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Age 18 - 50 years
More favorable outcome -> Treat these patients aggressively.
 
Cervical arterial dissection accounts for 20% of all ischemic strokes
and may often be preceded by only minor trauma
 
- Cardiac 心
- Hematologic 血
- Vasculopathy 管
- Metabolic 代謝
- Drug abuse 藥物
 
梅毒檢查 RPR/VDRL Blood
紅血球沈降速度測定 E.S.R  
D-D dimer test
Fibrinogen (Nephelometry)
抗細胞核抗體 ANA (anti-nuclear Ab) FLA法  
RA Factor(免疫比濁法 Nephelometry) 
<委外>抗磷脂抗體 Anti-phospholipid antibody-IgG 
<委外>抗心脂抗體 Anti-cardiolipin-IgG 
<委外>狼瘡抗凝血因子Lupus anticoagulant test 
<委外>抗凝血 III AT III (antithrombin) 
<委外>蛋白C Protein C 
<委外>蛋白S Protein S 
同半胱胺酸 Homocysteine 
 
Holter, Cardiac echo, Carotid echo 
 
 

Cardiac : Congenital heart disease
- Paradoxical embolism
- Hyperviscosity ( Chronic cyanosis -> polycythemia and compensatory erythrocytosis)
- Increased risk of infective endocarditis and septic embolism
- Dilated cardiac chambers with intra-cardiac thrombus formation
 

 

Hematologic :
 
- Anemia :
  * Sickle cell disease ( most common cause of stroke in children )
  * Iron deficiency
 
- Inherited hypercoagulable state :
  * Protein C, Protein S deficiency, Antithrombin III deficiency
 
- Aquired hypercoagulable state :
  * Pregnancy
  * Oral contraceptives - DIC
  * Leukemia and other malignancies
 
 
If patients with sickle cell disease otherwise qualify, administer IV thrombolysis
Despite a paucity of high-quality evidence, expert consensus also recommends emergent exchange packed red blood cell transfusion in sickle cell patients with acute ischemic stroke, with the goal of reducing hemoglobin S levels to <30%,
along with a target goal to achieve a total hemoglobin level of 10 grams/dL
 

 

Vasculopathy :
 
Non inflammatory :
  - Focal cerebral arteriopathy (Transient cerebral arteriopathy of childhood)
    unilateral focal or segmental stenosis of the distal carotid arteries and proximal Circle of Willis vessels
  - Moya moya : progressive stenosis of the ICA and formation of collateral vessels
    puff of smoke appearance on angiography.
 - Dissection may with Connective tissue disorders : Ehlers-Danlos syndrome, Marfan syndrome
 
Inflammatory (Vasculitis)
 - Primary : Takayasu arteritis, giant cell arteritis, polyarteritis nodosa, Kawasaki disease
 - Secondary : HIV, Varicella, Bacterial meningitis, Syphilis, Tuberculosis, Fungal
 
 
Patients who have human immunodeficiency virus and a recent CD4 cell count <200 cells/mm3
are also at increased risk for ischemic stroke (rate ratio 2.5; 95% CI, 1.3 to 4.6), as are young adults who survive cancer.
 
 
 

Metabolic :
 

 

Substance abuse :
 
Cocaine and Methamphetamine can cause stroke due to hypertension, vasospasm, or vasculitis.
 
 
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