Abstract
Background
There have been few studies of the long-term prognosis of young adults with ischemic stroke. The present study aimed to evaluate the long-term clinical outcome in a large series of young adults with ischemic stroke admitted to a tertiary medical center over the last 27 years, and to identify possible predictors for mortality, stroke recurrence and poor functional recovery.
Methods
We retrospectively reviewed 272 young adults (15–45 years) with a first-ever ischemic stroke admitted to the Neurology Department of University Hospital “12 de Octubre” between 1974 and 2001. Follow-up assessments were performed by review of medical records and telephone interviews.
Results
Nine patients (3 %) died as the result of their initial stroke and follow-up information about the status of 23 (8%) patients was not available. The remaining 240 patients (89%) were followed. Two hundred and ten of them (88%) were alive with a mean follow-up of 12.3 years and 30 (12%) died during follow-up. The average annual mortality rate was 1.4%, being notably higher during the first (4.9%) than in the subsequent years (0.9 %) after the initial stroke. Ninety per cent of the followed patients were independent and 53% returned to work, although adjustments were necessary for 23% of them. The annual stroke recurrence rate during the first year was 3.6% dropping to 1.7 % in subsequent years. Age over 35 years, male gender, the presence of cardiovascular risk factors and large-artery atherosclerosis in the carotid territory were predictors of negative long-term outcome after the initial stroke.
Conclusions
The long-term prognosis for the ischemic stroke in the young is better than in the elderly, but the risk of mortality in young adults with ischemic stroke is much higher than in the general population of the same age. A bad prognosis is associated with an atherosclerotic risk profile, with a higher mortality and recurrent stroke rates and poorer functional recovery. The main functional limitation in the young survivors of their initial ischemic stroke occurs in work activity, since most patients are independent but almost half of them do not return to work.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Bogousslavsky J, Pierre P (1992) Ischemic stroke in patients under age 45. Neurol Clin 10:113–124
Shriver ME, Prockop LD (1993) The economic approach to the stroke work-up. Curr Opin Neurol Neurosurg 6:74–77
Hart RG, Miller VT (1983) Cerebral infarction in young adults: a practical approach. Stroke 14:110–114
Lidegaard O, Sol M, Andersen MVN (1986) Cerebral thromboembolism among young women and men in Denmark 1977–1982. Stroke 17:670–675
Nencini P, Inzitari D, Baruffi MC, et al. (1988) Incidence of stroke in young adults in Florence, Italy. Stroke 19:977–981
Marini C, Totaro R, De Santis F, Ciancarelli I, Baldasarre M, Carolei A (2001) Stroke in young adults in the Community-Based L’Aquila registry. Incidence and prognosis. Stroke 32:52–56
Kappelle LJ, Adams HP Jr, Heffner NL, Torner JC, Gomez F, Biller J (1994) Prognosis of young adults with ischemic stroke. A long term follow-up study assessing recurrent vascular events and functional outcome in the Iowa registry of stroke in young adults. Stroke 25:1360–1365
Marini C, Totaro R, Carolei A (1999) Long-term prognosis of cerebral ischemia in young adults. Stroke 30:2320–2325
Leys D, Bandu L, Henon H, et al. (2002) Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology 59:26–33
National Institute of Neurological Disorders and Stroke (1990) Classification of cerebrovascular disease III. Stroke 21:637–741
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. (1993) Classification of subtype of acute ischemic stroke.Definitions for use in a multicenter clinical Trial. Stroke 23:35–41
Goldstein LB, Jones MR, Matchar DB, et al. (2001) Improving the reliability of Stroke group Classification Using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Criteria. Stroke 32:1091–1097
Rankin J (1957) Cerebrovascular accidents in patients over the age of 60. II: Prognosis. Scott Med J 2:200
Mahoney FI, Barthel DW (1965). Functional evaluation: The Barthel Index. Md State Med J 14:61–65
Hindfelt B, Nilsson O (1977) The prognosis of ischaemic stroke in young adults. Acta Neurol Scand 55:123–130
Ferro JM, Crespo M (1994) Prognosis after transient ischemic attack and ischemic stroke in young adults. Stroke 25:1611–1616
Leno C, Berciano J, Combarros O, et al. (1993) A prospective study of Stroke in young adults in Cantabria, Spain. Stroke 24:792–795
Rozenthul-Sorokin N, Ronen R, Tamir A, Geva H, Eldar R (1996). Stroke in the young in Israel. Stroke 27:838–841
Qureshi AI, Safdar K, Patel M, Janssen RS, Frankel MR (1995) Stroke in young black patients. Risk factors, subtypes, and prognosis. Stroke 26:1995–1998
Bogousslavsky J, Regli F (1987) Ischemic stroke in adults younger than 30 years of age: cause and prognosis. Arch Neurol 44:479–482
Marshall J (1982) The cause and prognosis of strokes in people under 50 years. J Neurol Sci 53:473–488
Lanzino G, Andreoli A, Di Pasquale G, et al. (1991) Etiopathogenesis and prognosis of cerebral ischaemia in young adults. A survey of 155 treated patients. Acta Neurol Scand 84:321–325
Camerlingo M, Casto L, Censori B, et al. (2000) Recurrence after first cerebral infarction in young adults. Acta Neurol Scand 102:87–93
Matias-Guiu J, Alvarez-Sabin J, Falip R, Codina J (1991) Prognosis of ischaemic stroke in young adults. Presented at the ECST collaborators meeting; September 12–15; Edinburgh, Scotland
Abraham J, Shetty G, Jose CJ (1971) Strokes in the young. Stroke 2:258–267
Haerer AF, Smith RR (1970) Cerebrovascular disease of young adults in a Mississippi Teaching Hospital. Stroke 1:466–476
Wells CE, Timberger RJ (1961) Cerebral thrombosis in patients under fifty years of age. Arch Neurol 4:268–271
Grindal AB, Cohen RJ, Saul RJ, Taylor JR (1978) Cerebral infarction in young adults. Stroke 9:39–42
Snyder BD, Ramirez-Lassepas M (1980) Cerebral infarction in young adults: long-term prognosis. Stroke 11(2):149–153
Srinivasen K (1984) Ischemic cerebrovascular disease in the young: two common causes in India. Stroke 15:733–735
Chancellor AM, Glasgow GL, Ockelford PA, Johns A, Smith J (1989) Etiology, prognosis and haemostatic function after cerebral infarction in young adults. Stroke 20:477–482
Instituto de Estadística. Consejería de Economía e Innovación Tecnológica. Comunidad de Madrid. Estadísticas del movimiento natural de la población de la Comunidad de Madrid 1999. III. Defunciones. 3 [3105] p 178
Censo de población. INE (MINECO). Padrón Municipal de habitantes. INE (MINECO).www. comadrid.es. May, 2003
Hankey GJ, Jamrozik K, Broadhurst RJ, et al. (2000) Five-years survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 31:2080–2086
Carolei A, Candelise L, Fiorelli M, Francucci BM, Motolese M, Fieschi C (1992) Long-term prognosis of transient ischemic attacks and reversible ischemic neurological deficits: a hospital-based study. Cerebrovasc Dis 2:266–272
Vauthey C, de Freitas GR, van Melle G, Devuyst G, Bogousslavsky J (2000) Better outcome after stroke with higher serum cholesterol levels. Neurology 54:1944–1949
Biller J, Adams Jr HP, Bruno A (1991) Mortality in acute cerebral infarction in young adults: a ten-year experience. Angiology 42:224–230
Dewey HM, Sturm J, Donnan GA, Macdonell RAL, McNeil JJ, Thrift AG (2003) Incidence and outcome of subtypes of ischaemic stroke: initial results from the North East Melbourne Stroke Incidence Study (NEMESIS). Cerebrovasc Dis 15:133–139
Bath PMW, Lees K (2000) Acute stroke. BMJ 320:920–923
Adunsky A, Hershkowitz M, Rabbi R (1992). Functional recovery in young stroke patients. Arch Phys Med Rehabil 73:859–862
Burn J, Dennis M, Bramford J, Sandercock P, Wade D, Warlow C (1994) Longterm risk of recurrent stroke after a first-ever stroke: the Oxfordshire community stroke project. Stroke 25:333–337
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Varona, J.F., Bermejo, F., Guerra, J.M. et al. Long-term prognosis of ischemic stroke in young adults. J Neurol 251, 1507–1514 (2004). https://doi.org/10.1007/s00415-004-0583-0
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00415-004-0583-0