BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain,known as transient ischemic attacks,or fullblown strokes.While atherosclerosis is commonl...BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain,known as transient ischemic attacks,or fullblown strokes.While atherosclerosis is commonly associated with intracranial arterial narrowing,it is frequently of a non-atherosclerotic nature in younger patients.CASE SUMMARY Here,we present the case of a young stroke patient with narrowing of the middle cerebral artery(MCA),characterized as non-atherosclerotic lesions,who experienced an ischemic stroke despite receiving standard drug therapy.The patient underwent digital subtraction angiography(DSA)to assess the entire network of blood vessels in the brain,revealing significant narrowing(approximately 80%)in the M1 segment of the right MCA.Subsequently,the patient underwent Drug-Coated Balloon Angioplasty to treat the stenosis in the right MCA's M1 segment.Follow-up DSA confirmed the resolution of stenosis in this segment.Although the remaining branches showed satisfactory blood flow,the vessel wall exhibited irregularities.A review of DSA conducted six months later showed no evident stenosis in the right MCA,with a smooth vessel wall.CONCLUSION The use of drug-coated balloon angioplasty demonstrated favorable outcomes in repairing and reshaping the blood vessel wall in young patients.Therefore,it may be considered a promising treatment option for similar cases.展开更多
Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-...Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.展开更多
Introduction: Cerebrovascular accidents (CVA) are an absolute neurovascular emergency and the main cause of mortality and acquired disability in adults. In the Congo, stroke is the leading cause of mortality and the l...Introduction: Cerebrovascular accidents (CVA) are an absolute neurovascular emergency and the main cause of mortality and acquired disability in adults. In the Congo, stroke is the leading cause of mortality and the leading cardiovascular emergency, with a hospital frequency of between 49.74% and 56.2%. The aim of the study was to identify the mortality factors associated with stroke in young people in Brazzaville. Patients and Methods: This is a longitudinal analytical study conducted from February to period from February to September 2019 in the neurology, general intensive care and medical emergency departments of the Brazzaville University Hospital (CHUB). All subjects aged 18 - 55 years of completed age, admitted for arterial stroke confirmed by brain imaging, were included. Study variables were: age, gender, socioeconomic level, laterality, time to admission and CT scan, vascular risk factors, history of cardiomyopathy, atrial fibrillation, TIA (transient ischemic attack) or stroke, NIHSS (National Institutes of Health Stroke Scale) score, Glasgow score, blood pressure, temperature, heart rate, occurrence or non-occurrence of complications, blood glucose, creatinine, lipid profile and blood count. Data were analyzed using SPSS 21 software. Descriptive analyses were performed using SPSS 21 software. Results: 103 patients were included in the study, of whom 45 (43.7%) had ischemic stroke and 58 (56.3%) with hemorrhagic stroke. Mortality was high at 29.1% in our study, and mainly concerned hemorrhagic strokes (73.7%). Two-week mortality in our study accounted for 63.33% of total lethality. After simple logistic regression, the factors associated with death within two weeks were age between 40 - 44 years (OR (odds ratio) = 2.95;p = 0.01), hemorrhagic stroke (OR = 1.41;p = 0.07), mass effect (OR = 3.26;p < 0.01), ventricular flooding (OR = 2.86;p < 0.001), Glasgow score (OR = 2.95 (0.92 - 9.43);p = 0.06), NIHSS score on admission > 15 (OR = 5.89 (2.90 - 11.95);p < 0.001) and bronchopulmonary infection (OR = 30, 95 (4.04 - 236.88), p < 0.001). From multivariate logistic regression, only NIHSS score on admission > 15 emerged as a predictor of death within two weeks (OR = 5.89 (2.90 - 11.95);p Conclusion: This study confirms the basic data of the African literature concerning stroke, as several factors were identified as independent factors associated with mortality.展开更多
Fibromuscular dysplasia(FMD)is a noninflammatory,nonatherosclerotic,and multifocal vascular disease,commonly involving the cerebral and renal arteries.Cerebrovascular stenosis and spontaneous dissection resulting from...Fibromuscular dysplasia(FMD)is a noninflammatory,nonatherosclerotic,and multifocal vascular disease,commonly involving the cerebral and renal arteries.Cerebrovascular stenosis and spontaneous dissection resulting from cerebrovascular FMD(cFMD)is one of the important causes of young stroke.Here,we reported the case of cFMD in a 28-year-old male patient with stroke.Digital subtraction angiogram demonstrated a dissecting aneurysm in the carotid artery and multiple stenoses in both vertebral arteries.Endovascular angioplasty with balloon predilation and stenting was successfully performed for the patient when the medical treatment was not adequate.The follow-up showed a remarkable improvement and no recurrence of stroke.展开更多
Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosi...Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.展开更多
BACKGROUND At present,the incidence rate of ischemic stroke in young people is increasing yearly,and the age of onset is increasingly young.Therefore,primary and secondary prevention of ischemic stroke in young people...BACKGROUND At present,the incidence rate of ischemic stroke in young people is increasing yearly,and the age of onset is increasingly young.Therefore,primary and secondary prevention of ischemic stroke in young people,especially secondary prevention,is particularly crucial.AIM We aimed to comprehensively evaluate risk factors for stroke recurrence in firstever young ischemic stroke(YIS)patients.METHODS The meta-analysis was used to quantitatively analyze the research results on risk factors for stroke recurrence in first-ever YIS patients both domestically and internationally.Stata12.0 software was used for heterogeneity testing,publication bias analysis,sensitivity analysis,and the calculation of combined odds ratios and 95%confidence intervals.RESULTS The odds ratio(OR)values of the relationship between hypertension and hyperlipidemia and recurrence of first-ever YIS were 1.54(1.05-2.26)and 1.12(1.00-1.25),respectively.The OR values of male sex,type 2 diabetes,smoking,drinking and YIS recurrence were 1.66(0.98-2.79),1.01(0.64-1.59),1.21(0.83-1.76),and 1.28(0.82-2.53),respectively.The relationship between male sex,type 2 diabetes,smoking,drinking and YIS recurrence was ambiguous.CONCLUSION Hypertension and hyperlipidemia are important risk factors for stroke recurrence in first-ever YIS patients,and active intervention should be taken.展开更多
Celiac disease(CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homoz...Celiac disease(CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homozygous 5,10-methylenetetrahydrofolate reductase mutation with hyperhomocysteinemia,was affected by two occipital ischemic strokes within a period of 5 mo.At the time of the second stroke,while she was being treated with folic acid,acetylsalicylic acid and a gluten-free diet,she had left hemianopsia,left hemiparesthesias,and gait imbalance.Brain magnetic resonance imaging showed a subacute right occipital ischemic lesion,which was extended to the dorsal region of the right thalamus and the ipsilateral thalamocapsular junction.Antitransglutaminase and deamidated gliadin peptide antibodies were no longer present,while antinuclear antibodies,antineuronal antibodies and immune circulating complexes were only slightly elevated.Since the patient was taking folic acid,her homocysteine levels were almost normal and apparently not sufficient alone to explain the clinical event.A conventional cerebral angiography showed no signs of vasculitis.Finally,rare causes of occipital stroke in young patients,such as Fabry's disease and mitochondrial myopathy,encephalomyopathy,lactic acidosis and stroke-like symptoms,were also excluded by appropriate tests.Thus,the most probable cause for the recurrent strokes in this young woman remained CD,although the mechanisms involved are still unknown.The two main hypotheses concern malabsorption(with consequent deficiency of vitamins known to exert neurotrophic and neuroprotective effects) and immunemediated mechanisms.CD should be kept in mind in the differential diagnosis of ischemic stroke in young patients.展开更多
BACKGROUND AND OBJECTIVE Approximately 10% of all strokes occur in adults below 50 years of age. Studies assessing cognition among young stroke patients have reported a higher prevalence of cognitive impairment than i...BACKGROUND AND OBJECTIVE Approximately 10% of all strokes occur in adults below 50 years of age. Studies assessing cognition among young stroke patients have reported a higher prevalence of cognitive impairment than in older adults with stroke. This prospective study further investigated the prevalence and course of cognitive dysfunction in young adult stroke patients. METHODS Consecutive patients admitted with an ischemic stroke, ages 18 to 55, were invited to participate. During the study period, 150 patients were recruited. All underwent baseline neurologic and neuropsychological evaluation, including MRI and assessment of stroke severity. RESULTS The mean age of the sample was 44.5 years, with median stroke severity in the mild range. Within three weeks after hospital admission 40% showed impaired cognitive function, including impaired attention. At three months′ follow-up, improvement was noted in general cognitive ability, processing speed, attention and flexibility, as well as executive function. However, cognitive deficits were still present in one third of the patients. CONCLUSION This prospective study of patients with an acute ischemic stroke, 55 years of age or younger, found that, at three months, cognitive impairment is present in 40%.展开更多
Stroke is a devastating and disabling cerebrovascular disease with some amount of residual deficit leading onto economic loss. Recent Indian studies have shown a stroke prevalence rate of 471.58/100,000 population. Th...Stroke is a devastating and disabling cerebrovascular disease with some amount of residual deficit leading onto economic loss. Recent Indian studies have shown a stroke prevalence rate of 471.58/100,000 population. This study was undertaken to analyse the clinical profile and to arrive at important factors contributing to stroke in 45 years group. This is a descriptive, retrospective cross—sectional study carried out on acute CVA patients, admitted to the I.I.M., RGGGH, Chennai. 150 patients were studied over a period of 3 months in the 2011. 20% of /= 45 years constituted our study population. 18.4% and 22.2% of males and females respectively were young stroke patients. Only 33.3% of patients were brought to the hospital within 6 hours. 90% patients had mild GCS score (>/=13/15) and presented with hemiplegia 76% and 18% had infarct and intracerebral hemorrhage(ICH) respectively. Risk factors: Type A personality (70.7%), Tobacco (60.7%) and Alcohol (44.7%) abuse, Systemic Hypertension (60.7%), Diabetes Mellitus (33.3%), Cardiac disorders (14%). Stroke was seen to be more common in >45 years but still young stroke carries paramount importance due to loss of productive years in these patients. Female predominance was seen in young stroke, with particular reference to puerperal period. Among the comorbid illness systemic hypertension followed by cardiac disorders had important contributing role in young strokes. Most of the patients with infarct and ICH were tobacco and alcohol abusers respectively. A holistic approach encompassing further research in factors involved in young stroke, public awareness, behavioural modification and comorbid medical illness management is the need for the hour.展开更多
Objective This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.Methods Data were obtained from the China national vital registration system.Significant changes in mort...Objective This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.Methods Data were obtained from the China national vital registration system.Significant changes in mortality were assessed by Joinpoint regression.Age-period-cohort analysis was used to explain the reasons for the changes.Future mortality and counts were predicted by the Bayesian age-period-cohort model.Results Between 2002 and 2019,a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded.The age-adjusted mortality rates(AAMRs)of women showed a downward trend.The annual percent changes(APC)were-3.5%(-5.2%,-1.7%)for urban women and-2.8%(-3.7%,-1.9%)for rural women.By contrast,the AAMRs per 100,000 for rural men aged 25–44 years continued to rise from 9.40 to 15.46.The AAMRS for urban men aged 25–44 years and urban and rural men aged 45–64years did not change significantly.Between 2020 and 2030,the projected stroke deaths are 1,423,584 in men and 401,712 in women.Conclusion Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China.Targeted health policy measures are needed to address the burden of stroke in the young generation,especially for rural men,with a focus on the prevention and management of high risk factors.展开更多
Objectives: Stroke is a major cause of morbidity and mortality worldwide. It is increasingly common from the sixth decade, but is particularly tragic when it occurs in young adults. There are limited studies of stroke...Objectives: Stroke is a major cause of morbidity and mortality worldwide. It is increasingly common from the sixth decade, but is particularly tragic when it occurs in young adults. There are limited studies of stroke in young adults in Nigeria. It is against this background that we embarked on this prospective hospital based study to determine the epidemiology, pattern and case fatality rate of stroke in young adults in Abakaliki Southeastern part of Nigeria. Patients and Method: The stroke patients between the ages of 18 - 50 years admitted to the medical wards of a tertiary health centre at Abakaliki Nigeria from 1st August 2012 to 30th April 2019 were consecutively recruited. They were followed up till discharge. Relevant data like biodata, and clinical features of the patients were extracted and analyzed. Results: A total of 983 (males—511, females—472) stroke cases were seen with 197 between 18 - 50 years. One hundred and fifty two (77%) did neuroimaging (mean age—40.7 years). Eighty-eight (57.9%) had Cerebral infarct (males—42, females—46) while 64 (42.1%) had Hemorrhagic stroke (males—35, females—29). For those that had hemorrhagic stroke, 11 (17.2%) were Subarachnoid hemorrhage (SAH) while 52 (82.8%) were Intracerebral hemorrhage (ICH). The identified risk factors range from hypertension, DM, dyslipidemia, alcoholism, cigarette smoking, HIV infection and chronic use of coffee drinks. Sixteen patients died during the admission with case fatality rate of 10.5%. Conclusion: Stroke is actually prevalent in young adults as 1 in every 5 stroke patients seen was a young adult. In addition to the traditional risk factors, HIV/AIDS and chronic use of coffee drinks were also noted as emerging risk factors. There is need for a continuous health education and strong campaign on primary stroke prevention. Also, there is need for training of more neurologists with interest in stroke management and establishing comprehensive stroke centers at national, regional and local levels in order to contend adequately with the rising burden of stoke in young adults.展开更多
Stroke etiology in young adults and older patient differs considerably, as well as epidemiology and clinical features vary according to geographical criteria. To improve clinical management and optimize diagnostic wor...Stroke etiology in young adults and older patient differs considerably, as well as epidemiology and clinical features vary according to geographical criteria. To improve clinical management and optimize diagnostic work-up of young adults with acute cerebrovascular events, we analyzed retrospectively data of 6-year stroke unit case series. In this hospital case series study, we enrolled 145 patients with acute cerebrovascular events aged 16 to 49, consecutively admitted to a Community Hospital Hub Stroke Unit. We studied risk factors for stroke, the distribution of acute cerebrovascular events, stroke subtype, length of stay and clinical outcome: 70% of patients were admitted for acute ischemic event (45 female-F, 57 male-M), 10.5% intracranial hemorrhages (5F, 10M), 2.7% subarachnoid hemorrhage (2F, 2M), 2% venous sinus thrombosis (3F), 14.5 for acute ischemic attack (12F, 9M). Among ischemic stroke patients, the etiology was as follows: atherothrombosis 29.4%, cardioembolism 19.6%, arterial dissection 13.7%, other determined causes 8.8%, lacunar stroke 5.8%, and undetermined causes 22.54%. 15% of ischemic young patients were treated with r-TPA. The majority of patients returned home at discharge, whereas 30% needed intensive rehabilitation programme to regain independence in the activity of daily living. Dedicated health care programme targeting prevention and optimizing treatment of acute cerebrovascular events in young adults are desirable to improve prognosis among this socioeconomically active age group.展开更多
<span style="font-family:Verdana;">Ischemic strokes (IS), also referred to as cerebral ischemia or brain ischemia, is a significant cause to the brain cells damage or death. Approximately, 10% - 14% of...<span style="font-family:Verdana;">Ischemic strokes (IS), also referred to as cerebral ischemia or brain ischemia, is a significant cause to the brain cells damage or death. Approximately, 10% - 14% of ischemic strokes cases occurred in young adults. Hence, we conducted a meta-analysis to find the effective interventions to prevent the best strokes caused by cerebral infarction in young adults. The search was done in different databases, including Google scholar, PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database, Scopus, and Web of Science from January 2016 to April 2020, and only English published articles were considered. Our analysis included studies that stratified the risk of ischemic stroke by CHA2DS2-VASc score for patients with nonvalvular atrial fibrillation. Further, random effects model was used to estimate the summary annual rate of IS. Pooled relative risks and odds ratios, with their 95% confidence intervals, were calculated, respectively. The analysis was conducted using STATA (version 12), pooled effect sizes were calculated using the random-effects model and heterogeneity was tested for using the <em>I</em><sup><em>2</em></sup> statistic. The analysis included 13 studies. The analysis shows that diabetes, high blood pressure, ischemic heart disease, atrial fibrillation, hypercholesterolemia, alcohol consumption and smoking are significant risk factors. In Caucasian and Chinese ischemic stroke patients, the risk factor associations associated with ischemic stroke subtypes are similar. Compared to all other ischemia subtypes, diabetes is more familiar with aortic stroke, atrial fibrillation, ischemic heart disease (with obstruction), hypertension and diabetes. Our research shows that atrial fibrillation, ischemic heart disease, and hypercholesterolemia are low in patients with ischemic stroke and the risk factors are higher. Further analysis of each patient’s data is required to enable confounders’ adjustments to confirm and expand these findings.</span>展开更多
<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Introduction:</strong> Stroke is a major public health problem even more dramatic in young peopl...<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Introduction:</strong> Stroke is a major public health problem even more dramatic in young people. <strong>Goal of the study:</strong> To make our contribution to the knowledge of strokes of the young subject. <strong>Methodology:</strong> It was a retrospective study conducted over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Department of Neurology of C between Hospitalier A Sino-Central African Friendship University (CHUSCA) from Bangui. <strong>Results:</strong> During the study, 225 cases of stroke were recorded, including 26 cases in young subjects, representing a hospital frequency of 11.5%. The average age was 42.5 years with extremes ranging from 24 to 49 years. The most represented age group was 45 and 49 with a sex ratio (M/F) of 1.36. The average age for men was 41.93 years compared to 39.27 years for women. Civil servants were in the majority in 50% of the cases. Alcohol was the main FDR (80.8%) followed by hypertension (61.5%) and tobacco (50%). The majority of patients (57.70%) were admitted to neurology after the first 24 hours. Ischemic stroke represented 73.08% compared to 26.92% of AVCH. The lethality was 20.08%. The sequelae were found in 69.20% of cases. Cardiac exploration had found 57.10% of LVH. <strong>Conclusion: </strong>This study confirms a high frequency of stroke in the young subject. The predominance of modifiable FRCVs requires the implementation of a specific strategy based on awareness, early detection and effective and adequate PEC.</span> </div>展开更多
Introduction: Stroke incidence in young patients is about 10 cases in 100.000, according to several European studies. In this age group arterial dissection is one of the main pathological mechanisms involved. The inte...Introduction: Stroke incidence in young patients is about 10 cases in 100.000, according to several European studies. In this age group arterial dissection is one of the main pathological mechanisms involved. The internal carotid’s artery (ICA) main supraclinoid branch is the anterior choroidal artery (AChA). The occurrence of infarction in its territory due to internal carotid dissection is considered to be a rare event and may have different clinical presentations due to anatomical variability. Clinical case: A 31-year-old male patient, without any known cardiovascular risk factors or chronic medication, presented with acute onset of stabbing right sided headache while practicing football. Visual disturbances and hemiparesis with hypesthesia of his left arm were also mentioned. On admission left homonymous hemianopsia, left hemiparesis and left extensor plantar reflex were present. Brain magnetic resonance showed hyperintensity of T2 and FLAIR signals and restricted diffusion pattern suggested acute/subacute infarctions in the thalamic and subcapsular area, corpus callosum, splenium and subcortical parietal right region. Magnetic resonance angiography (MRA) of the brain showed reduction of the right ICA’s caliber, mainly of its supraclinoid segment in which a marked irregular stenosis was visualized, suggestive of arterial dissection. This stenotic segment included the origin of the AChA and of the posterior communicating cerebral artery with an exchange in their territories. Lumbar puncture results were normal as were analytical investigations which included CBC, sedimentation rate, syphilis serology and immunologic and prothrombotic screen. There were no phenotype characteristics suggestive of connective tissue disease. Conclusion: Trauma seems to be the most probable lesion mechanism for the occurrence of intracranial carotid’s dissection in this particular case, as the patient was practicing vigorous sports at time of onset. In view of great anatomic variability and multiple anatomical sites supplied by the AChA its occlusion will induce a wide range of clinical manifestations.展开更多
BACKGROUND Cannabis use has increased among young individuals in recent years.Although dependent cannabis use disorder(CUD)has been associated with various cardiac events,its effects on young adults without concurrent...BACKGROUND Cannabis use has increased among young individuals in recent years.Although dependent cannabis use disorder(CUD)has been associated with various cardiac events,its effects on young adults without concurrent substance use remain understudied.AIM To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events(MACCE)in this cohort.METHODSWe used the National Inpatient Sample(2016-2019)to identify hospitalized young individuals(18-44 years),excluding those with concurrent substance usage(tobacco,alcohol,and cocaine).They were divided into CUD+and CUD-.Using International Classification of Diseases-10 codes,we examined the trends in MACCE hospitalizations,including all-cause mortality(ACM),acute myocardial infarction(AMI),cardiac arrest(CA),and acuteischemic stroke(AIS).RESULTSOf 27.4 million hospitalizations among young adults without concurrent substance abuse,4.2%(1.1 million)hadco-existent CUD.In CUD+group,hospitalization rates for MACCE(1.71%vs 1.35%),AMI(0.86%vs 0.54%),CA(0.27%vs 0.24%),and AIS(0.49%vs 0.35%)were higher than in CUD-group(P<0.001).However,rate of ACMhospitalizations was lower in CUD+group(0.30%vs 0.44%).From 2016 to 2019,CUD+group experienced arelative rise of 5%in MACCE and 20%in AMI hospitalizations,compared to 22%and 36%increases in CUDgroup(P<0.05).The CUD+group had a 13%relative decrease in ACM hospitalizations,compared to a 10%relative rise in CUD-group(P<0.05).However,when adjusted for confounders,MACCE odds among CUD+cohort remain comparable between 2016 and 2019.CONCLUSIONThe CUD+group had higher rates of MACCE,but the rising trends were more apparent in the CUD-group overtime.Interestingly,the CUD+group had lower ACM rates than the CUD-group.展开更多
Introduction: Neurological complications are possible during infective endocarditis. They are often life-threatening and can be a source of sequelae. Case Presentation: We report the case of an 11-year-old patient adm...Introduction: Neurological complications are possible during infective endocarditis. They are often life-threatening and can be a source of sequelae. Case Presentation: We report the case of an 11-year-old patient admitted to the cardiology department of the CHU-ME “LUXEMBOURG” in Bamako for functional impotence of the left hemibody, accompanied by fever and NYHA stage II dyspnea. The clinical examination on admission shows the poor general condition, normal consciousness, and sensory-motor deficit of the pyramidal type of the left hemibody. The cardiovascular examination notes a systolic murmur at the mitral focus, hepato-jugular reflux, hepatomegaly, and slight edema in the lower limbs. Brain CT showed localized hypodensity in favor of an ischemic stroke. The electrocardiogram shows a sinus rhythm. Transthoracic Doppler echocardiography revealed mitral insufficiency with vegetation of 17 × 14 mm on the anterior mitral valve, with left ventricular ejection fraction estimated at 75%. Dual antibiotic therapy associated with conventional treatment for heart failure was initiated. The clinical evolution was marked by the persistence of the deficit of the left upper limb, the cardiac Doppler echography of control after 6 weeks of treatment found the same vegetation. A discussion with the heart team with a view to a surgical cure has been initiated for the rest of the treatment. Conclusion: A motor deficit associated with fever related to an ischemic vascular accident should lead to a search for infective endocarditis on cardiac Doppler ultrasound.展开更多
文摘BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain,known as transient ischemic attacks,or fullblown strokes.While atherosclerosis is commonly associated with intracranial arterial narrowing,it is frequently of a non-atherosclerotic nature in younger patients.CASE SUMMARY Here,we present the case of a young stroke patient with narrowing of the middle cerebral artery(MCA),characterized as non-atherosclerotic lesions,who experienced an ischemic stroke despite receiving standard drug therapy.The patient underwent digital subtraction angiography(DSA)to assess the entire network of blood vessels in the brain,revealing significant narrowing(approximately 80%)in the M1 segment of the right MCA.Subsequently,the patient underwent Drug-Coated Balloon Angioplasty to treat the stenosis in the right MCA's M1 segment.Follow-up DSA confirmed the resolution of stenosis in this segment.Although the remaining branches showed satisfactory blood flow,the vessel wall exhibited irregularities.A review of DSA conducted six months later showed no evident stenosis in the right MCA,with a smooth vessel wall.CONCLUSION The use of drug-coated balloon angioplasty demonstrated favorable outcomes in repairing and reshaping the blood vessel wall in young patients.Therefore,it may be considered a promising treatment option for similar cases.
基金supported by the Special Fund of Basic Scientific Research Service Fee of Central Public Welfare Scientif ic Research Institute of China,No.2014CZ-13
文摘Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.
文摘Introduction: Cerebrovascular accidents (CVA) are an absolute neurovascular emergency and the main cause of mortality and acquired disability in adults. In the Congo, stroke is the leading cause of mortality and the leading cardiovascular emergency, with a hospital frequency of between 49.74% and 56.2%. The aim of the study was to identify the mortality factors associated with stroke in young people in Brazzaville. Patients and Methods: This is a longitudinal analytical study conducted from February to period from February to September 2019 in the neurology, general intensive care and medical emergency departments of the Brazzaville University Hospital (CHUB). All subjects aged 18 - 55 years of completed age, admitted for arterial stroke confirmed by brain imaging, were included. Study variables were: age, gender, socioeconomic level, laterality, time to admission and CT scan, vascular risk factors, history of cardiomyopathy, atrial fibrillation, TIA (transient ischemic attack) or stroke, NIHSS (National Institutes of Health Stroke Scale) score, Glasgow score, blood pressure, temperature, heart rate, occurrence or non-occurrence of complications, blood glucose, creatinine, lipid profile and blood count. Data were analyzed using SPSS 21 software. Descriptive analyses were performed using SPSS 21 software. Results: 103 patients were included in the study, of whom 45 (43.7%) had ischemic stroke and 58 (56.3%) with hemorrhagic stroke. Mortality was high at 29.1% in our study, and mainly concerned hemorrhagic strokes (73.7%). Two-week mortality in our study accounted for 63.33% of total lethality. After simple logistic regression, the factors associated with death within two weeks were age between 40 - 44 years (OR (odds ratio) = 2.95;p = 0.01), hemorrhagic stroke (OR = 1.41;p = 0.07), mass effect (OR = 3.26;p < 0.01), ventricular flooding (OR = 2.86;p < 0.001), Glasgow score (OR = 2.95 (0.92 - 9.43);p = 0.06), NIHSS score on admission > 15 (OR = 5.89 (2.90 - 11.95);p < 0.001) and bronchopulmonary infection (OR = 30, 95 (4.04 - 236.88), p < 0.001). From multivariate logistic regression, only NIHSS score on admission > 15 emerged as a predictor of death within two weeks (OR = 5.89 (2.90 - 11.95);p Conclusion: This study confirms the basic data of the African literature concerning stroke, as several factors were identified as independent factors associated with mortality.
基金the National Natural Science Foundation of China(Grant No.81471195)the second affiliated hospital of Soochow university preponderant clinic discipline group project funding(Grant No.XKQ2015002).
文摘Fibromuscular dysplasia(FMD)is a noninflammatory,nonatherosclerotic,and multifocal vascular disease,commonly involving the cerebral and renal arteries.Cerebrovascular stenosis and spontaneous dissection resulting from cerebrovascular FMD(cFMD)is one of the important causes of young stroke.Here,we reported the case of cFMD in a 28-year-old male patient with stroke.Digital subtraction angiogram demonstrated a dissecting aneurysm in the carotid artery and multiple stenoses in both vertebral arteries.Endovascular angioplasty with balloon predilation and stenting was successfully performed for the patient when the medical treatment was not adequate.The follow-up showed a remarkable improvement and no recurrence of stroke.
基金supported by the National Natural Science Foundation of China(82071468,82271507).
文摘Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.
基金The Key Research Project of The Third People's Hospital of Hefei,No.SYKZ202301.
文摘BACKGROUND At present,the incidence rate of ischemic stroke in young people is increasing yearly,and the age of onset is increasingly young.Therefore,primary and secondary prevention of ischemic stroke in young people,especially secondary prevention,is particularly crucial.AIM We aimed to comprehensively evaluate risk factors for stroke recurrence in firstever young ischemic stroke(YIS)patients.METHODS The meta-analysis was used to quantitatively analyze the research results on risk factors for stroke recurrence in first-ever YIS patients both domestically and internationally.Stata12.0 software was used for heterogeneity testing,publication bias analysis,sensitivity analysis,and the calculation of combined odds ratios and 95%confidence intervals.RESULTS The odds ratio(OR)values of the relationship between hypertension and hyperlipidemia and recurrence of first-ever YIS were 1.54(1.05-2.26)and 1.12(1.00-1.25),respectively.The OR values of male sex,type 2 diabetes,smoking,drinking and YIS recurrence were 1.66(0.98-2.79),1.01(0.64-1.59),1.21(0.83-1.76),and 1.28(0.82-2.53),respectively.The relationship between male sex,type 2 diabetes,smoking,drinking and YIS recurrence was ambiguous.CONCLUSION Hypertension and hyperlipidemia are important risk factors for stroke recurrence in first-ever YIS patients,and active intervention should be taken.
文摘Celiac disease(CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homozygous 5,10-methylenetetrahydrofolate reductase mutation with hyperhomocysteinemia,was affected by two occipital ischemic strokes within a period of 5 mo.At the time of the second stroke,while she was being treated with folic acid,acetylsalicylic acid and a gluten-free diet,she had left hemianopsia,left hemiparesthesias,and gait imbalance.Brain magnetic resonance imaging showed a subacute right occipital ischemic lesion,which was extended to the dorsal region of the right thalamus and the ipsilateral thalamocapsular junction.Antitransglutaminase and deamidated gliadin peptide antibodies were no longer present,while antinuclear antibodies,antineuronal antibodies and immune circulating complexes were only slightly elevated.Since the patient was taking folic acid,her homocysteine levels were almost normal and apparently not sufficient alone to explain the clinical event.A conventional cerebral angiography showed no signs of vasculitis.Finally,rare causes of occipital stroke in young patients,such as Fabry's disease and mitochondrial myopathy,encephalomyopathy,lactic acidosis and stroke-like symptoms,were also excluded by appropriate tests.Thus,the most probable cause for the recurrent strokes in this young woman remained CD,although the mechanisms involved are still unknown.The two main hypotheses concern malabsorption(with consequent deficiency of vitamins known to exert neurotrophic and neuroprotective effects) and immunemediated mechanisms.CD should be kept in mind in the differential diagnosis of ischemic stroke in young patients.
文摘BACKGROUND AND OBJECTIVE Approximately 10% of all strokes occur in adults below 50 years of age. Studies assessing cognition among young stroke patients have reported a higher prevalence of cognitive impairment than in older adults with stroke. This prospective study further investigated the prevalence and course of cognitive dysfunction in young adult stroke patients. METHODS Consecutive patients admitted with an ischemic stroke, ages 18 to 55, were invited to participate. During the study period, 150 patients were recruited. All underwent baseline neurologic and neuropsychological evaluation, including MRI and assessment of stroke severity. RESULTS The mean age of the sample was 44.5 years, with median stroke severity in the mild range. Within three weeks after hospital admission 40% showed impaired cognitive function, including impaired attention. At three months′ follow-up, improvement was noted in general cognitive ability, processing speed, attention and flexibility, as well as executive function. However, cognitive deficits were still present in one third of the patients. CONCLUSION This prospective study of patients with an acute ischemic stroke, 55 years of age or younger, found that, at three months, cognitive impairment is present in 40%.
文摘Stroke is a devastating and disabling cerebrovascular disease with some amount of residual deficit leading onto economic loss. Recent Indian studies have shown a stroke prevalence rate of 471.58/100,000 population. This study was undertaken to analyse the clinical profile and to arrive at important factors contributing to stroke in 45 years group. This is a descriptive, retrospective cross—sectional study carried out on acute CVA patients, admitted to the I.I.M., RGGGH, Chennai. 150 patients were studied over a period of 3 months in the 2011. 20% of /= 45 years constituted our study population. 18.4% and 22.2% of males and females respectively were young stroke patients. Only 33.3% of patients were brought to the hospital within 6 hours. 90% patients had mild GCS score (>/=13/15) and presented with hemiplegia 76% and 18% had infarct and intracerebral hemorrhage(ICH) respectively. Risk factors: Type A personality (70.7%), Tobacco (60.7%) and Alcohol (44.7%) abuse, Systemic Hypertension (60.7%), Diabetes Mellitus (33.3%), Cardiac disorders (14%). Stroke was seen to be more common in >45 years but still young stroke carries paramount importance due to loss of productive years in these patients. Female predominance was seen in young stroke, with particular reference to puerperal period. Among the comorbid illness systemic hypertension followed by cardiac disorders had important contributing role in young strokes. Most of the patients with infarct and ICH were tobacco and alcohol abusers respectively. A holistic approach encompassing further research in factors involved in young stroke, public awareness, behavioural modification and comorbid medical illness management is the need for the hour.
文摘Objective This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.Methods Data were obtained from the China national vital registration system.Significant changes in mortality were assessed by Joinpoint regression.Age-period-cohort analysis was used to explain the reasons for the changes.Future mortality and counts were predicted by the Bayesian age-period-cohort model.Results Between 2002 and 2019,a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded.The age-adjusted mortality rates(AAMRs)of women showed a downward trend.The annual percent changes(APC)were-3.5%(-5.2%,-1.7%)for urban women and-2.8%(-3.7%,-1.9%)for rural women.By contrast,the AAMRs per 100,000 for rural men aged 25–44 years continued to rise from 9.40 to 15.46.The AAMRS for urban men aged 25–44 years and urban and rural men aged 45–64years did not change significantly.Between 2020 and 2030,the projected stroke deaths are 1,423,584 in men and 401,712 in women.Conclusion Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China.Targeted health policy measures are needed to address the burden of stroke in the young generation,especially for rural men,with a focus on the prevention and management of high risk factors.
文摘Objectives: Stroke is a major cause of morbidity and mortality worldwide. It is increasingly common from the sixth decade, but is particularly tragic when it occurs in young adults. There are limited studies of stroke in young adults in Nigeria. It is against this background that we embarked on this prospective hospital based study to determine the epidemiology, pattern and case fatality rate of stroke in young adults in Abakaliki Southeastern part of Nigeria. Patients and Method: The stroke patients between the ages of 18 - 50 years admitted to the medical wards of a tertiary health centre at Abakaliki Nigeria from 1st August 2012 to 30th April 2019 were consecutively recruited. They were followed up till discharge. Relevant data like biodata, and clinical features of the patients were extracted and analyzed. Results: A total of 983 (males—511, females—472) stroke cases were seen with 197 between 18 - 50 years. One hundred and fifty two (77%) did neuroimaging (mean age—40.7 years). Eighty-eight (57.9%) had Cerebral infarct (males—42, females—46) while 64 (42.1%) had Hemorrhagic stroke (males—35, females—29). For those that had hemorrhagic stroke, 11 (17.2%) were Subarachnoid hemorrhage (SAH) while 52 (82.8%) were Intracerebral hemorrhage (ICH). The identified risk factors range from hypertension, DM, dyslipidemia, alcoholism, cigarette smoking, HIV infection and chronic use of coffee drinks. Sixteen patients died during the admission with case fatality rate of 10.5%. Conclusion: Stroke is actually prevalent in young adults as 1 in every 5 stroke patients seen was a young adult. In addition to the traditional risk factors, HIV/AIDS and chronic use of coffee drinks were also noted as emerging risk factors. There is need for a continuous health education and strong campaign on primary stroke prevention. Also, there is need for training of more neurologists with interest in stroke management and establishing comprehensive stroke centers at national, regional and local levels in order to contend adequately with the rising burden of stoke in young adults.
文摘Stroke etiology in young adults and older patient differs considerably, as well as epidemiology and clinical features vary according to geographical criteria. To improve clinical management and optimize diagnostic work-up of young adults with acute cerebrovascular events, we analyzed retrospectively data of 6-year stroke unit case series. In this hospital case series study, we enrolled 145 patients with acute cerebrovascular events aged 16 to 49, consecutively admitted to a Community Hospital Hub Stroke Unit. We studied risk factors for stroke, the distribution of acute cerebrovascular events, stroke subtype, length of stay and clinical outcome: 70% of patients were admitted for acute ischemic event (45 female-F, 57 male-M), 10.5% intracranial hemorrhages (5F, 10M), 2.7% subarachnoid hemorrhage (2F, 2M), 2% venous sinus thrombosis (3F), 14.5 for acute ischemic attack (12F, 9M). Among ischemic stroke patients, the etiology was as follows: atherothrombosis 29.4%, cardioembolism 19.6%, arterial dissection 13.7%, other determined causes 8.8%, lacunar stroke 5.8%, and undetermined causes 22.54%. 15% of ischemic young patients were treated with r-TPA. The majority of patients returned home at discharge, whereas 30% needed intensive rehabilitation programme to regain independence in the activity of daily living. Dedicated health care programme targeting prevention and optimizing treatment of acute cerebrovascular events in young adults are desirable to improve prognosis among this socioeconomically active age group.
文摘<span style="font-family:Verdana;">Ischemic strokes (IS), also referred to as cerebral ischemia or brain ischemia, is a significant cause to the brain cells damage or death. Approximately, 10% - 14% of ischemic strokes cases occurred in young adults. Hence, we conducted a meta-analysis to find the effective interventions to prevent the best strokes caused by cerebral infarction in young adults. The search was done in different databases, including Google scholar, PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database, Scopus, and Web of Science from January 2016 to April 2020, and only English published articles were considered. Our analysis included studies that stratified the risk of ischemic stroke by CHA2DS2-VASc score for patients with nonvalvular atrial fibrillation. Further, random effects model was used to estimate the summary annual rate of IS. Pooled relative risks and odds ratios, with their 95% confidence intervals, were calculated, respectively. The analysis was conducted using STATA (version 12), pooled effect sizes were calculated using the random-effects model and heterogeneity was tested for using the <em>I</em><sup><em>2</em></sup> statistic. The analysis included 13 studies. The analysis shows that diabetes, high blood pressure, ischemic heart disease, atrial fibrillation, hypercholesterolemia, alcohol consumption and smoking are significant risk factors. In Caucasian and Chinese ischemic stroke patients, the risk factor associations associated with ischemic stroke subtypes are similar. Compared to all other ischemia subtypes, diabetes is more familiar with aortic stroke, atrial fibrillation, ischemic heart disease (with obstruction), hypertension and diabetes. Our research shows that atrial fibrillation, ischemic heart disease, and hypercholesterolemia are low in patients with ischemic stroke and the risk factors are higher. Further analysis of each patient’s data is required to enable confounders’ adjustments to confirm and expand these findings.</span>
文摘<div style="text-align:justify;"> <span style="font-family:Verdana;"><strong>Introduction:</strong> Stroke is a major public health problem even more dramatic in young people. <strong>Goal of the study:</strong> To make our contribution to the knowledge of strokes of the young subject. <strong>Methodology:</strong> It was a retrospective study conducted over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Department of Neurology of C between Hospitalier A Sino-Central African Friendship University (CHUSCA) from Bangui. <strong>Results:</strong> During the study, 225 cases of stroke were recorded, including 26 cases in young subjects, representing a hospital frequency of 11.5%. The average age was 42.5 years with extremes ranging from 24 to 49 years. The most represented age group was 45 and 49 with a sex ratio (M/F) of 1.36. The average age for men was 41.93 years compared to 39.27 years for women. Civil servants were in the majority in 50% of the cases. Alcohol was the main FDR (80.8%) followed by hypertension (61.5%) and tobacco (50%). The majority of patients (57.70%) were admitted to neurology after the first 24 hours. Ischemic stroke represented 73.08% compared to 26.92% of AVCH. The lethality was 20.08%. The sequelae were found in 69.20% of cases. Cardiac exploration had found 57.10% of LVH. <strong>Conclusion: </strong>This study confirms a high frequency of stroke in the young subject. The predominance of modifiable FRCVs requires the implementation of a specific strategy based on awareness, early detection and effective and adequate PEC.</span> </div>
文摘Introduction: Stroke incidence in young patients is about 10 cases in 100.000, according to several European studies. In this age group arterial dissection is one of the main pathological mechanisms involved. The internal carotid’s artery (ICA) main supraclinoid branch is the anterior choroidal artery (AChA). The occurrence of infarction in its territory due to internal carotid dissection is considered to be a rare event and may have different clinical presentations due to anatomical variability. Clinical case: A 31-year-old male patient, without any known cardiovascular risk factors or chronic medication, presented with acute onset of stabbing right sided headache while practicing football. Visual disturbances and hemiparesis with hypesthesia of his left arm were also mentioned. On admission left homonymous hemianopsia, left hemiparesis and left extensor plantar reflex were present. Brain magnetic resonance showed hyperintensity of T2 and FLAIR signals and restricted diffusion pattern suggested acute/subacute infarctions in the thalamic and subcapsular area, corpus callosum, splenium and subcortical parietal right region. Magnetic resonance angiography (MRA) of the brain showed reduction of the right ICA’s caliber, mainly of its supraclinoid segment in which a marked irregular stenosis was visualized, suggestive of arterial dissection. This stenotic segment included the origin of the AChA and of the posterior communicating cerebral artery with an exchange in their territories. Lumbar puncture results were normal as were analytical investigations which included CBC, sedimentation rate, syphilis serology and immunologic and prothrombotic screen. There were no phenotype characteristics suggestive of connective tissue disease. Conclusion: Trauma seems to be the most probable lesion mechanism for the occurrence of intracranial carotid’s dissection in this particular case, as the patient was practicing vigorous sports at time of onset. In view of great anatomic variability and multiple anatomical sites supplied by the AChA its occlusion will induce a wide range of clinical manifestations.
文摘BACKGROUND Cannabis use has increased among young individuals in recent years.Although dependent cannabis use disorder(CUD)has been associated with various cardiac events,its effects on young adults without concurrent substance use remain understudied.AIM To examine trends in hospitalizations for major adverse cardiac and cerebrovascular events(MACCE)in this cohort.METHODSWe used the National Inpatient Sample(2016-2019)to identify hospitalized young individuals(18-44 years),excluding those with concurrent substance usage(tobacco,alcohol,and cocaine).They were divided into CUD+and CUD-.Using International Classification of Diseases-10 codes,we examined the trends in MACCE hospitalizations,including all-cause mortality(ACM),acute myocardial infarction(AMI),cardiac arrest(CA),and acuteischemic stroke(AIS).RESULTSOf 27.4 million hospitalizations among young adults without concurrent substance abuse,4.2%(1.1 million)hadco-existent CUD.In CUD+group,hospitalization rates for MACCE(1.71%vs 1.35%),AMI(0.86%vs 0.54%),CA(0.27%vs 0.24%),and AIS(0.49%vs 0.35%)were higher than in CUD-group(P<0.001).However,rate of ACMhospitalizations was lower in CUD+group(0.30%vs 0.44%).From 2016 to 2019,CUD+group experienced arelative rise of 5%in MACCE and 20%in AMI hospitalizations,compared to 22%and 36%increases in CUDgroup(P<0.05).The CUD+group had a 13%relative decrease in ACM hospitalizations,compared to a 10%relative rise in CUD-group(P<0.05).However,when adjusted for confounders,MACCE odds among CUD+cohort remain comparable between 2016 and 2019.CONCLUSIONThe CUD+group had higher rates of MACCE,but the rising trends were more apparent in the CUD-group overtime.Interestingly,the CUD+group had lower ACM rates than the CUD-group.
文摘Introduction: Neurological complications are possible during infective endocarditis. They are often life-threatening and can be a source of sequelae. Case Presentation: We report the case of an 11-year-old patient admitted to the cardiology department of the CHU-ME “LUXEMBOURG” in Bamako for functional impotence of the left hemibody, accompanied by fever and NYHA stage II dyspnea. The clinical examination on admission shows the poor general condition, normal consciousness, and sensory-motor deficit of the pyramidal type of the left hemibody. The cardiovascular examination notes a systolic murmur at the mitral focus, hepato-jugular reflux, hepatomegaly, and slight edema in the lower limbs. Brain CT showed localized hypodensity in favor of an ischemic stroke. The electrocardiogram shows a sinus rhythm. Transthoracic Doppler echocardiography revealed mitral insufficiency with vegetation of 17 × 14 mm on the anterior mitral valve, with left ventricular ejection fraction estimated at 75%. Dual antibiotic therapy associated with conventional treatment for heart failure was initiated. The clinical evolution was marked by the persistence of the deficit of the left upper limb, the cardiac Doppler echography of control after 6 weeks of treatment found the same vegetation. A discussion with the heart team with a view to a surgical cure has been initiated for the rest of the treatment. Conclusion: A motor deficit associated with fever related to an ischemic vascular accident should lead to a search for infective endocarditis on cardiac Doppler ultrasound.