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  • Print publication year: 2009
  • Online publication date: May 2010

14 - Ischemic stroke in the young and in children

from Section III - Diagnostics and syndromes

Summary

Introduction

Stroke is a major public health issue because of its high frequency, the risk of death and residual physical cognitive or behavioral impairments, and the risk of recurrent vascular events that may be cerebral or cardiac [1–3]. Although strokes occur at a mean age of 75 years in Western countries [4–6], they may also occur in younger patients, and even in children [4–7]. Most strokes occurring in young patients are ischemic in origin. They account for from 2 to 12% of all strokes, depending on whether figures are provided from community- or hospital-based data [8, 9].

The main specificities of ischemic strokes in young patients are their causes, their outcome and the possibility of occurring during pregnancy. These specificities may influence the management of patients. Therapeutic options should therefore take into account the presumed cause, the natural history of the disease and the long life expectancy. The clinical deficits and acute management have no specificity in young people, and will therefore not be addressed.

Epidemiology

Figures depend on the definition of “young”. Three upper thresholds can be found in the literature, at 30, 45 and 55 years of age. The most frequently used upper age limit is 45 years. It constitutes a good compromise between an age category where common causes of cerebral ischemia, such as atheroma, atrial fibrillation and lipohyalinosis, are very rare, and on the other hand a disorder that is not too rare. The incidence of ischemic strokes increases with age even in young people: most young people with stroke are between 40 and 45 years of age [7].

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