Ischaemic stroke in the young adult: clinical features, risk factors and outcome

Stroke is an important cause of morbidity and mortality in young adults, especially in developing countries. This study aimed to evaluate the clinical features, risk factors and outcome of ischaemic stroke in young adults aged 15-45 years.

A retrospective review was done of the medical records of 177 patients seen in a tertiary referral centre in Thiruvananthapuram, Kerala between January 1988 and March 1994.

There were 135 males and 42 females with a mean (SD) age of 34.7 (8) years at onset of stroke. An aetiological categorization of stroke was obtained in 111 (63%) patients and it was uncertain or unknown in the rest. Athero-thrombotic stroke and cardio-embolic stroke occurred in 24% and 17%, respectively. Hypertension, smoking, hyperlipidaemia and athero-thrombotic stroke were significantly more prevalent in the 31-45 year age group compared to the 15-30 year age group. There was only one patient with postpartum intracranial sinovenous thrombosis. At a mean follow up of 7 months (range 1-62 months), 75% of the patients were independent or only mildly disabled. The case-fatality rate was 1%.

Ischaemic stroke in the young adult is more frequent in males. The aetiopathogenesis can be determined in the majority and the athero-thrombotic process predominates. The mortality is negligible and the functional outcome is good in most patients.