Lacunar stroke in young male patients
DOI: 10.32364/2587-6821-2023-7-10-1
N.A. Pizov1, N.S. Baranova2, N.V. Pizova2, M.V. Bakucheva1
1Clinical Hospital No. 2, Yaroslavl, Russian Federation
2Yaroslavl State Medical University, Yaroslavl, Russian Federation
Background: ischemic strokes at a young age are one of the urgent problems of modern reality, since they occur in persons of working age. These vascular catastrophes are of great economic importance. Lacunar stroke (LS), or small vessel occlusion, is one of the main ischemic stroke (IS) subtypes with a variety of modifiable risk factors for its development.
Aim: to evaluate the main risk factors, the stroke patterns and the endothelial function state in young male patients (18—50 y.o.) with LS.
Patients and Methods: 46 male patients aged 18–50 y.o. with LS were included in the study. The NIHSS neurological deficit assessment scale, the Modified Rankin Scale and the Rivermead Mobility Index were used to objectify the severity of existing clinical symptoms and assess the IS severity. The patients underwent brain CT and/or MRI, ultrasound and duplex scanning of neck and head vessels, ECG, ECHO cardioscopy and laboratory examination. Shoulder ultrasound (SU) was used to assess the endothelial vasomotor function.
Results: in the examined patients, the main risk factors were hypertension (97.8%), smoking (67.4%), dyslipidemia (41.3%) and obesity (8.7%). At the same time, the combination of hypertension and smoking was noted in 67.4% of cases, the combination of hypertension, smoking and regular alcohol consumption — in 17.4% of cases, atherosclerosis of the major arteries of the head — in 56.5% of cases. Isolated common carotid artery (CCA) stenosis was observed in 22.2% of cases, the degree of which varied from 20 to 35%, in 50% — internal carotid artery (ICA) stenosis (20—40%) and in 33.3% — combined stenoses of the CCA and ICA (25—60%). SU revealed a disorder in the form of a decreased vasomotor reactivity in 20 (58.8%) of the 34 examined patients.
Conclusion: in male patients aged 18–50 y.o. with LS, multiple modifiable risk factors were identified. Ultrasound signs of endothelial dysfunction were detected in more than half of the patients.
Keywords: lacunar stroke, young age, modifiable risk factors, endothelial dysfunction, shoulder ultrasound.
For citation: Pizov N.A., Baranova N.S., Pizova N.V., Bakucheva M.V. Lacunar stroke in young male patients. Russian Medical Inquiry. 2023;7(10):614–619 (in Russ.). DOI: 10.32364/2587-6821-2023-7-10-1.
About the authors:
Nikolay A. Pizov — Head of the Department of Rehabilitation of Patients with Central Nervous System Disorders, Clinical Hospital No. 2; 39, Suzdalskoye highway, Yaroslavl, 150030, Russian Federation; ORCID iD 0000-0002-3009-3020.
Natalia S. Baranova — Dr. Sc. (Med.), Professor of the Department of Nervous Diseases with Medical Genetics and Neurosurgery, Yaroslavl State Medical University; 5, Revolutsionnaya str., Yaroslavl, 150000, Russian Federation; ORCID iD 0000-0003-1745-5354.
Natalia V. Pizova — Dr. Sc. (Med.), Professor of the Department of Nervous Diseases with Medical Genetics and Neurosurgery, Yaroslavl State Medical University; 5, Revolutsionnaya str., Yaroslavl, 150000, Russian Federation; ORCID iD 0000-0002-7465-0677.
Musa V. Bakucheva — Head of the Department of Functional Diagnostics, Clinical Hospital No. 2; 39, Suzdalskoye highway, Yaroslavl, 150030, Russian Federation.
Contact information: Natalia V. Pizova, e-mail: pizova@yandex.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 18.08.2023.
Revised 12.09.2023.
Accepted 28.09.2023.
2. Béjot Y., Bailly H., Durier J., Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Méd. 2016;45:e391–e398. DOI: 10.1016/j.lpm.2016.10.003.
3. Putaala J., Metso A.J., Metso T.M. et al. Analysis of 1008 consecutive patients aged 15 to 49 with first ever ischemic stroke: the Helsinki young stroke registry. Stroke. 2009;40:1195–1203. DOI: 10.1161/STROKEAHA.108.529883.
4. George M.G., Tong X., Kuklina E.V., Labarthe D.R. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995–2008. Ann Neurol. 2011;70:713–721. DOI: 10.1002/ana.22539.
5. Rutten-Jacobs L.C., Arntz R.M., Maaijwee N.A. et al. Long-term mortality after stroke among adults aged 18 to 50 years. JAMA. 2013;309:1136–1144. DOI: 10.1001/jama.2013.842.
6. Palmcrantz S., Widen Holmqvist L., Sommerfeld D.K. Young individuals with stroke: a cross sectional study of long-term disability associated with self-rated global health. BMC Neurol. 2014;14:20. DOI: 10.1186/1471-2377-14-20.
7. Edwards J.D., Kapoor A., Linkewich E., Swartz R.H. Return to work after young stroke: a systematic review. Int J Stroke. 2018;13:243–256. DOI: 10.1177/1747493017743059.
8. Adams H.P., Bendixen B.H., Kappelle L.J. et al. Classification of subtype of acute ischemic stroke definitions for use in a multicenter clinical trial. Stroke. 1993;24:35–41. DOI: 10.1161/01.STR.24.1.35.
9. Bamford J., Sandercock P., Jones L., Warlow C. The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. Stroke 1987;18:545–551. DOI: 10.1161/01.str.18.3.545.
10. Fisher C.M. The arterial lesions underlying lacunes. Acta Neuropathol (Berl). 1968;12:1–15. DOI: 10.1007/BF00685305.
11. Lammie G.A., Brannan F., Slattery J., Warlow C. Nonhypertensive cerebral small-vessel disease. An autopsy study. Stroke 1997;28(11):2222–2229. DOI: 10.1161/01.str.28.11.2222.
12. Rasura M., Spalloni A., Ferrari M. et al. A case series of young stroke in Rome. Eur J Neurol. 2006;13:146–152. DOI: 10.1111/j.1468-1331.2006.01159.
13. Varona J.F., Guerra J.M., Bermejo F. et al. Causes of ischemic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur Neurol. 2007;57:212–218. DOI: 10.1159/000099161.
14. Cerrato P., Grasso M., Imperiale D. et al. Stroke in young patients: etiopathogenesis and risk factors in different age classes. Cerebrovasc Dis. 2004;18:154–159. DOI: 10.1159/000079735.
15. Jovanovic D.R., Beslac-Bumbasirevic L., Raicevic R. et al. Etiology of ischemic stroke among young adults of Serbia. Vojnosanit Pregl. 2008;65:803–809. DOI: 10.2298/VSP0811803J.
16. Spengos K., Vemmos K. Risk factors, etiology, and outcome of first-ever ischemic stroke in young adults aged 15 to 45 — the Athens Young Stroke Registry. Eur J Neurol. 2010;17(11):1358–1364. DOI: 10.1111/j.1468-1331.2010.03065.
17. Tancredi L., Martinelli Boneschi F., Braga M. et al. Stroke care in young patients. Stroke Res Treat. 2013;2013:715380. DOI: 10.1155/2013/715380.
18. Пизов Н.А., Скачкова О.А., Пизова Н.В., Баранова Н.С. Традицонные и редкие причины ишемического инсульта у лиц 18–50 лет. Consilium Medicum. 2021;23(2):122–126. DOI: 10.26442/20751753.2021.2.200651. [Pizov N.A., Skachkova O.A., Pizova N.V., Baranova N.S. Traditional and rare causes of ischemic stroke in 18 to 50-year old persons. Consilium Medicum. 2021;23(2):122–126 (in Russ.)]. DOI: 10.26442/20751753.2021.2.200651.
19. Goldstein L.B., Bertels C., Davis J.N. Interrater reliability of the NIH stroke scale. Arch Neurol. 1989;46(6):660–662. DOI: 10.1001/archneur.1989.00520420080026.
20. Gao Y., Wang Y., Li D. et al. Disability assessment in stroke: Relationship among the pictorial-based Longshi Scale, the Barthel Index, and the modified Rankin Scale. Clin Rehab. 2020;35:606–613. DOI: 10.1177/0269215520975922.
21. Lennon S., Johnson L. The modified Rivermead Mobility Index: validity and reliability. Disabil Rehabil. 2000;22(18):833–839. DOI: 10.1080/09638280050207884.
22. Максимова М.Ю., Сазонова В.Ю. Факторы риска развития ишемического инсульта у мужчин и женщин в возрасте 45–74 лет. Неврология, нейропсихиатрия, психосоматика. 2023;15(4):38–44. DOI: 10.14412/2074-2711-2023-4-38-44. [Maksimova M.Yu., Sazonova V.Yu. Risk factors for ischemic stroke in men and women aged 45–74 years. Nevrologiya, neiropsikhiatriya, psikhosomatika. 2023;15(4):38–44 (in Russ.)]. DOI: 10.14412/2074-2711-2023-4-38-44.
23. Celermajer D.S., Sorensen K.E., Gooch V.M. et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111–1115. DOI: 10.1016/0140-6736(92)93147-f.
24. Домашенко М.А., Чечеткин А.О., Суслина З.А. Ультразвуковая оценка дисфункции эндотелия у пациентов в остром периоде ишемического инсульта. Ультразвуковая и функциональная диагностика. 2007;2:73–81. [Domashenko M.A., Chechetkin A.O., Suslina Z.A. Ultrasound Endothelium Dysfunction Assessment in Patients with Acute Period of an Ischemic Insult. Ultrazvukovaya i Funktsionalnaya Diagnostika. 2007;2:73–81 (in Russ.)].
25. Anderson T.J., Uehata A., Gerhard M.D. et al. Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol. 1995;26(5):1235–1241. DOI: 10.1016/0735-1097(95)00327-4.
26. Davignon J., Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004; 109(23 Suppl 1):III27–32. DOI: 10.1161/01.CIR.0000131515.03336.f8.
27. Прибылова Н.Н., Беззубцева М.В., Прибылов С.А. и др. Эндотелиальная дисфункция у больных гипертонической болезнью в остром периоде ишемического инсульта. Трудный пациент. 2016;14(6-7):17–20. [Pribylova N.N., Bezzubtseva M.V., Pribylov S.A. et al. Endothelial Dysfunction in Patients with Arterial Hypertension and Acute Ischemic Stroke. Trudnyi Patsient. 2016; 14(6-7):17–20 (in Russ.)].
28. Go A.S., Mozaffarian D., Roger V.L. et al. Heart disease and stroke statistics — 2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6–e245. DOI: 10.1161/CIR.0b013e31828124ad.
29. Ekker M.S., Boot E.M., Singhal A.B. et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17(9):790–801. DOI: 10.1016/S1474-4422(18)30233-3.
30. Boot E., Ekker M.S., Putaala J. et al. Ischaemic stroke in young adults: a global perspective. J Neurol Neurosurg Psychiatry. 2020;91(4):411–417. DOI: 10.1136/jnnp-2019-322424.
31. Tibæk M., Dehlendorff C., Jørgensen H.S. et al. Increasing incidence of hospitalization for stroke and transient ischemic attack in young adults: a registry-based study. J Am Heart Assoc. 2016;5(5):e003158. DOI: 10.1161/JAHA.115.003158.
32. Namaganda P., Nakibuuka J., Kaddumukasa M., Katabira E. Stroke in young adults, stroke types and risk factors: a case control study. BMC Neurol. 2022;22(1):335. DOI: 10.1186/s12883-022-02853-5.
33. Renna R., Pilato F., Profice P. et al. Risk factor and etiology analysis of ischemic stroke in young adult patients. J Stroke Cerebrovasc Dis. 2014;23(3):e221–227. DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.008.
34. Ohya Y., Matsuo R., Sato N. et al. Investigators for Fukuoka Stroke Registry. Causes of ischemic stroke in young adults versus non-young adults: A multicenter hospital-based observational study. PLoS One. 2022;17(7):e0268481. DOI: 10.1371/journal.pone.0268481.
35. Maaijwee N.A.M.M., Rutten-Jacobs L.C.A., Schaapsmeerders P. et al. Ischaemic stroke in young adults: Risk factors and long-term consequences. Nat Rev Neurol. 2014;10(6):315–325. DOI: 10.1038/nrneurol.2014.72.
36. Aigner A., Grittner U., Rolfs A. et al. Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults. Stroke. 2017;48(7):1744–1751. DOI: 10.1161/STROKEAHA.117.016599.
37. Rolfs A., Fazekas F., Grittner U. et al. Acute cerebrovascular disease in the young: The stroke in young fabry patients study. Stroke. 2013;44(2):340–349. DOI: 10.1161/STROKEAHA.112.663708.
38. Zhang B., Pu S., Zhang W. et al. Sex differences in risk factors, etiology, and short-term outcome of cerebral infarction in young patients. Atherosclerosis. 2011;216(2):420–425. DOI: 10.1016/j.atherosclerosis.2011.02.002.
39. Schwarzwald A., Fischer U., Seiffge D. et al. Impact of sex in stroke in the young. PLoS One. 2023;18(3):e0274722. DOI: 10.1371/journal.pone.0274722.
40. Khan F.Y. Risk factors of young ischemic stroke in Qatar. Clin Neurol Neurosurg. 2007;109(9):770–773. DOI: 10.1016/j.clineuro.2007.07.006.
41. Dharmasaroja P.A., Muengtaweepongsa S., Lechawanich C., Pattaraarchachai J. Causes of ischemic stroke in young adults in Thailand: a pilot study. J Stroke Cerebrovasc Dis. 2011;20(3):247–250. DOI: 10.1016/j.jstrokecerebrovasdis.2010.01.004.
42. Caplan L.R. Lacunar Infarction and Small Vessel Disease: Pathology and Pathophysiology. J Stroke. 2015;17(1):2. DOI: 10.5853/jos.2015.17.1.2.
43. Poggesi A., Pasi M., Pescini F. et al. Circulating biologic markers of endothelial dysfunction in cerebral small vessel disease: A review. J Cereb Blood Flow Metab. 2016;36(1):72–94. DOI: 10.1038/jcbfm.2015.116.
44. Wardlaw J.M., Smith C., Dichgans M. Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging. Lancet Neurol. 2013;12(5):483–497. DOI: 10.1016/S1474-4422(13)70060-7.
45. Regenhardt R.W., Das A.S., Ohtomo R. et al. Pathophysiology of Lacunar Stroke: History's Mysteries and Modern Interpretations. J Stroke Cerebrovasc Dis. 2019;28(8):2079–2097. DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.006.
46. Lucas C., Lecroart J.L., Gautier C. et al. Impairment of endothelial function in patients with spontaneous cervical artery dissection: evidence for a general arterial wall disease. Cerebrovasc Dis. 2004;17:170–174. DOI: 10.1159/000075787.
47. Omisore A.D., Ayoola O.O., Ibitoye B.O. et al. Sonographic evaluation of endothelial function in brachial arteries of adult stroke patients. J Ultrasound Med. 2017;36:345–351. DOI: 10.7863/ultra.16.03100.
48. Martinez-Majander N., Gordin D., Joutsi-Korhonen L. et al. Endothelial Dysfunction is Associated With Early-Onset Cryptogenic Ischemic Stroke in Men and With Increasing Age. J Am Heart Assoc. 2021;10(14):e020838. DOI: 10.1161/JAHA.121.020838.
49. Deplanque D., Lavallee P.C., Labreuche J. et al. Cerebral and Extracerebral Vasoreactivity in Symptomatic Lacunar Stroke Patients: A Case-Control Study. Int J Stroke. 2013;8(6):413–421. DOI: 10.1111/j.1747-4949.2011.00755.x.
50. Варакин Ю.Я., Гнедовская Е.В., Горностаева Г.В. и др. Функция эндотелия у больных с начальными клиническими проявлениями хронической цереброваскулярной патологии при артериальной гипертонии. Анналы клинической и экспериментальной неврологии. 2013;7(4):10–15. [Varakin Yu.Ya., Gnedovskaya E.V., Gornostaeva G.V. et al. Endothelial function in patients with initial clinical manifestations of chronic cerebrovascular pathology in arterial hypertension. Annals of Clinical and Experimental Neurology. 2013;7(4):10–15 (in Russ.)].
51. Modena M.G., Bonetti L., Coppi F. et al. Prognostic role of reversible endothelial dysfunction in hypertensive postmenopausal women. J Am Coll Cardiol. 2002;40(3)505–510. DOI: 10.1016/s0735-1097(02)01976-9.
52. Vita J.A., Keaney J.F.Jr. Endothelial function: a barometer for cardiovascular risk? Circulation. 2002;106(6):640–642. DOI: 10.1161/01.cir.0000028581.07992.56.
53. Goslawski M., Piano M.R., Bian J.T. et al. Binge drinking impairs vascular function in young adults. J Am Coll Cardiol. 2013;62:201–207. DOI: 10.1016/j.jacc.2013.03.049.
54. Hamburg N.M., Keyes M.J., Larson M.G. et al. Cross-sectional relations of digital vascular function to cardiovascular risk factors in the Framingham Heart study. Circulation. 2008;117:2467–2474. DOI: 10.1161/CIRCULATIONAHA.107.748574.
55. Хасанова Л.Т. Генетические факторы развития инсульта. РМЖ. 2019;(7): 34–36. [Khasanova L.T. Genetic factors of stroke development. RMJ. 2019;7:34–36 (in Russ.)].
56. Иванова Г.Е. Инновации в реабилитации больных после инсульта на амбулаторном этапе. РМЖ. 2019;(4): 100–104. [Ivanova G.E. Innovations in rehabilitation of patients after stroke at the outpatient stage. RMJ. 2019;(4): 100–104 (in Russ.)].
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