Stroke in young people: Diagnosis and treatment

The article was written by MSc Vu Duy Dung - Doctor of Neurology - Department of General Internal Medicine - Vinmec Times City International Hospital

In each stroke patient, young or old, the most common approach is emergency symptomatic treatment (where possible), followed by a diagnostic procedure to identify the underlying cause and to provide secondary prevention.
Management in the acute phase – eg, intravenous thrombolysis, intra-arterial thrombectomy (up to 24 hours after symptom onset, based on imaging criteria), or both – and receive patients admitted to a specialized stroke unit, was similar for both young and elderly stroke survivors.
Intravenous thrombolysis has been shown to be safer and more beneficial in younger patients, with lower mortality and complications compared with older patients. Thrombectomy in young stroke patients appears to be less complicated than in older patients, with emerging evidence of safe stenting of an occluded extracranial internal carotid artery prior to thrombectomy in young adults with occlusion. in the proximal skull; although there is little data available.
In the event of neurological deterioration due to malignant middle cerebral artery infarction, early decompression craniotomy (within 48 h of worsening neurological outcome) should be considered, as it reduces the risk of death. mortality and improve functional outcomes.
Young people are often under-characterized in randomized controlled trials investigating the effectiveness of secondary prevention. This underproportion is unfortunate, as the prevalence of traditional vascular risk factors is increasing in young adults whose stroke represents a higher risk for stroke recurrence and death than healthy controls, especially those who had strokes due to large artery disease or embolism from the heart.

Because the guidelines are not specific to young stroke patients, recommendations for secondary prevention are extrapolated from older patients with stroke (usually atherosclerotic), to include prolonged antiplatelet therapy for most causes of stroke. The exceptions are cervical dissection, where therapy can be stopped after 6 months, and with a cardiac embolic cause, where oral anticoagulation is indicated.
Since the management of young stroke patients and elderly stroke patients is generally similar, the following analysis focuses on the diagnosis and treatment of the causes and risk factors of stroke in young people with important advances (new techniques or new therapies) (Table 1).

Table 1: Causes and risk factors of stroke (sorted by TOAST classification) in young people with clinical features, diagnosis and treatment

Note:
CeAD = cervical artery dissection
CRP = C-reactive protein
PACNS = primary vasculitis of the central nervous system
TIA = transient ischemic attack
ECG = electrocardiogram chart
PFO = foramen ovale
TEE = transesophageal echocardiogram
TTE = transthoracic echocardiography
RoPE = risk of paradoxical embolism
NNT = number needed to benefit
NNH = quantity needed to cause harm
CADASIL = autosomal dominant cerebrovascular disease with subcortical infarcts and leukoencephalopathy
HELLP = hemolysis, elevated liver enzymes, and thrombocytopenia
SLE = systemic lupus erythematosus system
ANA = antinuclear antibody
ANCA = antineutrophil cytoplasmic antibody
ESR = erythrocyte sedimentation rate
MELAS = mitochondrial encephalopathy, lactic acidosis and stroke-like episodes.

DSA cerebral angiography images of a 42-year-old female patient with multiple cerebral infarctions, multiple foci, in many different arterial areas: partial cerebral vascular stenosis of small and medium vessels, think about Cerebral vasculitis.
Digital erasure angiography (DSA) catheter aspiration for acute cerebral artery thrombosis is the optimal method. The catheter thrombectomy DSA is performed by inserting a suitable diameter catheter to the site of the thrombus, followed by negative pressure aspiration to remove the thrombus.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, a system of modern equipment and technology. The hospital provides comprehensive and professional medical examination, consultation and treatment services, with a civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests here can be completely assured of the accuracy of test results.

References source:
Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, de Leeuw FE. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol 2018; 17: 790-801.