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Original Contribution
January 2013

Ischemic Stroke and Transient Ischemic Attack in Young Adults: Risk Factors, Diagnostic Yield, Neuroimaging, and Thrombolysis

Author Affiliations

Author Affiliations: Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts (Drs Ji, Schwamm, Pervez, and Singhal); and Department of Neurology, Capital Medical University, Beijing, China (Dr Ji).

JAMA Neurol. 2013;70(1):51-57. doi:10.1001/jamaneurol.2013.575

Background Approximately 10% to 14% of ischemic strokes occur in young adults.

Objective To investigate the yield of diagnostic tests, neuroimaging findings, and treatment of ischemic strokes in young adults.

Design We retrospectively reviewed data from our Get with the Guidelines–Stroke database from 2005 through 2010.

Setting University hospital tertiary stroke center.

Patients A total of 215 consecutive inpatients aged 18 to 45 years with ischemic stroke/transient ischemic attack. The mean (SD) age was 37.5 (7) years; 51% were male.

Results There were high incidence rates of hypertension (20%), diabetes mellitus (11%), dyslipidemia (38%), and smoking (34%). Relevant abnormalities were shown on cerebral angiography in 136 of 203 patients, on cardiac ultrasonography in 100 of 195, on Holter monitoring in 2 of 192; and on hypercoagulable panel in 30 of 189 patients. Multiple infarcts were observed in 31% and were more prevalent in individuals younger than age 35 years. Relevant arterial lesions were frequently detected in the middle cerebral artery (23%), internal carotid artery (13%), and vertebrobasilar arteries (13%). Cardioembolic stroke occurred in 47% (including 17% with isolated patent foramen ovale), and 11% had undetermined stroke etiology. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 0-9) and 81% had good outcome at hospital discharge. Of the 29 patients receiving thrombolysis (median National Institutes of Health Stroke Scale score, 14; interquartile range, 9-17), 55% had good outcome at hospital discharge and none developed symptomatic brain hemorrhage.

Conclusions This study shows the contemporary profile of ischemic stroke in young adults admitted to a tertiary stroke center. Stroke etiology can be determined in nearly 90% of patients with modern diagnostic tests. The causes are heterogeneous; however, young adults have a high rate of traditional vascular risk factors. Thrombolysis appears safe and short-term outcomes are favorable.