Risk Factors and Etiologies of Ischemic Strokes in Young Patients: A Tertiary Hospital Study in North India

Abstract

Background and PurposeStroke in young adults has a special significance in developing countries, as it affects the most economically productive group of the society. We identified the risk factors and etiologies of young patients who suffered ischemic strokes and were admitted to a tertiary referral hospital in North India.MethodsA retrospective review of case records from patients with ischemic stroke in the age range of 18-45 years was conducted from 2005 to 2010. Data regarding patients' clinical profiles, medical histories, diagnostic test results, and modified Rankin Scale scores at hospital discharge were examined. Stroke subtyping was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.ResultsOf the 2,634 patients admitted for ischemic stroke, 440 (16.7%) were in the 18-45 year age range and the majority (83.4%) were male. The most common risk factors were hypertension (34.4%) and dyslipidemia (26.5%). The most common subtype of stroke was undetermined (57%), followed by other determined causes (17.3%). Among the category of undetermined etiology, incomplete evaluation was the most common. Most of the patients demonstrated good functional outcomes.ConclusionsYoung adults account for 16.7% of all stroke patients in North India. Risk factors are relatively prevalent, and a high proportion of the patients are categorized under undetermined and other determined causes. The results highlight the needs for aggressive management of traditional risk factors and extensive patient work-ups to identify stroke etiology in India.

Acute ischemic stroke in young adults-a hospital based study in North India

“…Hergens et al in their study reported that oral tobacco increases the risk of fatal ischemic stroke but not of hemorrhagic stroke. [30] In this study, 8% of the patients had history of illicit drug abuse, which is supported by Dash et al [12] Majority of the subjects (84%) in this study presented with hemiplegia which is supported by HNH Kumar et al [13] In the present study, anterior circulation is the most common territory involved in brain of the young acute ischemic stroke patients as confirmed by CT scan/MRI. Similar findings have been reported by Dash et al in their study.…”

“…Similar finding had been reported in a study by a group of Indian authors. [12], [13] According to several studies, hypertension is the single common risk factor which is significantly associated with acute ischemic stroke. [10], [11] [14] In this study, 14% of the acute ischemic stroke patients were smokers.…”

“…Dash et al in their study also reported similar results in young acute ischemic stroke patients. [12] Diabetes mellitus is a long recognized risk factor for vascular disease and it doubles the risk of acute stroke compared to nondiabetics. [22] Majority (54%) of the young acute ischemic stroke were known case of heart disease such as valvular heart disease, atrial fibrillation, coronary artery disease etc.…”

“…as a risk factor of acute ischemic stroke in young adults. [12] Previous studies from India have reported rheumatic heart disease and prosthetic valves contributing to almost two thirds of all acute ischemic strokes due to cardio-embolism in young adults. [10], [11] In this study, some number of patients had a history of prior stroke and TIA (transient ischemic attack).…”

“…Dash et al in their study also reported alcoholism as a risk factor of acute ischemic stroke in young adults. [12] Alcohol may contribute to stroke by several mechanisms such as induction of cardiac arrhythmias and cardiac wall abnormalities (which may predispose to cerebral embolism), hypertension, stimulation of platelet aggregation, clotting cascade activation, reduction of cerebral blood flow and alteration of cerebral metabolism. [23] A Finnish study also reported alcohol as an important contributing factor in the development of acute ischemic stroke.…”