Episode 989: Young Strokes

Contributor: Aaron Lessen, MD

Educational Pearls:

The Case

• 24F brought in for anxiety. Patient is tearful, not talking, and potentially hyperventilating. History from boyfriend is that she suddenly stopped talking and started crying and it was hard to understand what she was saying. On exam, patient appears anxious and has a gaze preference for the right side and is still having difficulty speaking.

• Decision is made to stroke alert patient.

• CT shows early MCA stroke and M2 occlusion.

• Patient is treated by IR with mechanical thrombectomy.

What are the risk factors for strokes in young people (

• Traditional risk factors still matter

• Hypertension 

• Most important modifiable risk factor, present in 30-50% of young stroke patients

• Diabetes

• Especially insulin dependent type 1

• HLD

• Smoking

• Substance use

• Cocaine

• Meth

• Alcohol, especially binge drinking

• IV drug use

• Structural heart disease

• PFO

• Valvular heart disease like rheumatic disease

• Hypercoagulable states

• Factor V Leiden

• Protein C or S deficiency

• Antithrombin III deficiency

• Vertebral dissections

• Recent trauma

References

• Aigner A, Grittner U, Rolfs A, Norrving B, Siegerink B, Busch MA. Contribution of Established Stroke Risk Factors to the Burden of Stroke in Young Adults. Stroke. 2017 Jul;48(7):1744-1751. doi: 10.1161/STROKEAHA.117.016599. Epub 2017 Jun 15. PMID: 28619986.

• Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, de Leeuw FE. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018 Sep;17(9):790-801. doi: 10.1016/S1474-4422(18)30233-3. PMID: 30129475.

• Khan M, Wasay M, O'Donnell MJ, Iqbal R, Langhorne P, Rosengren A, Damasceno A, Oguz A, Lanas F, Pogosova N, Alhussain F, Oveisgharan S, Czlonkowska A, Ryglewicz D, Yusuf S. Risk Factors for Stroke in the Young (18-45 Years): A Cas