The most complete summary of the causes of "Middle-aged and Young People Stroke", with pictures and detailed explanations of the cases!

*Only for medical professionals to read and refer to see how Professor Liu Jianguo analyzes one by one? With the increase in unhealthy life>
.

At the 24th National Neurology Conference (NCN) of the Chinese Medical Association, Professor Liu Jianguo from the Neurology Department of the Sixth Medical Center of the PLA General Hospital gave a wonderful report on "Clinical Imaging and Rehabilitation of Stroke in Young People"! 1 Causes of stroke in young and middle-aged Professor Liu first analyzed the causes of stroke in young and middle-aged people, including traditional risk factors and other risk factors
.

▌ Traditional risk factors: 1.
Atherosclerosis 2.
Hypertension 3.
Diabetes 4.
Obesity 5.
Hyperlipidemia 6.
Hyperhomocysteinemia ▌ Other risk factors: 1.
Cerebrovascular malformation or congenital development Abnormal 2.
Hypercoagulability or abnormal composition: oral contraceptives, etc.
3.
Embolism (blood components, foreign bodies) 4.
Infection: syphilis, viruses, etc.
5.
Immune related: autoimmune vasculitis 6.
Genetic metabolism (CADASIL, CARASIL, HERNS, Fabry disease, PXE, mitochondrial ice accumulation, LCC) 7.
Injury: radiation, dissection, PRLS, RCVS, aneurysm 8.
Venous system thrombosis * autosomal dominant genetic disease with subcortical infarction and leukoencephalopathy (CADASIL) , Autosomal recessive cerebral artery disease with subcortical infarction and leukoencephalopathy (CARSIL), hereditary endothelial disease with retinopathy, nephropathy and stroke (HERNS), Fabry disease (Fabry disease), elastic fiber Pseudoxanthoma (PXE), leukoencephalopathy (LCC) with calcification and cystic transformation, reversible posterior leukoencephalopathy syndrome (PRLS), reversible cerebral vasoconstriction syndrome (RCVS) 2 clinical imaging cases of stroke in young people In this part, Professor Liu explained to us the imaging characteristics of various types of stroke in young people.
The description is as follows: 1.
Cerebrovascular malformations 1) The imaging characteristics of Moyamoya disease.
The etiology is unknown.
A cerebrovascular disease characterized by chronic progressive stenosis or occlusion at the beginning of the artery (MCA) and secondary formation of an abnormal vascular network at the base of the skull
.

The lesion does not conform to the blood supply distribution of the blood vessel.
T1WI in the basal ganglia area: long T1 dot shadow
.

T2WI: MCA disappeared, replaced by messy small vascular shadows, suggesting new blood vessels
.

The posterior cerebral artery (PCA) is thickened with multiple compensations
.

Some start with primary lateral ventricle hemorrhage
.

2) The imaging characteristics of arteriovenous malformations (AVM) are mostly clumps on MRI, with different sizes; T1WI and T2WI are mostly low-intensity, heterogeneous signals with the characteristics of empty signals; no space-occupying effects, surrounding Brain tissue may shrink to varying degrees
.

Accompanied by hemorrhage, hematomas in the brain or subarachnoid hemorrhage may be present at different stages
.

2.
abnormal clotting mechanisms: oral contraceptives
.

Professor Liu introduced a case: a 28-year-old female with intermittent paroxysmal headaches and dizziness for 18 days.
She was born in 2014.
She developed speech inability and weakness in her left limb after January
.

It appears as a confounding signal in imaging, which is like space-occupying performance
.

Surgical resection of the lesion was performed on February 8, 2014
.

On February 22, he developed drowsiness, aphasia, and MRI showed hemorrhage in the left temporal lobe
.

In the end, the patient was clearly pregnant and had a hypercoagulable state
.

3.
Embolization (blood components, foreign bodies, patent foramen ovale) embolization can be abnormal components in the blood, as well as fat tissue after fracture, air, and nucleus pulposus components after intervertebral disc surgery
.

Professor Liu introduced a case: a 29-year-old female, the main cause was "abrupt loss of left eye with headache and dizziness for 3 days during rhinoplasty surgery"
.

Head MRI showed the left occipital lobe lesion with paramagnetic material, SWI showed microbleeding and ophthalmic artery occlusion
.

Finally, it was clearly embolized with hyaluronic acid
.

Professor Liu talked about another case: a 21-year-old male who suffered from sudden disturbance of consciousness and weakness of the right limb during the leg press for 1 day
.

Ultrasound of the heart confirmed the presence of atrial myxoma
.

4.
Infection: This case of syphilis, tuberculosis, etc.
is a 38-year-old man, mainly because of "numbness of the left face and slurred speech for 4 days".
Both blood and cerebrospinal fluid were positive for syphilis
.

5.
Immune related: male with autoimmune vasculitis, 18 years old, poor speech, slow response for 2 months, mild papilledema of the fundus
.

For magnetic resonance enhancement, see ring enhancement, "dual track" performance
.

Plain MRI showed necrosis and hemorrhage within the lesion, and the biopsy clearly showed primary central nervous system vasculitis (PCANS)
.

6.
A patient with genetic metabolism (CADASIL, CARASIL, HERNS, Fabry disease, PXE, mitochondrial icing, LCC), female, 47 years old, with progressive walking instability with cognitive impairment for 3 years, and a long-term history of migraine
.

Head MRI showed multiple white matter lesions and abnormal signals at the temporal poles on both sides.
Notch3 gene detection was performed and it was clearly CADASIL
.

7.
Injury: Radiation, dissection, PRLS, RCVS, aneurysm patient, female, 41 years old, developed preeclampsia at 30 weeks of gestation, followed by cesarean section, sudden loss of binocular vision 2 days after delivery, and then left lower limb weakness
.

Multiple cerebrovascular stenosis can be seen on the image, which gradually improves after 2 days, which is clearly reversible cerebral vasoconstriction syndrome
.

8.
Venous system thrombosis 1) Direct CT signs of venous sinus thrombosis: cord, triangle sign, empty ∆ sign
.

CT indirect signs: shrinkage of the ventricle, cerebral edema, hemorrhage or hemorrhagic infarction
.

MRI: There are short T1 and long T2 signals in the sinuses
.

Case: 22 years old, male, with headache in the back occiput for 5 days
.

Head MRI showed high signal in the right transverse sinus
.

MRV confirmed the right transverse sinus thrombosis
.

2) Deep vein thrombosis: basal ganglia, bilateral thalamus, and corpus callosum: MRI long T1 and long T2 signals
.

The patient, female, 41 years old, was admitted to the hospital with headache, vomiting, and mental decline for 1 week
.

The imaging mainly showed bilateral ischemic lesions of the thalamus and bilateral corpus callosum, which showed high signal and mixed signal shadow
.

Significant improvement after anticoagulation, DSA confirmed the formation of deep cerebral vein thrombosis
.

3 Rehabilitation of young and middle-aged stroke patients Finally, Professor Liu briefly described the rehabilitation treatment strategies for stroke patients
.

For stroke patients, rehabilitation assessment should be performed first
.

Rehabilitation training