alexa Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis.
Neurology

Neurology

Journal of Neuroinfectious Diseases

Author(s): Ji R, Schwamm LH, Pervez MA, Singhal AB

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Abstract BACKGROUND: Approximately 10\% to 14\% of ischemic strokes occur in young adults. OBJECTIVE: To investigate the yield of diagnostic tests, neuroimaging findings, and treatment of ischemic strokes in young adults. DESIGN: We retrospectively reviewed data from our Get with the Guidelines-Stroke database from 2005 through 2010. SETTING: University hospital tertiary stroke center. PATIENTS: A total of 215 consecutive inpatients aged 18 to 45 years with ischemic stroke/transient ischemic attack. The mean (SD) age was 37.5 (7) years; 51\% were male. RESULTS: There were high incidence rates of hypertension (20\%), diabetes mellitus (11\%), dyslipidemia (38\%), and smoking (34\%). Relevant abnormalities were shown on cerebral angiography in 136 of 203 patients, on cardiac ultrasonography in 100 of 195, on Holter monitoring in 2 of 192; and on hypercoagulable panel in 30 of 189 patients. Multiple infarcts were observed in 31\% and were more prevalent in individuals younger than age 35 years. Relevant arterial lesions were frequently detected in the middle cerebral artery (23\%), internal carotid artery (13\%), and vertebrobasilar arteries (13\%). Cardioembolic stroke occurred in 47\% (including 17\% with isolated patent foramen ovale), and 11\% had undetermined stroke etiology. The median National Institutes of Health Stroke Scale score was 3 (interquartile range, 0-9) and 81\% had good outcome at hospital discharge. Of the 29 patients receiving thrombolysis (median National Institutes of Health Stroke Scale score, 14; interquartile range, 9-17), 55\% had good outcome at hospital discharge and none developed symptomatic brain hemorrhage. CONCLUSIONS: This study shows the contemporary profile of ischemic stroke in young adults admitted to a tertiary stroke center. Stroke etiology can be determined in nearly 90\% of patients with modern diagnostic tests. The causes are heterogeneous; however, young adults have a high rate of traditional vascular risk factors. Thrombolysis appears safe and short-term outcomes are favorable. This article was published in JAMA Neurol and referenced in Journal of Neuroinfectious Diseases

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