Non-penetrating arterial trauma and cerebral infarction in the young

In a retrospective study of 60 patients under the age of 45 with ischaemic stroke the commonest likely predisposing factor was trauma, which applied to 13 (22%) patients. In 9 of these patients neck movement was the most likely factor that precipitated the stroke and was the factor identified in all the 3 who had damage to the vertebral artery. The other 4 patients had sustained direct trauma in the neck area, 2 as a result of attempted strangulation and 2 by carrying heavy loads on the shoulder. There may be a delay between the traumatic event and manifestation of the stroke, probably because the initial damage, which is most likely a small tear, is of no immediate consequence, and the stroke results after thrombus has formed over the tear and subsequently embolised.