Apoplexy in young adults diagnostic and therapeutic observations.

Apoplexy in young adults is due to rupture of an artery or to obstruction, as by clot, by embolus, or by transitory vasospasm. In differential diagnosis, tumor and demyelinizing disease must be considered. Spinal fluid study helps to differentiate between hemorrhagic stroke and stroke due to vascular block. In hemorrhagic stroke, search for the site of bleeding is imperative and angiography, the preferred method of study, should be carried out as soon as the patient's general condition permits. In vascular occlusive stroke, measures to maintain the blood pressure and to dilate collateral channels are often helpful. Stellate block is most valuable in the acute phase immediately following embolism or thrombosis. In a small percentage of chronic cases, stellate block may be followed by significant recovery of function. Benefit may also be derived at times from systemic vasodilators such as niacin and intravenously administered histamine.