Occlusive cerebrovascular disease in young adults.

The charts of patients between the ages of 15-40 years admitted to the Foothills or Calgary General Hospitals in Alberta Canada between January 1 1976 and December 31 1981 and discharged with a diagnosis of reversible ischemic neurological deficits (RIND) or transient ischemic attacks (TIA) were reviewed. A basic work-up was done in almost every instance. 76 patients ranging in age from 16 to 40 years were identified -- 30 male and 46 female. 12 patients (16%) had angiographic evidence of atherosclerosis at a site appropriate to their symptoms and atheroslerosis was therefore assumed to be the cause of the occlusive cerebrovascular event. 11 (14.5%) were believed to have cardiac sources for emboli and 4 (5%) were thought to have emoblized from intracranial aneurysms. 6 (8%) had a stroke or RIND associated with complicated migraine. 12 patients were pregnant or taking oral contraceptives (OCs) at the time of their illness and in 7 (15% of the female group) this was apparently the only significant coincident risk factor. 11 (14.5%) had other causes for their ischemic episodes and in 25 instances (33%) no cause was identified. 56 patients (73.5%) had a cranial tomography (CT) scan 55 (72.5%) had cerebral angiography and 44 (58%) underwent echocardiography. Only 23 (30%) had all 3 tests. Of 12 patients with atherosclerosis 7 were male and 5 female. These persons tended to be at the upper end of the age range for the study with a mean age of 36 years. Almost all had 1 or more risk factors for atherosclerosis such as hypertension diabetes mellitus hyperlipidemia obesity or smoking. 11 patients had an identified cardiac source for an embolous. 55 patients (72.5%) in this series had cerebral angiograms and 4 of these demonstrated intracranial aneurysms. In 7 females with no direct discernible cause for an ischemic event 6 were using OCs and 1 was pregnant. A variety of other causes were detected in 11 patients. A total of 25 individuals had no cause identified for their illness. Occlusive cerebrovascular disease is not uncommon in young adults. OCs are seldom implicated and a high yield of identifiable treatable lesions justifies extending conventional screening investigations to include echocardiography and cerebral angiography.