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June 07, 2011; 76 (23) Articles

Etiologic investigation of ischemic stroke in young adults

V. Larrue, N. Berhoune, P. Massabuau, L. Calviere, N. Raposo, A. Viguier, N. Nasr
First published June 6, 2011, DOI: https://doi.org/10.1212/WNL.0b013e31821e5517
V. Larrue
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N. Berhoune
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P. Massabuau
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L. Calviere
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N. Raposo
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A. Viguier
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N. Nasr
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Citation
Etiologic investigation of ischemic stroke in young adults
V. Larrue, N. Berhoune, P. Massabuau, L. Calviere, N. Raposo, A. Viguier, N. Nasr
Neurology Jun 2011, 76 (23) 1983-1988; DOI: 10.1212/WNL.0b013e31821e5517

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Abstract

Objectives: We attempted to classify causes of ischemic stroke in young adults using a progressive diagnostic algorithm and the ASCO (atherosclerosis, small-vessel disease, cardiac source, other cause) classification system.

Methods: Patients aged 16–54 years consecutively treated for acute ischemic stroke in a tertiary stroke unit were included in this retrospective analysis. Causes of stroke were classified using the ASCO system, which assigns a graded level of likelihood to each potential cause in individual patients. The initial etiologic workup included brain imaging, magnetic resonance or CT angiography of cerebral and cervical vessels, EKG, and routine blood studies. Patients without a definite cause of ischemic stroke after initial evaluation underwent transesophageal echocardiography.

Results: We included 318 patients (195 men and 123 women); 131 patients were aged 16–44 years, and 187 were aged 45–54 years. A definite cause of stroke (ASCO grade 1) could be identified in 145 patients (45.5%). An uncertain cause of stroke (ASCO grade 2) was found in 59 (18.5%) further patients. Most (130 of 145) definite causes were identified by initial evaluation. The 2 major definite or uncertain causes of stroke were patent foramen ovale associated with atrial septal aneurysm (PFO-ASA) (20 of 131 [15.3%]) and dissection of the cervical or cerebral artery (19 of 131 [14.5%]) in patients aged 16–44 years and large-vessel atherosclerosis (37 of 187 [19.8%]) and PFO-ASA (23 of 187 [12.3%]) in patients aged 45–54 years.

Conclusions: Our findings suggest that PFO-ASA may be a major cause of ischemic stroke in young adults.

Footnotes

  • Supplemental data at www.neurology.org

  • ASA
    atrial septal aneurysm
    ASCO
    atherosclerosis, small-vessel disease, cardiac source, other cause
    PFO
    patent foramen ovale
    PFO-ASA
    patent foramen ovale associated with atrial septal aneurysm
    TEE
    transesophageal echocardiography
    TOAST
    Trial of ORG 10170 in Acute Stroke Treatment
    TTE
    transthoracic echocardiography.

  • Received November 8, 2010.
  • Accepted February 18, 2011.
  • Copyright © 2011 by AAN Enterprises, Inc.
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  • Etiologic investigation of ischemic stroke in young adults
    • Paul E. Cotter, Clinical Research Fellow, Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.paul.cotter@addenbrookes.nhs.uk
    • Mark Belham, Smriti Agarwal and Peter J. Martin
    Submitted August 25, 2011
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