Objective:

To describe the clinical and diagnostic characteristics of ischemic and hemorrhagic strokes in young adults.

Background:

The rising incidence of stroke and vascular risk factors in young adults poses a significant public health concern. Despite well-defined guidelines for pediatric and older populations, there is a lack of evidence-based recommendations for young adults. Particularly in the United States, the paucity of clinically descriptive studies in this population limits our understanding of risk factors and stroke mechanisms that guide prevention and management.

Design/Methods:

This was a retrospective study of young adults diagnosed with a stroke between the ages of 18-55 years. Data were sourced from the Mayo Clinic TAPESTRY database, a research program conducting whole exome sequencing for 100,000 participants. Participants were identified with ICD codes. Chart review yielded demographics, clinical characteristics, and diagnostic data. Descriptive statistics were used for all analyses.  

Results:

In total, 406 young stroke participants were identified (mean age 39.9 years, 71.7% female, 90.6% Caucasian). Common comorbidities were obesity (31.5%), hyperlipidemia (43.2%), hypertension (39.7%), and migraine (48.1%). Using TOAST classification for 363 ischemic strokes, 20 were large artery atherosclerosis, 58 cardioembolic, 10 small vessel disease, 165 undetermined, and 148 other determined etiologies. Of the other etiologies, most were patent foramen ovale (n=58), dissection (n=50), or hypercoagulable state (n=48). Several patients had multiple etiologies.  Of the 43 intracerebral hemorrhages, there were 6 aneurysmal, 6 arteriovenous malformation, 6 hemorrhagic transformations, 3 traumas, 2 substance abuse, and 20 undetermined. 

Conclusions:

In our cohort, 46% of strokes had an undetermined etiology. Our data showed themes that overlapped with analyses in pediatric and older adult studies, emphasizing the complexities of stroke in young adults. Further, despite rarely identified atherosclerotic mechanisms, modifiable vascular risk factors were common. More research is needed on the clinical profiles of this unique population to assess risks and inform clinical practice.