Risk factors and mechanisms of stroke in young adults: The FUTURE study

Abstract

Incidence of ischemic stroke and transient ischemic attack in young adults is rising. However, etiology remains unknown in 30–40% of these patients when current classification systems designed for the elderly are used. Our aim was to identify risk factors according to a pediatric approach, which might lead to both better identification of risk factors and provide a stepping stone for the understanding of disease mechanism, particularly in patients currently classified as “unknown etiology”. Risk factors of 656 young stroke patients (aged 18–50) of the FUTURE study were categorized according to the “International Pediatric Stroke Study” (IPSS), with stratification on gender, age and stroke of “unknown etiology”. Categorization of risk factors into ≥1 IPSS category was possible in 94% of young stroke patients. Chronic systemic conditions were more present in patients aged <35 compared to patients ≥35 (32.6% vs. 15.6%, p < 0.05). Among 226 patients classified as “stroke of unknown etiology” using TOAST, we found risk factors in 199 patients (88%) with the IPSS approach. We identified multiple risk factors linked to other mechanisms of stroke in the young than in the elderly. This can be a valuable starting point to develop an etiologic classification system specifically designed for young stroke patients.

Ischaemic stroke in young adults: a global perspective

“…The most frequent solitary rare cause of ischaemic stroke in young adults is arterial dissection, which causes up to 15% of all young strokes 35 36. Due to insufficient financial resources in developing countries, not all young stroke patients receive adequate imaging to detect an arterial dissection.…”

“…3 4 35 54 Young stroke patients have approximately twice as many risk factors compared with their peers 54. Furthermore, the prevalence of having multiple risk factors is increasing 36 54 55. The risk of future vascular events increases equally with the number of risk factors 56.…”

Time trends and patient selection in the use of continuous electrocardiography for detecting atrial fibrillation after stroke: a nationwide cohort study

“…Sum scores range from 0 to 58, the latter corresponding to no deficits. Stroke severity was classified according to the Scandinavian Stroke Scale score as mild (≥ 45), moderate (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), severe (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) and very severe (≤14).…”

“…Although cardiovascular risk factors contribute to stroke in young patients [30] stroke etiology is often diverse and more often classified as cryptogenic in patients under 55 years of age [31]. Hence, the tendency to choose the young patients with less comorbidity might reflect a clinical selection for cECG based on the presence of cryptogenic stroke [32] whereas an early documentation of probable stroke causes or risk factors could deter clinicians from further evaluation.…”

Fatal cerebral and cardiac infarction due to embolism of a mobile thrombus from aorta sinotubular junction atheroma in a 40-year-old female

“…1 Helios Kliniken Schwerin, Klinik für Kardiologie und Angiologie, Schwerin, Germany, ²Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine, 3 Universitätsklinikum Leipzig, Klinik und Poliklinik für Kardiologie, Leipzig, Germany, 4 Helios Kliniken Schwerin, Institut für Pathologie, Schwerin, Germany A -research concept and design; B -collection and/or assembly of data; C -data analysis and interpretation; D -writing the article; E -critical revision of the article; F -final approval of the article Strokes in young adults present a challenging problem in terms of care and social impact. Most of cases in this cohort are classified as strokes of uncertain etiology.…”