Etiopathogenesis and prognosis of cerebral ischemia in young adults. A survey of 155 treated patients

Acta Neurol Scand. 1991 Oct;84(4):321-5. doi: 10.1111/j.1600-0404.1991.tb04962.x.

Abstract

Etiology and long-term prognosis were prospectively investigated in 155 consecutive patients (96 men and 59 women), aged 16 to 45 years, referred to our Neurosurgical Unit with cerebral transient ischemic attacks or infarction during the period 1978-1988. All patients underwent neurological and medical-cardiological evaluation, cerebral computerized tomography scanning, electrocardiogram, and laboratory tests. Two-dimensional echocardiography was performed in 123 cases (79%), cerebral angiography in 147 (95%). Atherosclerosis was the leading etiology occurring in 48 patients (31%). A cardioembolic disorder was considered the probable cause of ischemia in 8 cases (5.1%). Further possible etiologies were contraceptive pill assumption (5.8% of the total, but 15.3% within the female group), spontaneous arterial dissection (4.5%), migraine (4%), puerperium (2.6%), cervical trauma (2.6%), and other, more uncommon conditions. Despite extensive evaluation, the cause of cerebral ischemia remained unknown in 40% of cases. All patients received antiplatelet medication and 16 underwent surgery. The long-term outcome at a mean follow-up of 5.8 years was favorable: 91% of subjects resumed their work on a full or part-time basis.

PIP: Etiology and longterm prognosis were prospectively investigated in 155 consecutive patients (96 men, 50 women) ages 16-45 years who were referred to the Neurosurgical Unit with cerebral transient ischemic attacks or infarction during the period 1978-88. All patients underwent neurological and medical-cardiological evaluation, cerebral computerized tomography scanning, electrocardiogram, and laboratory tests. 2-dimensional echocardiography was performed in 123 cases (79%), cerebral angiography in 147 (95%). Atherosclerosis was the leading etiology, occurring in 48 patients (31%). A cardioembolic disorder was considered the probable cause of ischemia in 8 cases (5.1%). Further possible etiologies were though to be: oral contraceptives (5.8% of the total, but 15.3% within the females), spontaneous arterial dissection (4.5%), migraine (4%), puerperium (2.6%), cervical trauma (2.6%), and other, more uncommon conditions. Despite extensive evaluation, the cause of cerebral ischemia remained unknown in 40% of the cases. All patients received antiplatelet medication and 16 underwent surgery. The longterm outcome at a mean followup of 5.8 years was favorable in that 91% of the subjects resumed their workload on a full or parttime basis.

MeSH terms

  • Adolescent
  • Adult
  • Arteriosclerosis / complications
  • Brain Ischemia / etiology*
  • Brain Ischemia / therapy
  • Carotid Artery Diseases / complications
  • Cerebral Infarction / etiology
  • Cerebral Infarction / therapy
  • Contraceptives, Oral / adverse effects
  • Female
  • Follow-Up Studies
  • Heart Diseases / complications
  • Humans
  • Ischemic Attack, Transient / etiology
  • Ischemic Attack, Transient / therapy
  • Male
  • Middle Aged
  • Migraine Disorders / complications
  • Neurologic Examination
  • Puerperal Disorders / etiology
  • Puerperal Disorders / therapy
  • Risk Factors

Substances

  • Contraceptives, Oral