Stroke in young adults

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By Bartlomiej Piechowski-Jozwiak MD, Jorge Moncayo-Gaete MD, and Julien Bogousslavsky MD

Current epidemiological data suggest that strokes are occurring at a younger age. As many as 1 out of every 6 strokes occurs in a young adult (18 to 50 years old). Heterogeneity in incidence rates, stroke subtypes, and etiology among younger stroke victims in both developed and developing countries is often noted. Certain historical features and clinical manifestations may occasionally serve as clues toward specific stroke etiologies; nevertheless, determination of etiology, particularly of ischemic stroke in the young, poses many challenges due to a broad array of potential causes, both common and uncommon. In this article, the authors emphasize areas in which the differential diagnosis of stroke and etiologies (including those in pregnancy and puerperium) differs from that in older adults. The authors also note relevant information concerning prognosis of young adults with stroke.

Key Points

  • Up to 15% of all cerebral infarcts occur in young adults (ages 18 to 50 years old).
  • Etiologic diagnosis of stroke in young adults requires a different and more complex diagnostic work-up than that of stroke in older adults.
  • Overall, cardiac embolism and nonatherosclerotic vasculopathy are the main etiologies of cerebral infarct in younger patients.
  • Arteriovenous malformation and arterial hypertension are the main etiologies of cerebral hemorrhages.
  • Overall, and despite thorough investigation, the causes of up to one third of ischemias and hemorrhages remain undetermined.
  • Motor recovery is generally better than that of older patients, although a negative impact on multiple cognitive domains may be observed after a long-term follow up.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited