       Document 0896
 DOCN  M9540896
 TI    [Cerebral infarction in patients aged 16 to 35 years. Prospective study
       of 52 cases]
 DT    9504
 AU    Milandre L; Brosset C; Habib G; Graziani N; Khalil R; Service de
       Neurologie, CHU de la Timone, Marseille.
 SO    Presse Med. 1994 Nov 12;23(35):1603-8. Unique Identifier : AIDSLINE
       MED/95132535
 AB    OBJECTIVES: Aetiologies of cerebral ischemic events in young adults are
       various and often contraversial: atherosclerosis plays a role after age
       35 years, cardioembolism is often recognized as the major cause, and
       numerous new predisposing conditions have been described. To evaluate
       very premature cerebral infarction, we studied prospectively 52
       consecutive patients (34 women and 18 men) aged 16-35 years (mean 28.6
       +/- 5.6 years) admitted over a 6-year period for an arterial cerebral
       infarct identified on CT, on MRI or both. METHODS: All patients were
       investigated using a standard protocol including cerebral angiography,
       transthoracic echocardiography, 24-hour Holter ECG monitoring,
       coagulation inhibitors levels, lupus anticoagulant testing, HIV and
       syphilitic serologies. Additional investigations were performed in a
       majority of patients: transesophageal echocardiography in 33, contrast
       echocardiography in 50, and anticardiolipin antibodies levels in 38.
       RESULTS: The arterial distribution of infarction did not differ from
       that of overall stroke patients. Sixteen cases were classified as
       certain aetiologies, including cardiac diseases with high embolic risk
       (n = 9), spontaneous arterial dissection (n = 4), moya-moya disease (n =
       1), atherosclerosis (n = 1), and inherited antithrombine III deficiency
       (n = 1). Eighteen cases were classified as possible aetiologies
       including cardiac diseases with low embolic risk (n = 11) such as mitral
       valve prolapse or atrial septal aneurysm, miscellaneaous arteriopathies
       (n = 3) such as arterial dysplasia, antiphospholipid antibodies syndrome
       (n = 1) and migrainous stroke (n = 3). The 18 last cases were classified
       as unknown aetiologies, despite all patients but one had at least one
       vascular risk factor: this group significantly differed from the formers
       in that the patients were more frequently women using oral contraceptive
       associated with tobacco consumption, hypercholesterolemia, or both. Two
       patients died acutely and the survivors were followed 31 +/- 18 months.
       Three patients experienced recurrent stroke. Functional outcome was
       assessed using the Rankin scale on admission and 6 to 12 months after
       the onset of stroke: patients evaluated < or = 2 (no to mild handicap)
       were 31% on admission and 82% after recovery. Twenty six p. cent
       remained unable to resume a work. CONCLUSION: Despite extensive
       evaluation, identification and classification of aetiologies of cerebral
       infarction in young adults should be cautious because the risk as well
       as the pathogenesis of many potential causes still need to be defined.
 DE    Adolescence  Adult  Age Factors  Cerebral
       Infarction/EPIDEMIOLOGY/*ETIOLOGY/PHYSIOPATHOLOGY  English Abstract
       Female  France/EPIDEMIOLOGY  Hospitals, University  Human  Male
       Prognosis  Prospective Studies  Risk Factors  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

