Retrospective analysis of demographic, clinical and radiological characteristics of young ischemic and hemorhagic stroke patients and their relation to prognosis

Introduction and Aims: Although stroke is considered as an advanced age disease, it can be seen in children and adolescents. The incidence of stroke is 11/100000 between ages 15-44. In this study, it was aimed to learn etiological reasons, risk factors and effect on prognosis of young stroke by investigating results of data belong to patients between the age of 17-45, and comparing them with the other related studies in the world. Furthermore, it was intended to contribute creating the strategies to prevent risk factors, to provide the information for the community, and to shed light the other studies conducted in Turkey. Materials and Methods:The clinical features, etiologic factors and the relationship between arterial areas and prognosis of hemorrhagic and ischemic stroke with young patients (17 -45 age group) that administered and followed by KTU Neurology between January 2003 and December 2011 in Trabzon KTU Farabi Hospital were rewieved with hospital records retrospectively. Findings:All of the 190 causes, 151 patients were ischemic and 39 was hemorrhagic stroke. Of ischemic stroke patients 70 were male and 81 were female and the average age of the patients was 34.69±7.19. 67 of the patientswere in the age group 17-34 and 84 were in 35-45. The percentages of the risk factors were hyperlipidemia 30.46 %, hypertension 23.18 %, smoking 23.18 %, heart disease 13.25 %, history of transient ischemic attack 11.92 %, migraine 11.26 %, oral contraceptive use 5.96 %, stroke 5.96 %, diabetes mellitus 5.30 %, family history 5.30 %, alcohol use 3.97 % and atrial fibrillation 3.97 %. Hypertension, diabetes mellitus and hyperlipidemia were significantly higher in the 35-45 age group (respectively, p=0.000, p=0.009 and p=0.008). Smoking, alcohol use and stroke were statistically significant in men (respectively, p=0.003, p=0.009 and p=0.012) and migraine and oral contraceptive use were statistically significant in women (respectively, p=0.003 and p=0.004). The causes of ischemic stroke is determined in 58.29 % of ischemic stroke patients, but in 47.71 % of that didn?t. Large artery atherosclerosis 9.27 % in patients, cardioembolism 15.23 % in patients, small vessel disease 4.64 % in patients and other causes 29.14% in patients were found. In cardioembolism group, pure valvular disease was identified in 6.62 % of the patients and AF with valvular disease was identified in 3.31 % of the patients. Hematological diseases were 23.18% and non-atherosclerotic causes were 8.61% in the other causes group. Hypertension and diabetes mellitus was detected higher in small vessel disease occlusion group and, heart disease and AF was detected higher in cardioembolism group (respectively, p=0.002, p=0.049, p=0.000 and p=0.011). Ischemic stroke was determined 51.66 % of patients at MCA region, 14.57 % of patients at VBA region and 14.57 % of patients at more than one region. It was least frequent in ACA region 5.30 % of patients. 4.64 % (5 female and 2 male) of the patients died during their stay in hospital. The average age of the patients who died was 37.71 (±4.07) and the average ages of the patients living was 34.90 (±7.24). Of the patients who dies 3 were at cardioembolism group, 2 was at large artery atherosclerosis group and 2 was in unknown causes group. Patients with mRS between 0-2 points, group 2 patients (73.81 %) was higher than group 1 (56.72 %). This different was statistically significant (p=0.027).The patients with NIHSS score between 0-6 points was higher in 35-45 age group (71.43 % vs. 59.70 %), NIHSS score between 7-14 points was higher in 17-34 age group (35.82 % vs. 16.17). and NIHSS score above 15 points was higher in 35-45 age group (11.90 % vs. 4.48 %). NIHSS was statistically significant for the distribution of age group (p=0.014). 25 of 39 patients with hemorrhagic stroke were male and 14 were female and the average age of them was 35.89±8.46. 16 of the patients were in 17-34 age group and 23 were in 35-45 age group. Hemorrhage location was lobar region in 48.72 %, thalamic and/or ganglionic region in 35.90 %, intraventricular region in 7.69 %, cerebellum in 2.56 %, brainstem in 2.56 % and other regions in 2.56 % of patients. Etiological factors for hemorrhagic stroke were hypertension 43.59 %, cavernous angioma 7.69 %, coagulation disorder 7.69 %, aneurysm 7.69%, AVM 5.13 % and other reasons 5.13 %. In 9 patients there couldn't be found any reason in spite of all investigations. 8 patients (6 men and 2 women) died during their stay in hospital. The average age of the patients who died was 35.75 and the average age of the patients living was 35.93. Of the patients who died 5 were in lobar hemorrhage, 2 were in intraventricular hemorrhage and 1 was in thalamic and/or ganglionic hemorrhage group. Results: In this study, it is observed that hypertension, hyperlipidemia and smoking were the most important risk factors in young patients with stroke. With the provision of lifestyle changes to minimize the risks of a public health problem smoking, hypertension and hyperlipidemia; regular treatment and follow-ups, it is thought to have significant reductions in ischemic and hemorrhagic stroke rates in young people.