A study of clinical, aetiological and radiological profile of ischemic stroke in young adults at a tertiary care centre

Abstract

Introduction: Stroke is one of the most important causes of high morbidity and mortality worldwide. Globally stroke is the third most important cause of mortality and the fourth leading cause of disease burden. Stroke in the younger age group adds to the social burden, these patients merit special attention in diagnostic, therapeutic, and preventive care. Stroke was defined by World Health Organization criteria as rapidly developing clinical signs of focal, at times, global disturbance of cerebral function lasting for more than 24 h or leading to death with no apparent cause other than vascular origin. The incidence of stroke under 45 year of age ranges from 7 to 15 in 1,00,000 people per year for all types of strokes.
Aim: To study the clinical, radiological and etiological profile of stroke in young patients.
Material And Method: It is a Prospective Observational study conducted in Dr D.Y Patil Medical College Hospital and Research Centre, Pimpri, Pune from February 2021 to february2023. Total 50 cases of ischemic arterial stroke between 15-45 years of age meeting inclusion criteria were included in the study.
Results: Stroke is more common in males than females, in our study ratio was 1.27:1, out of 50 patients studied, the most common presenting feature of stroke was motor weakness (66%), followed by headache (28%), followed by cognitive impairment and seizure. In only 5 (10%) cases no obvious risk factors were identified. The most common well-documented risk factor was dyslipidaemia, followed by hyperhomocystenemia, hypertension, diabetes, smoking and obesity. Brain imaging revealed one or more ischemic lesions correlating with current symptoms in 47 (94%) patients. Anterior circulation infarcts were more common among>30year old patients, whereas posterior territory infarcts in those <30, the latter being mostly attributable to cerebellar lesions. On evaluating the etiological factors according to TOAST classification, we found that 36% of patient (18/50) had other determined aetiology ,14% of the patients (7/50) had cardioembolic stroke, followed by atherosclerotic occlusive disease in 12% (6/50). The cause of the infarct was small vessel disease in 4 cases (8%), multiple possible aetiology in 4% (2/50). The aetiology was undetermined in 13 cases (26%). Other determined aetiology accounted for most common aetiology included 2 cases of cervical or intra cranial artery dissection, 6 cases of primary angiitis of cns,2 cases of APLA syndrome,2 cases of SLE,1 case of active malignancy,1 case of protein s deficiency ,1 case of CADASIL,1 case of Moya Moya syndrome, 3 case of post infectious stroke.
Conclusion: The most common risk factor for stoke in young was dyslipidaemia followed by hyperhomocystenemia. Other determined aetiology is the most common cause of ischemic stroke in our study followed by cardioembolic stroke and large vessel atherosclerosis.