Etiologies and risk factors of cerebral infarctions in Mongolian young adults / Монголын Анагаах Ухаан

Background Stroke in young person is less frequent than in older populations but has a major impact on the productive individuals and society. Objective To determining risk factors and etiological subtypes of cerebral infarctions in patients of young (20-49 years) age who were admitted to the First Central hospital in Ulaanbaatar, Mongolia. Methods This paper is based on a review of hospital-based studies of patients with cerebral infarction in age range 20-49 years which was conducted from 2009 to 2013. Data regarding onset of cerebral infarction, clinical manifestations, diagnostic test results of patients were examined during their hospital treatment and modified Rankin Scale scores at discharge. Subtyping of cerebral infarction was conducted in accordance with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Results Out of total number of 1289 patients admitted for cerebral infarctions, 259 (20.1%) were in the 20-49 year age range and the male-to-female ratio was 1.3:1. The most common conventional risk factors were hypertension (39.8%), premature atherosclerosis (20.8%) and dyslipidemia (17.8%). From the rare specific risk factors in young patients with cerebral infarction were migraine with aura in combination with other risk factors and hypotension, and cerebral vasculopathies. The majority of subtype of cerebral infarction was undetermined (34.7%), followed by other determined etiologies (19.7%). Among the category of undetermined etiology, incomplete evaluation (71.1%) was predominant. Most of the patients demonstrated good functional outcomes, at the time of hospital discharge, 86.9% patients had Rankin Scale scores in the range of 0-2 points. Conclusions Young adults with cerebral infarction account for 20.1% of all stroke patients in tertiary referral hospital in Ulaanbaatar. Risk factors, including conventional and specific causes in combination relatively prevalent in young adults, and a high rate of the patients are categorized under conventional, other determined and undetermined etiologies. Cerebral infarction in the young requires a different approach to investigation and management than ischemic stroke in the elderly given differences in the relative frequencies of possible underlying causes. The results show the needs for persistent management of conventional risk factors and properly patient investigation to determine etiology of cerebral infarction in young patients in Mongolia.

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

BACKGROUND AND PURPOSE: Stroke 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. METHODS: A 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. RESULTS: Of 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. CONCLUSIONS: Young 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.

Correlation study of CXCL16 gene rs3744700 polymorphisms and cerebral infarction subtypes / 中国脑血管病杂志

Objective: To study the correlation between the serum chemokine CXC Ligand 16 (CXCL16) levels or the CXCL16 gene rs3744700 polymorphisms and TOAST subtypes in patients with acute cerebral infarction. Methods: A total of 248 patients with atherosclerotic cerebral infarction within 7 days after symptom onset were selected, among them 149 patients were in a large artery atherosclerotic (LAA) cerebral infarction group, and 99 patients were in a small arterial occlusive (SAO) cerebral infarction group. The polymerase chain reaction (PCR) and gene sequencing were used to detect the genotypes. An enzyme-linked immunosorbent assay was used to detect the serum CXCL16 levels. Results: Circled digit oneSerum CXCL16 level in the LAA cerebral infarction group was 2.5 ± 0.3 μm/L and in the SAO cerebral infarction group were 2.3 ± 0.6 μg/L (P<0.01). Circled digit twoAmong the 149 patients in the LAA cerebral infarction group, the GG genotype frequency at polymorphic loci of CXCL16 gene rs3744700 was 91.9% (137/149) and the G allele frequency was 96.0% (286/298). They were higher than 81.8% and 89.9% in the SAO cerebral infarction group. There were significant differences (P < 0.05). Circled digit threeThe serum CXCL16 level in patients with CG genotype was 2.5 ± 0.3 μg/L in the LAA cerebral infarction group, ant it was higher than 2.1 ± 0.3 μg/L in patients with GT + TT genotype; the serum CXCL16 level in patients with CG genotype was 2.4 ± 0.6 μg/L in the SAO cerebral infarction group, and it was higher than 2.1 ± 0.3 μg/L in patients with GT + TT 2 genotype (all P < 0.01). Among the patients with GG genotype, the serum CXCL16 level in the LAA cerebral infarction group was higher than that in the SAO cerebral infarction group (P = 0.01); there was no significant difference in patients with GT + TT genotype between both groups. Circled digit fourMultivariate Logistic regression analysis showed that the serum CXCL16 level (OR =0.37, 95% CI 0.19 -0.70) and the GG genotype at polymorphic loci of CXCL16 gene rs3744700 (OR =2.57, 95% CI 1.23 -5.36) were the independent risk factors for affecting LAA cerebral infarction. Conclusion: In the TOAST subtypes, the correlation of serum CXCL16 level and the GG genotype at polymorphic loci of CXCL16 gene rs3744700 and LAA cerebral infarction are higher than SAO cerebral infarction.

Ischemic Stroke in Children: Analysis of Risk Factors / 대한소아신경학회지

PURPOSE: This paper evaluate and classified the risk factors that could possibly cause ischemic stroke in children, and investigate whether TOAST classification could be applied to the ischemic stroke in children. METHODS: From March 1995 to February 2002, we retrospectively reviewed the medical record of 87 patients under the age 16 who had been registered to the Ajou Stroke Registry. We evaluated the risk factors of ischemic stroke according to the Ajou Stroke Registry Protocol, and classified the risk factors into 6 main subgroups. In addition, the risk factors were investigated according to the age distribution. TOAST classification had been applied to children with ischemic stroke. RESULTS: There was 64 ischemic stroke(73.6%) and 23 hemorrhagic stroke(26.4%) among the 87 patients. In children with ischemic stroke, there was three major peak age; 13 patients younger than 1 year old(15.3%), 26 patients in age 5 to 8 years old(40.6 %), 22 patients in 9 to 12 years old(34.3%). Vasculopathy(48.6%) was the most common risk factor of the ischemic stroke in this study. Other important risk factors in order of frequency were hypertensive encephalopathy(12.5%), infectious disease(7.8%), metabolic disease(7.8%), and hematologic disease(6.2%). Moyamoya disease was the most common cause of ischemic stroke due to vasculopathy. If we analyze the risk factors according to the age at the presentation of ischemic stroke, 90% of the ischemic stroke due to vasculopathy had been developed after 5 years of age. However, ischemic stroke due to infectious disease had been developed less than 4 years of age. Major stroke was the most common subtype of the ischemic stroke in children, but TIA had been found in 80% of the patients with ischemic stroke due to moyamoya disease. TOAST classification determined the subtype of the ischemic stroke only in 2 children. Risk factors of ischemic stroke in the remained 62 patients were extremely variable, and could not be applicable to the TOAST classification. CONCLUSION: Risk factor of ischemic stroke were found in the 90% of patients. Although risk factors of ischemic stroke were extremely variable in children, cerebral vasculopathy including moyamoya disease was the most common. However, inherited metabolic disorder, coagulopathy, and hypertensive encephalopathy were also relatively common risk factors of ischemic stroke especially in children older than 5 years old. Therefore, we must extensively evaluate all the possible risk factors of ischemic stroke in children. TOAST classification could not be applicable in children because the risk factors of ischemic stroke were extremely variable.

Correlation between modified TOAST classification and OCSP classification in ischemic stroke / 中国实用内科杂志

Objective To study the correlation between 2007 modified TOAST classification and OCSP classification.Methods Totally 177 patients were classified based on the 2007 modified TOAST and OCSP criteria.Analyze whether there was any correlation between the two typing.Results TACI and LACI had significant deviation on distribution of modified TOAST subtype(P