Friday, January 15, 2010

Stroke in the young patient











Today we discussed stroke in a young patient. Most references use under 45 as the cutoff for invoking some of the possibilities discussed below.

Differential diagnosis to consider for any patient presenting with "stroke", particularly a young patient:

Structural disease (tumor, bleed), seizure (Todd's paresis), dissection, migraine (esp. migraine sensory aura), demyelination, hypoglycemia. Anything that can cause delirium can cause focal findings when superimposed on a structurally abnormal brain.

In pts 45 and younger, common causes of ischemic stroke include
-Cardioembolic is #1 etiology (structural heart disease, endocarditis, others)
-Always consider dissection, even in the absence of trauma (esp if pain with onset). Dissections are usually extracranial, assoc with trauma or neck manipulation.
-Vasculitis
-Hypercoagulable state
-Cocaine, amphetamines
-Sickle cell disease
-Migranous stroke
More exotic causes: CADASIL, MELAS, Moya-moya

In many patients, an underlying cause is never found.
Workup:
CT/MRI/MRA/MRV
TEE
carotid doppler
thrombophilia screen
skin bx if suspect CADASIL
Antiphospholipid antibodies

Link:
Click here for NEJM review of PFO and stroke in young patients

1 comment:

  1. Am Abdul Hakim so joyful giving this testimony of genius herbalist,Dr Moses anabic herbal home whom cured me of liver cancer.i was diagnosed of liver cancer 2years back I tried to cope with the sickness but unfortunately it had gone so bad,I went to so many medical centres I was told to go for a special xray which was computed tomography scan.it's result came out that my liver was rottening and was told that there was no cure,I collapsed there at the centre after getting myself an individual who came for a test after being cured from hiv,then gave me an email address of dr Moses anabic so I contacted him and he assured me of a total cure after three weeks of administering his herbs and I was cured totally.nothing is impossible for God almighty any individual suffering from any illness or virus no matter how bad it may be,don't ever think it's impossible.contact him through his personal email address via MOSESANABIC@GMAIL.COM or write him on WhatsApp with +2348100661264.thank you very much doctor Moses.

    ReplyDelete