The correlations between the etiology or risk factors of cerebral infarction in young patients and the severity

FU Lian-qun; WANG Xiao-li; MIN Lian-qiu; LI Fang

Abstract：Objective To investigate the risk factors and etiology of ischemic stroke in young adults , and to de-termine the correlation between the baseline NIHSS score and the risk factors or etiologies .Methods This retrospective study reviewed the hospital records of all adults aged between 18 and 45 years with ischemic strokes admitted to tertiary hospital in North China from 2006 to 2013 (n =1 395).Clinical evaluation consisted of a complete neurologic examination and the NIHSS score.Diagnostic workup consisted of medical history , extensive laboratory, radiologic, and cardiologic ex-aminations.Stroke etiologies were classified according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST). Those with more than two hospitalized courses for acute cerebral infarction were considered as recurrent inpatients . Spearman rank correlation analysis was used to evaluate potential associations between the baseline NIHSS score and risk factors as well as etiologies.Logistic regression analysis was used to identify predictors of stroke recurrence .Results A total of 1 395 consecutive inpatients aged 18 to 45 years with ischemic stroke.The mean age was (38.50 ±6.318) years, with 79.1% were male.There were high incidences of hypertension (44.4%), familial history of stroke, hypertension or diabetes (39.2%), dyslipidemia (16.8%), diabetes mellitus (13.8%), smoking (47.1%) and alcohol (41.6%), which were more prevalent in males .Valvular heart disease, atrial fibrillation and migraine were more observed in fe -males.According to TOAST classification, 42.7% of patients with large artery atherothrombosis stroke , cardioembolic stroke, small artery occlusion strike and other etiologies were accounted for 42.7%, 6.5%, 16.1%, 5.1%, 12.1% and 14.6% of cases, respectively.According to NIHSS scores, the percentage of severity of diseases for mild , moderate and severe levels were 76.4%, 21.0% and 1.6%, respectively.1.0% of patients with missing data.(5)There was no signif-icant correlation between the baseline NIHSS score and hypertension (P =0.869), diabetes (P =0.208) or TOAST (P =0.955).Predictor of stroke recurrence was atrial fibrillation (OR =3.842, 95%CI =1.039 ~14.203, P =0.044). Conclusion Ischemic stroke in young adults is more common in males , traditional vascular risk factors are also very com -mon in them.The major etiologies are large artery atherothrombosis , small artery occlusion, multiple potential causes and cardioembolic stroke.The majority of the baseline NIHSS scores are in mild level , which have no significant correlation with hypertension, diabetes or TOAST.Prevention of stroke recurrence should focus on cardioembolic stroke screening .