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JAMA Neurol. 2013 Jan;70(1):51-7. doi: 10.1001/jamaneurol.2013.575.

Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis.

Author information

1
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.

Abstract

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.

PMID:
23108720
DOI:
10.1001/jamaneurol.2013.575
[Indexed for MEDLINE]

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