Diapositiva 1

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STROKE IN YOUNG PEOPLE THE INCREASING ROLE OF
ADVANCED IMAGES
ROSARIO ARGENTINA
Dr. Ojeda Adriana Nallino, Ma. Belén
Uriarte,Ana Maria Santa Cruz, Daniela.
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INTRODUCTION
STROKE is a leading cause of death and disability
in developed countries. Ischemic stroke in
young adults ( 15-45 ys) is an unexpected event
. Etiological spectrum is varied and differs
significantly from the underlying causes in older
patients.
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PURPOSE
To highlight the increasing role of neuroimaging
in the diagnosis, prognosis and treatment in
young stroke patients. The most frequent causes
of ischemic stroke are considered and the
corresponding images are described.
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MATERIALS AND METHODS

• 30 patients (mean age 35 ys.) with Acute Ischemic
  Stroke diagnosis were retrospectively included
  and analized at our institution over one year
  period.
• Neurovascular imaging
• MSCT 8 - 64 channels Unenhanced CT, CTA, CT
  PERFUSION
• MRI 1.5 T Conventional MRI, MRA, DWI, PWI
• CLINICAL DATA-RISK FACTORS-CARDIOVASCULAR
  EXAMS-LAB TEST
• .

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RESULTS
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STROKE TOAST CLASSIFICACION
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• ATHEROSCLEROSIS
• Dislipidemy
• Hipertension smoking
• CARDIOEMBOLISM
• 2 P.F.O.
• 1 Atrial Septal Aneurysm
• UNDETERMINED
• 3 Complete evaluation
• 1 Incomplete

• DISSECTION
• 5 Vertebral A
• 1 Basilar A
• 2 Carotid A
• MISCELLANEOUS
• 3 Migrainous infarction
• 2 moya-moya
• 2 cerebral venous thrombosis
• 2 systemic vasculitis
• 1 SLE
• 1 Antiphospholipid syndrome
• 1 vasoespasm secondary

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• COMPLETE WORK-UP INCLUDES
• CT or MRI scanning, CTA or MRA.
• Echocardiography
• Routine and Specific Lab Test
• Risk Factors analysis
• Drug abuse report

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Healthy 40 year-old. female patient referring
acute headache, neck pain, dizziness and vomits
T1
LEFT VERTEBRAL DISSECTION
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45 year-old male patient with severe trauma
history due to a car accident 15 days before
showing sudden onset aphasy
INTIMAL FLAP DOUBLE LUMEN
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CAROTID DISSECTION
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24 year-old female patient with language and
speech disorder (aphasia)
ANTIPHOSPHOLIPID SYNDROME
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30 year-old male patient with drop attack, vomits
and stupor during a migraine episode.
T2
FLAIR
DWI
MIGRAINOUS INFARCTION
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45 year old female patient with right hemiparesis
and aphasia. Unenhanced CT normal
PERFUSION CT
CRYPTOGENIC STROKE
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DISCUSSION
The etiologic spectrum is quite broad, thus the
investigation represents a challenging
diagnosis. Atherosclerotic arteriopathy was a
rare cause of stroke. Artery dissection was the
most frequent cause identified in our series, as
has already been reported in the medical
literature. Underterminaded cause represented a
minor percentage compared to other studies.
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DISCUSSION
In our study the sample is relatively small and
show selection bias. Our results emphasize the
importance of a standardized protocol and a
comprehensive evaluation of stroke in young
patients. To carry out multicentrical randomized
studies to assay the stroke incidence in
Argentinean young people.
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CONCLUSION

• The aims of NEUROIMAGING in the study of young
  stroke patients are
• to confirm the ischemic nature of the lesion
• to determine its location
• to verify the patency of major neck and
  intracranial arteries
• MRI and MSCT offer great sensitivity and
  specificity

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MUCHAS GRACIAS!
THANKS!