Stroke is one of the most severe forms of cerebrovascular disease. From 100 to 120 thousand people suffer a stroke for the first time every year in Ukraine. The incidence is 280-290 cases per 100 thousand population and exceeds the average incidence of stroke in economically developed European countries, where the latter is 200 per 100 thousand population (TS Mishchenko in 2019).
The global nature of the problem of vascular diseases of the brain determines the need for interdisciplinary integration. Various aspects of this issue are intensively studied by neurologists, neurosurgeons, pathophysiologists, geneticists nowadays. In addition, the analysis of the dynamics of stroke in recent decades shows a steady upward trend - by 0,5-2% in one year. According to the WHO classification (1963), the young age includes 18-44 years (Prof. VN Yarigina, Prof. VS Melentyeva 2016). Studies over the past decade have shown that some genetic features are additional risk factors for stroke in young people. Genetic predisposition to cerebral ischemia is realized as a result of the additive effect of several genes (gene-dose effect). In addition, the increased risk of stroke is based on the interaction of the genotype with external influences or dynamic factors. Genetic factors influencing the risk of stroke depend on age - and it is more significant in the case of the disease at a young age, due to the lack of sufficient time to significantly change the phenotype under the influence of external influences and dynamic factors. (LA Dzyak , ES Tsurkalenko 2016).
Given the leading role of the enzyme methylenetetrahydrofolate reductase (MTHFR) in homocysteine metabolism, it can be assumed that the C677T and A1298C polymorphisms of its MTHFR gene and the A2756G polymorphism of the MTR gene encoding methionine synthase and development may be associated with young people.
The study of the problem of ischemic stroke in young people has significantly increased interest in predicting the consequences of the disease. The expediency of predicting the consequences of ischemic strokes at a young age is due to the ability to plan a set of diagnostic measures in each case, which can significantly improve the quality of treatment of this serious pathology and reduce mortality among young patients. The relevance of the dissertation topic is due to the medical and social significance of the problem of ischemic stroke in young patients, and the importance of clinical and diagnostic features and their prognostic value in order to improve the diagnostic algorithm.
To achieve the goals and objectives of the study, a comprehensive examination of 61 patients (38 men and 23 women) aged 18 to 44 years (mean age 36,5 ± 3,73 years) with a diagnosis of acute cerebrovascular accident by ischemic type. A control group of 29 patients aged 45 to 59 years (mean age 51,6 ± 3,1 years) (16 men and 13 women) with ischemic stroke was also involved. All patients, both main and control groups, underwent clinical-neurological, neuroimaging, instrumental and medical-genetic examination. The diagnosis of acute ischemic stroke was established according to WHO criteria (clinical observation and verification by MRI of the brain). To participate in our study, each patient signed a written consent.
Pathogenetic subtypes of ischemic strokes were determined taking into account TOAST -criteria. It should be noted that patients with subtypes of stroke, the genesis of which could not be definitively determined, were not included in the study.
