HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Read responses to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nedeltchev, K Articles by Baumgartner, R W Search for Related Content PubMed PubMed Citation Articles by Nedeltchev, K Articles by Baumgartner, R W

Ischaemic stroke in young adults: predictors of outcome and recurrence

¹ Department of Neurology, University Hospital of Bern, Switzerland
² Department of Neurology, University Hospital of Zürich, Switzerland
³ Department of Neuroradiology, University Hospital of Bern, Switzerland

Correspondence to:
Correspondence to:
Dr Ralf W Baumgartner
Department of Neurology, University Hospital of Zürich, Frauenklinikstrasse 26, CH-8091 Zürich, Switzerland; ralf.baumgartner{at}nos.usz.ch

Background: There is limited information about predictors of outcome and recurrence of ischaemic stroke affecting young adults.

Objective: To assess the predictive value of the presenting characteristics for both outcome and recurrence in young stroke victims.

Methods: Clinical and radiological data for 203 patients aged 16 to 45 years were collected prospectively; they comprised 11% of 1809 consecutive patients with ischaemic stroke. The National Institutes of Health stroke scale (NIHSS), the Bamford criteria, and the trial of ORG 10172 in acute stroke treatment (TOAST) classification were used to define stroke severity, subtype, and aetiology. The clinical outcome of 198 patients (98%) was assessed using the modified Rankin scale (mRS) and categorised as favourable (score 0–1) or unfavourable (score 2–6).

Results: Stroke was caused by atherosclerotic large artery disease in 4%, cardioembolism in 24%, small vessel disease in 9%, another determined aetiology in 30%, and undetermined aetiology in 33%. Clinical outcome at three months was favourable in 68%, unfavourable in 29%, and lethal in 3%. Thirteen non-fatal stroke, two fatal strokes, and six transient ischaemic attacks (TIA) occurred during a mean (SD) follow up of 26 (17) months. High NIHSS score, total anterior circulation stroke, and diabetes mellitus were independent predictors of unfavourable outcome or death (p<0.0001, p = 0.011, and p = 0.023). History of TIA predicted stroke recurrence (p = 0.02).

Conclusions: Severe neurological deficits at presentation, total anterior circulation stroke, and diabetes mellitus predict unfavourable outcome. Previous TIA are associated with increased risk of recurrence.

Abbreviations: LACS, lacunar stroke; mRS, modified Rankin scale; NIHSS, National Institutes of Health stroke scale; PACS, partial anterior circulation stroke; POCS, posterior circulation stroke; TACS, total anterior circulation stroke; TOAST, trial of ORG 10172 in acute stroke treatment

Keywords: stroke; recurrence; young adult; epidemiology

This article has been cited by other articles:

				K Lipska, P N Sylaja, P S Sarma, K R Thankappan, V R Kutty, R S Vasan, and K Radhakrishnan Risk factors for acute ischaemic stroke in young adults in South India J. Neurol. Neurosurg. Psychiatry, September 1, 2007; 78(9): 959 - 963. [Abstract] [Full Text] [PDF]

				S. T. Engelter, T. Brandt, S. Debette, V. Caso, C. Lichy, A. Pezzini, S. Abboud, A. Bersano, R. Dittrich, C. Grond-Ginsbach, et al. Antiplatelets Versus Anticoagulation in Cervical Artery Dissection Stroke, September 1, 2007; 38(9): 2605 - 2611. [Abstract] [Full Text] [PDF]

				J. L. Banks and C. A. Marotta Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials: A Literature Review and Synthesis Stroke, March 1, 2007; 38(3): 1091 - 1096. [Abstract] [Full Text] [PDF]

				K. Nedeltchev, U. Fischer, M. Arnold, P. Ballinari, T. Haefeli, L. Kappeler, C. Brekenfeld, L. Remonda, G. Schroth, and H. P. Mattle Long-Term Effect of Intra-Arterial Thrombolysis in Stroke Stroke, December 1, 2006; 37(12): 3002 - 3007. [Abstract] [Full Text] [PDF]

				M. Bondanelli, M. R. Ambrosio, A. Onofri, A. Bergonzoni, S. Lavezzi, M. C. Zatelli, D. Valle, N. Basaglia, and E. C. degli Uberti Predictive Value of Circulating Insulin-Like Growth Factor I Levels in Ischemic Stroke Outcome J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3928 - 3934. [Abstract] [Full Text] [PDF]

eLetters: