ABSTRACT
Up to 15% of all strokes affect young patients and the incidence of ischemic stroke in this population is rising. Nevertheless, there is limited information of cerebrovascular events in this population both in our country and in Latin America. The aim of our study was to evaluate the clinical characteristics and risk factors of young adults with stroke in Argentina. This is a prospective, multicenter study of stroke in young adults (18 - 55 years) in Argentina. Patients presenting with a cerebrovascular event within 180 days were included. Stroke subtypes were classified according to TOAST criteria. A total number of 311 patients were enrolled (men 53.9%, mean age: 43.3 years). Ischemic strokes occurred in 91.8% (brain infarcts 82.6%, transient ischemic attack 9.2%) and hemorrhagic strokes in 8.2%. The most frequent vascular risk factors (including ischemic and hemorrhagic strokes) were: hypertension 120 (41%), smoking 92 (31.4%), dyslipidemia 81 (27.6%) and, overweight/obesity: 74 (25.3%). Stroke subtypes were: large artery disease 12.3%, cardioembolism 7.5%, small artery occlusion 11.5%, other defined etiology 27.1%, and undetermined etiology 41.6%. Our study demonstrates that vascular risk factors are very frequent in young adults with stroke. Our findings underline that urgent strategies are required for primary and secondary stroke prevention in this group of patients.
Aproximadamente un 15% de todos los ataques cerebrovasculares afectan a pacientes jóvenes y su incidencia estaría en aumento. Existe escasa información sobre el ataque cerebral en esta población tanto en nuestro país como en Latinoamérica. El objetivo de nuestro estudio fue evaluar las características clínicas y los factores de riesgo de los adultos jóvenes con ictus en Argentina. Realizamos un estudio prospectivo y multicéntrico en adultos jóvenes (18-55 años) en Argentina, que presentaron un evento cerebrovascular dentro de los 180 días previos. Los subtipos de ictus se clasificaron según los criterios de TOAST. Se incluyeron un total de 311 pacientes (hombres 53.9%, edad media: 43,3 años). Los ataques cerebrovasculares isquémicos ocurrieron en el 91.8% (infartos cerebrales 82.6%, ataque isquémico transitorio 9.2%) y los eventos hemorrágicos correspondieron al 8.2%. Los factores de riesgo vascular más frecuentes (incluyendo los eventos isquémicos y hemorrágicos) fueron: hipertensión 120 (41%), tabaquismo 92 (31.4%), dislipidemia 81 (27.6%) y sobrepeso/obesidad: 74 (25.3%). Los subtipos de ictus isquémicos fueron: arteriopatía de gran vaso 12.3%, cardioembolismo 7.5%, oclusión de pequeña arteria 11.5%, otra etiología definida 27.1% y etiología indeterminada 41.6%. Los factores de riesgo vascular son muy frecuentes en los adultos jóvenes con ictus. Nuestros hallazgos subrayan que se requieren estrategias urgentes para la prevención primaria y secundaria del ictus en este grupo particular de pacientes en nuestro país.
Subject(s)
Brain Ischemia , Hypertension , Ischemic Attack, Transient , Stroke , Adult , Argentina/epidemiology , Brain Ischemia/epidemiology , Brain Ischemia/etiology , Humans , Hypertension/complications , Hypertension/epidemiology , Male , Prospective Studies , Risk Factors , Stroke/epidemiology , Stroke/etiology , Young AdultABSTRACT
Abstract Up to 15% of all strokes affect young patients and the incidence of ischemic stroke in this population is rising. Nevertheless, there is limited information of cerebrovascular events in this population both in our country and in Latin America. The aim of our study was to evaluate the clinical characteristics and risk factors of young adults with stroke in Argentina. This is a prospective, multicenter study of stroke in young adults (18 - 55 years) in Argentina. Patients presenting with a cerebrovascular event within 180 days were included. Stroke subtypes were classified according to TOAST criteria. A total number of 311 patients were enrolled (men 53.9%, mean age: 43.3 years). Ischemic strokes occurred in 91.8% (brain infarcts 82.6%, transient ischemic attack 9.2%) and hemorrhagic strokes in 8.2%. The most frequent vascular risk factors (including ischemic and hemorrhagic strokes) were: hypertension 120 (41%), smoking 92 (31.4%), dyslipidemia 81 (27.6%) and, over weight/obesity: 74 (25.3%). Stroke subtypes were: large artery disease 12.3%, cardioembolism 7.5, small artery occlusion 11.5%, other defined etiology 27.1%, and undetermined etiology 41.6%. Our study demonstrates that vascular risk factors are very frequent in young adults with stroke. Our findings underline that urgent strategies are required for primary and secondary stroke prevention in this group of patients.
Resumen Aproximadamente un 15% de todos los ataques cerebrovasculares afectan a pacientes jóvenes y su incidencia estaría en aumento. Existe escasa información sobre el ataque cerebral en esta población tanto en nuestro país como en Latinoamérica. El objetivo de nuestro estudio fue evaluar las características clínicas y los factores de riesgo de los adultos jóvenes con ictus en Argentina. Realizamos un estudio prospectivo y multicéntrico en adultos jóvenes (18-55 años) en Argentina, que presentaron un evento cerebrovascular dentro de los 180 días previos. Los subtipos de ictus se clasificaron según los criterios de TOAST. Se incluyeron un total de 311 pacientes (hombres 53.9%, edad media: 43,3 años). Los ataques cerebrovasculares isquémicos ocurrieron en el 91.8% (infartos cerebrales 82.6%, ataque isquémico transitorio 9.2%) y los eventos hemorrágicos correspondieron al 8.2%. Los factores de riesgo vascular más frecuentes (incluyendo los eventos isquémicos y hemorrágicos) fueron: hipertensión 120 (41%), tabaquismo 92 (31.4%), dislipidemia 81 (27.6%) y sobrepeso/obesidad: 74 (25.3%). Los subtipos de ictus isquémicos fueron: arteriopatía de gran vaso 12.3%, cardioembolismo 7.5%, oclusión de pequeña arteria 11.5%, otra etiología definida 27.1% y etiología indeterminada 41.6%. Los factores de riesgo vascular son muy frecuentes en los adultos jóvenes con ictus. Nuestros hallazgos subrayan que se requieren estrategias urgentes para la prevención primaria y secundaria del ictus en este grupo particular de pacientes en nuestro país.
Subject(s)
Humans , Male , Adult , Young Adult , Brain Ischemia/etiology , Brain Ischemia/epidemiology , Ischemic Attack, Transient , Stroke/epidemiology , Hypertension/complications , Hypertension/epidemiology , Argentina/epidemiology , Prospective Studies , Risk Factors , Stroke/etiologyABSTRACT
Misdiagnosis is a challenging risk in young patients with ischemic stroke that leads to delayed recognition, prevents thrombolytic therapy and increases morbidity and mortality. To assess the frequency and reasons for misdiagnosis of ischemic stroke in young adults in the emergency department, we retrospectively evaluated 101 consecutive patients. The diagnosis required both the presence of an ischemic lesion in diffusion-weighted MRI as well as neurological symptoms. Twenty-three individuals were misdiagnosed (15 females, mean age 43 years [range 26-55 years]). The most common diagnostic errors included headache/neck pain n = 11 (48%) and peripheral vertigo n = 4 (17.3%), and the most common missed etiology was arterial dissection (AD) n = 15 (65.2%). The initial diagnosis was made by emergency physicians in 22 persons. The group with misdiagnosis had a significantly higher frequency of AD at 15 vs. 8 (p < 0.01), posterior territory involvement at 12 vs. 6 (p < 0.01), and female predominance. Misdiagnosis occurred in a third of young patients with an ischemic stroke and was more frequent in those with arterial dissection involving the posterior circulation and presenting with non-specific symptoms.
El error diagnóstico es una situación riesgosa en pacientes jóvenes con infarto cerebral, ya que conduce a demora en el reconocimiento, previene la administración de terapia trombolítica e incrementa la morbimortalidad. Para valorar la frecuencia y las razones de errores en esta población, evaluamos retrospectivamente 101 pacientes consecutivos. El diagnóstico de infarto cerebral requirió tanto la presencia de lesión isquémica aguda en resonancia magnética como también la presencia de síntomas neurológicos. Veintitrés pacientes fueron mal diagnosticados (15 mujeres, edad media 43 años, [rango 26-55 años]). El error más frecuente incluyó cefalea/cervicalgia n = 11 (48%) y vértigo periférico n = 4 (17.3%). La etiología menos sospechada fue disección arterial n = 15 (62.2%). La evaluación inicial en 22 pacientes fue realizada por emergentólogos. El grupo con errores tuvo significativamente mayor frecuencia de disección arterial 15 vs. 8 (p < 0.01), afectación del territorio posterior 12 vs. 6 (p < 0.01) y sexo femenino. En conclusión, los errores diagnósticos ocurrieron en un tercio de los pacientes jóvenes con infarto cerebral, y fueron más frecuentes en aquellos con disección arterial, compromiso del territorio posterior y síntomas de presentación inespecífica.
Subject(s)
Brain Ischemia/diagnosis , Diagnostic Errors/statistics & numerical data , Stroke/diagnosis , Adult , Age Factors , Argentina/epidemiology , Brain Ischemia/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Statistics, Nonparametric , Stroke/epidemiologyABSTRACT
Misdiagnosis is a challenging risk in young patients with ischemic stroke that leads to delayed recognition, prevents thrombolytic therapy and increases morbidity and mortality. To assess the frequency and reasons for misdiagnosis of ischemic stroke in young adults in the emergency department, we retrospectively evaluated 101 consecutive patients. The diagnosis required both the presence of an ischemic lesion in diffusion-weighted MRI as well as neurological symptoms. Twenty-three individuals were misdiagnosed (15 females, mean age 43 years [range 26-55 years]). The most common diagnostic errors included headache/ neck pain n = 11 (48%) and peripheral vertigo n = 4 (17.3%), and the most common missed etiology was arterial dissection (AD) n = 15 (65.2%). The initial diagnosis was made by emergency physicians in 22 persons. The group with misdiagnosis had a significantly higher frequency of AD at 15 vs. 8 (p < 0.01), posterior territory involvement at 12 vs. 6 (p < 0.01), and female predominance. Misdiagnosis occurred in a third of young patients with an ischemic stroke and was more frequent in those with arterial dissection involving the posterior circulation and presenting with non-specific symptoms.
El error diagnóstico es una situación riesgosa en pacientes jóvenes con infarto cerebral, ya que conduce a demora en el reconocimiento, previene la administración de terapia trombolítica e incrementa la morbimortalidad. Para valorar la frecuencia y las razones de errores en esta población, evaluamos retrospectivamente 101 pacientes consecutivos. El diagnóstico de infarto cerebral requirió tanto la presencia de lesión isquémica aguda en resonancia magnética como también la presencia de síntomas neurológicos. Veintitrés pacientes fueron mal diagnosticados (15 mujeres, edad media 43 años, [rango 26-55 años]). El error más frecuente incluyó cefalea/cervicalgia n = 11 (48%) y vértigo periférico n = 4 (17.3%). La etiología menos sospechada fue disección arterial n = 15 (62.2%). La evaluación inicial en 22 pacientes fue realizada por emergentólogos. El grupo con errores tuvo significativamente mayor frecuencia de disección arterial 15 vs. 8 (p < 0.01), afectación del territorio posterior 12 vs. 6 (p < 0.01) y sexo femenino. En conclusión, los errores diagnósticos ocurrieron en un tercio de los pacientes jóvenes con infarto cerebral, y fueron más frecuentes en aquellos con disección arterial, compromiso del territorio posterior y síntomas de presentación inespecífica.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Brain Ischemia/diagnosis , Stroke/diagnosis , Diagnostic Errors/statistics & numerical data , Argentina/epidemiology , Severity of Illness Index , Brain Ischemia/epidemiology , Retrospective Studies , Risk Factors , Age Factors , Statistics, Nonparametric , Risk Assessment , Stroke/epidemiologyABSTRACT
BACKGROUND: Fabry disease (FD) is an underdiagnosed cause of stroke in young adults, but the frequency of this association is largely unknown. We estimated the prevalence of FD in a nationwide cohort of young adults who had stroke and transient ischemic attack (TIA) in Argentina. METHODS: This was a prospective, multicenter study of stroke and FD in young adults (18-55 years) conducted in Argentina between 2011 and 2015. Patients were enrolled if they had had a TIA or an ischemic or hemorrhagic stroke within the previous 180 days. FD was diagnosed by measuring α-galactosidase A activity (males) and through genetic studies (females). RESULTS: We enrolled 311 patients (54% men, mean age: 41 years). Ischemic events occurred in 89% of patients (80% infarcts, 9% TIA) and hemorrhagic strokes in 11%. One female (.3% of the total group, 1% of the cryptogenic ischemic strokes) had the pathogenic mutation c.888G>A/p.Met296Ile /Exon 6 on the GAL gene. Her only other manifestation of FD was angiokeratoma. Eighteen females had nonpathogenic intronic variations: c.-10C>T, c.-12G>A, or both. Two patients had the nonpathogenic mutation D313Y, while a third had the likely benign mutation S126G. CONCLUSIONS: FD was identified in 1 patient (.3%) in this first Latin American study. The patient presented with a late-onset oligo-symptomatic form of the disease. A large number of nonpathogenic mutations were present in our cohort, and it is essential that they not be mistaken for pathogenic mutations to avoid unnecessary enzyme replacement treatment.