Diagnostic strategies in young patients with ischemic stroke in Canada.
BACKGROUND
A preliminary national survey of ischemic stroke in the young (15-45 years) undertaken by the Canadian Stroke Consortium indicated that in 44% of 356 patients, no cause was found.


OBJECTIVE
To determine the reason for this high incidence of diagnostic uncertainty in young patients with ischemic stroke.


METHODS
Neurologists in the ten Canadian stroke centers completed a detailed questionnaire for patients aged 15-45 years admitted to hospital between January 1993 and December 1997. Using a stepwise diagnostic algorithm incorporating clinical, neuroimaging, neurovascular and laboratory data, we divided patients into three groups: (1) those with established cause for the ischemic stroke, (2) those who remained unexplained despite adequate investigation, (3) those who remained unexplained but were, in our opinion, under-investigated.


RESULTS
In 197 patients (56%), an identified cause was established including cardioembolic sources (14%), extracranial arterial dissection (13%), lacunar infarcts (8%) atherosclerosis (6%). A miscellaneous group of 15%, included cerebral venous thrombosis, coagulopathies, vasculitis and others. In 159 patients (44%) with no apparent cause for their stroke, we considered only 81 (23%) adequately investigated, and 78 (21%) inadequately investigated.


CONCLUSIONS
About one in five young patients was inadequately investigated by a stroke-oriented group of neurologists. The major problem appears to be restriction of investigations to neuroimaging alone (usually computerized cerebral tomography), without further tests such as cerebral angiography and cardiac imaging.
Chan
M T
MT
Stroke Research Unit, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Canada.
Nadareishvili
Z G
ZG
Norris
J W
JW
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis*; D002170:Canada; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000175:diagnosis; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000592:standards; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*