title: MRI in acute cerebral ischemia of the young: the Stroke in Young Fabry Patients (sifap1) Study.
abstract: OBJECTIVE
  We focused on cerebral imaging findings in a large cohort of young patients with a symptomatic ischemic cerebrovascular event (CVE) to extract relevant pathophysiologic and clinical information.
  
  
  METHODS
  We analyzed the scans of 2,979 patients (aged 18-55 years) enrolled in the sifap1 project with clinical evidence of ischemic stroke (IS) or clinically defined TIA in whom MRI, including diffusion-weighted imaging, was obtained within 10 days of the CVE. Age groups were categorized as 18-34, 35-44, and 45-55 years. We compared age- and sex-specific proportions of infarct features, white matter hyperintensities, and old microbleeds.
  
  
  RESULTS
  Acute infarcts were identified in 1,914 of 2,264 patients (84.5%) with IS and 101 of 715 patients (14.1%) with TIA. Among patients with IS, younger age was significantly associated with acute infarcts in the posterior circulation, while anterior circulation infarcts and acute lacunar infarcts were more frequent in older age groups. One or more old infarcts were present in 26.8% of IS and 17.1% of TIA patients. This rate remained high even after excluding patients with a prior CVE (IS, 21.7%; TIA, 9.9%). The prevailing type of old infarction was territorial in patients younger than 45 years and lacunar in those aged 45 years or older. The frequency of white matter hyperintensities (46.4%) and their severity was positively associated with age. Old microbleeds were infrequent (7.2%).
  
  
  CONCLUSIONS
  Young adults show a high frequency of preexisting and clinically silent infarcts and a relative preference for acute ischemia in the posterior circulation. Findings suggesting small-vessel disease become apparent at age 45 years and older.
authors.affiliation: From the Departments of Neurology (F.F., C.E., R.S., S.R.) and Radiology (C.E.), Division of Neuroradiology, Medical University of Graz, Austria; Institute for Stroke and Dementia Research (M.D.), Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Germany; Department of Biostatistics and Clinical Epidemiology (B.G., M.H., P.M.), Charité-Universitätsmedizin, and Robert Koch Institut (B.G.), Berlin; Department of Neurology and Center for Stroke Research Berlin (G.J.J.), Charité-Universitätsmedizin Berlin; Department of Neurology (M.G.H.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim; Institute of Clinical Epidemiology and Biometry (P.H.), Comprehensive Heart Failure Center, University of Würzburg, and Centre for Clinical Studies, University Hospital Würzburg; Justus Liebig University (M.K., C.T.), Giessen; Department of Neurology (C.K.), University of Greifswald, Germany; Department of Neurology (J.P., T.T.), Helsinki University Central Hospital, Helsinki, Finland; Department of Clinical Neuroscience (B.N.), Lund University Hospital, Lund, Sweden; and Albrecht-Kossel-Institute for Neuroregeneration (A.R.), University of Rostock, Germany.
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schmidt
authors.forename: Martin
authors.initials: M
authors.lastname: Dichgans
authors.forename: Beate
authors.initials: B
authors.lastname: Gaertner
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Jungehulsing
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.forename: Peter
authors.initials: P
authors.lastname: Heuschmann
authors.forename: Martin
authors.initials: M
authors.lastname: Holzhausen
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaps
authors.forename: Christof
authors.initials: C
authors.lastname: Kessler
authors.forename: Peter
authors.initials: P
authors.lastname: Martus
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Stefan
authors.initials: S
authors.lastname: Ropele
authors.forename: Christian
authors.initials: C
authors.lastname: Tanislav
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Arndt
authors.initials: A
authors.lastname: Rolfs
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002540:Cerebral Cortex / Q000473:pathology*; D002544:Cerebral Infarction / Q000209:etiology*; D015331:Cohort Studies; D005060:Europe; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007391:International Cooperation; D002546:Ischemic Attack, Transient / Q000150:complications / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult