Ischemic and Hemorrhagic Stroke in Young Adults: Etiological Considerations, Risk Factors, and Management Strategies
Main Article Content
Abstract
Cerebrovascular events in young adults constitute a significant and often underestimated cause of long-term disability and mortality. While ischemic stroke (IS) remains the predominant subtype in this population, hemorrhagic stroke (HS) also represents a considerable burden. The etiological spectrum in younger individuals differs markedly from that in the elderly, encompassing non-traditional risk factors such as arterial dissection, prothrombotic states, cardiac embolism due to structural anomalies (e.g., patent foramen ovale), vasculitis, and substance abuse. Genetic predisposition and autoimmune conditions further complicate the diagnostic and therapeutic landscape.
This review provides an in-depth analysis of the pathophysiological mechanisms underlying stroke in young adults, highlighting the distinct clinical presentations, diagnostic modalities, and therapeutic options. The role of advanced neuroimaging, thrombophilia screening, and cardiac workup is emphasized in optimizing diagnostic accuracy. Additionally, we discuss the implications of early intervention strategies, including thrombolysis and endovascular therapy, alongside secondary prevention approaches tailored to this demographic. A comprehensive understanding of the unique aspects of stroke in young adults is imperative for improving clinical outcomes and reducing long-term disability in this patient population.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Varona JF, Guerra JM, Bermejo F. Ictus en el adulto joven. Med Clin (Barc). 2004;122(2):70-4.
II. Higgie J, Urban L, Hackembruch HJ, Gaye A. Análisis de una cohorte de pacientes con ACV del joven: Hospital de Clínicas, Montevideo. Rev Urug Med Int. 2018;3(2):3-12.
doi: http://dx.doi.org/10.26445/rmu.3.2.1.
III. Alet M, Rosales J, Claverie S, González L, Lepera S. Accidente cerebrovascular isquémico en paciente joven asociado a aneurisma del septo interauricular multifenestrado.Neurol argentina. 2017;10(2):110-4
IV. Terni E, Giannini N, Brondi M, Montano V, Bonuccelli U, Mancuso M. Genetics of ischaemic stroke in young adults. BBA Clin. 2015;3:96-106.
V. Darke S, Duflou J, Kaye S, Farrell M, Lappin J. Body mass index and fatal stroke in young adults: A national study. J Forensic Leg Med. 2019;63:1-6.
VI. Bhatt N, Malik AM, Chaturvedi S. Stroke in young adults five new things. Neurol Clin Pract. 2018;8(6):501-6
VII. Calvet D. Infarctus cérébral du sujet jeune. Rev Med Intern. 2016;37(1):19-24
VIII. Ojeda A, Nallino MB, Uriarte AM, Santa Cruz D. Stroke in young people: The increasing role of advanced imaging.Neuroradiol J. 2011;24(2):193-8.
IX. Leandro-Sandí V, Barboza-Elizondo M, Vindas-Angulo G. Evento cerebrovascular isquémico en el adulto joven. Acta Med Costarric.2013;55(3):143-6.
X. Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: A review. J Neurol Neurosurg Psychiatry.2017;88(12):1079-91.
XI. Gómez Ochoa SA. Stroke and cannabis use in patients with no cardiovascular risk factors: A systematic review of case reports. Neurologia. 2021;36(3):222-8. doi: 10.1016/j.nrl.2017.09.016.
XII. Parekh T, Pemmasani S, Desai R. Marijuana use among young adults (18-44 years of age) and risk of stroke: a behavioral risk factor surveillance system survey analysis. Stroke. 2020;51(1):308-10.
XIII. Kalla A, Krishnamoorthy PM, Gopalakrishnan A, Figueredo VM. Cannabis use predicts risks of heart failure and cerebro-vascular accidents: Results from the National Inpatient Sample. J Cardiovasc Med. 2018;19(9):480-4.
XIV. Crespo Pimentel B, Willeit J, Toll T, Kiechl S, Pinho e Melo T, Canháo P, et al. Etiologic evaluation of ischemic stroke in young adults: a comparative study between two European centers. J Stroke Cerebrovasc Dis. 2019;28(5):1261-6.
XV. González-Gómez FJ, Pérez-Torre P, De-Felipe A, Vera R, Matute C, Cruz-Culebras A, et al. Stroke in young adults: Incidence rate, risk factors, treatment and prognosis. Rev Clínica Española (English Edition). 2016;216(7):345-51.
XVI. Sim-Sim MMSF, Abrantes MJ, dos Reis MGM, Pires EMG, Fernandes MAM, Barros MF. Conocimiento de adultos jóvenes sobre el accidente cerebrovascular en una ciudad del sur de Portugal. Enfermería Glob. 2019;18(4):423-58.
XVII. Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, et al. Epidemiology, aetiology, and management of isch-aemic stroke in young adults. Lancet Neurol. 2018;17(9):790-801.