CARDIAC AND CAROTID EMBOLISM, AND OTHER RARE DEFINITE DISORDERS ARE UNLIKELY CAUSES OF LACUNAR ISCHEMIC STROKE IN YOUNG-PATIENTS

The difference in stroke causes between younger and elderly stroke pat ients may largely depend on differences in the cause of cortical ischa emic stroke, the pathogenesis in lacunar ischaemic stroke being more h omogeneous. We therefore compared the vascular risk factor profile and stroke causes between 60 ischaemic stroke patients of 50 years or les s and 756 patients older than 50 years, in relation to these two ischa emic stroke subtypes. The stroke causes were classified as small-vesse l occlusion, large-vessel atherosclerosis, cardioembolism dioembolism and as rare definite causes (such as dissection, vasculitis, and coagu lation disorders). The rare definite stroke causes were significantly more frequent among young patients (15 vs. 3%, odds ratio 6.2; 95%, co nfidence interval, CI, 2.8-13.6). All these young patients had a corti cal stroke. The whole group of lacunar stroke patients (young and old) had significantly less frequently rare definite stroke causes than th e whole group of cortical stroke patients (1 vs. 5%; odds ratio 0.22; 95% CI 0.07-0.71). Young patients have more varied stroke causes than older patients, but this is largely confined to cortical stroke patien ts. Our data suggest that cardiac and carotid embolism, and other rare definite disorders are unlikely stroke causes in young patients with a lacunar stroke.