Study on the etiology of ischemic stroke in young adults
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Author: Wang, Department of Neurology, An Zhen Hospital, Capital Medical University, Beijing. Vice chairman, China microcirculation society, neurodegenerative diseases, Specialized Committee.
Original title: "Chinese general practice" April 2015 eighteenth volume twelfth
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Stroke is one of the most serious diseases endangering human health and life in the world today, the average age of onset of stroke is declining, but so far the research on young ischemic stroke etiology screening method is still relatively small, early diagnosis and treatment is still a difficult problem for clinical, system, targeted to help check for the diagnosis of cryptogenic stroke, reduce (CS) the ratio of benefit to targeted therapy. In this paper, a systematic review of the search strategy, based on the results of the search for the causes of ischemic stroke in young people to review the status of research.
1, search strategy
Search in January 2009 -2014 year in May published literature, Chinese database including China Journal Full-text Database, Wan Fang database, the "Youth" and "stroke" and "cerebrovascular disease, cerebral thrombosis, cerebral infarction is one of the key words", "Youth" and "cryptogenic" and "cardiac" and "unexplained embolic stroke" as one of the key words; English database for PubMed, "young" and "stroke" and "cryptogenic" as one of the key words of "young" and "cardioembolism", "embolism stroke of unknown source" as one of the key words, searching for young ischemic stroke etiology screening literature, a total of Chinese 146 articles (including Meta analysis of 1 papers), 85 papers (including English guide 3, Meta analysis of 8 articles). The observational study was conducted in 100 cases with guidelines, expert consensus, randomized controlled study, and case number. The results were included in the study, and finally included in the Chinese literature in 4, the English literature of 52.
2. The definition and relationship of ischemic stroke, cardiac stroke (CES) and CS
2.1 young ischemic stroke
Cerebral ischemic stroke in young patients with ischemic stroke. At present, there is no exact definition of ischemic stroke in young people, although there are studies on the definition of ischemic stroke in young people 15~49 years old, but most studies will be limited to 18~45 years of age. It is important to note that this limitation is artificial, and there is no clear boundary between ischemic stroke and ischemic stroke in the elderly. Studies have shown that the older, the more the etiology of ischemic stroke in young people is closer to the elderly ischemic stroke, early atherosclerosis and the traditional factors associated with the more obvious. Therefore, the diagnosis and treatment of ischemic stroke in young people should pay attention to the principle of individualization.
CES is a clinical syndrome that causes cerebral embolism caused by cerebral embolism, which accounts for about 20% of all stroke patients.
CES is not a recognized diagnosis standard, published in 1993 TOAST diagnostic criteria for clinical and imaging manifestations and large artery atherosclerosis patients with multiple similarity; and a plurality of cerebral vascular supply area transient ischemic attack (TIA) or stroke or systemic embolism ECG monitoring, cardiac ultrasound evidence; or coronary angiography confirmed at least 1 cardiogenic emboli or there are at least 1 kinds of cardiac diseases. The recommendations of the European Society of Cardiology (ESC) in 2010 may be helpful in diagnosis:
(1) sudden onset of stroke symptoms, especially in the absence of a history of TIA, and this is a serious first stroke;
(2) the older patients with severe stroke [National Institute of Health Stroke Scale (NIHSS) was 10; 10 years of age or older;
(3) the distribution of different arterial areas: multiple space (both before and after the circulation of simultaneous infarction, bilateral infarction), multiple times (different ages of the infarction);
(4) other signs of systemic thromboembolism (wedge infarction of the kidney and spleen, Osler splits, Blue toe - syndrome);
(5) infarction vascular distribution is mainly cortical or subcortical large lenticulostriate artery infarction;
(6) high density imaging of middle cerebral artery () and no severe stenosis of ipsilateral internal carotid artery (CT);
(7) rapid recanalization of occluded vessels.
In addition, STAF (score for targeting of atrial fibrillation) score can help to identify CES and arterial stroke, and its specific content is as follows: the:
(1) age score of =2;
(2) NIHSS scores were more than or equal to 8 =1;
(3) left atrial enlargement was more than 35mm=2;
(4) vascular causes: =3 stenosis was not found.
The total score is 8 points, 5 points more than 90% CES.
According to the classic TOAST classification, the CS includes 3 aspects: the complete evaluation is not accepted; the person who has failed to find the cause of the disease has been evaluated; and it is found that there are 2 or more possible causes, but it is impossible to determine which one is the actual cause (TMC). In 2009, Timsit clearly defined the CS as an active investigation, and there is still a lack of stroke which can explain the cause of the stroke, and the CS, TMC, and the complete evaluation of the general cause of stroke is unknown. According to this definition, CS accounts for 15.0%~42.5% of all cerebral infarction.
Embolic stroke (ESUS) is a special kind of CS, and its diagnostic criteria are as follows: non lacunar cerebral infarction, stenosis of proximal stenosis, 50%, no major cardiac embolism. Embolization of ESUS patients may come from the heart, which may require antithrombotic therapy or new anticoagulants.
It should be noted that CS is an unstable definition, with the development of imaging technology, biochemistry and molecular biology