CEREBRAL INFARCTION IN PATIENTS AGED 16-3 5 YEARS - A PROSPECTIVE-STUDY OF 52 CASES

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.