Exploring stroke in young patients, topics include genetic features of catacil and carasil, cardiac causes of stroke, imaging in carotid dissections, Fabry's disease, vasculitis as a cause of stroke, and treatment challenges in young individuals.
Stroke also affects young individuals due to evolving risk factors.
Diverse causes like dissections and genetic disorders contribute to young strokes.
Comprehensive evaluations and tailored treatments are vital for managing strokes in the young.
Deep dives
Stroke in the Young: Demographics and Trends
10 to 15% of strokes occur in individuals under 50 years old, challenging the perception of stroke as an elderly disease. The increasing incidence of stroke in the young over the years raises concerns, potentially attributed to better diagnostic tools and a heightened awareness of modifiable risk factors like high blood pressure and diabetes.
Risk Factors and Causes of Stroke in the Young
Various risk factors contribute to stroke in the young, including large artery atherosclerosis, cardioembolism, and small vessel occlusions. Atypical causes like carotid web and cryptogenic strokes pose diagnostic challenges, emphasizing the need for a comprehensive evaluation to determine the underlying causes. Gender differences and disparities in stroke occurrence are also noteworthy.
Diagnostic Workup and Management Approaches
The diagnostic workup for stroke in the young involves imaging studies like CT and MRI scans, alongside cardiac evaluations to assess potential causes like atrial fibrillation and endocarditis. Thrombophilias, genetic predispositions, and acquired risk factors like antiphospholipid antibody syndrome also play a crucial role, guiding treatment decisions towards anticoagulation or antiplatelet therapy based on the location and characteristics of arterial dissections, a common cause of stroke in young adults.
Treatment of Dissection and Imaging Signs
Treating dissections with antithrombotic therapy is recommended, with variations in details based on individual cases. Imaging of dissections, such as the flame sign in carotid dissections, can provide distinct and interesting visuals. Differentiating between dissections and pseudo-occlusions is crucial, highlighting the importance of understanding imaging nuances.
Fabry's Disease and Myelos
Fabry's disease, an X-linked lysosomal storage disorder, results from GLA gene dysfunction, causing gloetriacylis ceramide accumulation that can lead to strokes. Symptoms include acroparathesia, angiokeratomas, and systemic issues, managed with enzyme replacement therapy. Myelos, a mitochondrial encephalomyopathy, presents with unique imaging patterns and symptoms like short stature and seizures, requiring comprehensive evaluation for diagnosis.
A discussion of evaluation and treatment of stroke in young patients, with Drs. Aaron Bower and Adam Jasne.
Note: This podcast is intended solely as an educational tool for learners, especially neurology residents. The contents should not be interpreted as medical advice.
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