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    Long-Term Prognosis of Ischemic Stroke in Young Adults

    • Qiqi Wang
    • Lixin Zhou
    • Jun Nib


    Abstract

    In recent years, the prevalence of ischemic stroke in young adults has been rising, which is of great significance to public health. In young stroke patients, the long-term effects on neurological, psychological, and social functioning are incalculable. This article reviews the latest knowledge on the prognosis of young ischemic stroke, with a particular focus on the long-term prognosis and socio-economic issues of young individuals who have experienced an ischemic stroke. The review revealed that young patients with ischemic stroke have a significantly higher long-term mortality rate compared to the general population of the same age and gender. The majority of these deaths are caused by cardiovascular issues. The overall occurrence rate of subsequent stroke can reach up to 9.4%~11.5% over 5 years and up to 19.4%~21.6% within 10 years. Among young stroke patients with atherosclerosis, cardioembolism, and multiple vascular risk factors, the risk of mortality and recurrent vascular events increased, whereas cryptogenic stroke was associated with the lowest risk of recurrent cerebrovascular events. During extended periods of observation, young individuals who have experienced a stroke frequently encounter additional negative long-term effects, such as epilepsy, cognitive decline, depression, and difficulties in returning to work. Overall, the outlook for young individuals with ischemic stroke in the long term is generally unfavorable, with the specific outcome depending on the cause and risk factors of the stroke. Early detection and proactive management of risk factors, together with the improvement of primary and secondary prevention and treatment, are essential in minimizing the impact of stroke on young individuals in the future.

    Keywords: Ischemic stroke Young adults Prognosis Long-term.
    Section

    References

    1. 1.Nedeltchev K, der Maur TA, Georgiadis D, et al. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005;76(2):191-195. doi:10.1136/jnnp.2004.040543
    2. 2.George MG, Tong X, Bowman BA. Prevalence of Cardiovascular Risk Factors and Strokes in Younger Adults. JAMA Neurology. 2017;74(6):695-703. doi:10.1001/jamaneurol.2017.0020
    3. 3.Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. The Lancet. 2014;383(9913):245-255. doi:10.1016/S0140-6736(13)61953-4
    4. 4.Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. The Lancet Neurology. 2009;8(4):355-369. doi:10.1016/S1474-4422(09)70025-0
    5. 5.Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009;40(4):1195-1203. doi:10.1161/STROKEAHA.108.529883
    6. 6.Kappelle LJ, Adams HP, Heffner ML, Torner JC, Gomez F, Biller J. Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke. 1994;25(7):1360-1365. doi:10.1161/01.str.25.7.1360
    7. 7.von Sarnowski B, Putaala J, Grittner U, et al. Lifestyle risk factors for ischemic stroke and transient ischemic attack in young adults in the Stroke in Young Fabry Patients study. Stroke. 2013;44(1):119-125. doi:10.1161/STROKEAHA.112.665190
    8. 8.Williams LS, Garg BP, Cohen M, Fleck JD, Biller J. Subtypes of ischemic stroke in children and young adults. Neurology. 1997;49(6):1541-1545. doi:10.1212/wnl.49.6.1541
    9. 9.Ferro JM, Massaro AR, Mas JL. Aetiological diagnosis of ischaemic stroke in young adults. The Lancet Neurology. 2010;9(11):1085-1096. doi:10.1016/S1474-4422(10)70251-9
    10. 10.Rutten-Jacobs LCA, Maaijwee NAM, Arntz RM, et al. Risk factors and prognosis of young stroke. The FUTURE study: a prospective cohort study. Study rationale and protocol. BMC Neurol. 2011;11:109. doi:10.1186/1471-2377-11-109
    11. 11.George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol. 2011;70(5):713-721. doi:10.1002/ana.22539
    12. 12.Vangen-Lønne AM, Wilsgaard T, Johnsen SH, Carlsson M, Mathiesen EB. Time trends in incidence and case fatality of ischemic stroke: the tromsø study 1977-2010. Stroke. 2015;46(5):1173-1179. doi:10.1161/STROKEAHA.114.008387
    13. 13.Zhang R, Liu H, Pu L, et al. Global Burden of Ischemic Stroke in Young Adults in 204 Countries and Territories. Neurology. 2023;100(4):e422-e434. doi:10.1212/WNL.0000000000201467
    14. 14.Fonseca AC, Ferro JM. Drug abuse and stroke topical collection on stroke. Current Neurology and Neuroscience Reports. 2013;13(2). doi:10.1007/s11910-012-0325-0
    15. 15.Yesilot Barlas N, Putaala J, Waje-Andreassen U, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013;20(11):1431-1439. doi:10.1111/ene.12228
    16. 16.Rolfs A, Fazekas F, Grittner U, et al. Acute cerebrovascular disease in the young: the Stroke in Young Fabry Patients study. Stroke. 2013;44(2):340-349. doi:10.1161/STROKEAHA.112.663708
    17. 17.Jacob MA, Ekker MS, Allach Y, et al. Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults—A Worldwide Meta-analysis: The GOAL Initiative. Neurology. 2022;98(6):e573-e588. doi:10.1212/WNL.0000000000013195
    18. 18.Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke. 2014;45(7):2160-2236. doi:10.1161/STR.0000000000000024
    19. 19.Wu X, Zou Y, You S, Zhang Y. Distribution of risk factors of ischemic stroke in Chinese young adults and its correlation with prognosis. BMC Neurol. 2022;22(1):26. doi:10.1186/s12883-022-02552-1
    20. 20.Fonarow GC, Reeves MJ, Zhao X, et al. Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation. 2010;121(7):879-891. doi:10.1161/CIRCULATIONAHA.109.892497
    21. 21.Varona JF, Bermejo F, Guerra JM, Molina JA. Long-term prognosis of ischemic stroke in young adults. Study of 272 cases. J Neurol. 2004;251(12):1507-1514. doi:10.1007/s00415-004-0583-0
    22. 22.Naess H, Nyland H i., Thomassen L, Aarseth J, Nyland G, Myhr KM. Incidence and Short-Term Outcome of Cerebral Infarction in Young Adults in Western Norway. Stroke. 2002;33(8):2105-2108. doi:10.1161/01.STR.0000023888.43488.10
    23. 23.Schneider S, Vibo R, Taba N, Kõrv J. Mortality in young adult patients with acute ischaemic stroke. Acta Neurol Scand. 2020;141(3):242-249. doi:10.1111/ane.13217
    24. 24.Ferro JM, Crespo M. Prognosis after transient ischemic attack and ischemic stroke in young adults. Stroke. 1994;25(8):1611-1616. doi:10.1161/01.str.25.8.1611
    25. 25.Brouwer J, Smaal JA, Emmer BJ, et al. Endovascular Thrombectomy in Young Patients With Stroke: A MR CLEAN Registry Study. Stroke. 2022;53(1):34-42. doi:10.1161/STROKEAHA.120.034033
    26. 26.Rutten-Jacobs LCA, Arntz RM, Maaijwee NAM, et al. Long-term Mortality After Stroke Among Adults Aged 18 to 50 Years. JAMA. 2013;309(11):1136-1144. doi:10.1001/jama.2013.842
    27. 27.Leys D, Bandu L, Hénon H, et al. Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology. 2002;59(1):26-33. doi:10.1212/wnl.59.1.26
    28. 28.Marini C, Totaro R, Carolei A. Long-term prognosis of cerebral ischemia in young adults. National Research Council Study Group on Stroke in the Young. Stroke. 1999;30(11):2320-2325. doi:10.1161/01.str.30.11.2320
    29. 29.Waje-Andreassen U, Naess H, Thomassen L, Eide GE, Vedeler CA. Long-term mortality among young ischemic stroke patients in western Norway. Acta Neurol Scand. 2007;116(3):150-156. doi:10.1111/j.1600-0404.2007.00822.x
    30. 30.Ekker MS, Verhoeven JI, Vaartjes I, Jolink WMT, Klijn CJM, de Leeuw FE. Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality. JAMA. 2019;321(21):2113-2123. doi:10.1001/jama.2019.6560
    31. 31.Putaala J, Curtze S, Hiltunen S, Tolppanen H, Kaste M, Tatlisumak T. Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke: the Helsinki Young Stroke Registry. Stroke. 2009;40(8):2698-2703. doi:10.1161/STROKEAHA.109.554998
    32. 32.Putaala J, Haapaniemi E, Metso AJ, et al. Recurrent ischemic events in young adults after first-ever ischemic stroke. Ann Neurol. 2010;68(5):661-671. doi:10.1002/ana.22091
    33. 33.Camerlingo M, Casto L, Censori B, et al. Recurrence after first cerebral infarction in young adults. Acta Neurol Scand. 2000;102(2):87-93. doi:10.1034/j.1600-0404.2000.102002087.x
    34. 34.Rutten-Jacobs LCA, Maaijwee NAM, Arntz RM, et al. Long-term risk of recurrent vascular events after young stroke: The FUTURE study. Annals of Neurology. 2013;74(4):592-601. doi:10.1002/ana.23953
    35. 35.Spengos K, Vemmos K. Risk factors, etiology, and outcome of first-ever ischemic stroke in young adults aged 15 to 45 - the Athens young stroke registry. Eur J Neurol. 2010;17(11):1358-1364. doi:10.1111/j.1468-1331.2010.03065.x
    36. 36.Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. The Lancet Neurology. 2018;17(9):790-801. doi:10.1016/S1474-4422(18)30233-3
    37. 37.Verburgt E, Hilkens NA, Ekker MS, et al. Short-Term and Long-Term Risk of Recurrent Vascular Event by Cause After Ischemic Stroke in Young Adults. JAMA Netw Open. 2024;7(2):e240054. doi:10.1001/jamanetworkopen.2024.0054
    38. 38.Verhoeven JI, van Lith TJ, Ekker MS, et al. Long-term Risk of Bleeding and Ischemic Events After Ischemic Stroke or Transient Ischemic Attack in Young Adults. Neurology. 2022;99(6):e549-e559. doi:10.1212/WNL.0000000000200808
    39. 39.Broman J, Fandler-Höfler S, von Sarnowski B, et al. Long-term risk of recurrent vascular events and mortality in young stroke patients: Insights from a multicenter study. Eur J Neurol. 2023;30(9):2675-2683. doi:10.1111/ene.15850
    40. 40.Wang L, Ge J, Chen Y, et al. Predictors for the prognosis and recurrence of ischaemic stroke among young Chinese patients: a cohort study. BMJ Open. 2022;12(5):e052289. doi:10.1136/bmjopen-2021-052289
    41. 41.Roivainen R, Haapaniemi E, Putaala J, Kaste M, Tatlisumak T. Young adult ischaemic stroke related acute symptomatic and late seizures: risk factors. Eur J Neurol. 2013;20(9):1247-1255. doi:10.1111/ene.12157
    42. 42.Arntz RM, Maaijwee NAM, Rutten-Jacobs LCA, et al. Epilepsy after TIA or stroke in young patients impairs long-term functional outcome. Neurology. 2013;81(22):1907-1913. https://n.neurology.org/content/neurology/81/22/1907.full.pdf
    43. 43.Menon B, Shorvon SD. Ischaemic stroke in adults and epilepsy. Epilepsy Res. 2009;87(1):1-11. doi:10.1016/j.eplepsyres.2009.08.007
    44. 44.Schaapsmeerders P, Maaijwee NAM, van Dijk EJ, et al. Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke. 2013;44(6):1621-1628. doi:10.1161/STROKEAHA.111.000792
    45. 45. 王少石, 周新雨, 朱春燕. 卒中后抑郁临床实践的中国专家共识. 中国卒中杂志. 2016;(8):9.
    46. 46.史宇, 杨冬冬, 黄国志, 吴文. 卒中后抑郁发病机制及相关影响因素. 实用医学杂志. 2016;032(006):867-869.
    47. 47.Eriksson M, Glader EL, Norrving B, Asplund K. Poststroke suicide attempts and completed suicides: a socioeconomic and nationwide perspective. Neurology. 2015;84(17):1732-1738. doi:10.1212/WNL.0000000000001514
    48. 48.Chung JH, Kim JB, Kim JH. Suicidal ideation and attempts in patients with stroke: a population-based study. J Neurol. 2016;263(10):2032-2038. doi:10.1007/s00415-016-8231-z
    49. 49.Kapoor A, Scott C, Lanctot KL, et al. Symptoms of depression and cognitive impairment in young adults after stroke/transient ischemic attack. Psychiatry Research. 2019;279:361-363. doi:10.1016/j.psychres.2019.06.022
    50. 50.Röding J, Glader EL, Malm J, Lindström B. Life satisfaction in younger individuals after stroke: different predisposing factors among men and women. J Rehabil Med. 2010;42(2):155-161. doi:10.2340/16501977-0497
    51. 51.Vestling M, Tufvesson B, Iwarsson S. Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction. J Rehabil Med. 2003;35(3):127-131. doi:10.1080/16501970310010475
    52. 52.Hannerz H, Holbæk Pedersen B, Poulsen OM, Humle F, Andersen LL. A nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996-2006. BMJ Open. 2011;1(2):e000180. doi:10.1136/bmjopen-2011-000180
    53. 53.Glozier N, Hackett ML, Parag V, Anderson CS, Auckland Regional Community Stroke (ARCOS) Study Group. The influence of psychiatric morbidity on return to paid work after stroke in younger adults: the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke. 2008;39(5):1526-1532. doi:10.1161/STROKEAHA.107.503219
    54. 54.Andersen G, Christensen D, Kirkevold M, Johnsen SP. Post-stroke fatigue and return to work: a 2-year follow-up. Acta Neurol Scand. 2012;125(4):248-253. doi:10.1111/j.1600-0404.2011.01557.x
    55. 55.Mackay MT, Wiznitzer M, Benedict SL, et al. Arterial ischemic stroke risk factors: The international pediatric stroke study. Annals of Neurology. 2011;69(1):130-140. doi:10.1002/ana.22224
    56. 56.van Alebeek ME, Arntz RM, Ekker MS, et al. Risk factors and mechanisms of stroke in young adults: The FUTURE study. J Cereb Blood Flow Metab. 2018;38(9):1631-1641. doi:10.1177/0271678X17707138
    57. 57.Tang M, Han G, Yao M, et al. Risk Factors of Ischemic Stroke in Young Adults: A Chinese Single-Center Study. Front Neurol. 2022;13:874770. doi:10.3389/fneur.2022.874770
    58. 58.Dodds JA, Xian Y, Sheng S, et al. Thrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke. Neurology. 2019;92(24):e2784-e2792. doi:10.1212/WNL.0000000000007653
    59. 59.Deb-Chatterji M, Pinho J, Flottmann F, et al. Health-related quality of life after thrombectomy in young-onset versus older stroke patients: a multicenter analysis. J Neurointerv Surg. 2022;14(11):1145-1150. doi:10.1136/neurintsurg-2021-017991
    60. 60.Yeo LLL, Chen VHE, Leow AST, et al. Outcomes in young adults with acute ischemic stroke undergoing endovascular thrombectomy: A real-world multicenter experience. Eur J Neurol. 2021;28(8):2736-2744. doi:10.1111/ene.14899
    61. 61.Han B, Raynald null, Sun D, et al. Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry. Front Neurol. 2023;14:1255043. doi:10.3389/fneur.2023.1255043
    62. 62.Ntaios G, Papavasileiou V, Sagris D, et al. Closure of Patent Foramen Ovale Versus Medical Therapy in Patients With Cryptogenic Stroke or Transient Ischemic Attack: Updated Systematic Review and Meta-Analysis. Stroke. 2018;49(2):412-418. doi:10.1161/STROKEAHA.117.020030
    63. 63.Khan F, Fiorilli P, Messé SR, et al. Clinicians’ Approach to Patent Foramen Ovale Closure after Stroke: Comparing Cardiologists and Neurologists. J Am Heart Assoc. 2022;11(14):e025598. doi:10.1161/JAHA.122.025598
    64. 64.Kim J, Kim JY, Kang J, et al. Improvement in Delivery of Ischemic Stroke Treatments but Stagnation of Clinical Outcomes in Young Adults in South Korea. Stroke. 2023;54(12):3002-3011. doi:10.1161/STROKEAHA.123.044619
    65. 65.Pezzini A, Grassi M, Lodigiani C, et al. Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults. Circulation. 2014;129(16):1668-1676. doi:10.1161/CIRCULATIONAHA.113.005663
    66. 66.van Dongen MME, Aarnio K, Martinez-Majander N, et al. Use of antihypertensive medication after ischemic stroke in young adults and its association with long-term outcome. Ann Med. 2019;51(1):68-77. doi:10.1080/07853890.2018.1564358
    67. 67.van Dongen MME, Aarnio K, Martinez-Majander N, et al. Use of Statins After Ischemic Stroke in Young Adults and Its Association With Long-Term Outcome. Stroke. 2019;50(12):3385-3392. doi:10.1161/STROKEAHA.119.026992

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    “Long-Term Prognosis of Ischemic Stroke in Young Adults”. Human Brain, vol. 3, no. 2, Sept. 2024, https://doi.org/10.37819/hb.2.2013.
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    “Long-Term Prognosis of Ischemic Stroke in Young Adults”. Human Brain, vol. 3, no. 2, Sept. 2024, https://doi.org/10.37819/hb.2.2013.

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