Importance and repercussions of renal and cardiovascular pathology on stroke in young adults: an anatomopathologic study of 52 clinical necropsies

ABSTRACT

INTRODUCTION: Stroke in young adults has seldom been studied in a necropsy series. The objective of the present clinical necropsy-based investigation was to analyze stroke and its relationship with cardiovascular and renal pathology in young adults. MATERIALS AND METHODS:The protocols of 52 clinical necropsies with diagnoses of stroke in patients aged 18 - 49 years, performed between the years 1990-2006, were reviewed. RESULTS: Hemorrhagic stroke was diagnosed in 36 patients (69.3 percent), whereas the remaining 16 (30.7 percent) had ischemic stroke. Hypertensive cardiopathy was evident in 88.4 percent of the cases. Chronic renal pathology, directly or indirectly related to hypertension, was observed in 55.7 percent of the patients. Ischemic stroke as a result of occlusive atherosclerotic disease was seen in 50 percent of cases. Cardiogenic emboli were found in 25 percent of the cadavers. Hemorrhagic stroke was associated with hypertension in 43 percent of the cases, with ruptured vascular malformations in 29 percent, and coagulopathies in 17 percent of the cases. Hypertensive cardiopathy was present in patients with either ischemic or hemorrhagic stroke (81.2 percent and 91.6 percent, respectively). The most frequently observed renal ailments were chronic pyelonephritis (23 percent) and nephrosclerosis (21.1 percent). These were associated with ischemic stroke in 43.7 percent, and 12.5 percent of the cases, respectively, and with 13.8 percent and 25 percent of the hemorrhagic stroke cases. DISCUSSION: Hypertensive cardiopathy, occlusive atherosclerotic disease, chronic pyelonephritis and nephrosclerosis are among the pathophysiologycal mechanisms that apparently and eventually interact to induce a significant number of cases of stroke in young adults. A chronic systemic inflammatory state appears to be an important related condition because it possibly constitutes an accelerant of the pathophysiologycal process.