Article Text

Download PDFPDF
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

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.

  • 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
  • stroke
  • recurrence
  • young adult
  • epidemiology

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • Competing interests: none declared