Cerebral ischemia in young patients (under 45 years of age): clinical and neuroradiological follow-up.

Ischemic stroke in young patients is a relatively rare event. Few studies have examined the long-term prognosis. The aim of this study was to evaluate the long-term outcome to identify clinical, laboratory and radiologic patterns as possible predictors for mortality, recurrence and functional recovery. We prospectively evaluated 94 patients (42 males and 52 females, aged 14-45 years, mean age 35.5 years, SD 8.4) admitted to our Neurological Department, for first acute ischemic stroke. A 48-month follow-up was performed. The patients were classified according to TOAST and Baltimore classification and Bamford criteria. The severity of the neurological deficit on admission was assessed using the NIHSS. The follow-up included a clinical visit, the modified Ranking scale (mRs) score, Barthel index (BI), and magnetic resonance imaging and intra-extracranial vessel Angio MRI. A good functional outcome (mRS 0-1) was found in 74 patients and unfavourable outcome (mRS 2-6) in 20 patients. 16 patients had a recurrent cerebral ischemic event: 5 patients had stroke and 11 patients had TIA. The average incidence annual rate of recurrence was 4.5% and a mortality rate was of 1.06%. Our study does not demonstrate any predictive factor related to clinical outcome. The relevant data of neuroradiological follow-up is the presence of clinically silent lesions in nine patients, considered as a recurrent stroke. To attribute a prognostic role to these lesions, clinical and neuroradiological follow-up needs to be continued

Propensity Score-Based Analysis of Percutaneous Closure Versus Medical Therapy in Patients with Cryptogenic Stroke and Patent Foramen Ovale: The IPSYS Registry (Italian Project on Stroke in Young Adults)

Background-We sought to compare the benefit of percutaneous closure to that of medical therapy alone for the secondary prevention of embolism in patients with patent foramen ovale (PFO) and otherwise unexplained ischemic stroke, in a propensity scored study. Methods and Results-Between 2000 and 2012, we selected consecutive first-ever ischemic stroke patients aged 18 to 45 years with PFO and no other cause of brain ischemia, as part of the IPSYS registry (Italian Project on Stroke in Young Adults), who underwent either percutaneous PFO closure or medical therapy for comparative analysis. Primary end point was a composite of ischemic stroke, transient ischemic attack, or peripheral embolism. Secondary end point was brain ischemia. Five hundred and twenty-one patients qualified for the analysis. The primary end point occurred in 15 patients treated with percutaneous PFO closure (7.3%) versus 33 patients medically treated (10.5%; hazard ratio, 0.72; 95% confidence interval, 0.39-1.32; P=0.285). The rates of the secondary end point brain ischemia were also similar in the 2 treatment groups (6.3% in the PFO closure group versus 10.2% in the medically treated group; hazard ratio, 0.64; 95% confidence interval, 0.33-1.21; P=0.168). Closure provided a benefit in patients aged 18 to 36 years (hazard ratio, 0.19; 95% confidence interval, 0.04-0.81; P=0.026) and in those with a substantial right-to-left shunt size (hazard ratio, 0.19; 95% confidence interval, 0.05-0.68; P=0.011). Conclusions-PFO closure seems as effective as medical therapy for secondary prevention of cryptogenic ischemic stroke. Whether device treatment might be more effective in selected cases, such as in patients younger than 37 years and in those with a substantial right-to-left shunt size, deserves further investigation

Association between migraine and cervical artery dissection the Italian project on stroke in young adults

IMPORTANCE Although sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS). OBJECTIVE To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of consecutive patients aged 18 to 45 years with first-ever acute ischemic stroke enrolled in the multicenter Italian Project on Stroke in Young Adults was conducted between January 1, 2000, and June 30, 2015. In a case-control design, the study assessed whether the frequency of migraine and its subtypes (presence or absence of an aura) differs between patients whose IS was due to CEAD (CEAD IS) and those whose IS was due to a cause other than CEAD (non-CEAD IS) and compared the characteristics of patients with CEAD IS with and without migraine. MAIN OUTCOMES AND MEASURES Frequency of migraine and its subtypes in patients with CEAD IS vs non-CEAD IS. RESULTS Of the 2485 patients (mean [SD] age, 36.8 [7.1] years; women, 1163 [46.8%]) included in the registry, 334 (13.4%) had CEAD IS and 2151 (86.6%) had non-CEAD IS. Migraine was more common in the CEAD IS group (103 [30.8%] vs 525 [24.4%], P = .01), and the difference was mainly due to migraine without aura (80 [24.0%] vs 335 [15.6%], P < .001). Compared with migraine with aura, migraine without aura was independently associated with CEAD IS (OR, 1.74; 95%CI, 1.30-2.33). The strength of this association was higher in men (OR, 1.99; 95%CI, 1.31-3.04) and in patients 39.0 years or younger (OR, 1.82; 95%CI, 1.22-2.71). The risk factor profile was similar in migrainous and non-migrainous patients with CEAD IS (eg, hypertension, 20 [19.4%] vs 57 [24.7%], P = .29; diabetes, 1 [1.0%] vs 3 [1.3%], P > .99). CONCLUSIONS AND RELEVANCE In patients with IS aged 18 to 45 years, migraine, especially migraine without aura, is consistently associated with CEAD. This finding suggests common features and warrants further analyses to elucidate the underlying biologic mechanisms

Screening for Fabry disease in patients with ischaemic stroke at young age: the Italian Project on Stroke in Young Adults

reserved85nomixedPoli, L.; Zedde, Marialuisa; Zini, Andrea; Del Sette, Massimo; Lodigiani, Corrado; Spalloni, Alessandra; Di Lisi, Filomena; Toriello, Antonella; Piras, Valeria; Stilo, Cesare; Tomelleri, Giampaolo; Tancredi, Lucia; Paciaroni, Maurizio; Silvestrelli, Giorgio; Adami, Alessandro; Costa, P.; Morotti, A.; De Giuli, V.; Caria, F.; Gamba, Massimo; Malferrari, Giovanni; Simone, Anna Maria; Musolino, Rossella; Giorli, Elisa; Banfi, Elena; Marcheselli, Simona; Rasura, Maurizia; Pugliese, Nicola; Melis, Maurizio; Bovi, Paolo; Padovani, A.; Burlina, A.; Pezzini, A; Del Zotto, Elisabetta; Giossi, Alessia; Sessa, Maria; Gilberti, Nicola; Magoni, Mauro; Ferrazzi, Paola; Librè, Luca; Rota, Lidia Luciana; Patella, Rosalba; Calabrò, Rocco Salvatore; Bramanti, Placido; La Spina, Paolo; Finocchi, Cinzia; Balestrino, Maurizio; Bruno, Chiara; Massucco, Davide; Gandolfo, Carlo; Traverso, Elisabetta; Delodovici, Maria Luisa; Verrengia, Elena Pinuccia; Carimati, Federico; Bono, Giorgio; Dell'Acqua, Maria Luisa; Bigliardi, Guido; Vandelli, Laura; Nichelli, Paolo Frigio; Carletti, Monica; Cerrato, Paolo; Iacoviello, Licia; Di Castelnuovo, Augusto; de Gaetano, Giovanni; Grassi, Mario; Locatelli, Giampiero; Caso, Valeria; D'Amore, Cataldo; Agnelli, Giancarlo; Checcarelli, Nicoletta; Guidotti, Mario; Arnaboldi, Marco; Giacalone, Giacomo; Zanoli, Elisa; Cavallini, Anna; Persico, Alessandra; Micieli, Giuseppe; Chiti, Alberto; Orlandi, Giovanni; Marchi, Piernicola; Lanari, Alessia; Ciccone, Alfonso; Cucurachi, Laura; Bonifati, Marco Domenico; Marcello, NorinaPoli, L.; Zedde, Marialuisa; Zini, Andrea; Del Sette, Massimo; Lodigiani, Corrado; Spalloni, Alessandra; Di Lisi, Filomena; Toriello, Antonella; Piras, Valeria; Stilo, Cesare; Tomelleri, Giampaolo; Tancredi, Lucia; Paciaroni, Maurizio; Silvestrelli, Giorgio; Adami, Alessandro; Costa, P.; Morotti, A.; De Giuli, V.; Caria, F.; Gamba, Massimo; Malferrari, Giovanni; Simone, Anna Maria; Musolino, Rossella; Giorli, Elisa; Banfi, Elena; Marcheselli, Simona; Rasura, Maurizia; Pugliese, Nicola; Melis, Maurizio; Bovi, Paolo; Padovani, A.; Burlina, A.; Pezzini, A; Del Zotto, Elisabetta; Giossi, Alessia; Sessa, Maria; Gilberti, Nicola; Magoni, Mauro; Ferrazzi, Paola; Librè, Luca; Rota, Lidia Luciana; Patella, Rosalba; Calabrò, Rocco Salvatore; Bramanti, Placido; La Spina, Paolo; Finocchi, Cinzia; Balestrino, Maurizio; Bruno, Chiara; Massucco, Davide; Gandolfo, Carlo; Traverso, Elisabetta; Delodovici, Maria Luisa; Verrengia, Elena Pinuccia; Carimati, Federico; Bono, Giorgio; Dell'Acqua, Maria Luisa; Bigliardi, Guido; Vandelli, Laura; Nichelli, Paolo Frigio; Carletti, Monica; Cerrato, Paolo; Iacoviello, Licia; Di Castelnuovo, Augusto; de Gaetano, Giovanni; Grassi, Mario; Locatelli, Giampiero; Caso, Valeria; D'Amore, Cataldo; Agnelli, Giancarlo; Checcarelli, Nicoletta; Guidotti, Mario; Arnaboldi, Marco; Giacalone, Giacomo; Zanoli, Elisa; Cavallini, Anna; Persico, Alessandra; Micieli, Giuseppe; Chiti, Alberto; Orlandi, Giovanni; Marchi, Piernicola; Lanari, Alessia; Ciccone, Alfonso; Cucurachi, Laura; Bonifati, Marco Domenico; Marcello, Norin