Cerebral hemodynamics in young patients after ischemic stroke

The actuality of the problem is conditioned by the high death rate and invalidism of working-age persons, which is a severe burden for society.

Our aim was the analysis of the cerebral hemodynamics in young patients during an acute period of ischemic stroke (IS).

We examined 17 patients (nine men and eight women) with IS, their mean age was 44.2 ± 4.9 years. None of these patients was observed apropos cerebral vascular disease before IS. Brain CT scans of all patients demonstrated the symptoms of ischemic stroke as the decreased density foci in the basin of the middle cerebral artery.

To study cerebral hemodynamics, all patients underwent duplex scanning of the neck and brain vessels using the scanner ACUSON 128XP/10c (USA) according to the standard method.

Only one patient (6.4%) had no changes during the US examination of the vessels. Six patients (35.3%) demonstrated small thickening of more than 1.1 mm of the 'intima-media' complex in the carotid artery in the absence of plaque formation, 30–40% asymmetry of the blood flow velocity in the medial cerebral arteries, and peripheral resistance indexes increased in the medial cerebral arteries or in the vertebrobasilar basin. In 11.5% of cases the symptoms of atherosclerotic change of the carotid arteries were more evident, but they were hemodynamically insignificant. There were small plaques in the bifurcation zone of the internal carotid arteries and S-shape tortuosity of the orifices of the internal carotid arteries. Almost one-half of the patients had evident signs of atherosclerosis. Occlusion and significant stenosis were observed in two patients with moderate changes at the extracranial level in one of the medial cerebral arteries. The atherosclerotic changes were evident in other patients (six persons, 35.3%); moreover, one-half of the patients had significant stenosis revealed in the carotid and in the vertebral arteries. Two patients had occlusion in one of the internal carotid arteries and one patient had significant stenosis only in the vertebrobasilar basin.

In spite of the young age of the patients, they all therefore had quite evident changes of the cerebral hemodynamics in the background of the different degrees of atherosclerotic signs. The ultrasonic markers of early-stage atherosclerosis in the increased arterial tonus were revealed in one-third of patients. More than one-half of the patients after IS had the evident atherosclerotic changes of the cerebral vessels. In spite of the presence of the arterial occlusion in some patients, the clinical manifestation was absent before the stroke.