Etiology, prognosis, and hemostatic function after cerebral infarction in young adults.
We retrospectively evaluated 66 patients younger than 40 years of age who presented with acute nonhemorrhagic cerebral infarction (n = 63) or transient ischemic attacks (n = 3) to determine the possible etiology and long-term outcome at a mean follow-up interval of 3 years after initial presentation. A probable cause for the stroke was identified in 24 patients (36%); this group included one woman with a history of recurrent spontaneous abortions and a positive test for the presence of the lupus anticoagulant. We performed detailed hemostatic investigations at follow-up in 38 (90%) of the remaining 42 patients in whom the cause of the stroke was unknown or uncertain; results of the basic hemostatic screening tests (including that for fibrinogen) were uniformly normal. All 38 patients demonstrated a normal fibrinolytic response as measured by tissue plasminogen activator release to a standard venous occlusion stress test; concentration of the inhibitor of tissue plasminogen activator was not increased. No abnormalities in the concentrations of the inhibitory proteins C or S or antithrombin III were identified, and none of the 38 patients had evidence of a lupus anticoagulant. Neurologic recovery was complete or the residual disability mild in 46 of 59 (78%) patients. Overall prognosis was excellent and independent of whether a precipitating factor for the stroke could be identified.
Chancellor
A M
AM
Departments of Neurology, Auckland Hospital, New Zealand.
Glasgow
G L
GL
Ockelford
P A
PA
Johns
A
A
Smith
J
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000435:Alcoholic Intoxication / Q000150:complications; D001780:Blood Coagulation Tests; D002544:Cerebral Infarction / Q000097:blood / Q000209:etiology; D002648:Child; D005260:Female; D005342:Fibrinolysis; D005500:Follow-Up Studies; D006487:Hemostasis; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood / Q000150:complications*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000097:blood
D010959:Tissue Plasminogen Activator