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Background and Objectives:There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional healthcare services. To study the global distribution of risk factors, causes and 3-month mortality of young ischemic stroke patients, by performing a patient data meta-analysis form different cohorts worldwide.Methods:We did a pooled analysis of individual patient data from cohort studies which included consecutive ischemic stroke patients aged 18-50 years. We studied differences in prevalence of risk factors and causes between different ethnic and racial groups, geographic regions and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression.Results:We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Blacks (hypertension, 52.1%; diabetes, 20.7%) and Asians (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often cause of stroke in high-income countries (HICs; both p<0.001), whereas ‘’other determined stroke’’ and ‘’undetermined stroke’’ were higher in low and middle-income countries (LMICs; both p<0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (OR 2.49; 95% CI 1.42-4.36).Discussion:The ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial, and regional differences in incidence of ischemic stroke. Our results also visualize the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve healthcare facilities in LMICs.

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Objective Cerebral amyloid angiopathy-related inflammation (CAA-RI) is a rare and potentially treatable encephalopathy that usually affects people older than 50 years old and has an acute or subacute clinical presentation characterized by rapidly evolving cognitive decline, focal deficits and seizures. In a small subset of patients the disease can adopt a pseudotumoral form in the neuroimages that represents a very difficult diagnostic challenge. Methods Here in we report a patient with a tumour-like presentation of histopathologically confirmed CAA-RI. Results We also conducted a search and reviewed the clinical and radiological features of 41 cases of pseudotumoral CAA-RI previously reported in the literature in order to identify those characteristics that should raise diagnostic suspicions of the disease, there by avoiding unnecessary surgical treatments. ConclusionThe therapy of CAA-RI with steroids is usually effective and clinical and radiological remission can be achieved in the first month in approximately 70% of cases.

The article's abstract is no available.

Nontraumatic convexity subarachnoid hemorrhage is an increasingly recognized subtype of subarachnoid bleeding. Objective: Our aim was to describe the etiology and clinical features of a cohort of patients with convexity subarachnoid hemorrhage. Methods: We retrospectively analyzed all cases of convexity subarachnoid hemorrhage admitted to our hospital between January 2012 and April 2017. Demographic features, clinical characteristics, complementary investigations, etiology and mortality were assessed. Twenty patients (65% females) were identified. Mean age: 53 years (range, 15-86 years). Results: Symptoms on admission: headache (65%), sensory and/or motor symptoms (50%) and seizures (35%). Commonest causes: cerebral vein thrombosis (20%), reversible cerebral vasoconstriction syndrome (20%) and cerebral amyloid angiopathy (20%). Two patients died. Conclusion: Convexity subarachnoid hemorrhage may be related to a wide spectrum of etiologies. In our patients, an increased prevalence of cerebral vein thrombosis was observed. Mortality was low and not related to the bleeding itself.Keywords: cerebral amyloid angiopathy, etiology; sinus thrombosis, intracranial; subarachnoid hemorrhage. RESUMOA hemorragia subaracnóidea não traumática da convexidade é um subtipo cada vez mais reconhecido de sangramento subaracnóideo. Objetivo: Nosso objetivo foi descrever a etiologia e as características clínicas de uma coorte de pacientes com hemorragia subaracnóidea da convexidade. Métodos: Foram analisados retrospectivamente todos os casos de hemorragia subaracnóidea da convexidade admitidos em nosso hospital entre janeiro de 2012 e abril de 2017. Foram avaliados os aspectos demográficos, características clínicas, investigações complementares, etiologia e mortalidade. Vinte pacientes (65% mulheres) foram identificados. Média de idade: 53 anos (intervalo, 15-86). Resultados: Sintomas na admissão: dor de cabeça (65%), sintomas sensitivos e/ou motores (50%) e convulsões (35%). Causas mais comuns: trombose venosa cerebral (20%), síndrome de vasoconstrição cerebral reversível (20%) e angiopatia amilóide cerebral (20%). Dois pacientes morreram. Conclusão: A hemorragia subaracnóidea da convexidade pode estar relacionada a um amplo espectro de etiologias. Em nossos pacientes, observou-se uma maior prevalência de trombose venosa cerebral. A mortalidade foi baixa e não relacionada à própria hemorragia.Palavras-chave: angiopatia amiloide cerebral, etiologia; trombose dos seios intracranianos; hemorragia subaracnóidea.Nontraumatic nonaneurysmal convexity subarachnoid hemorrhage (cSAH) is an increasingly recognized subtype of subarachnoid bleeding localized in one or more cortical sulci of the brain without involvement of the neighboring parenchyma or extension to the interhemispheric fissure, basal cisterns or ventricles 1 . These features help to distinguish cSAH from aneurysmal bleeding and nontraumatic perimesencephalic subarachnoid hemorrhage. Recently, many case series have described the clinical features, etiology and outcome of t...

Introducción: Un 15% del total de los ataques cerebrovasculares ocurren en pacientes jóvenes, afectando a los mismos en los momentos más productivos de sus vidas. Actualmente la información disponible (particularmente en Latinoamérica) sobre las consecuencias psicosociales a largo plazo, y la repercusión de las mismas en las actividades de la vida diaria de los pacientes jóvenes con ataque cerebral, son muy limitadas. Por lo tanto el objetivo de nuestro estudio fue analizar el impacto funcional de los aspectos psicosociales en este grupo particular de pacientes. Material y Métodos: Se administró un Inventario de depresión de Beck a pacientes ambulatorios con accidente cerebrovascular isquémico entre 16 y 55 años de edad en dos centros de Argentina; se compararon las siguientes variables en individuos deprimidos y no deprimidos: NIHSS, Rankin Score modificado, Mini-MentalState Examination, Índice de Barthel, así como variables clínico-demográficas. Una puntuación del Inventario de depresión de Beck BDI superior a 10 se consideró depresión. Resultados: Se incluyeron 34 pacientes con infarto cerebral, el 67% (n = 23) fueron mujeres. La edad media: 45,53 ± 9,78 años (rango: 21-59), 11 pacientes (33%) presentaron depresión; 50% de la población no pudo continuar su actividad laboral habitual y 15% se divorció o se separó de su pareja luego del evento vascular. La tasa de recurrencia de ataque cerebral fue de 0,03%. Conclusiones: Se observó una elevada proporción de pacientes con síntomas depresivos al momento de la evaluación, y cabe resaltar que en la mayoría los síntomas de depresión no habían sido reconocidos y los pacientes se encontraban sub-tratados. Así mismo la depresión se prolongó de manera persistente luego de varios años de ocurrido el evento cerebrovascular. Asimismo, una proporción no menor de pacientes no pudo re-insertarse en su actividad laboral habitual y el evento vascular también impactó de manera importante en sus relaciones afectivas, particularmente en su vida en pareja. El tratamiento y acompañamiento, teniendo en cuenta la expectativa a largo plazo en estos enfermos, deben ser tenidos en cuenta y ofrecidos a estos pacientes con el objetivo de alcanzar la más alta calidad de recuperación posible luego del ataque cerebrovascular.

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