Document Detail


Stroke in younger patients: the heart of the matter.
MedLine Citation:
PMID:  20623300     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Stroke in young adults is not a rare entity, and often provides difficult management decisions for neurologists. The knowledge gained from stroke in older adults does not transfer easily to this younger group given the different causes of stroke observed. Cardiac causes of stroke are common in this group, but often consist of low risk cardiac lesions such as a patent foramen ovale. Appropriate investigation should follow a stepwise approach to initially exclude higher risk pathology for recurrent stroke such as arterial dissection. Similarly, stepwise application of cardiac investigations will allow early identification of significant pathology, with investigation for abnormalities of the inter-atrial septum reserved for those with no other identified cause of stroke. Bubble contrast echo is now widely available, and with improved image quality may be performed with either transthoracic or transoesophageal echo, as well as with transcranial Doppler. Following this approach, patients can be best categorised by the expected rate of recurrent stroke, as informed by observational studies. Appropriate secondary prevention can then be tailored to the recurrence rate, with anticoagulation and possibly device closure reserved for those at highest risk of recurrence.
Authors:
P E Cotter; M Belham; P J Martin
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-07-11
Journal Detail:
Title:  Journal of neurology     Volume:  257     ISSN:  1432-1459     ISO Abbreviation:  J. Neurol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1777-87     Citation Subset:  IM    
Affiliation:
Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. pec33@medschl.cam.ac.uk
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