Epidemiology

Epidemiology can be used to reveal new causes of ischaemic stroke in young adults. Each year, about 2 million patients worldwide suffer a young stroke between the ages of 18 and 49 years. The overall stroke incidence is decreasing; however, an increase in the incidence of young stroke has been witnessed, possibly due to better awareness, new imaging techniques, and the increased prevalence of traditional risk factors already at a young age. Nevertheless, not all young stroke patients have cardiovascular risk factors. The proportion of patients with arterial dissection, cardioembolic stroke, and cryptogenic stroke is higher in young patients than in older patients. This chapter uses sex differences in both incidence and prognosis to provide leads for new risk factors in young men and women. Lastly, prognosis after young stroke is poor. The risk of death is higher than expected from the general population and remains high even years after stroke. Young stroke strikes suddenly, with attendant life-long consequences.

Traditional Risk Factors and Ischemic Stroke in Young Adults: The Baltimore-Washington Cooperative Young Stroke Study

Archives of Neurology ◽

10.1001/archneur.1996.00550070041010 ◽

1996 ◽

Vol 53 (7) ◽

pp. 603-607 ◽

Cited By ~ 74

Author(s):

J. Rohr ◽

S. Kittner ◽

B. Feeser ◽

J. R. Hebel ◽

M.-G. Whyte ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Young Stroke ◽

Stroke In Young Adults ◽

Stroke Study ◽

Prevalence and outcome of young stroke patients with middle cerebral artery stenosis

BMC Neurology ◽

10.1186/s12883-021-02125-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenjuan Xu ◽

Xiaoyu Zhang ◽

Huan Chen ◽

Zhangning Zhao ◽

Meijia Zhu

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Risk Factor ◽

Factor Score ◽

Unfavorable Outcome ◽

Stroke Patients ◽

Young Stroke ◽

Stroke In Young Adults ◽

Risk Factor Score ◽

Abstract Background Etiologies of acute ischemic stroke in young adults are heterogeneous. Middle cerebral artery (MCA) stenosis is a common finding in Asians which may be an important cause of stroke in young adults. However, studies of stroke in young Asian populations are rare. Our study was to investigate the prevalence and outcome of young stroke patients with MCA stenosis in Chinese populations. Methods Young patients with MCA territory infarction between January 2013 and September 2018 were retrospectively recruited. Subjects were defined as stenosis group (MCA stenosis ≥50%) and no-stenosis group (MCA stenosis<50% or no stenosis) by their MCA stenosis. For patients in stenosis group, they were categorized as uni-MCA stenosis subgroup and multiple stenosis subgroup. Demographic data, risk factors, imaging feature and complications were compared between groups. Prevalence of MCA stenosis and risk factor score (score ≥ 2 or 3) in different age groups were investigated. Modified Rankin Scale (mRS) was used for evaluating functional outcome at discharge (unfavorable outcome: 3–6). Binary logistic regression was performed to determine independent risk factors of unfavorable outcome. Results Two hundred forty-nine young stroke patients were included in our study and 110 (44.2%) patients were defined as stenosis group. 55 (50%) patients were categorized as uni-MCA stenosis subgroup and 55 (50%) were multiple stenosis subgroup. The most common traditional vascular risk factors included hypertension, hyperlipemia, smoking, hyperhomocysteinemia and alcohol consumption. Prevalence of risk factor score ≥ 2 or 3 increased with age, but not incidence of MCA stenosis. By TOAST classification, the most common etiologies were large-artery atherosclerosis (41.0%) and small vessel disease (33.7%). Compared with no-stenosis group, patients in stenosis group were more likely to have large territorial infarct, develop complications and have unfavorable outcome. No significant difference was found between patients in uni-MCA stenosis and multiple stenosis subgroups except history of stroke/TIA, risk factor score ≥ 3 and silent infarct. By logistic regression, hypertension (OR = 3.561; 95%CI, 1.494 to 8.492; p = 0.004), NIHSS scores at admission (OR = 1.438; 95%CI, 1.276 to 1.620; p = 0,000) and infarct size (p = 0.015) independently predicted unfavorable outcome. Conclusions Forty-four point two percent young Chinese adults with MCA territory infarction had MCA stenosis. Prevalence of MCA stenosis did not increase with age. Patients with MCA stenosis had worse clinical outcome, however, only hypertension, NIHSS scores at admission and infarct size were independent predictors.

CLINICAL PROFILE OF PATIENTS OF YOUNG STROKE.

10.36106/ijar/3218440 ◽

2021 ◽

pp. 68-70

Author(s):

Nitin Hiraman Suryawanshi ◽

Amit Aggarwal ◽

Abhijit Kadam

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Young Patients ◽

Behavioural Pattern ◽

Long Term Outcomes ◽

Short Term ◽

The Individual ◽

A study of stroke in young patients has recently become a subject of interest. This is due to a lot of impact on the individual and society. Study of stroke in young patients can lead to therapeutical results affecting both short term and long-term outcomes. Our study is hospital based retrospective study for duration of 1 year. Thi Methods: Results: s study revealed stroke in young in 25.16% of all stroke cases, with cerebral infarction in 56% and followed by intracerebral haemorrhage in 25.64%, and cerebral venous thrombosis in 18%. The most common presenting symptom was hemiparesis. The most prevalent risk factor for stroke in young was hypertension followed by diabetes mellitus, alcohol consumption and smoking. Stroke in young requires a differe Conclusion: nt approach to investigate and treat. This is due to different underlying etilogy as compared to elderly. Although traditional risk factors are associated with stroke, behavioural pattern such as smoking and alcohol may cause and promote development of stroke in young.

Young Ischemic Stroke in South Asia: A review

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v2i1.7636 ◽

2013 ◽

Vol 2 (1) ◽

pp. 27-33 ◽

Cited By ~ 1

Author(s):

Rajeev Ojha ◽

Dongya Huang ◽

Hedi An ◽

Lian Zuo ◽

Wenxia Zhu

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

South Asia ◽

Rural Areas ◽

Young Stroke ◽

Stroke In Young Adults ◽

Incidence Risk ◽

Young Ischemic Stroke ◽

Undetermined Etiology

Stroke in young adults may have early impact on quality of life in survivors. Uncontrolled stroke risk factors, lack of treatment facilities and a dense population has made its special significance in South Asia. The main aim of this study is to evaluate incidence, risk factors, etiology and clinical characteristics of young ischemic stroke in South Asia. Incidence of young stroke is more common in South Asian countries than developed western countries and has higher prevalence in rural areas. Traditional risk factors, such as hypertension, smoking, hyperlipidemia and diabetes are associated with majority of cases. Cardioembolism and undetermined etiology contribute to a large proportion of stroke etiology. Appropriate stepwise investigations are suggested to diagnose stroke of other determined etiology. Regular intake of drugs to control risk factors, cessation of smoking, and promote physical activity is suggested to reduce the burden of young stroke. Journal of Advances in Internal Medicine 2013;02(01):27-33 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7636

Global Outcome Assessment Life-long after stroke in young adults initiative—the GOAL initiative: study protocol and rationale of a multicentre retrospective individual patient data meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-031144 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031144

Author(s):

Merel Ekker ◽

Mina Jacob ◽

Myrna van Dongen ◽

Karoliina Aarnio ◽

Arunkar Annamalai ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Secondary Prevention ◽

Stroke Risk ◽

Individual Patient Data ◽

Meta Analysis ◽

Stroke Patients ◽

Young Stroke ◽

Stroke In Young Adults ◽

IntroductionWorldwide, 2 million patients aged 18–50 years suffer a stroke each year, and this number is increasing. Knowledge about global distribution of risk factors and aetiologies, and information about prognosis and optimal secondary prevention in young stroke patients are limited. This limits evidence-based treatment and hampers the provision of appropriate information regarding the causes of stroke, risk factors and prognosis of young stroke patients.Methods and analysisThe Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18–50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.Ethics and disseminationEthical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.

Erratum to: Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS)

Journal of Neurology ◽

10.1007/s00415-015-7977-z ◽

2015 ◽

Vol 263 (1) ◽

pp. 199-200 ◽

Cited By ~ 1

Author(s):

Barbara Goeggel Simonetti ◽

Marie-Luise Mono ◽

Uyen Huynh-Do ◽

Patrik Michel ◽

Celine Odier ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischaemic Stroke ◽

Young Stroke ◽

Stroke In Young Adults ◽

Stroke Study ◽

Stroke in young adults

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000522 ◽

2018 ◽

Vol 8 (6) ◽

pp. 501-506 ◽

Cited By ~ 7

Author(s):

Nirav Bhatt ◽

Amer M. Malik ◽

Seemant Chaturvedi

Keyword(s):

Young Adults ◽

Ischemic Stroke ◽

Management Strategies ◽

Cryptogenic Stroke ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Stroke In Young Adults ◽

New Information ◽

Purpose of reviewThe incidence of stroke in young adults is increasing, mainly driven by an increasing incidence of ischemic stroke in this population. We provide new information that has been recently presented regarding the risk factor prevalence, some specific etiologic causes, and management strategies in ischemic stroke in this population.Recent findingsRecent studies indicate a rapid increase in traditional risk factors in young adults. New information regarding the management of patent foramen ovale in cryptogenic stroke and cervical artery dissection is available.SummaryStroke in young adults is a rapidly growing problem with deep public health implications. There are many areas in this field, which require further research.

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

P.090 Risk factors and etiology of stroke in young adults: a 6-years retrospective hospital-based study, OMAN

10.1017/cjn.2018.192 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S40-S40

Author(s):

AM Al Hashmi ◽

S Jose ◽

S Al Mawali

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Chart Review ◽

Young Patients ◽

Life Time ◽

Royal Hospital ◽

Stroke In Young Adults ◽

Single Center Study ◽

Stroke In The Young ◽

Background: Stroke in the young is particularly tragic because of its potential for life time disability. Although a large number of studies have been published Worldwide. Very few have looked at etiologies in the youth of the Middle East,and none have focused on Oman. Methods: Retrospective,single center study,carried out at the Royal Hospital in Muscat. Chart review identifying all patients under 50 years of age admitted for acute stroke from 2009-2014. We analyzed the detailed history,examination and brain imaging (CT or MRI) for each case. We identified 588 young patients,163 of these were excluded due to other diagnosis or absence of neuroimaging (CT or MRI). Results: Out of the 425 stroke cases,67.3% were men. IS occurred in 69.6% compared to 30.4% for HS. Hypertension was the number one risk factor for both IS and HS,with a prevalence 50.7% and 60.5% respectively. DM was the second leading risk factor,with a prevalence of 32.1% in IS and 27.1% in HS. Underlying etiologies were identified in only 35.5% of cases in IS and 29.5% in HS.Cardiac etiology and vasculopathy were commonest for IS. Aneurysm was the main underlying etiology for HS. Conclusions: IS was more frequent than HS.Hypertension and DM were the leading risk factors for both stroke subtypes. Cardioembolism and vasculopathy were the main etiologies for IS.Cerebral aneurysm for HS.

Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS)

Journal of Neurology ◽

10.1007/s00415-015-7805-5 ◽

2015 ◽

Vol 262 (9) ◽

pp. 2025-2032 ◽

Cited By ~ 32

Author(s):

Barbara Goeggel Simonetti ◽

Marie-Luise Mono ◽

Uyen Huynh-Do ◽

Patrik Michel ◽

Celine Odier ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischaemic Stroke ◽

Young Stroke ◽

Stroke In Young Adults ◽

Stroke Study ◽

Abstract WMP49: Disparities in Rising Incidence of Stroke in Adults Younger Than 65

Stroke ◽

10.1161/str.51.suppl_1.wmp49 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Erica Jones ◽

Kristie Chu ◽

Anjail Sharrief ◽

Sean Savitz ◽

Farhaan Vahidy

Keyword(s):

Risk Factors ◽

Young Adults ◽

Stroke Risk ◽

Stroke Incidence ◽

Stroke In Young Adults ◽

Hospitalization Rates ◽

Increased Risk ◽

Asian Pacific ◽

Increase In Risk ◽

Introduction: Increased incidence of stroke in young adults has been attributed to rising prevalence of known stroke risk factors such as hypertension. Our aim is to identify young adult demographic groups most in need of clinical and public health intervention to prevent future increases in stroke incidence. Methods: We performed retrospective analyses on hospitalization data from the National Inpatient Sample (NIS) in adults aged 18- 64 years with diagnosis of ischemic stroke, hemorrhagic stroke, or subarachnoid hemorrhage from 2006 to 2015 and compared hospitalization rates over two-year periods. Results: We included data from 1,750,081 hospitalizations meeting inclusion criteria. Comparing 2006-07 to 2014-15, rates of hospitalization for stroke increased significantly across all analyzed gender and racial groups except Asian/Pacific Islanders aged 18-34 and 34-45. Non-Hispanic Blacks (NHB) had the highest stroke hospitalization rates in those aged 18-44, and Asian/Pacific Islander rates were highest in ages 45-64 (Figure 1d,f). In this period, there was a 26% overall increase in risk of hospitalization for stroke in young adults with 42% (CI 1.28 - 1.57) increased risk in women aged 18-34 and 41% (1.32 -1.51) in men aged 35-44. Regionally, the South had the highest incidence of stroke hospitalization in all age groups but the highest increase in risk over the decade was seen in the Northeast. Prevalence of hypertension among hospitalized patients remained unchanged or decreased while prevalence of all other risk factors increased, mostly in obesity and lipid disorders (Figure 1h). Conclusions: Despite public awareness, stroke incidence continues to increase in young patients remaining highest among minorities and in the Southern states, but rising more in the Northeast. Personalized approaches and geographic aspects, in addition to vascular risk factor control, will all likely be needed to reduce stroke risk in these different patient populations.