 months after onset of stroke. Survival among patients returning the questionnaire was determined by November 2009. Stroke severity was defined by the modified Rankin score (mRS), 7 days after stroke onset. About 30% of the 408 patients had moderate to severe PSP. On logistic regression, PSP was associated with females (odds ratio (OR) = 2.1, p = 0.002), lower age (OR = 0.98, p = 0.04), fatigue (OR = 3.1, p < 0.001), sleep disturbances (OR = 3.3, p < 0.001), and mRS 3-5 (OR = 1.9, p = 0.03). Among patients with pareses (persistent or transient), there was no difference between paretic and non-paretic side as to frequency of limb pain on follow-up (p = 0.91). By November 2009, 26 patients had died. Cox regression analysis showed that mortality was associated with PSP (hazard ratio (HR) = 2.4, p = 0.040), high age (HR = 1.07, p = 0.001), males (HR = 2.5, p = 0.04), and low BI (HR = 0.97, p < 0.001). In conclusion, our study indicates a multifactorial basis for post-stroke pain. The main new findings were that the frequencies of pain were similar in paretic and non-paretic limbs and that long-term mortality was associated with post-stroke pain.
Journal of Neurology 03/2010; 257(9):1446-52. DOI:10.1007/s00415-010-5539-y · 3.38 Impact Factor
J M Cucalon Arenal, C Buisac Ramón, A Marin Ibáñez, S Castan Ruiz, M G Blay Cortes, J I Barrasa Villar
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