Stroke in Young Adults

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Aug 12

PMID 37568401

Authors

Syed Bukhari

Shadi Yaghi

Zubair Bashir

Affiliations

Soon will be listed here.

Abstract

Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults.

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References

. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1736-1788. PMC: 6227606. DOI: 10.1016/S0140-6736(18)32203-7. View

Verduzco L, Nathan D . Sickle cell disease and stroke. Blood. 2009; 114(25):5117-25. DOI: 10.1182/blood-2009-05-220921. View

Ekker M, Verhoeven J, Vaartjes I, van Nieuwenhuizen K, Klijn C, de Leeuw F . Stroke incidence in young adults according to age, subtype, sex, and time trends. Neurology. 2019; 92(21):e2444-e2454. DOI: 10.1212/WNL.0000000000007533. View

Bevan H, Sharma K, Bradley W . Stroke in young adults. Stroke. 1990; 21(3):382-6. DOI: 10.1161/01.str.21.3.382. View

Kittner S, McCarter R, Sherwin R, Sloan M, STERN B, Johnson C . Black-white differences in stroke risk among young adults. Stroke. 1993; 24(12 Suppl):I13-5; discussion I20-1. View

Arntz R, Rutten-Jacobs L, Maaijwee N, Schoonderwaldt H, Dorresteijn L, van Dijk E . Post-stroke epilepsy in young adults: a long-term follow-up study. PLoS One. 2013; 8(2):e55498. PMC: 3563638. DOI: 10.1371/journal.pone.0055498. View

Leppert M, Burke J, Lisabeth L, Madsen T, Kleindorfer D, Sillau S . Systematic Review of Sex Differences in Ischemic Strokes Among Young Adults: Are Young Women Disproportionately at Risk?. Stroke. 2022; 53(2):319-327. PMC: 8852306. DOI: 10.1161/STROKEAHA.121.037117. View

Virani S, Alonso A, Benjamin E, Bittencourt M, Callaway C, Carson A . Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020; 141(9):e139-e596. DOI: 10.1161/CIR.0000000000000757. View

Krishnamurthi R, Moran A, Feigin V, Barker-Collo S, Norrving B, Mensah G . Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Adults Aged 20-64 Years in 1990-2013: Data from the Global Burden of Disease 2013 Study. Neuroepidemiology. 2015; 45(3):190-202. DOI: 10.1159/000441098. View

10.

Ismael S, Khan M, Kumar P, Kodidela S, Mirzahosseini G, Kumar S . HIV Associated Risk Factors for Ischemic Stroke and Future Perspectives. Int J Mol Sci. 2020; 21(15). PMC: 7432359. DOI: 10.3390/ijms21155306. View

11.

Schurks M, Rist P, Bigal M, Buring J, Lipton R, Kurth T . Migraine and cardiovascular disease: systematic review and meta-analysis. BMJ. 2009; 339:b3914. PMC: 2768778. DOI: 10.1136/bmj.b3914. View

12.

Holmqvist M, Simard J, Asplund K, Arkema E . Stroke in systemic lupus erythematosus: a meta-analysis of population-based cohort studies. RMD Open. 2016; 1(1):e000168. PMC: 4692049. DOI: 10.1136/rmdopen-2015-000168. View

13.

Staessen J, Gasowski J, Wang J, Thijs L, Den Hond E, Boissel J . Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2001; 355(9207):865-72. DOI: 10.1016/s0140-6736(99)07330-4. View

14.

Edlow J, Selim M . Atypical presentations of acute cerebrovascular syndromes. Lancet Neurol. 2011; 10(6):550-60. DOI: 10.1016/S1474-4422(11)70069-2. View

15.

Maaijwee N, Arntz R, Rutten-Jacobs L, Schaapsmeerders P, Schoonderwaldt H, van Dijk E . Post-stroke fatigue and its association with poor functional outcome after stroke in young adults. J Neurol Neurosurg Psychiatry. 2014; 86(10):1120-6. DOI: 10.1136/jnnp-2014-308784. View

16.

Hathidara M, Saini V, Malik A . Stroke in the Young: a Global Update. Curr Neurol Neurosci Rep. 2019; 19(11):91. DOI: 10.1007/s11910-019-1004-1. View

17.

Lidegaard O, Lokkegaard E, Jensen A, Skovlund C, Keiding N . Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012; 366(24):2257-66. DOI: 10.1056/NEJMoa1111840. View

18.

Mokdad A, Ford E, Bowman B, Dietz W, Vinicor F, Bales V . Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2002; 289(1):76-9. DOI: 10.1001/jama.289.1.76. View

19.

Urbanus R, Siegerink B, Roest M, Rosendaal F, de Groot P, Algra A . Antiphospholipid antibodies and risk of myocardial infarction and ischaemic stroke in young women in the RATIO study: a case-control study. Lancet Neurol. 2009; 8(11):998-1005. DOI: 10.1016/S1474-4422(09)70239-X. View

20.

Ji R, Schwamm L, Pervez M, Singhal A . Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis. JAMA Neurol. 2012; 70(1):51-7. DOI: 10.1001/jamaneurol.2013.575. View