Etiologic Study of Young Ischemic Stroke in Taiwan

Abstract

Background and Purpose-The etiologic mechanisms of young ischemic stroke in Chinese are largely unknown. This work thus studied the etiologies of young ischemic stroke in Taiwan Chinese and made a comparison with previous reports. Methods-From January 1997 to October 2001, a total of 264 consecutive young ischemic stroke patients (18 to 45 years old) were admitted to the Department of Neurology in our hospital. The risk factors for stroke and the distribution of stroke subtype were studied. The vascular ultrasound and angiographic findings of these patients were also studied. Results-The sample contained 188 men and 76 women. Cerebral infarction was diagnosed in 241 patients and transient ischemic attack in 23 (8.7%). Regarding stroke subtype, stroke of small-vessel occlusion was diagnosed in 20.5% of cases, large-artery atherosclerosis in 7.2%, cardioembolism in 17.8%, other determined etiology in 22.3%, and undetermined etiology in 23.5%. The 4 most common risk factors were hyperlipidemia (53.1%), smoking (49.8%), hypertension (45.8%), and family history of stroke (29.3%). Twenty-three patients (9.6%) had significant stenosis (Ն50%) of the carotid (7.5%) and vertebral arteries (2.1%), the most common cause of which was dissection (60.9%). Forty-five patients (26.5%) had significant intracranial stenosis with 18.8% in the carotid and 10.6% in the vertebrobasilar system, and 5 (2.9%) had stenosis in both systems. Premature atherosclerosis (33.3%) was the most common cause of intracranial stenosis. Conclusions-Our study found that strokes of other determined etiology and undetermined etiology were most common among the sample group, and a battery of extensive examinations is indicated to elucidate the etiology for further stroke prevention. Intracranial stenosis is more common than extracranial stenosis in both the carotid and vertebrobasilar systems.

Lifestyle risk factors of stroke in young Indians

“…4 A study from Pakistan showed hypertension in 14% and miscellaneous causes in 4% of cases. 33 Among 4467 patients in Fabry patients study, most frequented modifiable risk factors were smoking (55.5%), physical inactivity (48.2%), arterial hypertension (46.6%), dyslipidemia (34.9%), obesity 922.3%) and alcohol consumption (33%) 10 as also in our study we found alcohol(48.6%), smoking(25%), dyslipidemia (38.8%) diabetes ( 10.4%) and multiple risk factors in 15 29 In a study on long term prognosis after stroke in Netherland (n 406), smoking (46.1%), dyslipidemia (30.8%), hypertension (25.4%), diabetes (4.7%), and excess drinking (4.9%) were significant cardiovascular risk factors. 2 In our study, we found that diabetes is mainly a risk factor for ischemic stroke as supported by previous studies.…”

“…In this study, highest incidence of ischemic strokes (69%) was found as compared to hemorrhagic strokes (13.2%) and CVT (18.1%), which is corroborated by previous studies from Asia and other parts of the world. 4,17,25,26,27 This study showed that common risk factors in cases of stroke in young were dyslipidemia (38.8%), hypertension (34.7%), followed by multiple risk factors in 15.3% cases and diabetes was found in 10.4% cases. In this study, we found alcohol consumption in 48.6% and smoking in 25% of strokes in young.…”

“…Previous studies also showed that alcohol and smoking were important risk factors. 15,28,29,30 Strong dose response relationship between cigarette smoking and risk of ischemic stroke in young has reinforced the need for aggressive smoking cessation efforts. The risk of having stroke decreases after 3 years of cessation of smoking and reaches to the level of non smokers after 5 years of cessation of smoking.…”

“…10 In a study by Lee et al, vascular risk factors like hypertension, diabetes mellitus, dyslipidemia were seen more commonly in patients with large artery atherosclerotic disease and small vessel occlusive disease. 15 The beneficial impact of low risk lifestyle on prevention of stroke has already been established in Nurses Health Study. 16 In the light of available literature, it is emphasised that risk factors, particularly related to life style, needs to be studied in detail, stratified and primordial and primary preventive strategies need to be re-evaluated to curb the menace of lifestyle related cerebrovascular events which are definitely preventable.…”

Young Ischemic Stroke in South Asia: A review

“…Small arterial atherosclerosis is a common finding in young adults with history of hypertension and diabetes. 52,53 But atherosclerosis was found to be less common in most of the studies. This may be due to lack of use of vascular imaging applications in hospitals of South Asia.…”