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CAUSES OF ISCHEMIC STROKE IN THE YOUNG
 

The mean age for ischemic stroke is about 75 years. Occasionally, ischemic stroke occurs in the younger patient (<45 years). Although some of the same traditional risk factors for stroke are found in younger patients, there are some causes of ischemic stroke which are more specific to the younger population which should be strongly considered when faced with a younger patient.

• Hypercoagulable states

Genetic

Factor V Leiden

Protein C deficiency

Protein S deficiency

Antithrombin III deficiency

Prothrombin gene mutation

Acquired

Lupus anticoagulant

Antiphospholipid antibodies

Oral contraceptives

Associated with neoplasia
 

• Drugs

Cocaine

Amphetamine

Heroin

Other Sympathomimetics


• Arterial dissection

Carotid

Vertebral


• Cerebral Venous Thrombosis
 

• Eclampsia
 

• Premature atherosclerosis


• Sickle cell disease


• Migraine


• Vasculopathies

CNS vasculitis/angiitis

Homocysteinuria

Fibromuscular dysplasia
 

• Cardiac embolus

Patent foramen ovale and atrial septal aneursym

Left ventricular diverticulum

Bacterial endocarditis

Atrial fibrillation

Mitral stenosis

Dilated cardiomyopathy

           

• PULMONARY ARTERIOVENOUS FISTULA


• CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.


• MELAS (mitochondrial myopathy and encephalopathy with lactic acidosis and stroke.

The following is a list of causes of ischemic stroke in 287 consecutive young patients 15-45 years:

Table. Causes of ischemic strokes

Cause No. of patients (%)
Cervical artery atheroma 24 (8.4)
High-risk cardiopathies* 15 (5.2)
    Atrial fibrillation 13 (4.5)
    Bacterial endocarditis 3 (1.0)
    Mechanical prosthetic valve 2 (0.7)
    Mitral stenosis 2 (0.7)
    Thrombus in left atrium 2 (0.7)
Small-vessel occlusion 5 (1.7)
Other definite causes 64 (22.3)
    Cervical artery dissections 54 (18.8)
    Angiitis and acute angiopathies 5 (1.7)
    CADASIL 3 (1.0)
    Pseudovalvular fold in ICA artery 1 (0.3)
    Intracranial ICA dissection 1 (0.3)
Undetermined 179 (62.4)

No cause despite complete diagnostic workup

 124 (43.2)

>1 potential cause

 31 (10.8)

Incomplete diagnostic workup

 24 (8.4)
Adapted from Leys, et. al, Clinical outcome in 287 consecutive young adults (15 to 45 years) with ischemic stroke. Neurology, Vol 59. 1. July 9, 2002.

The following table lists causes of stroke and risk factors of TIA in 213 patients < 45 years:

From Gilon et al. Lack of an Association between Mitral-Valve Prolapse and Stroke in Young Patients. NEJM. 341 (1): 8, Table 1 July 1, 1999.