Long-term prognosis of ischemic stroke in young adults

Abstract

There is limited information about long-term prognosis of ischemic stroke in young adults. Giving the potentially negative impact in physical, social, and emotional aspects of an ischemic stroke in young people, providing early accurate long-term prognostic information is very important in this clinical setting. Moreover, detection of factors associated with bad outcomes (death, recurrence, moderate-to-severe disability) help physicians in optimizing secondary prevention strategies. The present paper reviews the most relevant published information concerning long-term prognosis and predictors of unfavorable outcomes of ischemic stroke affecting young adults. As a summary, we can conclude that, in the long term, stroke in the young adult increases slightly the risk of mortality, implies higher risk of future cardiovascular events, and determines functional limitations in a significant percentage of patients. Nevertheless, in every individual case the prognosis has to be considered depending on several factors (stroke subtype, initial severity, cardiovascular risk factors) that determine the long-term outcomes.

Arterial Events after Ischemic Stroke at a Young Age: A Cross-Sectional Long-Term Follow-Up of Patients and Controls in Western Norway

“…We found 26% recurrent stroke among our young ischemic stroke patients, which is comparable to the 25% Varona et al [4] reported. However, Varona et al [4], who acquired follow-up information from hospital records and telephone interviews, did not assess PAD and grouped CD with cardiac failure and arrhythmia, which makes comparison with our other results difficult.…”

“…Two other studies of young ischemic stroke patients from western Europe with mean follow-up times of 16 and 12.3 years, respectively, either had no control group [9] or used a reference population for comparing survival data [4]. …”

“…However, long-term studies comparing young patients with reference populations have shown significantly higher mortality among patients [3, 4] and cardiac death occurring frequently after surviving the first year after stroke [3, 5]. There is scant follow-up information on vascular morbidity among young patients surviving ischemic stroke compared with controls.…”

Causes of Ischemic Stroke in Young Adults, and Evolution of the Etiological Diagnosis over the Long Term

“…We must thus treat every possible cause. Even so, we must make an effort to improve our diagnostic evaluation to determine a specific cause in every patient in order to prescribe appropriate, secondary prevention therapy and to provide proper assessment of long-term prognosis [25]. …”

“…Uncertain etiology is a very heterogeneous subtype of stroke that involves cases where the cause cannot be determined with any degree of confidence, including those with more than one potential cause identified. We must thus subclassify and separate the three components of undetermined etiology, taking into consideration that everyone is managed differently and has a different prognosis [25]. …”