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July 9, 2002

Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke

July 9, 2002 issue
59 (1) 26-33

Abstract

Objective: To determine the 3-year outcome in 287 young adults (15 to 45 years old) consecutively admitted between 1992 and 1996 for an ischemic stroke.
Methods: Follow-up was obtained with clinical examinations or telephone interviews, and data were recorded about risk factors, associated disorders, causes of stroke, and current treatments. Functional outcomes were classified with the modified Rankin Scale (mRS). Endpoints were stroke recurrence, myocardial infarction, epileptic seizures, and death.
Results: After a mean follow-up of 3 years, no patient was lost to follow-up; 25.4% of the follow-up visits were performed by telephone interview. The authors found 1) an annual mortality rate of 4.5% during the first year and then of 1.6%; 2) an annual stroke recurrence rate of 1.4% during the first year and then of 1.0%; 3) a 0.2% annual rate of myocardial infarct; 4) epileptic seizures occurring in 6.6% of patients, during the first year in most patients; 5) independence (mRS = 0 to 2) in 94.0% of patients; 6) 4.2% of patients lost their job after stroke despite an mRS score of ≤1; 7) 7.0% of patients reported divorce; and 8) only 22.2% of smokers gave up smoking.
Conclusion: Although young patients who experience ischemic strokes have a low risk of stroke recurrence and myocardial infarction, some patients do not regain independence.

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Letters to the Editor
16 August 2002
Reply to Letter to the Editor
Didier Leys

Dr. Barrett has very important questions but unfortunately our study was not designed and, therefore not powered, to provide an appropriate answer. After exclusion of the 22 patients who died, and of the 69 patients whose infarcts were located in the posterior fossa or multiple, 196 survivors had a clearly defined unilateral hemispheric infarct (right hemisphere 101; left hemisphere 95). In the follow-up period, a divorce was reported in 10 patients with a right hemispheric infarct and five with a left hemispheric infarct (odds ratio: 1.98; 95% confidence interval: 0.05- 6.02). Of the 196 survivors with an unilateral hemispheric infarct, seven patients with right-hemispheric lesions did not return to work despite an apparently good recover, as defined in our paper [1], and three with left hemispheric infarcts (odds ratio: 2.28; 95% confidence interval: 0.57- 9.10).

Therefore, because of the low power of the statistical tests our study cannot help to answer the question of whether right hemispheric infarcts lead more often than left hemispheric infarcts to social or family impairment in young patients with ischemic infarcts. A larger group of patients would be necessary.

Reference:

1)Leys D, Bandu L, Hénon H, et al. Clinical outcome in 287 consecutive young adults (15-45 years) with ischemic stroke. Neurology 2002;59:26-33.

16 August 2002
Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke
Anne M Barrett

I read with interest the report of Leys et al. on clinical outcome in young ischemic stroke. [1]

Disorders of emotional processing and communication are common after right hemisphere stroke [2], and a common clinical teaching is that divorce occurs more frequently after right hemisphere than left hemisphere injury. Were right hemisphere stroke patients over-represented among their 20 patients reporting post-stroke divorce?

Spatial neglect is also highly associated with right hemisphere injury and post-stroke disability. [3] Was there a preponderance of right hemisphere injury in those patients who did not return to work, particularly those regarded employable by their health insurance?

References:

1)Leys D, Bandu L. Hénon H, Lucas C, et al. Clinical outcome in 287 consecutive adults (15 to 45 years) with ischemic stroke. Neurology 2002;59:26-33.

2)Heilman KM, Blonder LX, Bowers D, Crucian GP. Neurological disorders and emotional dysfunction. In: Borod JC, ed. The neuropsychology of emotion. NY: Oxford University Press, 2000.

3)Paolucci S, Antonucci G, Grasso MG, Pizzamiglio L. The role of unilateral spatial neglect in rehabilitation of right-brain-damaged ischemic stroke patients: A matched comparison. Arch Phys Med Rehab 2001;82:743-749.

Information & Authors

Information

Published In

Neurology®
Volume 59Number 1July 9, 2002
Pages: 26-33
PubMed: 12105303

Publication History

Received: July 18, 2001
Accepted: February 5, 2002
Published in print: July 9, 2002
Published online: July 2, 2023

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Authors

Affiliations & Disclosures

D. Leys, MD
From the Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, Lille, France.
L. Bandu, MD
From the Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, Lille, France.
H. Hénon, MD, PhD
From the Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, Lille, France.
C. Lucas, MD, PhD
From the Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, Lille, France.
F. Mounier-Vehier, MD
From the Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, Lille, France.
P. Rondepierre, MD
From the Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, Lille, France.
O. Godefroy, MD, PhD
From the Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, Lille, France.

Notes

Address correspondence and reprint requests to Dr. D. Leys, Stroke Department, Department of Neurology, University of Lille, Roger Salengro Hospital, F-59037 Lille, France; e-mail: [email protected]

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