IschemicStrokeinYoungadultDefinition：16-45y/oDistribution：3-4%ofallstrokeEtiology,clinicalmanifestation,andprognosisaredifferentfromelderlyItisimportanttofindtheetiologicfactorandtreatthemadequatelyforpreventingtherecurrence

OrvHetil2001Mar25;142(12):607-10IschemicStrokeinYoungadult1EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM2EpidemiologyTable1.AverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994From:

Kristensen:Stroke,Volume28(9).September1997.1702-1709Epidemiology3EpidemiologyTable1.AgesofYoungMenandWomenWithIschemicStrokeArchNeurol.1995;52:491-495Epidemiology4EtiologyAtherosclerosis

isthemaincauseofstrokein

elderly,while

emboligenouscardiopathy

istheoneofthemaincauseof

youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism

wasthemostcommoncauseofstrokeinp’t

youngerthan40

Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%

ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe5EtiologyAtherosclerosis33.3%,Prothromboticstate15.5%,Cardiogenic9.5%

OrvHetil2001Mar25;142(12):607-10Atherosclerosis29.8%,Cardioembolism19.5%,Hematologic5.8%

ArchNeurol.1995;52:491-495SocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsCausearediverseEtiologyAtherosclerosis33.3%,6EtiologyEtiology7AMI/LVaneurysm:Coagulopathy:Inflammatory:Atherosclerosiswas38.Overall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.AtaxiahemiparalysisdeterioratLargearteryb.SuddenonsetofcorticalimpairmentRiskfactorNon-cardiogenicHemologicaldisorder:Non-inflammatoryLargearteryb.MDS:CML,polycythemiavera,essentialthrombocythemiaInflammatory:7%(within28days)4.Dramaticincreasedafter45inotherreportInfectious:Syphiliticarteritis,TB,HIV-associatedEtiologyAMI/LVaneurysm:Etiology8EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:9EtiologyEmbolism:

a.Cardiogenic:1.Valvular:RH,prosthetic,endocarditis,MVP2.Arrhythmia:Af,sicksinussyndrome3.AMI/LVaneurysm:4.LVmyxoma:5.Cardiomyopathy:EtiologyEmbolism:10Annualincidence：11.Casefatalityrate：5.Inflammatory:Atherosclerosis33.Dramaticincreasedafter45inotherreportNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.ArchNeurol.PuremotorhemiparesisAverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994Hemologicaldisorder:EpidermiologySocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsHematologicaldisorder:involvementAnnaliItalianidiMedicinaInterna.5%,Cardiogenic9.Definition：16-45y/oRiskfactorAnnaliItalianidiMedicinaInterna.Hemologicaldisorder:Dramaticincreasedafter45inotherreportHyperlipidemiaEtiologyEmbolism:b.Non-cardiogenic:1.PulmonaryAVM:Osler-Weber-Rendusyndrome2.ASD/VSDorPOFwithshunt:3.Pulmonaryembolism:Annualincidence：11.EtiologyEm11EtiologyNon-atherosclerosisarteriopathy:a.Inflammatory:1.Takayasu’sdisease:=Granulomatousarteritis,mono,無脈癥2.Hepersensitivearteritis:Churg-straussdisease3.Infectious:Syphiliticarteritis,TB,HIV-associated4.Drugrelated:heroin,amphetamine5.Systemicdisease:SLE,RA,polyarteritisnodosaEtiologyNon-atherosclerosisar12EtiologyNon-atherosclerosisarteriopathy:

a.Non-inflammatory:1.Moyamoyadisease:2.Arterydissection:3.Irradiationvasculopathy:4.Fibromusculardysplasia:5.Firinoidvasculopathy:EtiologyNon-atherosclerosisar13EtiologyHematologicaldisorder:a.Viscosity:1.MDS:CML,polycythemiavera,essentialthrombocythemia2.Multiplemyeloma:3.Leukemiab.Coagulopathy:

EtiologyHematologicaldisorder14EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder15EtiologyOthers:1.Migraine2.Pregnancy3.TraumaEtiologyOthers:16青缺血性卒中最新版課件17RiskFactorStroke,Volume28(9).September1997.1702-1709

RiskFactor18RiskfactorAgreedbymostreportersare:1.Cigarettesmoking2.Hypertension3.Hyperlipidemia

OrvHetil2001Mar25;142(12):607-10Postgraduatemedicine.81(5):141-4,149-511987Apr.

ActaNeurologicaScandinavica.101(1):19-24,Jan2000

RiskfactorAgreedbymostrepo19ClinicalPresentationEmbolism:1.Suddenonsetofcorticalimpairment2.Heartconditionpredisposingtoembolism3.Maybefluctuated,andmayrecoverordeterioratClinicalPresentationEmbolism:20ClinicalPresentationLargearteryatherosclerosis:1.Cerebralcorticalimpairment:aphasia,apraxia,anopia,agnosia,restrictedmotorinvolvement2.Historyofintermittentclaudication,TIA

ClinicalPresentationLargeart21e.d.EpidermiologyArchNeurol.Hematologicaldisorder:CT/MRI/angiographyMoyamoyadisease:1991-May1996,totally88casesNon-inflammatoryDistribution：3-4%ofallstrokeClinicalPresentationCardiogenic:Non-cardiogenicIschemicStrokeinYoungadultOrvHetil2001Mar25;142(12):607-101991-May1996,totally88casesPuremotorhemiparesisNon-inflammatoryProteinC/SdeficiencyValvular:RH,prosthetic,endocarditis,MVP101(1):19-24,Jan2000Atherosclerosis29.ClinicalPresentationSmallarteryocclusion(lacunae)1.Traditionalclinicallacunarsyndromea.Puremotorhemiparesisb.Puresensorystrokec.Ataxiahemiparalysisd.Dysarthria-clumsyhande.Sensorymotorstroke2.HistoryofHTNandDMsupportsDxe.ClinicalPresentationSmalla22PrognosisFirst28daysmortality:4.8/5.7%Neurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.1/3;6moAlthoughinfarctsizeusuallybigger(>3cm)Recurrenceriskislow:1.1-1.2annuallyOverall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.PrognosisFirst28daysmortali23AdvisedClinicalStudyCT/MRI/angiography12leadEKGEchocardiogram/TEEDupplex(carotidandICdoppler)BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…AdvisedClinicalStudyCT/MRI/a24ConclusionIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.

AnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarConclusionIschemiastrokeiny25EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM26EtiologyAtherosclerosis

isthemaincauseofstrokein

elderly,while

emboligenouscardiopathy

istheoneofthemaincauseof

youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism

wasthemostcommoncauseofstrokeinp’t

youngerthan40

Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%

ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe27EtiologyEtiology28EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:29EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder30Casefatalityrate：5.Etiology,clinicalmanifestation,andprognosisaredifferentfromelderlyAntithrombinIIIdeficiencyNon-cardiogenicDramaticincreasedafter45inotherreportDupplex(carotidandICdoppler)EpidemiologyAMI/LVaneurysm:7%(within28days)4.Coagulopathy:ActaNeurologicaScandinavica.Viscosityb.Dramaticincreasedafter45inotherreportCardiogenicb.Coagulopathy:Hemologicaldisorder:SocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsClinicalPresentationTakayasu’sdisease:=Granulomatousarteritis,mono,無脈癥Cardiogenicb.PuresensorystrokeLargearteryb.Increasedwithage：especiallyafter35y/oSystemicdisease:SLE,RA,polyarteritisnodosaRiskfactorLargearteryb.Arterydissection:1991-May1996,totally88casesCardiogenicb.PuremotorhemiparesisembolismIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.Atherosclerosis:SuddenonsetofcorticalimpairmentAntithrombinIIIdeficiencySmallarteryocclusion(lacunae)Infectious:Syphiliticarteritis,TB,HIV-associatedCardiogenicb.ClinicalPresentationCoagulopathy:IschemicStrokeinYoungadult5%,Hematologic5.RiskfactorNon-atherosclerosisarteriopathy:Infectious:Syphiliticarteritis,TB,HIV-associated1991-May1996,totally88casesDefinition：16-45y/oClinicalPresentationSuddenonsetofcorticalimpairmentAtherosclerosiswas38.Hematologicaldisorder:ProteinC/SdeficiencyRiskfactorEpidermiologyArchNeurol.Casefatalityrate：5.ProteinC/SdeficiencyDramaticincreasedafter45inotherreportAtherosclerosiswas38.Hematologicaldisorder:Riskfactor101(1):19-24,Jan2000.From:

Kristensen:Stroke,Volume28(9).Moyamoyadisease:Infectious:Syphiliticarteritis,TB,HIV-associatedProteinC/SdeficiencySystemicdisease:SLE,RA,polyarteritisnodosaCasefatalityrate：5.embolismInflammatory:ClinicalPresentationPuremotorhemiparesisAtherosclerosis29.Cardiogenicb.11(1):33-8,1996Jan-Mar30(11):2320-5,1999Nov.8inNeuroNeurochirpol2000Nov-Dec;7%(within28days)4.d.AnnaliItalianidiMedicinaInterna.OrvHetil2001Mar25;142(12):607-10Definition：16-45y/oCT/MRI/angiography7%(within28days)4.AdvisedClinicalStudy101(1):19-24,Jan2000.Infectious:Syphiliticarteritis,TB,HIV-associatedValvular:RH,prosthetic,endocarditis,MVPIncreasedwithage：especiallyafter35y/oMDS:CML,polycythemiavera,essentialthrombocythemiaCoagulopathy:Atherosclerosiswas38.Overall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.3/10000013.Stroke.AdvisedClinicalStudyOrvHetil2001Mar25;142(12):607-10OrvHetil2001Mar25;142(12):607-10Atherosclerosisisthemaincauseofstrokeinelderly,whileemboligenouscardiopathyistheoneofthemaincauseofyoungadultc.EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.Coagulopathy:Dramaticincreasedafter45inotherreportLargearteryatherosclerosis:Smallarteryocclusion(lacunae)Infectious:Syphiliticarteritis,TB,HIV-associatedAverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994ClinicalPresentation7%(within28days)4.5%,Hematologic5.Atherosclerosiswas38.d.OrvHetil2001Mar25;142(12):607-10AdvisedClinicalStudyInflammatory:1991-May1996,totally88casesValvular:RH,prosthetic,endocarditis,MVP30(11):2320-5,1999Nov.September1997.Ischemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.Overall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.apraxia,anopia,agnosia,restrictedmotorAtherosclerosisisthemaincauseofstrokeinelderly,whileemboligenouscardiopathyistheoneofthemaincauseofyoungadultKristensen:Stroke,Volume28(9).101(1):19-24,Jan2000.Definition：16-45y/oAnnaliItalianidiMedicinaInterna.Inflammatory:1991-May1996,totally88cases101(1):19-24,Jan2000AdvisedClinicalStudyCT/MRI/angiography12leadEKGEchocardiogram/TEEDupplex(carotidandICdoppler)BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…Casefatalityrate：5.Largeart31IschemicStrokeinYoungadultDefinition：16-45y/oDistribution：3-4%ofallstrokeEtiology,clinicalmanifestation,andprognosisaredifferentfromelderlyItisimportanttofindtheetiologicfactorandtreatthemadequatelyforpreventingtherecurrence

OrvHetil2001Mar25;142(12):607-10IschemicStrokeinYoungadult32EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM33EpidemiologyTable1.AverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994From:

Kristensen:Stroke,Volume28(9).September1997.1702-1709Epidemiology34EpidemiologyTable1.AgesofYoungMenandWomenWithIschemicStrokeArchNeurol.1995;52:491-495Epidemiology35EtiologyAtherosclerosis

isthemaincauseofstrokein

elderly,while

emboligenouscardiopathy

istheoneofthemaincauseof

youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism

wasthemostcommoncauseofstrokeinp’t

youngerthan40

Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%

ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe36EtiologyAtherosclerosis33.3%,Prothromboticstate15.5%,Cardiogenic9.5%

OrvHetil2001Mar25;142(12):607-10Atherosclerosis29.8%,Cardioembolism19.5%,Hematologic5.8%

ArchNeurol.1995;52:491-495SocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsCausearediverseEtiologyAtherosclerosis33.3%,37EtiologyEtiology38AMI/LVaneurysm:Coagulopathy:Inflammatory:Atherosclerosiswas38.Overall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.AtaxiahemiparalysisdeterioratLargearteryb.SuddenonsetofcorticalimpairmentRiskfactorNon-cardiogenicHemologicaldisorder:Non-inflammatoryLargearteryb.MDS:CML,polycythemiavera,essentialthrombocythemiaInflammatory:7%(within28days)4.Dramaticincreasedafter45inotherreportInfectious:Syphiliticarteritis,TB,HIV-associatedEtiologyAMI/LVaneurysm:Etiology39EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:40EtiologyEmbolism:

a.Cardiogenic:1.Valvular:RH,prosthetic,endocarditis,MVP2.Arrhythmia:Af,sicksinussyndrome3.AMI/LVaneurysm:4.LVmyxoma:5.Cardiomyopathy:EtiologyEmbolism:41Annualincidence：11.Casefatalityrate：5.Inflammatory:Atherosclerosis33.Dramaticincreasedafter45inotherreportNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.ArchNeurol.PuremotorhemiparesisAverageAnnualAge-andSex-SpecificIncidenceRatesofFirstIschemicStrokeinYoungAdultsinNorthernSweden,1991to1994Hemologicaldisorder:EpidermiologySocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsHematologicaldisorder:involvementAnnaliItalianidiMedicinaInterna.5%,Cardiogenic9.Definition：16-45y/oRiskfactorAnnaliItalianidiMedicinaInterna.Hemologicaldisorder:Dramaticincreasedafter45inotherreportHyperlipidemiaEtiologyEmbolism:b.Non-cardiogenic:1.PulmonaryAVM:Osler-Weber-Rendusyndrome2.ASD/VSDorPOFwithshunt:3.Pulmonaryembolism:Annualincidence：11.EtiologyEm42EtiologyNon-atherosclerosisarteriopathy:a.Inflammatory:1.Takayasu’sdisease:=Granulomatousarteritis,mono,無脈癥2.Hepersensitivearteritis:Churg-straussdisease3.Infectious:Syphiliticarteritis,TB,HIV-associated4.Drugrelated:heroin,amphetamine5.Systemicdisease:SLE,RA,polyarteritisnodosaEtiologyNon-atherosclerosisar43EtiologyNon-atherosclerosisarteriopathy:

a.Non-inflammatory:1.Moyamoyadisease:2.Arterydissection:3.Irradiationvasculopathy:4.Fibromusculardysplasia:5.Firinoidvasculopathy:EtiologyNon-atherosclerosisar44EtiologyHematologicaldisorder:a.Viscosity:1.MDS:CML,polycythemiavera,essentialthrombocythemia2.Multiplemyeloma:3.Leukemiab.Coagulopathy:

EtiologyHematologicaldisorder45EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder46EtiologyOthers:1.Migraine2.Pregnancy3.TraumaEtiologyOthers:47青缺血性卒中最新版課件48RiskFactorStroke,Volume28(9).September1997.1702-1709

RiskFactor49RiskfactorAgreedbymostreportersare:1.Cigarettesmoking2.Hypertension3.Hyperlipidemia

OrvHetil2001Mar25;142(12):607-10Postgraduatemedicine.81(5):141-4,149-511987Apr.

ActaNeurologicaScandinavica.101(1):19-24,Jan2000

RiskfactorAgreedbymostrepo50ClinicalPresentationEmbolism:1.Suddenonsetofcorticalimpairment2.Heartconditionpredisposingtoembolism3.Maybefluctuated,andmayrecoverordeterioratClinicalPresentationEmbolism:51ClinicalPresentationLargearteryatherosclerosis:1.Cerebralcorticalimpairment:aphasia,apraxia,anopia,agnosia,restrictedmotorinvolvement2.Historyofintermittentclaudication,TIA

ClinicalPresentationLargeart52e.d.EpidermiologyArchNeurol.Hematologicaldisorder:CT/MRI/angiographyMoyamoyadisease:1991-May1996,totally88casesNon-inflammatoryDistribution：3-4%ofallstrokeClinicalPresentationCardiogenic:Non-cardiogenicIschemicStrokeinYoungadultOrvHetil2001Mar25;142(12):607-101991-May1996,totally88casesPuremotorhemiparesisNon-inflammatoryProteinC/SdeficiencyValvular:RH,prosthetic,endocarditis,MVP101(1):19-24,Jan2000Atherosclerosis29.ClinicalPresentationSmallarteryocclusion(lacunae)1.Traditionalclinicallacunarsyndromea.Puremotorhemiparesisb.Puresensorystrokec.Ataxiahemiparalysisd.Dysarthria-clumsyhande.Sensorymotorstroke2.HistoryofHTNandDMsupportsDxe.ClinicalPresentationSmalla53PrognosisFirst28daysmortality:4.8/5.7%Neurologicaldeficit(Canadianneurologicalscale)andhandicapseverity(Rankinclassification,Barthelindex)areallmuchbetterthanelderly.1/3;6moAlthoughinfarctsizeusuallybigger(>3cm)Recurrenceriskislow:1.1-1.2annuallyOverall,prognosisismuchbetter,soaggressivetreatmentinterventionisimportant.PrognosisFirst28daysmortali54AdvisedClinicalStudyCT/MRI/angiography12leadEKGEchocardiogram/TEEDupplex(carotidandICdoppler)BCS,rheumaticprofile,autoimmuneprofile,coagulationprofile…AdvisedClinicalStudyCT/MRI/a55ConclusionIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.

AnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarConclusionIschemiastrokeiny56EpidermiologyNorthernSwedenMonica,13thirdlevelandlocalhospital,age18-44y/o,fromJan.1991-May1996,totally88casesAnnualincidence：11.3/10000013.6mvs8.9wCasefatalityrate：5.7%(within28days)4.8inNeuroNeurochirpol2000Nov-Dec;Increasedwithage：especiallyafter35y/oDramaticincreasedafter45inotherreportKristensen:Stroke,Volume28(9).September1997.1702-1709EpidermiologyNorthernSwedenM57EtiologyAtherosclerosis

isthemaincauseofstrokein

elderly,while

emboligenouscardiopathy

istheoneofthemaincauseof

youngadultAnnaliItalianidiMedicinaInterna.11(1):33-8,1996Jan-MarCardiacembolism

wasthemostcommoncauseofstrokeinp’t

youngerthan40

Stroke.30(11):2320-5,1999Nov.20018350Atherosclerosiswas38.2%andcardioembolismwas18.1%

ActaNeurologicaScandinavica.101(1):19-24,Jan2000.EtiologyAtherosclerosisisthe58EtiologyEtiology59EtiologyAtherosclerosis:a.Largearteryb.SmallarteryEmbolism:a.Cardiogenicb.Non-cardiogenicNon-Atherosclerosisartriopathy:a.Inflammatoryb.Non-inflammatoryHemologicaldisorder:a.Viscosityb.CoagulopathyOthers:EtiologyAtherosclerosis:60EtiologyHematologicaldisorder:b.Coagulopathy:1.Hemoglobindisorder2.ProteinC/Sdeficiency3.AntithrombinIIIdeficiency4.DIC5.Anti-phospholipidantibodyEtiologyHematologicaldisorder61Casefatalityrate：5.Etiology,clinicalmanifestation,andprognosisaredifferentfromelderlyAntithrombinIIIdeficiencyNon-cardiogenicDramaticincreasedafter45inotherreportDupplex(carotidandICdoppler)EpidemiologyAMI/LVaneurysm:7%(within28days)4.Coagulopathy:ActaNeurologicaScandinavica.Viscosityb.Dramaticincreasedafter45inotherreportCardiogenicb.Coagulopathy:Hemologicaldisorder:SocardioembolismandatherosclerosisaretowmajorcauseofstrokeinyoungadultsClinicalPresentationTakayasu’sdisease:=Granulomatousarteritis,mono,無脈癥Cardiogenicb.PuresensorystrokeLargearteryb.Increasedwithage：especiallyafter35y/oSystemicdisease:SLE,RA,polyarteritisnodosaRiskfactorLargearteryb.Arterydissection:1991-May1996,totally88casesCardiogenicb.PuremotorhemiparesisembolismIschemiastrokeinyoungadultsmustbestudiedwithadifferentprotocolfromthatusedfortheelderly,duetothedifferenceoftheetiologyandtheprognosis.Atherosclerosis:SuddenonsetofcorticalimpairmentAntithrombinIIIdeficiencySmallarteryocclusion(lacunae)Infectious:Syphiliticarteritis,TB,HIV-associatedCardiogenicb.ClinicalPresentationCoagulopathy:IschemicStrokeinYoungadult5%,Hematologic5.RiskfactorNon-atherosclerosisarteriopathy:Infectious:Syphiliticarteritis,TB,HIV-associated1991-May1996,totally88casesDefinition：16-45y/oClinicalPresentationSuddenonsetofcorticalimpairmentAtherosclerosiswas38.Hematologicaldisorder:ProteinC/SdeficiencyRiskfactorEpidermiologyArchNeurol.Casefatalityrat