Risk factors according to the established model of cerebrovascular disease in young women

Women aged 15-45 years treated in the neurology service of a general hospital in Mexico in 1983-84 for occlusive type cerebral infarcts were prospectively studied for risk factors. Cases of intracerebral hemorrhage were excluded and in all cases the area of the infarct was corroborated with computerized axial tomography. The average hospital stay was 10 days and patients were followed for 6 months in the outpatient service. 25 cases were identified of which 23 had arterial thromboses and 2 venous. The average age was 32.1 years. Identified risk factors included oral contraceptive (OC) use in 9 cases prolapse of the mitral valve in 6 cases immediate postpartum in 5 smoking in 5 rheumatic heart disease in 3 hyperlipidemia in 3 systemic lupus erythematosus in 2 migraines in 2 obesity in 2 alcoholism in 1 Takayasus disease in 1 and hypertension in 1. In the 9 cases in which multiple risk factors were identified there was a combination of mitral valve prolapse with other factors in 5 smoking and other factors in 4 OCs and prolapse of the mitral valve in 3 hyperlipidemia and other factors in 3 and OCs and smoking in 2. Among 14 cases on which a single risk factor was identified it was immediate postpartum period in 4 vasculitis in 3 rheumatic cardiopathy in 3 OCs in 2 mitral valve prolapse in 1 and smoking in 1. Use of OCs was the most frequent risk factor. The average age of OC users was 33.7 years. In 7 of the 9 cases there were associated risk factors. The combination of OCs with smoking migraine mitral valve prolapse or age appears to increase the risk of cerebral infarct in young women. The patients included in the study were prospectively subjected to a wide battery of tests designed to elucidate the causes of their cerebral infarcts. In previous studies up to 40% of young people with cerebral infarcts have lacked etiological diagnoses but in this series only 8% had no identifiable risk factor.