Determine the predominant stroke etiologies among young adult stroke patients who are active substance users.

Substance use is increasing among young people. Prior studies have reported multivarious stroke mechanisms associated with specific substances; however, stroke etiology ascribed to the active use of substances in general has been less well-described.

We conducted a retrospective review of stroke patients between 18 to 50 years of age presenting to our Young Stroke Center between April 2022 and August 2023. Data including demographics and medical history were collected, and stroke etiology was determined by a vascular neurologist. Patients with active substance use by history or toxicology screen at the time of stroke were compared to all other non-substance use related stroke. Substance use was defined as use of opioids, cocaine, marijuana, or alcohol abuse. Analysis was performed with logistic regression adjusting for age, sex, and race.

Of 187 patients, 25 (13.4%) had active substance use at time of stroke compared with 162 with non-substance use related stroke. There were 10 marijuana, 4 opioid, 3 alcohol abuse and 8 polysubstance use (including 3 cocaine) cases. There were no significant differences in age at time of stroke (36.9 ± 7.1 vs. 38.8 ± 8.2 years), race (50.0% vs. 53.4% Black), and baseline stroke comorbidities. In the active substance use group, there was a significantly higher proportion of males (62.5% vs. 31.9%; OR [95% CI]: 4.0 [1.6-10.0]), smokers (45.8% vs. 20.3%; 3.6 [1.4-9.2]) and cardioembolic stroke etiology (20.8% vs. 9.2%; 4.1 [1.2-14.0]); however, there was no significant difference with respect to the other stroke etiologies.

Overall, our findings indicate that among young individuals with active substance use at the time of their stroke, a cardioembolic etiology is more likely than in those without substance use. This underscores the need for comprehensive cardiac evaluation in this population.