Genç inme hastalarının demografik özellikleri, etyolojik sınıflaması, lezyon lokalizasyonu ve prognostik faktör değerlendirmesi: Üçüncü basamak sağlık merkezi verilerinin bir yıllık sonuçları

Abstract

Genç inmeler, tüm inmelerin %5-%20 kadarını oluşturmakta ve yaşlı popülasyona göre inmenin altta yatan nedeni farklılık gösterebilmektedir. Bu çalışmanın amacı, 1 yıllık süre içinde hastanemiz nöroloji servisinde yatırılarak izlenen genç inme hastalarında; inmenin tipi, lokalizasyonu, etyolojisi, uygulanan tedavi yöntemleri, rekürrens oranı ve prognozu etkileyen faktörleri ortaya koymaktır. Ocak 2022-Aralık 2022 tarihleri arasında akut inme nedeni ile acil servise başvuran ve yatarak tedavi gören 18-60 yaş arasındaki hastaların verileri retrospektif olarak taranmıştır. Hastalarda kranial görüntüleme, gerekli biyokimyasal tetkiklerin yanı sıra, vaskülit belirteçleri, kanser markerleri, protrombotik faktörler, genetik incelemeler de yapılmıştır.Toplam 147 hastanın 124’ü iskemik, 23’ü hemorajik inme ile başvurmuştur. Hemorajik inme ile başvuran hastalarda lezyon lokalizasyonu en sık putamende olurken, etyoloji de en önemli risk faktörü kontrolsüz hipertansiyondur. İskemik inme ile gelen hastalarda en sık lokalizasyon orta serebral arter lokalizasyonunda saptanırken, risk faktörü olarak hipertansiyon, hiperlipidemi ilk iki sırayı oluşturmaktadır. TOAST sınıflamasına göre büyük damar aterosklerozu %16.9, küçük damar hastalığı %20.9, kardiyoembolik %15.3, nedeni bilinen %29, nedeni bilinmeyen inme %17.7 olarak saptanmıştır. Hastaların 20’si akut inme ile başvurmuş olup, tpa ve/veya trombektomi tedavileri uygulanmıştır. Hastalarımız arasında rekürrens oranı…olup, serviste yatışları sırasında ölüm saptanmamıştır. İnme her yaşta görülebilen bir hastalıktır. Genç inme hastaları arasında inme etyolojisi farklılıklar göstermekte birlikte, genç inme hastalarında rekürrensi önlemek için risk faktörlerinin sıkı kontrolü önem taşımaktadır.

Keywords

• Genç inme
• inme lokalizasyonu
• etyoloji

DEMOGRAPHIC FEATURES, ETIOLOGICAL CLASSIFICATION, LESION LOCALIZATION AND PROGNOSTIC FACTOR EVALUATION OF YOUNG STROKE PATIENTS: ONE-YEAR RESULTS OF TERTIARY HEALTH CENTER DATA

Abstract

Young strokes constitute 5%-20% of all strokes, and the underlying cause of stroke may differ according to the elderly population. The aim of this study is to evaluate in young stroke patients who were hospitalized and followed up in the neurology service of our hospital for a period of 1 year and to reveal the type, localization, etiology of stroke, treatment methods, recurrence rate and the prognosis of the patients. The data of patients aged 18-60 years who applied to the emergency department due to acute stroke and were hospitalized between January 2022 and December 2022 were reviewed retrospectively. In addition to cranial imaging, cardiac examination and necessary biochemical tests, vasculitis markers, cancer markers, prothrombotic factors, and genetic examinations were performed in patients deemed necessary. A total of 147 patients presented with 124 ischemic (%84.35), 23 hemorrhagic (%15.65) stroke. In patients presenting with hemorrhagic stroke, lesion localization was most common in the putamen, while the most important risk factor in etiology was uncontrolled hypertension. In patients presenting with ischemic stroke, the most common localization was in the middle cerebral artery, while hypertension and hyperlipidemia were the first two risk factors. According to the TOAST classification, large vessel atherosclerosis was found to be 16.9%, small vessel disease 20.9%, cardioembolic 15.3%, 29% of determined cause, and 17.7% of undetermined etiology. Twenty patients were admitted with acute stroke, and t-PA and/or thrombectomy treatments were applied. The recurrence rate among patients with ischemic stoke was 21.1%, and no death was detected during their hospitalization in the ward.Stroke is a disease that can be seen at any age. Although the etiology of stroke varies among young stroke patients, strict control of risk factors is important to prevent recurrence in young stroke patients.

Keywords

• Young stroke
• stroke localization
• etiology

References

1. World Health Organization. Health statistics and information systems. 2019; Available from: https://www.who.int/healthinfo/ global_burden_disease/en/.
2. Bang, OY., Chung, JW., Lee, MJ., Seo, WK., Kim, GM., Ahn, MJ.(2020) Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms. J Stroke. (1):1-10. doi: 10.5853/jos.2019.02278. Epub 2020 Jan 31. PMID: 32027788; PMCID: PMC7005348.
3. Bogousslavsky, J., Pierre, P.(1992) Ischemic stroke in patients under age 45. Neurol Clin;10:113-124.
4. Boot, E., Ekker, MS., Putaala, J., Kittner, S., De Leeuw, FE., Tuladhar, AM. (2020) Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry;91(4):411-417.
5. Ekker, MS., Boot, EM., Singhal, AB., Tan, KS., Debette, S., Tuladhar, AM. et al.(2018) Epidemiology, aetiology, and management of ischaemic stroke in young adults. The Lancet Neurology;17(9), 790-801
6. Ekker, MS., Verhoeven, JI., Vaartjes, I., van Nieuwenhuizen, KM., Klijn, CJM., de Leeuw, FE.(2019) Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology;21;92(21):e2444-e2454.
7. George, MG.(2020) Risk Factors for Ischemic Stroke in Younger Adults: A Focused Update. Stroke;51(3):729-735. doi: 10.1161/STROKEAHA.119.024156. Epub 2020 Feb 12. PMID: 32078487; PMCID: PMC7112557.
8. Hamedani, AG., Cole, JW., Mitchell, BD., Kittner, SJ.(2010) Meta-analysis of factor V Leiden and ischemic stroke in young adults: the importance of case ascertainment. Stroke;41(8):1599-603. doi: 10.1161/STROKEAHA.110.581256. Epub 2010 Jul 8. PMID: 20616326; PMCID: PMC3180852.

9. İnan, RA., Özer, D., Barut, BÖ.(2021) Etiological Investigation of Young Ischemic Stroke Patients in the Tertiary Health Centre. KSU Medical Journal;16(1):46-52
10. Ji, R., Schwamm, LH., Pervez, MA., Singhal, AB.(2013) Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis. JAMA Neurol;70:51–57. doi: 10.1001/jamaneurol.2013.575
11. Kes, VB., Zavareo, I., Demarin, V.(2012) Etiology and diagnostic workup in young stroke patients. Period Biol;114(3):355–359.
12. Lindhardsen, J., Ahlehoff, O., Gislason, GH., Madsen, OR., Olesen, JB., Svendsen. JH., et al.(2012) Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ;8;344:e1257. doi: 10.1136/bmj.e1257. PMID: 22403267; PMCID: PMC3297675.
13. Maaijwee, NA., Rutten-Jacobs, LC., Schaapsmeerders, P., van Dijk, EJ., de Leeuw, FE.(2014) Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol. ;10:315–325. doi: 10.1038/nrneurol.2014.72
14. Marini, C., Russo, T., Felzani, G.(2011) Incidence of stroke in young adults: a review. Stroke Res Treat;2011:1–5.
15. Özer, İŞ., Sorgun, MH,. Rzayev, S., Kuzu, M., Tezcan, S., Yılmaz, V., et al. (2015) Genç İskemik İnme Hastalarında İnme Etiyolojisi, Risk Faktörleri ve Hastaların İzlemdeki Fonksiyonel Durumları. Turk J Neurol;21:159-64
16. Putaala, J., Yesilot, N., Waje-Andreassen, U., Pitkaniemi, J., Vassilopoulou, S., Nardi, K., et al.(2012) Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: the 15 Cities Young Stroke Study. Stroke;43: 2624– 2630.
17. Putaala, J., Metso, AJ., Metso, TM, Konkola, N., Kraemer, Y., Haapaniemi, E. et al.(2009) Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke;40(4):1195-203.
18. Putaala, J.(2016) Ischemic stroke in the young: current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J;1:28–40. doi: 0.1177/2396987316629860
19. Sarfo, FS., Ovbiagele, B., Gebregziabher, M., Wahab, K., Akinyemi, R., Akpalu, A., et al (2018) Stroke among young West Africans: evidence from the SIREN (stroke investigative research and educational network) large multisite case-control study. Stroke;49:1116–22.
20. Singhal, AB., Biller, J., Elkind, MS., Fullerton, HJ., Jauch, EC., Kittner, SJ., et al.(2013) Recognition and management of stroke in young adults and adolescents. Neurology;81:1089–1097. doi: 10.1212/WNL.0b013e3182a4a451
21. Smajlović, D.(2015) Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag;11:157-64.
22. Tsai, C-F., Thomas, B., Sudlow, CLM.(2013) Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology;81:264–72.
23. Wiseman, SJ., Ralston, SH., Wardlaw, JM.(2016) Cerebrovascular Disease in Rheumatic Diseases: A Systematic Review and Meta-Analysis. Stroke;47(4):943-50. doi: 10.1161/STROKEAHA.115.012052. Epub 2016 Feb 25. PMID: 26917565.