Etiology, prognosis, and hemostatic function after cerebral infarction in young adults

• Published in: Stroke (1970) 1989-04, Vol.20 (4), p.477-482
• Main Authors: CHANCELLOR, A. M, GLASGOW, G. L, OCKELFORD, P. A, JOHNS, A, SMITH, J
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Alcoholic Intoxication - complications; Biological and medical sciences; Blood Coagulation Tests; Cerebral Infarction - blood; Cerebral Infarction - etiology; Child; Female; Fibrinolysis; Follow-Up Studies; Hemostasis; Humans; Ischemic Attack, Transient - blood; Ischemic Attack, Transient - complications; Male; Medical sciences; Neurology; Prognosis; Retrospective Studies; Tissue Plasminogen Activator - blood; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.20.4.477

We retrospectively evaluated 66 patients younger than 40 years of age who presented with acute nonhemorrhagic cerebral infarction (n = 63) or transient ischemic attacks (n = 3) to determine the possible etiology and long-term outcome at a mean follow-up interval of 3 years after initial presentation. A probable cause for the stroke was identified in 24 patients (36%); this group included one woman with a history of recurrent spontaneous abortions and a positive test for the presence of the lupus anticoagulant. We performed detailed hemostatic investigations at follow-up in 38 (90%) of the remaining 42 patients in whom the cause of the stroke was unknown or uncertain; results of the basic hemostatic screening tests (including that for fibrinogen) were uniformly normal. All 38 patients demonstrated a normal fibrinolytic response as measured by tissue plasminogen activator release to a standard venous occlusion stress test; concentration of the inhibitor of tissue plasminogen activator was not increased. No abnormalities in the concentrations of the inhibitory proteins C or S or antithrombin III were identified, and none of the 38 patients had evidence of a lupus anticoagulant. Neurologic recovery was complete or the residual disability mild in 46 of 59 (78%) patients. Overall prognosis was excellent and independent of whether a precipitating factor for the stroke could be identified.