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Premature vascular disease in young adult stroke: a pathology-based case series

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Abstract

Introduction

The prevalence of modifiable vascular risk factors is increasing in young adults and may contribute to the growing frequency of stroke in this population. The neuropathology and end-organ damage profile of young adult stroke patients with clinically advanced atherosclerosis or arteriosclerosis has not been studied.

Methods

This retrospective study included patients aged 18–60 years admitted to our hospital from 1995 to 2017 with recurrent ischemic or hemorrhagic strokes, fatal stroke, or stroke associated with advanced small vessel disease (SVD) on brain MRI, who had no evidence for structural, genetic, inflammatory, or infectious etiology for stroke, and had adequate pathological materials available for analysis. The presence of atherosclerosis, arteriolosclerosis, left ventricular hypertrophy, and nephrosclerosis was evaluated.

Results

Twelve patients (mean age 47 ± 9 years, range 31–57 years, 67% male) met inclusion criteria. Four had fatal intracerebral hemorrhage (ICH), three had recurrent non-fatal ICH, one had ICH with advanced SVD on MRI, and four had recurrent ischemic strokes including two with transient ischemic attacks. Pathological studies showed moderate/severe atherosclerosis in 64% and moderate/severe arteriolosclerosis in 42% of patients. Pathological data to evaluate end-organ damage were available for nine patients; eight showed left ventricular hypertrophy and all showed nephrosclerosis.

Conclusion

Young adult stroke patients with recurrent stroke, fatal stroke, or SVD on imaging have advanced atherosclerosis and arteriolosclerosis-related pathological changes in multiple organ systems. Aggressive control of atherosclerosis risk factors is warranted even in young individuals.

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Funding

Eva Rocha reports the following research support: Capes Foundation, Ministry of Education, Brazil. Aneesh B. Singhal reports the following research supports: NIH grants U10 NS086729, U01NS095869, R01NS105875, and R01DC012584.

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Author notes

  1. Marco Pasi and Eva Rocha These authors contribute equally to this work

Authors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Marco Pasi, Eva Rocha, Anand Viswanathan & Aneesh B. Singhal

  2. Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Université de Lille, Lille, France

    Marco Pasi

  3. Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Brazil

    Eva Rocha

  4. C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, USA

    Wesley Samore & Matthew P. Frosch

Authors
  1. Marco Pasi
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  2. Eva Rocha
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  3. Wesley Samore
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  4. Matthew P. Frosch
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Corresponding author

Correspondence to Aneesh B. Singhal.

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Conflicts of interest

Marco Pasi reports no conflicts of interest relevant to this work. Eva Rocha reports no conflicts of interest relevant to this work. Wesley Samore reports no conflicts of interest relevant to this work. Matthew P. Frosh reports no conflicts of interest relevant to this work. Anand Viswanathan reports no conflicts of interest relevant to this work. Aneesh B. Singhal reports no conflicts of interest relevant to this work.

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Pasi, M., Rocha, E., Samore, W. et al. Premature vascular disease in young adult stroke: a pathology-based case series. J Neurol 267, 1063–1069 (2020). https://doi.org/10.1007/s00415-019-09623-3

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  • DOI: https://doi.org/10.1007/s00415-019-09623-3

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