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 (<50 y.o.)?
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 Case-Control Analysis of INTERSTROKE Data from 32 Countries. Neuroepidemiology. 2023;57(5):275-283. doi: 10.1159/000530675. Epub 2023 May 17. PMID: 37231971.
Summarized and edited by Jeffrey Olson MS4
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