Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke
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.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Giroud M, Milan C, Beuriat P, et al. Incidence and survival rates during a two-year period of intracerebral and subarachnoid haemorrhages, cortical infarcts, lacunes and transient ischaemic attacks. The Stroke Registry of Dijon: . 1985–1989. Int
2.
Carolei A, Marini C, Di Napoli M, et al. High stroke incidence in the prospective community-based L’Aquila registry (1994–1998): first year’s results. Stroke . 1997; 28: 2500–2506.
3.
Bonita R. Epidemiology of stroke. Lancet . 1992; 339: 342–344.
4.
Ducrocq X, Lacour JC, Debouverie M, Bracard S, Girard F, Weber M. Accidents vasculaires cérébraux ischémiques du sujet jeune. Étude prospective de 296 patients âgés de 16 à 45 ans. Rev Neurol (Paris) . 1999; 155: 575–582.
5.
Rozenthul-Sorokin N, Ronen R, Tamir A, Geva H, Eldar R. Stroke in the young in Israel. Incidence and outcomes. Stroke . 1996; 27: 838–841.
6.
Leno C, Berciano J, Combarros O, et al. A prospective study of stroke in young adults in Cantabria, Spain. Stroke . 1993; 24: 792–795.
7.
Nencini P, Inzitari D, Baruffi MC, et al. Incidence of stroke in young adults in Florence, Italy. Stroke . 1988; 19: 977–981.
8.
Qureshi AI, Safdar K, Patel M, Janssen RS, Frankel MR. Stroke in young black patients. Risk factors, subtypes, and prognosis. Stroke . 1995; 26: 1995–1998.
9.
Marini C, Totaro R, Carolei A. Long-term prognosis of cerebral ischemia in young adults. National Research Council Study Group on Stroke in the Young. Stroke . 1999; 30: 2320–2325.
10.
Camerlingo M, Casto L, Censori B, et al. Recurrence after first cerebral infarction in young adults. Acta Neurol Scand . 2000; 102: 87–93.
11.
Bogousslavsky J, Pierre P. Ischemic stroke in patients under age 45. Neurol Clin . 1992; 10: 113–124.
12.
Adams HP Jr, Kappelle LJ, Biller J, et al. Ischemic stroke in young adults. Experience in 329 patients enrolled in the Iowa Registry of Stroke in Young Adults. Arch Neurol . 1995; 52: 491–495.
13.
Carolei A, Marini C, Ferranti E, et al. A prospective study of cerebral ischemia in the young: analysis of pathogenic determinants. Stroke . 1993; 24: 362–367.
14.
Milandre L, Ceccaldi M, Ali Cherif A, Khalil R. Complications ischémiques artérielles cérébrales de l’adulte jeune. Etiologies et pronostic. Rev Med Int . 1990; 11: 29–35.
15.
Lisovoski F, Rousseaux P. Cerebral infarction in young people. A study of 148 patients with early cerebral angiography. J Neurol Neurosurg Psychiatry . 1991; 54: 576–579.
16.
Kwon SU, Kim JS, Lee JH, Lee MC. Ischemic stroke in Korean young adults. Acta Neurol Scand . 2000; 101: 19–24.
17.
Hoffmann M. Stroke in the young in South Africa—an analysis of 320 patients. S Afr Med J . 2000; 90: 1226–1237.
18.
Chancellor AM, Glasgow GL, Ockelford PA, Johns A, Smith J. Etiology, prognosis and hemostatic function after cerebral infarction in young adults. Stroke . 1989; 20: 477–482.
19.
Ferro JM, Crespo M. Prognosis after transient ischemic attack and ischemic stroke in young adults. Stroke . 1994; 25: 1611–1616.
20.
Kappelle LJ, Adams HP, Heffner ML, Torner JC, Gomez F, Biller J. Prognosis of young adults with ischemic stroke: a long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke . 1994; 25: 1360–1365.
21.
Neau JP, Ingrand P, Mouille-Brachet C, et al. Functional recovery and social outcome after cerebral infarction in young adults. Cerebrovasc Dis . 1998; 8: 296–302.
22.
Nayak SD, Nair M, Radhakrishnan K, Sarma PS. Ischaemic stroke in the young adult: clinical features, risk factors and outcome. Natl Med J India . 1997; 10: 107–112.
23.
Bogousslavsky J, Regli F. Ischemic strokes in adults younger than 30 years of age: cause and prognosis. Arch Neurol . 1987; 44: 479–482.
24.
Hindfelt B, Nilsson O. Long-term prognosis of ischemic stroke in young adults. Acta Neurol Scand . 1992; 86: 440–445.
25.
Marini C, Totaro R, De Santis F, Ciancarelli I, Baldassarre M, Carolei A. Stroke in young adults in the community-based L’Aquila registry: incidence and prognosis. Stroke . 2001; 32: 52–56.
26.
Johnson S, Skre H. Transient cerebral ischemic attacks in the young and middle aged: a population study. Stroke . 1986; 17: 662–666.
27.
Larsen BH, Sorenson PS, Marquardsen J. Transient ischaemic attacks in young patients: a thromboembolic or migrainous manifestation? A 10 year follow-up study of 46 patients. J Neurol Neurosurg Psychiatry . 1990; 53: 1029–1033.
28.
The members of the Lille Stroke Program. Misdiagnoses in 1250 consecutive patients admitted in an acute stroke unit. Cerebrovasc Dis . 1997; 7: 284–288.
29.
Cordonnier C, Girot M, Bouillaguet S, et al. Stroke units from scientific evidence to practice: the experience of the Lille Stroke Unit. Cerebrovasc Dis . 2000; 10 (suppl 4): 17–20.
30.
Hénon H, Godefroy O, Leys D, et al. Early predictors of death and disability after acute cerebral ischemic event. Stroke . 1995; 26: 392–398.
31.
International Headache Society. Classification and diagnosis criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia . 1988; 8: 1–28.
32.
CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet . 1996; 348: 1329–1339.
33.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtypes of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Stroke . 1993; 24: 35–41.
34.
Lucas CH, Leys D, Mounier-Vehier F, Hénon H, Pruvo JP. Stroke patterns in patients with atrial septal aneurysm and ischemic stroke of unknown cause. Cerebrovasc Dis . 1994; 4: 337–340.
35.
Leys D, Moulin TH, Stojkovic T, Begey S, Chavot D, for the Donald investigators. Follow-up of patients with history of cervical-artery dissection. Cerebrovasc Dis 1995;5:43–49.
36.
International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19,435 patients with acute ischaemic stroke. Lancet . 1997; 349: 1569–1581.
37.
CAST (Chinese Acute Stroke Trial) Collaborative Group. Randomized placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet . 1997; 349: 1641–1649.
38.
Sulter G, Steen C, de Keyser J. Use of the Barthel Index and modified Rankin Scale in acute stroke trials. Stroke . 1999; 30: 1538–1541.
39.
Candelise L, Pinardi G, Aritzu E, Musicco M. Telephone interview for stroke outcome assessment. Cerebrovasc Dis . 1994; 4: 341–343.
40.
Lindley RI, Waddell F, Livingstone M, et al. Can simple questions assess outcome after stroke? Cerebrovasc Dis . 1994; 4: 314–324.
41.
Colditz GA, Bonita R, Stampfer MJ, et al. Cigarette smoking and risk of stroke in middle-aged women. N Engl J Med . 1988; 318: 937–941.
42.
Schievink WI, Mokri B, O’Fallon WM. Recurrent spontaneous cervical-artery dissection. N Engl J Med . 1994; 330: 393–397.
43.
Vauthey C, de Freitas GR, van Melle G, Devuyst G, Bogousslavsky J. Better outcome after stroke with higher serum cholesterol levels. Neurology . 2000; 54: 1944–1949.
44.
Chen J, Simon R. Ischemic tolerance in the brain. Neurology . 1997; 48: 306–311.
45.
Leys D, Deplanque D, Mounier-Vehier C, Lucas C, Bordet R. Cholesterol lowering agents for stroke prevention. Clin Exp Hypertens 2002 (in press).
Information & Authors
Information
Published In
Copyright
© 2002.
Publication History
Received: July 18, 2001
Accepted: February 5, 2002
Published in print: July 9, 2002
Published online: July 2, 2023
Authors
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India, Cureus, (2024).https://doi.org/10.7759/cureus.63640
- Ischemic stroke in young adults: Risk factors, etiology, and outcome, Turkish Journal of Neurology, 30, 2, (108-116), (2024).https://doi.org/10.55697/tnd.2024.142
- Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report, Pediatrics, 154, 1, (2024).https://doi.org/10.1542/peds.2024-066855
- High pillow and spontaneous vertebral artery dissection: A case-control study implicating “Shogun pillow syndrome”, European Stroke Journal, 9, 2, (501-509), (2024).https://doi.org/10.1177/23969873231226029
- Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study, Circulation: Cardiovascular Quality and Outcomes, 17, 4, (2024).https://doi.org/10.1161/CIRCOUTCOMES.123.010307
- Elevated Blood Pressure: A Genetically Determined Risk Factor for Cerebral Artery Dissection, American Journal of Hypertension, (2024).https://doi.org/10.1093/ajh/hpae102
- Ambulatory care of patients with arteriopathies: Overview for vascular medicine advanced practice providers, Journal of Vascular Nursing, (2024).https://doi.org/10.1016/j.jvn.2024.05.001
- Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report, Journal of the American College of Radiology, 21, 7, (e37-e69), (2024).https://doi.org/10.1016/j.jacr.2024.03.016
- Genetics of Cervical Artery Dissection, Stroke Genetics, (389-407), (2024).https://doi.org/10.1007/978-3-031-41777-1_15
- Patent Foramen Ovale and Cryptogenic Stroke: Integrated Management, Journal of Clinical Medicine, 12, 5, (1952), (2023).https://doi.org/10.3390/jcm12051952
- See more
Loading...
View Options
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.
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.
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.