教育講演
若年者の脳卒中の鑑別疾患と治療
キーワード:
stroke in young adults,
arterial dissection,
moyamoya disease,
anitphospholipid syndrome,
pregnancy
2019 年 36 巻 3 号 p. 135-139
詳細
2019 年 36 巻 3 号 p. 135-139
The causes of strokes in young adults differ from older patients whose main causes are atherothrombosis and non–valvular atrial fibrillation. It's very important to understand the specific cause with young adults. According to “Strategies against Stroke Study for Young Adults in Japan” (SASSY–Japan), 8.9% of all stroke patients are under 50 years of age. Arterial dissection, moyamoya disease, and antiphospholipid syndrome are the most common three causes of ischemic strokes in young adults. Arteriovenous malformation and moyamoya disease are the most common two causes of hemorrhagic strokes.
Arterial dissection is the most common disease in young adults. Most causes are unknown, but sometimes slight trauma is the cause. Dissection causes not only ischemic strokes but also subarachnoid hemorrhage (SAH). The mechanisms of ischemic strokes are artery–to–artery mechanisms and/or hemodynamic mechanisms. The therapies are blood pressure control and anti thrombotic agency. When patients suffer SAH, open surgery and endovascular therapy are considered.
In these days, strokes accompanied with pregnancy are studied. Changes in cardiovascular hemodynamics and in the coagulation mechanisms of pregnancy increase the risk of ischemic and hemorrhagic stroke, SAH, and venous thrombosis. Reversible posterior leukoencephalopathy syndrome (RPLS) and reversible cerebral vasoconstriction syndrome (RCVS) are also reported. RPLS's main symptoms are headaches, visual abnormalities, and epilepsy. In a MRI, the main disease location is parieto–occipital lobe's white matter and where brain edemas occur. If blood pressure is decreased, symptom and image abnormalities disappear. RCVS's main symptom is a headache called thunderclap headache. Cerebral artery temporary becomes vasoconstriction but after anti hypertension therapy, the artery returns to normal.
Otherwise, cryptogenic stroke, and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are important stroke causes.
In this paper, I summarized causes of strokes which occur in young adults.
