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  • Title: Occlusive cerebrovascular disease in young adults.
    Author: Klein GM, Seland TP.
    Journal: Can J Neurol Sci; 1984 May; 11(2):302-4. PubMed ID: 6733611.
    Abstract:
    This retrospective study documents the experience of two large Canadian teaching hospitals with occlusive cerebrovascular disease in young adults. Chart review disclosed 76 patients aged 15-40 years during a recent six year period. An apparent cause, or significant coincident risk factors were found in 51 patients (67%). The most prevalent recognized causes were atherosclerosis, emboli from cardiac sources or intracranial aneurysms, and complicated migraine. Pregnancies or use of oral contraceptives were apparent coincident risk factors. The charts of patients between the ages of 15-40 years admitted to the Foothills or Calgary General Hospitals in Alberta, Canada between January 1, 1976 and December 31, 1981 and discharged with a diagnosis of reversible ischemic neurological deficits (RIND) or transient ischemic attacks (TIA) were reviewed. A basic work-up was done in almost every instance. 76 patients ranging in age from 16 to 40 years were identified -- 30 male and 46 female. 12 patients (16%) had angiographic evidence of atherosclerosis at a site appropriate to their symptoms, and atheroslerosis was therefore assumed to be the cause of the occlusive cerebrovascular event. 11 (14.5%) were believed to have cardiac sources for emboli and 4 (5%) were thought to have emoblized from intracranial aneurysms. 6 (8%) had a stroke or RIND associated with complicated migraine. 12 patients were pregnant or taking oral contraceptives (OCs) at the time of their illness and in 7 (15% of the female group) this was apparently the only significant coincident risk factor. 11 (14.5%) had other causes for their ischemic episodes, and in 25 instances (33%) no cause was identified. 56 patients (73.5%) had a cranial tomography (CT) scan, 55 (72.5%) had cerebral angiography, and 44 (58%) underwent echocardiography. Only 23 (30%) had all 3 tests. Of 12 patients with atherosclerosis, 7 were male and 5 female. These persons tended to be at the upper end of the age range for the study with a mean age of 36 years. Almost all had 1 or more risk factors for atherosclerosis, such as hypertension, diabetes mellitus, hyperlipidemia, obesity, or smoking. 11 patients had an identified cardiac source for an embolous. 55 patients (72.5%) in this series had cerebral angiograms and 4 of these demonstrated intracranial aneurysms. In 7 females with no direct discernible cause for an ischemic event, 6 were using OCs and 1 was pregnant. A variety of other causes were detected in 11 patients. A total of 25 individuals had no cause identified for their illness. Occlusive cerebrovascular disease is not uncommon in young adults. OCs are seldom implicated, and a high yield of identifiable treatable lesions justifies extending conventional screening investigations to include echocardiography and cerebral angiography.
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