Stroke in young adults

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

The symptoms and signs of stroke are directly related to the affected blood vessel (artery or vein), quantity of cerebral injury, and etiology; there is no apparent relationship to the specific age group affected. As such, a comprehensive history and physical examination (Table 1) are critical to detect the etiology of stroke (Stern et al 1991; Kristensen et al 1997; Martin et al 1997; Kittner 1998; Kittner et al 1998).

Table 1. Selected Historical Information

May suggest a vascular cause:

  • Atherosclerosis
    - Tobacco use
    - Arterial hypertension
    - Hyperlipidemia
    - Diabetes mellitus
    - Prior radiation therapy
    - Homocystinuria
  • Dissection
    - Trauma
    - Chiropractic manipulation

May suggest a cardiac cause:

  • Intravenous drug abuse
  • Cardiac murmur
  • Splinter hemorrhages
  • Deep venous thrombosis
  • Association of stroke with exercise or straining
  • Valve replacement
  • Cancer

May suggest a hematologic cause:

  • Sickle cell disease
  • Deep venous thrombosis
  • Livedo reticularis
  • History of miscarriages or spontaneous abortions
  • Leukostasis
  • Asymmetric radial arterial pulses
  • Bone marrow transplantation

Other clues:

  • Recurrent headaches
  • Use of hormonal contraceptives
  • Papilledema
  • Alcohol use
  • Recent (within one week) febrile illness or systemic infection
  • Pregnancy or recent delivery
  • HIV infection
  • Family history of stroke, thrombosis, spontaneous abortion, or premature myocardial infarction
  • Hearing loss
  • History of uterine or bowel rupture or pneumothorax, suggesting a connective tissue disorder

Adapted from (Stern and Wityk 1994)

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors