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

ABSTRACT

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 1.31. 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.