COMMENTARY

Ischemic Stroke in Young Adults

Laurie L. Barclay, MD

Disclosures

February 20, 2013

Ischemic Stroke and Transient Ischemic Attack in Young Adults: Risk Factors, Diagnostic Yield, Neuroimaging, and Thrombolysis

Ji R, Schwamm LH, Pervez MA, Singhal AB
JAMA Neurol. 2013;70:51-57

Study Summary

Young adults account for 10%-14% of patients who have ischemic strokes. The goal of this study was to examine risk factors, diagnostic performance of neuroimaging and tests, and treatment outcomes of ischemic strokes in this age group.

This retrospective review used data from the "Get with the Guidelines -- Stroke" database at a university hospital tertiary stroke center from 2005 through 2010. Ji and colleagues identified 215 consecutive inpatients, aged 18-45 years (mean, 37.5 ± 7 years), with ischemic stroke or transient ischemic attack. Both sexes were about equally represented (51% men).

Risk factors for stroke included dyslipidemia in 38% of patients, smoking in 34%, hypertension in 20%, and diabetes mellitus in 11%. Positive, pertinent findings were present on cerebral angiography in 136 of 203 patients, on cardiac ultrasonography in 100 of 195 patients, on Holter monitoring in 2 of 192 patients, and on hypercoagulable panel in 30 of 189 patients. Nearly one third (31%) of patients, particularly those younger than 35 years, had multiple infarcts.

The middle cerebral artery (23%), internal carotid artery (13%), and vertebrobasilar artery (13%) territories were often involved. The cause of stroke was cardioembolic in 47% (including 17% with isolated patent foramen ovale) and undetermined in 11%.

The median National Institutes of Health Stroke Scale (NIHSS) score was 3 overall (interquartile range [IQR], 0-9) and 14 (IQR, 9-17) in the 29 patients receiving thrombolysis. At hospital discharge, the outcome was good in 81% of patients overall and in 55% of those given thrombolytic therapy. None of the latter group developed symptomatic brain hemorrhage.

Viewpoint

The limitations of this study are its retrospective design and the possible lack of generalizability to patients who are not hospitalized in a tertiary stroke center. Nonetheless, the findings may help to develop cost-effective diagnostic and treatment strategies for ischemic stroke in young adults.

Among young adults admitted to a tertiary stroke center, modern diagnostic tests reveal the cause of stroke in nearly 90%. Despite a range of etiologies, traditional and modifiable vascular risk factors are common even in this age group, highlighting the need to implement evidence-based stroke prevention efforts that target traditional risk factors. For appropriately selected patients, thrombolysis seems to be safe, with good short-term outcomes.

Abstract

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