Investigação Etiológica do Acidente Vascular Cerebral no Adulto Jovem
DOI:
https://doi.org/10.24950/rspmi/revisao/200/3/2018Palavras-chave:
Acidente Vascular Cerebral/diagnóstico, Acidente Vascular Cerebral/etiologia, Adulto JovemResumo
A incidência do acidente vascular cerebral (AVC) no adulto jovem tem vindo a aumentar nas últimas décadas, traduzindo- -se em cada vez mais hospitalizações. De igual modo, o peso de factores de risco cardiovascular tradicionais como a hipertensão arterial, dislipidemia, tabagismo, obesidade e sedentarismo parece ser cada vez maior, em detrimento de outros mais raros classicamente associados ao AVC nesta faixa etária. A lista de possíveis etiologias é extensa e a identificação dos factores de risco não se traduz na completa compreensão etiológica do AVC, pelo que a abordagem desta patologia exige não só o adequado uso de exames complementares como também um pensamento hierarquizado. Neste artigo, os autores apresentam uma revisão sobre os factores de risco e etiologias do AVC no adulto jovem, focando alguns aspectos clínicos e diagnósticos úteis para a abordagem etiológica destes doentes na prática clínica.
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Feigin VL, Norrving B, Mensah GA. Global Burden of Stroke. Circ Res. 2017;120:439-48. doi: 10.1161/CIRCRESAHA.116.308413.
Kappelle LJ, Adams HP Jr, Heffner ML, Torner JC, Gomez F, Biller J. Prognosis of young adults with ischemic stroke. A long-term follow-up study assessing recurrent vascular events and functional outcome in the Iowa Registry of Stroke in Young Adults. Stroke. 1994;25:1360-5.
Neau JP, Ingrand P, Mouille-Brachet C, Rosier MP, Couderq C, Alvarez A, et al. Functional recovery and social outcome after cerebral infarction in young adults. Cerebrovasc Dis. 1998 ;8:296-302.
Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, et al. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry 2005; 76:191–5.
Rutten-Jacobs LC, Maaijwee NA, Arntz RM, Van Alebeek ME, Schaapsmeerders P, Schoonderwaldt HC, et al. Risk factors and prognosis of young stroke. The FUTURE study: a prospective cohort study. Study rationale and protocol. BMC Neurol. 2011;11:109. doi: 10.1186/1471-2377-11-109.
Putaala J, Metso AJ, Metso TM, Konkola N, Kraemer Y, Haapaniemi E, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first ever ischemic stroke: the Helsinki Young Stroke Registry. Stroke. 2009; 40:1195–1203.
Yesilot BN, Putaala J, Waje-Andreassen U, Vassilopoulou S, Nardi K, Odier C, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013;20:1431–9. doi: 10.1111/ ene.12228.
Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O, et al. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012; 79:1781–7. doi: 10.1212/WNL.0b013e318270401d.
Tibaek M, Dehlendorff C, Jørgensen HS, Forchhammer HB, Johnsen SP, Kammersgaard LP. Increasing Incidence of Hospitalization for Stroke and Transient Ischemic Attack in Young Adults: A Registry Based Study. J Am Heart Assoc. 2016;5: e003158. doi: 10.1161/JAHA.115.003158.
Marini C, Russo T, Felzani G. Incidence of stroke in young adults: a review. Stroke Res Treat. 2010; 2011:535672.
Jacobs BS, Boden-Albala B, Lin IF, Sacco RL. Stroke in the Young in the Northern Manhattan Stroke Study. Stroke. 2002; 33:2789-93.
Morikawa Y, Nakagawa H, Naruse Y, Nishijo M, Miura K, Tabata M, et al. Trends in Stroke Incidence and Acute Case Fatality in a Japanese Rural Area. The Oyabe Study. Stroke. 2000; 31:1583-7.
Kissela B, Schneider A, Kleindorfer D, Khoury J, Miller R, Alwell K, et al. Stroke in a Biracial Population. The Excess Burden of Stroke Among Blacks. Stroke. 2004;35:426-31
Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015;11:157-64. doi: 10.2147/VHRM.S53203.
Ramírez-Moreno JM, Felix-Redondo FJ, Fernández-Bergés D, Lozano-Mera L. Tendencias en las tasas de hospitalización por ictus en Extremadura en el periodo 2002-2014. Cambiando la idea del ictus como una enfermedad propia de la senectud. Neurologia. 2016; S0213-4853:30207-9.
Wang G, Zhang Z, Ayala C, Dunet DO, Fang J, George MG. Costs of Hospitalization for Stroke Patients Aged 18-64 Years in the United States. J Stroke Cerebrovasc Dis. 2014; 23: 861–8.
Ferro JM, Massaro AR, Mas JL. Aetiological diagnosis of ischaemic stroke in young adults. Lancet Neurol. 2010; 9: 1085–96. doi: 10.1016/S1474- 4422(10)70251-9.
Maaijwee NA, Rutten-Jacobs LC, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol. 2014;10:315-25.
George MG, Tong X, Kuklina EV, Labarthe DR. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995– 2008. Ann Neurol. 2011;70:713–21.
Putaala J, Yesilot N, Waje-Andreassen U, Pitkaniemi J, Vassilopoulou S, Nardi K, et al. Demographic and geographic vascular risk factor differences in European young adults with ischemic stroke: the 15 Cities Young Stroke Study. Stroke. 2012;43:2624-30.
von Sarnowski B, Putaala J, Grittner U, Gaertner B, Schminke U, Curtze S, et al. Lifestylerisk factors for ischemic stroke and transient ischemic attack in young adultsin the Stroke in Young Fabry Patients study. Stroke 2013;44:119–25.
Nedeltchev K, der Maur TA, Georgiadis D, Arnold M, Caso V, Mattle HP, et al. Ischaemic stroke in young adults: predictors of outcome and recurrence. J Neurol Neurosurg Psychiatry. 2005; 76:191–5.
Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:3754-832. doi: 10.1161/STR.0000000000000046.
Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670–81.
Cholesterol Treatment Trialists’ (CTT) Collaboration, Fulcher J, O’Connell R, Voysey M, Emberson J, Blackwell L, et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015;385:1397–1405.
Amarenco P, Labreuche J. Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurol. 2009;8: 453–63.
The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016; 37:2999-3058.
Csordas A, Bernhard D. The biology behind the atherothrombotic effects of cigarette smoke. Nat Rev Cardiol. 2013;10:219–30.
Messner B, Bernhard D. Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol. 2014;34:509–15. doi: 10.1161/ATVBAHA.113.300156.
Bhat VM, Cole JW, Sorkin JD, Wozniak MA, Malarcher AM, Giles WH, Stern BJ, Kittner SJ. Dose-response relationship between cigarette smoking and risk of ischemic stroke in young women. Stroke. 2008;39:2439-2443.
Harriott AM, Barrett KM. Dissecting the association between migraine and stroke. Curr Neurol Neurosci Rep. 2015; 15:5.
Spector JT, Kahn SR, Jones MR, Jayakumar M, Dalal D, Nazarian S. Migraineheadache and ischemic stroke risk: an updated meta-analysis. Am J Med. 2010; 123:612–24.
Falco FA, Falco A. Migraine with aura: which patients are most at risk of stroke? Neurol Sci. 2015; 36 (Suppl 1):S57–S60.
Donaghy M, Chang CL, Poulter N, on behalf of the European Collaborators of The World Health Organisation Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Duration, frequency, recency, and type of migraine and the risk of ischaemic stroke in women of childbearing age. J Neurol Neurosurg Psychiatry. 2002; 73:747–50.
Milhaud D, Bogousslavsky J, van Melle G, Liot P. Ischemic stroke and active migraine. Neurology. 2001; 57:1805–11. Kurth T, Kase C, Schürks, Tzourio C, Buring JE. Migraine and risk of haemorrhagic stroke in women: prospective cohort study. BMJ. 2010; 341:c3659.
Sacco S, Ornello R, Ripa P, Pistoia F, Carolei A. Migraine and hemorrhagic stroke - a meta-analysis. Stroke. 2013; 44:3032-8. doi: 10.1161/ STROKEAHA.113.002465.
Cappy H, Lucas C, Catteau-Jonard S, Robin G. Migraine et contraception. Gynécol Obstét Fertilité. 2015; 43:234-41.
Stegeman BH, de Bastos M, Rosendaal FR, van Hylckama Vlieg A, Helmerhost FM, Stijnen T, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis. BMJ. 2013;347:f5298. doi: 10.1136/bmj.f5298.
Roach RE, Helmerhorst FM, LijferingWM, Stijnen T, Algra A, Dekkers OM. Combined oral contraceptives: the risk ofmyocardial infarction and ischemic stroke. Cochrane Database Syst Rev. 2015; 27:CD011054.
Chakhtoura Z, Canonico M, Gompel A, Thalabard JC, Scarabin PY, Plu-Bureau G. Progestogen-only contraceptives and the risk of stroke: a meta-analysis. Stroke 2009; 40: 1059–62.
Lizarelli PM, Martins WP, Vieira CS, et al. Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women. Contraception. 2009;79:35–40.
Kaku DA, Lowenstein DH. Emergence of recreational drug abuse as a major risk factor for stroke in young adults. Ann Intern Med. 1990;113:821-7.
Sloan MA, Kittner SJ, Feeser BR, Gardner J, Epstein A, Wozniak MA, et al. Illicit drug-associated ischemic stroke in the Baltimore-Washington Young Stroke Study. Neurology. 1998; 50: 1688–93.
Barbieux M, Véran O, Detante O. Ischemic strokes in young adults and illegal drugs. Rev Med Interne. 2012;33:35-40.
Fonseca AC, Ferro JM. Drug abuse and stroke. Curr Neurol Neurosci Rep. 2013; 13:325
Grear KE, Bushnell CD. Stroke and pregnancy: clinical presentation, evaluation, treatment and epidemiology. Clin Obstet Gynecol. 2013; 56: 350–9.
Kuklina EV, Tong X, Bansil P, George MG, Callaghan WM. Trends in Pregnancy Hospitalizations That Included a Stroke in the United States From 1994 to 2007: Reasons for Concern? Stroke. 2011; 42: 2564-70.
Tettenborn B. Stroke and Pregnancy. Neurol Clin. 2012; 30: 913–24
Cerneca F, Ricci G, Simeone R, Malisano M, Alberico S, Guaschino S. Coagulation and fibrinolysis changes in normal pregnancy increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis. Eur J Obstet Gynecol Reprod Biol. 1997;73:31-6.
Cipolla MJ, Vitullo L McKinnon J. Cerebral artery reactivity changes during pregnancy and the postpartum period: a role in eclampsia? Am J Physiol Heart Circ Physiol. 2004; 286: H2127–H32.
Calvet, D. Ischemic stroke in the young adult. Rev Med Interne. 2015; 37: 19-24.
Adams Jr HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41.
von Sarnowski B, Schminke U, Tatlisumak T, Putaala J, Grittner U, Kaps M, et al. Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients. Neurology. 2013;80:1287-94. doi: 10.1212/ WNL.0b013e31828ab2ed.
Yesilot BN, Putaala J, Waje-Andreassen U, Vassilopoulou S, Nardi K, Odier C, et al. Etiology of first-ever ischaemic stroke in European young adults: the 15 cities young stroke study. Eur J Neurol. 2013;20:1431–9. doi: 10.1111/ ene.12228.
Manina G, Agnelli G, Becattini C, Zingarini G, Paciaroni M. 96 hours ECG monitoring for patients with ischemic cryptogenic stroke or transient ischaemic attack. Intern Emerg Med. 2014;9:65-7. doi: 10.1007/s11739-012-0755-3.
Higgins P, MacFarlane PW, Dawson J, McInnes GT, Langhorne P, Lees KR. Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial. Stroke. 2013;44:2525-31.
Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370:2478-86.
Reiffel JA, Verma A, Kowey PR, Halperin JL, Gersh BJ, Wachter R, et al. Incidence of Previously Undiagnosed Atrial Fibrillation Using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study. JAMA Cardiol. 2017;2:1120-7.
Komar M, Olszowa M, Przewlocki T, Podolec J, Stepniewski J, Sobién B, Badacz R, Kablak-Ziembicka A, Tomkiewicz-Pajak L, Podolec P. Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening? Cardiovasc Ultrasound. 2014, 12:16
Chabriat H, Joutel A, Dichgans M, Tournier-Lasserve E, Bousser MG. Cadasil. Lancet Neurol. 2009;8:643–53.
Terni E, Giannini N, Brondi M, Montano V, Bonuccelli U, Mancuso M. Genetics of ischaemic stroke in young adults. BBA Clin. 2015; 3:96–106.
Federico A, Donato ID, Bianchi S, Di Palma C, Taglia I, Dotti MT. Hereditary cerebral small vessel diseases: A review. J Neurol Sci. 2012; 322: 25–30.
Fukutake T. Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopaty (CARASIL): From discovery to gene identification. J Stroke Cerebrovasc Dis. 2011;20:85-93.
Gould DB, Phalan FC, van Mil SE, Sundberg JP, Vahedi K, Massin P, et al. Role of COL4A1 in small-vessel disease and hemorrhagic stroke. N Engl J Med. 2006;354:1489–96.
Kolar GR, Kothari PH, Khanlou N, Jen JC, Schmidt RE, Vinters HV. Neuropathology and genetics of cerebroretinal vasculopathies. Brain Pathol. 2014;24:510-8.
Rice GI, Rodero MP, Crow YJ. Human disease phenotypes associated with mutations in TREX1. J Clin Immunol. 2015;35:235-43.
Seydelmann N, Wanner C, Störk S, Ertl G, Weidemann F. Fabry disease and the heart. Best Pract Res Clin Endocrinol Metab. 2015;29:195-204.
Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009;8:668–78.
Timlin H, Petri M. Transient ischemic attack and stroke in systemic lupus erythematosus. Lupus. 2013; 22: 1251–8.
Chaturvedi S, McCrae K. The antiphospholipid syndrome: still an enigma. Hematology Am Soc Hematol Educ Program. 2015 ; 2015: 53–60
Sciascia S, Sanna G, Khamashta MA, Cuadrado MJ, Erkan D, Andreoli L, et al. The estimated frequency of antiphospholipid antibodies in young adults with cerebrovascular events: a systematic review. Ann Rheum Dis. 2015; 74:2028.
Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4: 295–306.
Duarte MM, Geraldes R, Sousa R, Alarcão J, Costa J. Stroke and transient ischemic attack in Takayasu’s arteritis: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2016 ; 25:781-91. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.005.
Alibaz-Oner F, Direskeneli H. Update on Takayasu´s arteritis. Presse Med. 2015;44:e259-65.
Serra R, Butrico L, Fugetto F, Chibireva MD, Malva A, De Caridi G, et al. Updates in pathophysiology, diagnosis and management of Takayasu arteritis. Ann Vasc Surg. 2016;35:210-25.
de Paula LE, Alverne AR, Shinjo SK. Clinical and vascular features of Takayasu arteritis at the time of ischemic stroke. Acta Reumatol Port. 2013;38:248- 51.
Kempster PA, McLean CA, Phan TG. Ten year clinical experience with stroke and cerebral vasculitis. J Clin Neurosci. 2016;27:119-25.
Jamieson DG, Cheng NT, Skliut M. Headache and Acute Stroke. Curr Pain Headache Rep.2014;18:444.
Twilt M, Benseler SM. The spectrum of CNS vasculitis in children and adults. Nat Rev Rheumatol. 2012; 8: 97–107.
Berlit P, Kraemer M. Cerebral vasculitis in adults: what are the steps in order to establish the diagnosis? Red flags and pitfalls. Clin Exp Immunol. 2014;175:419-24.
Fugate JE, Lyons JL, Thakur KT, Smith BR, Hedley-Whyte ET, Mateen FJ. Infectious causes of stroke. Lancet Infect Dis. 2014; 14:869-80. doi: 10.1016/ S1473-3099(14)70755-8.
Dobbs MR, Berger JR, Stroke in HIV and AIDS. Expert Rev Cardiovasc Ther. 2009; 7:1263-71.
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