Acute Cerebrovascular Disease in the Young

Abstract

Background and Purpose-Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients. Methods-Overall, 5023 patients aged 18 to 55 years with the diagnosis of ischemic stroke (3396) *Drs Rolfs, Fazekas and Grittner contributed equally to this work. Authors contributions: Dr Rolfs has conceptualized, initiated, and designed and organized the study, has been involved in the recruitment of the patients, and wrote significant parts of the manuscript. Dr Fazekas was involved in the study planning and has done together with Drs Enzinger and Schmidt the analysis of all MRI scans; this group was mainly involved in the statistical analysis of the MRI data. Drs Martus, Grittner, Holzhausen have taken responsibility for all statistical analysis and for the data structure of the total data bank. Drs Dichgans, Böttcher, Tatlisumak, Tanislav, Jungehulsing, Putaala, Huber, Bodechtel, Lichy, Hennerici, Kaps, Meyer, Kessler have been most active in the recruitment of the patients, drafting the manuscript and significantly influencing the scientific discussion. Dr Heuschmann was involved in drafting the manuscript and influencing the scientific discussion. Dr Norrving chaired the steering and publication committees of sifap, has written parts of the manuscript, and has significantly influenced the scientific discussions. Drs Lackner and Paschke, H. Mascher, Dr Riess have been involved in the laboratory analyses. Dr Kolodny has mostly contributed to the discussion of the Fabry cases. Dr Giese assisted in writing and editing the manuscript. All authors have reviewed, critically revised and approved the final version of the manuscript.The sponsors of the study had no role in the study design, data collection, data analysis, interpretation, writing of the manuscript, or the decision to submit the manuscript for publication. The academic authors had unrestricted access to the derived dataset, and assume full responsibility for the completeness, integrity, and interpretation of the data, as well as writing the study report and the decision to submit for publication.†Listed in Appendix I in the online-only Data Supplement. Jeffrey L. Saver, MD, was guest editor for this article.

Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

“…This is in line with recent studies on young and middle‐aged patients 5, 17, while others have observed a further increase in small‐vessel occlusion at older ages 22. Large‐artery atherosclerosis followed a similar time course as small‐vessel occlusions.…”

“…This illustrates a well‐known limitation of the TOAST classification, as the stroke of undetermined cause category not only includes cases of truly unknown cause, but also cases with several potential causes 14, 15. Stroke of undetermined cause comprised the largest subtype among young and middle‐aged patients, which is in accordance with other studies 16, 17, whereas stroke of undetermined cause was outnumbered by cardioembolism among the elderly 18. The lowest proportion of stroke of undetermined cause was found among those younger than 30 years.…”

“…In our study, the proportion of this subtype declined steeply during mid‐age and was non‐existent among the elderly. Other young stroke studies also support a decline of stroke of other determined cause towards mid‐age, although their rates declined more gently than in our study 5, 17.…”

Frequency of MELAS main mutation in a phenotype-targeted young ischemic stroke patient population

“…The study protocol, patient population, and main outcomes were described in detail elsewhere [9][10][11][12]. This study was approved by the ethics committee at the leading center (University of Rostock, Rostock, Germany) and in all participating centers according to their national and institutional legislation.…”

“…Imaging data were collected and interpreted centrally as described elsewhere [9][10][11]. There was also a mandatory core data set for the collection of demographic and clinical patient characteristics as all patients underwent a detailed evaluation along with all adequate testing.…”