Angiography of nonhemorrhagic cerebral infarction in young adults.

Smoker, Wendy R. K.; Biller, José; Hingtgen, W L; Adams, Harold P.; Toffol, Gilbert J.

doi:10.1161/01.str.18.4.708

Cited by 22 publications

(6 citation statements)

References 27 publications

(14 reference statements)

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“…Migraine and dissection of extracranial arteries were the most common non-atherosclerotic vasculopathies identified in our series, with values similar to other studies [3, 5, 21,28,29,30,31,32,33]. There is a recognized association between migraine (with or without aura) and ischemic stroke, especially among women taking oral contraceptives [34].…”

Section: Discussionsupporting

confidence: 89%

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Varona¹,

Guerra²,

Bermejo

et al. 2007

Eur Neurol

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Background: Causes of ischemic stroke in young adults (15–45 years) are diverse, but undetermined etiology is common in a majority of studies. Aims: The present series study aims to evaluate causes and changes in the etiological diagnosis of ischemic stroke in young adult patients admitted to a tertiary medical center over a period of 27 years. Methods: We retrospectively reviewed the records of patients with a first-ever stroke in the age range of 15–45 years who were admitted to the ‘12 de Octubre’ University Hospital between 1974 and 2002. Results: 272 young adults with ischemic stroke were identified. The etiological diagnoses were: undetermined in 36% of patients, large-artery atherosclerosis in 21%, cardioembolism in 17%, non-atherosclerotic vasculopathy in 17%, and other specific etiologies in 9%. While in the first study period (1974–1988) 45% of patients were diagnosed with uncertain etiology, in the last period (1989–2002) only 26% were diagnosed with cryptogenic stroke (45% with two or more potential etiologies identified; 45% with no identified cause despite complete evaluation, and 10% with incomplete evaluation). Conclusions: The etiological diagnosis of stroke in young adults has changed over time as a result of improvements in diagnostic workup. While cryptogenic stroke was the most frequent diagnosis in the past, today specific causes (non-atherosclerotic vasculopathy, large-artery atherosclerosis, cardioembolism and hematological disorder) are identified in the majority of patients.

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Section: Discussionsupporting

confidence: 89%

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Varona¹,

Guerra²,

Bermejo

et al. 2007

Eur Neurol

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“…As DSA is not without risk,15 16 many clinicians hesitate to submit patients to this technique until obvious neurological symptoms are present. This underlines the need for a non-invasive method to support the diagnosis of vertebral artery dissection to improve the selection of patients for DSA or even to replace the invasive procedure.…”

mentioning

confidence: 99%

Magnetic resonance angiographic and clinical features of extracranial vertebral artery dissection

Auer

Felber

Schmidauer

et al. 1998

Journal of Neurology, Neurosurgery & Psychiatry

111

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Objectives-Clinical data and neuroradiological findings of 19 patients with 20 vertebral artery dissections were analysed to describe the features of time of flight magnetic resonance angiography (MRA) for the diagnosis and follow up of this vascular disorder. Methods-All patients underwent a combined MRI and MRA protocol with 1.5 T scanners, using a three dimensional flow compensated gradient echo sequence for MRA. Duplex sonography was performed on all patients and selective angiography was available from 17 vertebral artery dissections. Results-MRI showed ischaemic lesions of the brain in 18 of 19 patients (95%). In the acute and subacute stage, MRA detected signal abnormalities within the dissected vertebral artery in 94% (16/17) and MRI was specific for a dissection in 29% (5/17). Sensitivity of selective angiography was 100% and specificity was 35% (6/17). Combination of the results of both methods increased the specificity to 50%. Duplex sonography was sensitive in 79% (15/19), but lacked specific results. Follow up magnetic resonance in 16 patients showed recanalisation of the dissected vessel in 10 (63%), persistent occlusion in five (31%), and a dissecting aneurysm in one (6%) patient. Conclusions-Magnetic resonance improves the triage for selective angiography and discloses complementary information for the diagnosis of vertebral artery dissection. If magnetic resonance identifies a double lumen or a mural haematoma with a stenosis or aneurysmal dilatation, invasive procedures can be omitted. (J Neurol Neurosurg Psychiatry 1998;64:474-481)

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“…This supports the use of angiography in most cases, unless a clearcut alternative etiology is present. Population-based re-search [6] including multiple acute care community hospitals has also confirmed referral center [7] findings of relative safety of cerebrovascular angiography in young adults.…”

mentioning

confidence: 81%

Stroke in Young Adults: Progress and Opportunities

Kittner¹

1998

Neuroepidemiology

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The epidemiology of stroke in young adults has been a relatively neglected area of study considering its relative prevalence in clinical practice; the relationship of oral contraceptive use, pregnancy, and migraine to stroke risk; and the importance of prognosis when stroke occurs at a young age. In addition, stroke in young adults can be used as a model system for understanding stroke incidence trends, the excess stroke risk experienced by African-Americans, and novel risk factors for stroke, including the genetic basis for stroke risk.

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Angiography of nonhemorrhagic cerebral infarction in young adults.

Cited by 22 publications

References 27 publications

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

Magnetic resonance angiographic and clinical features of extracranial vertebral artery dissection

Stroke in Young Adults: Progress and Opportunities

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