Stroke in the young
Stuart Fraser1,2, Lisa Pabst3, Fiona Smith4
1Division of Child and Adolescent Neurology, Department of Pediatrics, The University of Texas McGovern Medical School.
Insights
Stroke incidence is rising in young adults, with poorer outcomes in developing nations. Advances in thrombectomy, genetic testing, and treatments like hydroxyurea offer new hope for pediatric and young adult stroke patients.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Stroke in children and young adults presents a significant global health challenge, marked by increasing incidence in young adults and disparities in outcomes.
- The disease imposes substantial societal costs and a high burden of long-term disability.
Approach:
- This review synthesizes recent findings on stroke epidemiology, etiologies, and treatment modalities in pediatric and young adult populations.
- It examines emerging therapeutic strategies and diagnostic advancements.
Key Points:
- Rising stroke incidence in young adults necessitates updated management guidelines, including consideration of patent foramen ovale closure for cryptogenic stroke.
- Thrombectomy is showing promise in carefully selected pediatric cases of acute ischemic stroke.
- Sickle cell disease remains a major contributor to stroke burden; hydroxyurea offers cost-effective prevention in children.
- Advances in genetic testing are improving outcomes for monogenic stroke causes like adenosine deaminase 2 deficiency, hemophilia, and Fabry's disease.
Conclusions:
- Recent therapeutic and diagnostic advancements are improving care access for large vessel occlusion in children and rare stroke causes in adults.
- Future research holds potential for novel treatments for monogenic stroke and expanded access to hyperacute therapies for young stroke patients.
Purpose Of Review:
The purpose of this review is to review recent findings regarding stroke epidemiology, etiologies, and treatment in children and young adults.
Recent Findings:
Incidence in young adults is increasing, and incidence, recurrence, and survival is worse in patients with cryptogenic stroke and in developing countries. Careful consideration of patent foramen ovale closure is now recommended in young adults with cryptogenic stroke. Thrombectomy has recently been extended to carefully selected children with acute ischemic stroke, and two recent publications strongly suggest that it can be beneficial for children. Sickle cell is also an important global contributor to stroke burden, but hydroxyurea can be a cost effective medication for stroke prevention in children. Recent advances in genetic testing and treatments may improve outcomes for patients with monogenic causes of stroke, such as deficiency of adenosine deaminase 2, hemophilia, and Fabry's disease.
Summary:
Stroke in children and young adults is a morbid disease responsible for enormous indirect societal costs and a high burden of years with disability per affected patient. Recent advances have improved access to care for children with large vessel occlusion and adults with rare causes of stroke. Future research may bring effective treatments for other monogenic causes of stroke as well as increasing access to hyperacute therapies for young stroke patients.
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