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J Neurol Neurosurg Psychiatry 2005;76:191-195 doi:10.1136/jnnp.2004.040543
  • Paper

Ischaemic stroke in young adults: predictors of outcome and recurrence

  1. K Nedeltchev1,
  2. T A der Maur1,
  3. D Georgiadis2,
  4. M Arnold1,
  5. V Caso2,
  6. H P Mattle1,
  7. G Schroth3,
  8. L Remonda3,
  9. M Sturzenegger1,
  10. U Fischer1,
  11. R W Baumgartner2
  1. 1Department of Neurology, University Hospital of Bern, Switzerland
  2. 2Department of Neurology, University Hospital of Zürich, Switzerland
  3. 3Department of Neuroradiology, University Hospital of Bern, Switzerland
  1. Correspondence to:
 Dr Ralf W Baumgartner
 Department of Neurology, University Hospital of Zürich, Frauenklinikstrasse 26, CH-8091 Zürich, Switzerland; ralf.baumgartnernos.usz.ch
  • Received 1 March 2004
  • Accepted 24 May 2004
  • Revised 19 May 2004

Abstract

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.

Footnotes

  • Competing interests: none declared

Responses to this article

  • Authors' Reply
    • Ralf W. Baumgartner,
    • Krassen Nedeltchev, Marcel Arnold, Heinrich P. Mattle
    J Neurol Neurosurg Psychiatry published online April 5, 2005
  • Thrombophilia screen should not be routinely performed
    • Joseph Kwan
    J Neurol Neurosurg Psychiatry published online February 16, 2005

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