Abstract Background and purpose Studies of risk factors for ischemic stroke in the young have generally considered ischemic stroke as a whole. The purpose of the present study was to evaluate the ...association of traditional cardiovascular risk factors with etiological subtypes of ischemic stroke in young adults. Methods Retrospective review of data from patients aged 16–54 years consecutively treated for first-ever ischemic stroke in an academic stroke unit. Definite causes of stroke were classified using the ASCO (A for atherothrombosis, S for small vessel disease, C for cardiac source, O for other cause) classification system. We used multinomial logistic regression analysis to evaluate associations of age, gender, smoking, hypertension, diabetes and blood lipids with each etiological subtype. Results A total of 400 patients were included: 244 men (61.1%), 156 women (38.9%); mean age (SD) 44.5 (8.5) years. A definite cause of stroke could be identified in 202 (50.5%) patients. Definite causes of stroke included: atherothrombosis, 72 (18.0%) patients; cardioembolism, 37 (9.25%) patients; small vessel disease, 28 (7.0%) patients; other definite cause, 65 (16.25%) patients including 44 patients with carotid or vertebral artery dissection. Atherothrombosis was associated with age, smoking, diabetes, hypertension and low HDL-cholesterol. Small vessel disease was associated with age and hypertension. Cardioembolism was associated with age. Conclusion The risk factor profile differs between etiological subtypes of ischemic stroke in young adults. Our findings emphasize the impact of smoking, diabetes, hypertension and low HDL-cholesterol as risk factors for atherothrombosis, and of hypertension as a risk factor for small vessel disease in young adults.
Tobacco Use and Cryptogenic Stroke in Young Adults Jaffre, Aude, MD; Ruidavets, Jean Bernard, MD, PhD; Nasr, Nathalie, MD, PhD ...
Journal of stroke and cerebrovascular diseases,
12/2015, Letnik:
24, Številka:
12
Journal Article
Recenzirano
Objective: Cryptogenic stroke is the leading subtype of ischemic stroke in the young. We sought to evaluate the association between traditional cardiovascular risk factors and cryptogenic stroke by ...using a case–control study. Methods: Patients aged 18-54 years, consecutively treated for first-ever cryptogenic ischemic stroke in an academic stroke unit, were compared with subjects from the general population living in the same geographic area. Control subjects were matched for age and sex with patients. We further evaluated the association between significant risk factors and nonobstructive (<50% stenosis) carotid plaque and thrombus among patients with cryptogenic stroke. Odds ratios OR were calculated using logistic regression analysis. Results: A total of 155 patients with cryptogenic stroke (66.4% men, mean age 43.5 years SD 8.4) were included in the study. Cryptogenic stroke was associated with current tobacco use (42.6% in patients versus 23.9% in control subjects; OR = 2.38, 95% confidence interval CI 1.40-4.05, P = .002). Current tobacco use was associated with nonobstructive carotid plaque (OR = 6.22; 95% CI, 2.43-15.9; P = .001) and nonobstructive carotid thrombus (OR = 13.7; 95% CI, 1.42-132.7; P = .03) among the patients. Conclusion: Our case–control study showed a strong link between current tobacco use and cryptogenic stroke in young adults.
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension.
Case report.
We report a case of RCVS-related ICH leading to ...refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good.
RCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered.
The role of nonobstructive (<50% stenosis) carotid atherosclerosis (NOCA) in young adults with ischemic stroke is not well understood. In the present study, we investigated the prevalence and the ...ultrasonic characteristics of NOCA in a consecutive series of young adults with cryptogenic stroke (CS).
Patients aged 18-54, consecutively treated in a tertiary hospital for first-ever CS (defined as an ischemic stroke without ASCOD (A: atherosclerosis; S: small-vessel disease; C: cardiac pathology; O: other causes) grade 1 potential cause) in the carotid artery territory, were prospectively enrolled. NOCA was assessed using carotid duplex ultrasonography.
Of 148 patients with first-ever ischemic stroke, 70 had CS, including 44 patients with carotid CS. NOCA was found in 22 of 44 (50%) patients. All but 1 plaque were echolucent. NOCA was bilateral in 15 patients and unilateral in 7 patients. All unilateral plaques were on the symptomatic side (P = .02). Plaque thickness, plaque length, and plaque volume were greater on the symptomatic side than on the asymptomatic side (P = .001, P < .001, and P < .001, respectively). Discrimination between the symptomatic and the asymptomatic side using any of these plaque metrics was good with areas under the curve (95% confidence interval) of .82 (.69-0.95), .85 (.74-0.96), and .87 (.75-0.99) for plaque thickness, plaque length, and plaque volume, respectively.
NOCA is frequent in young adults with CS. Measurement of the plaque burden with carotid duplex may help to identify symptomatic NOCA.
Endothelium protection is critical, because of the impact of vascular leakage and edema on pathological conditions such as brain ischemia. Whereas deficiency of class II phosphoinositide 3‐kinase ...alpha (PI3KC2α) results in an increase in vascular permeability, we uncover a crucial role of the beta isoform (PI3KC2β) in the loss of endothelial barrier integrity following injury. Here, we studied the role of PI3KC2β in endothelial permeability and endosomal trafficking in vitro and in vivo in ischemic stroke. Mice with inactive PI3KC2β showed protection against vascular permeability, edema, cerebral infarction, and deleterious inflammatory response. Loss of PI3KC2β in human cerebral microvascular endothelial cells stabilized homotypic cell–cell junctions by increasing Rab11‐dependent VE‐cadherin recycling. These results identify PI3KC2β as a potential new therapeutic target to prevent aggravating lesions following ischemic stroke.
SYNOPSIS
This study reveals that PI3KC2β inactivation in mice confers protection against blood brain barrier leakage and inflammation in stroke models, thereby identifying PI3KC2β as a potential therapeutic target for treatment of ischemic injury.
PI3KC2β inactivation preserves blood brain barrier integrity against reperfusion lesions in mice models of ischemic stroke.
Mice with an inactive PI3KC2β are protected against vascular permeability, edema, cerebral infarction and inflammation in ischemia/reperfusion stroke model.
PI3KC2β knockdown in endothelial cells promotes expansion of very early (APPL1+) endosomes, favor recycling endosomes (Rab11+) and enhances VE‐cadherin expression at the plasma membrane.
This study reveals that PI3KC2β inactivation in mice confers protection against blood brain barrier leakage and inflammation in stroke models, thereby identifying PI3KC2β as a potential therapeutic target for treatment of ischemic injury.
BACKGROUNDReversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracerebral hemorrhage (ICH) causing intracranial hypertension. METHODSCase report. RESULTSWe report a case of ...RCVS-related ICH leading to refractory intracranial hypertension. A decompressive craniectomy was performed to control intracranial pressure. We discuss here the management of RCVS with intracranial hypertension. Decompressive craniectomy was preformed to avoid the risky option of high cerebral perfusion pressure management with the risk of bleeding, hemorrhagic complications, and high doses of norepinephrine. Neurological outcome was good. CONCLUSIONRCVS has a complex pathophysiology and can be very difficult to manage in cases of intracranial hypertension. Decompressive craniectomy should probably be considered.
Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, ...few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.
In order to understand the impact of human activities on soil microbial diversity, we investigated bacterial communities in samples recovered from four New Caledonia environments that have been ...disturbed by varying degrees of nickel mining associated activities: an undisturbed area with natural soil (characterized by pristine vegetation), a mine spoil (devoid of vegetation), two revegetated mine spoils by endemic plants. For each sample, total DNA was extracted and 16S rDNA clone library were constructed. 442 clones were sequenced and analyzed. Using these clones, diversity was estimated not only in terms of species richness (non-parametric estimators) and evenness (Reciprocal of Simpson's index), but also in terms of phylogenetic diversity (LIBSHUFF program). Statistically significant differences were detected in phylogenetic composition between mine spoils and natural soil (
p
=
0.001), between revegetated soils and natural soil (
p
=
0.001), and between revegetated soils and mine spoils (
p
=
0.001). On the other hand, no significant differences in species richness were observed between the different environmental samples.
These findings provide insights into the response of bacterial community following environmental perturbations caused by nickel-mining activities and revegetation efforts.
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