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按一下以編輯母片標題樣式,*,按一下以編輯母片,第二層,第三層,第四層,第五層,Ischemic,Stroke in Young Adult,2001/08/13,Ischemic,Stroke in Young adult,Definition：16-45 y/o,Distribution：3-4%of all stroke,Etiology,clinical manifestation,and prognosis are different from elderly,It is important to find the etiologic factor and treat them adequately for preventing the recurrence,Orv Hetil,2001 Mar 25;142(12):607-10,Epidermiology,Northern Sweden Monica,13 third level and local hospital,age 18-44 y/o,from Jan.1991-May 1996,totally 88 cases,Annual incidence：11.3/100000,13.6 m,vs,8.9 w,Case fatality rate：5.7%(within 28 days),4.8 in,Neuro Neurochir pol,2000Nov-Dec;,Increased with age：especially after 35 y/o,Dramatic increased after 45 in other report,Kristensen,:Stroke,Volume 28(9).September 1997.1702-1709,Epidemiology,Table 1,.Average Annual Age-and Sex-Specific Incidence Rates of First,Ischemic,Stroke in Young Adults in Northern Sweden,1991 to 1994,From:,Kristensen,:Stroke,Volume 28(9).September 1997.1702-1709,Epidemiology,Table 1.Ages of Young Men and Women With,Ischemic,Stroke,Arch,Neurol,.1995;52:491-495,Etiology,Atherosclerosis,is the main cause of stroke in,elderly,while,emboligenous cardiopathy,is the,one,of the main cause of,young adult,Annali Italiani di Medicina Interna,.11(1):33-8,1996 Jan-Mar,Cardiac embolism,was the most common cause of stroke in pt,younger than 40,Stroke.,30,(11):2320-5,1999 Nov.20018350,Atherosclerosis,was 38.2%and,cardioembolism,was 18.1%,Acta Neurologica Scandinavica,.101(1):19-24,Jan 2000.,Etiology,Atherosclerosis,33.3%,Prothrombotic,state,15.5%,Cardiogenic,9.5%,Orv Hetil,2001 Mar 25;142(12):607-10,Atherosclerosis,29.8%,Cardioembolism,19.5%,Hematologic,5.8%,Arch,Neurol,.1995;52:491-495,So,cardioembolism,and,atherosclerosis,are tow major cause of stroke in young adults,Cause are diverse,Etiology,Etiology,Etiology,Atherosclerosis,:,a.Large artery b.Small artery,Embolism:,a,.Cardiogenic,b.Non,-cardiogenic,Non,-Atherosclerosis artriopathy,:,a.Inflammatory b.Non-inflammatory,Hemological,disorder:,a.Viscosity b,.Coagulopathy,Others:,Etiology,Embolism:,a,.Cardiogenic,:,1,.,Valvular,:,RH,prosthetic,endocarditis,MVP,2.,Arrhythmia,:,Af,sick sinus syndrome,3.,AMI/LV aneurysm,:,4.,LV,myxoma,:,5,.,Cardiomyopathy,:,Etiology,Embolism:,b.Non,-cardiogenic,:,1.Pulmonary AVM:,Osler,-Weber,-Rendu,syndrome,2.ASD/VSD or POF with shunt:,3.Pulmonary embolism:,Etiology,Non,-atherosclerosis arteriopathy,:,a.Inflammatory:,1,.Takayasu,s disease:,=Granulomatous arteritis,mono,無脈症,2,.Hepersensitive arteritis,:,Churg-strauss,disease,3.Infectious:,Syphilitic,arteritis,TB,HIV-associated,4.Drug related:,heroin,amphetamine,5.Systemic disease:,SLE,RA,polyarteritis nodosa,Etiology,Non,-atherosclerosis arteriopathy,:,a.Non-inflammatory:,1,.Moya moya,disease:,2.Artery dissection:,3.Irradiation,vasculopathy,:,4,.Fibromuscular dysplasia,:,5,.Firinoid vasculopathy,:,Etiology,Hematological disorder:,a.Viscosity:,1.MDS:,CML,polycythemia vera,essential,thrombocythemia,2.Multiple,myeloma,:,3.Leukemia,b,.Coagulopathy,:,Etiology,Hematological disorder:,b,.Coagulopathy,:,1.,Hemoglobin disorder,2.Protein C/S deficiency,3,.Antithrombin,III deficiency,4.DIC,5.Anti,-phospholipid,antibody,Etiology,Others:,1.Migraine,2.Pregnancy,3.Trauma,Risk Factor,Stroke,Volume 28(9).September 1997.1702-1709,Risk factor,Agreed by most reporters are:,1.Cigarette smoking,2.Hypertension,3,.Hyperlipidemia,Orv Hetil,2001 Mar 25;142(12):607-10,Postgraduate medicine.81(5):141-4,149-51 1987 Apr.,Acta Neurologica Scandinavica,.101(1):19-24,Jan 2000,Clinical Presentation,Embolism:,1.Sudden onset of cortical impairment,2.Heart condition predisposing to,embolism,3.May be fluctuated,and may recover or,deteriorat,Clinical Presentation,Large artery,atherosclerosis,:,1.Cerebral cortical impairment:,aphasia,apraxia,anopia,agnosia,restricted motor,involvement,2.History of intermittent,claudication,TIA,Clinical Presentation,Small artery occlusion(lacunae),1.Traditional clinical,lacunar,syndrome,a.Pure motor,hemiparesis,b.Pure sensory stroke,c.Ataxia,hemiparalysis,d.,Dysarthria,-clumsy hand,e.Sensory motor stroke,2.History of HTN and DM supports,Dx,Prognosis,First 28 days mortality:4.8/5.7%,Neurological deficit,(Canadian neurological scale),and handicap severity,(Rankin classification,Barthel,index),are all much better than elderly.,1/3;6mo,Although infarct size usually bigger,(3cm),Recurrence risk is low:1.1-1.2 annually,Over all,prognosis is much better,so aggressive treatment intervention is important.,Advised Clinical Study,CT/MRI,/angiography,12 lead EKG,Echocardiogram/TEE,Dupplex,(carotid and IC,doppler,),BCS,rheumatic profile,autoimmune profile,coagulation profile,Conclusion,Ischemia,stroke in young adults must be studied with a different protocol from that used for the elderly,due to the difference of the etiology and the prognosis.,Annali Italiani di Medicina Interna,.11(1):33-8,1996 Jan-Mar,
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