Various Stroke Etiologies Stroke In The Young

In addition to arteriosclerosis of the cerebral arteries, diseases of the heart, and hypertension, a variety of conditions predispose to strokes;,vasculitis and vascu-lopathies, hematologic disorders, iatrogenic complications, and abuse of illicit substances being the most prevalent. These and several other conditions (see following sections) predispose to strokes at any age, but are particularly common and important causes of strokes that affect younger subjects, ranging in age from infancy through childhood and adolescence, to adulthood. Additional causes of strokes in the young are cardiac diseases particular to the young, early atherothrombosis of hereditary dyslipoproteinemia, and some inherited metabolic and neurodegenerative diseases (Table 4.11). In a significant number of patients, the etiology remains undetermined.

Stroke in the young population accounts for 5% of all strokes; the incidence of ischemic stroke is only slightly higher than that of hemorrhagic. Stroke in the pediatric age group usually presents with headaches and acute hemiplegia, often associated with seizures. Because of diverse etiologies, young stroke patients require a comprehensive cardiovascular, hematologic, and metabolic screening.

The prognosis of ischemic stroke among young subjects is favorable, and mortality is low. Recovery ranges from complete to partial, with variable motor deficits, movement disorder, seizures and, in children, learning difficulties and mental retardation. Prognosis of intrace-rebral hemorrhage is less favorable, and mortality in sub-arachnoid hemorrhage is high, possibly reaching 40%.

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