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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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