Stroke in the young in South Africa--an analysis of 320 patients.

BACKGROUND: Aetiology of young stroke populations varies markedly between countries. AIM: We present one of the largest prospective studies of stroke in young adults, with specific attention given to aetiology and black-white differences to assist with secondary prevention and economic planning.
SETTING: Durban, KwaZulu-Natal, South Africa.
METHODS: Only first occurrence of stroke by World Health Organisation definition was recorded in patients who had undergone anatomical brain imaging. A hierarchy of investigative modalities divided into three tiers was applied and a range of standardised scales was scored for each patient. This protocol allowed for quantification of clinical deficit, aetiopathogenesis, disability and handicap. Cognitive impairment was evaluated separately according to predefined criteria.
RESULTS: Young stroke patients (15-49 years) comprised one-quarter of patients seen at this tertiary referral institution (320:1, 260, 25.4%). Significant black-white differences were encountered for mean age, risk factors, severity of clinical stroke, topography of stroke, severity of neurological deficit (Canadian Neurological scale), handicap (Rankin scale), aetiology (Trial of Org 10172 in Acute Stroke (TOAST) classification) and frequency and subtype of cognitive impairment. In blacks, HIV-associated stroke was highest in the otherwise unknown aetiological TOAST category.
CONCLUSION: In South Africa, race and endemic disease both appear to be important determinants of stroke in young adults. Knowledge of these variations will streamline the increasingly expensive diagnostic and therapeutic approach.