Objective:

This narrative review aims to consolidate current knowledge on AYA stroke, focusing on epidemiology, unique etiological factors, and diagnostic challenges to guide future research and clinical practice.

Background:

Stroke in adolescents and young adults (AYA, ages 15–50) is increasingly prevalent, with incidence rates rising by 40% over the past two decades. Unlike older adults, AYA strokes are driven by distinct etiologies such as cervical arterial dissection (CAD), patent foramen ovale (PFO), and cerebral venous sinus thrombosis (CVST), complicated by stroke mimics (e.g., migraines, seizures) in up to 30% of cases. Despite this, comprehensive narrative reviews analyzing AYA-specific epidemiology, risk factors, and diagnostic strategies are lacking.

Design/Methods:

A systematic literature search of PubMed, Scopus, and Web of Science (2010–2025) was conducted, focusing on studies addressing AYA stroke etiology, epidemiology, and diagnostic approaches. Key themes include risk factors (e.g., hypercoagulable states, substance use), diagnostic tools (e.g., MRI with DWI, transesophageal echocardiography), and barriers to accurate diagnosis (e.g., stroke mimic misdiagnosis rates of 20–30%).

Results:

AYA strokes account for 10–15% of all strokes, with CAD and PFO implicated in 25–30% of cases. Limited access to advanced neuroimaging and variable clinician awareness contribute to diagnostic delays. Emerging biomarkers (e.g., neurofilament light chain) show promise but require further validation. Current guidelines, adapted from older adults, fail to address AYA-specific needs.

Conclusions:

This review highlights the urgent need for AYA-tailored diagnostic protocols and increased research into non-traditional risk factors. It provides a framework for developing targeted guidelines to improve outcomes in this understudied population.