Stroke in the Young: a Global Update

AbstractPurpose of ReviewWe aim to evaluate the epidemiology, racial and gender disparity, etiology, and treatment of stroke in the younger population.Recent FindingsThe younger age group without vascular risk factors exhibits an increased prevalence of cardio-embolism in context of patent foramen ovale/atrial septal aneurysm strokes, from other determined etiology of non-atherosclerotic vasculopathy including dissection, inherited or acquired thrombophilia, and other unusual causes of stroke. Ethnic disparities also exist in certain populations.SummaryThe prevalence of stroke in the young is increasing due to several factors. Since stroke is often disabling, this trend poses an enormous threat to socioeconomic stability especially in developing countries. In young patients with an absence of conventional vascular risk factors and negative preliminary stroke work-up, clinicians must consider less common causes of stroke in this population. There is prime opportunity for future investigations as there is currently a lack of evidence-based management guidelines for these uncommon etiologies based on research completed to date.
Source: Current Neurology and Neuroscience Reports - Category: Neuroscience Source Type: research

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Patent foramen ovale (PFO) is a potential cause of cryptogenic cerebrovascular events (c-CVEs). A score has been developed to identify stroke-related versus incidental PFO in c-CVEs. The Risk of Paradoxical Embolism (RoPE) score indicates that otherwise healthy young adults with a high score are likely to have pathogenic PFO.1 –3 Until recently, there was a lack of evidence for routine closure of PFO in patients who suffered from c-CVEs.4–6 However, three recent randomized studies showed a benefit of transcatheter PFO closure compared with medical therapy.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
CONCLUSION: Compared with drug therapy, PFO closure reduced the risk of recurrent stroke among patients with a risk score of ≥2 and reduced the incidence of serious bleeding without increasing the risk of new-onset atrial fibrillation or atrial flutter. PMID: 32394019 [PubMed - as supplied by publisher]
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
Abstract BACKGROUND: Residual shunt is observed in up to 25% of patients after patent foramen ovale (PFO) closure, but its long-term influence on stroke recurrence currently is unknown. OBJECTIVE: To investigate the association of residual shunt after PFO closure with the incidence of recurrent stroke and transient ischemic attack (TIA). DESIGN: Prospective cohort study comparing stroke or TIA recurrence in patients with and without residual shunt after PFO closure. SETTING: Single hospital center. PARTICIPANTS: 1078 consecutive patients (mean age, 49.3 years) with PFO-attributable cryptogenic ...
Source: Annals of Internal Medicine - Category: Internal Medicine Authors: Tags: Ann Intern Med Source Type: research
ConclusionsConclusions:  cRoPE might help in stratification of patients with CS, allowing accurate esteem of the likelihood of PFO to be found, especially in cases when neuroimaging is inconclusive.
Source: Neurological Sciences - Category: Neurology Source Type: research
We present a case report of a patient with a pulmonary embolus placed on venoarterial extracorporeal membrane oxygenation who developed venous cannula migration through an undiagnosed patent foramen ovale causing an ischemic stroke due to a thrombus and requiring thrombectomy and device closure of the atrial defect.
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: CASE REPORT Source Type: research
Conclusion: VTE can be detected in patients with CS linked to PFO. While –based on the presented literature–routine screening for VTE in patients with CS linked to PFO does not appear justified, history taking, and clinical exam should consider concomitant VTE. Whenever clinically suspected, the threshold to trigger ancillary testing for VTE should be low. Among patients with an acute PE and PFO, vigilance for new neurologic deficits should be increased, with a low threshold for brain imaging.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Rationale: Patent foramen ovale (PFO) is not considered to be the main cause of stroke and is classified as the infarction of undetermined cause. The relationship between PFO and cerebral embolism is still unclear and cerebral embolism accompanied with coronary artery embolization in PFO patient is rare. In this case, we reported a patient with PFO suffered acute cerebral and myocardial infarction simultaneously, and analyzed the source of emboli and potential pathogenesis. Patient concerns: A 53-year-old female presented with chief complaints of intermittent palpitations and chest tightness for 6 years, aggravated fo...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
In an updated practice advisory, the American Academy of Neurology says closure of patent foramen ovale may be recommended for some people who have had a stroke.Medscape Medical News
Source: Medscape Critical Care Headlines - Category: Intensive Care Tags: Neurology & Neurosurgery News Source Type: news
(American Academy of Neurology) New guidance from the American Academy of Neurology (AAN) concludes that closure of a common heart defect called a patent foramen ovale (PFO) may be recommended for some people who have had a stroke. The updated practice advisory is published in the April 29, 2020, online issue of Neurology ® , the medical journal of the American Academy of Neurology.
Source: EurekAlert! - Medicine and Health - Category: International Medicine & Public Health Source Type: news
Introduction: Percutaneous closure of patent foramen ovale (PFO) in selected patients with cryptogenic cerebrovascular ischemic events (CEs) decreases the risk of recurrent stroke; however, optimal patient selection criteria are still under investigation. Candidates for PFO closure are usually selected from the pool of CE patients with a high risk of Paradoxical Embolism (RoPE) score. The RoPE score calculates the probability that PFO is causally related to stroke, based on PFO prevalence in patients with CE compared with that in healthy subjects. The latter has been set at 25% based on the average of autopsy and transesop...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
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