ABSTRACT
Background@#The frequency of cerebral infarction and stenosis of intra- and extracranial arteries may be vary with age-group and gender. @*Objective@#This study was conducted to clarify the risk factors and characteristics of cerebral infarction and stenosis of vessels in Mongolian young adults.@*Methods@#This was a prospective study, from October 2015 to July 2020, of 100 patients below 50 years diagnosed with acute cerebral infarction. Patient characteristics were compared according to sex (61 males and 39 females) and age group (29 patients were below 34 years and 71 patients were 35–49 years). Characteristics of acute cerebral infarction were studied by DWI-diffusion weighted MRI imaging. Stenosis of intra- and extracranial arteries was diagnosed by duplex sonography, head and cervical magnetic resonance angiography (MRA). @*Results@#Leading causes for cerebral infarction in the young patients were hypertension (71%), smoking (57%), dyslipidemia (45%), diabetes (33%), and migraine with aura (25%). Lacunar Infarction was most common in our patients (33%). Partial anterior circulation infarction was predominant in males (45.9% vs 38.5%; P<0.05) and posterior circulation infarction in females (23.1% vs 11.5 %; P<0.05). Small artery atherosclerosis was found in 33% cases, with higher prevalence in patients of the 35–49 years age-group. Intracranial stenosis was more common than extracranial stenosis, and middle cerebral artery stenosis was most prevalent (38.9%). Stenosis in the anterior circulation was more frequent than in the posterior circulation (P<0.001). @*Conclusions@#In these young patients, hypertension, smoking, dyslipidemia, diabetes, and migraine with aura were common risk factors. Intracranial stenosis was most common, particularly in the middle cerebral artery.
ABSTRACT
Background Ischemic stroke or cerebral infarction in young adults (20-50 years) is relatively frequent, accounting for more than 10%-26% of all first strokes and its incidence rises steeply with age. Causes of “Young stroke” are heterogeneous and while it generally has a good prognosis, it has a significant socioeconomic impact, including functional deficits and financial costs. The most frequent causes of cerebral infarction in young adults are cardio-embolism, hypertension, premature atherosclerosis, migraine, smoking and hypercoagulable states. Objective The aim of this study was to compare characteristics of cerebral infarction between young (20-49 years) and old (50-89 years) patients undergoing investigations and treatment according to one common protocol in the tertiary hospital. Methods This Descriptive case series study was conducted in Department of Neurology of First State Central Hospital from October 2014 to July 2016. During this study, we observed 220 patients with first-onset of cerebral infarction from which 90 young patients (under 50 years) and 130 old one (above 50 years), based on prospective study. Data regarding the etiology and risk factors of the stroke, clinical manifestations, and diagnostic test results of patients were examined during their hospital treatment as well as a NIHSS, modified Rankin Scale scores, and Barthel Index at admission and discharge, also at 21 day. Stroke subtyping was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results In total, 220 patients with cerebral infarction were included, from which 90 (40.9%) were 20-50 years and 130 (59.1%) were 50-89 years. The proportion of males was higher among both groups: 61.1% vs. 70.0%. Common causes for cerebral infarction in the young patients were current smoking (53.3.1% vs. 37.8%), long-term alcohol consumption (51.1 vs. 12.3), cardiac embolism (36.0% vs. 16.2%), migraine with aura (25.5% vs. 12.2%), infective diseases (15.6% vs. 0.8%), and oral contraceptive use (14.4 vs. 0%). Leading causes for ischemic stroke in old patients were the conventional risk factors such as hypertension (75.4% vs. 38.9%), atherosclerosis (66.9% vs. 31.1), coronary artery disease (24.3% vs. 12%), and diabetes mellitus (26.9% vs. 6.7%). Most of the young stroke patients demonstrated good functional outcomes, at the time of discharge (71.1% vs. 60%) and three weeks (86.6% vs. 66.2%) patients had Rankin Scale scores in the range of 0-2. Conclusions There are significant differences between young and old patients with cerebral infarction regarding to risk factors, etiological subtypes and improvement of functional deficits associated with the stroke. However, severity of stroke on admittance is similar but three weeks outcome is different among young and old patients with relatively rapid improvement of functional deficit in young stroke patients than old one.