Diagnosis, Investigation, Treatment and Management of Young Stroke in Clinic

It has been estimated that approximately 10% of all strokes occur in young adults. Stroke in young people has a significant long-term socioeconomic impact and constitutes a growing problem in the United States. The stroke etiology in older patients with long-standing vascular risk factors is typically related to atherosclerosis or cardioembolism. In comparison, the causes of stroke in young adults are more heterogeneous and include hypercoagulable states, genetic disorders, infections, inflammatory disease, and structural cardiac abnormalities. However, an increased prevalence of hypertension, diabetes mellitus, obesity, and hypercholesterolemia in young adults has been observed resulting in an increased incidence of stroke secondary to early atherosclerosis. The basic evaluation of stroke in young adults is similar to that of older adults, and includes brain and cerebrovascular imaging, cardiac assessment, and screening for traditional vascular and life-style risk factors. Genetic testing, advanced blood workup for uncommon inflammatory and procoagulable conditions, brain biopsy, and cerebrospinal fluid analysis may be indicated in specific scenarios. The treatment depends on the stroke etiology, and stroke prevention measures should be initiated early after the first event to reduce the risk of recurrence and the associated morbidity and mortality.