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Juvenile Stroke
Florian Schöberl1, Peter Arthur Ringleb, Reza Wakili
1Neurological Clinic and Policlinic, Großhadern Hospital, Ludwig-Maximilians-Universität München; Neurological Clinic, Heidelberg University Hospital; Medical Clinic and Policlinic I, Großhadern Hospital, Ludwig-Maximilians-Universität München; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, München; Department of Cardiology and Angiology, Westdeutsches Herz- und Gefäßzentrum Essen, Essen University Hospital; Clinic of Neurology, Hertie Institute for Clinical Brain Research (HIH), University Hospital Tübingen; Institute for Stroke and Dementia Research (ISD), Großhadern Hospital, Ludwig-Maximilians-Universität München.
Insights
Juvenile stroke affects young adults, with cardiogenic emboli and vascular dissection as common causes. Diagnosis and treatment remain challenging, highlighting the need for further research.
Area of Science:
- Neurology
- Vascular Medicine
- Public Health
Background:
- Juvenile stroke (ages 18-55) impacts 30,000 annually in Germany, causing significant mortality and morbidity.
- The causes of stroke in younger individuals are more diverse than in older populations.
Purpose of the Study:
- To review the causes, diagnosis, and treatment of juvenile stroke.
- To highlight diagnostic uncertainties and the need for tailored approaches.
Main Methods:
- Selective PubMed search of pertinent publications.
- Review of current guideline recommendations.
Main Results:
- Common causes include cardiogenic emboli (25%) and vascular dissection (20%).
- Cryptogenic strokes (25-50%) and embolic stroke of undetermined source (ESUS) (20-30%) are prevalent.
- Acute ischemic stroke treatment involves rapid vascular recanalization; long-term outcomes are often poor, with only 40% returning to work.
Conclusions:
- High rates of cryptogenic stroke and ESUS indicate diagnostic and therapeutic gaps.
- Identifying rare causes requires significant diagnostic effort.
- Individualized diagnostic strategies, including cardiac monitoring, are crucial.
Background:
So-called juvenile stroke, i.e., stroke in a person aged 18 to 55, affects approximately 30 000 persons per year in Germany and is thus an important cause of mortality and permanent morbidity. The spectrum of causes of stroke is broader in this age group than in older patients and is also differently distributed.
Methods:
This review is based on pertinent publications retrieved by a selective search in PubMed and on current guideline recommendations.
Results:
Juvenile strokes are often caused by cardiogenic emboli (ca. 25%) and by vascular dissection (ca. 20%). Approximately 10% are due to rare causes such as vasculitis or thrombophilia, 25-50% remain cryptogenic, and 20-30% meet the criteria for an embolic stroke of undetermined source (ESUS). A rational diagnostic algorithm should be applied that is based on the relative frequencies of the potential causes. The acute treatment of ischemic stroke is the same for patients of all ages: the patient must be transferred as soon as possible to a hospital where a vascular recanalization procedure can be performed. From age 40 onward, there is a steep rise in vascular risk factors and therefore also in the resulting macro- and microangiopathy, which lead, in turn, to stroke. Only 40% of patients with juvenile stroke are ever able to return to their original occupation, and approximately one-third remain permanently unable to work.
Conclusion:
The high rates of cryptogenic stroke and ESUS among patients with juvenile stroke indicate that uncertainties remain in the diagnosis and treatment of this entity. The identification of rare causes of juvenile stroke requires a major diagnostic effort. Which diagnostic tests are useful or necessary in which patients is a matter that is currently decided on an individual basis. This is true, above all, of the indication for long-term cardiac monitoring.
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