Transient cerebral ischemic attacks in the young and middle aged. A population study.

Johnson, Susan E.; Skre, H

doi:10.1161/01.str.17.4.662

Cited by 23 publications

(14 citation statements)

References 18 publications

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“…In our series of 38 TTAs, the prognosis was benign. This agrees with the reports of Levy, 26 Tippin et al, 27 and Johnson and Skre, 28 who followed young adults who experienced a transient central nervous system deficit, amaurosis fugax, and presumed TTAs from a population screening, respectively. The high rate of recurrence (5%) found by Marshall 8 is probably due to a referral bias because in England many stroke patients are not referred to neurologists.…”

supporting

confidence: 91%

Prognosis after transient ischemic attack and ischemic stroke in young adults.

Ferro

Crespo

1994

Stroke

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We undertook this study to describe the risk of stroke recurrence and functional and occupational status in the long-term follow-up of young adults with ischemic strokes and to identify possible predictors for stroke recurrence, disability, and working status. A cohort of 215 patients aged < or = 45 years with ischemic cerebral events (43 transient ischemic attacks, 135 minor strokes, 37 major strokes), evaluated at our institution from May 1985 through March 1992, was followed for a mean of 43.1 months (SD, 39.7 months; range, 1 to 228 months). Information on death and recurrent cerebral vascular events, functional disability (Rankin Scale), retirement, and working status was obtained from direct observation, mail questionnaire, and telephone interviews. Four patients (2%) with major strokes died acutely. Information on stroke recurrence and disability was available for 184 (87%) of the survivors and on retirement and working status for 140 (67%) of the patients. Two patients died from cancer. Seven transient ischemic attacks and eight strokes (two hemorrhagic) occurred during follow-up. Patients with strokes of unknown cause experienced no recurrent strokes, contrasting with two deaths and eight strokes in those whose stroke cause was identified (difference between proportions: 8%; 95% confidence interval, 3 to 13). Eighty-eight patients had a complete recovery, and only 21 were disabled (Rankin grades 4 or 5). Logistic regression analysis identified the severity of the initial stroke (Rankin grade > 3) as the only significant predictor of disability (odds ratio, 10.7; 95% confidence interval, 3.7 to 30.6). Of the survivors, 73% were working, and only 18% were retired. Disability at follow-up was the best (but nonsignificant) predictor of retirement (odds ratio, 1.6; 95% confidence interval, 0.8 to 3.4). Ischemic stroke in young adults has a low acute mortality and few recurrences, more so if the cause is not identified. The majority of patients return to an active professional life. Severity of the initial stroke is the major predictor of independence. The relation between disability and return to work or retirement is less clear.

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supporting

confidence: 91%

Prognosis after transient ischemic attack and ischemic stroke in young adults.

Ferro

Crespo

1994

Stroke

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“…In a Danish study [2] whose sam ple was similar in age to ours (75% between 40 and 69 years), the prevalence rate of 4.6, with a 95% confidence interval of 2.6-9.4 per 1,000, overlapped our value. In another recent population study [11] using the ques tionnaire method, the sample was not com parable in age to ours.…”

Section: Discussioncontrasting

confidence: 68%

Transient Ischemic Attacks in the Community: Occurrence and Clinical Characteristics

Fratiglioni

Nencini

et al. 1989

Neuroepidemiology

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A simple self-administered questionnaire was mailed to a population sample of 8,626 (40–65 years old) to identify transient ischemic attacks (TIAs) that occurred in the previous 12 months. This study was conducted in a well-defined, medically controlled geographic area. 75.4% of the questionnaires were returned. The procedure identified 52 TIA cases (43 definite and 9 uncertain). The 12-month period prevalence for TIAs was 6.6 per 1,000 (95% confidence limits of 4.8–8.9) among the respondents. The annual incidence rate for first TIAs was 3.1 per 1,000 (95% confidence limits of 1.9–4.7). Our results differ from those reported in hospital series or in population surveys based on clinical records, with higher incidence and prevalence rates, female preponderate and higher frequency of vertebrobasilar attacks.

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“…4,[6][7][8] Most of the data referred to small cohorts whose follow-up was far from being complete. 4,[6][7][8] A further study of 74 stroke patients with an average follow-up of 16 years reported an average annual mortality rate of 1% and an average annual incidence rate of new strokes of 0.5%. These proportions were very close to the 1.44% mortality and the 0.52% incidence of new strokes in our patients with a first-ever stroke.…”

Section: Marini Et Al Prognosis Of Cerebral Ischemia In the Young 2323mentioning

confidence: 99%

“…4,5 Long-term prognosis of young patients with transient ischemic attack (TIA) is reported to be even more favorable, although the risk of new ischemic events depends on the presence of vascular risk factors. 6,7 The available prospective studies report annual incidence rates of death and recurrent stroke ranging from 1% to 2.6%, with higher long-term mortality in patients who had a large-vessel stroke. 5,8,9 The prognosis has been reported to be severe in patients with carotid stenosis and mild in patients with coexisting stroke and migraine.…”

mentioning

confidence: 99%

Long-Term Prognosis of Cerebral Ischemia in Young Adults

Marini

Totaro

Carolei

1999

Stroke

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Background and Purpose-Prognosis of ischemic stroke in young adults is reported as favorable, and transient ischemic attack (TIA) is commonly considered a benign event. We investigated long-term outcome and prognostic predictors of cerebral ischemia in patients under 45 years of age. Methods-Three hundred thirty-three patients aged 15 to 44 years who suffered from a first-ever TIA or ischemic stroke were prospectively followed up with annual clinical evaluation or complete phone interview. End points were the composite outcome event of stroke, myocardial infarction, and vascular or nonvascular death and death from all causes. The probability of event-free survival was estimated by the Kaplan-Meier method. Univariate and multivariate estimates of hazard ratios were calculated according to the Cox proportional hazards analysis. Results-An average follow-up of 96 months was available in 330 patients (99.1%). Survival was worse in patients with stroke at entry (86.5%) than in those with TIA (97.1%). Mortality in both groups was significantly higher than in the general population (standardized mortality ratio [SMR] 14.5, PϽ0.0001, Poisson distribution test, and SMR 7.9, Pϭ0.002). The average annual mortality rate was higher during the first (3.94%, 95% CI 1.84 to 6.04) than in the subsequent years. The average annual incidence rate of new stroke was higher in patients with stroke than in those with TIA at entry, and it declined from 1.56% (95% CI 0.21 to 2.91) during the first year to 0.06% (95% CI 0.04 to 0.08) at the end of the follow-up. Myocardial infarction occurred later, after the first year, with similar rates in patients with stroke and TIA at entry. The average annual rates of new stroke (2.36%), myocardial infarction (1.68%), and death (3.05%) were higher in patients with the mixed atherothrombotic and cardioembolic etiology than in the remaining patients. Male gender, age Ͼ35 years, stroke at entry, and cardiac diseases were independent predictors of the composite outcome event at the Cox regression analysis, whereas only stroke at entry and cardiac diseases predicted death from all causes. Conclusions-Stroke and TIA in young adults have severe prognostic implications, because the mortality risk was highly increased with respect to the general population. Preventive measures are strongly recommended in the presence of any unfavorable prognostic profile. (Stroke. 1999;30:2320-2325.)

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Transient cerebral ischemic attacks in the young and middle aged. A population study.

Cited by 23 publications

References 18 publications

Prognosis after transient ischemic attack and ischemic stroke in young adults.

Prognosis after transient ischemic attack and ischemic stroke in young adults.

Transient Ischemic Attacks in the Community: Occurrence and Clinical Characteristics

Long-Term Prognosis of Cerebral Ischemia in Young Adults

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