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MRI Suggested Even For Young Stroke Patients

June 10, 2010
Written by: , Filed in: Diagnostic Imaging, Emergency Radiology
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Even young, vigorous people may unknowingly suffer small “silent strokes.” Therefore, all stroke patients, including those ages 18 through 50, should get brain MRI to check for such previous damage and guide efforts to prevent recurrence.

So suggests new research from Hospital Notre Dame in Montreal, as presented this week at the Canadian Stroke Congress in Quebec City.

“This study tells us when younger people come in with a first stroke, they may already have signs of preexisting damage in their brains,” said lead investigator Alexandre Poppe, a neurologist at the hospital’s Cerebrovascular Disease Centre. “We should pay particular attention to those who do, because they are at higher risk of having a second stroke, and prevention efforts need to be greatly emphasized.”

Silent brain infarcts (SBI) are tiny strokes that are asymptomatic but can be detected by brain imaging. Even though the patient has no idea they are taking place, they still cause damage. Previous research has shown that they are commonly found to have occurred in older adults with acute ischemic stroke. In those older patients, SBI predict recurrent stroke and cognitive decline.

Dr. Poppe and his colleagues for the first time looked for SBI in younger patients: 168 stroke patients ages 18 through 50, all of whom underwent MRI after a first stroke. The researchers followed the patients for 27 months, during which 11 of the patients suffered another stroke.

Those for whom MRI found previous silent strokes were three times more likely to have another stroke than those without lesions from SBI.

“All young people with stroke should be scanned, preferably using MRI,” said Dr. Poppe. “Doing a CT scan alone is often insufficient to pick up the brain changes caused by covert brain infarcts. With an MRI, you can actually tell how old the lesions are. You can see if they occurred before the stroke.”

Stroke risk factors are increasing for all ages, said Antoine Hakim, MD, PhD, spokesman for the Canadian Stroke Network. “Stroke in the young is underappreciated,” said Dr. Hakim. “Ten percent of stroke patients are under 50.”

Dr. Hakim suggested that young people may be making themselves more vulnerable to stroke because of unhealthy eating and living habits, including overeating and lack of physical activity. “This may be accelerating the impact of risk factors, especially high blood pressure, which are now converging and have the potential to erase the progress we’ve made in treating heart disease and stroke over the last 50 years.”

Related seminar: Emergency Radiology

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