Ischemic stroke in young adults: an overview of etiological aspects

Abstract

Ischemic stroke (IS) in young adults is reported as uncommon, comprising less than 10% of all stroke patients 1 . However, In our clinical practice, we are faced not infrequently with patients aged less than 45 years who suffered a stroke, many of them with no risk factors for atherosclerosis and no ultimate clear etiological diagnosis even after a thorough investigation. This diagnostic challenge is one of the main scopes of studying and researching mechanisms of brain ischemia in young adults in addition to the dramatic personal, familial, and socio-economic consequences by affecting individuals at the top of their productive age.Although cardioembolism and cervicocephalic arterial dissection have been established as principal etiological factors of IS in young adults 2 , a systematic diagnostic approach must be applied to all patients, regarding the great number of potential causes in this group and the multifactorial nature in many of these patients.Despite more accurate diagnostic tools recently acquired in vascular imaging, hematological and genetic studies, currently, the number of young patients with cryptogenic IS remains high, performing 30-40% 3,4 . Considered an unusual cause of IS in the young two decades ago 5 , atherosclerosis has gaining projection by recent reports of significant raise in traditional risk factors as hypertension, diabetes, obesity, dyslipidemia and tabagism among hospitalized adolescents and young adults 6. Table 1 shows the main categorizations of etiologic subtypes of IS in young adults that must be considered in every young patient with IS. NoNAthERoSclERotIc ANgIopAthIES AbStRActStroke affects mainly people aged over 65 years, and atherosclerosis predominates as the main etiopathogenic factor in ischemic stroke (IS). On the other hand, cardiac embolism and arterial dissection are the most frequent causes of IS in patients aged less than 45 years. However, inappropriate control of traditional vascular risk factors in young people may be causing a significant increase of atherosclerosis-related IS in this population. Furthermore, a variety of etiologies, many of them uncommon, must be investigated. In endemic regions, neurocysticercosis and Chagas' disease deserve consideration. Undetermined cause has been still reported in as many as one third of young stroke patients.Key words: stroke, brain ischemia, young adult. RESumoA doença aterosclerótica é o fator etiopatogênico mais importante no acidente vascular cerebral isquêmico (AVCI), afecção que acomete predominantemente pessoas acima da sétima década de vida. Entretanto, nos adultos jovens a aterosclerose exibe frequência menor, sendo a embolia de origem cardíaca e as dissecções arteriais as causas mais comuns de AVCI em pacientes com até 45 anos de idade. Porém, o controle inadequado dos fatores de risco vascular nas faixas mais jovens da população pode estar levando à elevação significativa no nú-mero de infartos cerebrais associados à aterosclerose nessa faixa etária.Uma ampla gama de fatores etiológicos, muitos deles rar...

Multidetector computed tomography angiography in clinically suspected hyperacute ischemic stroke in the anterior circulation: an etiological workup in a cohort of Brazilian patients

“…Extra-or intra-cranial atheromas, cardioembolic sources, and microvascular disease have been identified as the major causes of ischemic stroke 8,9 .…”

Análisis de una Cohorte de Pacientes con ACV del Joven. Hospital de Clínicas, Montevideo.

“…El bajo porcentaje de mecanismo aterotrombotico: 9%, coincide con los datos comunicados, dado que en esta franja etaria la ateromatosis es menos frecuente (7,14) . La cardioembolia es responsable de entre el 20-30% de los ACV en el joven en la literatura internacional.…”

“…A pesar de una minuciosa búsqueda etiológica, un 30-35% aproximadamente de los casos de ACV isquémicos en el joven quedan sin etiología aclarada (ACV indeterminados a pesar de estudio completo o criptogénicos) (6,13,14) . Por lo tanto el principal reto para el neurólogo que se enfrenta ante un paciente con ACV en el joven es identificar su causa para lograr un correcto manejo terapéutico y la prevención secundaria adecuada del mismo (5,6,11) .…”

Social Support and Occupational Aspects of Adults After Stroke

“…As consequências pessoais, familiares e socioeconômicas após AVC se apresentam de forma dramática por afetar indivíduos jovens no topo da sua idade produtiva (Yamamoto, 2012). A idade dos participantes apresentou uma correlação moderada e significativa com o domínio Instrumental da EPSUS-A, demonstrando que quanto maior a idade do participante maior a percepção de suporte de ordem material.…”

“…As consequências pessoais, familiares e socioeconômicos apresentadas pelo AVC, podem ser devastadoras ao afetar indivíduos jovens no topo da sua idade produtiva (Yamamoto, 2012). Estudos revelam que sobreviventes de AVC que retornam ao trabalho apresentam um nível significativamente mais elevado de bem estar subjetivo e satisfação com a vida (Hartke, Trierweiler, & Bode, 2011 Para avaliação do suporte social utilizou-se a Escala de Percepção de Suporte Social -versão adulto EPSUS-A (Cardoso, & Baptista, 2013).…”