Major Finding: Men had significantly higher rates of stroke caused by cardioembolism, hemorrhage, or substance abuse, whereas women had significantly higher rates of stroke with a vasculopathic etiology.
Data Source: A prospective study of 363 stroke patients aged 18-49 years.
Disclosures: Dr. Nakagawa had no relevant disclosures.
TORONTO — The etiology of first-time strokes in young to middle-aged adults differed according to sex in a prospective study of patients seen at one center.
Men tended to have a higher risk of strokes caused by cardioembolism, intracerebral hemorrhage, or substance abuse, whereas women had more strokes related to a vasculopathic etiology, Dr. Emily M. Nakagawa reported at the annual meeting of the American Academy of Neurology.
“When you have a young stroke patient, a lot of physicians tend to think of the etiology to be atherosclerotic disease or a cardioembolic event. If you have a patient who is a young woman, you have to start thinking about other etiologies to appropriately treat and avoid future strokes. At the same time, young women who have already been diagnosed with a vasculopathy need to be educated on their vulnerability to strokes and the signs of stroke to get immediate care, and discuss with their primary care physician about using traditionally known stroke preventions such as use of aspirin,” said Dr. Nakagawa, a resident in neurology at the University of South Florida, Tampa.
Dr. Nakagawa's sample consisted of 202 women and 161 men with a mean age of 40 years (ranging from 18 to 49 years) who presented during a 4-year period to Tampa General Hospital. Patients underwent MR imaging, angiography, echocardiography, and stroke blood investigations. Strokes were stratified using expanded TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification and neurological deficit was assessed using the NIH Stroke Scale (NIHSS).
The women tended to present with a better clinical picture than men, making the diagnosis of stroke in women more difficult. The mean NIHSS was significantly lower among women (4.7) than men (6.0).
Compared with women, men had significantly higher rates of stroke caused by cardioembolism (26 of 42 vs. 16 of 42), intracerebral hemorrhage (63 of 106 vs. 43 of 106), or substance abuse (26 of 41 vs. 15 of 41).
Women were significantly more likely than men to have strokes associated with cerebral venous thrombosis, vasculitis, migraine, or miscellaneous vasculopathy.
Knowing that there are differences between the sexes in stroke etiology can help guide treatment decisions, Dr. Nakagawa said. Female patients can have strokes due to causes that “neurologists do not traditionally think of first for stroke.”