Yoonkyung Chang; Tae-Jin Song; Young-Jae Kim; Ji Hoe Heo; Kyung-Yul Lee; Young Eun Kim; Min Uk Jang; Soo-Jin Cho; Suk Yun Kang

doi:10.12771/emj.2017.40.3.128

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Chang, Song, Kim, Heo, Lee, Kim, Jang, Cho, and Kang: Characteristics for Ischemic Stroke in 18–30 Years Old Patients, Multicenter Stroke Registry Study

Orginal Article

Ewha Med J 2017;40(3):128-135.

Published online: 28 July 2017

DOI: https://doi.org/10.12771/emj.2017.40.3.128

Characteristics for Ischemic Stroke in 18–30 Years Old Patients, Multicenter Stroke Registry Study

Yoonkyung Chang, Tae-Jin Song, Young-Jae Kim, Ji Hoe Heo¹, Kyung-Yul Lee¹, Young Eun Kim², Min Uk Jang³, Soo-Jin Cho³, Suk Yun Kang³

Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea

¹Departments of Neurology, Yonsei University College of Medicine, Seoul, Korea

²Department of Neurology, Hallym University College of Medicine, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

³3Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea

Corresponding author Suk Yun Kang Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong 18450, Korea Tel: 82-31-8086-2310, Fax: 82-31-8086-2317 E-mail: sukyunkang@hanmail.net

Received 15 January 2017 Revised 20 April 2017 Accepted 26 April 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry.

Methods

We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke.

Results

The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3).

Conclusion

In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.

Keywords: Young age stroke, Cerebral infarction, Carotid artery, internal, dissection, Vertebral artery dissection, Undetermined negative etiology, Prognosis

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Fig. 1.

Stroke subtype comparison for very young age (18–30 years old) with young age (31–44 years old) or above young age (≥45 years old). Values are presented as number (%). The stroke of other determined etiology and undetermined negative evaluation stroke subtype were more frequently noted in 18–30 years old patients than those of 31–44 years old and ≥45 years old. The frequency of large artery atherosclerosis and small vessel occlusion subtypes was increased in elderly groups (31–44 years old and ≥45 years old groups; P=0.001).

Table 1.

Demographic and clinical data of included patients

Variable		mRS<3 (n=95)	mRS≥3 (n=27)	Total (N=122)	P-value
Male sex		61 (64.2)	15 (55.6)	76 (62.3)	0.413
Age (yr)		25.1±3.8	24.8±3.3	25.1±3.7	0.646
Risk factor
	Hypertension	12 (12.6)	3 (11.1)	15 (12.3)	0.832
	Diabetes mellitus	1 (1.1)	0	1 (0.8)	0.592
	Dyslipidemia	8 (8.4)	0	8 (6.6)	0.119
	Smoking	45 (47.4)	9 (33.3)	54 (44.3)	0.195
	Regular alcohol intake	23 (24.2)	7 (25.9)	30 (24.6)	0.855
	Recent alcohol intake	8 (8.4)	0	8 (6.6)	0.126
	Atrial fibrillation	2 (2.1)	5 (18.5)	7 (5.7)	0.001
Occupation situation					0.140
	Without routine job	13 (13.7)	7 (25.9)	20 (16.4)
	White collar	37 (38.9)	4 (18.9)	41 (33.6)
	Soldier	22 (23.2)	6 (22.2)	28 (23.0)
	Student	20 (21.1)	9 (33.3)	29 (23.8)
	Blue collar	3 (3.2)	1 (3.7)	4 (3.3)
Activity at stroke occurrence					0.183
	Resting	68 (71.6)	23 (85.2)	91 (74.6)
	Vigour activity	17 (17.9)	1 (3.7)	18 (14.8)
	Wake-up stroke	10 (10.5)	3 (11.1)	13 (10.7)
Stroke classification					0.028
	Large artery atherosclerosis	8 (8.4)	2 (7.5)	10 (8.3)
	Small vessel occlusion	7 (7.4)	0	7 (5.7)
	Cardioembolism	18 (18.9)	13 (48.1)	31 (25.4)
	Other determined etiology	30 (31.6)	7 (25.9)	37 (30.3)
	Undetermined negative	32 (33.7)	5 (18.5)	37 (30.3)
NIHSS		3 (1–5)	12 (9–14)	4 (2–8)	0.001

Values are presented as mean±standard deviation, number (%), or median (interquartile range).

mRS, modified Rankin scale at 3 months after index stroke; NIHSS, National Institute of Health Stroke Scale.

Table 2.

Causes for other determined etiology

Variable	Causes for other determined etiology (n=37)
Arterial dissection	21 (56.8)
Extracranial internal carotid artery	8 (21.6)
Intracranial internal carotid artery^*	1 (2.7)
Extracranial vertebral artery	6 (16.2)
Intracranial vertebral artery	3 (8.1)
Middle cerebral artery	3 (8.1)
Vasculitis meningitis	4 (10.8)
Moyamoya diseases	4 (10.8)
Takayasu’s diseases	3 (8.1)
Systemic lupus erythematosus	3 (8.1)
Sneddon’s syndrome	1 (2.7)
Familial protein C, S deficiency	1 (2.7)

Values are presented as number (%).

^* One patient had both right intracranial internal carotid artery and middle cerebral artery dissection.

Table 3.

Independent factors for poor functional outcome at 3 months (mRS≥3)

Variable	Adjusted OR (95% confidence interval)	P-value
Male sex	1.41 (0.56–3.54)	0.455
Age (yr)	0.96 (0.84–1.09)	0.564
NIHSS	2.94 (1.61–5.37)	0.001
Stroke subtype
Large artery atherosclerosis	1.53 (0.23–9.91)	0.652
Small vessel occlusion	No case
Cardioembolism	4.68 (1.42–15.48)	0.011
Other determined etiology	1.37 (0.38–4.86)	0.626
Undetermined negative	Reference

mRS, modified Rankin scale; OR, odds ratio; NIHSS, National Institute of Health Stroke Scale.

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