Молодежный инновационный вестникМолодежный инновационный вестник2415-7805Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации7281Conference ProceedingsCAUSES OF ISCHEMIC STROKE IN YOUNG PEOPLEAlievaDiana Imamdinovna<p>6th year student of the Faculty of Medicine</p>dianochka.alieva.200420@mail.ruhttps://orcid.org/0000-0001-6523-6645ZamanovaLeyla Azer qizi<p>6th year student of the Faculty of Medicine</p>leyla.zamanova96@yandex.ruhttps://orcid.org/0000-0003-0407-3760Voronezh Medical University named after N.N. Burdenko30062022112712741402202202042022Copyright © 2022, Alieva D.I., Zamanova L.A.2022<p>Structured annotation<br />Modern society, unfortunately, is subject to a significant number of diseases, both infectious and non-infectious etiology. In this scientific study, I would like to analyze and highlight the issue of the defeat of young people with such pathology as ischemic stroke. Strangely enough, but it is this disease that causes great excitement among doctors not only specialized institutions and hospitals aimed at treating the consequences of neurological pathology, but also ordinary part-time therapists who encounter such patients quite often in their practice.<br />Ischemic stroke is a violation of cerebral circulation with damage to brain tissue, a violation of its functions due to difficulty or cessation of blood flow to a particular department.<br />The purpose of my research is to identify the specific causes of ischemic stroke, its early diagnosis and effective methods of prevention.<br />So, we have made a statistical analysis of the results of studies of young patients who received therapeutic care on the basis of BUZ VOKB No. 1, clinical examples from domestic and foreign literature were also considered. In hospital conditions , patients were thoroughly and comprehensively examined as follows :<br />They were assigned as laboratory methods of examination:<br />UAC (erythrocytes, leukocytes, platelets, hemoglobin, CP)<br />Biochemical blood analysis : lipid profile (HDL, VLDL,LDL,cholesterol), glucose (glucose tolerance test for people with suspected diabetes) , ,CRP, creatinine, liver enzymes (ASAT, ALAT)<br />Coagulogram<br />OAM: color, density, medium, presence of bacteria and cylinders , specific gravity, shaped elements of blood (leukocytes, erythrocytes)<br />And instrumental methods : MRI of the brain, ECG, echocardiography<br />During the analysis of the obtained data of laboratory and instrumental diagnostics, as well as medical histories, we have established the following possible causes of ischemic stroke.<br />Arterial dissections, the presence of rheumatic or infectious diseases in the anamnesis that provoked cerebral arteritis, in people taking narcotic drugs-thromboembolism from vegetations on the heart valves; also, women taking oral anticoagulants, which provoke all kinds of coagulopathy, for example, antiphospholipid syndrome, chronic stress and, as a consequence, spasm of the cerebral vessels, can be placed in a separate group. brain; drinking alcohol in large quantities and tobacco abuse.<br />Based on everything we have studied, we concluded that it is worth more in-depth and accurate diagnosis of the development of ischemic stroke in the early stages of its development, possibly with the use of more highly sensitive laboratory and instrumental examination methods, pay great attention to educational work with the young population, and do not forget about the role of prevention of relapses in those who have already faced this young age.</p>ischemic strokeyoung agethromboembolism etiologyишемический инсультмолодой возрасттромбоэмболы этиология<p>Relevance. Strangely enough, but taking into account the development of medicine from the diagnostic aspect, it still remains a big problem to identify, establish and recognize the prerequisites for the development of ischemic stroke in young people.<br />Our study is very relevant due to the fact that the causes of ischemic stroke in young people have a completely different etiology and are fundamentally different from those in old age. If in old age the dominant position is occupied by hypertensive heart disease and atherosclerotic vascular lesion , then for young people there is a high probability of occurrence of cryptogenic stroke. This is what makes diagnosis difficult, and even more so therapy and prevention.<br />It is precisely because of the growth, progression and large spread of this pathology among the young contingent of the population that the state is incurring huge losses in the economic sphere.The probability of ischemic stroke at the age of 18-45 among strokes in all age groups is 5-14%. The number of "young" patients with ischemic stroke in the USA reaches 225,000 per year, which is more than 2 times higher than the prevalence in the UK. In Russia in the period in 2018 , this figure amounted to 130,000 cases , according to the Ministry of Health .<br />According to the World Health Organization, the number of strokes has increased by 70% over the past 30 years, and deaths in the population have doubled. Russian people belong to the people of "ultra-high" risk of stroke, because in our country, due to the high cost of quality treatment, people cannot be properly examined, because it's no secret that many examinations, for example, tests for adrenal hormones or sex hormones in budget clinics are not carried out because the lack of appropriate reagents also plays an important role in the negligent attitude of the population to their health , a tendency to frequent alcohol consumption and have low adherence to treatment. Starting in 2020, the situation is aggravated by the emergence and spread of a new coronavirus infection and, as a result, the number of strokes may increase not only because of the risk of thrombosis in COVID-19 patients, but also because of the heavy load on hospitals and the general negative psycho-emotional background.<br />The aim of the study was to determine the etiological factors leading to the development of ischemic stroke in young patients ( 18-45 years).<br />Materials and methods. We examined 20 patients: 12 (60%) men and 8 (40%) women with ischemic stroke aged 18-45 years (the average age was 34.6 8.2 years) who were treated in the neurological department of the BUZ VOKB N1 with impaired cerebral circulation. the study involved patients who were diagnosed with "ischemic stroke" on the basis of anamnestic data, patient interview, physical examination, laboratory and instrumental research methods. Such as: a general blood test, a general urine test, a biochemical blood test taking into account the main indicators that may be triggers on the way to the onset of the disease; blood clotting ability; CT of the brain. MRI of cerebral vessels, ECG , transesophageal echocardiography . When detecting at the time of ultrasound examination of the heart such heart defects as open oval - window duplex scanning of the veins of the lower extremities ; examination of cerebral vessels (duplex scanning, MRA, less often - computer or puncture contrast angiography); study of antibodies to phospholipids (aFL): cardiolipin (aCL), in some patients - to its cofactor protein 2GI, lupus anticoagulant (VA); determination of mutations in genes II and V of blood clotting factors, in methylenetetrahydrofolate reductase gene; study of coagulogram and platelet aggregation; homocysteine; C-reactive protein (CRP).<br />As a result of evaluating the data obtained, we carefully analyzed them and identified etiological factors that provoke the appearance and progression of cerebral vascular ischemia. During the study, we relied on TOAST criteria: 1) atherosclerosis of large blood vessels; 2) pathology of small cerebral arteries due to the presence of GB and diabetes mellitus 3) cardioembolism; 4) other causes: arterial dissection and blood disease 5) stroke of unspecified etiology.<br />The atherothrombotic subtype of AI was detected in 5/25% of patients. Cardioembolic subtype II was diagnosed in 4/20% of patients. Unspecified subtype was detected in 11/55%.<br />Results. The diagnosis of "dissection" was established on the basis of physical examination data, as well as data from laboratory and instrumental research methods: angiographic (a symptom of a "candle flame" at the mouth of the internal carotid artery (ICA), a symptom of a "string", a clear change in the artery, an increase in its diameter, gradual recovery or improvement within 2-3 months patency along the artery, taking into account the fact that the lumen of this artery at the time of exacerbation of the disease was subject to occlusion, as well as on the basis of MRI data of the neck, when an intramural hematoma was detected. ICA dissection occurs more often than PA. But in the first case, a greater commitment is observed in men, in the second - in women. The average age of the Russian people affected by ischemic stroke is 37 years. Stroke caused by dissection develops in young people who do not have a history of diabetes mellitus, atherosclerotic vascular lesions, clinical signs of thrombophilia, and who considered themselves healthy before the examination. Basically, half of the patients complained of headaches, as well as arterial hypotension, a moderate increase in blood pressure.<br />The diagnosis of AFS took into account international criteria developed in Sydney. Patients diagnosed with AFS mainly include people with Sneddon syndrome who had positive aFL.<br />.The diagnosis of coagulopathy was established in patients with ischemic stroke caused by damage to medium- and small-caliber arteries, who had laboratory and sometimes clinical signs of hypercoagulation, as well as a good effect of anticoagulant treatment. Other causes of ischemic stroke in patients with coagulopathies were excluded . aFL-negative patients with Sneddon syndrome were included in this group.<br /><br />Discussion. Thus , the main triggers of the causes that lead to the development of ischemic stroke in young patients are: pathology of the heart , atherosclerotic process, AFS .However, an unspecified subtype was found in a large number of patients (11/55%). Unfortunately, it was not possible to identify the leading cause of AI among patients with unspecified subtypes.<br />Conclusion. In the course of our analysis, we found a paradoxical increase in morbidity, complicated by severe long-term consequences. Ischemic stroke should be considered as a catastrophically rapidly developing and rejuvenating disease of modern society . In a global and full - scale plan , this pathology should be considered as a threat to society and health care . Despite the fact that young people do not belong to the risk group of people with diseases of the cardiovascular system, you should always be on the alert and not lose sight of patients with suspected ischemic stroke, work on a thorough diagnosis of the disease, always competently be able to differentiate it, conduct appropriate therapy, and do not forget about the prevention of long-term consequences stroke.</p>[Добрынина Л. А. Ишемический инсульт в молодом возрасте. / Л.А. Добрынина, Л.А. Калашникова, Л.Н. Павлова // Журнал неврологии и психиатрии им. С.С. Корсакова. – 2011. Т. 111, №3. – С. 4-8][Есауленко И.Э. Неврологические проявления вторичного антифосфолипидного синдрома / И.Э. Есауленко, В.А. Куташов, О.В. 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