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Journal of Neurology

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01-04-2020 | Stroke | Original Communication

Premature vascular disease in young adult stroke: a pathology-based case series

Authors: Marco Pasi, Eva Rocha, Wesley Samore, Matthew P. Frosch, Anand Viswanathan, Aneesh B. Singhal

Published in: Journal of Neurology | Issue 4/2020

Abstract

Introduction

The prevalence of modifiable vascular risk factors is increasing in young adults and may contribute to the growing frequency of stroke in this population. The neuropathology and end-organ damage profile of young adult stroke patients with clinically advanced atherosclerosis or arteriosclerosis has not been studied.

Methods

This retrospective study included patients aged 18–60 years admitted to our hospital from 1995 to 2017 with recurrent ischemic or hemorrhagic strokes, fatal stroke, or stroke associated with advanced small vessel disease (SVD) on brain MRI, who had no evidence for structural, genetic, inflammatory, or infectious etiology for stroke, and had adequate pathological materials available for analysis. The presence of atherosclerosis, arteriolosclerosis, left ventricular hypertrophy, and nephrosclerosis was evaluated.

Results

Twelve patients (mean age 47 ± 9 years, range 31–57 years, 67% male) met inclusion criteria. Four had fatal intracerebral hemorrhage (ICH), three had recurrent non-fatal ICH, one had ICH with advanced SVD on MRI, and four had recurrent ischemic strokes including two with transient ischemic attacks. Pathological studies showed moderate/severe atherosclerosis in 64% and moderate/severe arteriolosclerosis in 42% of patients. Pathological data to evaluate end-organ damage were available for nine patients; eight showed left ventricular hypertrophy and all showed nephrosclerosis.

Conclusion

Young adult stroke patients with recurrent stroke, fatal stroke, or SVD on imaging have advanced atherosclerosis and arteriolosclerosis-related pathological changes in multiple organ systems. Aggressive control of atherosclerosis risk factors is warranted even in young individuals.

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Title: Premature vascular disease in young adult stroke: a pathology-based case series
Authors: Marco Pasi
Eva Rocha
Wesley Samore
Matthew P. Frosch
Anand Viswanathan
Aneesh B. Singhal
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Autopsy
Cranial MRI
Arterial Occlusive Disease
Pathology
Cerebral Hemorrhage
Published in: Journal of Neurology / Issue 4/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09623-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Premature vascular disease in young adult stroke: a pathology-based case series

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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