International study: strokes among young people often overlooked #ens12

Strokes in young adults are often overlooked, Prof Dr Franz Fazekas (Head of the Department of Neurology, Medical University of Graz) told the 22nd Meeting of the European Neurological Society (ENS) in Prague.

In the framework of the “Stroke in Young Fabry Patients Study” (Sifap), 3,000 patients between 18 and 55 years of age, from 15 European countries, underwent MRI examinations. Those examined had recently suffered either ischemic strokes, caused by blockage of a blood vessel in the brain, or a transient ischemic attack (TIA), a disruption of cerebral blood flow with neurological deficits that last only temporarily. "We found that almost a quarter of the subjects had previously suffered a cerebral infarct. Old infarcts were even found among 18.8% of those who never before had noticed any signs of a stroke," said Prof Fazekas. "Strokes in younger people probably proceed ‘silently’ in many cases, or so atypically that one doesn’t think of a stroke. In the future, that needs to be taken into account more in clinical practice. And suspicious symptoms should more frequently serve as an indication for an MRI brain scan."

The study also revealed a more frequent manifestation among younger men of stroke in the supply region of the posterior cerebral artery. This needs to be researched further, Prof Fazekas said. Their occlusion typically leads to failure of the visual field of the opposite side and also to cognitive and impaired consciousness. In particular need of clarification is whether or not this increased frequency is associated with a case history of migraine.

The causes of stroke are diverse among young people, i.e. those aged between 18 and 55, according to the WHO definition. The observed high numbers in the study of lacunar infarcts suggests the importance of vascular risk factors as a cause of stroke at a young age. Other frequent causes are vascular dissections, but rare diseases such as genetically determined defects can also be factors. One trigger is the congenital genetic defect in Fabry disease. Because of the underlying metabolic defect, a deposit of certain lipids can develop in individual organs, including in the cells of the brain’s vasculature.

The SIFAP trial (Stroke in Young Fabry Patients) is a joint project with 35 participating European research centers.