Yield of Screening Tests for Systemic Vasculitis in Young Adults with Ischemic Stroke

Abstract

Systemic vasculitis, which can involve the brain, may be one of the causes of stroke in young adults; therefore, a test panel for systemic vasculitis is considered for some young stroke patients. However, little is known about this test’s yield as a screening test in young adults with ischemic stroke. We evaluated the yield of a panel for systemic vasculitis as a screening test in young patients with ischemic stroke. Consecutive patients aged 18–45 years with ischemic stroke between January 2010 and December 2017 were included. They all underwent screening tests for systemic vasculitis including rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibodies, anticardiolipin antibody, lupus anticoagulant, anti-DNA antibody, and anti-Ro/SSA and La/SSB antibodies. Among 3,593 consecutive patients with acute ischemic stroke during the study period, 198 (5.5%) were aged 18–45 years. Only 4 patients (2.0%) were diagnosed with systemic vasculitis; 2 had systemic lupus erythematosus, 1 had Sjogren’s syndrome, and 1 had Churg-Strauss syndrome. Vasculitis panel screening in every young ischemic stroke patient is not of high yield unless a vasculitic process is highly suspected based on other systemic symptoms or signs of vasculitis. Screening should be targeted toward persons with clinical suspicion.

Hospital Based Study in Assessment of Risk Factors of Stroke in Young Adults

“…Von Sarnowski et al (19) in Sifap study in 15 European countries, Kefi et al (9) in Tunisia, Gökçal et al (20) in Turkey and Li et al (17) in China found that smoking was the most prevalent risk factor by nearly 44%, 55%, 56%, 45 %and 47 % of their samples respectively. Moreover, Yoon et al (21) in South Korea also found that smoking was the most prevalent risk factor among their study populations by 57% of patients.…”

Eosinophilic granulomatosis with polyangiitis: an unusual cause of stroke

“…However, to the best of our knowledge, there are no reports of SVT in the setting of EGPA, though there are reports of ventricular tachycardia and other cardiac arrhythmias. Vasculitis screening panels in young adults with ischaemic stroke have been found to be low yield, with only 2% of patients testing positive 17. However, patients with a history of adult-onset asthma and elevated eosinophil counts presenting with stroke in the absence of metabolic risk factors should prompt a clinical suspicion of EGPA.…”

Recurrent acute ischaemic strokes as the primary presentation of Sjögren’s syndrome

“…[6][7][8] The overall prevalence of vasculitis in young stroke patients, based on a single-centre Korean study, was approximately 2%. 9 Changes seen in the cerebral angiography performed led us to belief that a more prominent vasculitic pathophysiological process had taken place.…”