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