Abstract
Background
There has been an increase in the incidence of ischemic stroke in young adults. It is believed that it is due to the increase in traditional cardiovascular risk factors. This change has affected the quality of life of young adults.
Aims
To describe the most common etiologies and risk factors in patients aged ≤ 50 who had ischemic stroke between 2011 and 2018.
Methodology
A cross-sectional study of patients under 50 years who had ischemic stroke between 2011 and 2018 who were evaluated at a comprehensive center in Bogotá, Colombia. We carried out a descriptive analysis of comorbidities, the Trial of Org for Acute Stroke (TOAST), the National Institute of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS).
Results
A total of 152 patients were included, out of which 50.66% were men. The most frequent traditional risk factors were smoking history (19%), history of high blood pressure (18%), presence of cardiovascular disease (17%), and history of migraine (15%). The most common etiological subgroups were those classified as “other determined etiologies” (33.5%) and “undetermined etiology” (33.5%), while the most common etiology was carotid or vertebral artery dissection (23%).
Conclusion
This study demonstrates the need to make a deep evaluation of the past medical history, laboratory tests, and new risk factors in young adults. On the other hand, modifiable cardiovascular risk factors top the list, showing the need to implement health promotion strategies for young adults.
Similar content being viewed by others
References
Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, de Leeuw FE (2018) Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol 17:790–801
Uggetti C (2003) Stroke in young people: imaging. Neurol Sci 24(S1):s15–s16
Kristensen B, Malm J, Carlberg B, Stegmayr B, Backman C, Fagerlund M, Olsson T (1997) Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in Northern Sweden. Stroke 28:1702–1709
Kittner SJ, McCarter RJ, Sherwin RW et al (1993) Black-White differences in stroke risk among young adults. Stroke 24:15
Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, Kaste M, Tatlisumak T (2009) Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke 40:1195–1203
Fonarow GC, Reeves MJ, Zhao X, Olson DM, Smith EE, Saver JL, Schwamm LH, Get With the Guidelines-Stroke Steering Committee and Investigators (2010) Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation 121:879–891
Kappelle LJ, Adams HP, Heffner ML, Torner JC, Gomez F, Biller J (1994) Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke 25(7):1360–1365
Putaala J, Curtze S, Hiltunen S, Tolppanen H, Kaste M, Tatlisumak T (2009) Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke: The Helsinki Young Stroke Registry. Stroke 40(8):2698–2703
Varona JF, Bermejo F, Guerra JM, Molina JA (2004) Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol 251:1507–1514
Waje-Andreassen U, Thomassen L, Jusufovic M, Power KN, Eide GE, Vedeler CA, Naess H (2013) Ischaemic stroke at a young age is a serious event--final results of a population-based long-term follow-up in Western Norway. Eur J Neurol 20:818–823
Aarnio K, Rodríguez-Pardo J, Siegerink B, Hardt J, Broman J, Tulkki L et al (2018) Return to work after ischemic stroke in young adults: a registry-based follow-up study. Neurology 91(20):e1909–e1917
Maaijwee NAMM, Rutten-Jacobs LC, Schaapsmeerders P et al (2014) Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 10:315–325
Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw F, Tuladhar AM (2020) Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry 91(4):411–417
Ji R, Schwamm LH, Pervez MA, Singhal AB (2013) Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis. JAMA Neurol 70:51–57
Saavedra M, Asociada P, Trujillo FG et al (2001) Factores de riesgo en enfermedad cerebro vascular isquémica en pacientes menores de 45 años. Rev la Fac Med 49(2):89–99
Adams H Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24(1):35. (d)
Lyden P, Brott T, Tilley B, Welch KM, Mascha EJ, Levine S et al (1994) Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group. Stroke 25(11):2220
Oliveira Filho MD, T Mullen MD. Initial assessment and management of acute stroke. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc https://www.uptodate.com (Accessed on June 02, 2019)
WF Wilson MD. Overview of established risk factors for cardiovascular disease. Post TW, ed. UpToDate. Waltham, MA:UpToDate Inc. https://www.uptodate.com(Accessed on June 17, 2019)
Harmsen P, Berglund G, Larsson O, Tibblin G, Wilhelmsen L (1979) Stroke Registration in Göteborg, Sweden, 1970–75. Acta Med Scand 206:337–344
Rasura M, Spalloni A, Ferrari M, Castro S, Patella R, Lisi F, Beccia M (2006) A case series of young stroke in Rome. Eur J Neurol 13:146–152
Ellis C (2010) Stroke in young adults. Disabil Health J 3:222–224
Patella R, Spalloni A, Ferrari M, La Starza S, Bozzao A, Rasura M (2011) Cerebral ischemia in young patients (under 45 years of age): clinical and neuroradiological follow-up. Neurol Sci 32(3):427–432
Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, Schroth G, Remonda L, Sturzenegger M, Fischer U, Baumgartner RW (2005) Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry 76:191–195
Lee T-H, Hsu W-C, Chen C-J, Chen ST (2002) Etiologic study of young ischemic stroke in Taiwan. Stroke 33:1950–1955
Jaffre A, Ruidavets JB, Nasr N, Guidolin B, Ferrieres J, Larrue V (2015) Tobacco use and cryptogenic stroke in young adults. J Stroke Cerebrovasc Dis 24:2694–2700
Bhat VM, Cole JW, Sorkin JD, Wozniak MA, Malarcher AM, Giles WH, Stern BJ, Kittner SJ (2008) Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke 39:2439–2443
Saposnik G, Del Brutto OH (2003) Stroke in South America: a systematic review of incidence, prevalence, and stroke subtypes. Stroke 34:2103–2107
Koellhoffer EC, McCullough LD (2013) The effects of estrogen in ischemic stroke. Transl Stroke Res 4:390–401
Cífková R, Krajčoviechová A (2015) Dyslipidemia and cardiovascular disease in women. Curr Cardiol Rep 17:1–10
Camerlingo M, Romorini A, Ferrante C, Valente L, Moschini L (2010 Jun) Migraine and cerebral infarction in young people. Neurol Sci 31(3):293–297
Scher AI, Launer LJ (2010) Migraine with aura increases the risk of stroke. Nat Rev Neurol 6:128–129
Laurell K, Artto V, Bendtsen L, Hagen K, Kallela M, Meyer EL, Putaala J, Tronvik E, Zwart JA, Linde M (2011 Oct) Migrainous infarction: a Nordic multicenter study. Eur J Neurol 18(10):1220–1226
Altamura C, Cascio Rizzo A, Maggio P, Viticchi G, Paolucci M, Brunelli N et al (2019) Prevalence and clinical profile of migraine with aura in a cohort of young patients with stroke: a preliminary retrospective analysis. Neurol Sci 40(S1):185–186
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Wolf ME, Hennerici MG (2013) The ASCOD phenotyping of ischemic stroke (Updated ASCO Phenotyping). Cerebrovasc Dis 36:1–5
Leys D, Bandu L, Hénon H et al (2002) Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology 59:26–33
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception, design, material preparation, and data collection. Analyses were performed by Maria Paula Aguilera Peña, Andrés Felipe Cardenas Cruz, and Elkin Garcia Cifuentes. The first draft of the manuscript was written by Maria Paula Aguilera Peña and Andrés Felipe Cardenas Cruz, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The ethics committee from Hospital Universitario San Ignacio in Bogotá, Colombia approved the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
ESM 1
(DOCX 16 kb)
Rights and permissions
About this article
Cite this article
Aguilera-Pena, M.P., Cardenas-Cruz, A.F., Baracaldo, I. et al. Ischemic stroke in young adults in Bogota, Colombia: a cross-sectional study. Neurol Sci 42, 639–645 (2021). https://doi.org/10.1007/s10072-020-04584-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-020-04584-2