Reason for study: 10% of strokes are in adults younger than 50. What do we know about their natural history?
Study design: prospective study that followed a cohort of 959 consecutive patients aged 18-50 who presented with their first lifetime TIA, ischemic stroke or ICH to an academic medical center in the Netherlands. Patients were excluded for hemorrhage secondary to trauma, SAH or aneurysmal ICH, tumor, or venous sinus thrombosis. Primary outcome was all cause mortality compared to expected mortality based on the entire Dutch population.
- 30 day mortality was 0.4% for TIA, 3.6% for ischemic stroke, 22% for ICH
- Mortality was higher than expected mortality across the board. Mortality for TIA was 2.5% at five years, 9.2% at 10, and 24.9% at 20. For the same time points, mortality after ischemic stroke was 5.8%/12.4%/26.8%; for ICH, 6.1%/10.3%/13.7%
- 55% of deaths after ischemic stroke was due to vascular causes
Long term mortality wasn’t that much higher for stoke vs TIA, so it’s good that we essentially treat them the same. One of my attendings says that it’s good to admit people to the hospital even for a TIA with a low ABCD2 score, since it scares them into understanding it’s a big deal–and data like this supports that.