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Ischemic stroke in young adults

Stack, Christopher A.a; Cole, John W.b

doi: 10.1097/HCO.0000000000000564

Purpose of review Although the clinical approach to the young adult stroke patient is similar to that of an older adult, several important differences exist. The purpose of this article is to concisely review the epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic methods and current treatment options for the young adult ischemic stroke patient.

Recent findings Evidence clearly indicates that the incidence ischemic stroke in young adults is on the rise. A variety of factors are implicated, including an increased burden of classic and emerging vascular risk factors, and improved stroke detection, among other causes. Improved awareness, prevention and successful treatment of the young adult stroke patient is of great importance, particularly given the major long-term socioeconomic impact strokes have on the patient, their family and society at large.

Summary In this review, we focus on the latest epidemiologic, diagnostic and treatment paradigms to improve physician awareness and optimize outcomes in young adult ischemic stroke patients. An overview of the clinical presentations of various stroke syndromes is described, emphasizing key causes physicians should consider, as well as providing recommendations regarding evaluation and treatment. Important causes including dissection and inflammatory and noninflammatory vasculopathies are emphasized. The diagnoses of cerebral venous thromboses, cardioembolic stroke and paradoxical emboli are also discussed. The effects of established and emerging risk factors on large and small vessel disease, as well as genetic contributions, are also highlighted.

aDepartment of Neurology, University of Maryland School of Medicine

bDepartment of Neurology, Baltimore VA Medical Center and University of Maryland School of Medicine, Baltimore, Maryland, USA

Correspondence to John W. Cole, MD, MS, Department of Neurology, Baltimore VA Medical Center and University of Maryland School of Medicine, 12th Floor, Bressler Building, Room 12-006, 655 West Baltimore Street, Baltimore, MD 21201, USA. Tel: +1 410 328 6483; 1 410 706 0414; fax: +1 410 328 5899; e-mail:

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