Young women have poorer outcomes than men after stroke.

BACKGROUND AND PURPOSE: Gender differences in stroke outcome have not been fully assessed in young patients. METHODS: We conducted an observational study of consecutive young ischemic stroke patients (≤ 50 years of age) admitted to a stroke unit (January 1999 to December 2009). Basal data, subtype of ischemic stroke, stroke severity [Canadian Neurological Scale (CNS)], length of hospital stay, inhospital complications, mortality and functional outcome at discharge [modified Rankin Scale (mRS) score] were analyzed. For stroke severity and outcome analyses, 2 age groups were established: 15-30 (very young group) and 31-50 years old (middle-aged young group). RESULTS: A total of 310 patients were enrolled; 128 females and 182 males. The mean age was similar in women and men (41.07 ± 8.6 vs. 42.12 ± 8.2, NS). Migraine was more frequent in women, whereas arterial hypertension, hyperlipidemia, alcohol abuse, current smoking and atherothrombotic infarction were more frequent in men (p < 0.05). Females presented greater stroke severity than men [median CNS (IQR) = 8 (3.5) vs. 9 (2.5), p = 0.014] except in the very young group [median CNS (IQR) = 9 (1.8) vs. 8 (5), p = 0.022]. Female sex was a predictor of unfavorable outcomes (mRS >2) at discharge in the total sample (OR = 3.33; 95% CI = 1.41-7.84) and in the middle-aged young group (OR = 2.62; 95% CI = 1.05-6.53), adjusted by baseline data, stroke subtype, inhospital complications, length of stay and stroke severity. CONCLUSIONS: Female gender is associated with worse outcomes in adult ischemic stroke patients up to 50 years old. However, this effect is not observed in younger patients (15-30 years).

[Migraine and interatrial septal abnormalities in patients under 55 with cryptogenic stroke]. / Migraña y alteraciones del septo auricular en pacientes menores de 55 años con infarto cerebral criptogenético.

BACKGROUND AND OBJECTIVE: Patent foramen ovale (PFO) is more frequent in migraine patients and is a cause of brain infarct among patients under 55 years old. Our goal was to study the association between PFO and migraine in ischemic stroke patients under 55 years old. PATIENTS AND METHOD: Observational study with inclusion of consecutive stroke patients admitted to a stroke unit (1995--2005). We selected patients under 55 years of age with first-ever acute cerebral infarction of cryptogenic origin. Demographic data, vascular risk factors, stroke vascular territory, stroke severity, the presence of PFO and/or atrial septal aneurysm (ASA) in echocardiography and functional status at discharge by the modified Rankin Scale score were analysed according to previous migraine. RESULTS: From a total of 130 patients, 76 were males. The 13.8% had previous migraine, 3.9% among male and 27.8% among female (p < 0.001). Migraine patients were younger than non migraine ones (p = 0.041) and had a higher frequency of vascular risk factors (not significant [NS]). Stroke severity and functional status at discharge were similar in both groups. Previous history of migraine was associated with FOP (38.9% vs. 26.8%; NS) and FOP plus ASA (odds ratio = 5; 95% confidence interval, 1.422-17.580). The latter association was higher in female (33.3% vs. 0%; NS). CONCLUSIONS: Previous migraine is more frequently associated with double interatrial septal abnormality (PFO plus ASA) in cerebral infarct patients under 55 years of age. This association could be higher in women.

Migraña y alteraciones del septo auricular en pacientes menores de 55 años con infarto cerebral criptogenético / Migraine and interatrial septal abnormalities in patients under 55 with cryptogenic stroke

FUNDAMENTO Y OBJETIVO: El foramen oval permeable (FOP) es más frecuente en los pacientes conmigraña y es una causa de infarto cerebral en menores de 55 años. Este trabajo estudia la asociaciónentre FOP y migraña en pacientes con infarto cerebral menores de 55 años.PACIENTES Y MÉTODO: Se ha realizado un estudio observacional con inclusión secuencial y consecutivade pacientes en una unidad de ictus (1995-2005). Se estudió a los menores de 55 añoscon un primer infarto cerebral de origen criptogenético. Se analizaron: datos demográficos, factoresde riesgo vascular, subtipo territorial de ictus, gravedad del infarto, presencia de FOP y/oaneurisma del septo auricular (ASA) en ecocardiograma y situación funcional al alta (escala deRankin modificada). Para el análisis se establecieron 2 grupos, según presentaran o no antecedentede migraña.RESULTADOS: Se incluyó a 130 pacientes (76 varones), de los que el 13,8% tenía migraña previa(el 3,9% de los varones y el 27,8% de las mujeres; p < 0,001). Los que presentaban migrañaeran más jóvenes (p = 0,041) y tenían una menor frecuencia de factores de riesgo vascular (pno significativa [NS]). La gravedad del ictus y la situación funcional al alta fueron similares enambos grupos. El antecedente de migraña se asoció a la presencia de FOP (el 38,9 frente al26,8%; p: NS) y FOP más ASA (odds ratio = 5; intervalo de confianza del 95%, 1,422-17,580), siendo esta última asociación mayor en las mujeres (el 33,3 frente al 0%; p: NS).CONCLUSIONES: En pacientes menores de 55 años con infarto cerebral criptogenético, el antecedentede migraña se asocia a doble lesión del septo auricular (FOP más ASA) y esta asociaciónpodría ser mayor en las mujeres

BACKGROUND AND OBJECTIVE: Patent foramen ovale (PFO) is more frequent in migraine patientsand is a cause of brain infarct among patients under 55 years old. Our goal was to study theassociation between PFO and migraine in ischemic stroke patients under 55 years old.PATIENTS AND METHOD: Observational study with inclusion of consecutive stroke patients admittedto a stroke unit (1995-2005). We selected patients under 55 years of age with first-ever acutecerebral infarction of cryptogenic origin. Demographic data, vascular risk factors, stroke vascularterritory, stroke severity, the presence of PFO and/or atrial septal aneurysm (ASA) in echocardiographyand functional status at discharge by the modified Rankin Scale score were analysedaccording to previous migraine.RESULTS: From a total of 130 patients, 76 were males. The 13.8% had previous migraine, 3.9%among male and 27.8% among female (p < 0.001). Migraine patients were younger than nonmigraine ones (p = 0.041) and had a higher frequency of vascular risk factors (not significant[NS]). Stroke severity and functional status at discharge were similar in both groups. Previoushistory of migraine was associated with FOP (38.9% vs. 26.8%; NS) and FOP plus ASA (oddsratio = 5; 95% confidence interval, 1.422-17.580). The latter association was higher in female(33.3% vs. 0%; NS).CONCLUSIONS: Previous migraine is more frequently associated with double interatrial septal abnormality(PFO plus ASA) in cerebral infarct patients under 55 years of age. This associationcould be higher in women