Distribution of etiologies in patients above and below age 45 with first-ever ischemic stroke

• Published in: Acta neurologica Scandinavica Vol. 117; no. 5; pp. 311 - 316
• Main Authors: Telman, G., Kouperberg, E., Sprecher, E., Yarnitsky, D.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2008; Blackwell
• Subjects: Adult; Age Distribution; Aging; Anticoagulants - therapeutic use; Aspirin - therapeutic use; Atrial Fibrillation - complications; Biological and medical sciences; Embolism - complications; etiology; Female; Foramen Ovale - physiopathology; Human viral diseases; Humans; Infectious diseases; ischemia; Male; Medical sciences; Middle Aged; Neurology; outcome; Registries; Retrospective Studies; Risk Factors; Stroke - epidemiology; Stroke - etiology; Stroke - prevention & control; treatment; Viral diseases; Viral diseases of the nervous system; Warfarin - therapeutic use; Human; Cerebral infarction; Stroke; Nervous system diseases; Prognosis; Cardiovascular disease; Cerebral disorder; ischemia; Vascular disease; Treatment; Etiology; Central nervous system disease; Distribution; Brain ischemia; Cerebrovascular disease; Age; outcome
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/j.1600-0404.2007.00953.x

Background –  There is limited information about distribution of etiologies of ischemic stroke in different age groups. Materials and methods –  In this study, we applied the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification in 87 patients aged ≤45, and in 347 patients aged 46–60 years with first‐ever ischemic stroke in order to follow the distribution of stroke etiologies in different age groups. Results –  Traditional risk factors, except smoking and atrial fibrillation, were more frequent in older patients. The most frequent etiologies in the younger stroke patients (aged ≤45) were ‘other’ than routine causes (26.4%), cardioembolism (22.4%) and ‘idiopathic’ strokes (20.7%), when no cause was found. In older patients (aged 46–60), small vessel disease (25.1%) and cardioembolism (22.2%) were the most frequent etiologies of stroke. Conclusions –  In stroke patients below the age of 45, the TOAST classification should be expanded to better classify the wide diversity of stroke etiologies. The relatively low frequency of routine stroke etiologies in patients aged ≤45 can be explained by the significantly lower prevalence of traditional risk factors in these patients. In patients 46–60 years old, the TOAST classification is adequate in the characterization of ischemic stroke etiologies.