Stroke in young adults

Jorge Moncayo-Gaete MD (Dr. Moncayo-Gaete of the International University of Ecuador has no relevant financial relationships to disclose.)
Julien Bogousslavsky MD (Dr. Bogousslavsky of the Swiss Medical Network has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released September 15, 1994; last updated November 9, 2017; expires November 9, 2020

This article includes discussion of stroke in young adults, stroke in the young, and young stroke. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Current epidemiological data suggest that strokes are occurring at a younger age. As many as 1 out of every 6 strokes occurs in a young adult (18 to 50 years old). Heterogeneity in incidence rates, stroke subtypes, and etiology among younger stroke victims in both developed and developing countries is often noted. Certain historical features and clinical manifestations may occasionally serve as clues toward specific stroke etiologies; nevertheless, determination of etiology, particularly of ischemic stroke in the young, poses many challenges due to a broad array of potential causes, both common and uncommon. In this article, the authors emphasize areas in which the differential diagnosis of stroke and etiologies (including those in pregnancy and puerperium) differs from that in older adults. The authors also note relevant information concerning prognosis of young adults with stroke.

Key points

 

• Up to 15% of all cerebral infarcts occur in young adults (ages 18 to 50 years).

 

• Etiologic diagnosis of stroke in young adults requires a different and more complex diagnostic work-up than that of stroke in older adults.

 

• Overall, cardiac embolism and nonatherosclerotic vasculopathy are the main etiologies of cerebral infarct in younger patients.

 

Arteriovenous malformation and arterial hypertension are the main etiologies of cerebral hemorrhages.

 

• Overall, and despite thorough investigation, the causes of up to one-third of ischemias and hemorrhages remain undetermined.

 

• Motor recovery is generally better than that of older patients, although a negative impact on multiple cognitive domains may be observed after a long-term follow up.

Historical note and terminology

Information regarding stroke in the younger patient population first began appearing in the literature in the 1950s and 1960s. Interest in this topic has increased due to escalating stroke rates in the younger age group and improvements in patient evaluation. A standardized definition of “young adults” is lacking. People under 40, 45, 50, or even 55 years of age have been classified as young adults. Currently, strokes occurring after adolescence and before the age of 50 are typically considered as occurring in young adults. Although several of the causes of stroke in the young are rare, they account in aggregate for many of the conditions leading to stroke (Kristensen et al 1997; Martin et al 1997; Kittner et al 1998). The incidence of stroke increases sharply after the age of 40, and the spectrum of etiology narrows, with atherosclerosis becoming increasingly common as the risk factors start resembling those in the elderly.

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