medigraphic.com
ISSN 2594-3006 (Digital)
ISSN 2007-1752 (Impreso)
Archivos de Medicina de Urgencia de México

2011, Número 2

<< Anterior Siguiente >>

Arch Med Urg Mex 2011; 3 (2)


Evento vascular isquémico en pacientes jóvenes

Hernández PF

Idioma: Español
Referencias bibliográficas: 62
Paginas: 67-78
Archivo PDF: 95.92 Kb.


RESUMEN

El evento vascular cerebral en pacientes jóvenes (EVCJ) en menores de 45 años es un evento raro en general, con una frecuencia entre un 4 al 5% de los pacientes con EVC, con una incidencia de 10 en 100,000 habitantes y una mortalidad del 2.5%. A pesar de que es un evento poco frecuente, las consecuencias pueden ser devastadoras porque afecta tanto al paciente en edad reproductiva como a sus familias. Correlativamente hay una mejor supervivencia en pacientes jóvenes que en aquellos pacientes de edad avanzada con un evento vascular, sin embargo, la mayoría de jóvenes sobrevivientes a un evento vascular cerebral tienen secuelas emocionales, sociales y/o físicas que deterioran su calidad de vida. Así mismo, el EVCJ puede ocurrir con una amplia variedad de signos y síntomas dependiendo del área afectada; convulsiones, alteraciones del lenguaje, incoordinación, dificultad para caminar o inexplicables cambios del estado de alerta, aunque los más comunes son los déficit motores focalizados. Y a pesar de que el EVC tiene poca frecuencia, su causalidad es variada; arriba del 20% no se encuentra causa alguna y en un 4% corresponderán a una causa hematológica. Los factores de riesgo fuertemente asociados con un EVC en jóvenes son el tabaquismo, la hipertensión, la dislipidemia y la historia de eventos vasculares en familiares jóvenes.
Las causas más comunes son la ateroesclerosis, el cardioembolismo asi como las vasculopatías y las alteraciones hematológicas aunque un porcentaje alto no es posible determinar su causa a pesar de lo variado de los estudios que incluyen estudios contrastados de cráneo, así como cardiaco y hematológicos.
En el tratamiento se pone énfasis en la prevención, dada las consecuencias, la rehabilitación y la mayoría de casos necesitan antiagregantes plaquetarios y anticoagulación.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Barinagarrementeria F, Cantu BC, De la Peña A, Izaguirre R. Prothrombotic states in young people with idiopathic stroke. A prospective study. Stroke 1994; 25: 287-290.

  2. Dinesh S, Nair M, Radhakrishnan K, Sankara P. Ischaemic stroke in young adult: Clinical features risk factors and outcomes. Natl Med J India 1997; 10: 107-12.

  3. Gandolfo C, Conti M. Stroke in young adults: epidemiology. Neurol Sci 2003; 24 Suppl 1: S1-3.

  4. Bevan H, Sharma K, Bradley W. Stroke in young adults. Stroke 1990; 21: 382-386.

  5. You R, McNeil J, O’Malley H, Davis S, Thrift A, Donnan G. Risk factors for stroke due to cerebral infarction in young adults. Stroke 1997; 28: 1913-1918.

  6. Nencini P, Inzitari D, Baruffi MC, Fratiglioni L, Gagliardi R, Benvenuti L, Buccheri AM, Cecchi L, Passigli A, Rosselli A. Incidence of stroke in young adults in Florence. Italy Stroke 1988; 19: 977-981.

  7. Goldenberg N. Stroke in children and young adults awareness. Prevention Treatment Support. 1-15.

  8. Rozenthul SN, Ronen R, Tamir A, Geva H, Eldar R. Stroke in the Young in Israel. Stroke 1996; 27: 838-841.

  9. Kristensen B, Malm J, Carlberg B, Stegmayr B, Backman C, Fagerlund M, Olsson T. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in Northern Sweden. Stroke 1997; 28: 1702-1709.

  10. Leno C, Berciano J, Combarros O, Polo JM, Pascual J, Quintana F, Merino J, Sedano C, Martín-Durán R, Álvarez C. A prospective study of stroke in young adults in Cantabria, Spain. Stroke 1993; 24: 792-795.

  11. Haapaniemi H, Hillbom M, Juvela S. Weekend and holiday increase in the onset of ischemic stroke in young women stroke. 1996; 27: 1023-1027.

  12. Adams H, Bendixen B, Kappelle L, Biller J, Love B, Gordon D, Marsh E. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment Stroke 1993 Jan; 24: 35-41.

  13. Lacruz F, Herrera M, Bujanda M, Erro E, Gallego J. Clasificación del ictus ANALES Sis San Navarra 2000; 23 (Suppl. 3): 59-65.

  14. Lee T, Hsu W, Chen C, Chen S. Etiologic study of young ischemic stroke in Taiwan stroke. 2002; 33: 1950-1955.

  15. Lipska K, Sylaja P, Sarma P, Thankappan K, Kutty V, Vasan R, Radhakrishnan K. Risk factors for acute ischaemic stroke in young adults in South India. J Neurol Neurosurg Psychiatry 2007; 78: 959-963.

  16. Rohr J, Kittner S, Feeser B et al. Traditional risk factors and ischemic stroke in young adults: the Baltimore-Washington Cooperative Young Stroke Study. Arch Neurol 1996; 53: 603-607.

  17. Love B, Biller J, Jones M, Adams HA. Cigarette smoking. A risk factor for cerebral infarction in young adults. Arch Neurol 1990; 47: 693-698.

  18. Jovanovic Z. Risk factors for stroke in young people. Srp Arh Celok Lek 1996; 124: 232-235.

  19. Bi Q. Study on the risk factors among stroke in young people Zhonghua Liu Xing Bing Xue Za Zhi 2003; 24: 106-8.

  20. Musolino R, La Spina P, Granata A et al. Ischaemic stroke in young people: a prospective and long-term follow-up study cerebrovascular diseases 2003; 15: 121-128.

  21. You R, McNeil J, O’Malley H et al. Risk Factors for stroke due to cerebral infarction in young adults. Stroke. 1997; 28: 1913-1918.

  22. White H, Simes J, Anderson N et al. Pravastatin therapy and the risk of stroke. N Engl J Med 2000; 343: 317-26.

  23. Albucher J, Ferrieres J, Ruidavets J, Guiraud-Chaumeil B, Perret B, Chollet F. Serum lipids in young patients with ischaemic stroke: a case-control study. J Neurol Neurosurg Psychiatry 2000; 69: 29-33.

  24. Miyazaki K, Uchiyama S, Iwata M. Drug abuse and stroke. Rinsho Shinkeigaku 2006; 46: 906-908.

  25. Jeffrey S. Stimulant abuse may increase stroke among young adults. Arch Gen Psychiatry 2007; 64: 495-502.

  26. Campos C, Iglesias J, García F, Soler J. Isquemia cerebral secundaria a consumo de cocaína. Emergencias 2001; 13: 53-55.

  27. Mateo I, Pinedo A, Gómez M, Basterretxea J, García J. Recurrent stroke associated with cannabis use. J Neurol Neurosurg Psychiatry 2005; 76: 435-437.

  28. Etminan M, Takkouche B, Caamaño F, Samii A. Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies. BMJ 2005; 330: 63-71.

  29. Tzourio C, Iglesias S, Hubert J et al. Migraine and risk of ischaemic stroke: A case-control study. BMJ 1993; 307: 289-292.

  30. Thomas D. Migraine and ischaemic stroke: They are associated, but risks are low and surmountable. BMJ 2005; 330: 54–55.

  31. Donaghy M, Chang C, Poulter N. Duration, frequency, regency, and type of migraine and the risk of ischaemic stroke in women of childbearing age. J Neurol Neurosurg Psychiatry 2002; 73: 747-750.

  32. Jousilahti P. Headache and the risk of stroke. Curr Atheroscler Rep 2004; 6: 320-325.

  33. Hoffmann M. Stroke and chest pain in young people with migraine. Headache 2006; 46: 208-211.

  34. Schürks M, Rist P, Bigal M, Buring J, Lipton R, Kurth T. Migraine and cardiovascular disease: systematic review and meta-analysis BMJ 2009; 339: b3914.

  35. Kittner S, Stern B, Feeser B et al. Pregnancy and the risk of stroke. N Engl J Med 1996; 335: 768-74.

  36. Srinivasan K. Ischemic cerebrovascular disease in the young. Two common causes in India. Stroke 1984; 15; 733-735.

  37. Nedeltchev K, Maur T, Georgiadis D et al. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry 2005; 76: 191-195.

  38. Abraham J, Shetty G, José C. Strokes in the young. Stroke 1971; 2: 258-267.

  39. Lipska K, Sylaja P, Sarma P, Thankappan K, Kutty V, Vasan R. Radhakrishnan K. Risk factors for acute ischaemic stroke in young adults in South India. J Neurol Neurosurg Psychiatry 2007; 78: 959-963.

  40. Lisovoski F, Rousseaux P. Cerebral infarction in young people. A study of 148 patients with early cerebral angiography. J Neurol Neurosurg Psychiatry 1991; 54: 576-57.

  41. Albucher J, Ferrieres J, Ruidavets J, Guiraud CHB, Perret B, Chollet F. Serum lipids in young patients with ischaemic stroke: a case-control study. J Neurol Neurosurg Psychiatry 2000; 69: 29-33.

  42. Freed L, Levy D, Levine R et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 1999; 341: 1-7.

  43. Gilon D, Buonanno F, Joffe M et al. Lack of evidence of an association between mitral-valve prolapse and stroke in young patients. N Engl J Med 1999; 341: 8-13.

  44. Zabal C. Foramen oval permeable. Definición del problema y tratamiento. Arch de Cardiol de Mex 2004; 74(Supl. 2): S437-S441.

  45. Negrão E, Brandi IV, Nunes S, Beraldo P. Abnormalities of interatrial septum and ischemic stroke in young people. Arq Neuropsiquiatr 2005; 63: 1047-53.

  46. Berthet K, Lavergne T, Cohen A et al. Significant association of atrial vulnerability with atrial septal abnormalities in young patients with ischemic stroke of unknown cause. Stroke 2000; 31: 398-403.

  47. Ferro J, Crespo M. Young adult stroke: neuropsychological dysfunction and recovery. Stroke 1988; 19: 982-986.

  48. Quintana S. Actualidades en hemostasia. Gac Méd Méx 2002; (Suppl 13): S46-S59.

  49. Bushnell C, Goldstein L. Diagnostic testing for coagulopathies in patients with ischemic stroke. Stroke 2000; 31: 3067-3078.

  50. Brey R, Stallworth C, McGlasson D. Antiphospholipid antibodies and stroke in young women. Stroke 2002; 33: 2396-2401.

  51. Montero P, Franco V, Strauss Y, De la Peña A. The antiphospholipid syndrome. Medicrit Rev Med Int y Crit 2008; 5: 27-40.

  52. Ellis M, Kesler A, Friedman Z, Drucker I, Radnai Y, Kott E. Value of prothrombin fragment 1.2 (F 1.2) in the diagnosis of stroke in young patients with antiphospholipid antibodies. Clin Appl Thromb Hemost 2000; 6: 61-4.

  53. Ganesan V, McShane M, Liesner R, Cookson J, Hann I, Kirkham F. Inherited prothrombotic states and ischaemic stroke in childhood. J Neurol Neurosurg Psychiatry 1998; 65: 508-511.

  54. Macko R, Kittner S, Epstein A et al. Elevated tissue plasminogen activator antigen and stroke risk: The stroke prevention in young women study. Stroke 1999; 30: 7-11.

  55. Brey R, Stallworth C, McGlasson D et al. Antiphospholipid antibodies and stroke in young women. Stroke 2002; 33: 2396-2401.

  56. Furlan A, Lucas F, Craciun R, Wohl R. Stroke in a young adult with familial plasminogen disorder. Stroke 1991; 22: 1598-1602.

  57. Ferro D, Quintarelli C, Rasura M, Antonini G, Violi F. Lupus anticoagulant and the fibrinolytic system in young patients with stroke. Stroke 1993; 24: 368-370.

  58. Kasner S, Morgenstern L. Cerebrovascular disorders: Ischemic Stroke ACP Medicine Online 2006.

  59. Markus H, Hambley H. Neurology and the blood: haematological abnormalities in ischaemic stroke. J Neurol Neurosurg Psychiatry 1998; 64: 150-159.

  60. Goldenberg N. Stroke in children and young adults awareness. Prevention. Treatment. Support 2006. www.nattinfo.org/provider.htm.

  61. Roach E, Golomb M, Adams R et al. Management of stroke in infants and children: A scientific statement from a special writing group of the American Heart Association stroke council and the council on cardiovascular disease in the young. Stroke 2008; 39: 2644-2691.

  62. Marsh J. Progress in stroke prevention and treatment. Cardiology Rounds 2006; 10: 302-352.




2020     |     www.medigraphic.com