Skip to main content

Two-Dimensional Echocardiography in Young Adults with Cerebral Ischemia: Emerging Issues

  • Conference paper
Heart-Brain Interactions
  • 66 Accesses

Abstract

Young adults aged less than 45 years represent only 3%–4% of all patients with ischemic stroke seen in Western countries [1, 2]. This low prevalence accounts for the paucity of available data from a limited group of referring institutions which have investigated this issue. Among young patients who suffered from a cerebral ischemic attack, atherosclerosis, the main cause of stroke in older populations, is less frequent (23%–39%) [3], and it is nearly absent in patients under 30 years [4]. Because of the wide spectrum of causes of cerebral ischemia in young populations, only a systematic diagnostic approach can improve our understanding of stroke mechanisms, which remain unknown in many cases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Walker AE, Robins M, Weinfeld FD (1981) Clinical findings. Stroke 12: 1–15

    Article  Google Scholar 

  2. Hachinski V (1985) The young stroke. In: Hachinski V, Norris JV (eds) The acute stroke. Davis, Philadelphia, pp 141–163

    Google Scholar 

  3. Adams HP, Butler MJ, Biller J, Toffol GJ (1986) Nonhemorrhagic cerebral infarction in young adults. Arch Neurol 43: 793–796

    Article  PubMed  Google Scholar 

  4. Bogousslavsky J, Regli F (1987) Ischemic stroke in adults younger than 30 years of age. Cause and prognosis. Arch Neurol 44: 479–482

    Article  CAS  PubMed  Google Scholar 

  5. Lovett JK, Sandok BA, Giulian ER et al. (1981) Two-dimensional echocardiography in patients with focal cerebral ischemia. Ann Intern Med 95: 1–4

    Article  CAS  PubMed  Google Scholar 

  6. Nishide M, Irino T, Gotoh M, Naka M, Tsuji K (1983) Cardiac abnormalities in ischemic cerebrovascular disease studied by two-dimensional echocardiography. Stroke 14: 541–545

    Article  CAS  PubMed  Google Scholar 

  7. Come PC, Riley MF, Bivas NK (1983) Roles of echocardiography and arrhythmia monitoring in the evaluation of patients with suspected systemic embolism. Ann Neurol 13: 527–531

    Article  CAS  PubMed  Google Scholar 

  8. Hart RG, Miller TV (1983) Cerebral infarction in young adults: a practical approach. Stroke 14 (1): 110–114

    Article  CAS  PubMed  Google Scholar 

  9. Grindal AB, Cohen RJ, Saul RF, Taylor JR (1978) Cerebral infarction in young adults! Stroke 9: 39–42

    Article  CAS  PubMed  Google Scholar 

  10. Chopra JS, Prabhakar S (1979) Clinical features and risk factors in stroke in young. Acta Neurol Scand 60: 289–300

    Article  CAS  PubMed  Google Scholar 

  11. Snyder BD, Ramirez-Lassepas (1980) Cerebral infarction in young adults. Long-term prognosis. Stroke 11: 149–153

    Google Scholar 

  12. Marshall J (1982) The cause and prognosis of strokes in people under 50 years. J Neurol Sci 53: 123–130

    Google Scholar 

  13. Hilton-Jones D, Warlow CP (1985) The cause of stroke in the young. J Neurol 232: 137–143

    Article  CAS  PubMed  Google Scholar 

  14. Radhakrishnan J, Regli F (1986) Stroke in the young: incidence and pattern in Benhazi, Libya. Acta Neurol Scand 74: 434–438

    Article  Google Scholar 

  15. Biller J, Johnson MR, Adams HP, Kerber RE, Toffol GJ, Butler MJ (1986) Echocardiographic evaluation of young adults with non hemorrhagic cerebral infarction. Stroke 17 (4): 608–612

    Article  CAS  PubMed  Google Scholar 

  16. Toffol GH, Biller J, Adams HP (1987) Nontraumatic intracerebral hemorrhage in young adults. Arch Neurol 44: 483–485

    Article  CAS  PubMed  Google Scholar 

  17. Nencini P, Inzitari D, Baruffi MC, Fratiglioni L, Gagliardi R, Benvenuti L, Buccheri AM, Cecchi L, Passigli A, Rosselli A, Amaducci L (1988) Incidence of stroke in young adults in Florence, Italy. Stroke 19: 977–981

    Article  CAS  PubMed  Google Scholar 

  18. Alvarez J, Matias-Guju J, Sumalla J, Molins M, Insa R, Molto JM, Martin R, Codina A, Martinez-Vasquez JM (1989) Ischemic stroke in young adults. I Analysis of the etiological subgroups. Acta Neurol Scand 80: 28–34

    Google Scholar 

  19. Bevan H, Sharma K, Bradley W (1990) Stroke in young adults. Stroke 21: 382–386

    Article  CAS  PubMed  Google Scholar 

  20. Urbinati S, Di Pasquale G, Andreoli A, Lusa AM, Manini GL, Lanzino G, Grazi P, Ruffini M, Pinelli G (1992) Role and indication of two-dimensional echocardiography in young adults with cerebral ischemia: a prospective study in 125 patients. Cerebrovasc Dis 2: 14–21

    Article  Google Scholar 

  21. Malm J, Forssell A (1991) Cerebral angiography as a diagnostic method in patients with cerebral infarction aged 18–44 years. Cerebrovasc Dis. 1: 76–81

    Article  Google Scholar 

  22. Cerebral Embolism Task Force (1986) Cardiogenic brain embolism. Arch Neurol 43: 71–84

    Article  Google Scholar 

  23. Cerebral Embolism Task Force (1989) Cardiogenic brain embolism. The second report of the Cerebral Embolism Task Force. Arch Neurol 46: 727–743

    Article  Google Scholar 

  24. Barnett HJM (1982) Embolism in mitral valve prolapse. Ann Rev Med 33: 489–507

    Article  CAS  PubMed  Google Scholar 

  25. Schnee MA, Bucal A A (1983) Fatal embolism in mitral valve prolapse. Chest 83: 285–286

    Article  CAS  PubMed  Google Scholar 

  26. Fieschi C, Francia A, Allori L, Argentino C, Bernardi S, Bertazzoni C, Carpintieri F, Di Piero V, Ferroluzzi M, Lenzi GL, Prencipe M, Servi M, Zanette E (1983) Mitral valve prolapse as risk factor for TIA. Eur Neurol 22: 233–239

    Article  CAS  PubMed  Google Scholar 

  27. Nishimura RA, McGoon MD, Shub C, Miller FA, Ilstrup DM, Taijk AJ, (1985) Echocardiogra- phically documented mitral valve prolapse Long-term follow-up of 237 patients. N Engl J Med 313: 1305–1309

    Google Scholar 

  28. Gagliardi R, Benvenuti L, Frosini F, Ammannati F, Barletta GA, Fantini F (1985) Frequency of echocardiography abnormalities in patients with ischemia of the carotid territory: a preliminary report. Stroke 16: 118–120

    Article  CAS  PubMed  Google Scholar 

  29. Kouvaras G, Bacoulas G (1985) Association of mitral leaflet prolapse with cerebral ischemic events in the young and early middle-aged patient. Q J Med 55: 387–392

    Google Scholar 

  30. Poole CJM, Ross Russel RW, Harrison P, Savidge GF (1987) Amaurosis fugax under the age of 40 years. J Neurol Neurosurg Psychiatry 48: 902–905

    Article  Google Scholar 

  31. Perloff JK, Child JS, Edwards JE (1986) New guidelines for the clinical diagnosis of mitral valve prolapse. Am J Cardiol 57: 751–758

    Article  Google Scholar 

  32. Levine RA, Stathogiannis E, Newell JB, Harrigan P, Weyman AE (1988) Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to apical-four chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol 11: 1010–1019

    Article  CAS  PubMed  Google Scholar 

  33. Egeblad H, Sorensen PS (1984) Prevalence of mitral valve prolapse in younger patients with cerebral ischemic attack: a blinded controlled study. Acta Med Scand 216: 385–391

    Article  CAS  PubMed  Google Scholar 

  34. Rothrock JF, Dittrich HC, Fleck P, Blacky AR, Watson RT (1988) Mitral valve prolapse and ischemic stroke in the young. Circulation 78: 601–604

    Google Scholar 

  35. Urbinati S, Lanzino G, Andreoli A, Di Pasquale G, Grazi P, lacono G, Limoni P, Ruffini M, Pinelli G, Testa C (1989) Carotid atherosclerosis and cardioembolic diseases: incidence and pathogenetic relevance in cerebral TIA and amaurosis fugax. In: Descovich GC, Gaddi A, Magri GL, Lenzi S (eds) Atherosclerosis and cardiovascular disease. Editrice Compositori, Bologna, pp 645–650

    Google Scholar 

  36. Zencker G, Erbel R, Kramer G, Mohr-Kahaly, Drexler M, Harnoncourt K, Meyer J (1988) Transesophageal two-dimensional echocardiography in young patients with cerebral ischemic events. Stroke 19: 345–348

    Article  Google Scholar 

  37. Marks AR, Choong CY, Sanfilippo AJ, Ferry M, Weyman AE (1989) Identification of high-risk and low-risk subgroups of patients with mitral valve prolapse. N Engl J Med 313: 1305–1309

    Google Scholar 

  38. Naggar CZ, Pearson WN, Selijan MP (1986) Frequency of complications of mitral valve prolapse in subjects aged 60 years and older. Am J Cardiol 58: 1209–1212

    Article  CAS  PubMed  Google Scholar 

  39. Walsh PN, Phil D, Kansu TA (1981) Platelets, thromboembolism and mitral valve prolapse. Circulation 63: 522–559

    Article  Google Scholar 

  40. Scharf RE, Hennerici M, Blutscke V, Lueck J, Kladetzky (1982) Cerebral ischemia in young patients: is it associated with mitral valve prolapse and abnormal platelet activity in vivo? Stroke 13: 454–458

    CAS  Google Scholar 

  41. Fisher M, Weiner BH, Ockene IS, Forsberg A, Duffy CP, Levine PH (1983) Platelet activation and mitral valve prolapse. Neurology 33: 384–386

    Article  CAS  PubMed  Google Scholar 

  42. Wolf PA, Sila CA (1987) Cerebral ischemia with mitral valve prolapse. Am Heart J 113: 1308–1315

    Article  CAS  PubMed  Google Scholar 

  43. Zuppiroli A, Cecchi F, Ciaccheri M (1986) Platelet function and coagulation studies in patients with mitral valve prolapse. Clin Cardiol 9: 487–492

    Article  CAS  PubMed  Google Scholar 

  44. Cheng TO (1989) Transient ischemic attack: a complication of mitral valve prolapse in pregnancy. Obstet Gynecol 73 (2): 297–298

    CAS  PubMed  Google Scholar 

  45. Degani S, Abinader EG, Scharf RE (1989) Mitral valve prolapse and pregnancy: a review. Obstet Gynecol Surv 44 (9): 642–649

    Article  CAS  PubMed  Google Scholar 

  46. Herman P (1989) Migraine and mitral valve prolapse. Arch Neurol 46 (11): 1165–1169

    Article  CAS  PubMed  Google Scholar 

  47. Elam MB, Viar MJ, Ratts TE, Chesney CM (1986) Mitral valve prolapse in women with oral contraceptive related cerebrovascular insufficiency. Arch Intern Med 146: 73–77

    Article  CAS  PubMed  Google Scholar 

  48. Busch EH, Snyder DW, Barron RE (1986) Embolic risk in a woman with mitral valve prolapse who used oral contraceptives. Chest 90: 454–455

    Article  CAS  PubMed  Google Scholar 

  49. Salgado AV, Furlan AJ, Salcedo EE (1990) Risk of stroke with bicuspid valve. J Neurol 237 (2): 137–141

    Google Scholar 

  50. Di Pasquale G, Ribani MA, Andreoli A, Zampa GA, Pinelli G (1989) Cardioembolic stroke in primary oxalosis with cardiac involvement. Stroke 20: 1403–1406

    Article  PubMed  Google Scholar 

  51. Aita J A (1972) Systemic and non-atherosclerotic causes of cerebral infarctions. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology. American Elsevier, New York, pp 421–429

    Google Scholar 

  52. Bassand JP, Bihr E, Becque O et al. (1979) Cerebral emboli of cardiac origin. J Neuroradiol 6: 117–126

    CAS  PubMed  Google Scholar 

  53. Webster MWI, Smith HJ, Sharpe DN, Chancellor AM, Swift DL, Bass NM, Glasgow GL (1988) Patent foramen ovale in young stroke patients. Lancet ii: 11–12

    Google Scholar 

  54. Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimzae M, Drobinski G, Thamas D, Grosgoseat Y (1988) Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 318: 1148–1152

    Article  CAS  PubMed  Google Scholar 

  55. Gallet B, Malergue MC, Adams C et al. (1985) Atrial septal aneurysm: potential cause of systemic embolism: an echocardiographic study. Br Heart J 53: 292–297

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Hanley PC, Taijk AJ, Hines JK et al. (1985) Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol 6: 1370–1382

    Article  CAS  PubMed  Google Scholar 

  57. Di Pasquale G, Andreoli A, Grazi P, Dominici P, Pinelli G (1988) Cardioembolic stroke from atrial septal aneurysm. Stroke 19: 640–643

    Article  PubMed  Google Scholar 

  58. Belkin RN, Hurwitz BJ, Kisslo KB (1987) Atrial septal aneurysm: association with cerebrovascular and peripheral embolic events. Stroke 18: 856–862

    Article  CAS  PubMed  Google Scholar 

  59. Zagalboita-Reyes M, Herrera C, Gandhi DK, Mehlman DJ, McPherson DD, Talano JV (1990) A possible mechanism for neurologic ischemic events in patients with atrial septal aneurysm. Am J Cardiol 66: 761–764

    Article  Google Scholar 

  60. Rahko PS, Xu QB (1990) Increased prevalence of atrial septal aneurysm in mitral valve prolapse. Am J Cardiol 66: 235–237

    Article  CAS  PubMed  Google Scholar 

  61. Abinader EG, Rokey R, Goldhammer E, Kuo LC, Said E (1988) Prevalence of atrial septal aneurysm in patients with mitral valve prolapse. Am J Cardiol 62: 1139–1140

    Article  CAS  PubMed  Google Scholar 

  62. Glesby MJ, Pyeritz RE (1989) Association of mitral valve prolapse and systemic abnormalities of connective tissue. A phenotypic continuum. JAMA 262 (4): 523–528

    Article  CAS  PubMed  Google Scholar 

  63. Hart RG, Kanter MC (1990) Hematologic disorders and ischemic stroke. Stroke 21: 1111–1121

    Article  CAS  PubMed  Google Scholar 

  64. Brey RL, Hart RG, Sherman DG, Tegeler CH (1990) Antiphospholipid antibodies and cerebral ischemia in young people. Neurology 40: 1190–1196

    Article  CAS  PubMed  Google Scholar 

  65. Takano K, Yamaguchi T, Kato H, Omae T (1991) Activation of coagulation in acute cardioembolic stroke. Stroke 22: 12–16

    Article  CAS  PubMed  Google Scholar 

  66. The Antiphospholipid Antibodies in Stroke Study Group (1990) Clinical and laboratory findings in patients with antiphospholipid antibodies and cerebral ischemia. Stroke 21: 1268–1273

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1992 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Urbinati, S., Di Pasquale, G., Andreoli, A., Pinelli, G. (1992). Two-Dimensional Echocardiography in Young Adults with Cerebral Ischemia: Emerging Issues. In: Di Pasquale, G., Pinelli, G. (eds) Heart-Brain Interactions. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-76652-7_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-76652-7_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-76654-1

  • Online ISBN: 978-3-642-76652-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics