L. Milandre et al., CEREBRAL INFARCTION IN PATIENTS AGED 16-3 5 YEARS - A PROSPECTIVE-STUDY OF 52 CASES, La Presse medicale, 23(35), 1994, pp. 1603-1608
Objectives: Aetiologies of cerebral ischemic events in young adults ar
e various and often controversial: atherosclerosis plays a role after
age 35 years, cardioembolism is often recognized as the major cause, a
nd numerous new predisposing conditions have been described. To evalua
te very premature cerebral infarction, we studied prospectively 52 con
secutive patients (34 women and 18 men) aged 16-35 years (mean 28.6 +/
- 5.6 years) admitted over a 6-year period for an arterial cerebral in
farct identified on CT, on MRI or both. Methods: All patients were inv
estigated using a standard protocol including cerebral angiography, tr
ansthoracic echocardiography, 24-hour Holter ECG monitoring, coagulati
on inhibitors levels, lupus anticoagulant testing, HIV and syphilitic
serologies. Additional investigations were performed in a majority of
patients: transesophageal echocardiography in 33, contrast echocardiog
raphy in 50, and anticardiolipin antibodies levels in 38. Results: The
arterial distribution of infarction did not differ from that of overa
ll stroke patients. Sixteen cases were classified as certain aetiologi
es, including cardiac diseases with high embolic risk (n = 9), spontan
eous arterial dissection (n = 4), moya-moya disease (n = 1), atheroscl
erosis (n = 1), and inherited antithrombine III deficiency (n = 1). Ei
ghteen cases were classified as possible aetiologies including cardiac
diseases with low embolic risk (n = 11) such as mitral valve prolapse
or atrial septal aneurysm, miscellaneous arteriopathies (n = 3) such
as arterial dysplasia, antiphospholipid antibodies syndrome (n = 1) an
d migrainous stroke (n = 3). The 18 last cases were classified as unkn
own aetiologies, despite all patients but one had at least one vascula
r risk factor: this group significantly differed from the formers in t
hat the patients were more frequently women using oral contraceptive a
ssociated with tobacco consumption, hypercholesterolemia, or both. Two
patients died acutely and the survivors were followed 31 +/- 18 month
s. Three patients experienced recurrent stroke. Functional outcome was
assessed using the Rankin scale on admission and 6 to 12 months after
the onset of stroke: patients evaluated less than or equal to 2 (no t
o mild handicap) were 31% on admission and 82% after recovery. Twenty
six p. cent remained unable to resume a work. Conclusion: Despite exte
nsive evaluation, identification and classification of aetiologies of
cerebral infarction in young adults should be cautious because the ris
k as well as the pathogenesis of many potential causes still need to b
e defined.