Ischemic Stroke in

Young Adult

2001/08/13
 Ischemic Stroke in Young adult
Definition 16-45 y/o
Distribution 3-4% of all stroke
Etiology, clinical manifestation, and prognosis
are different from elderly
It is important to find the etiologic factor and
treat them adequately for preventing the
recurrence

Orv Hetil 2001 Mar 25;142(12):607-10

 Epidermiology
Northern Sweden Monica, 13 third level and local hospital, age 18-44
y/o, from Jan.1991-May 1996, totally 88 cases
Annual incidence 11.3/100000 13.6 m vs 8.9 w
Case fatality rate 5.7% (within 28 days) 4.8
in Neuro Neurochir pol 2000Nov-Dec;
Increased with age especially after 35 y/o
Dramatic increased after 45 in other report

Kristensen: Stroke, Volume 28(9).September 1997.1702-1709

 Epidemiology

Table 1. Average Annual Age- and Sex-Specific Incidence Rates of First

Ischemic Stroke in Young Adults in Northern Sweden, 1991 to 1994
From: Kristensen: Stroke, Volume 28(9).September 1997.1702-1709
 Epidemiology

Table 1. Ages of Young Men and Women With Ischemic Stroke

Arch Neurol. 1995;52:491-495
 Etiology
Atherosclerosis is the main cause of stroke in elderly,
while emboligenous cardiopathy is the one of the
main cause of young adult
Annali Italiani di Medicina Interna. 11(1):33-8,1996 Jan-Mar
Cardiac embolism was the most common cause of stroke
in pt younger than 40
Stroke. 30(11):2320-5, 1999 Nov. 20018350
Atherosclerosis was 38.2% and
cardioembolism was 18.1%
Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000.
 Etiology
Atherosclerosis 33.3%, Prothrombotic state
15.5%, Cardiogenic 9.5%
Orv Hetil 2001 Mar 25;142(12):607-10
Atherosclerosis 29.8%, Cardioembolism
19.5%, Hematologic 5.8%
Arch Neurol. 1995;52:491-495
So cardioembolism and atherosclerosis are
tow major cause of stroke in young adults
Cause are diverse
Etiology
Etiology
 Etiology
Atherosclerosis:
a.Large artery b.Small artery
Embolism:
a.Cardiogenic b.Non-cardiogenic
Non-Atherosclerosis artriopathy:
a.Inflammatory b.Non-inflammatory
Hemological disorder:
a.Viscosity b.Coagulopathy
Others:
 Etiology
Embolism:
a.Cardiogenic:
1.Valvular: RH, prosthetic, endocarditis, MVP
2.Arrhythmia: Af, sick sinus syndrome
3.AMI/LV aneurysm:
4.LV myxoma:
5.Cardiomyopathy:
 Etiology
Embolism:
b.Non-cardiogenic:
1.Pulmonary AVM: Osler-Weber-Rendu syndrome
2.ASD/VSD or POF with shunt:
3.Pulmonary embolism:
 Etiology
Non-atherosclerosis arteriopathy:
a.Inflammatory:
1.Takayasus disease:=Granulomatous arteritis,mono,
2.Hepersensitive arteritis: Churg-strauss disease
3.Infectious: Syphilitic arteritis, TB, HIV-associated
4.Drug related: heroin, amphetamine
5.Systemic disease: SLE, RA, polyarteritis nodosa
 Etiology
Non-atherosclerosis arteriopathy:
a.Non-inflammatory:
1.Moya moya disease:
2.Artery dissection:
3.Irradiation vasculopathy:
4.Fibromuscular dysplasia:
5.Firinoid vasculopathy:
 Etiology
Hematological disorder:
a.Viscosity:
1.MDS: CML, polycythemia vera, essential thrombocythemia
2.Multiple myeloma:
3.Leukemia
b.Coagulopathy:
 Etiology
Hematological disorder:
b.Coagulopathy:
1.Hemoglobin disorder
2.Protein C/S deficiency
3.Antithrombin III deficiency
4.DIC
5.Anti-phospholipid antibody
 Etiology
Others:
1.Migraine
2.Pregnancy
3.Trauma
Risk Factor

Stroke, Volume 28(9).September 1997.1702-1709

 Risk factor
Agreed by most reporters are :
1.Cigarette smoking
2.Hypertension
3.Hyperlipidemia

Orv Hetil 2001 Mar 25;142(12):607-10

Postgraduate medicine.81(5):141-4,149-51 1987 Apr.
Acta Neurologica Scandinavica. 101(1):19-24, Jan 2000
 Clinical Presentation
Embolism:
1. Sudden onset of cortical impairment
2. Heart condition predisposing to
embolism
3. May be fluctuated,and may recover or
deteriorat
 Clinical Presentation
Large artery atherosclerosis:
1. Cerebral cortical impairment: aphasia,
apraxia, anopia, agnosia, restricted motor
involvement
2.History of intermittent claudication,TIA
 Clinical Presentation
Small artery occlusion (lacunae)
1.Traditional clinical lacunar syndrome
a. Pure motor hemiparesis
b. Pure sensory stroke
c. Ataxia hemiparalysis
d. Dysarthria-clumsy hand
e. Sensory motor stroke
2.History of HTN and DM supports Dx
 Prognosis
First 28 days mortality: 4.8/5.7%
Neurological deficit(Canadian neurological scale) and
handicap severity(Rankin classification, Barthel index)
are all much better than elderly. 1/3; 6mo
Although infarct size usually bigger (>3cm)
Recurrence risk is low :1.1-1.2 annually
Over all, prognosis is much better, so
aggressive treatment intervention is
important.
 Advised Clinical Study
CT/MRI/angiography
12 lead EKG
Echocardiogram/TEE
Dupplex( carotid and IC doppler)
BCS, rheumatic profile, autoimmune
profile, coagulation profile
 Conclusion
Ischemia stroke in young adults must be
studied with a different protocol from that
used for the elderly, due to the difference
of the etiology and the prognosis.

Annali Italiani di Medicina Interna. 11(1):33-8,1996 Jan-Mar