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Related Experiment Video

Updated: Aug 28, 2025

Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
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Trigger Factors for Stroke in Young Adults: A Case-Crossover Study.

Merel S Ekker1, Jamie I Verhoeven1, Karlijn M L Rensink1

  • 1From the Department of Neurology (M.S.E., J.I.V., K.M.L.R., M.M.I.S., E.M.B., C.J.M.K., A.M.T., F.-E.L.), Radboud University Medical Centre, Donders Institute for Brain, Cognition and BehaviourNijmegen, the Netherlands; Department of Neurology (M.E.A., A.G.W.N.), Amphia Hospital, Breda, the Netherlands; Department of Neurology (P.J.A.M.B., R.M.A.), Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology (G.W.D.), Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology (R.A.R.G., I.W.M.U.), Catharina Hospital, Eindhoven, the Netherlands; Department of Neurology (T.H.), Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Neurology (P.L.M.K.), Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (K.F.L.), Haga Hospital, the Hague, Netherlands; Department of Neurology (S.E.V.), Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology (M.Z.), Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands; Department of Neurology (R.J.O.), Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Neurology (M.J.H.W.), Leiden University Medical Centre, Leiden, the Netherlands; Department of Neurology (P.J.N.), Amsterdam University Medical Centres, Location AMC, Amsterdam, the Netherlands; Department of Neurology (H.K.), Albert Schweitzer Hospital, Dordrecht, the Netherlands; Department of Neurology (F.R.), Zuyderland Hospital, Sittard-Geleen, the Netherlands; Department of Neurology (F.G.R.), Medical Centre Leeuwarden, Leeuwarden, the Netherlands; and Department of Neurology (I.R.W.), Haaglanden Medical Center, the Hague, the Netherlands.

Neurology
|September 20, 2022
PubMed
Summary

Young adults experiencing stroke may have triggers like cola, exercise, or illness. Identifying these factors helps understand stroke causes in younger populations.

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Area of Science:

  • Neurology
  • Epidemiology
  • Public Health

Background:

  • Stroke in young adults presents unique etiological challenges compared to older populations.
  • A significant percentage of strokes in young individuals remain cryptogenic (of unknown cause).
  • Investigating potential short-term trigger factors is crucial for understanding stroke in this demographic.

Purpose of the Study:

  • To explore the association between specific trigger factors and the occurrence of stroke in young adults.
  • To differentiate trigger factor associations across various etiological subgroups of ischemic stroke.
  • To enhance the understanding of pathophysiological mechanisms underlying stroke in the young.

Main Methods:

  • A case-crossover study design was employed involving 1146 patients aged 18-49 years with first-ever ischemic stroke or intracerebral hemorrhage (ICH).
  • Participants completed questionnaires on exposure to 9 potential trigger factors during defined hazard periods and on a regular basis.
  • Relative risks (RRs) were calculated using the Mantel-Haenszel case-crossover method to assess associations between triggers and stroke events.

Main Results:

  • Significant stroke risk increases were observed within hours of cola consumption (RR 2.0), vigorous physical exercise (RR 2.6), sexual activity (RR 2.4), and illicit drug use (RR 2.8).
  • Fever or flu-like illness within 24 hours showed a markedly increased risk (RR 14.1 and 13.9, respectively).
  • Specific trigger factors were associated with different etiological subtypes of ischemic stroke, including cryptogenic, cardioembolic, and large vessel atherosclerosis.

Conclusions:

  • Cola consumption, vigorous physical exercise, sexual activity, illicit drug use, fever, and flu-like illness are identified as potential stroke triggers in young adults.
  • The study highlights distinct trigger factor profiles across different stroke etiologies in the young.
  • These findings contribute to a better comprehension of stroke pathophysiology in younger individuals.