Analysis of 1008 Consecutive Patients Aged 15 to 49 With First-Ever Ischemic Stroke

Abstract

Background and Purpose-To analyze trends in occurrence, risk factors, etiology, and neuroimaging features of ischemic stroke in young adults in a large cohort. Comparisons were done between groups stratified by gender and age. Results-Estimated annual occurrence was 10.8/100 000 (range 8.4 to 13.0), increasing exponentially with aging. Of our 628 male and 380 female (ratio 1.7:1) patients, females were preponderant among those Ͻ30, whereas male dominance rapidly increased around age of 44. The most frequent risk factors were dyslipidemia (60%), smoking (44%), and hypertension (39%). Males and patients Ͼ44 clearly had more risk factors. Cardioembolism (20%) and cervicocerebral artery dissection (15%) were the most frequent etiologic subgroups. Proportions of large-artery atherosclerosis (8%) and small-vessel disease (14%) began to enlarge at age 35, whereas frequency of undetermined etiology (33%) decreased along aging. Posterior circulation infarcts were more common among patients Ͻ45 years of age. Left hemisphere infarcts were more frequent in general. There were 235 (23%) patients with multiple and 126 (13%) with silent infarcts, and 55 (5%) patients had leukoaraiosis. Conclusions-The frequency of ischemic stroke increases sharply at age 40. Etiology and risk factors start resembling those seen in the elderly in early midlife but causes defined in younger patients still are frequent in those aged 45 to 49. Subclinical infarcts were surprisingly common in the young.

Age dependency of ischaemic stroke subtypes and vascular risk factors in western Norway: the Bergen Norwegian Stroke Cooperation Study

“…This illustrates a well‐known limitation of the TOAST classification, as the stroke of undetermined cause category not only includes cases of truly unknown cause, but also cases with several potential causes 14, 15. Stroke of undetermined cause comprised the largest subtype among young and middle‐aged patients, which is in accordance with other studies 16, 17, whereas stroke of undetermined cause was outnumbered by cardioembolism among the elderly 18. The lowest proportion of stroke of undetermined cause was found among those younger than 30 years.…”

Influenza‐like illness as a trigger for ischemic stroke

“…We found that younger patients were at relatively increased odds of stroke after ILI compared to older patients; for every decade younger age, the odds increased by almost 10%. While the absolute risk of stroke is greater in older adults, approximately 10–14% of all strokes occur in people 18–45 years old, with the incidence and prevalence of stroke in the young increasing 4, 28, 29, 30, 31, 32, 33, 34. This increasing prevalence, moreover, coupled with greater heterogeneity in stroke etiology within the younger age group than in the older stroke population, presents a unique and vulnerable patient population where risk reduction efforts are of increasing importance.…”

Frequency of MELAS main mutation in a phenotype-targeted young ischemic stroke patient population

“…Previous studies reported mitochondrial diseases among consecutive young IS patients to be as low as 2 in 1008 [6] and 6 among 3331 [8], with higher rates (4 among 104) among pediatric patients [7]. Underdiagnosis is potentially possible as all patients in these studies were not systematically tested for mitochondrial diseases and no results of comprehensive testing for mitochondrial diseases in selected or unselected IS patient series are available.…”

“…The pathophysiology and course of stroke-like episodes in patients with mitochondrial diseases are distinct from IS and are probably underlied by a number of mechanismsalone or in combination-discussed in detail elsewhere [4]. We previously reported only two MELAS patients among 1008 young patients with first-ever IS at their age of 15-49 years [6]. Mitochondrial disease was reported in 4 out of 104 Saudi children presenting with stroke [7].…”