Diagnostic Strategies in Young Patients with Ischemic Stroke in Canada: Tables

Table 1: Cause of stroke

Cause

Total
n = 356

15-30 years
n = 76

31-45 years
n = 280

Unknown

159 (44%)

35 (47%)

124 (43%)

Miscellaneous

54 (15%)

18 (23%)

36 (13%)

Cardioembolic

51 (14%)

15 (20%)

36 (13%)

Dissection of extracranial artery

44 (13%)

7 (9%)

37 (14%)

Small vessel disease

27 (8%)

0 (0%)

27 (10%)**

Large artery disease

21 (6%)

1 (1%)

20 (7%)*

* p < 0.01 compared with 15-30 years old subgroup
** p < 0.05 compared with 15-30 years old subgroup

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Table 2: Cardiac causes of stroke (n = 51)

n %

Acquired (n=27)

Ischemic heart disease
17 33

Rheumatic heart disease
4 8

Bacterial endocarditis
3 6

Atrial fibrillation
2 4

Atrial myxoma
1 2

Congenital (n = 24)

Patent Foramen Ovale
15 29

Mitral valve prolapse
3 6

Valvular heart disease
3 6

Atrial septal defect
3 6

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Table 3: Miscellaneous causes of stroke (n = 54)

Cause
n %

Venous thrombosis
13 24

APLA and LA*
8 15

Migraine
7 13

Vasculitis
6 11

Substance abuse
4 8

Pregnancy or peri-partum
4 8

Moya-Moya disease
2 4

Meningitis/ vasculitis
2 4

Other**
8 15*

*APLA indicates antiphospholipid antibody syndrome. LA indicates lupus anticoagulant.
**Single cases of Susac's microangiopathy, HIV, MELAS, homocystinemia, sickle cell crisis, subclavian steal, radiation arteritis and Epstein-Barr virus associated lymphoid granulomatosis were documented.

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Table 4: Frequency of investigations (n = 356)

Investigations

Established
n = 197

Unknown ("Cryptogenic")
n = 159

Unknown with completely investigated
n = 81

Unknown with inadequately investigated
n = 78

Angiogram

138 (70%)*

77 (49%)

57 (70%)

20 (25%)

Duplex

75 (38%)

70 (44%)

46 (57%)

24 (31%)

TTE

125 (64%)**

108 (68%)

81 (100%)

27 (35%)

TEE

54 (27%)**

36 (22%)

31 (38%)

5 (6%)

Hematology

177 (90%)

106 (67%)

80 (99%)

26 (34%)

* p <0.001 compared with unknown
** p < 0.001 compared with inadequate investigation

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Cause	Total n = 356	15-30 years n = 76	31-45 years n = 280
Unknown	159 (44%)	35 (47%)	124 (43%)
Miscellaneous	54 (15%)	18 (23%)	36 (13%)
Cardioembolic	51 (14%)	15 (20%)	36 (13%)
Dissection of extracranial artery	44 (13%)	7 (9%)	37 (14%)
Small vessel disease	27 (8%)	0 (0%)	27 (10%)**
Large artery disease	21 (6%)	1 (1%)	20 (7%)*
* p < 0.01 compared with 15-30 years old subgroup ** p < 0.05 compared with 15-30 years old subgroup

	n	%
Acquired (n=27)
Ischemic heart disease	17	33
Rheumatic heart disease	4	8
Bacterial endocarditis	3	6
Atrial fibrillation	2	4
Atrial myxoma	1	2
Congenital (n = 24)
Patent Foramen Ovale	15	29
Mitral valve prolapse	3	6
Valvular heart disease	3	6
Atrial septal defect	3	6

Cause	n	%
Venous thrombosis	13	24
APLA and LA*	8	15
Migraine	7	13
Vasculitis	6	11
Substance abuse	4	8
Pregnancy or peri-partum	4	8
Moya-Moya disease	2	4
Meningitis/ vasculitis	2	4
Other**	8	15*
APLA indicates antiphospholipid antibody syndrome. LA indicates lupus anticoagulant. *Single cases of Susac's microangiopathy, HIV, MELAS, homocystinemia, sickle cell crisis, subclavian steal, radiation arteritis and Epstein-Barr virus associated lymphoid granulomatosis were documented.

Investigations	Established n = 197	Unknown ("Cryptogenic") n = 159	Unknown with completely investigated n = 81	Unknown with inadequately investigated n = 78
Angiogram	138 (70%)*	77 (49%)	57 (70%)	20 (25%)
Duplex	75 (38%)	70 (44%)	46 (57%)	24 (31%)
TTE	125 (64%)**	108 (68%)	81 (100%)	27 (35%)
TEE	54 (27%)**	36 (22%)	31 (38%)	5 (6%)
Hematology	177 (90%)	106 (67%)	80 (99%)	26 (34%)
* p <0.001 compared with unknown ** p < 0.001 compared with inadequate investigation