Cerebral infarction in patients aged 15 to 40 years

Infartos cerebrais em pacientes com idade entre 15 e 40 anos

THESES

Cerebral infarction in patients aged 15 to 40 years (abstract)^*

Infartos cerebrais em pacientes com idade entre 15 e 40 anos (resumo)

José Ibiapina Siqueira Neto^**

Cerebral infarction in patients aged 15 to 40 years (abstract). Thesis. Ribeirão Preto, 1996.

Ischemic stroke (IS) in young patients was considered rare in the past and has been poorly studied in our country. Few studies analysed differences between age ranges. We proposed the present study to determine etiologies of cerebral infarction and possible specific age subpopulations.

One hundred and six (51 women; 55 men) IS patients whose ages ranged from 15 to 40 were studied. They were evaluated by means of a standardized protocol that included a complete basic investigation indicated in suspected cases of IS, special hematological tests for coagulation inhibitors and assays for antiphospholipid antibodies (aPL). All cases were classified according to criteria recommended by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment), into the following 5 groups: (1) large-artery atherosclerosis, (2) small-vessel occlusion or lacune, (3) cardioembolism, (4) other determined causes, and (5) undetermined causes. We also divided the patients into two subpopuplations by age at time of ictus (ie, 15 to 29 and 30 to 40 years old) to compare the group distribution between these age ranges.

Sixty patients (56.6%) were submitted to cerebral angiograms and 96 (90.5%) had transthoracic echocardiograms. Eleven (10.4%) patients were positive for aPL and 3 (2.8%) had deficiencies in natural anticoagulant proteins. The largest number of patients was included in group 4 being followed by the cardioembolic group. The proportion of these groups was significantly high (n=31; 81.6%) in the 15 to 29 year age range while in the 30 to 40 year interval this trend was partially reverted and we observed an increase in the aterothrombotic and lacunar groups. There were statistically significant differences between these two age intervals in the groups of lacunar infarcts and other etiologies. In the 15 to 29 age interval there was predominance of woman while in the other range men predominated. The most common causes of cardioembolism were mitral valve prolapse, rheumatic heart disease, dilated cardiomiopathy and specially Chagas disease. The hematologic causes, the arterial dissections and Moyamoya disease were more frequent in group 4.

Due to the great variety of etiologies including some preventable ones a large investigation in IS young patients is highly recommended since some of them will live 50 years or more. This study suggest the existence of different populations related to age limits and propose that these age ranges should be considered separately.

Key words: cerebral infarction, brain ischemia, young adults, stroke subpopulations.

*

Tese de Doutorado, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (Área: Neurologia). Orientador: Américo Ceiki Sakamoto.

**

Address: Rua Silva Jatahy 200/ 700, 60165-070 Fortaleza CE, Brasil.

Publication Dates

• Publication in this collection
  21 Oct 2010
• Date of issue
  1997