TY - JOUR
T1 - Diagnostic strategies in young patients with ischemic stroke in Canada
AU - Chan, Michael T.Y.
AU - Nadareishvili, Zurab G.
AU - Norris, John W.
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2000
Y1 - 2000
N2 - Background: A preliminary national survey of ischemic stroke in the young (15-45 years) undertaken by the Canadian Stroke Consortium indicated that in 44% of 356 patients, no cause was found. Objective: To determine the reason for this high incidence of diagnostic uncertainty in young patients with ischemic stroke. Methods: Neurologists in the ten Canadian stroke centers completed a detailed questionnaire for patients aged 15-45 years admitted to hospital between January 1993 and December 1997. Using a stepwise diagnostic algorithm incorporating clinical, neuroimaging, neurovascular and laboratory data, we divided patients into three groups: (1) those with established cause for the ischemic stroke, (2) those who remained unexplained despite adequate investigation, (3) those who remained unexplained but were, in our opinion, under-investigated. Results: In 197 patients (56%), an identified cause was established including cardioembolic sources (14%), extracranial arterial dissection (13%), lacunar infarcts (8%) atherosclerosis (6%). A miscellaneous group of 15%, included cerebral venous thrombosis, coagulopathies, vasculitis and others. In 159 patients (44%) with no apparent cause for their stroke, we considered only 81 (23%) adequately investigated, and 78 (21%) inadequately investigated. Conclusion: About one in five young patients was inadequately investigated by a stroke-oriented group of neurologists. The major problem appears to be restriction of investigations to neuroimaging alone (usually computerized cerebral tomography), without further tests such as cerebral angiography and cardiac imaging.
AB - Background: A preliminary national survey of ischemic stroke in the young (15-45 years) undertaken by the Canadian Stroke Consortium indicated that in 44% of 356 patients, no cause was found. Objective: To determine the reason for this high incidence of diagnostic uncertainty in young patients with ischemic stroke. Methods: Neurologists in the ten Canadian stroke centers completed a detailed questionnaire for patients aged 15-45 years admitted to hospital between January 1993 and December 1997. Using a stepwise diagnostic algorithm incorporating clinical, neuroimaging, neurovascular and laboratory data, we divided patients into three groups: (1) those with established cause for the ischemic stroke, (2) those who remained unexplained despite adequate investigation, (3) those who remained unexplained but were, in our opinion, under-investigated. Results: In 197 patients (56%), an identified cause was established including cardioembolic sources (14%), extracranial arterial dissection (13%), lacunar infarcts (8%) atherosclerosis (6%). A miscellaneous group of 15%, included cerebral venous thrombosis, coagulopathies, vasculitis and others. In 159 patients (44%) with no apparent cause for their stroke, we considered only 81 (23%) adequately investigated, and 78 (21%) inadequately investigated. Conclusion: About one in five young patients was inadequately investigated by a stroke-oriented group of neurologists. The major problem appears to be restriction of investigations to neuroimaging alone (usually computerized cerebral tomography), without further tests such as cerebral angiography and cardiac imaging.
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U2 - 10.1017/s0317167100052215
DO - 10.1017/s0317167100052215
M3 - Article
C2 - 10830344
AN - SCOPUS:0034129791
SN - 0317-1671
VL - 27
SP - 120
EP - 124
JO - Canadian Journal of Neurological Sciences
JF - Canadian Journal of Neurological Sciences
IS - 2
ER -