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ISCHEMIC STROKE IN YOUNG PEOPLE.
FEATURES OF ETIOPATHOGENESIS
Rakhmatova Sanobar Nizamovna
Dzhumaev Bahodir Igamovich
Bukhoro davlat Tibbet institutes
https://orcid.org/0009-0009-5082-5450
The thesis
https://doi.org/10.5281/zenodo.15425996
The relevance
of studying the problem of stroke in young people is due to
the fact that its etiology in a significant proportion of patients differs from the
etiology of stroke in older age groups and often remains unclear, and this affects
secondary prevention; the algorithm for examining these patients has not been
sufficiently developed; the medical and social consequences are great. Among
young people with AI, over 40% return to work, which is associated with better
recovery of motor and speech functions compared with patients of older age
groups [2, 7]. In connection with the above aspects, a number of studies are
being conducted studying stroke in young people. The most common
classification in clinical practice is the etiopathogenetic subtypes of AI (TOAST),
let's consider some provisions [12, 15]:
1. Atherothrombotic stroke (due to atherosclerosis of large arteries,
including arterioarterial embolism).
2. Cardioembolic stroke (cardiac embolism).
3. Lacunar stroke (due to occlusion of small-caliber arteries).
4. Stroke of another known etiology.
5. Stroke of unknown etiology.
The aim of the study
was to determine the features of etiopathogenesis
and, as a result, the features of secondary prevention of ischemic stroke in young
people.
Materials and methods.
We examined 10 patients (n = 10) with diagnosed
ischemic stroke aged 19 to 45 years (39 ± 9.24), of whom 5 were women and 5
were men. The age at the time of the stroke, gender, life history and illness were
assessed (attention was paid to the presence in the anamnesis known risk
factors for CVD and CVD and their primary prevention), neurological status,
clinical and instrumental examination and therapy in the acute period, as well as
prescribed secondary prevention.
Results.
Based on the data obtained, the following etiopathogenetic
subtypes of ischemic stroke were diagnosed in the study group: n = 5 (50%) – AI
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of unknown etiology, n = 2 (20%) – AI of another known etiology, n = 2 (20%) –
AI lacunar, n = 1 (10%) – AI atherothrombotic. The group of patients with AI of
unknown etiology is predominantly represented (4 out of 5 examined patients)
by women. In 4 out of 5 cases, blood screening tests were performed to look for
pathology of the coagulation system. In all cases, certain deviations from the
norm were found (genes for the "risk" of thrombophilia, the development of
CVD, a tendency to hypocoagulation, antiphospholipid syndrome, folate cycle
disorders, and others). All of the above patients are consulted by a hematologist.
However, in order to accurately verify a clinically significant pathology of the
blood coagulation system, a wider range of tests was needed that went beyond
the standards of medical care. A group of patients with AI of another known
etiology is very interesting. 1 case is represented by a 19-year-old man who was
diagnosed with acute dissection of the right internal carotid artery (ICA), for
which carotid artery stenting was performed at the end of the acute period of
the disease
. In 2 cases, AI occurred during pregnancy due to transverse sinus
thrombosis, and an examination based on blood tests revealed elevated levels of
lupus anticoagulant, folate, and homocysteine in the patient.
In the group of patients with lacunar AI, diseases and pathological
conditions unknown before the onset of stroke were diagnosed, which are risk
factors for CVD – hypertension, carotid atherosclerosis with less than 50%
stenosis, impaired glucose tolerance in 1 case and hyperuricemia in 2 cases.
Conclusions. The incidence of etiopathogenetic subtypes of ischemic stroke
in young people differs from the general population, since this pathology is more
typical for people of older age groups. Stroke of unknown etiology was most
often diagnosed, which is associated with a certain difficulty in verifying risk
factors. The distribution of the studied patients by etiopathogenetic subtypes
generally coincides with the results of other publications.
Thus, it makes sense for all young people with ischemic stroke to search for
possible pathology of the blood coagulation system, since the incidence of
abnormalities shown by screening studies is very high (40%).
Literature:
1. Chemakin, N.Y. Etiological aspects of stroke at a young age with a clinical case
analysis / N.Y. Chemakin // Ural University Medicine. – 2019. – No. 2. – pp.43-
44.
2. Yanishevsky, C.N. Modern treatment options for patients after ischemic stroke
/ C.N. Yanishevsky,
SCIENCE AND INNOVATION IN THE
EDUCATION SYSTEM
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N.V. Tsygan, S.Y. Golokhvastov, R.V. Andreev // Polyclinic. – 2017. – No.4-2. –
pp.55-60.
3. Hemorrhagic stroke // Clinical recommendations. - 2020. – 64 p.
(http://ruans.org/Text/ Guidelines/hemorrhagic_stroke-2020.pdf ).
4. Stakhovskaya, L.V. Epidemiology of stroke in Russia according to the results of
the territorial population registry (2009-2010) / L.V. Stakhovskaya, O.A.
Klochikhina, M.D. Bogatyreva, V.V. Kovalenko // Journal of Neurology and
Psychiatry named after S.S. Korsakov. – 2013. – Vol.113, No. 5. – pp.4-10.
5. Gaivoronskaya, E.S. Features of the etiology, clinical course and outcomes of
strokes in young patients / E.S. Gaivoronskaya, A.D. Gaivoronskaya, S.S.
Gaivoronsky // The Journal of scientific articles “Health and Education
Millennium". – 2018. – Vol.20, №7. – P.53-57.
6. Andreeva A.Yu., Kudryavtseva M.M., Drobot G.P. Study of the blood lipid
profile and the state of the hemostasis system in patients with acute
hemorrhagic stroke // Modern problems of medicine and natural sciences:
collection of theses. / Ed . Dubinin M.V., Vedernikov A.A., Drobot G.P. [et al.].
Yoshkar-Ola: Mari State University, 2018. pp.86-92.
7. Prilepskaya, O.A. Stroke in young people: do we know everything? / O.A.
Prilepskaya, O.A. Dubrovina // Ural University Medicine. - 2016. – Vol. 2, No.
1(4). – pp.75-79.
8. Pisova, N.V. Cryptogenic stroke at a young age: diagnostic difficulties and new
therapeutic possibilities. Pisova, O.A. Skachkova, N.A. Pisov // Polyclinic. – 2019.
– No.3. – pp.18-22.
9. Ornello, R. Distribution and Temporal Trends From 1993 to 2015 of Ischemic
Stroke Subtypes: A Systematic Review and Meta-Analysis / R. Ornello, D. Degan,
C. Tiseo [et al.] // Stroke. – 2018. – Vol.49, №4. – P.814-819.
10. Wilner, A. Stroke in Young Patients: 5 New Things / A. Wilner // Neyrology
Times. – 2018. – (https://www.neurologytimes.com/stroke/strokeyoung-
patients-5-new-things).
11. Kissela, B. Stroke in the Young: Preliminary Results for Temporal Trends in
the Age of Stroke Incidence in a Large, Bi-Racial Population / B. Kissela, K.
Alwell, J. Khoury [et al.] // Stroke. – 2014. – Vol.45, №1. – P.46-51.
12. Adams, H.P. Design of the trial of Org 10172 in acute stroke treatment
(TOAST) / H.P. Adams, R.F. Woolson, W.R. Clarke // Controlled Clinical Trials. –
1997. – Vol.18, №4. – P.358-377.
13. Huang, Y. Evaluation of the Influence of Etiological Factors on the Economic
Burden of Ischemic Stroke in Younger Patients in China Using the Trial of Org
SCIENCE AND INNOVATION IN THE
EDUCATION SYSTEM
International scientific-online conference
101
10172 in Acute Stroke Treatment (TOAST) Classification / Y. Huang, X. Liao, Z.
Song [et al.] // Medical Science Monitor. – 2019. – Vol.25. – P.637-642.
14. Nawaz, B. Young ischaemic stroke incidence and demographic
characteristics – The Norwegian stroke in the young study – A threegeneration
research program / B. Nawaz, G. Eide, A. Fromm [et al.] // Eur. Stroke J. – 2019. –
Vol.4, №4. – P.347-354.
15. Adams, H.P. Classification of subtype of acute ischemic stroke. Definitions for
use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke
Treatment / H.P. Adams, B. Bendixen, L. Kappelle [et al.] // Stroke. – 1993. –
Vol.24, №1. – P.35-41
