Although stroke is usually associated with old age, the incidence of stroke in young people is increasing. It is important to understand the common causes of stroke in young people (latest definition of stroke in young people ≤35 years of age). Common and possible causes of stroke in young people include the following.
1. Atherosclerosis.
The major cause of stroke in young people is atherosclerosis. This is associated with an increasing number of young people with abnormal lipid metabolism, hypertension, diabetes, obesity, smoking, high work stress and eating a high-calorie diet.
2. Non-atherosclerotic.
(1) Arterial entrapment: Trauma is the most common cause of aneurysm of the entrapped neck vessels.
(2) Moyamoya disease: The mechanism is not clear; some cases are congenital, but it may also be related to acquired factors, such as trauma, etc. A portion of young Moyamoya is associated with atherosclerosis. The clinical presentation of patients varies widely.
The disease should be considered in pediatric and young patients with recurrent unexplained transient ischemic attacks, cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage without evidence of hypertension or atherosclerosis in clinical practice.
(3) Inflammatory diseases: Takayasu arteritis, for example, is a chronic, progressive, nonspecific inflammatory disease involving the aorta and its major branches as well as the pulmonary arteries, mostly in young women. Among them, the cephalobrachial artery type causes varying degrees of ischemia mainly in the brain and upper extremities. In severe cerebral ischemia, there may be recurrent syncope, convulsions, aphasia, hemiparesis or coma.
(4) Radiation-induced arterial disease: Radiation induction can cause arteritis, but it may also cause carotid atherosclerosis and stenosis.
3. Cardiogenic stroke
Emboli usually arise from structural lesions of the heart and are commonly associated with.
(1) Heart valve disease and endocardial lesions: mitral stenosis, reparative valves and infective endocarditis, etc.
(2) Arrhythmias: atrial fibrillation is the most common and can also be seen in sick sinus syndrome.
(3) Ovular foramen insufficiency: It accounts for a large proportion of cardiogenic strokes in young people. retrograde emboli from the venous system can enter the arterial system directly through the right-to-left shunt channel when the foramen insufficiency is present, causing cerebral embolism. foaming test of TCD is the most cost-effective imaging tool.
(4) Cardiac mucinous tumor: It is more common in women. The possibility of cardiac mucinous tumor needs to be considered in young patients with ischemic stroke, no evidence of cerebrovascular pathology, especially sinus rhythm, extensive facial freckling, and endocrine hyperactivity; especially in young women with unexplained peripheral neuropathy with vascular occlusion and inflammatory signs and negative autoantibodies.
4. Hypercoagulable state
Many patients may be associated with a then undiagnosed hypercoagulable state, which is a less common cause of ischemic stroke.
(1) Antiphospholipid syndrome: a group of clinical syndromes characterized by recurrent habitual abortion, thrombocytopenia, reticulocytosis, recurrent venous thrombosis and positive antiphospholipid antibody (APL). ischemic stroke patients with positive APL are generally characterized by young age at first onset, few comorbid other risk factors, easy recurrence and multifocal nature.
(2) Hyperviscosity: Various causes of hyperviscosity can lead to the development of ischemic stroke, such as erythrocytosis, myelodysplastic syndrome, abnormal proteinemia (myeloma, Waldenstrom disease, cryoglobulinemia), etc.
(3) Protein C and protein S deficiency: Protein S and protein C system is an important natural anticoagulation system in the body to balance the coagulation process and prevent thrombosis, and its deficiency may cause hypercoagulation of blood, thus inducing the occurrence of ischemic stroke.
5.Other
1, migraine: migraine strokes tend to occur in young women, young people with migraine combined with cerebral infarction, the reason may be related to vasospasm or hypercoagulable state with platelet increase.
2. Oral contraceptives: Estrogen in contraceptives can increase various coagulation factors in the blood, resulting in hypercoagulable blood and causing strokes.
3, idiopathic.