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Cerebrovascular disease and risk of stroke

Submitted by Dr. Yasser Mokhtar, MD. Dept. of internal medicine. School of medicine, University of South Dakota.

 

Stroke is a loss of cerebral function with symptoms lasting >24 hrs or death due to vascular disease

 
 

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Stroke in the young

Although cerebral infarction is predominantly a disease of the senescence, its occurrence in younger age groups is not rare (Thorvaldsen et al., 1995).

Stroke in the young is particularly tragic because of the potential to create a long term burden for the victims, their families and the community (You et al., 1997).

Only three percent of cerebral infarcts occur in patients under forty years of age (Hart and Miller 1983).

Regardless of the percentage of cases occuring among young individuals, most authors today agree that among victims of cerebral infarction, young people are not rare (Bogousslavsky and Pierre 1992, Bevan et al., 1990 and Rouhart et al., 1993).

Although etiologic investigations of young patients with cerebral infarction have identified a large number of possible causes (Bansal and Sood 1986, Biller et al., 1986 and Adams et al., 1986), yet in almost sixteen per cent of these patients, a clear underlying cause is not found despite extensive investigation (Adams et al., 1995 and Neto et al., 1996).

In 1996, Neto et al. studied the possible causes of cerebral infarction in patients aged fifteen to forty years. They classified the patients into five subgroups namely large artery atherosclerosis, small vessel occlusion or lacunes, cardioembolism, stroke of other determined cause and stroke of undetermined cause (Neto et al., 1996).

In patients diagnosed as large artery atherosclerosis as the cause of cerebral infarction, risk factors recognized were arterial hypertension, smoking, left ventricle hypertrophy, heavy alcohol consumption and hypercholesterolemia. According to most investigators, the number of atherothrombotic infarctions is small among young patients (Alvarez et al., 1989 and Bogousslavsky and Pierre 1992).

In patients diagnosed as lacunar infarction, risk factors were hypertension, diabetes mellitus and left ventricular hypertrophy.

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In patients diagnosed as cardioembolism, the source of embolism detected were synthetic valve prosthesis, MVP, dilated cardiomyopathy, apical aneurysm, double mitral lesion, segmental hypokinesia, recent myocardial infarction and aseptic endocarditis.

The fourth group included patients having more than fifteen different causes of cerebral infarction. These causes include sickle cell anemia, protein C deficiency, protein S deficiency, arterial dissection, moyamoya syndrome, vasculitis, systemic lupus erythematosus, primary antiphospholipid syndrome, migraine, use of oral contraceptive pills and secondary to SAH vasospasm.

The fifth group included patients in whom the etiology of cerebral infarction was undetermined despite an extensive workup. The percentage of patients with cerebral infarction of undetermined etiology was similar to the results published by Adams and his colleagues in 1995 (Adams et al., 1995).  

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