Young adults (aged 45 or under) account for as many as 1 out of every 8 strokes. In the long-term, stroke may produce a huge impact on independence and performance in familial, occupational, and societal roles among young survivors. Heterogeneity in incidence rates, stroke subtypes, and etiology between younger stroke victims in developed and developing countries is often noted. Moreover, etiologic investigation, particularly of ischemic stroke in the young, poses many challenges in the search for a broad array of potential causes, both common and uncommon. In this updated clinical summary, Jorge Moncayo-Gaete MD of International University of Ecuador and Eugenio Espejo Hospital in Quito, Ecuador, and Julien Bogousslavsky MD, Head of the Neurology Department at Clinique Valmont-Genolier in Montreux, Switzerland, emphasize areas in which the differential diagnosis of stroke in young adults differs from that in older patients. Overall, management is similar to that for older adults. Also summarized are some aspects of treatment dictated by specific causes.