Etiologies and Subtypes of Young Adult Stroke in Korea : Experience in 309 Patients

Abstract

Background : In general, etiologies of stroke in the young are known to be different from those in older patients and it has been believed to be true also in Korea. However, there have been few studies on Korean and most studies on other races have focused on ischemic stroke. Recently possible differences in etiologies of young adult stroke between specific age groups were suggested. The objective of our study was to clarify the etiologies and subtypes of both ischemic and hemorrhagic strokes in young Korean adults and to analyze the difference of stroke etiologies between the age-specific subgroups. Methods : We retrospectively studied the patients aged 15 to 45 with first ever ischemic or hemorrhagic stroke, who were admitted to Seoul National University Hospital during 5 years. The potential causes of stroke were investigated and classified into 5 subgroups in each type of stroke. Results : Three hundred nine patients were aged 15-45(10.7% of stroke patients with all ages; 189 with cerebral infarctions(CIs) and 120 with intracerebral hemorrhages(ICHs)). The leading cause of CIs was cardioembolism(30.7%), followed by other determined etiologies(28.0%), undetermined etiology(19.0%), large-artery atherosclerosis(13.8%), and small-vessel disease(8.5%). Half of the patients with cardioembolism had rheumatic heart disease. Moyamoya disease comprised one-third of other determined etiologies. In ICHs, the most common cause was hypertension(30.8%) followed by arteriovenous malformation(AVM, 21.7%), unknown etiology(20.0%), other causes(15.8%), and blood dyscrasia(11.7%). Moyamoya disease occupied a majority of other causes(78.9%) and was also the most common cause of PIVH(78.6%), which consisted of 11.7% of ICH. The proportion of each cause in both types of stroke was compared between two age groups(group I; 15-29 years, group II; 30-45 years). The proportions of large-artery atherosclerosis and other determined etiologies in CI(2.2% vs. 17.4% and 46.7% vs. 22.2%, respectively) and those of all the subgroups except other causes in ICH were significantly different between two groups. Conclusions : The proportions of etiologies or subtypes in both types of stroke were presented. Cardioembolism was the leading cause in CIs and hypertension was in ICHs. Our study also suggested that there were differences in the distributions of etiologies according to age in young Korean adults. Therefore, age range should be considered when investigating young stroke patients in Korea. Korean Journal of Stroke 1999;1(1):28~34