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Ischemic stroke in adults younger than 30 years of age. Cause and prognosis
Insights
Young adults experiencing ischemic stroke often have underlying conditions like mitral valve prolapse or arterial dissection. Prognosis after stroke is generally reasonable, with most survivors returning to work.
Area of Science:
- Neurology
- Cardiology
Background:
- The etiology and prognosis of ischemic stroke in adults under 30 remain poorly understood.
- This age group presents unique challenges for stroke diagnosis and management.
Purpose of the Study:
- To investigate the causes and outcomes of ischemic stroke in young adults (under 30).
- To determine the diagnostic utility of specific investigations in this population.
Main Methods:
- A cohort of 41 young adults with ischemic stroke was studied.
- Standard investigations included cerebral angiography and echocardiography.
Main Results:
- Mitral valve prolapse and arterial dissection were identified in 51% of cases.
- Migrainous infarction and uncommon causes accounted for 15% and 34% of infarcts, respectively.
- Oral contraceptive use was noted in two-thirds of women, with a potential link to stroke in one case.
Conclusions:
- Cerebral angiography and echocardiography are recommended for all young adults experiencing ischemic stroke.
- The long-term prognosis for stroke survivors in this age group is reasonable, with a low incidence of recurrent stroke and death.
Abstract:
Because the cause and prognosis of ischemic stroke in adults younger than 30 years of age are not known, we observed 41 such patients (26 females and 15 males) using a standard protocol of investigations, including cerebral angiography and echocardiography. Mitral valve prolapse and arterial dissection accounted for 51% of infarcts, migrainous infarction was the likely cause in 15% of infarcts, and uncommon causes accounted for 34% of infarcts. Atherosclerosis played a role in only two patients. Two thirds of the women were taking oral contraceptives, which may have been the primary cause of stroke in one woman who had recurrent venous thromboses followed by thrombosis of the aortic arch. Three patients (7.3%) died of acute causes. During follow-up (mean, 46 months), the annual incidence of death (0.7%) and recurrent stroke (0.7%) was low. Eighty-one percent of the survivors could return to work. We conclude that cerebral angiography and echocardiography are indicated in all adults younger than 30 years of age. After the acute phase of stroke, prognosis is reasonable.