青年缺血性卒中課件

1、青年缺血性卒中青年缺血性卒中青年缺血性卒中Ischemic Stroke in Young adultDefinition：16-45 y/oDistribution：3-4% of all stroke Etiology, clinical manifestation, and prognosis are different from elderlyIt is important to find the etiologic factor and treat them adequately for preventing the recurrence Orv Hetil 2001 Mar 25;

2、142(12):607-102021/4/272Ischemic Stroke in Young adultDefinition：16-45 y/oDistribution：3-4% of all stroke Etiology, clinical manifestation, and prognosis are different from elderlyIt is important to find the etiologic factor and treat them adequately for preventing the recurrence Orv Hetil 2001 Mar

3、25;142(12):607-102021/4/272EpidermiologyNorthern Sweden Monica, 13 third level and local hospital, age 18-44 y/o, from Jan.1991-May 1996, totally 88 casesAnnual incidence：11.3/100000 13.6 m vs 8.9 wCase fatality rate：5.7% (within 28 days) 4.8 in Neuro Neurochir pol 2000Nov-Dec;Increased with age：esp

4、ecially after 35 y/oDramatic increased after 45 in other report Kristensen: Stroke, Volume 28(9).September 1997.1702-17092021/4/273EpidemiologyTable 1. Average Annual Age- and Sex-Specific Incidence Rates of First Ischemic Stroke in Young Adults in Northern Sweden, 1991 to 1994 From: Kristensen: Str

5、oke, Volume 28(9).September 1997.1702-17092021/4/274EpidemiologyTable 1. Ages of Young Men and Women With Ischemic Stroke Arch Neurol. 1995;52:491-495 2021/4/275EtiologyAtherosclerosis is the main cause of stroke in elderly, while emboligenous cardiopathy is the one of the main cause of young adult

6、Annali Italiani di Medicina Interna. 11(1):33-8,1996 Jan-MarCardiac embolism was the most common cause of stroke in pt younger than 40 Stroke. 30(11):2320-5, 1999 Nov. 20018350Atherosclerosis was 38.2% and cardioembolism was 18.1% Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000.2021/4/276Etiol

7、ogyAtherosclerosis 33.3%, Prothrombotic state 15.5%, Cardiogenic 9.5% Orv Hetil 2001 Mar 25;142(12):607-10Atherosclerosis 29.8%, Cardioembolism 19.5%, Hematologic 5.8% Arch Neurol. 1995;52:491-495 So cardioembolism and atherosclerosis are tow major cause of stroke in young adultsCause are diverse202

8、1/4/277Etiology2021/4/278Etiology2021/4/279EtiologyAtherosclerosis: a.Large artery b.Small arteryEmbolism: a.Cardiogenic b.Non-cardiogenicNon-Atherosclerosis artriopathy: a.Inflammatory b.Non-inflammatoryHemological disorder: a.Viscosity b.CoagulopathyOthers:2021/4/2710EtiologyEmbolism: a.Cardiogeni

9、c: 1.Valvular: RH, prosthetic, endocarditis, MVP 2.Arrhythmia: Af, sick sinus syndrome 3.AMI/LV aneurysm: 4.LV myxoma: 5.Cardiomyopathy:2021/4/2711EtiologyEmbolism: b.Non-cardiogenic: 1.Pulmonary AVM: Osler-Weber-Rendu syndrome 2.ASD/VSD or POF with shunt: 3.Pulmonary embolism:2021/4/2712EtiologyNon

10、-atherosclerosis arteriopathy: a.Inflammatory: 1.Takayasus disease:=Granulomatous arteritis,mono,無脈癥 2.Hepersensitive arteritis: Churg-strauss disease 3.Infectious: Syphilitic arteritis, TB, HIV-associated 4.Drug related: heroin, amphetamine 5.Systemic disease: SLE, RA, polyarteritis nodosa2021/4/27

11、13EtiologyNon-atherosclerosis arteriopathy: a.Non-inflammatory: 1.Moya moya disease: 2.Artery dissection: 3.Irradiation vasculopathy: 4.Fibromuscular dysplasia: 5.Firinoid vasculopathy:2021/4/2714EtiologyHematological disorder: a.Viscosity: 1.MDS: CML, polycythemia vera, essential thrombocythemia 2.

12、Multiple myeloma: 3.Leukemia b.Coagulopathy: 2021/4/2715EtiologyHematological disorder: b.Coagulopathy: 1.Hemoglobin disorder 2.Protein C/S deficiency 3.Antithrombin III deficiency 4.DIC 5.Anti-phospholipid antibody2021/4/2716EtiologyOthers: 1.Migraine 2.Pregnancy 3.Trauma2021/4/27172021/4/2718Risk

13、Factor Stroke, Volume 28(9).September 1997.1702-1709 2021/4/2719Risk factorAgreed by most reporters are : 1.Cigarette smoking 2.Hypertension 3.Hyperlipidemia Orv Hetil 2001 Mar 25;142(12):607-10 Postgraduate medicine.81(5):141-4,149-51 1987 Apr. Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000

14、2021/4/2720Clinical PresentationEmbolism: 1. Sudden onset of cortical impairment 2. Heart condition predisposing to embolism 3. May be fluctuated,and may recover or deteriorat2021/4/2721Clinical PresentationLarge artery atherosclerosis: 1. Cerebral cortical impairment: aphasia, apraxia, anopia, agno

15、sia, restricted motor involvement 2.History of intermittent claudication,TIA 2021/4/2722Clinical PresentationSmall artery occlusion (lacunae) 1.Traditional clinical lacunar syndrome a. Pure motor hemiparesis b. Pure sensory stroke c. Ataxia hemiparalysis d. Dysarthria-clumsy hand e. Sensory motor st

16、roke 2.History of HTN and DM supports Dx2021/4/2723PrognosisFirst 28 days mortality: 4.8/5.7%Neurological deficit(Canadian neurological scale) and handicap severity(Rankin classification, Barthel index) are all much better than elderly. 1/3; 6moAlthough infarct size usually bigger (3cm)Recurrence risk is low :1.1-1.2 annuallyOver all, prognosis is much better, so aggressive treatment intervention is important. 2021/4/2724Advised Clinical StudyCT/MRI/angiography12 lead EKGEchocardiogram/TEEDupplex( carotid and IC doppler)BCS, rheumatic profile, autoimmune profile, coagulatio