Transcript Dr. Ojeda Adriana; Nallino, Ma. Belén; Uriarte,Ana Maria; Santa Cruz,...

Dr. Ojeda Adriana; Nallino, Ma. Belén; Uriarte,Ana Maria; Santa Cruz, Daniela.
STROKE is a leading cause of death and disability
in developed countries.
Ischemic stroke in young adults ( 15-45 ys) is an
unexpected event .
Etiological spectrum is varied and differs significantly from
the underlying causes in older patients.
To highlight the increasing role of neuroimaging in
the diagnosis, prognosis and treatment in young
stroke patients.
The most frequent causes of ischemic stroke are
considered and the corresponding images are
described.
30 patients (mean age 35 ys.) with Acute Ischemic
Stroke diagnosis were retrospectively included and
analized at our institution over one year period.
Neurovascular imaging
•MSCT 8 - 64 channels: Unenhanced CT, CTA, CT PERFUSION
•MRI 1.5 T: Conventional MRI, MRA, DWI, PWI
CLINICAL DATA-RISK FACTORS-CARDIOVASCULAR EXAMS-LAB TEST
.
women
50%
MEAN AGE= 35 years old
AGE
men
50%
50
45
40
35
30
25
20
15
10
5
0
1
3
5
7
9
11
13
15
17
PATIENTS
19
21
23
25
27
29
10%
27%
14%
dissection
miscellaneous
atherosclerosis
unexplained
cardioembolism
7%
43%
DISSECTION:
ATHEROSCLEROSIS:
5 Vertebral A
1 Basilar A
2 Carotid A
 Dislipidemy
 Hipertension + smoking
MISCELLANEOUS:
 2 P.F.O.
 1 Atrial Septal Aneurysm
3
2
2
2
1
1
1
Migrainous infarction
moya-moya
cerebral venous thrombosis
systemic vasculitis
SLE
Antiphospholipid syndrome
vasoespasm secondary
CARDIOEMBOLISM:
UNDETERMINED:
3 Complete evaluation
1 Incomplete
COMPLETE WORK-UP INCLUDES
•
•
•
•
•
CT or MRI scanning, CTA or MRA.
Echocardiography
Routine and Specific Lab Test
Risk Factors analysis
Drug abuse report
Healthy 40 year-old. female patient referring acute headache, neck
pain, dizziness and vomits
LEFT VERTEBRAL
DISSECTION
45 year-old male patient with severe trauma history due to a car accident
15 days before showing sudden onset aphasy
INTIMAL FLAP
DOUBLE LUMEN
CAROTID
DISSECTION
24 year-old female patient with language and speech disorder (aphasia)
ANTIPHOSPHOLIPID
SYNDROME
30 year-old male patient with drop attack, vomits and stupor during a migraine
episode.
MIGRAINOUS
INFARCTION
45 year old female patient with right hemiparesis and aphasia. Unenhanced CT
normal
CRYPTOGENIC STROKE
The etiologic spectrum is quite broad, thus the investigation
represents a challenging diagnosis.
Atherosclerotic arteriopathy was a rare cause of stroke.
Artery dissection was the most frequent cause identified in our
series, as has already been reported in the medical literature.
Underterminaded cause represented a minor percentage
compared to other studies.
In our study the sample is relatively small and show selection
bias.
Our results emphasize the importance of a standardized
protocol and a comprehensive evaluation of stroke in young
patients.
To carry out multicentrical randomized studies to assay the
stroke incidence in Argentinean young people.
The aims of NEUROIMAGING in the study of young stroke
patients are:
 to confirm the ischemic nature of the lesion
 to determine its location
 to verify the patency of major neck and intracranial arteries
MRI and MSCT offer great sensitivity and specificity
BIBLIOGRAFÍA
o
Heather Bevan, MD, Khema Sharma, MD, and Walter Bradley, MD. Stroke in young adults. Stroke 1990; 21:382386.
o
Jose Ibiapina Siqueira MD, PhD; Santos Antonio Carlos MD; Fabio, Soraria Ramos Cabete MD, Sakamoto,
Americo C. MD, PhD. Cerebral infarction in patients aged 15 to 40 years, Stroke 1996; 26:2016-2019
o
Kristensen, Bo MD; Malm, Jan PhD; Carlberg, Bo PhD; Stegmayr, Birgitta PhD. Epidemiology and Etiology of
Ischemic Stroke in Young Adults Aged 18 to 44 Years in Northern Sweden. Stroke 1997; 28:1702-1709.
o
J.F. Varona, J.M Guerra, F. Bermejo, J.A. Molina, A. Gomez. Causes of ischemic Stroke in Young Adults, and
Evolution of the Etiological Diagnosis over the Long Term. European Neurology 2007; 57:210-218.
o
Fahmi Yousef Khan, risk factors of young ischemic stroke in Qatar, Clinical Neurology and Neurosurgey 2007;
109:770-773.
o
Michael T.Y. Chan, Zurab G. Nadareishvili, John W. Norris. Diagnostic Strategies in Young Patients with
Ischemic Stroke in Canada. Can. J. Neurol. Sci. 2000; 27:120-124.
o
Tali Jonas Kimchi, MD, Ronit Agid, MD, Seon-Kyu Lee, MD, Karel G. Ter Brugge, MD. Arterial Ischemic Stroke in
Children. Neuroimag. Clin. N. Am. 2007; 17:175-187.
o
Ashok Srinivasan, MD, Moyank Goyal, MD, Faisal Al Azri, MD, Cheemun Lum, MD. State-of-the-Art Imaging of
Acute Stroke. Radiographics 2006; 26: S75-S95.
o
C. Uggetti. Stroke in young people:imaging. Neurol. Sci. 2003; 24:S15-S16.
o
Christine M. Flis, H. Rolf Jâger, Paul S. Sidhu. Carotid and vertebral dissections: clinical aspects, imaging
features and endovascular treatment. Eur. Radiol. 2007; 17: 820-834.
o
Mathieu H. Rodallec, MD, Veronique Marteau, MD, Sophie Gerber, MD, Loîc Desmonttes, MD, Marc Zins, MD.
Craniocervical Arterial Dissection : Spectrum of Imaging Findings and Differential Diagnosis. Radiographics
2008; 28: 1711-1728.
o
A.T. Vertinsky, N.E. Schwartz, N.J. Fischbein, J. Rosenberg, G.W. Albers, G. Zaharchuk. Comparison of
Multidetector CT Angiography and MR Imaging of Cervical Artery Dissection. AJNR 2008; 29: 1753-60.
o
Marie-Germaine Bousser, KMichael A Welch. Relation between migraine and stroke. Lancet Neurol 2005; 4:53342.
o
Kurth T, Gaziano JM, Cook NR et al. Migraine and risk of cardiovascular disease in women. JAMA 2006; 296
Rosario
Argentina