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Importance and repercussions of renal and cardiovascular pathology on stroke in young adults: an anatomopathologic study of 52 clinical necropsies.

Arismendi-Morillo G, Fernández-Abreu M, Cardozo-Duran J, Vilchez-Barrios G - Clinics (Sao Paulo) (2008)

Bottom Line: Ischemic stroke as a result of occlusive atherosclerotic disease was seen in 50% of cases.Cardiogenic emboli were found in 25% of the cadavers.These were associated with ischemic stroke in 43.7%, and 12.5% of the cases, respectively, and with 13.8% and 25% of the hemorrhagic stroke cases.

View Article: PubMed Central - PubMed

Affiliation: Servicio de Anatomía Patológica y Nefrología, Hospital General del Sur Dr. Pedro Iturbe, Instituto de Investigaciones Biológicas - Laboratorio de Microscopía Electrónica, Universidad del Zulia, Venezuela.

ABSTRACT

Introduction: Stroke in young adults has seldom been studied in a necropsy series. The objective of the present clinical necropsy-based investigation was to analyze stroke and its relationship with cardiovascular and renal pathology in young adults.

Materials and methods: The protocols of 52 clinical necropsies with diagnoses of stroke in patients aged 18 - 49 years, performed between the years 1990-2006, were reviewed.

Results: Hemorrhagic stroke was diagnosed in 36 patients (69.3%), whereas the remaining 16 (30.7%) had ischemic stroke. Hypertensive cardiopathy was evident in 88.4% of the cases. Chronic renal pathology, directly or indirectly related to hypertension, was observed in 55.7% of the patients. Ischemic stroke as a result of occlusive atherosclerotic disease was seen in 50% of cases. Cardiogenic emboli were found in 25% of the cadavers. Hemorrhagic stroke was associated with hypertension in 43% of the cases, with ruptured vascular malformations in 29%, and coagulopathies in 17% of the cases. Hypertensive cardiopathy was present in patients with either ischemic or hemorrhagic stroke (81.2% and 91.6%, respectively). The most frequently observed renal ailments were chronic pyelonephritis (23%) and nephrosclerosis (21.1%). These were associated with ischemic stroke in 43.7%, and 12.5% of the cases, respectively, and with 13.8% and 25% of the hemorrhagic stroke cases.

Discussion: Hypertensive cardiopathy, occlusive atherosclerotic disease, chronic pyelonephritis and nephrosclerosis are among the pathophysiologycal mechanisms that apparently and eventually interact to induce a significant number of cases of stroke in young adults. A chronic systemic inflammatory state appears to be an important related condition because it possibly constitutes an accelerant of the pathophysiologycal process.

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Related in: MedlinePlus

Causes of Hemorrhagic Stroke in Young People.
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f2-cln63_1p0015: Causes of Hemorrhagic Stroke in Young People.

Mentions: Hemorrhagic stroke was present in 36 cadavers and represented 69.3% of the cases. Figure 2 displays the causes of hemorrhagic stroke. Hemorrhagic stroke appeared as an intraparenchymal hematoma in 18 cases (50%); of these, 14 (78%) cases were hypertensive in nature. In ten instances, the lesion was located in the basal ganglia, in three of the patients the pons was involved and in one case the cerebellum was the site of the lesion. In four (22%) cadavers, the neuropathological findings were represented by lobar hematoma secondary to one of the following causes: vasculitis, disseminated intravascular coagulation or ruptured vascular malformation. Subarachnoid hemorrhage was present in nine cadavers (25%), seven of these were the result of a ruptured aneurysm and two were the product of a ruptured arteriovenous malformation. Hypertensive cardiopathy was diagnosed in all cases of subarachnoid hemorrhage secondary to the rupture of a sacular aneurysm, whereas chronic renal disease was seen in three cases (42.8%). Multiple petechiae were found in seven cases (19.4%); these were secondary to vasculitis, leukemia-associated blood dyscrasias and idiopathic thrombocytopenic purpura. Intraventricular hemorrhage was seen in two cases (5.5%). As for the hemorrhagic stroke group, chronic pyelonephritis was observed in five cadavers (13.8%) and nephrosclerosis in nine (25%). Causes of death for the hemorrhagic stroke group were a consequence of cerebral herniation in 26 cases (72%), pulmonary complications represented the cause of death in four patients (11.1%), sepsis in one (2.7%) and other causes in five (14%).


Importance and repercussions of renal and cardiovascular pathology on stroke in young adults: an anatomopathologic study of 52 clinical necropsies.

Arismendi-Morillo G, Fernández-Abreu M, Cardozo-Duran J, Vilchez-Barrios G - Clinics (Sao Paulo) (2008)

Causes of Hemorrhagic Stroke in Young People.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2664177&req=5

f2-cln63_1p0015: Causes of Hemorrhagic Stroke in Young People.
Mentions: Hemorrhagic stroke was present in 36 cadavers and represented 69.3% of the cases. Figure 2 displays the causes of hemorrhagic stroke. Hemorrhagic stroke appeared as an intraparenchymal hematoma in 18 cases (50%); of these, 14 (78%) cases were hypertensive in nature. In ten instances, the lesion was located in the basal ganglia, in three of the patients the pons was involved and in one case the cerebellum was the site of the lesion. In four (22%) cadavers, the neuropathological findings were represented by lobar hematoma secondary to one of the following causes: vasculitis, disseminated intravascular coagulation or ruptured vascular malformation. Subarachnoid hemorrhage was present in nine cadavers (25%), seven of these were the result of a ruptured aneurysm and two were the product of a ruptured arteriovenous malformation. Hypertensive cardiopathy was diagnosed in all cases of subarachnoid hemorrhage secondary to the rupture of a sacular aneurysm, whereas chronic renal disease was seen in three cases (42.8%). Multiple petechiae were found in seven cases (19.4%); these were secondary to vasculitis, leukemia-associated blood dyscrasias and idiopathic thrombocytopenic purpura. Intraventricular hemorrhage was seen in two cases (5.5%). As for the hemorrhagic stroke group, chronic pyelonephritis was observed in five cadavers (13.8%) and nephrosclerosis in nine (25%). Causes of death for the hemorrhagic stroke group were a consequence of cerebral herniation in 26 cases (72%), pulmonary complications represented the cause of death in four patients (11.1%), sepsis in one (2.7%) and other causes in five (14%).

Bottom Line: Ischemic stroke as a result of occlusive atherosclerotic disease was seen in 50% of cases.Cardiogenic emboli were found in 25% of the cadavers.These were associated with ischemic stroke in 43.7%, and 12.5% of the cases, respectively, and with 13.8% and 25% of the hemorrhagic stroke cases.

View Article: PubMed Central - PubMed

Affiliation: Servicio de Anatomía Patológica y Nefrología, Hospital General del Sur Dr. Pedro Iturbe, Instituto de Investigaciones Biológicas - Laboratorio de Microscopía Electrónica, Universidad del Zulia, Venezuela.

ABSTRACT

Introduction: Stroke in young adults has seldom been studied in a necropsy series. The objective of the present clinical necropsy-based investigation was to analyze stroke and its relationship with cardiovascular and renal pathology in young adults.

Materials and methods: The protocols of 52 clinical necropsies with diagnoses of stroke in patients aged 18 - 49 years, performed between the years 1990-2006, were reviewed.

Results: Hemorrhagic stroke was diagnosed in 36 patients (69.3%), whereas the remaining 16 (30.7%) had ischemic stroke. Hypertensive cardiopathy was evident in 88.4% of the cases. Chronic renal pathology, directly or indirectly related to hypertension, was observed in 55.7% of the patients. Ischemic stroke as a result of occlusive atherosclerotic disease was seen in 50% of cases. Cardiogenic emboli were found in 25% of the cadavers. Hemorrhagic stroke was associated with hypertension in 43% of the cases, with ruptured vascular malformations in 29%, and coagulopathies in 17% of the cases. Hypertensive cardiopathy was present in patients with either ischemic or hemorrhagic stroke (81.2% and 91.6%, respectively). The most frequently observed renal ailments were chronic pyelonephritis (23%) and nephrosclerosis (21.1%). These were associated with ischemic stroke in 43.7%, and 12.5% of the cases, respectively, and with 13.8% and 25% of the hemorrhagic stroke cases.

Discussion: Hypertensive cardiopathy, occlusive atherosclerotic disease, chronic pyelonephritis and nephrosclerosis are among the pathophysiologycal mechanisms that apparently and eventually interact to induce a significant number of cases of stroke in young adults. A chronic systemic inflammatory state appears to be an important related condition because it possibly constitutes an accelerant of the pathophysiologycal process.

Show MeSH
Related in: MedlinePlus