arterial ischemic stroke in young adults
TRANSCRIPT
![Page 1: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/1.jpg)
ARTERIAL ISCHEMIC STROKE IN YOUNG
ADULTSAhmed Abdul Ghany
![Page 2: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/2.jpg)
Annual incidence • The annual incidence of AIS is 3.4 – 11.3 / 100.000
people / year While in Black adults is as high as
22.8/100.000
![Page 3: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/3.jpg)
Risk factors• A study of 324 patients undergoing standardized
clinical assessment traditional risk factors such as
Smoking 56%, Hypertension 23%, Dyslipidemia 15%,
and Diabetes 2% were not uncommon
• Oral contraceptives were used by 38% of women
![Page 4: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/4.jpg)
One of the largest cohorts in FILAND
Etiology
Cardioembolic 20%
Dissection 15%
Atherosclerosis 8%
Vasculopathies 14%
Undetermined 33%
![Page 5: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/5.jpg)
![Page 6: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/6.jpg)
Cardiac
Congenital Endocarditis Prosthetic
valve replacement
Cardiomyopathy
![Page 7: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/7.jpg)
Hematologic
Sickle cell anemia
AntiphospholipidSyndrome
Factor V Leiden
mutation
AntithrombinIII deficency
Ptn C & S deficency
![Page 8: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/8.jpg)
Vasculopathy
Vasculitis
1ry
Takayaso
2ry
SLE
Dissection
MarfanSyndrome
MoyamoyaSyndrome
![Page 9: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/9.jpg)
Metabolic
MELAS CADASIL Fabry disease
Mitochondrial encephalopathy with lactic acidosis and strokeCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
![Page 10: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/10.jpg)
Initial management
![Page 11: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/11.jpg)
Supportive measures• ABC
• Maintain normoglycemia and normothermia.
• Allow modest Hypertension.
• Pneumatic compression and elastic stocking.
![Page 12: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/12.jpg)
Thrombolysis (rt-PA)Inclusion criteria Exclusion criteria
• Clinical diagnosis with neurologic deficit.
• Onset ≤ 4.5 hours before
beginning treatment.
• Age ≥ 18 years
• History of
stroke, ICH, tumor.
• Clinical: Systolic BP ≥ 185
or diastolic ≥ 110
• Active internal bleeding
• Lab: platelets ≤ 100.000 &
INR ≥ 1.7
• CT brain: ICH or
hypodensity ≥ 33% of the
cerebral hemisphere
![Page 13: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/13.jpg)
Initial antithrombotic treatment
guidelines• American Academy of chest physicians (ACCP)
recommend either unfractionated heparin or LMWH
or Aspirin until dissection and embolic causes have
been excluded.
![Page 14: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/14.jpg)
• American heart association (AHA) stroke council
states that it may be reasonable to initiate
anticoagulation in patients with AIS pending
completion of diagnostic evaluation.
• Royal collage of physicians recommends initial
therapy with Aspirin.
![Page 15: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/15.jpg)
• Aspirin 3-5 mg/kg day as initial therapy for all
patients except those with sickle cell disease or
intracranial hemorrhage.
![Page 16: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/16.jpg)
• AIS due to confirmed cardioembolic source, arterial
dissection or hypercoagulable state: intravenous
unfractionated heparin( PTT 60 -85) or LMWH
subcutaneous (1 mg/kg q12 hr) for 5 – 7 days
followed by LMWH or warfarin.
![Page 17: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/17.jpg)
• AIS with sickle cell disease: UK guidelines
recommends urgent IV hydration and blood
transfusion.
![Page 18: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/18.jpg)
• AIS with vasculopathy: Aspirin +/-
immunosuppression for inflammatory vacuities.
![Page 19: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/19.jpg)
• Decompressive hemicraniotomy: in patients with
mass effect or large (malignant) MCA territory
stroke.
![Page 20: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/20.jpg)
Prognosis Predictors of poor outcome:
• First year Mortality in
young adults 4 – 6 %
after AIS
• Young age
• Fever at presentation
• Altered consciousness at
presentation
• Bilateral ischemia
• MCA stroke volume ≥ 10 %
![Page 21: Arterial ischemic stroke in young adults](https://reader033.vdocuments.net/reader033/viewer/2022042715/5594b1661a28ab23648b4698/html5/thumbnails/21.jpg)
THANK YOU