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Author: Andreea Ördög, Madalina Stetca, Nicoleta Tohanean, Lacramioara Perju-Dumbrava

Category: Medical


The incidence of ischaemic stroke in young adults (18-50 years) has increased substantially in the last 3 decades, mainly because of the rising incidence of vascular risk factors in this age group (hypertension, hypercholesterolemia, diabetes mellitus, smoking, obesity) and increased illicit drugs and alcohol consumption. Although progress has been made in early diagnosis of stroke, specific guidelines for the management and secondary prevention of ischaemic stroke in the young are lacking.

Ischaemic stroke in young adults has a considerable socio-economic impact and is responsible for an important decrease in the labor force. While subarachnoid and intracerebral hemorrhage are more frequent in the young population, hemorrhagic stroke still remains less common than ischaemic stroke.

The etiology of ischaemic stroke can be represented by non-atherosclerotic vasculopathy (arterial dissection, inherited or acquired thrombophilia) or cardioembolism in the context of patent foramen ovale and atrial septal aneurysm. In this age group, specific investigations for less common causes of stroke are needed (genetic diseases, autoimmune diseases, vasculitis).

Secondary prevention is of major importance because young patients have a long life expectancy after stroke, including mainly changes in lifestyle, diet and long-term antiplatelet or anticoagulant therapy.

The aim of this presentation is to illustrate recent findings on the heterogeneity of stroke etiology in the young, the adequate case management considering its severe long-term disability and mortality risk and the need for guidelines specifically devoted to ischaemic stroke in this population.

DOI: 10.51546/JSUM.2023.10201



1. Hathidara MY, Saini V, Malik AM. Stroke in the Young: a Global Update. Curr Neurol Neurosci Rep. 2019;19(11).

2. Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17(9):790–801.

3. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016 Aug 1;15(9):913–24.

4. George MG, Tong X, Bowman BA. Prevalence of Cardiovascular Risk Factors and Strokes in Younger Adults. JAMA Neurol. 2017 Jun 1;74(6):695–703.

5. Gjærde LK, Gamborg M, Ängquist L, Truelsen TC, Sørensen TIA, Baker JL. Association of Childhood Body Mass Index and Change in Body Mass Index With First Adult Ischemic Stroke. JAMA Neurol. 2017 Nov 1;74(11):1312.

6. Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, et al. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2012 Aug 14;79(7):686–9.

7. Tiu VE, C??aru B, Badea R?. Accidentul vascular cerebral. In: Panea CA, editor. Ghid practic de abordare a urgen?elor neurologice. Bucure?ti: Editura Medical?; 2021. p. 7–29.

8. Berkman SA, Song SS. Ischemic Stroke in the Young. Clin Appl Thromb. 2021;27.

9. Fonseca AC, José MF. Drug abuse and stroke. Curr Neurol Neurosci Rep. 2013 Nov;13(2):906–8.

10. Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry. 2017 Dec 1;88(12):1079–91.

11. Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS, et al. Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke. N Engl J Med. 2017 Sep 14;377(11):1022–32.

12. Gourraud JB, Khairy P, Abadir S, Tadros R, Cadrin-Tourigny J, Macle L, et al. Atrial fibrillation in young patients. Expert Rev Cardiovasc Ther. 2018;16(7):489–500.

13. Jillella D V., Wisco DR. Infectious causes of stroke. Curr Opin Infect Dis. 2019;32(3):285–92.

14. Ricci S. Embolism from the heart in the young patient: A short review. Neurol Sci. 2003;24(SUPPL. 1):13–4.

15. Omran SS, Lerario MP, Gialdini G, Merkler AE, Moya A, Chen ML, et al. Clinical Impact of Thrombophilia Screening in Young Adults with Ischemic Stroke. J Stroke Cerebrovasc Dis. 2019 Apr 1;28(4):882–9.

16. Aarnio K, Joensuu H, Haapaniemi E, Melkas S, Kaste M, Tatlisumak T, et al. Cancer in young adults with ischemic stroke. Stroke. 2015 Jun 4;46(6):1601–6.

17. Abanoz Y, Gülen Abanoz Y, Gündüz A, Uludüz D, ?nce B, Yavuz B, et al. Migraine as a risk factor for young patients with ischemic stroke: a case-control study. Neurol Sci. 2017 Apr 1;38(4):611–7.