Non-atherosclerotic vasculopathies as the cause of cerebral infarction in young age

S.G. Kuzmenka, V.V. Ponomarev


An analytical review of the literature on the problem of cerebral infarction in young people (18–45 years old) is presented. The relevance of the diagnosis and treatment of cerebral infarction in young people in Belarus, Ukraine and the Russian Federation has been shown. In accordance with the generally accepted concept of heterogeneity of cerebral infarction some rare causes of stroke in young adults have been considered. Cerebral infarction in this category of patients differs in terms of etiological polymorphism, has features of the course and prognosis. Non-atherosclerotic vasculopathies that include a large variety of diseases with various basic mechanisms such as immunological, infectious, connective tissue pathology have been examined in detail. Much attention has been paid to the cerebral arterial dissection, its causes and clinical features. Results of the international trials on the new approaches to the diagnosis and treatment of spontaneous dissection of cervico-cerebral arteries, vasculitis and fibromuscular dysplasia are given. Advanced brain neuroimaging techniques and quality improvements of non-invasive angiographic images have been introduced. This resulted in more accurate and well-timed diagnosis and differentiation of vasculopathy, which is of great importance for further management. All in all, pathogenetic characteristics of cerebral infarction in young patients require further clarification.


cerebral infarction; young age; non-atherosclerotic vasculopathies


Инсульт. Руководство для врачей. Под ред. Л.В. Стаховской, С.В. Котова. М.: ООО «Медицинское информационное агентство», 2018. 488 с.

Виберс Д., Фейгин В., Браун Р. Инсульт: клиническое руководство. М.: БИНОМ, 2005. 608 с.

Griffiths D., Sturm J. Epidemiology and Etiology of young stroke. Stroke research and treatment. 2011. Article ID 209370. 9 p.

Putaala J., Metso A.J., Metso T.M. et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke. The Helsinki young stroke registry. Stroke. 2009. Vol. 40 (4). P. 1195-1203.

Добрынина Л.А., Калашникова Л.А., Павлова Л.Н. Ишемический инсульт в молодом возрасте. Журн. неврологии и психиатрии. 2011. Vol. 111 (3). P. 4-8.

Калашникова Л.А., Чайковская Р.П., Добрынина Л.А. и др. Диссекция внутренней сонной артерии как причина тяжелого ишемического инсульта с летальным исходом. Журн. неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2015. № 115 (12). P. 19-25.

Барабанова Э.В., Барановский А.Е., Мисникова В.А. и др. Диагностика типов и причин инсультов в молодом возрасте (предварительные результаты популяционного исследования, клинические примеры, данные литературы). Ars. Medica. 2013. № 4. С. 6-12.

Пизова Н.В. Редкие причины инсульта в молодом возрасте. Медицинский алфавит. 2016. № 14. С. 41-46.

Евтушенко С.К., Лисовский Е.В., Евтушенко О.С. Дисплазия соединительной ткани в неврологии и педиатрии (клиника, диагностика, лечение): руководство для врачей. Донецк, 2009. 372 с.

Евтушенко С.К. От этиологии и подвидов инсультов у лиц молодого возраста — к их эффективному лечению и профилактике. News of medicine and pharmacy. 2010. Неврология (328), тематический номер. published online.

Прилепская О.А., Дубровина О.А. Инсульт у лиц молодого возраста: все ли мы знаем? Университетская медицина Урала. 2016. № 1. С. 75-78.

Дубенко О.Е. Криптогенный инсульт. Международный неврологический журнал. 2016. № 2 (80). С. 90-94.

Adams H.P., Bendixen B.H., Kapelle J. et al. Classification of subtype of acute ischemic stroke. Definition for use in a multicentre clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 2000. Vol. 247 (4). P. 35-41.

Kwon S.U., Kim J.S., Lee V.C. Ischemic Stroke in Korean young adult. Acta Neurol. Scand. 2000. Vol. 101. P. 19-24.

Yonemura K., Kimura K., Hasegawa Y. et al. Analysis ische-mic stroke in patients aged up to 50 years. Rinsho Shinkegaku. 2000. Vol. 40 (9). P. 881-889.

Varona J.F., Guerra J.M., Bermejo F. et al. Causes of ische-mic stroke in young adults, and evolution of the etiological diagnosis over the long term. Eur. Neurol. 2007. Vol. 57 (4). P. 212-218.

Rima M. Dafer. Secondary Prevention After Non-atherosclerotic Cerebral Vasculopathies. Springer International Publishing Switzerland. 2016. P. 169-187.

Калашникова Л.А., Добрынина Л.А. Диссекция артерий головного мозга: ишемический инсульт и другие клинические проявления. M.: ВАКО, 2013. 208 с.

Schievink W.I. Spontaneous dissection of the carotid and vertebral arteries. N. Engl. J. Med. 2001. Vol. 344 (12). P. 898-906.

Baumgartner R.W., Lienhardt B., Mosso M. et al. Spontaneous and endotelial-independent vasodilation are impaired in patients with spontaneous carotid dissection: a case-control study. Stroke. 2007. Vol. 38 (2). P. 405-406.

Schievink W.I., Bjornsson J., Piepgras D.G. Coexistence of fibromuscular dysplasia and cystic medial necrosis in a patients with Marfan's syndrome and bilateral carotid artery dissection. Stroke. 1994. Vol. 25 (12). P. 2492-2496.

Vila N., Millan M., Ferrer X., Riutort N., Escudero D. Levels of alpha 1-antitripsin in plasma and risk of spontaneous cervical artery dissection: a case-control study. Stroke. 2003. Vol. 34 (9). P. 168-169.

Volker W., Ringelstein E.B., Dittrich R. et al. Morphometric analysis of collagen fibrills in skin of patients with spontaneous cervical artery dissections. J. Neurol. Neurosurg. Psychiatry. 2008. Vol. 79 (9). P. 1007-1012.

Brandt T., Morsher M., Hausser I. Association of cervical artery dissection with connective tissue abnormalities in skin and arteries. Front. Neurol. Neurosci. 2005. Vol. 20. P. 16-29.

Schievink W.I., Atkinson J.L., Bartleson J.D., Whisnant J.P. Traumatic internal carotid artery dissections caused by blunt softball injuries. Am. J. Emerg. Med. 1998. Vol. 16 (2). P. 179-182.

Caso V., Paciaroni M., Bogousslavsky J. Enviromental factors and cervical artery dissection. Front. Neurol. Neurosci. 2005. Vol. 20. P. 44-53.

Smith W.S., Johnston S.C., Skalabrin E.J. et al. Spinal manipulative therapy is a independent risk factor for vertebral artery dissection. Neurology. 2003. Vol. 60 (9). P. 1424-1428.

Rubinstein S.M., Peerdeman S.M., van Tulder M.W. et al. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005. Vol. 36 (7). P. 1575-1580.

Norris J.W., Beletsky V., Nadareishvili Z.G. Sudden neck movement and cervical artery dissection. CMAJ. 2000. Vol. 163. P. 38-40.

Schievink W.I., Wijdicks E.F.M., Kuiper J.D. Seasonal pattern of spontaneous cervical artery dissection. J. Neurosurg. 1998. Vol. 89. P. 101-103.

Guillon B., Berthet K., Benslamis L. et al. Infection and risk of spontaneous cervical artery dissection: a case-control study. Stroke. 2003. Vol. 34. P. 79-81.

Wang S., Le Y.Q., Chida J. et al. Mechanisms of matrix metalloproteinase-9 unregulation and tissue destruction in various organs in influenza A virus infection. J. Med. Invest. 2010. Vol. 57. P. 26-34.

Naggara O., Touzé E., Marsico R. High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection. Eur. Radiol. 2009. Vol. 19 (9). P. 2255-2260.

Bhayani N., Ranade P., Clark N.M., McGuinn M. Vari-cella-Zoster virus and cerebral aneurysm: case report and review of the literature clinical infectious diseases. 2008. Vol. 47. P. 1-3.

Pezzini A., Del Z.E., Archetti S. et al. Plasma homocysteine concentration, C677T MTHFR genotype, and 844ins68bp genotype in young adults with spontaneous cervical artery dissection and atherotrombotic stroke. Stroke. 2002. Vol. 33 (3). P. 664-669.

Pezzini A., Caso V., Zanferreri C. et al. Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study. J. Neurol. Neurosurg. Psychiatry. 2006. Vol. 77 (1). P. 95-97.

Pezzini A., Granella F., Grassi M. et al. History of migraine and the risk of spontaneous cervical artery dissection. Cephalalgia. 2005. Vol. 25 (8). P. 575-580.

Барабанова Э.В., Капацевич С.В. Неврологические проявления спонтанной экстракраниальной диссекции внутренней сонной артерии: инфаркт мозга: учеб.-метод. пособие. Минск: БелМАПО, 2012. 20 с.

Добрынина Л.А. Ишемический инсульт в молодом возрасте: причины, клиника, диагностика, прогноз восстановления двигательных функций: Автореф. дис… д.м.н. М., 2013. 48 с.

Lichy C., Metso A., Pezzini A. et al. Predictors of delayed stroke in patients with cervical artery dissection. Int. J. Stroke. 2012. Vol. 11. P. 4949.

Pelkonen O., Tikkakoski T., Pyntinen J., Sotaniemi K. Cerebral CT and MRI findings in cervico-cephalic artery dissection. Acta. Radiol. 2004. Vol. 45 (3). P. 259-265.

Древаль М.В., Кротенкова М.В., Калашникова Л.А. Современные возможности визуализации спонтанной диссекции экстракраниальных отделов внутренних сонных и позвоночных артерий. Медицинская визуализация. 2012. № 3. С. 59-69.

Bachmann R., Nassenstein I., Kooijman H. et al. Spontaneous acute dissection of the internal carotid artery: high-resolution magnetic resonance imaging at 3.0 tesla with a dedicated surface coil. Invest. Radiol. 2006. Vol. 41. P. 105-111.

Sturzenegger M. Spontaneous internal carotid artery dissection: early diagnosis and management in 44 patients. J. Neurol. 1995. Vol. 242. P. 231-238.

De Bray J.M., Lhoste P., Dubas F. et al. Ultrasonic features of extracranial carotid dissections: 47 cases studied by angiography. J. Ultrasound Med. 1994. Vol. 13. P. 659-664.

Menon R., Kerry S., Norris J.W., Markus H.S. Treatment of cervical artery dissection: a systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatr. 2008. Vol. 79 (10). P. 1122-1127.

Kennedy F., Lanfranconi S., Hichs C. et al. Antiplatelets vs. anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2012. Vol. 79 (7). P. 686-689.

Antiplatelet treatment compared with anticoagulation treatment for Cervical Artery Dissection in Stroke Study (CADISS): a randomized trial. Lancet Neurol. 2015, published online Feb.12. (15)70018-9.

Kernan W.N., Ovbiagele B., BlackH. R. et al. American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guidelines for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014. Vol. 45 (7). P. 2160-2236.

Derex L., Nighoghossian N., Turjman F. et al. Intravenous t-PA in acute ischemic stroke related to internal carotid artery dissection. Neurology. 2000. Vol. 54 (11). P. 2159-2161.

Georgiadis D., Lanczik O., Schwab S. et al. IV thrombolysis in patients with acute ischemic stroke due to spontaneous carotid dissection. Neurology. 2005. Vol. 64 (9). P. 1612-1614.

Engelter S.T., Dallongeville J., Kloss M. et al. Thrombolysis in cervical artery dissection — data from the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) database. Eur. J. Neurol. 2012. Vol. 19 (9). P. 1199-1206.

Барабанова Э.В., Пономарев В.В., Кузьменко С.Г. и др. Лечение и прогноз при диссекции брахиоцефальных артерий. Лечебное дело. 2015. № 4 (44). С. 31-35.

Lyrer P., Engelter S. Antitrombotic drugs for carotid artery dissection. Cochrane Database Syst. Rev. 2003. Vol. 3: CD000255.

Edwards N.M., Fabian T.C., Claridge J.A. et al. Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from long-term follow-up. J. Am. Coll. Surg. 2007. Vol. 204 (5). P. 1007-1013.

Chiche L., Praquin B., Koskas F., Kieffer E. Spontaneous dissection of the extracranial vertebral artery: indications and long-term outcome of surgical treatment. Ann. Vasc. Surg. 2005. Vol. 19 (1). P. 5-10.

Touze E., Gauvrit J.Y., Moulin T. et al. Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology. 2003. Vol. 61 (10). P. 1347-1351.

Slovut D.P., Olin J.W. Fibromuscular dysplasia. N. Engl. J. Med. 2004. Vol. 350 (18). P. 1862-1871.

Rushton A.R. The genetic of fibromuscular dysplasia. Arch. Intern. Med. 1980. Vol. 140 (2). P. 233-234.

Olin J.W., Gornik H.L., Bacharach J.M. et al. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American heart association. Circulation. 2014. Vol. 129 (9). P. 1048-1078.

Hudgins L.B., Limbacher J.P. Fibromuscular dysplasia in Alport's syndrome. J. Tenn. Med. Assoc. 1982. Vol. 75 (11). P. 733-735.

Schievink W.I., LimburgM. Angiographic abnormalities mimicking fibromuskular dysplasia in a patient with Ehlers-Danlos syndrome, type IV. Neurosurgery. 1989. Vol. 25 (3). P. 482-483.

Persu A., Touze E., Mousseaux E. et al. Diagnosis and ma-nagement of fibromuscular dysplasia: an expert consensus. Eur. J. Clin. Invest. 2012. Vol. 42 (3). P. 338-347.

Насонов Е.Л., Баранов А.А., Шилкина Н.П. Васкулиты и васкулопатии. Верхняя Волга, 1999. 616 с.

Селезнева C.В. Церебральные васкулопатии (васкулиты): особенности клиники, диагностика, принципы лечения. Неврология, психиатрия, психотерапия. 2017. № 3 (42). С. 42-43.

Евтушенко С.К., Ефименко О.М. Прояви ураження нервовоï системи у ВIЛ-iнфiкованих та стратегiя подальшого спостережения. Мiжнародний неврологiчний журнал. 2015. № 4. С. 20-28.

Cravioto H., Feigin I. Noninfectious granulomatous angiitis with a predilection for the nervous system. Neurology. 1959. Vol. 9. P. 599-609.

Salvarani C., Broen Jr. R.D., Hunter G.G. Adult primary central nervous system vasculitis. Lancet. 2012. Vol. 380 (9843). P. 767-777.

Hajj-Ali R.A., Calabrese L.H. Primary angiitis of the central nervous system. Autoimmun. Rey. 2013. Vol. 12 (4). P. 463-466.

Salvarani C., Hunder G.G., Morris J.M., et al. Ab-related angiitis: Comparison with CAA without inflammation and primary CNS vasculitis. Neurology. 2013. Vol. 81. P. 1596-603.

Greenberg S. Cerebral amyloid angiopathy: prospects for clinical diagnosis and treatment. Neurology. 1998. Vol. 51. P. 690-94.

Salvarani C., Brown R.D. Jr, Calamia K.T. et al. Primary central nervous system vasculitis: comparison of patients with and without cerebral amyloid angiopathy. Rheumatology. 2008. Vol. 47. P. 1671-1677.

Кузьменко С.Г., Пономарев В.В., Римашевский В.Б., Деркачева Н.В. Клинико-нейровизуализационные сопоставления при болезни моя-моя. Международный неврологический журнал. 2017. № 5 (91). C. 130-135.


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