Abstract
Obstacles to thrombolytic treatment could be unique in young stroke patients and identifying and addressing them would potentially enhance outcomes. However, it has not been well studied how age affects the time to presentation, diagnosis or treatment of acute strokes. Although studies suggest that younger patients may be more aware of stroke symptoms and signs than older ones, they may be less likely to use emergency medical services. Importantly, for strokes of similar severity, younger patients have more favorable outcomes with thrombolysis than older patients. On the other hand, young patients who experience extensive middle cerebral artery strokes are more likely to develop fatal brain edema than older patients. Current data support the use of thrombolytics for all ischemic stroke etiologies, including entities such as cervical artery dissection that are more common in young patients.
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References
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–1587.
The NINDS tPA Stroke Study Group. Generalized efficacy of t-PA for acute stroke: Subgroup analysis of the NINDS t-PA stroke trial. Stroke 1997;28:2119–2125.
Schroeder E, Rosamond WD, Dexter ML, Evanson KE, Hinn AR. Determinants of use of emergency medical services in a population with stroke symptoms (DASH II). Stroke 2000:31:2591–2596.
Morris DL, Rosamond WD, Madden K, Schultz C, Hamilton S. Prehospital and emergency department delays after acute stroke. Stroke 2000:31:2585–2590.
Rosamond WD, Gorton RA, Hinn AR, Hohenhaus SM, Morris DL. Rapid response to stroke symptoms: The delay in accessing stroke healthcare (DASH) study. Academic Emergency Medicine 1998:5:45–51.
Kwan J, Hand P, Sandercock P. A Systematic review of barriers to delivery of thrombolysis for acute stroke. Age and Ageing 2004:33:116–121.
Fogelholm R, Murros K, Rissanen A, Matti I. Factors delaying hospital admission after actue stroke. Stroke 1996:27:398–400.
Feldmann E, Gordon N, Brooks JM, et al. Factors associated with early presentation of acute stroke. Stroke 1993:24:1805–1810.
Kothari R, Sauerbeck L, Jauch A, et al. Patients' awareness of stroke signs, symptoms, and risk factors. Stroke 1997:28:1871–1875.
Morgenstern LB, Lisabeth LD, Mecozzi AC, et al. A population based study of acute stroke and TIA diagnosis. Neurology 2004:62:895–900.
Scott P, Silbergleit R. Misdiagnosis of stroke in tissue plasminogen activator-treated patients. Annals of Emergency Medicine 2003:42:611–618.
Garg S, Nashed AH, Roche LM. Fibrinolytic therapy in young women with acute myocardial infarction. Annals of Emergency Medicine 1999:33:646–651.
Activase (alteplase, recombinant) package insert, Genentech, Inc., South San Francisco, CA, June 1996.
Krieger DW, Demchuk AM, Kasner SE, Jauss M, Hantson L. Early clinical and readiological predictors of fatal brain swelling in ischemic stroke. Stroke 1999;30:287–292.
Naess H, Nyland HI, Thomassen I, Aarseth J, Nyland G, Myhr K-M. Incidence and short-term outcome of cerebral infarction in young adults in Western Norway. Stroke 2002;33:2105–2108.
Delashaw JB, Broaddus WC, Kassell NF, et al. Treatment of right hemispheric cerebral infarction by hemicraniectomy. Stroke 1990;21:874–881.
Schwab S, Steiner T, Aschoff A, et al. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 1998;29:1888–1893.
Kristensen B, Malm J, Carlberg, et al. Epidemiology and etiology of ischemic stroke in young adults aged 18 to 44 years in Northern Sweden. Stroke 1997;28:1702–1709.
Kittner SJ, Stern BJ, Wozniak M, et al. Cerebral infarction in young adults: The Baltimore-Washington Cooperative Young Stroke Study. Neurology 1998;50:890–894.
Lisovoski F, Rousseaux P. Cerebral infarction in young people: A study of 148 patients with early cerebral angiography. J Neurol Neurosurg Psychiatry 1991;54:576–579.
Arnold M, Nedeltchev K, Sturzenegger M, et al. Thrombolysis in patients with acute stroke caused by cervical artery dissection: Analysis of 9 patients and review of the literature. Archives of Neurology 2002;59:549–553.
Derex L, Nighoghossian N, Turjman F, et al. Intravenous tPA in acute ischemic stroke related to internal carotid artery dissection. Neurology 54:2159–2161.
Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset: the ATLANTIS study: A randomized controlled trial. JAMA 1999;282:2019–2026.
Furlan A, Higashida R, Wechsler L, et al. Intra-arterial prourokinase for acute ischemic stroke: The PROACT II Study: A randomized controlled trial. JAMA 1999;282:2003–2011.
North EL, Lutsep HL, Clark WM. Endovascular stenting for acute internal carotid artery dissection after anticoagulation failure. Stroke 2004;35:297 abstract.
Flemming KD, Brown RD. Acute cerebral infarction caused by aortic dissection: Caution in the thrombolytic era. Stroke 1999:30:477–478 letter.
Fessler AJ, Alberts MJ. Stroke treatment with tissue plasminogen activator in the setting of aortic dissection. Neurology 2000;54:1010.
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Wagner, J.C., Lutsep, H.L. Thrombolysis in Young Adults. J Thromb Thrombolysis 20, 133–136 (2005). https://doi.org/10.1007/s11239-005-3207-3
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DOI: https://doi.org/10.1007/s11239-005-3207-3