TY - JOUR
T1 - Neurology Concepts
T2 - Young Women and Ischemic Stroke—Evaluation and Management in the Emergency Department
AU - Chang, Bernard P.
AU - Wira, Charles
AU - Miller, Joseph
AU - Akhter, Murtaza
AU - Barth, Bradley E.
AU - Willey, Joshua
AU - Nentwich, Lauren
AU - Madsen, Tracy
N1 - Funding Information:
From the Department of Emergency Medicine (BPC) and the Department of Neurology, Stroke Service (JW), Columbia University Medical Center; New York, NY; the Department of Emergency Medicine, Yale-New Haven Medical Center (CW), New Haven, CT; the Department of Emergency Medicine, Henry Ford Medical Center (JM), Detroit, MI; the Department of Emergency Medicine, University of Arizona College of Medicine–Phoenix, Maricopa Integrated Health System (MA), Phoenix, AZ; the Department of Emergency Medicine, University of Kansas Medical Center (BEB), Kansas City, KS; the Department of Emergency Medicine, Boston Medical Center (LN), Boston, MA; and the Department of Emergency Medicine, Alpert Medical School of Brown University (TM), Providence, RI. Received April 18, 2017; revision received June 9, 2017; accepted June 19, 2017. The authors have no potential conflicts to disclose. Bernard Chang (BC) was supported by a KL2 mentored K training grant by the NIH: TR001874 TRANSFORM. Supervising Editor: Peter D. Panagos, MD. Address for correspondence and reprints: Bernard P. Chang, MD, PhD; e-mail: [email protected]. ACADEMIC EMERGENCY MEDICINE 2018;25:54–64.
Publisher Copyright:
© 2017 by the Society for Academic Emergency Medicine
PY - 2018/1
Y1 - 2018/1
N2 - Objective: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting. Methods: A panel of six board-certified emergency physicians, one with fellowship training in stroke and one with training in sex- and sex-based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors. Results: Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals. Conclusion: Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.
AB - Objective: Ischemic stroke is a leading cause of morbidity and mortality worldwide. While the incidence of ischemic stroke is highest in older populations, incidence of ischemic stroke in adults has been rising particularly rapidly among young (e.g., premenopausal) women. The evaluation and timely diagnosis of ischemic stroke in young women presents a challenging situation in the emergency department, due to a range of sex-specific risk factors and to broad differentials. The goals of this concepts paper are to summarize existing knowledge regarding the evaluation and management of young women with ischemic stroke in the acute setting. Methods: A panel of six board-certified emergency physicians, one with fellowship training in stroke and one with training in sex- and sex-based medicine, along with one vascular neurologist were coauthors involved in the paper. Each author used various search strategies (e.g., PubMed, PsycINFO, and Google Scholar) for primary research and reviewed articles related to their section. The references were reviewed and evaluated for relevancy and included based on review by the lead authors. Results: Estimates on the incidence of ischemic stroke in premenopausal women range from 3.65 to 8.9 per 100,000 in the United States. Several risk factors for ischemic stroke exist for young women including oral contraceptive (OCP) use and migraine with aura. Pregnancy and the postpartum period (up to 12 weeks) is also an important transient state during which risks for both ischemic stroke and cerebral hemorrhage are elevated, accounting for 18% of strokes in women under 35. Current evidence regarding the management of acute ischemic stroke in young women is also summarized including use of thrombolytic agents (e.g., tissue plasminogen activator) in both pregnant and nonpregnant individuals. Conclusion: Unique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.
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U2 - 10.1111/acem.13243
DO - 10.1111/acem.13243
M3 - Article
C2 - 28646558
AN - SCOPUS:85031112046
SN - 1069-6563
VL - 25
SP - 54
EP - 64
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 1
ER -