Ischemic Stroke in Young Adults

Jukka Putaala, MD, PhD, MSc Cerebrovascular Disease p. 386-414 April 2020, Vol.26, No.2 doi: 10.1212/CON.0000000000000833
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PURPOSE OF REVIEW This article reviews current knowledge on epidemiology, risk factors and causes, diagnostic considerations, management, and prognosis of ischemic stroke in young adults (those 55 years old and younger).

RECENT FINDINGS The incidence of ischemic stroke in young adults has been increasing since the 1980s, which has occurred in parallel with increasing prevalence of vascular risk factors and substance abuse among the younger population. Young adults have a considerably wider range of risk factors than older patients, including age-specific factors such as pregnancy/puerperium and oral contraceptive use. Behavioral risk factors such as low physical activity, excess alcohol consumption, and smoking are factors as well. More than 150 identified causes of early-onset ischemic stroke exist, including rare monogenic disorders. Several recent advances have been made in diagnosis and management of stroke in young adults, including molecular characterization of monogenic vasculitis due to deficiency of adenosine deaminase 2 and transcatheter closure of patent foramen ovale for secondary prevention. Compared with the background population of the same age and sex, long-term mortality in patients remains fourfold higher with cardiovascular causes underlying most of the deaths. The cumulative rate of recurrent stroke extends up to 15% at 10 years. Patients with atherosclerosis, high-risk sources of cardioembolism, and small vessel disease underlying their stroke seem to have the worst prognosis regarding survival and recurrent vascular events. Young stroke survivors also often have other adverse outcomes in the long term, including epilepsy, pain, cognitive problems, and depression.

SUMMARY Systematic identification of risk factors and causes and the motivation of patients for long-term prevention and lifestyle changes are of utmost importance to improve the prognosis of early-onset ischemic stroke.

Address correspondence to Dr Jukka Putaala, Neurocenter, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland, jukka.putaala@hus.fi.

RELATIONSHIP DISCLOSURE: Dr Putaala has served on the scientific advisory board for Bayer AG, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer Inc, and Portola Pharmaceuticals, Inc; is an editorial board member of the European Stroke Journal; and is a visiting editor for Terve Media. Dr Putaala has received compensation for lectures for Abbott, Bayer AG, Boehringer Ingelheim, and Bristol-Myers Squibb/Pfizer Inc and for research collaboration for BCB Medical Ltd, Bittium, Nokia Technologies, and Vital Signum. Dr Putaala has received research funding from the Academy of Finland, Business Finland, Hospital District of Helsinki and Uusimaa, Pfizer Inc, and St. Jude Medical, Inc, and owns stock in Vital Signum.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Putaala reports no disclosure.

© 2020 American Academy of Neurology.