Objective:

Background:

Significant research has been dedicated to identifying RFs for CIS in younger patients. To our knowledge, no such analysis exists for SCI. Elucidating the prevalence of RFs for SCI in younger patients is crucial for delineating at-risk individuals.

Design/Methods:

The Epic Cosmos database was used to collect RF prevalence data on SCI, CIS, and all database patients ages 5-50 from 2004-2024. Clinical data on 24 putative stroke RFs was collected for each group and compared using Chi-Square tests. 

Results:

Data from 2,001 SCI patients, 59,196 CIS patients, and 105,044,268 general patients was gathered. All 24 RFs studied were significantly more prevalent in the CIS and SCI cohorts vs. the general population (p < 0.0001). Young CIS patients had higher rates of atrial fibrillation, hyperlipidemia, A1c > 6.5%, BMI > 35, smoking, peripheral artery disease, ischemic heart disease, and chronic kidney disease vs. young SCI patients (all p < 0.001). Young SCI patients in contrast had higher rates of hypertension, DVT history, sickle cell anemia, and aortic dissection or aneurysm (all p < 0.0001). 

Conclusions:

CIS patients were found to have higher rates of traditional vascular and embolic RFs like hyperlipidemia and atrial fibrillation, while SCI patients had elevated rates of pro-thrombotic and vascular integrity RFs, including sickle cell anemia and aortic pathology. These findings suggest underlying hematologic conditions and aortic pathologies may be stronger drivers of SCI in young patients than common mechanisms of CIS like atherosclerosis or cardioembolism. Further analysis is required to concretely establish a set of RFs that can direct surveillance, workups, and clinical management.