Risk Factor and Etiology Analysis of Ischemic Stroke in Young Adult Patients

• Published in: Journal of stroke and cerebrovascular diseases Vol. 23; no. 3; pp. e221 - e227
• Main Authors: Renna, Rosaria, MD, Pilato, Fabio, MD, Profice, Paolo, MD, Della Marca, Giacomo, MD, Broccolini, Aldobrando, MD, Morosetti, Roberta, MD, Frisullo, Giovanni, MD, Rossi, Elena, MD, De Stefano, Valerio, PhD, Di Lazzaro, Vincenzo, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2014
• Subjects: Adult; Age Factors; Atherosclerosis - complications; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Brain Ischemia - mortality; Cardiovascular; Dyslipidemias - complications; Embolism - complications; Female; Foramen Ovale, Patent - complications; Humans; Hypertension - complications; Ischemic stroke; Male; Middle Aged; Neurology; patent foramen ovale; Prognosis; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Rome; Smoking - adverse effects; Stroke - diagnosis; Stroke - etiology; Stroke - mortality; Survival Rate; thrombophilia; Time Factors; young adults; Rome; thrombophilia; patent foramen ovale; risk factors; Ischemic stroke; prognosis; young adults
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.008

Background Approximately 10%-14% of ischemic strokes occur in young adults. Aims To investigate risk factors and etiologies of strokes of young adults admitted to the “stroke unit” of Policlinico “Gemelli” of Rome from December 2005 to January 2013. Methods In all, 150 consecutive patients younger than 50 years diagnosed with ischemic stroke were enrolled. Clinical evaluation consisted of a complete neurologic examination and the National Institutes of Health Stroke Scale. Diagnostic workup consisted of anamnesis, extensive laboratory, radiologic, and cardiologic examination. Stroke etiologies were classified according to the Trial of Org 10172 in Acute Stroke Treatment. Results Patients' mean age was 41 ± 8.0 years. The most common risk factors were dyslipidemia (52.7%), smoking (47.3%), hypertension (39.3%), and patent foramen ovale (PFO, 32.8%). Large-artery atherosclerosis was diagnosed as the cause of stroke in 17 patients (11.3%). Cardioembolism was presumed in 36 patients (24%), most of them presented a PFO at transesophageal echocardiography. Small-vessel occlusion was diagnosed in 12 patients (8%); all of them were hypertensive and most of them presented additional risk factors. Forty-one patients (27.3%) presented a stroke of other determined etiology and 44 (29.3%) presented a stroke of undetermined etiology. The 3-year survival was 96.8% and recurrent strokes occurred in only 3 cases. Conclusions Traditional vascular risk factors are also very common in young adults with ischemic stroke, but such factors increase the susceptibility to stroke dependent to other causes as atherosclerosis and small-artery occlusion represent less than 20% of cases. Prognosis quoadvitam is good, being characterized by low mortality and recurrence rate.