Tang, Mingyu, Zhuoga Cidan, Yang Ci, Yaxiong Hu, Yuhua Zhao, Fei Han, Lixin Zhou, and Jun Ni. Ischemic stroke in young adults at high altitude: different etiology and pathogenesis. High Alt Med Biol. 27:100-106, 2026. INTRODUCTION:Current knowledge indicates that exposure to high altitude increases the risk of ischemic stroke. However, its impact on ischemic stroke in young adults is still unknown. METHODS:This two-center retrospective study analyzed 451 patients aged 18-50 years who experienced a first-ever ischemic stroke and were hospitalized at Peking Union Medical College Hospital (44 m) or Tibet Autonomous Region People's Hospital (3,650 m) between 2013 and 2021. Clinical characteristics, stroke etiology, and the results of auxiliary tests were compared. RESULTS:A total of 451 patients were enrolled in this study, with a median age of 43, and 66.5% were male. At high altitude, hypertension (41.0% vs. 52.7%, p < 0.05) and diabetes mellitus (11.8% vs. 25.9%, p < 0.05) were less prevalent, whereas small-vessel occlusion stroke (21.7% vs. 8.0%, p < 0.01) was more common. Elevated levels of D-dimer (51.5% vs. 39.3%, p < 0.05) and hemoglobin (11.8% vs. 0%, p < 0.01) were observed more at high altitude. High altitude was associated with small-vessel occlusion stroke (odds ratio [OR] = 3.26, 95% confidence interval [CI] = 1.56-6.82, p < 0.01). CONCLUSION:The etiology of ischemic stroke in young adults at high altitude differs from that at low altitude. The higher frequency of hyperhemoglobinemia and hypercoagulable status suggests a distinct pathophysiological mechanism resulting from chronic high-altitude exposure.

Objective To explore the clinical,therapeutic,and prognostic characteristics of post-stroke epilepsy(PSE)among residents at high altitude,and to analyze the risk factors affecting the prognosis of PSE,which might provide a certain basis for formulating clinical diagnosis and treatment strategies in PSE at high altitude. Methods The PSE patients at high altitude who were hospitalized in the Tibet Autonomous Region People's Hospital from January 2019 to June 2023 were included retrospectively.According to the type of PSE,patients were divided into two groups:early-onset(≤7 days after stroke)PSE group and late-onset(＞7 days after stroke)PSE group.Follow-up was conducted in September 2023 through a combination of telephone and outpatient service to obtain the patients'functional prognosis(mRS score).The differences in clinical data,such as gender,age,type of stroke distribution,stroke severity(mRS score at onset)and laboratory examination,and functional prognosis during follow-up were compared between the two groups,and the influencing factors of poor prognosis(mRS score ≥3 at follow-up)were analyzed. Results A total of 89 PSE patients who met the inclusion criteria were included,accounting for 4.2％of hospitalized stroke patients during the same period.Among PSE patients,the median age of onset was 55(44-69)years,with 59 males(66.3％)and 87 Tibetans(97.8％).The mRS score of PSE patients at onset was 3(1-4)points.Among the enrolled patients,49 cases(55.1％)were in the early-onset PSE group and 40 cases(44.9％)were in the late-onset PSE group.Among the type of stroke in PSE patients,intracerebral hemorrhage accounted for the highest proportion,accounting for 39.3％(35 cases).The most common type of epileptic seizure was comprehensive origin(69 cases,77.5％).A total of 36 cases(40.4％)of PSE patients complicated with status epilepticus.Imaging showed that the most common lesion of stroke was cortical lesion,accounting for 53.9％(48 cases).In terms of treatment,85(95.5％)PSE patients received antiepileptic drugs,of which 79 cases(88.8％)received monotherapy.The most commonly used antiepileptic drug was oxcarbazepine/carbamazepine(36 cases,40.4％).The in-hospital mortality of PSE patients was 10.1％(9 cases).The median follow-up time was 27(15-40)months.The patients with poor prognosis accounted for 56.7％(38/67)and the mortality was 35.8％(24/67).Compared with the early-onset PSE group,the late-onset PSE group had a higher proportion of males(78.6％vs.56.6％,P=0.043)and a higher proportion of family history of epilepsy(10.0％vs.0,P=0.037).There were significant differences in the distribution of stroke types(P=0.040)and the distribution of antiepileptic drug types(P=0.047)between the two groups.Multivariate regression analysis showed that severe symptom of stroke(high mRS score at onset)was an independent risk factor for poor prognosis of PSE(OR 1.691,95％CI 1.245-2.297,P＜0.001). Conclusions The incidence of PSE in hospitalized stroke patients at high altitude was 4.2％.Patients with PSE in high altitude areas had severe clinical symptoms at onset,with 40.4％of patients coexisting with status epilepticus.Patients with PSE in high altitude areas had poor prognosis,with a high risk of disability and mortality.

Background and purpose:Cerebral small-vessel disease (CSVD) is prevalent worldwide and one of the major causes of stroke and dementia. For patients with CSVD at high altitude, a special environmental status, limited information is known about their clinical phenotype and specific neuroimaging change. We investigated the clinical and neuroimaging features of patients residing at high altitude by comparing with those in the plain, trying to explore the impact of high altitude environment on CSVD.Methods:Two cohorts of CSVD patients from the Tibet Autonomous Region and Beijing were recruited retrospectively. In addition to the collection of clinical diagnoses, demographic information and traditional vascular risk factors, the presence, location, and severity of lacunes and white matter hyperintensities were assessed by manual counting and using age-related white matter changes (ARWMC) rating scale. Differences between the two groups and influence of long-term residing in the plateau were analyzed.Results:A total of 169 patients in Tibet (high altitude) and 310 patients in Beijing (low altitude) were enrolled. Fewer patients in high altitude group were found with acute cerebrovascular events and concomitant traditional vascular risk factors. The median (quartiles) ARWMC score was 10 (4, 15) in high altitude group and 6 (3, 12) in low altitude group. Less lacunes were detected in high altitude group [0 (0, 4)] than in low altitude group [2 (0, 5)]. In both groups, most lesions located in the subcortical (especially frontal) and basal ganglia regions. Logistic regressions showed that age, hypertension, family history of stroke, and plateau resident were independently associated with severe white matter hyperintensities, while plateau resident was negatively correlated with lacunes.Conclusion:Patients of CSVD residing at high altitude showed more severe WMH but less acute cerebrovascular events and lacunes in neuroimaging, comparing to patients residing at low altitude. Our findings suggest potential biphasic effect of high altitude on the occurrence and progression of CSVD.

Objective To explore the improvement effect of green channel process optimization in acute ischemic stroke (AIS) on intravenous thrombolysis (IVT) quality in Lhasa. Methods All patients with AIS who received IVT by the stroke center of Tibet Autonomous Region from August 2019 to December 2021 were included. According to whether the stroke green channel process was optimized, they were divided into the pre-optimization group (August 2019 to June 2021) and the post-optimization group (July to December 2021). The quality of IVT and stroke prognosis were compared and analyzed between the two groups. Results A total of 34 patients with AIS who received IVT were included (an average of 1.2 patients per month), including 16 in the pre-optimization group and 18 in the post-optimization group. The National Institutes of Health Stroke Scale scores at baseline, immediately after thrombolysis, and 24 hours after thrombolysis were 6.5(3.0, 12.0), 3.0(1.0, 5.5)and 2.0(0, 6.3), respectively. The door to needle time in the post-optimization group was significantly shortened, as compared with that of the pre-optimization group[(67.1±37.8)min vs. (108.9±53.8)min, P=0.035]. Onset to needle time [(176.7±69.7)min vs. (199.1±47.8)min, P=0.065], the compliance rate of door to needle time ≤60 min (50.0% vs. 18.8%, P=0.061) and the proportion of good short-term efficacy of thrombolysis (77.8% vs. 62.5%, P=0.336) were improved, but the differences were not statistically significant. Conclusions After the process optimization of stroke green channel, the in-hospital delay of IVT for AIS in Lhasa is significantly improved, which is helpful to enhance the first-aid efficiency of early treatment of AIS.

病例摘要 患者 男性,42岁,汉族.因反复发作性右侧肢体无力3小时,于2021年9月2日收入西藏自治区人民医院.患者于2021年9月2日10:43突发右侧肢体无力,伴口角歪斜、言语不清,无发热、头痛、头晕症状,持续5分钟后自行缓解,间隔数分钟再次发作,于10:57急诊至我院就诊.急诊查体:体温36.4℃,心率82次/min,呼吸18次/min,血压为133/87 mm Hg(1 mm Hg=0.133 kPa),动脉血氧饱和度(Sp02)0.92(0.90～1.00);神志清楚,构音障碍,右侧鼻唇沟变浅,伸舌偏左,右侧肢体肌力为零、Babinski征阳性.