Research Article
BibTex RIS Cite

Epidemiology, aetiology and clinical characteristics of ischaemic stroke in young adults: a retrospective study from Denizli, Türkiye

Year 2023, Volume: 16 Issue: 2, 188 - 194, 05.04.2023
https://doi.org/10.31362/patd.1142810

Abstract

Purpose: The incidence of cerebrovascular disease (CVD) in young adults is approximately 6-26 per 100,000 worldwide, and this numbers are increasing every year. Stroke aetiology among young adults are more diverse than those among older adults and require extensive diagnostic work-up. The aim of our study is to determine risk factors and stroke etiology in stroke patients aged 45 years and younger, followed in our clinic for the last 10 years, and to compare them with literature.
Materials and methods: The study is included in the patients between the age of 18-45 years and are followed by Ischemic CVD in Pamukkale University Neurology clinic between January 2010 and November 2020.The clinical and demographic data of the patients were retrospectively analyzed.
Results: The most common risk factor was smoking (31.4%); hypertension (20.2%), diabetes mellitus (14.4%), hyperlipidemia (14.4%) and coronary arterial disease (11.6%) were following it. According to Trial of Org in Acute Stroke Treatment (TOAST)classification there were, large vessel disease in 13.4%, small vascular disease in 19.8%, cardioembolism in 16.7%, other determined aetiology in 11.5% and the most frequently stroke of undetermined etiology in 38.6%. The most common reason in other determined aetiology was Antiphospholipid Antibody Syndrome.
Conclusion: The incidence of young stroke is increasing every year and it is necessary to determine the underlying reasons to prevent and to give treatment for aetiology. Thus this will contribute to head off major health care costs, loss of workforce and to save young lives.

Supporting Institution

-

References

  • 1. Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk fac-tors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet Neurol 2016; 15: 913–24.
  • 2. Griffiths D, Sturm J. Epidemiology and etiology of young stroke. Stroke Res Treat 2011; 2011: 209370.
  • 3. Putaala J, Yesilot N, Waje-Andreassen U, et al. Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: the 15 cities young stroke study. Stroke 2012; 43: 2624–30.
  • 4. Putaala J. Ischemic stroke in the young: Current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J. 2016 Mar;1(1):28-40. doi: 10.1177/2396987316629860.
  • 5. Ferro JM, Massaro AR, Mas JL. Aetiological diagnosis of ischaemic stroke in young adults. Lancet Neurol 2010;9:1085-1096.
  • 6. Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke regi-stry. Stroke 2009; 40: 1195203.
  • 7. Kristensen B, Malm J, Carlberg B, Stegmayr B, Backman C, Fagerlund M, Olsson T. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke. 1997 Sep;28(9):1702-9. doi: 10.1161/01.str.28.9.1702. PMID: 9303012.
  • 8. Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41.
  • 9. Yesilot Barlas N, Putaala J, Waje-Andreassen U, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013 Nov;20(11):1431-9. doi: 10.1111/ene.12228.
  • 10. Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med 2016;45: e391–98.
  • 11. Boot E, Ekker MS, Putaala J, et al. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry 2020;91:411-7.
  • 12. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and man-agement of ischaemic stroke in young adults. Lancet Neurol 2018;17:790-801.
  • 13. Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 2014; 10: 315–25.
  • 14. Rutten-Jacobs LC, Arntz RM, Maaijwee NA, et al.Long-term mortality after stroke among adults aged 18 to 50 years. JAMA 2013; 309: 1136–44.
  • 15. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015 Feb 24;11:157-64. doi: 10.2147/VHRM.S53203.
  • 16. George MG. Risk Factors for Ischemic Stroke in Younger Adults: A Focused Update. Stroke. 2020 Mar;51(3):729-735. doi: 10.1161/STROKEAHA.119.024156. Epub 2020 Feb 12. PMID: 32078487; PMCID: PMC7112557.
  • 17. Aarnio K, Siegerink B, Pirinen J, Sinisalo J, Lehto M, Het al. Cardiovascular events after ischemic stroke in young adults: A prospective follow-up study. Neurology. 2016 May 17;86(20):1872-9. doi: 10.1212/WNL.0000000000002689.
  • 18. Rutten-Jacobs LC, Maaijwee NA, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, et al. Long-term risk of recurrent vascular events after young stroke: The FUTURE study. Ann Neurol. 2013 Oct;74(4):592-601. doi: 10.1002/ana.23953.
  • 19. Mialovytska O, Nebor Y. ANALYSIS OF RELATIONSHIP BETWEEN PO-LYMORPHISM OF MTHFR (C677T), MTHFR (A1298C), MTR (A2756G) GENES IN THE DEVELOPMENT OF ISCHEMIC STROKE IN YOUNG PATIENTS. Georgian Med News. 2021 Oct;(319):87-92.
  • 20. Holmen M, Hvas AM, Arendt JFH. Hyperhomocysteinemia and Ischemic Stroke: A Potential Dose-Response Association-A Systematic Review and Me-ta-analysis. TH Open. 2021 Sep 24;5(3):e420-e437. doi: 10.1055/s-0041-1735978.
  • 21. Hanly JG, Li Q, Su L, Urowitz MB, Gordon C, et al. Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Care Res (Hoboken). 2018 Oct;70(10):1478-1487. doi: 10.1002/acr.23509.
  • 22. Kheradmand E, Pourhossein M, Amini G, Saadatnia M. Factor V Leiden does not have a role in cryptogenic ischemic stroke among Iranian young adults. Adv Biomed Res. 2014 Feb 28;3:80. doi: 10.4103/2277-9175.127993. PMID: 24761388; PMCID: PMC3988598.
  • 23. Bolaji P, Das S, Ahmad N. JAK 2 positive myeloproliferative neoplasm pre-senting as stroke, recurrent TIA and isolated third nerve palsy. BMJ Case Rep. 2021 Jun 10;14(6):e242270. doi: 10.1136/bcr-2021-242270. PMID: 34112633; PMCID: PMC8194324.
  • 24. Song X, Li Z. Co-existing of craniofacial fibrous dysplasia and cerebrovascular diseases: a series of 22 cases and review of the literature. Orphanet J Rare Dis. 2021 Nov 4;16(1):471. doi: 10.1186/s13023-021-02102-x. PMID: 34736485; PMCID: PMC8567608.
  • 25. Thaler A, Kvernland A, Kelly S, Song C, Aparicio HJ, et al. Stroke Prevention in Patients with Patent Foramen Ovale. Curr Cardiol Rep. 2021 Oct 30;23(12):183. doi: 10.1007/s11886-021-01605-0. PMID: 34718891.
  • 26. Lamassa M, Di Carlo A, Pracucci G, et al. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (the European community stroke project). Stroke 2001;32:392–8.
  • 27. Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham study. Stroke 1996;27:1760–4.
  • 28. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American heart association Task force on clinical practice guidelines and the heart rhythm Society. J Am Coll Cardiol 2019;21:S0735–1097(19)30209–8.
  • 29. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the man-agement of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893–962.
  • 30. Kwon HS, Kim YS, Lee JM, Koh SH, Kim HY, et al; SKY In-vestigators. Causes, Risk Factors, and Clinical Outcomes of Stroke in Korean Young Adults: Systemic Lupus Erythematosus is Associated with Unfavorable Outcomes. J Clin Neurol. 2020 Oct;16(4):605-611. doi: 10.3988/jcn.2020.16.4.605. PMID: 33029967; PMCID: PMC7541989.
  • 31. Kunt R, Çınar BP, Yüksel B, Güllüoğlu H, Sayılır İ, et al. Clinical-epidemiological and radiological characteristics of stroke patients: A multicentre study. Int J Clin Pract. 2021 Oct 8:e14963. doi: 10.1111/ijcp.14963. Epub ahead of print. PMID: 34626055.

Genç erişkinlerde iskemik inmenin epidemiyoloji, etiyoloji ve klinik özellikleri: Denizli ili retrospektif tek merkez verileri

Year 2023, Volume: 16 Issue: 2, 188 - 194, 05.04.2023
https://doi.org/10.31362/patd.1142810

Abstract

Amaç: Genç erişkinlerde serebrovasküler hastalık (SVH) insidansı dünyada yaklaşık 100.000'de 6-26'dır ve bu oran her yıl artmaktadır. Genç erişkinlerde inme etiyolojisi, yaşlılara göre daha çeşitlidir ve kapsamlı tanısal çalışma gerektirir. Çalışmamızın amacı, kliniğimizde son 10 yıldır takip edilen 45 yaş ve altı inme hastalarında risk faktörlerini ve inme etiyolojisini belirlemek ve literatürle karşılaştırmaktır.
Gereç ve yöntem: Çalışmaya Pamukkale Üniversitesi Nöroloji Kliniği’nde Ocak 2010-Kasım 2020 tarihleri arasında İskemik SVH ile takip edilen 18-45 yaş arası hastalar dahil edilmiştir. Hastaların klinik ve demografik verileri retrospektif olarak incelenmiştir.
Bulgular: En sık görülen risk faktörü sigara (%31,4) iken; hipertansiyon (%20,2), diabetesmellitus (%14,4), hiperlipidemi (%14,4) ve koroner arter hastalığı (%11,6) bunu izlemekteydi. Trial of Org in AcuteStrokeTreatment (TOAST) sınıflamasına göre etiyoloji: %13,4 büyük damar hastalığı, %19,8 küçük damar hastalığı, %16,7 kardiyoembolizm, %11,5 diğer etiyoloji idi ve hastaların çoğunu (%38,6) etiyolojisi belirlenemeyen inmeler oluşturuyordu. Belirlenen diğer etiyolojide en sık neden Antifosfolipid Antikor Sendromu idi.
Sonuç: Genç erişkinlerde inme insidansı her yıl artmakta olup, altta yatan nedenlerin belirlenmesi ve etiyolojisine yönelik tedavi verilmesi gerekmektedir. Böylece, bakım maliyetlerinin, işgücü kaybının önüne geçilmesine ve genç hayatların kurtarılmasına katkıda bulunulacaktır.

References

  • 1. Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk fac-tors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet Neurol 2016; 15: 913–24.
  • 2. Griffiths D, Sturm J. Epidemiology and etiology of young stroke. Stroke Res Treat 2011; 2011: 209370.
  • 3. Putaala J, Yesilot N, Waje-Andreassen U, et al. Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: the 15 cities young stroke study. Stroke 2012; 43: 2624–30.
  • 4. Putaala J. Ischemic stroke in the young: Current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J. 2016 Mar;1(1):28-40. doi: 10.1177/2396987316629860.
  • 5. Ferro JM, Massaro AR, Mas JL. Aetiological diagnosis of ischaemic stroke in young adults. Lancet Neurol 2010;9:1085-1096.
  • 6. Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke regi-stry. Stroke 2009; 40: 1195203.
  • 7. Kristensen B, Malm J, Carlberg B, Stegmayr B, Backman C, Fagerlund M, Olsson T. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in northern Sweden. Stroke. 1997 Sep;28(9):1702-9. doi: 10.1161/01.str.28.9.1702. PMID: 9303012.
  • 8. Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41.
  • 9. Yesilot Barlas N, Putaala J, Waje-Andreassen U, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013 Nov;20(11):1431-9. doi: 10.1111/ene.12228.
  • 10. Béjot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med 2016;45: e391–98.
  • 11. Boot E, Ekker MS, Putaala J, et al. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry 2020;91:411-7.
  • 12. Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and man-agement of ischaemic stroke in young adults. Lancet Neurol 2018;17:790-801.
  • 13. Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 2014; 10: 315–25.
  • 14. Rutten-Jacobs LC, Arntz RM, Maaijwee NA, et al.Long-term mortality after stroke among adults aged 18 to 50 years. JAMA 2013; 309: 1136–44.
  • 15. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015 Feb 24;11:157-64. doi: 10.2147/VHRM.S53203.
  • 16. George MG. Risk Factors for Ischemic Stroke in Younger Adults: A Focused Update. Stroke. 2020 Mar;51(3):729-735. doi: 10.1161/STROKEAHA.119.024156. Epub 2020 Feb 12. PMID: 32078487; PMCID: PMC7112557.
  • 17. Aarnio K, Siegerink B, Pirinen J, Sinisalo J, Lehto M, Het al. Cardiovascular events after ischemic stroke in young adults: A prospective follow-up study. Neurology. 2016 May 17;86(20):1872-9. doi: 10.1212/WNL.0000000000002689.
  • 18. Rutten-Jacobs LC, Maaijwee NA, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, et al. Long-term risk of recurrent vascular events after young stroke: The FUTURE study. Ann Neurol. 2013 Oct;74(4):592-601. doi: 10.1002/ana.23953.
  • 19. Mialovytska O, Nebor Y. ANALYSIS OF RELATIONSHIP BETWEEN PO-LYMORPHISM OF MTHFR (C677T), MTHFR (A1298C), MTR (A2756G) GENES IN THE DEVELOPMENT OF ISCHEMIC STROKE IN YOUNG PATIENTS. Georgian Med News. 2021 Oct;(319):87-92.
  • 20. Holmen M, Hvas AM, Arendt JFH. Hyperhomocysteinemia and Ischemic Stroke: A Potential Dose-Response Association-A Systematic Review and Me-ta-analysis. TH Open. 2021 Sep 24;5(3):e420-e437. doi: 10.1055/s-0041-1735978.
  • 21. Hanly JG, Li Q, Su L, Urowitz MB, Gordon C, et al. Cerebrovascular Events in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Care Res (Hoboken). 2018 Oct;70(10):1478-1487. doi: 10.1002/acr.23509.
  • 22. Kheradmand E, Pourhossein M, Amini G, Saadatnia M. Factor V Leiden does not have a role in cryptogenic ischemic stroke among Iranian young adults. Adv Biomed Res. 2014 Feb 28;3:80. doi: 10.4103/2277-9175.127993. PMID: 24761388; PMCID: PMC3988598.
  • 23. Bolaji P, Das S, Ahmad N. JAK 2 positive myeloproliferative neoplasm pre-senting as stroke, recurrent TIA and isolated third nerve palsy. BMJ Case Rep. 2021 Jun 10;14(6):e242270. doi: 10.1136/bcr-2021-242270. PMID: 34112633; PMCID: PMC8194324.
  • 24. Song X, Li Z. Co-existing of craniofacial fibrous dysplasia and cerebrovascular diseases: a series of 22 cases and review of the literature. Orphanet J Rare Dis. 2021 Nov 4;16(1):471. doi: 10.1186/s13023-021-02102-x. PMID: 34736485; PMCID: PMC8567608.
  • 25. Thaler A, Kvernland A, Kelly S, Song C, Aparicio HJ, et al. Stroke Prevention in Patients with Patent Foramen Ovale. Curr Cardiol Rep. 2021 Oct 30;23(12):183. doi: 10.1007/s11886-021-01605-0. PMID: 34718891.
  • 26. Lamassa M, Di Carlo A, Pracucci G, et al. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (the European community stroke project). Stroke 2001;32:392–8.
  • 27. Lin HJ, Wolf PA, Kelly-Hayes M, et al. Stroke severity in atrial fibrillation. The Framingham study. Stroke 1996;27:1760–4.
  • 28. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American heart association Task force on clinical practice guidelines and the heart rhythm Society. J Am Coll Cardiol 2019;21:S0735–1097(19)30209–8.
  • 29. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the man-agement of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893–962.
  • 30. Kwon HS, Kim YS, Lee JM, Koh SH, Kim HY, et al; SKY In-vestigators. Causes, Risk Factors, and Clinical Outcomes of Stroke in Korean Young Adults: Systemic Lupus Erythematosus is Associated with Unfavorable Outcomes. J Clin Neurol. 2020 Oct;16(4):605-611. doi: 10.3988/jcn.2020.16.4.605. PMID: 33029967; PMCID: PMC7541989.
  • 31. Kunt R, Çınar BP, Yüksel B, Güllüoğlu H, Sayılır İ, et al. Clinical-epidemiological and radiological characteristics of stroke patients: A multicentre study. Int J Clin Pract. 2021 Oct 8:e14963. doi: 10.1111/ijcp.14963. Epub ahead of print. PMID: 34626055.
There are 31 citations in total.

Details

Primary Language English
Subjects Neurology and Neuromuscular Diseases
Journal Section Research Article
Authors

Selin Betaş 0000-0002-7372-2907

Zeynep Ünlütürk 0000-0003-3236-6712

Çağatay Öncel 0000-0002-4037-7617

Publication Date April 5, 2023
Submission Date July 9, 2022
Acceptance Date August 21, 2022
Published in Issue Year 2023 Volume: 16 Issue: 2

Cite

AMA Betaş S, Ünlütürk Z, Öncel Ç. Epidemiology, aetiology and clinical characteristics of ischaemic stroke in young adults: a retrospective study from Denizli, Türkiye. Pam Med J. April 2023;16(2):188-194. doi:10.31362/patd.1142810

Creative Commons Lisansı
Pamukkale Medical Journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License