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Diagnostic Strategies in Young Patients with Ischemic Stroke in Canada

Published online by Cambridge University Press:  04 August 2016

Michael T.Y. Chan ,
Zurab G. Nadareishvili ,
John W. Norris  and
Canadian Stroke Consortium
Michael T.Y. Chan
Affiliation:
Stroke Research Unit, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Canada
Zurab G. Nadareishvili*
Affiliation:
Stroke Research Unit, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Canada
John W. Norris
Affiliation:
Stroke Research Unit, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Canada
*
Stroke Branch, NIH, NINDS, 36 Convent Drive, Bldg. 36, 4A03 Bethesda, Maryland, 20892-4128 U.S.A..
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Abstract:

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Background:

A preliminary national survey of ischemic stroke in the young (15-45 years) undertaken by the Canadian Stroke Consortium indicated that in 44% of 356 patients, no cause was found.

Objective:

To determine the reason for this high incidence of diagnostic uncertainty in young patients with ischemic stroke.

Methods:

Neurologists in the ten Canadian stroke centers completed a detailed questionnaire for patients aged 15-45 years admitted to hospital between January 1993 and December 1997. Using a step-wise diagnostic algorithm incorporating clinical, neuroimaging, neurovascular and laboratory data, we divided patients into three groups: (1) those with established cause for the ischemic stroke, (2) those who remained unexplained despite adequate investigation, (3) those who remained unexplained but were, in our opinion, under-investigated.

Results:

In 197 patients (56%), an identified cause was established including cardioembolic sources (14%), extracranial arterial dissection (13%), lacunar infarcts (8%) atherosclerosis (6%). A miscellaneous group of 15%, included cerebral venous thrombosis, coagulopathies, vasculitis and others. In 159 patients (44%) with no apparent cause for their stroke, we considered only 81 (23%) adequately investigated, and 78 (21%) inadequately investigated.

Conclusion:

About one in five young patients was inadequately investigated by a stroke-oriented group of neurologists. The major problem appears to be restriction of investigations to neuroimaging alone (usually computerized cerebral tomography), without further tests such as cerebral angiography and cardiac imaging.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 2 , May 2000 , pp. 120 - 124
Copyright
Copyright © The Canadian Journal of Neurological 2000

References

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