Analysis Of Clinical Characteristics In Young Patients With Acute Cerebral Infarction

Objective: Study the risk factors ,clinical analysis and TOAST subtyping of acute cerebral infarction in young adults to further guide clinical prevention and treatment.Methods: Analysed 134 cases of clinical characteristics of young patients with acute cerebral infarction and compared them with 220 cases of old age patients. Aimed to evaluate the risk factors; Compared the prognosis by neurological examination score; Compared the laboratory tests of uric acid, high sensitivity C-reactive protein, D dimmer and fibrinogen and the imaging data. Defined the subtypes of etiology according to the TOAST classification criteria and compared them with the old patients.Result:The young cases of cerebral infarction accounted 3.6% of all patients enrolled for ischemic stroke in the same period. Percentage ratio of men (65.7%) in the young group is more than that in the old group (45.5%) (χ~2 =13.67,P <0.001);Onset in activities was more often in youth group than in older group(χ~2 =35.16,P<0.001);Risk factors: Young patients had a higher frequency of smoking (OR, 5.43; 95% CI = 3.16 ~ 9.32; P <0.001), rheumatic heart disease (OR, 15.77; 95% CI = 1.97 ~ 125.9; P <0.005), drinking ( OR, 1.89; 95% CI = 1.07 ~ 3.35; P <0.05), hypertriglyceridemia (OR, 1.80; 95% CI = 1.06 ~ 3.06; P <0.05) and a lower frequency of coronary heart disease (OR, 0.04; 95% CI = 0.01 ~ 0.12; P <0.001), stroke history (OR, 0.11; 95% CI = 0.04 ~ 0.29; P <0.001), hypercholesterolemia (OR, 0.29; 95% CI = 0.13 ~ 0.63; P <0.005), hypertension (OR, 0.29; 95% CI = 0.13 ~ 0.63; P <0.005) and density lipoprotein hyperlipidemia (OR,0.44;95%CI= 0.20～0.95 ;P<0.05)than the older patients. There was no significant difference between the two groups about the frequency of diabetes and atrial fibrillation , etc .(P> 0.05). Hypertension was found to be the main risk factor 62% (83/134) followed by cigarette smoking 40% (55/134), lipid metabolism disorders 39.6% (53/134), alcohol 21.6% (29/134) and heart disease 13.4% (18/134) in the young group; Neurological examination: Young patients'NIHSS score was less than that of the older group when admission and the mRS score was less than that of the older group either (P <0.005, P <0.05). Laboratory tests:There was no significant difference between the two groups about the deta of Hs-CRP , uric acid ,D dimer,and FIB measured in young adults with cerebral infarction and the control group; Imaging: Lobe lesions in young group were more common than in the older group (P <0.05), subcortical white matter lesions were rare than in the older group (P <0.05), There was no significant difference between the two groups about the rate of intracranial vascular abnormalities (P > 0.05),extracranial vascular abnormalities was less than older group (P <0.0001).In young patients intracranial vascular abnormalities were more common than extracranial vascular abnormalities (P<0.05); TOAST subtyping: The subtype of undetermined etiology (SUE) (P <0.0001), other determined etiology (SOE) (P <0.05) in young group were more common than the older group, large artery atherosclerosis (LAA) was rare than the older group (P <0.0001), there was no significant difference about the type of cardiac embolism (CE) and small vessel occlusion (SVO) (P> 0.05). TOAST classification in young patients constitutes Large-artery atherosclerosis(LAA)32.1%, stroke of undetermined etiology(SUE) 27.6%,small-vessel occlusion (SVO) 16.4%, cardioembolism(CE) 13.4%, and other determined etiology(SOE) accounted for 10.4%.Conclusions: 1.Young patients were more commonly male than older patients,and onset in activities was more often in youth group than in older group .2. Risk factors: Young patients had a higher frequency of smoking, rheumatic heart disease, drinking, hypertriglyceridemia and a lower frequency of coronary heart disease, stroke history, hypercholesterolemia, hypertension , density lipoprotein hyperlipidemia than the older patients. The frequency of diabetes and atrial fibrillation were same in the two groups.3. The prognosis of youth was better than older ones. 4. C-reactive protein, uric acid, coagulation testings could provide clues for diagnosis in young adults with cerebral infarction as well as old ones. Imaging: Lobe lesions in young group were more common than in the older group. The rate of intracranial vascular abnormalities was same in the two groups and extracranial vascular abnormalities in young group was less than older group. In young patients intracranial vascular abnormalities were more common than extracranial vascular abnormalities.5. TOAST subtyping: The subtype of undetermined etiology (SUE), other determined etiology (SOE) in young group were more common than the older group, large artery atherosclerosis (LAA) was rare than the older group, there was no significant difference about the type of cardiac embolism (CE) and small vessel occlusion (SVO).Large-artery atherosclerosis and stroke of undetermined etiology(SUE) were the main subtypes followed by small-vessel occlusion (SVO), cardioembolism(CE), and other determined etiology(SOE )by the TOAST classification criteria in young patients .